Patient Perception of Hospital Affiliations Influences Care

https://revcycleintelligence.com/news/patient-perception-of-hospital-affiliations-influences-care?eid=CXTEL000000093912&elqCampaignId=7597&elqTrackId=22665a87f2b6456d8a0257a5829fa32f&elq=8c464455b5764b358a94a8541d0fc832&elqaid=8029&elqat=1&elqCampaignId=7597

Hospital affiliation and healthcare mergers

About 85 percent of individuals said they would forgo local care and travel one hour based on hospital affiliation with a top-ranked system, a study reveals.

Hospital affiliations can influence patient volume, a new study by the Yale Cancer Center shows.

The study recently published in the journal Annals of Surgical Oncology revealed that 85 percent of individuals about to receive complex cancer surgery would travel one hour away to receive care at a top-ranked hospital specializing in cancer care. The respondents said they would travel to a top-ranked affiliated hospital rather than go to their local hospital.

However, almost one-third of the respondents (31 percent) would change their mind about where to seek care if their local hospital was affiliated with a top-ranked hospital or system.

Researchers at Yale Cancer Center explained that the trend in where patients seek care indicated that individuals believe that hospital affiliation with top-rank hospitals means that both hospitals – the top-ranked and affiliate organizations – offer similar quality care. And about one-half of the 1,000 individuals surveyed said that safety and quality of care were identical at both the top=ranked and affiliate hospitals.

But the perception that top-ranked hospitals and their affiliates offer the same level of care quality is not necessarily true, researchers warned.

“There is no evidence that the care is the same, and no regulation that governs the advertising and marketing of these affiliations,” explained the study’s senior author, Daniel J. Boffa, MD, professor of surgery (thoracic surgery), program leader of the Thoracic Oncology Program at Smilow Cancer Hospital at Yale Cancer Center, and investigator at Yale’s Cancer Outcomes, Public Policy, and Effectiveness Research Center (COPPER).

Boffa and his colleagues further investigated how brand-sharing, like hospital affiliations, via the internet impact an individual’s healthcare decision-making process. Researchers asked the over 1,000 individuals about their hospital preferences for complex cancer surgery between large top-ranked organizations and small, local hospitals.

When researchers asked the respondents to compare top-ranked and small hospitals, the survey showed:

  • 47 percent of respondents said that surgical safety, 66 percent felt that guideline compliance, and 53 percent reported cure rates would be the same at both hospitals
  • 47 percent of respondents thought that the surgical care at a top-ranked hospital and its affiliates would be the same across all four safety features (rate of complications, readmissions rate, length of stay, and postoperative mortality rate)
  • 44 percent of respondents thought the affiliated hospital would be the same in terms of surgical quality standards, including surgical cure rate

“It is completely understandable that the public would make assumptions that hospitals advertising the same name offer the same care,” Boffa stated in a press release. “Some hospital advertising could be even be interpreted as encouraging this line of thinking.”

“The truth is that we do not yet know if care received at an affiliated hospital is the same as care at the brand name center, whether that is for complex cancer care or other procedures,” he continued. “Currently hospitals are free to share their brand with almost any hospital they choose. The hospitals are not required to inform patients of any differences in the quality or safety of care provided by the different hospitals within a network. This study suggests that the public is making assumptions in care equality that are potentially influencing their choice for hospital care.”

The perception about hospital affiliations could be problematic for the healthcare industry as providers rapidly consolidate.

Healthcare organizations announced 115 merger and acquisition transactions in 2017, consulting firm Kaufman Hall reported. And that was the highest number of transactions in recent history, the firm pointed out.

2018 is likely to meet or even exceed the number of healthcare mergers and acquisitions, healthcare experts predict. For example, recent data from Kaufman Hall show 255 healthcare merger and acquisition deals announced in the second quarter of 2018.

Many leaders of healthcare organizations engaging in a merger and/or acquisition claim the deal will improve care quality while lowering costs for patients.

But Boffa et al. pointed out that care quality may not necessarily be the same across affiliate hospitals, creating confusion among individuals seeking high-quality, low-cost care.

“I see these findings as a wake-up call to the medical community to investigate if there are important differences in care between affiliated hospitals and their mother ship, as well as a wake-up call to name brand medical centers to take ownership for outcomes at hospitals that share their names,” Boffa stated.

“What is known is that the issue of where to receive complex cancer care is seen as crucial to patient outcome,” he added. “Studies have found that the quality and safety of such complex cancer care is particularly prone to outcome variability across hospitals, and the risk of dying after an operation can be up to four times greater at hospitals that perform procedures infrequently. Yet other data suggests that, in general, outcomes at top-ranked hospitals can vary widely, and are not always superior to non-ranked hospitals.”

