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Kaiser Permanente plans $200M medical hub in N. Va.

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Kaiser Permanente of the Mid-Atlantic States is looking to build a medical center in Prince William County.

Kaiser Permanente of the Mid-Atlantic States is seeking approval to build a $200 million medical facility in Woodbridge as a “hub” for its ongoing growth in Greater Washington.

According to an application filed with Prince William County, Kaiser officials propose a 270,000-square-foot, five-and-a-half story medical center on a 15-acre parcel the company already owns at 13285 Minnieville Road. The project would include 1,270 surface and structured parking spaces and a plan for future expansion of about 65,000 square feet.

Kaiser officials declined Tuesday to comment about the project, but the application says Kaiser wants to make it the health system’s sixth hub in the region to offer urgent and specialty care. The company has been aggressively growing its footprint across the region in recent months in an apparent bid to gain market share in the already highly competitive Northern Virginia health care business.

The Woodbridge space would include space for adult and pediatric care, women’s health services and pharmacy, lab, optometry and outpatient surgery. It will also include virtual visit technology, an MRI suite and consult rooms. The Kaiser hub model offers specialty care for issues that are too complex for a doctor’s office but do not require a multiple-day hospitalization.

“Kaiser plans to continue to expand throughout Maryland, Virginia and Washington D.C. based on the needs of the community and its growing membership base,” officials said in the application.

The company, an affiliate of health care giant Kaiser Permanente, is headquartered in Rockville. It has more than 710,000 members in Maryland, Virginia and D.C. and comprises Kaiser Foundation Health Plan of the Mid-Atlantic States Inc. and The Mid-Atlantic Permanente Medical Group PC, an independent medical group of more than 1,300 physicians.

Kaiser has partnerships with 11 area hospitals, including Virginia Hospital Center, Reston Hospital Center and Stafford Hospital, as well as Sibley Memorial Hospital and Children’s National Health System in the District, Suburban Hospital in Bethesda and Holy Cross Hospital in Silver Spring.

Kaiser officials said they plan to employ 185 people at the Woodbridge site, which would accommodate an additional 60 jobs following future expansion. They also expect the project would create 200 temporary construction jobs.

Kaiser officials said they will create a “health park” with recreational elements such as workout stations, trails, woodlands and “sensory nooks.”

Documents show Kaiser is working with HKS Architects Inc. Law firm Cooley LLP is listed as the authorized agent and Annandale-based Dewberry Consulting LLC is listed as the engineer.

The project is among of a blitz of real estate moves by the health care in giant in Greater Washington this year.

Kaiser officials said they have invested more than $446 million across the region between 2012 and 2016.

 

It’s not over

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This was a dramatic week for the Senate’s efforts to repeal and replace the Affordable Care Act.

Revised bills were introduced, each with an updated CBO score. There were last-minute meetings to wrangle votes, and surprise announcements from senators bucking their party’s leaders. There might even be another twist by the time you finish reading this.

The headlines keep changing, but the bottom line is the same. Whatever version of repeal and replace – or repeal without replacement – that the Senate votes on will take away health care coverage for tens of millions of Americans.

The Senate is expected to vote on the “Motion to Proceed” to a repeal bill next week. If the motion passes, senators will begin consideration of a bill. The vote could come as early as Monday or Tuesday.

This debate isn’t over! We need to keep the pressure on. Please contact your senators, especially Republicans, and urge them to vote “no” on the Motion to Proceed.

Hospital and health system leaders have done a tremendous job reaching out to their senators and letting them know how much every community relies on its local hospital. We can’t stop speaking out on behalf of our patients and their families now.

I’ll be in San Diego next week for our annual Leadership Summit, where I hope to see many of you – but rest assured our advocacy team will be fully engaged on the front lines in Washington. At the Summit, look for our advocacy center, where we’ll be monitoring the latest developments and providing platforms for you to send messages to legislators. Coverage for millions of patients is at stake. Let’s see this effort through.

Texas Health Resources utilizes work-from-home model to increase revenue cycle productivity

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Whatever hours they’re at their best is when Texas Health Resources wants them to work, system says.

When Texas Health Resources hires new staff members to work in its revenue cycle department, it’s now required — for most functions, anyway — that they work virtually from home. Staff who have been there since before the virtual implementation have the choice, but many choose to go the route of the new hires. It’s a nice perk for the employees, but an even nicer one for the system, which has seen productivity increase significantly since taking this approach.

James Logsdon, THR’s vice president of revenue cycle operations and strategic revenue services, said the concept emerged in 2011 during the Super Bowl.

