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Trump needs to stop sabotaging Obamacare — before it’s too late

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https://www.washingtonpost.com/opinions/trump-needs-to-stop-sabotaging-obamacare–before-its-too-late/2017/08/17/1c1404ba-8133-11e7-902a-2a9f2d808496_story.html?utm_term=.40564141606c

THE CONGRESSIONAL Budget Office released on Tuesday yet another damning report on health care, this time highlighting the damage President Trump will do if he continues his Obamacare sabotage campaign. Over the next few weeks, during which the government and insurers must sort out what will happen to Obamacare insurance markets next year, everyone in the administration and every member of Congress must recognize that they have no more time to entertain repeal-and-replace fantasies. The fate of the health-insurance markets on which millions of people rely hangs on their willingness to accept reality.

The Trump administration has shown some flexibility. The Department of Health and Human Services last week offered insurers an extra few weeks to file rates for next year. Earlier, Alaska got $323 million in federal money to backstop its individual insurance market in a reinsurance arrangement that could drive down premiums and serve as a model for stabilizing insurance markets across the nation. Though Mr. Trump has repeatedly vowed to let Obamacare collapse, these moves show willingness to bolster, not undermine, the insurance markets that Obamacare created.

Yet the administration has stoked more uncertainty than it has allayed, leaving the health system in peril. The White House has been deciding month-to-month whether to keep important subsidy payments flowing to insurance companies — payments that were simply assumed during the Obama administration. Without these payments, insurers would have to jack up premiums or leave Obamacare markets next year. The CBO estimated Tuesday that average premiums would jump by 20 percent next year if the Trump administration pulled them. Moreover, because of how the payments interact with other elements of the health-care system, the government would end up losing money — $194 billion over a decade.

Though it would be irrational to subvert the health-care system and the budget, Mr. Trump has repeatedly threatened to do so. His officials also have taken steps in that direction, pulling advertisements meant to encourage people to enroll in health insurance, cutting programs that helped people sign up, railing about Obamacare’s “victims” and generally insisting, against the facts, that the law is a disaster. The administration’s moves to weaken the individual mandate, which requires all Americans to carry health coverage and underpins the Obamacare system, have led insurers to contemplate increasing premiums or leaving the system.

The president wanted and failed to overhaul Obamacare. That does not excuse him from faithfully executing the law. Unless Mr. Trump wants to be blamed for health-care chaos, the administration’s mixed messages must stop. Mr. Trump should commit to keeping the subsidies going permanently, to enforcing the individual mandate and to working with Congress on a bipartisan bill that would bolster insurance markets.

The broad strokes are clear: Democrats would ensure that subsidy payments are made permanent and Republicans would get more flexibility for states in administering Obamacare. More money should also go into reinsurance programs like Alaska’s. Though such a bill might come too late to hold down 2018 premiums, serious legislative activity could persuade insurers to stay in the market, riding out next year with the promise of a more stable situation in 2019.

All of this would be easier if the administration would commit to a strategy of stewardship, not sabotage.

Sutter will shift 10,000 Anthem Medi-Cal enrollees to community health centers

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http://www.sacbee.com/news/local/health-and-medicine/article167900272.html

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In Sacramento and Placer counties, roughly 10,000 adult Medi-Cal enrollees with Anthem Blue Cross are learning this summer that Sutter’s primary-care doctors will no longer see them.

Instead, those patients are being shifted to primary-care doctors at community health centers such as Sacramento’s WellSpace Health or Auburn’s Chapa-De Indian Health, said Dr. Ken Ashley, the medical director for primary care at Sutter Medical Group. He said the change in providers will allow the patients to access more services.

“Some of the things that the (community health centers) can provide with the funding that they are receiving are things that sometimes we struggle to find for our Medi-Cal patients, things like optometry and dental, behavioral medicine,” Ashley said. “I feel like these patients are finally going to receive things I could not provide as their primary-care doctor. I’m OK with our partners helping to take care of these patients.”

Sutter, Dignity Health, UC Davis and other providers have all contributed funding and expertise to expand the network of community health centers, more formally known as federally qualified health centers.

The so-called FQHC’s have long been the primary-care delivery network for uninsured, low-income people across the country, but Sacramento did not have a strong network of the centers until the Affordable Care Act set aside funding to help them grow to meet the needs of an expanding Medicaid population.

That flood of new patients has swamped many primary-care providers and has made it harder for all patients to get appointments through commercial providers, Ashley said. Meanwhile, in meetings with the leaders of local FQHC’s, he and other leaders were hearing how those organizations had expanded services, lengthened hours and had capacity for more patients.

About a year ago at one of the meetings, Ashley said, all the attendees began to feel that, if they could shift Anthem’s adult Medi-Cal enrollees, they would improve the health of the primary-care delivery system for a broad set of customers.

“We’ve been having a difficult time getting all our patients in at the time they would like, where they would like,” Ashley said. “This is one more step to try to help allow the rest of the community to help us take care of all these patients.”

