http://www.beckershospitalreview.com/finance/kaiser-s-operating-income-dips-35-4-in-q2.html
Kaiser Permanente said operating revenue for its nonprofit hospital and health plan units increased in the second quarter of 2016, but the Oakland, Calif.-based system reported lower operating income and net income than in the same period of the year prior.
SK&A has identified the top health systems in the nation based on number of employed and affiliated physicians.
Becker’s obtained the information from SK&A via email. Here are the top 25 integrated health systems based on the number of employed and affiliated MDs and DOs, according to SK&A.
1. Kaiser Permanente (Oakland, Calif.) — 8,780 total MDs and DOs
2. Ascension Health (St. Louis) — 5,366
3. Trinity Health (Livonia, Mich.) — 4,190
4. Community Health Systems (Franklin, Tenn.) — 3,794
5. HCA (Nashville, Tenn.) — 3,670
6. Partners HealthCare System (Boston) — 3,405
7. Sutter Health (Sacramento, Calif.) — 2,976
8. Carolinas Healthcare System (Charlotte, N.C.) — 2,659
9. University of Texas Health System (Austin) — 2,615
10. Tenet Healthcare (Dallas) — 2,576
11. Cleveland Clinic Health System — 2,530
12. Mayo Clinic (Rochester, Minn.) — 2,527
13. NewYork-Presbyterian Healthcare (New York City) — 2,448
14. UPMC (Pittsburgh) — 2,413
15. Mercy Health System (Chesterfield, Mo.) — 1,971
16. Baylor Scott & White Health (Dallas) — 1,950
17. Mount Sinai Health System (New York City) — 1,915
18. Providence Health & Services (Renton, Wash.) — 1,849
19. Northwell Health (New Hyde Park, N.Y.) — 1,835
20. Catholic Health Initiatives (Englewood, Colo.) — 1,792
21. Indiana University Health (Indianapolis) — 1,716
22. Henry Ford Health System (Detroit) — 1,689
23. Banner Health (Phoenix) — 1,532
24. SSM Health Care System (St. Louis) — 1,509
25. MedStar Health (Columbia, Md.) — 1,506
http://www.modernhealthcare.com/article/20160113/blog/160119943
Some liberal healthcare policy experts are urging an ambitious, costly program to expand and improve the Affordable Care Act’s coverage. Meanwhile, conservative policy mavens are promoting an even more ambitious ACA replacement packagethey say would reduce the uninsured rate and lower healthcare spending with less government intervention.
Falling in between, the centrist Bipartisan Policy Center recommended last month that the Obama administration meet with governors to advance new health insurance approaches, including flexible use of the ACA’s Section 1332 state innovation waivers allowing implementation of alternative coverage models.
These proposals represent efforts from the left, right and center to frame the health policy options for the next president and Congress following the November elections. Indeed, Democratic presidential candidate Hillary Clinton has proposed measures similar to those offered by the liberal reformers to make healthcare more affordable, while Republican hopefuls Jeb Bush, Marco Rubio and Chris Christie have borrowed ideas from the conservative experts.
“The smart players realize this isn’t a healthcare election,” said Lawrence Jacobs, a political science professor at the University of Minnesota who studies healthcare politics. “But that doesn’t mean you’re not active preparing the ground for post-election discussions.”
The authors, including Joseph Antos of the American Enterprise Institute, James Capretta of the Ethics and Public Policy Center, and Gail Wilensky of Project Hope, acknowledged the political and policy difficulties in implementing these changes. “The depth and breadth of the reforms listed here are not likely to be accomplished and perhaps not even attempted in a single presidential term,” they wrote.
Republicans have been sharply criticized for failing to present their own reform plan. They are hobbled by sharp differences between various factions of the party. Some favor a comprehensive plan with tax subsidies to help people afford coverage, similar to the conservative policy experts’ proposal described above. Others prefer a much more limited approach featuring Republican standbys such as limits on medical malpractice lawsuits, allowing insurers to sell plans across state lines, letting employers band together to buy insurance, and greater reliance on health savings accounts.
Despite the prodding from liberal and conservative reformers, the University of Minnesota’s Jacobs predicts that neither Republican nor Democratic candidates will offer detailed healthcare proposals during this year’s election campaign. The Democrats will avoid it because they don’t want to open themselves to criticism about more costs and regulation. Their message is “consolidation and bite-size improvements” in the ACA. Meanwhile, he said, Republicans don’t want to discuss specific plans with features that may resemble Obamacare and would alienate their political base.
After the election, even if the Republicans win the White House, “reality is staring them in the face, the world has changed, and going back (to the pre-Obamacare system) is not an option,” Jacobs said. Depending on the size of their victory, they may ratchet down premium subsidies and convert Medicaid into a state block grant program. But given healthcare industry and public support for many key ACA features, he predicted Republicans largely would be “relabeling aspects of Obamacare.”
http://www.modernhealthcare.com/article/20160723/MAGAZINE/307239984
The November elections surely won’t end the nonstop, eight-year political war over the shape of the U.S. healthcare system. But the ballot results likely will determine whether the changes driven by the Affordable Care Act continue in the same direction or the system returns to its less-regulated, pre-ACA contours.
