Tag Archives: Health System

ACA Changes Favored 2 to 1 by Healthcare Leaders Over Repeal and Replace

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http://www.healthleadersmedia.com/leadership/aca-changes-favored-2-1-healthcare-leaders-over-repeal-and-replace

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As the Trump administration officially begins later this week, a new HealthLeaders Media survey shows that healthcare industry leaders support changes to the existing law rather than replacing it. Two-thirds of respondents (66%) say the best option for the healthcare industry regarding the Patient Protection and Affordable Care Act is to make some changes but otherwise retain it.

At the opposite ends of the spectrum, 27% favor full repeal and replacement, while only 7% of respondents say keep it as it is, indicating the extent of dissatisfaction with the PPACA.

Interestingly, a greater share of health systems (78%) than hospitals (66%) and physician organizations (65%) favor making some changes to the PPACA.

On the other hand, a greater share of hospitals (28%) and physician organizations (27%) than health systems (17%) prefer full repeal and replacement. This is perhaps an indication that health systems are less able than other providers to accept full repeal and replacement because of their greater complexity as organizations.

Among the 66% of respondents who say that the best option for the PPACA is to make some changes, the top three changes they advocate are adding a public health insurance option (61%), eliminating the excise tax on high-cost employer health benefit plans (‘Cadillac tax’) (50%), and eliminating the individual mandate and noncompliance penalty (37%).

The two changes receiving the fewest responses are eliminating Medicaid expansion (10%) and abandoning the focus on value-based care and reimbursement (16%).

Healthcare Leaders Split on Incoming Trump Administration

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http://www.healthleadersmedia.com/leadership/healthcare-leaders-split-incoming-trump-administration?spMailingID=10260830&spUserID=MTY3ODg4NTg1MzQ4S0&spJobID=1081571803&spReportId=MTA4MTU3MTgwMwS2#

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While 41% of executives are generally positive about the potential impact of a Trump administration, nearly as many (37%) are generally negative about the prospects. The figures regarding Tom Price at HHS and Seema Verma at CMS are similar in a HealthLeaders Media survey.

Dynamics of Decline: The Truth About HMOs

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http://www.chcf.org/articles/2016/11/dynamics-decline-truth-hmos

California Commercial HMO Enrollment, Kaiser Foundation Health Plan ("Kaiser") vs. Non-Kaiser, 2004-2015

California’s commercial health maintenance organization population shrank from 11.9 million to 9.8 million enrollees between 2004 and 2015 (see figure below), a 17.5% decline. But the decline has not been consistent across all HMOs — Kaiser’s commercial enrollment has actually grown during this period.

Two new publications from CHCF take a closer look at how commercial managed care enrollment (including individual enrollment) and the public sector’s embrace of managed care are shifting the way physician organizations are paid — important trends that could affect California’s delivery system.

Superbug infection kills patient in Reno

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http://www.healthcarefinancenews.com/news/superbug-infection-kills-patient-reno

A superbug infection resistant to all 27 available antibiotics killed a woman in Reno, Nevada, the Centers for Disease Control and Prevention reported Friday, in issuing a precaution to hospitals nationwide.

While this superbug case was rare, sepsis blood infections reportedly kill an estimated 258,000 Americans each year.

Medical experts have been warning for years of the dangers of overprescribing antibiotics because of the potential for antibiotic-resistant superbugs.

The female patient who died this September from the superbug infection was a Washoe County, Nevada resident in her 70s who arrived in the United States in early August 2016 after an extended visit to India, the CDC said.

On August 18, she was admitted to an acute care hospital with a primary diagnosis of an infection called systemic inflammatory response syndrome, which likely resulted from an infected right hip.

A week after she was admitted, the hospital notified the Washoe County Health District in Nevada that the patient had a bacterial infection of carbapenem-resistant Enterobacteriaceae, called CRE.

 

Pennsylvania Rural Health Model to use global capitation to pay for inpatient, outpatient care

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http://www.healthcarefinancenews.com/news/pennsylvania-rural-health-model-use-global-capitation-pay-inpatient-outpatient-care

Building on all-payer models in Maryland and Vermont, the Centers for Medicare and Medicaid Services this week announced a new global capitation model for rural hospitals in Pennsylvania.

Participating critical access hospitals and acute care hospitals will receive all-payer global budgets for a fixed amount of money that is set in advance and funded by all participating insurers, to cover inpatient and outpatient services, CMS said.

In addition, other commercial health plan payers in the state are eligible to participate by paying participating rural hospitals through global budgets.

“Rural hospitals will use this predictable funding to deliberately redesign the care they deliver to improve quality and meet the health needs of their local communities,” CMS said.

CMS is giving Pennsylvania $25 million, which is a portion of the funding, to begin implementing the Pennsylvania Rural Health Model.

The Pennsylvania Department of Health and CMS will jointly administer the model. The state will be responsible for data analytics, quality assurance, and technical assistance.

The model seeks to increase rural Pennsylvanians’ access to care while also reducing the growth of hospital expenditures across payers, including Medicare, to increase the financial viability of the state’s rural hospitals, CMS said.