Hospital affiliations, however, do have the potential to increase patient access to high quality care, the researchers elaborated. But stakeholders need to provide patients with quality of care data to help them make informed healthcare decisions.

“To our knowledge, this is the first survey to focus on the difference in the public’s perception of care between these two environments, but it is likely that affiliation status and co-branding has already impacted the distribution of patients across the healthcare spectrum,” Boffa said. “The development of affiliations could, potentially, bring cancer expertise closer to patients— but without facts that is just a theory.”

 

Children’s Hospital Oakland doctors revolt against UCSF partnership

Children’s Hospital Oakland doctors revolt against UCSF partnership

Children's Hospital Oakland doctors are photographed in front of the hospital in Oakland, Calif., on Wednesday, May 2, 2018. The doctors are upset over the integration of UCSF and Children's Hospital Oakland. They believe UCSF is receiving preferential treatment over the Oakland facility. (Doug Duran/Bay Area News Group)

Doctors in Oakland are revolting against the much-hyped partnership that combined UCSF Benioff Children’s Hospital and Children’s Hospital Oakland, saying the four-year-old deal is turning the world-renowned East Bay hospital into a second-class facility to its San Francisco sibling.

Doctors are fleeing the East Bay hospital, claiming UCSF has prioritized San Francisco, locating most of its specialists and leadership at its new Mission Bay campus over the Oakland facility.

Fewer kids are being hospitalized in Oakland, down about 11 percent since the 2014 merger, according to doctors. Currently, no new patients can get routine psychiatric appointments or can see a lung specialist in Oakland, a community with the highest rate of asthma in Alameda County, the doctors say.

The doctors say a new 89,000-square-foot outpatient clinic opening this month predated the affiliation and hides the problems.“There’s a lot of anger. The anger is palpable,” said Dr. Stephen Long, a pediatric anesthesiologist who has worked at the Oakland hospital for four years and has represented his colleagues in communication with UCSF executives. “At the time (of the affiliation), it was sold to us in a different way. We were told we’d be stronger not weaker. They sold it to us like a healthy marriage, but where it is now feels like a Cinderella adoption.”

Hospital officials dispute the claim saying the Oakland facility is a valued partner and the deal has improved the care and finances.

“There’s a strong commitment in the entire organization to keep a strong presence in the East Bay,” said David Durand, Oakland’s chief medical officer. “We’ve been here for 100 years and we anticipate being here another 100 years.”

Durand said hospital care is shifting to outpatient care rather than treating people inside a hospital, and the Oakland facility saw a 12 percent increase in outpatient care from two years ago, treating about 220,000 kids last year and sending them home.

The new outpatient clinic will increase capacity to 99 exam and treatment rooms, he said, adding that surgical services in the East Bay increased 7 percent over the last two years.

“If UCSF truly values outpatient care, then why are there no (lung specialist) or psychiatry appointments?” Long said, speaking of two departments that have been integrated, others are in the works. “Why has it become so difficult to retain doctors in Oakland or recruit new ones to serve our community?”

Durand said there’s a national shortage in pediatric lung specialists and far fewer mental health providers than patients need in any community. The hospital has about 60 mental health providers, and last year Oakland handled about 60,000 outpatient mental health visits, he said, but there’s always more need.

He added that the Oakland doctor uprising may also be tied to contract negotiations.

Kristof Stremikis, director of market analysis and insight for the California Health Care Foundation, said the UCSF integration is not unique.

“It’s something happening not only across Northern California, but across the state and country,” he said.

Stremikis said the consolidation can create more efficiency and allow the joint venture to command a market and leverage that into higher prices.

The long simmering unrest reached a head on March 6 when Oakland doctors sent a letter, signed by 120 physicians, to UCSF Chancellor Sam Hawgood, addressing their concerns.

The doctors declared “no confidence” in the integration plan and expressed concerns the changes would increase a “health disparity.”

UC

Hawgood wrote back, saying change can be “difficult,” but that the Oakland hospital plans to improve its finances, the facility and the care to the area’s most needy children.

“Our combined mission of service to all children is not — and will not — be compromised,” Hawgood wrote.

Juan Luis Chavez was frustrated that his 2-year-old son Juan Pablo needed an emergency to get required surgery for his lung condition because he had to wait four months to see a lung specialist in Oakland.

