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The Future is Now – New Drone Ambulance Concept
Research: Higher U.S. Physician Spending Doesn’t Lead to Better Patient Outcomes
Health care spending in the United States reached $3.2 trillion in 2013, which accounted for 17% of U.S. GDP. This is almost twice as much as the OECD average of 9%, yet health outcomes in the U.S. are not twice as good as in these other countries. In fact, many outcomes are worse. For example, life expectancy at birth in the U.S. is 78.8 years, which falls short of the OECD average of 80.5 years.
Health care spending also varies substantially within the United States. Many studies have documented enormous geographic variation in spending, finding no clear relationship with quality of care and health outcomes. While some differences in spending and patient outcomes are due to factors outside the health care system, this evidence suggests that there is considerable waste in U.S. health care spending. Many have concluded that at least 20% of spending could be reduced without harming patients.
Geographic regions, however, do not make health care treatment decisions; hospitals, doctors, and patients do. Yet surprisingly few studies have attempted to analyze how health care spending patterns vary for individual doctors, and more important, whether the practice patterns of doctors relate to their patients’ outcomes. Understanding how practice patterns differ among doctors and whether higher-spending doctors have better outcomes is critically important for finding ways to reduce health care costs and improve efficiency of care without harming patients.
In a study recently published in JAMA Internal Medicine, we investigated how spending varies among individual doctors and how spending relates to patient outcomes. We found that individual physicians vary substantially in their health care spending, even within the same hospital, and that greater spending does not lead to improvement in patient outcomes.
By law, hospitals must now tell Medicare patients when care is ‘observation’ only
Under a new federal law, hospitals across the country must now alert Medicare patients when they are getting observation care and why they were not admitted—even if they stay in the hospital a few nights. For years, seniors often found out only when they got surprise bills for the services Medicare doesn’t cover for observation patients, including some drugs and expensive nursing home care.
The notice may cushion the shock but probably not settle the issue.
When patients are too sick to go home but not sick enough to be admitted, observation care gives doctors time to figure out what’s wrong. It is considered an outpatient service, like a doctor’s visit. Unless their care falls under a new Medicare bundled-payment category, observation patients pay a share of the cost of each test, treatment or other services.
And if they need nursing home care to recover their strength, Medicare won’t pay for it because that coverage requires a prior hospital admission of at least three consecutive days. Observation time doesn’t count.
“Letting you know would help, that’s for sure,” said Suzanne Mitchell of Walnut Creek, California. When her 94-year-old husband fell and was taken to a hospital last September, she was told he would be admitted. It was only after seven days of hospitalization that she learned he had been an observation patient. He was due to leave the next day and enter a nursing home, which Medicare would not cover. She still doesn’t know why.
“If I had known [he was in observation care], I would have been on it like a tiger because I knew the consequences by then, and I would have done everything I could to insist that they change that outpatient/inpatient,” said Mitchell, a retired respiratory therapist. “I have never, to this day, been able to have anybody give me the written policy the hospital goes by to decide.” Her husband was hospitalized two more times and died in December. His nursing home sent a bill for nearly $7,000 that she has not yet paid.
The notice is—as of last Wednesday—one of the conditions hospitals must meet in order to get paid for treating Medicare beneficiaries, who typically account for about 42% of hospital patients. But the most controversial aspect of observation care hasn’t changed.
“The observation care notice is a step in the right direction, but it doesn’t fix the conundrum some people find themselves in when they need nursing home care following an observation stay,” said Stacy Sanders, federal policy director at the Medicare Rights Center, a consumer advocacy group.
Medicare officials have wrestled for years with complaints about observation care from patients, members of Congress, doctors and hospitals. In 2013, officials issued the “two-midnight” rule. With some exceptions, when doctors expect patients to stay in the hospital for more than two midnights, they should be admitted, although doctors can still opt for observation.
But the rule has not reduced observation visits, the Health and Human Services inspector general reported in December. “An increased number of beneficiaries in outpatient stays pay more and have limited access to [nursing home] services than they would as inpatients,” the IG found.
The new notice drafted by Medicare officials must be provided after the patient has received observation care for 24 hours and no later than 36 hours. Although there’s a space for patients or their representatives to sign it “to show you received and understand this notice,” the instructions for providers say signing is optional.
Some hospitals already notify observation patients, either voluntarily or in more than half a dozen states that require it, including California and New York.
Geisinger takes ‘radical’ approach to improve population health
Geisinger Health System will unveil a new “radical” population health initiative this week that aims to transform the health of an entire community.
“When it comes to the social determinants of health, we know there are many more causes impacting the health of a population than access to quality medical care,” said Geisinger CEO David Feinberg, M.D., in an announcement. “We want to transform healthcare at its core by focusing on preventive care, behavioral health and economic growth.”
The Danville, Pennsylvania-based system’s new program, called Springboard Health, will kick off in Scranton, Pennsylvania, and targets both patients’ chronic conditions and the community’s overall socioeconomic health, Geisinger said.
The organization will partner with several local stakeholders to implement the program, which features broad goals. The program’s website says it will test several approaches to tackle large-scale socioeconomic issues like hunger and housing insecurity. Potential projects that make it through testing will also be cost-effective, sustainable and designed so that they can be replicated in other regions, according to the website.