Jonathan Porteus, the CEO of Wellspace Health, also leads the Central Valley Health Network, a group of health centers up and down the Central Valley that manage almost 3 million visits a year. He said that Anthem began earlier this year investigating whether the FQHC’s truly had the capacity to absorb the adult Medi-Cal patients served through Sutter.

“We were notified – we being the federally qualified health centers – that this change was coming and that there was a keen interest to make sure that it was smooth, that people would not be left without access,” Porteus said. “The wisdom of Sutter and others has been to help our region have a network of federally qualified health centers, a true blanket of care for the first time ever. This is one of the early tests.”

Porteus said he knows that people have questions about whether the quality of care at his centers is on par with what they would receive from primary-care doctors. He said he welcomes those questions because they give him an opportunity to tell the WellSpace story.

“The Joint Commission, which is the accrediting body that accredits hospitals and shuts them down if they don’t think they’re good enough, has accredited us to be a patient-centered medical home, has accredited all our behavioral health,” Porteus said. “This is a standard many of our commercial colleagues in this community don’t have. If you went into some of these primary-care practices and asked them if they had Joint Commission accreditation for ambulatory care, they will tell you ‘no.’”

There will unquestionably be upheaval in this process for both doctors and patients, Ashley said.

Sutter’s pediatricians will continue to provide primary-care to Medi-Cal-enrolled children covered by Anthem Blue , and the insurer’s Medi-Cal enrollees also still will be able to access Sutter specialists. Sutter primary-care doctors will continue to see anyone on Regular Medi-Cal recipients whose medical providers are paid directly by the government.

By the Numbers: E-Visits Not Hitting the Mark?

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https://www.medpagetoday.com/PublicHealthPolicy/by-the-numbers/67379?xid=nl_mpt_DHE_2017-08-19&eun=g1061559d0r&pos=0

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Study shows more work, fewer new patients, little health benefit.

Telemedicine and other “e-visits” are supposed to be a win-win for physicians and patients alike. Doctors could spend less time on simple requests, patients would get frictionless access to their provider.

But a new study published in Management Science finds that all that access hasn’t translated into the outcomes so many had hoped for. Instead, e-visits lead to more office visits and more phone consultations without measurable improvement to patients’ health. And maybe most damaging for physicians’ practices, they’re associated with fewer new patients.

The findings may be surprising, but study leader Hessam Bavafa, PhD, of the University of Wisconsin School of Business, said they make sense when you consider the process of the usual e-visit. Patients can reach out with even the smallest concerns, he said, and that puts doctors in a bind.

“There’s an issue of obligation,” Bavafa told MedPage Today. “If you ignore the signal, who knows what’s going to happen next, right?”

The study used five years of data from a large health system with multiple hospitals and more than 2,000 total beds. It included all primary care encounters for 140,000 patients from 2008 to 2013, including office visits, phone calls, and e-visits, all cholesterol tests, and all blood glucose tests for the physicians with the largest panel sizes. It was limited, however, to those patients who had three or more office visits over the period analyzed, as the study was designed to focus on active healthcare users.

The results were stark. After adopting e-visits — in this instance, essentially an email with a subject line and generic box of text — office visits increased by 6% as physicians met with patients who had reached out online. Physicians also ended up spending 45 more minutes each month on those visits.

Oh, and the extra work of responding to patients requests did not bring extra compensation. “God knows what happens if you start paying doctors for these,” Bavafa said.

And with the increased workload came a corresponding 15% drop in the number of new patients physicians saw.

Bavafa said the findings are a natural consequence of physicians’ limited time: if one patient group is getting more of it, another will feel the squeeze.

But Peter Yellowlees, MD, president of the American Telemedicine Association, said the findings go against his own experience and much of the literature.

He questioned the wisdom of excluding patients who had fewer than three office visits. That eliminated a large group of patients, he pointed out, and may have affected the outcome.

“Effectively they only looked at two-thirds of the patients, which is a bit odd to me,” he said. “It’s perfectly reasonable that those people had problems that could be managed with an occasional email and everything’s fine and they don’t need to come in.”

He also pointed to strong adoption of e-visits in the paper as evidence of their value. The study found fewer than 100 monthly e-visits in 2008. By the end of the period analyzed, that had ballooned to nearly 6,500.

“As a physician, we don’t do things that we don’t think are worthwhile. That level of adoption is strong evidence, from my perspective, that this is a really good idea,” Yellowlees said.

He also wondered whether some other change within the system analyzed could have led to the changes observed. He said the e-visits couldn’t be considered causative.

While he didn’t agree with the findings, he said he was happy to see a study try to examine their impact.

Bavafa, too, was hopeful about the future of e-visits and other telemedicine efforts. Already, he said, some providers are toying with pricing to see if they can affect the way patients communicate with their doctors. The experiments include charging a “subscription” fee for electronic access to doctors, or even a charge for each individual contact.

He compared the current process to Amazon in the 1990s, or taxis as opposed to Uber and Lyft.

“This is the future, we just have to think about how to do it,” he said. “The ideas may not be novel, but it’s about figuring out the whole ecosystem.”

PEOPLE CAN’T SEE YOUR HEART WHEN YOU’RE LOST IN YOUR HEAD

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People Can’t See Your Heart When You’re Lost in Your Head

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I can not notice people. I want to notice, but I’m easily distracted.

