Tag Archives: Health System
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IBM Watson Health debuts cloud solutions for value-based care
Dive Brief:
- IBM Watson Health unveiled a new series of value-based cloud solutions aimed at helping providers, health plans and employers better manage their healthcare costs and quality.
- The solutions — debuted at HIMSS17 in Orlando, FL—will integrate patient-level data from electronic health records and other sources to enhance understanding of different patient populations, risk factors and red flags at the individual, group and population level.
- Watson Health also announced an agreement with Atrius Health to develop a cloud-based service to improve the doctor-patient experience.
Dive Insight:
The shift to value-based care and reimbursement models is forcing hospitals, payers and employers to rethink the way they manage risk in patient populations and come up with new approaches to improve quality while reducing costs. However, CMS’ new Quality Payment Program lacks needed IT infrastructure for collecting the data allowed by MACRA, which implemented the program, a recent HHS report concluded. But IBM is not the only company hoping to provide helpful solutions for value-based care. Earlier this month, Epic said it will incorporate care management content into its electronic health records (EHRs) and Health Catalyst deployed a new software tool that can be used to identify and align quality measure selection.
The value-based solutions set combines capabilities of Watson Care Manager, Truven Health Analytics, Phytel and Explorys. Initial applications, to be rolled out later this year, will focus on provider performance, patient engagement, bundled payments forecasting and management and custom analytics. Under the agreement with Atrius Health, Watson Cognitive Insights will combined the various influences on an individual’s health, including behavioral determinants, to improve primary care physicians’ effectiveness and efficiency and the quality and safety of ambulatory care. Among other things, the IBM solution could summarize key cognitive insights about a patient’s health status, assemble a de-identified cohort of similar patients and predict how those people might respond to various treatment options, according to the company.
During her keynote address at HIMSS17, IBM CEO Ginni Rometty talked of a new “golden age” in healthcare, thanks to cognitive computing, digitalhealth reports. Yet the industry must work to ease concerns about transparency, privacy of personal health information and artificial intelligence replacing highly skilled healthcare workers, she said. Rometty urged companies to invest in scalable — rather than piecemeal — solutions and to support an open platform, noting that will allow users to combine data being generated with their own insights.
A Surprising Place to Find Anti-Kickback Rules
Some aspects of EHRs, telemedicine might technically be illegal.
Federal anti-kickback laws may be old, but they’re still relevant, even with something very modern like health information technology (IT), Scott Grubman, JD, said here Thursday at the annual meeting of the Healthcare Information and Management Systems Society (HIMSS).
“So much technology in the healthcare space is to facilitate referrals,” such as when one provider transmits information to another, said Grubman, an attorney at Chilivis, Cochran, Larkins & Bever, in Atlanta. “If those referrals wind up being reimbursed by a federal healthcare program, a company can violate the anti-kickback statute.”
An 82-Year-Old Law
The anti-kickback statute, a version of which was first passed in 1935 and has been amended several times since with the introduction of Medicare and Medicaid, prohibits anyone from “knowingly and willfully paying, offering, soliciting, or receiving remuneration” in return for referring patients to services that are paid for by Medicare, Medicaid, and other federal healthcare programs.
The statute not only prohibits payments to providers, but also prohibits remuneration to beneficiaries, which means services like telemedicine and electronic health records (EHRs) might also be involved, Grubman noted.
Although the government says it wants to encourage technology growth in healthcare, “unfortunately sometimes what they don’t realize is that regulations that have been on the books for years — and are still applicable — don’t mesh well with the explosion of healthcare technology.”
There are two ways technology could be implicated in violations of the anti-kickback rule, he continued. The first way is if technology is being given to a provider to be used to actually issue the referrals that are implicated in the act — in bygone days this would mean if physicians are given fax machines to fax referral orders for which they get bonuses.
“There is lots of guidance [in the rule] that’s related to fax machines, so we have to figure out how to apply [the fax machine guidance] to the provision of tablets or electronic health records [to doctors],” he said.