Dallas was the host city that year, and the big game took place in the midst of a rare ice storm. Logsdon came into work with the wind still whipping and noticed immediately that the office was like a ghost town, with few employees in sight. The system lost three to four days of productivity because people simply couldn’t make it into work, and thus a challenge was born: Turn revenue cycle operations 100 percent virtual within a year.

“It started out as a business continuity plan, but progressed into an initiative,” said Logsdon, recalling the event during the Healthcare Financial Management Association‘s annual ANI conference in Orlando. “It was a drive.”

It took longer than a year, and it may never reach 100 percent; some functions have to stay in-house, particularly with the jobs that involve direct patient interaction. But the effects have been noticeable. Employee satisfaction and morale are at an all-time high, and the turnover rate has been reduced substantially. The system used to lose revenue cycle employees to jobs that paid 10 or 15 cents an hour more, but no longer.

The linchpin of the program’s success is quality. It can’t budge an inch, and employees have to be held accountable.

“The metrics have to be award-winning,” said Logsdon. “You’ve got to set the expectation that this is a privilege. It’s something that could potentially be taken away. Basically, the message was, ‘Don’t let me down.'”

So far they haven’t, and part of the reason is the flexibility the virtual job affords them. Workers are allowed to set their own schedules as long as they put in the minimum eight hours. At whatever hours they’re at their best is when THR wants them to work.

Benefits aren’t just limited to reduced turnover and higher productivity, either. The system allows for better use of its real estate. Where there were cubicles packed tightly together like honeycomb bees, there are now classrooms, war rooms and revenue cycle training areas.

All that saves the system money, since it now uses its existing space for such purposes rather than expanding its footprint. New revenue cycle personnel are expected to work at least 90 days in the office while they undergo their training and education, but after that, they’re released to their virtual offices.

That’s not to say there aren’t challenges. Logsdon said that in some instances employees feel a sense of entitlement, resisting requests to return to the office when the need arises. There are also distractions that differ from the usual office distractions — children, neighbors, friends and family can sometimes intercede. To address this, THR conducts unannounced site visits to make sure everything’s copacetic.

The arrangement has created some new challenges for management, as they now have to ensure employees are using the right equipment and protocols and have an appropriately speedy internet connection. Few issues have arisen.

“Productivity is a topic that always comes up,” said Logsdon. “The requirement for employees, in writing, is to increase productivity by 5 percent. They have no problem hitting it. It’s amazing what you can pull out of people when they’re motivated by the right reasons.”

Venrock Partner offers take on Senate health bill debate and how ACA can be fixed (Q&A)

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Venrock Partner offers take on Senate health bill debate and how ACA can be fixed (Q&A)

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Before he joined venture capital firm Venrock and became a partner investing in healthcare startups, Dr. Bob Kocher served as special assistant to President Obama for healthcare and economic policy from 2009 to 2010 and played a role in the development of the Affordable Care Act. Given another rollercoaster week for ACA repeal and replace machinations in the Senate, we thought it would be helpful to check in with Kocher to get his perspective. Kocher responded to questions in a couple of emails. What follows is a lightly edited Q&A.

What do you make of Trump’s comment this week: “We’re not going to own it. I’m not going to own it. I can tell you the Republicans are not going to own it. We’ll let Obamacare fail, and then the Democrats are going to come to us.”

Trump is responsible for the performance and premiums of State Exchanges.  The regulations that Trump enacts governing the individual insurance market, the day-to-day operations of HHS’ insurance exchanges, and efforts to reduce political uncertainty around policies like funding cost-sharing rebates, enforcing the employer and individual mandates, and extending reinsurance all have enormous effects on the premiums.  Also, HHS has a great deal of latitude on how to design the purchasing experience and can make it harder or easier for individuals and brokers trying to help people buy insurance.  How Trump chooses to oversee the Affordable Care Act could easily have a larger impact on premium growth than underlying medical trend.

What aspects of the Affordable Care Act need to be fixed at this point?

The ACA is working well in most places and premiums under the ACA have grown more slowly than prior to the ACA.  Moreover, premiums today are almost exactly what the Congressional Budget Office predicted.  To make the ACA work even better, and to reduce future premiums, five things should be done:

  1. The Trump Administration should enforce the individual and employer mandates
  2. The Trump administration should commit to funding cost sharing rebates (failure to fund these will lead to 10 percent to 15 percent increases in premiums)
  3. Ask Congress to reinstate the risk-corridor funding, that Marco Rubio removed, like we do for Medicare Advantage
  4. Ask Congress to extend and make permanent reinsurance funding like we do for Medicare Advantage
  5. Require plans to bid on large regions or entire states to create larger risk pools and more plan options in less populated counties.

