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Kaiser Health News report questions safety of ASCs: 5 things to know
Ambulatory surgery centers are often considered low-cost alternatives to expensive in-hospital care, but a new report from Kaiser Health News and USA Today raises questions about the safety of ASCs and the regulations that govern their practices.
Here are five things to know about the report.
1. The report claims the proliferation of increasingly complex surgeries at ASCs has shone a light on facilities’ poor preparation for emergency scenarios. ASCs are required to have patient transfer agreements to local hospitals in the event of an emergency, complying with state and federal regulations. The report cited examples of patients who were transferred from ASCs in rural areas where hospitals were up to 30 miles away and were unable to access the emergency care needed.
2. ASCs are a surgical site option for elective procedures for patients who are good candidates for the outpatient setting, typically otherwise healthy patients without comorbidities. Not every patient is a good candidate for outpatient surgery; those with pre-existing conditions are better suited for the hospital.
Preexisting conditions can complicate even the most routine surgeries, and the report claims over 260 patients have died since 2013 after procedures at ASCs. Though federal regulations require ASCs keep resuscitation equipment on hand in case of emergencies, a number of the patient deaths detailed in the article took place in facilities that skirted these regulations. However, the Ambulatory Surgery Center Association issued a statement March 2 in response to the article, reporting more than 200 million successful procedures have been performed in ASCs across the country over the same five year period.
3. The report cites examples of patients who felt hurried out of ASCs and dying on the way home.
“The stories these reporters tell are indeed tragic and will no doubt be deeply concerning to readers. Unfortunately, the article fails to provide a comparison to other sites of care and make clear that medical errors occur across all sites of care, including hospitals, and typically at much higher rates than in ASCs,” said Rebecca Craig, RN, MBA, the CEO of Fort Collins, Colo.-based Harmony Surgery Center and Peak Surgical Management.
4. In the third quarter of 2017, the most recent data available, the rate of all cause emergency department visits within one day of ASC discharge was 0.69 percent, according to statistics from ASC Quality.
5. Physicians are allowed to have ownership in ASCs, collecting a percentage of the facility fee for each case. The article’s authors suggest this ownership may influence their decision to direct cases to the center , but the laws governing ASC referrals vary by state, with some states barring surgeon referrals to any ASC in which they or a family member maintain a financial interest.
Tenet continues hospital sell-off spree with deals in Illinois, Texas
Dallas-based Tenet Healthcare divested a Chicago-area hospital and sold its minority interest in four Texas hospitals.
Tenet completed the sale of MacNeal Hospital in Berwyn, Ill., and its local physician practices to Chicago-based Loyola Medicine, which is part of Livonia, Mich.-based Trinity Health. MacNeal Hospital includes 374 acute care beds, a 12-bed rehabilitation unit, a 25-bed inpatient skilled nursing facility and a 68-bed behavioral health program.
“We look forward to serving a greater number of patients through our expanded delivery network, thanks to the resources, providers and value-added care made possible by adding MacNeal Hospital and its physicians to our system,” Larry M. Goldberg, president and CEO of Loyola Medicine and Trinity Health’s Illinois region, said in a statement.
Tenet also announced the completion of several other deals on Feb. 2. The company sold its minority interest in Baylor Scott & White-Centennial in Frisco, Texas, and Baylor Scott & White-Lake Pointe in Rowlett, Texas, to Dallas-based Baylor Scott & White Health. The company transferred its minority interest in Baylor Scott & White-Sunnyvale (Texas) to Texas Health Ventures Group, which is a joint venture between Tenet’s United Surgical Partners International subsidiary and Baylor Scott & White Health. Tenet also sold its minority interest in Baylor Scott & White Medical Center-White Rock in Dallas to Pipeline Health, a hospital management company based in Manhattan Beach, Calif.
Tenet ended the fourth quarter of 2017 with a net loss of $230 million, compared to a net loss of $79 million in the same period of the year prior. To improve its financial position, Tenet launched a $250 million cost reduction initiative last year, which involves divesting hospitals in non-core markets and cutting 2,000 jobs, or about 2 percent of the company’s workforce.