“We are going to introduce innovative programs and foster robust community collaborations and back it all up with data to make sure Scranton is the healthiest place to be in the country,” Feinberg said in the announcement. “Once we successfully implement Springboard Healthy Scranton, we’ll take the program on the road to communities with similar socioeconomic health challenges.”
The program’s first project (PDF), titled Fresh Food Pharmacy, aims to provide more healthy eating options to people in the Scranton area. Chronic conditions like diabetes are a significant driver of healthcare costs, research has shown, so the program will identify patients at risk for the disease and enroll them in the project.
The project will ensure that participants have access to at least 10 healthy meals per week and will connect them with local farmers and farmers’ markets to provide them with fresh options they may have had no access to otherwise. Geisinger is already eyeing other Pennsylvania communities for the project.
A new public health crisis: Preventable harm in healthcare
5 steps to get your hospital’s MACRA strategy off and running
Anand Krishnaswamy, vice president of Kaufman Hall’s strategic and financial planning practice, makes the case that MACRA readiness should be a priority not only for physicians, but also for hospital boards and executives.
The first performance year of the Medicare Access and CHIP Reauthorization Act is now underway, which will determine Medicare Part B payments in 2019. Although 2017 is designed to be a transition year, providers who dive in now have the opportunity to maximize financial rewards and set themselves up for success down the line.
“The biggest underlying issue is the lack of awareness and engagement by health systems and physician groups,” Mr. Krishnaswamy tells Becker’s. Though many providers are distracted by the uncertainty on Capitol Hill, MACRA and value-based care are likely here to stay — and it’s time for hospitals to craft a strategy.
Mr. Krishnaswamy suggested providers take the following five steps to prepare for MACRA.
Fitch: Changes to Medicaid in ACA repeal bill pose risks for hospitals
House Republicans’ proposed ACA repeal and replacement plan, known as the American Health Care Act, calls for changes to Medicaid that expose states and hospitals to new fiscal risks, according to a Fitch Ratings report.
The AHCA would eliminate Medicaid’s entitlement structure and restructure the program’s federal funding to a per-capita cap system on Jan. 1, 2020. This change is intended to slow Medicaid spending growth. The Kaiser Commission on Medicaid and the Uninsured estimates switching to a per-capita cap system would reduce federal spending on Medicaid by $1 trillion (or 26 percent) over 10 years. This reduction would require states to make significant budgetary changes and could result in reduced reimbursement for hospitals, according to the report.
The AHCA calls for the government to freeze expanded Medicaid programs on Jan. 1, 2020, and restrict funding only to people who were enrolled in the expanded programs as of Dec. 31, 2019. Under the ACHA, states that expanded Medicaid “will be faced with a unique policy predicament of denying Medicaid access to individuals who would otherwise qualify beginning in 2020, or taking on significant costs they had anticipated would be bored largely by the federal government,” according to Fitch.
5 hospital bankruptcies, closures so far in 2017
http://www.beckershospitalreview.com/finance/5-hospital-bankruptcies-closures-so-far-in-2017.html
Here are five hospitals that filed for bankruptcy protection or closed since Jan. 1, beginning with the most recent.
1. Humble (Texas) Surgical Hospital filed for Chapter 11 bankruptcy Feb. 24. The hospital filed its bankruptcy petition after a judge ordered it to pay Hartford, Conn.-based Aetna $51.4 million in a seven-year-old court battle over the hospital’s out-of-network charges.
2. Louisiana Heart Hospital in Lacombe closed Feb. 10. The 134-bed hospital and its affiliated medical group filed for Chapter 11 bankruptcy Jan. 30.
3. Gardens Regional Hospital and Medical Center, a 137-bed hospital in Hawaiian Gardens, Calif., closed Feb. 1. The hospital, which served mostly low-income patients and was part of Los Angels County’s safety net, faced financial troubles for years and filed for Chapter 11 bankruptcy in 2016.
4. North Texas Medical Center in Gainesville, which is owned by the Gainesville Hospital District, filed for Chapter 9 bankruptcy Jan. 17. With the hope of regaining its financial footing, the hospital’s board approved a partnership with King of Prussia, Pa.-based Universal Health Services in December.
5. The public trust that operates Atoka (Okla.) County Medical Center filed for Chapter 9 bankruptcy Jan. 10. The critical access hospital is about $16 million in debt.
Moody’s: GOP’s American Health Care Act is credit negative for nonprofit hospitals
If House Republicans’ proposed ACA repeal and replacement plan, known as the American Health Care Act, were to become law in its current form it would be credit negative for nonprofit hospitals, according to Moody’s Investors Service.
The components of the AHCA most likely to negatively affect hospitals are transitioning federal Medicaid payments to a per-capita payment to the states, the Medicaid expansion freeze in 2020 and how subsidies are calculated for individuals who purchase insurance on the exchanges, according to Moody’s.
Under the legislation, the uninsured rate would rise, which would cause hospitals’ bad debt and uncompensated care costs to increase, according to Moody’s.
The AHCA’s retention of Medicaid expansion and elimination of scheduled disproportionate share cuts for states that did not expand Medicaid would have a positive impact on nonprofit hospitals, according to Moody’s. However, the rating agency said the positive effects are not enough to compensate for the credit negative components of the AHCA.
HENRY KOTULA 