How do you expect the healthcare reform debate to unfold from here?

I think Republicans will find it politically advantageous to move on to other agenda items and work with Democrats to enact these five policies as part of the end-of-year flurry of must-pass government funding bills.   

What aspects of the healthcare reform debate are getting overlooked or missed that you think are important? 

The fundamental problem is that healthcare costs too much. Premiums under the Republican health care plans are forecast to go up even faster than the ACA.  Premiums today are already over $17,000 per year for a family.  That is simply unaffordable.  We need to redesign healthcare to be lower cost.  We know that healthcare can be delivered at lower costs since groups like Kaiser, Geisinger, Group Health, ChenMed, Healthcare Partners, and CareMore have delivered care that is about 30 percent lower cost with great outcomes done this for years.  We need policy makers to argue more about how to create incentives to drive down cost and less about what cost sharing should be for individuals.

Has the healthcare debate on Capitol Hill shown that the shift to value-based care is at risk or can overcome the current uncertainty?

I think the shift towards payment models that reward better outcomes at lower cost is certain. The legislation that drives this change is MACRA and it is not being debated.  MACRA passed Congress with bipartisan support and Secretary Price committed to enact it faithfully during his confirmation hearing.

Does the Senate’s lack of success (so far) with the ACA repeal and replace effort say more about the GOP and the members of this party, the ACA or the divisiveness of the healthcare debate in general?

I think that most Americans think the ACA is working.  Having access to high quality insurance with subsidies to make care more affordable is valued by Americans.  The thought that they would suddenly have to pay both more out of pocket when they go to the doctor with higher deductibles, pay higher annual premiums, and have plans that cover fewer conditions is scary. The rhetoric of “repeal and replace” may have sounded good politically but it is sure unattractive when you consider the reality.

You noted in an editorial you wrote for The Wall Street Journal last year that one thing you got wrong about Obamacare was how the change in the delivery of healthcare would and should happen:

“I believed then that the consolidation of doctors into larger physician groups was inevitable and desirable under the ACA….What I know now, though, is that having every provider in health care “owned” by a single organization is more likely to be a barrier to better care.

Is there anything that can be done to improve this situation through amendments to ACA?

While we anticipated ongoing consolidation of healthcare providers into larger systems, we thought that these systems would also embrace the new payment models the ACA launched.  These new models reward coordination of care that can be made easier through scale and being part of a single organization that can do everything from primary care and hospital care to rehab and hospice.  In reality, these larger systems have discovered that they have the market power to say no to health plans trying to get them to take part in new payment models and to raise prices.  We now need to do more work on creating local market competition and price pressure.

What are the chances that after the repeal effort fails, that a truly bipartisan effort may emerge to deal with areas of the U.S., where the healthcare exchanges are not working well because too few insurers are participating?
I think there can be bipartisan support for solutions to make Exchanges work better and to lower premiums for consumers. Just like Democrats and Republicans have come together to fund reinsurance, risk corridors, and reduce uncertainty for private health plans in Medicare Advantage and Medicare Part D, fortunately, these same solutions will work again for Exchanges. I think we can achieve bipartisan support to bolster the ACA and that Republicans will have the desire to do these things soon.

Small Missouri Town Went For Trump, Now Some Fear Health Care Overhaul

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The closest emergency room is 20 miles east on the highway. That’s why it isn’t unusual for people experiencing heart attacks, blood clots and strokes to show up at Dr. Rodney Yager’s clinic on Main Street in Monroe City, Missouri.

Yager, who grew up in the area, can handle the fast pace of a small-town clinic. What worries him more is how federal health care policies being shaped in Washington, D.C., could affect his patients.

The most recent proposal by Senate Republicans would cut taxes for the wealthy and leave 22 million more U.S. residents uninsured by 2026, compared to current law.

But voter frustrations with the Affordable Care Act’s rollout in communities like Monroe City helped fuel the elections of candidates who promised to dismantle it.

“Honestly, I can see the Republican side of wanting to make budget cuts and try to eliminate waste,” Yager said.”But at the same time, they’re hurting a lot of people.”

This town of almost 2,500 people sprang up about 130 miles northwest of St. Louis, along the railroad in the 1850s. Monroe City, which is just west of Hannibal, was once a Democratic stronghold in northeast Missouri. In the last decades, voters have shifted to favor conservative Republican candidates and their policies. In the most recent presidential election, Monroe, Marion, and Ralls counties voted for Republican Donald Trump over Hillary Clinton, his Democratic rival, by a 3 to 1 margin.