Tenet’s hospital divestiture plan is expected to yield more than $1 billion of proceeds. In the first quarter of 2018, Tenet received $550 million of cash proceeds from the divestiture of MacNeal Hospital, the sale of its minority interest in the Texas hospitals and the sale of two hospitals in Philadelphia.
Healthcare execs say EHRs don’t do enough to manage value-based contracts
Dive Brief:
- A survey of 100 healthcare executives found that most of them are seeing ROI on value-based contracts, but investments in EHRs are not sufficient to manage those contracts.
- The Sage Growth Partners study found most respondents were not satisfied with their EHRs’ “ability to help them manage core functions necessary to succeed in (value-based care) — such as care coordination, risk stratification, decision support and patient engagement.”
- About two-thirds of respondents said EHRs are not delivering promises concerning lower costs, better population health management and improved patient and physician satisfaction.
Healthcare providers are increasingly looking to EHRs and third-party population health management solutions to help them with value-based care.
A recent Healthcare Financial Management Association (HFMA) survey found that value-based payment programs doubled since 2015. Nearly three-quarters of executives in the HFMA survey said their organizations achieved positive financial results, including return on investment, from value-based payment programs.
Although providers expect value-based programs to continue to increase, the new Sage Growth Partners survey found dissatisfaction with EHRs and concern they are not helping enough in value-based care. The report found 64% of respondents said EHRs haven’t delivered many critical value-based tools. At least 60% of respondents said they are looking for value-based solutions beyond EHRs.
The survey included a finding that will likely get the attention of EHR and population health management vendors — half of respondents said they are somewhat or highly likely to switch population health management vendors over the next three years.
Nearly three-quarters of survey respondents have had an EHR for at least three years. About half also have third-party population health management solutions. These findings offer a glimpse into the dissatisfaction as well as opportunity in population health management.
The executives surveyed said there are issues with interoperability, addressing social determinants of health, patient engagement, stakeholder coordination and risk analytics. They also spoke of health systems having trouble aggregating and using data from numerous EHR systems and other data sources.
These issues have led half to two-thirds of healthcare executives turning to population health management or do-it-yourself solutions beyond EHRs “to compensate for the lack of these capabilities within their EHRs.” Many of those executives said population health management solutions enabled their value-based success. Those successes are also coming at a lower cost than the investments in EHRs.
The study authors predicted more healthcare executives will look beyond EHRs in the coming years to help with value-based contracting. They said “suboptimal tools” that manage care and costs for populations won’t be enough in coming years.
“As (value-based care) reaches the tipping point, and as they take on programs with greater risk and greater complexity, they will need to continue looking beyond their EHRs to get the functionality they need,” the authors wrote.
Atrium, UNC Health put merger plan on ice
https://www.healthcaredive.com/news/atrium-unc-health-put-merger-plan-on-ice/518311/
Dive Brief:
- Atrium Health, formerly known as Carolinas HealthCare System, announced Friday that its planned merger with UNC Health has been suspended because of disagreements between the two systems on which would control the combined company, The Charlotte Observer first reported. The now-stalled deal would have created a system with more than 50 hospitals and 100,000 employees.
- The lapse in negotiations comes less than a month after Atrium signed a letter of intent to partner with Navicent Health.
- Although consolidation among hospital systems has ramped up over the past year, the failure of the two groups to come to terms shows it’s not always a smooth path.
Dive Insight:
The merger plan was announced in September, but the deal now appears to be going nowhere.
“In our letter sent to UNC Health Care today, we informed them that while we have not been able to reach an agreement, our respect for UNC Health Care, its team and UNC Health Care’s accomplishments has grown through this process,” said an Atrium Health statement also obtained by Healthcare Dive.
Merger mania is still clearly evident in the industry, however.