The boy, diagnosed with a lung disease called bronchopulmonary dysplasia, was scheduled for surgery in March to close a hole that had developed between his stomach and his skin, but his surgery was canceled when there were no available appointments, his father said.

“We were concerned,” Chavez said. “We had planned for it for quite awhile … when he leaked it was messing up his skin pretty badly.”

Meanwhile, continued meetings between UCSF management and Oakland doctors have not assuaged concerns.

Dr. Julie Saba, a senior cancer scientist at the Research Institute, said the research arm of the Oakland facility has suffered “catastrophically” since the transition. She said so many researchers have left that there is a 30 percent occupancy in available research space, which has led to a major funding drop.

“It has devastated our ranks,” she said. “Our scientific environment is at a catastrophic level.”

She’s worried with insured patients funneled to San Francisco and poorer patients seen at Oakland, the East Bay facility will suffer financially, which will impact the type of care those kids get in Oakland.

“I don’t want to put any intention behind it, all I know is without a significant change with the current plans, this will end up being a second class hospital with poor physician retention and no paying patients,” Saba said. “Like something out of the 1950s.”

 

 

 

Anatomy of a post-acute care partnership

http://www.beckershospitalreview.com/hospital-transactions-and-valuation/anatomy-of-a-post-acute-care-partnership-a-guide-to-finding-the-right-partner-and-forming-a-successful-joint-venture.html

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In communities across America — large and small — local hospitals serve a purpose that goes beyond being a center for on-demand emergency care. Our nation’s healthcare facilities have a legacy and responsibility as leaders and guardians for the health of individuals in the communities they serve.

As such, it is imperative that local hospitals continue to take the lead in community patient care and avoid being relegated to the position of bystander through managed care or government mandate.

In addition to providing quality patient care, hospitals also have a responsibility to remain financially healthy. And in today’s environment of uncertain and changing regulation, government-mandated penalties, and shifting payment models, hospital leaders are being reminded that financial health and quality patient outcomes go hand-in-hand.

Balancing these two responsibilities is an increasingly tough task. Avoidable readmissions are a cost no organization can afford to ignore, and many of America’s best healthcare facilities are struggling to find an effective solution to their patients’ post-acute needs.

For many hospitals and health systems seeking an answer, partnering with an experienced and proven post-acute care provider has been the solution.

In a value-based world, the ability to manage the total cost of care — from admittance, through acute care, to the post-acute environment — is a strategic advantage for sustaining organizational health and getting patients the right care at the right time, obtaining efficient outcome and attracting and retaining the best and brightest of professional caregivers.

But how do executives and hospital leaders find the right partner, and how can they determine competence and compatibility for their needs?

William F. “Bud” Barrow II, the recently retired president and CEO of Our Lady of Lourdes Regional Medical Center in Lafayette, La., developed what he calls his “Four-Way Test” for evaluating prospective  post-acute care partners.

“There are many players in the sub-acute space, and a lot of them are not in it for the right reasons,” Mr. Barrow says. “There are many small companies formed not to advance care AND make a profit, but to make a profit and flip the company for even more profit.”

“It’s important to partner with a large capital healthcare provider that has demonstrated long-term commitment to patients, to profitability and to doing the right thing at the right time — every time,” adds Mr. Barrow.

The four “C’s” in Mr. Barrow’s test include:

  • Character: Examine the cultural history of the organization and the character of key individuals.
  • Competence: Can they demonstrate long-term, systemic success and expertise in their field?
  • Capital: Is there a financial model in place that suggests sustainability in a profitable way?
  • Creativity: Does the organization demonstrate nimbleness and the ability to rethink and adjust on-the-go based on the uncertainties inherent in healthcare reimbursement and the overall healthcare landscape?

Once a suitable partner is found, Mr. Barrow further identifies three “must-haves” for forming a successful and sustainable joint venture.

  • Organization-wide support

    Support must come from all areas of the organization. Everyone — from board members to medical staff — must understand and support the goal of the enterprise and fully endorse what is a time-consuming process and significant investment.

  • A critical eye

    You must be willing and able to employ a critical eye when viewing your own organization and make a clear and unbiased assessment of what you do well versus what you wish you did well. “Most people are unable to make this critical internal evaluation,” Barrow says. “As a result, they continue to try and do things on their own, often times leading to long-term failure.”

  • Assemble the right team

    The right people must be in place to evaluate various alternatives and possible solutions as you go through the process and fill in the deficit gaps determined in the critical assessment.

Poor evaluation of organizational readiness, Mr. Barrow adds, is one of the most common pitfalls — particularly when it comes to the vital mutual commitment from administration and medical staff.