Heading into this week’s Democratic National Convention, Hillary Clinton has promised to preserve and expand the ACA’s coverage expansions and delivery system reforms. Donald Trump, who accepted the Republican nomination last week, says he wants to repeal them, without offering much detail about what he would put in their place. The fate of the victor’s proposals, however, will depend heavily on the partisan makeup of Congress.
The clearest scenario is if Trump wins and his party retains control of both the House and the Senate, which would enable conservatives to repeal or roll back the ACA and implement at least some of the proposals outlined in the GOP party platform and the recent House Republican leadership white paper on healthcare. But there are divisions even among conservatives over issues such as Medicare restructuring and how to help Americans afford health insurance. And Senate Democrats almost certainly would use their filibuster power to block major ACA changes.
If Clinton wins and Democrats take control of both the Senate and the House—which is considered unlikely—she might be able to push through proposals such as increasing funding for federally qualified community health centers. But Senate Republicans also could use the filibuster to foil her. In the more likely scenario of a Democratic-controlled Senate and a GOP-controlled House, it’s not clear how much Clinton could achieve through the legislative process.
With Donald Trump’s presidential campaign faltering, Republican health policy experts are gaming out Plan B for working with a Hillary Clinton administration to achieve conservative healthcare goals.
Their focus is on a possible “grand bargain” that would give conservative states greater flexibility to design market-based approaches to make coverage more affordable and reduce spending in exchange for covering low-income workers in non-Medicaid expansion states. A key element, conservative experts say, would be for a Clinton administration to make it easier for states to obtain Section 1332 waivers under the Affordable Care Act. Those waivers allow states to replace the law’s insurance exchange structure with their own innovative models.
While none are ready to sign on yet, congressional Republicans would have to agree to shore up the ACA’s struggling exchange markets by paying insurers for enrolling sicker populations and continuing to help low-income enrollees’ with cost-sharing responsibilities. House Republicans are challenging the cost-sharing subsidies in court.
Not A Priority
Hospitals can be hazardous places for elderly patients, who are at increased risk of falling, drug-induced injury and confusion.
But as the nation’s senior population grows, many facilities are ill-equipped to address their unique needs.
Kaiser Health News visited hospitals around the country, reviewed data and interviewed dozens of patients, family members and health providers to document the extent of the problem and highlight possible solutions.
How hospitals handle the old — and very old — is a pressing problem. Elderly patients are a growing clientele for hospitals, a trend that will only accelerate as baby boomers age. Patients over 65 already make up more than one-third of all discharges, according to the federal government, and nearly 13 million seniors are hospitalized each year. And they stay longer than younger patients.
Many seniors are already suspended precariously between independent living and reliance on others. They are weakened by multiple chronic diseases and medications.
http://khn.org/news/sometimes-tiny-is-just-the-right-size-microhospitals-filling-some-er-needs/
http://www.healthcaredive.com/news/think-small-making-the-case-for-microhospitals/423710/
Eyeing fast-growing urban and suburban markets where demand for health care services is outstripping supply, some health care systems are opening tiny, full-service hospitals with comprehensive emergency services but often fewer than a dozen inpatient beds.
These “microhospitals” provide residents quicker access to emergency care, and they may also offer outpatient surgery, primary care and other services. They are generally affiliated with larger health care systems, which can use the smaller facility to expand in an area without incurring the cost of a full-scale hospital. So far, they are being developed primarily in a few states — Texas, Colorado, Nevada and Arizona.
“The big opportunity for these is for health systems that want to establish a strong foothold in a really attractive market,” said Fred Bentley, a vice president at the Center for Payment & Delivery Innovation at Avalere Health. “If you’re an affluent consumer and you need services, they can fill a need.”
SCL Health has two microhospitals operating in the Denver metropolitan area and another two in the works. Microhospitals “are helping us deliver hospital services closer to home, and in a way that is more appropriately sized for the population compared to larger, more complex facilities,” said spokesman Brian Newsome.
The concept is appealing, and some people suggest they should be developed in rural or medically underserved areas where the need for services is great.
http://www.healthcaredive.com/news/when-is-it-time-to-bring-in-a-consultant/424031/
There are several good reasons to hire consultants. One is a lack of internal resources. That could be due to management vacancies, or the proposed project could be temporary in nature and hospital officials don’t want to divert existing staff or hire more full-time employees to get it done.
Still another reason is to get a gut check on decisions that are of vital importance to the organization, like planning an acquisition or a major capital expansion.
In other cases, hospitals may have expertise, but bringing in a third party — say, to assess a vendor selection process — can lend independence and objectivity to the solution, resulting in more confidence in the final decision, says Brad Armstrong, senior partner at T2C.
Hospitals turn to consultants during mergers and acquisitions, not only to advise the logistics of deal itself but also on operational changes — figuring out how to bring two entities together in a way is more efficient and functional. Consultants can also bring needed expertise to issues like staff productivity and operational efficiencies.