The second way is if a technology that is used in any way to facilitate referrals — such as to provide the medical information to justify a referral order. “So if there’s technology that can facilitate a referral between a physician and a hospital, or between a hospital and pathology lab, that technology potentially implicates the anti-kickback statute.”
CHS to sell 25 more hospitals after $1.7B loss in 2016
http://www.healthcaredive.com/news/chs-to-sell-25-more-hospitals-after-17b-loss-in-2016/436555/
Dive Brief:
- The net loss attributable to Community Health Systems (CHS) stockholders totalled $1.7 billion for 2016, compared with net income of $158 million for 2015, according to a financial report released Monday.
- Full year operating revenues fell to $18.4 billion in 2016 from $19.4 billion in 2015 and are expected to fall to $16.2 million or lower in 2017.
- The struggling hospital operator plans to sell an additional 25 hospitals this year, the report states, after it announced last week it would continue divestiture with the sale of eight hospitals to Steward Health Care.
Dive Insight:
The downfall of CHS continued into the fourth quarter of 2016, although it could have been worse. On a per share basis, earnings came in at 46 cents per share while financial analysts had predicted earnings of 12 cents per share, according to an Associated Press report.
How CHS will proceed from here remains unclear. The hospital operator divested from dozens of hospitals last year and deals to sell additional hospitals are in the works. Reports surfaced last year that CHS was considering a sale, but it may be difficult to find a buyer willing to take on debt accumulated by CHS.
In 2016, CHS’ net losses were “primarily related to impairment charges totaling approximately $315 million to reduce the value of long-lived assets,” the earnings report states. “These impairment charges were partially offset by the gain of $91 million on the sale of a majority ownership interest in the company’s home care division, which closed on Dec. 31, 2016.”
CHS has made some progress paying off its debt, but there is still a long way to go. Long-term debt totaled $16.5 billion at the end of 2015 and dipped to $14.8 billion at the end of 2016. The hospital operator has entered into agreements and letters of intent, “consisting of ten separate contemplated transactions,” to divest the additional 25 hospitals, which represent about $3.0 billion of 2016 net revenue.
5 RCM metrics hospitals should monitor to improve cash flow
Hospitals and health systems continuously monitor revenue cycle management metrics, as they play a key role in helping organizations receive maximum reimbursement and an accurate assessment of their billing department.
However, to maintain profitability, organizations must select and track metrics that push them to surpass expectations.
“Understand where you are today and have goals of where you want to go. Looking at how you’re summarizing the information, looking at how you’re tracking and trending the information, looking at how you’re budgeting and trending for that information is very important,” says Nicole Davis, senior vice president of channel managementat IKS Health, which manages RCM functions for health systems and large physician groups.
“Some metrics you’ll want to look at on a daily basis, while others you’ll look at from an operational standpoint and others from a quarterly or monthly perspective to get a better understanding of holistically are we moving in the direction we want to go,” she added.
But with so many metrics to evaluate, which are most important to track?
Ms. Davis recently spoke with Becker‘s Hospital Review about which metrics to focus on to improve cash flow. Below, she provides five metrics for hospitals and health systems to continuously monitor.
Hospitals target nutrition, other social needs to boost health
Tom Shicowich “really, really, really liked Coca-Cola” before he began a new nutrition program targeting his Type 2 diabetes and weight. Being on a “very tight budget,” he couldn’t afford the fruit and vegetables he cut up for a living at his part-time grocery store job. Dinner was often a pizza or fast food meal he picked up on the way home.
Six months after getting free healthy groceries every week through the Geisinger hospital near his rural Pennsylvania home, Shicowich has cut his blood sugar level from nearly 11 to close to a normal level of 7. The 6′ 5″ former high school track team competitor has lost 35 pounds but is still nearly 200 pounds from his target weight of 250 pounds.
The Geisinger Health System is on its way to making its own numbers. On March 1, Geisinger plans to expand its five-patient pilot project to 50 more of its sickest and highest-cost diabetes patients. So far, all of those participating in Geisinger’s Fresh Food Pharmacy have lost weight, lowered their body mass indices, decreased their use of medication, lowered their cholesterol and improved their hemoglobin A1C levels, says Andrea Feinberg, an internal medicine doctor who is “clinical program champion.”