“There has to be alignment between the business of medicine and the practice of medicine — it’s paramount,” he says. “The prevailing attitude must be that failure is not an option. This is not something where you put your toe in the water, see what happens, and then back out the first time you hit a bump in the road. Everyone must be on board with an all-in focus on clinical networks, evidenced-based best practices, shared accountability and a singular focus on best patient outcomes.”

Nearly two decades ago, LHC Group pioneered a model of post-acute care partnership that has since earned a reputation for enhancing patient outcomes and financial performance in cities and towns across the country. Since then, the company has pursued a mission to build stronger healthcare delivery systems in the communities it serves.

Quality outcomes — for patients and partners — are the driving force behind everything LHC Group does. Quality metrics are now the preferred standard for evaluating post-acute providers, and with more than 60 percent of its home health locations named among the 2016 HomeCare Elite®, and with the highest CMS Star Ratings compared to home health national averages, LHC Group continues to enhance its reputation as one of the top quality home health providers in the country.

“I can think of no other post-acute provider that demonstrates all of the ‘Four C’s’ at the level of LHC Group,” says Mr. Barrow, who formed his first joint-venture partnership with the company in 2007. “Their overwhelming commitment to character, competence and creativity has allowed them to develop the strong capital to deliver on what they promise.”

LHC Group’s record of designing and growing successful post-acute care partnerships throughout the country is the result of years of dedication, tireless work and experience. Their team is accustomed to rising to the challenge of succeeding in the constantly shifting landscape that is the healthcare industry, and they know how to provide value for partners and improved outcomes for their patients.

The conclusion is clear: Choose the right partner. The health of your community and your organization is at stake.

12 recent hospital transactions and partnerships

http://www.beckershospitalreview.com/hospital-transactions-and-valuation/12-recent-hospital-transactions-and-partnerships-51517.html

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The following healthcare mergers, acquisitions and general partnerships took place or were announced the week of May 15.

1. Erlanger in talks to acquire or affiliate with 25-bed Murphy Medical Center
Erlanger Health System, a five-hospital system in Chattanooga, Tenn., is in talks to partner with 25-bed Murphy (N.C.) Medical Center.

2. 3rd hospital joins Beth Israel Deaconess, Lahey Health merger
Newburyport, Mass.-based Anna Jaques Hospital is the third health system to join the proposed merger between Boston-based Beth Israel Deaconess Medical Center and Burlington, Mass.-based Lahey Health, bringing the total number of health systems interested in merging up to five.

3. Quorum to divest 2 hospitals in Tennessee
Brentwood, Tenn.-based Quorum Health Corp., signed a definitive agreement May 15 to sell two hospitals in Tennessee.

4. Steward Health Care to acquire IASIS Healthcare
Boston-based Steward Health Care signed a definitive agreement to acquire Franklin, Tenn.-based IASIS Healthcare.

5. Mount Auburn joins Beth Israel Deaconess, Lahey merger: 3 things to know
Cambridge, Mass.-based Mount Auburn Hospital will join a proposed merger between Boston-based Beth Israel Deaconess Medical Center and Burlington, Mass.-based Lahey Health.

6. Quorum Health seeks to sell 6 more hospitals
Brentwood, Tenn.-based Quorum Health, the 35-hospital spinoff of Franklin, Tenn.-based Community Health Systems, plans to sell six hospitals to restructure its portfolio to improve financial performance.

7. Accumen partners with SSM Health hospital to improve quality of care, patient outcomes
SSM Health Saint Louis University Hospital partnered with Accumen on a multiyear agreement to implement a comprehensive patient blood management program.

8. Geisinger Health System, Jersey Shore Hospital sign integration agreement
Danville, Pa.-based Geisinger Health System and 25-bed Jersey Shore (Pa.) Hospital and Foundation signed an agreement integrating Jersey Shore’s facilities into Geisinger.

9. HealthEast, Fairview Health Services receive final OK to merge
The respective boards of directors of HealthEast, a four-hospital system in St. Paul, Minn., and Fairview Health Services, a seven-hospital system in Minneapolis, approved the organizations’ plans to merge, effective June 1. The merger will create one of the largest hospital networks in Minnesota.

10. Hackensack Meridian, St. Joseph’s Healthcare to partner on home health, hospice services
Hackensack Meridian Health, a 13-hospital system in Edison, N.J., and Paterson, N.J.-based St. Joseph’s Healthcare revealed plans to form a jointly owned home health services agency and a hospice services agency.