People can’t see your heart, when you’re lost in your head.

It doesn’t matter if you want to notice people. It only matters that you do.

Distraction blocks interaction.

I walk around distracted by a million things – what’s next, problems, opportunities, and performance, to name a few. I’m contemplating a coaching client’s concerns or the next presentation.

Remember you matter.

It’s easy to forget that people watch leaders. A frown on your face signals problems to the team. You may not mean to be a downer, but a nagging frown drags others down.

It ain’t hard, but it’s important.

People talk about simple things like smiling when they describe how leaders might improve their leadership.

You object that you’re not good at smiling. That’s so sad.

Bad is stronger than good. You need at least three smiles to overcome the negative impact of one frown. You’re in the hole baby. You better get smiling.

3 tips for frowning leaders to get their smile on.

  1. Tell yourself you like people. Think of something you like about the person in front of you. If you don’t like people, get out of leadership.
  2. Find a positive thing to believe in. What positive thing might you believe about others on the team?
  3. Admire a strength. When you walk up to someone, think about something you admire about them.

A smile that creates wrinkles around your eyes indicates that you notice positive things.

7 small things that make a positive difference.

  1. Smile.
  2. Show interest. “How are the kids?”
  3. Pat on the back.
  4. Bring coffee for the team.
  5. Celebrate progress and hard work.
  6. Sing happy birthday.
  7. Say thank you. (A smile and a little eye contact takes ‘thank you’ to a whole new level.)

110 ACOs to know | 2017

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http://www.beckershospitalreview.com/lists/110-acos-to-know-2017.html

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In its sixth edition, Becker’s Healthcare is pleased to highlight a variety of Medicare and commercial payer accountable care organizations led by hospitals, health systems, physician groups and other organizations.

Leavitt Partners, a Salt Lake City-based healthcare consulting firm, reports 934 active public and private ACOs in the United States during the first quarter of 2017 covering 2.2 million lives. Over the past year, 138 new ACOs began operation and 46 dropped their accountable care contracts, leading to an 11 percent growth year-over-year, according to Health Affairs.

Several ACOs represented on this list participate in the Medicare Shared Savings Program. Tracks 1 and 2 have limited provider risk; participants can benefit from shared savings but aren’t at risk for loss. MSSP Track 3, added in 2016, creates shared savings opportunities with greater risk. Track 3 ACO providers can share up to 25 percent of savings, but are at risk for loss. The most recently reported data for MSSP ACOs is the 2015 performance year.

CMS launched the Next Generation ACO Model in 2016, requiring providers to shoulder greater financial risk with the potential of earning more shared savings. The Next Generation ACOs qualify as advanced alternative payment models under the Medicare Access and CHIP Reauthorization Act’s Quality Payment Program in the 2017 reporting year. There are currently 45 participants in the Next Generation ACO Model.

These governmental contracts are in addition to commercial ACO arrangements, which at 715 in number, represent the plurality of all contracts, according to Health Affairs. Commercial ACOs tend to cover more lives than their Medicare counterparts.

Becker’s included ACOs on this list based on several factors, such as cost performance, participation in CMS ACO models and participation in innovative commercial agreements. ACOs are presented in alphabetical order. ACOs with multiple contracts are listed by the health system or provider group name.

Swedish Health’s Cherry Hill campus at risk of losing Medicare, Medicaid funding

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http://www.beckershospitalreview.com/quality/swedish-health-s-cherry-hill-campus-at-risk-of-losing-medicare-medicaid-funding.html

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CMS is threatening to cut off Medicare and Medicaid funding to Seattle-based Swedish Health’s Cherry Hill campus in 90 days unless it resolves patient safety issues, according to The Seattle Times.

The Washington Department of Health inspected Swedish’s Cherry Hill campus after a February Seattle Times investigative report exposed troubles, including staff members feeling intimidated, patient care concerns and surgeons performing overlapping surgeries.

The state surveyors identified numerous patient safety issues at the Cherry Hill campus, including failure to outline the roles of medical fellows, failure to address behavioral concerns, failure to document surgical tasks of medical residents, failure to listen to staff concerns and failure to track when the attending physician was in the operating room.

“Staff members feared punishment and retaliation for voicing concerns,” the regulators wrote, according to the Seattle Times. “Staff members stated they were frequently bullied and intimidated for voicing concerns about the working conditions in the neurosurgical operating area.”

To keep federal funding for the Cherry Hill campus, Swedish Health must submit a corrective action plan to CMS. Regulators will conduct another survey to ensure the hospital is in compliance with Medicare and Medicaid rules.

Swedish Health said that many of the deficiencies cited have been addressed, according to the report. The system implemented a new policy to ban overlapping surgeries. Additionally, Swedish Health CEO Guy Hudson, MD, insured that the culture of intimidation will be addressed

“We are sorry for what occurred at Swedish Cherry Hill on our watch,” Swedish Health board members told the Seattle Times. “As volunteers, we continue to be deeply committed to our critical governance role in overseeing patient quality and safety, as well as physician credentialing.”