Geisinger is what’s known as an accountable care organization, which makes it fully responsible for the insurance and all health costs for their patients. They employ the doctors and own the hospitals and insurance company. The better-known Kaiser Permanente is another example. That means unlike other hospitals, their profits aren’t based upon patients’ visits and treatments.
“It is no coincidence that the health systems and hospitals that are doing it the best have aligned their incentives more closely to the health of their patients,” says Joshua Sharfstein, a pediatrician who is a former secretary of health for Maryland and top Food and Drug Administration official. “It’s very hard to ask a hospital that’s getting paid for every preventable admission to invest in ways that would eliminate those admissions.”
Read more:
Healthcare: Transition refining quality care
http://www.sandiegouniontribune.com/business/economy/sd-fi-outlook-healthcare-20170218-story.html
Where do you see San Diego’s health care sector headed in 2017?
Along with the trend nationally, I see a continued shift in San Diego to treating patients not in hospitals, but in other locations that provide the right level of care in the right place at the right time. Patients will benefit by getting the care they need in a setting that’s more convenient for them, with easier access to appointments and with an integrated approach to care among all of their care providers. We need to be where patients need us when they need us.
I also see a growing emphasis not just on prolonging a patient’s life — which medicine is good at doing — but improving the quality of that life, as well. End-of-life care should be what the patient wants it to be, where they want it to be.
Scientific advances will continue to transform medicine and the delivery of health care through this year and years to come. There will be more advances in individualized medicine that tailors treatment to patients based on genomics, which will continue to affect everything from which drugs are right for each patient to understanding the best way to treat different cancers. At the same time, there will be advances in helping whole populations of patients as health care’s ability to use data changes the research landscape and helps translate findings to the patient bedside faster. Other technological advances will help perform seeming miracles, like detecting potential heart attacks before they happen.
State fears Trump will topple health care gains under Obamacare
What will become of MACRA, Obamacare, health IT? HIMSS boss weighs in (podcast)
What will become of MACRA, Obamacare, health IT? HIMSS boss weighs in (podcast)
The annual Healthcare Information and Management Systems Society (HIMSS) conference gets under way Monday in Orlando, Florida, with numerous preconference activities starting Sunday.
As more than 40,000 people descend on Central Florida for the grueling event, MedCity News talked to HIMSS CEO and President H. Stephen Lieber for what has become an annual ritual, at least for this reporter. As usual, it’s on tape.
HIMSS17 is the last HIMSS conference with Lieber in charge; he announced in December that he would retire at the end of 2017.
Lieber is preparing to depart at a time when health IT is at a crossroads.
Healthcare organizations in the U.S. have spent the better part of the last 10 years installing and now optimizing electronic health records, though they continue to lag when it comes to sharing data across systems. And they continue to gripe about EHR usability and Meaningful Use requirements.
Providers in recent years also have grappled with updates to HIPAA regulations and the conversion to ICD-10 coding. Now, they face some new regulations affecting health IT.
Notably, the 2016 Medicare Access and CHIP Reauthorization Act (MACRA) is coming into force for ambulatory care. The rise of accountable care is “certainly having an impact already in terms of how care is not only delivered,” as well as how payers calculate reimbursements, Lieber noted.
They also face the uncertainty that comes with a change in administration in Washington.
Still, some things do remain relatively constant in health IT.
“The ongoing challenge in dealing with security, there is going to be an even greater focus this year as we try to bring more attention, more focus on what it takes to make sure that we’re handling data in a secure way,” Lieber said.
Clinical analytics has become a normal course of business in the field as well, though it has changed from merely clinical decision support and retrospective analytics to predictive analytics and machine learning. “As the field evolves, we’re evolving the programming with it.” Lieber noted.
Policy seems to be where a lot of intrigue is right now. It’s easy to make assumptions about what the new Trump administration might do, but assumptions are just that.
HENRY KOTULA 