Advocate Health Care and Aurora Health Care recently moved closer to merging to form the 10th largest nonprofit healthcare system in the U.S. after receiving regulatory approval from both the Federal Trade Commission and Illinois.
Meanwhile, Ascension and Presence Health recently signed a definitive agreement to combine, and Ascension is reportedly in talks to also buy Providence St. Joseph Health. Catholic Health Initiatives and Dignity Health are also working to merge into a new health system, which would have 139 hospitals operating in 28 states.
The mergers are evidence that health systems continue to search for ways to capture economies of scale and cut costs as hospitals face lower reimbursements and patient volumes. But despite the trend, combining massive health systems can be difficult with regulatory and other challenges.
Geisinger reports net income increase despite issues with ACA health plan
Dive Brief:
- In a new financial report, Geisinger Health System reported a gain of nearly $200 million in net income to $324.9 million for the first half of fiscal year 2018 compared to the previous year, for an excess margin of 9%.
- Operating income for the first six months was up from $51.9 million a year ago to $61.2 million in the current fiscal year and net revenue increased 8.1% to $3.3 billion. However, Geisinger’s operating margin dropped from 3% for the first three months of the fiscal year to 1.8% through half the year.
- One area of concern for the integrated healthcare system was its Affordable Care Act (ACA) health plan. Geisinger Health Plan (GHP) struggled after the company didn’t get $11 million in cost-sharing reduction (CSR) payments following President Donald Trump’s decision to stop payments in October.
Dive Insight:
Geisinger’s net revenue growth is connected to an increase in net patient service revenue after the provision for bad debts of nearly 5% and an increase in premium revenue of 11%.
“Net patient service revenue benefited from the realization of growth plans centered on market share growth and the opportunistic capture of high-acuity, clinical service volumes. Premium revenue benefited primarily from rate increases,” Geisinger said in the report.
ACA marketplace volatility, namely the end of CSR payments, as well as higher utilization affected GHP. The company believes the higher utilization is connected to GHP members concerned they would lose coverage if Congress repealed the ACA. Despite Congress’ and the president’s threats and a few close votes, the repeal didn’t happen. But before that effort stalled, Geisinger said many members got healthcare services just in case.
“Similarly, provider tiering in benefit plan changes for self-insured employees were announced in the fall of 2017. These benefit changes caused certain employees to accelerate medical services through providers that fall under higher out-of-pocket tiers beginning Jan. 1, 2018. These one-time impacts, while negatively affecting second-quarter results, are expected to improve operating profits beginning in the third fiscal quarter,” Geisinger said in the report.
Geisinger expects to resolve the CSR non-payment issue this year after raising the average premium rate by 31% to help offset the loss of payments. GHP also gained more than 20,000 members in its exchange plans, a 39% increase, for 2018, which should help offset losses.
GHP had 559,643 members in its health plans through the first half, which was a 0.4% increase compared to a year ago.
Concerning utilization, Geisinger had an increase of 3.5% in discharges and 2.6% in discharges and observations/23-hour stays compared to a year ago. “This growth was attributable to success in expanding clinical programs. Based solely upon hospitals controlled for two years or more, Geisinger experienced a 2.9% increase in discharges when compared to the year-earlier period,” the report states.
However, percent of occupancy based on physically available beds dipped from 60.2% to 59.9%.
Meanwhile, outpatient visits were on the rise. Outpatient emergency room visits increased from nearly 174,000 the previous year to almost 181,000 in fiscal 2018. Clinic outpatient visits increased from 1.65 million to 1.77 million.
Geisinger is the latest nonprofit to offer updates about finances. Over the past week, other major nonprofits have released financial information, including:
All had positive notes in their reports. Cleveland Clinic and Mayo Clinic said operating income and revenue bounced back in 2017 after rough numbers in the previous year. UPMC said its clinical and insurance sides had strong performances as net income hit $1.3 billion. Profits for these companies have been scrutinized as critics question whether they are giving enough back to their communities as nonprofit organizations.
HENRY KOTULA 