Nevertheless, Democratic U.S. Sen. Claire McCaskill received a warm welcome at the Monroe City Senior Nutrition Center last week, where she held her eighth of 10 town halls during the Senate’s July 4 recess. Her Republican counterpart, Sen. Roy Blunt, held none, a decision that drew protests in the St. Louis area. Members of Blunt’s staff said he met with constituents one-on-one throughout the week.

McCaskill is in a tough spot. Her six-year term will be up at the end of 2018, and she’s running for re-election in an increasingly red state. But in Monroe City, about 60 people listened as she vowed to vote against the latest Republican plan to gut the Affordable Care Act, and reiterated a call for Republican senators to accept amendments proposed by Democrats.

“It’s really a big tax break for wealthy folks, paid for by cutting the Medicaid program,” McCaskill said. “So I’m hoping it doesn’t pass. And then we can sit down together and try and fix what we have, repair what we have.”

It took just three questions before someone asked whether health insurance should be the basis of a health care system at all. Nearly everyone in the room raised their hands when McCaskill asked who would favor extending Medicare coverage to everyone, of any age. The idea of a single-payer system for American health care is a non-starter for conservative lawmakers and think tanks, but has grown in popularity among the general public. A recent Politico poll found that 44 percent of respondents would support a federal health care program for everyone.

“Even though more of you are for ‘Medicare for all,’ I’m worried that we can’t afford it right now,” McCaskill told the crowd. “It’s very expensive.”

Like many small towns in the United States, Monroe City’s population is aging. While voters are more likely to cast their ballot for Republican candidates, they are disproportionately affected by cuts in public spending for health care programs.

These Americans Hated the Health Law. Until the Idea of Repeal Sank In.

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Five years ago, the Affordable Care Act had yet to begin its expansion of health insurance to millions of Americans, but Jeff Brahin was already stewing about it.

“It’s going to cost a fortune,” he said in an interview at the time.

This week, as Republican efforts to repeal the law known as Obamacare appeared all but dead, Mr. Brahin, a 58-year-old lawyer and self-described fiscal hawk, said his feelings had evolved.

“As much as I was against it,” he said, “at this point I’m against the repeal.”

“Now that you’ve insured an additional 20 million people, you can’t just take the insurance away from these people,” he added. “It’s just not the right thing to do.”

As Mr. Brahin goes, so goes the nation.

When President Trump was elected, his party’s long-cherished goal of dismantling the Affordable Care Act seemed all but assured. But eight months later, Republicans seem to have done what the Democrats who passed the law never could: make it popular among a majority of Americans.

Support for the Affordable Care Act has risen since the election — in some polls, sharply — with more people now viewing the law favorably than unfavorably. Voters have besieged their representatives with emotional telephone calls and rallies, urging them not to repeal, one big reason Republicans have had surprising trouble in fulfilling their promise despite controlling both Congress and the White House.

The change in public opinion may not denote newfound love of the Affordable Care Act so much as dread of what might replace it. The nonpartisan Congressional Budget Office estimates that both the House and Senate proposals to replace the law would result in over 20 million more uninsured Americans. The shift in mood also reflects a strong increase in support for Medicaid, the health insurance program for the poor that the law expanded to cover far more people, and which faces the deepest cuts in its 52-year history under the Republican plans.

Most profound, though, is this: After years of Tea Party demands for smaller government, Republicans are now pushing up against a growing consensus that the government should guarantee health insurance. A Pew survey in January found that 60 percent of Americans believe the federal government should be responsible for ensuring that all Americans have health coverage. That was up from 51 percent last year, and the highest in nearly a decade.

The belief held even among many Republicans: 52 percent of those making below $30,000 a year said the federal government has a responsibility to ensure health coverage, a huge jump from 31 percent last year. And 34 percent of Republicans who make between $30,000 and about $75,000 endorsed that view, up from 14 percent last year.

“The idea that you shouldn’t take coverage away really captured a large share of people who weren’t even helped by this bill,” said Robert Blendon, a health policy expert at Harvard who has closely followed public opinion of the Affordable Care Act.

In 2012, when The New York Times talked to Mr. Brahin and others here in Bucks County, Pa., a perennial swing district outside Philadelphia, their attitudes on the law tracked with national polls that showed most Americans viewed it unfavorably.

But now, too, sentiment here reflects the polls — and how they have shifted. Many people still have little understanding of how the law works. But Democrats and independents have rallied around it, and many of those who opposed it now accept the law, unwilling to see millions of Americans stripped of the coverage that it extended to them.