11. Yale New Haven, Day Kimball Healthcare partner to improve clinical care
Yale New Haven (Conn.) Health System and Putnam, Conn.-based Day Kimball Healthcare inked an agreement to become community partners and enhance the breadth of clinical care services available at Day Kimball.

12. Wake Forest Baptist partners with Northern Hospital of Surry County on cardiac rehabilitation care
Winston-Salem, N.C.-based Wake Forest Baptist Medical Center and Mount Airy, N.C.-based Northern Hospital of Surry County will partner to provide residents with better access to cardiac rehabilitation services.

The health system CEO’s affiliation playbook — 5 thoughts from a CEO who has executed 50+ agreements

http://www.beckershospitalreview.com/hospital-management-administration/michael-dowling-the-health-system-ceo-s-affiliation-playbook-5-thoughts-from-a-ceo-who-has-executed-50-agreements.html

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As hospitals and health systems seek ways to fortify their organizational strategies amid the transition to value-based care, the drive to forge new partnerships will continue. Although analysts forecast the consolidation trend will carry on, strategic organizations are increasingly realizing the value of establishing other relationships, such as affiliations and joint ventures.

The local forces at play in a given region are a significant determinant of an organization’s need to merge with, acquire or be acquired by another hospital or health system. And while transactional deals will always be necessary, ongoing financial pressures stemming from the transition to value-based reimbursement and the overall emphasis on population health management have prompted health care leaders to partner with their likeminded peers to deliver better, more cost-effective care.

The key is figuring out where your organization can do a better job working with a partner than alone, and more importantly, who to collaborate with.

In some cases, this has led to the union of unlikely bedfellows — organizations that were formerly competitors are, in some cases, coming together to pursue a joint goal. In other cases, hospitals and health systems may benefit from establishing partnerships with pharmaceutical companies, medical device makers, retail clinics or even non-healthcare entities. For example, Northwell Health has worked with The Ritz-Carlton and Tiffany & Co. as part of our efforts to improve the patient experience and our operational processes.

As with all relationships, the most positive and high functioning are symbiotic; both partners must satisfy and complement the other. They must also — at the most basic level — get along. Here are five more ideas on successful partnerships, affiliations and joint ventures.

1. Know what you need and what you can offer. Partnerships create opportunities to expand into new markets and broaden your reach. But when it comes to selecting a partner, it’s important to clarify what it is they have that you want — and visa versa.

For example, we have a strategic affiliation with Cold Spring Harbor (N.Y.) Laboratory, a premier cancer research facility on Long Island. They have an international reputation, with  several Nobel laureates in their ranks. We needed to strengthen our cancer research, and they needed a clinical partner that would allow them to connect with patients. We entered into a long-term partnership in 2015. Even though we’re very different organizations, we both benefit from the relationship. 

2. Don’t overemphasize the short-term benefits. Focus as much on the short-term benefits of a partnership or affiliation as you do on your goals for five or 10 years down the line. Most relationships hit a rough patch in the beginning, but if you give up on the partnership because your troubles are making you doubt the viability of your short-term goals, you’re being too impetuous. In other words, success takes time. Take steps to solve short-term complications, but hang in there and try to make it work.

3. Be open to new partners. Keep an open mind when it comes to discussing new relationships with different partners — even those that don’t seem to make much sense in the beginning. The rapid pace of change in healthcare and our collective pursuit of innovation oblige us to at least listen to others’ ideas and consider new possibilities. 

4. Don’t get stuck in an abusive relationship. New partners might hit a rough patch or need to adjust their communication style to meet one another’s needs, but it is also important to know when it’s better to cut your losses and call it quits. If a relationship becomes abusive or dysfunctional and there is no longer any benefit for being involved, then it’s time to re-evaluate the situation.

5. Determine whether you’re truly compatible with a potential partner. If your organization is looking for a long-term partner — not just a fling — the two entities must mesh culturally. When considering a potential partner, ask yourself if there is mutual respect on both sides. Do those who are in charge of communication and collaboration work well together? Is the relationship riddled with conflicts or is it smooth sailing? Keep in mind, however, that conflicts are not necessarily a symptom of an impending breakup. Sometimes the issue can be resolved by changing the people or metrics at hand.

Most importantly, there must be ongoing and open communication. Two partners can disagree, but in most cases they can work it out.

Executive Roundtable: A High-Level Look at Hospital Affiliations

http://www.beckershospitalreview.com/leadership-management/executive-roundtable-a-high-level-look-at-hospital-affiliations.html