“The Pennsylvania Rural Health Model presents a historic opportunity for rural hospitals,” said Patrick Conway, MD, CMS principal deputy administrator and chief medical officer. “The model will help rural hospitals remain financially viable and continue to provide essential services to the people in their communities.”

The Pennsylvania Rural Health Model was done in agreement with the state and signed by Governor Tom Wolf and Pennsylvania Secretary of Health Karen Murphy.

University of Vermont Health Network to implement $112.4 million Epic EHR

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http://www.healthcarefinancenews.com/news/university-vermont-health-network-implement-1124-million-epic-ehr

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The University of Vermont Medical Center filed a certificate of need, or CON application, with the state of Vermont Jan. 3, seeking approval to create a unified electronic health record system across four hospitals in the University of Vermont Health Network.

The submission of the CON application signals the start of a regulatory review process for the project.

A unified EHR would significantly improve patient care by having all of a patient’s information available to a healthcare provider regardless of location whenever it is needed, health system officials noted in their CON application.

“If a patient needs to go from their primary care provider’s office to a specialist, that specialist would have instant access to the patient’s full record rather than just portions that can be shared electronically today,” John Brumsted, MD, president and CEO of UVM Health Network, in a statement.

“There are still times when the medical records are faxed or even hand-delivered by the patient at the appointment,” he added. “In urgent situations, and especially during an emergency, having immediate access to important information is critical. A unified EHR is foundational to our ability to collaborate fully to provide the highest quality care possible.”

The capital cost of the project, which is subject to CON review, is $112.4 million. It includes $3.1 million in capitalized interest. The total cost of the project over the first six years of implementation and operation is expected to be $151.6 million.

Done independently, it could cost up to $200 million for the four hospitals to upgrade their own systems, and it would lack the network connectivity, UVM officials calculated.

Mayo summit: Healthcare payment reform requires commitment to change

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http://www.fiercehealthcare.com/healthcare/summit-panel-payment-reform-requires-sustained-commitment-to-change?utm_medium=nl&utm_source=internal&mkt_tok=eyJpIjoiTmpaall6QmtNV0k0WkRRNCIsInQiOiIrZkVQTkVnTk1kdTlIWU9ZSmluUDhHTXI0bmY1V2VWN1NtZE9uRVlOZjRzWUM4eTZ4bFJmRmd6U3BBMks5bDl5cmVpdjRITCs5RlNoa1ZJQktQXC94TE9NWkpwbFV4dlVWaGwzMlpUOHZPTkJzSTVkamdjOHFEREIrcEpqVEU0T2kifQ%3D%3D

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Healthcare payment reforms won’t be effective unless hospitals and health systems adopt a “policy of continuous improvement” to ensure that they meet patient needs across the spectrum of care

So said a panel of experts convened by the Mayo Clinic and Arizona State University Alliance for Healthcare.

The panel attended last week’s Health Care Payment Reform Summit, and met with the press on Saturday to discuss their findings. The biggest takeaway: There must be a sustained culture change in order for payment reforms to take hold.

“Healthcare historically has been a status quo model—improve to a certain point and stay there,” George Halvorson, chair and CEO of the Institute for Intergroup Understanding, told reporters. “The model of the future needs to be better.”

Halvorson said that the industry as a whole must embrace data and computer systems that can make care better and track where improvements are most needed. This extends to payment reform, he said, as a model needs to be established that encourages innovation and consistent improvement.

One particular area of focus is to look at ways to reduce costs and improve care for the most complex patients. Elliott S. Fisher, M.D, director of The Dartmouth Institute for Health Policy and Clinical Practice, said that the top 5% of the sickest patients incur the most costs and use the most healthcare resources. These patients often have needs outside of the hospital’s control that can contribute to their situations, like homelessness or food insecurity, he said.

The panelists agreed that an effective solution is for providers to better identify patients with complex conditions and unmet socioeconomic needs. Therefore, Fisher said, it’s important that adequate data is gathered for providers to improve care for patients with complex conditions.

Private vs. public prices

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http://www.academyhealth.org/blog/2017-01/private-vs-public-prices

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You probably knew that the prices private health insurers pay hospitals are higher than those of Medicare and Medicaid. But you may not have known that the gap between private and public payers used to be a lot smaller and has grown tremendously in recent years.

Using Medical Expenditure Panel Survey (MEPS) data, by payer (private health insurance, Medicare, and Medicaid) and over time (1996-2012), the chart shows average hospital payment rates (in constant dollars), adjusted for age, sex, race/ethnicity, geography, income, health conditions, charges, length-of-stay, and whether or not a surgical procedure was performed. To produce figures for the chart, the authors used this model to predict hospital payment per stay for each MEPS observation, as if they were covered by private insurance, Medicare, or Medicaid, in turn.

As is clear from the chart, adjusted, average private pay rates have always been above public rates, but were closest in 1996-2000. Back then, private rates were no more than 10% above Medicare rates. Perhaps this was the effect of managed care, which kept growth in private rates down. Those rates began to grow during the managed care backlash, until 2005. From 2005-2009, adjusted, average private hospital rates—while considerably above Medicare and Medicaid rates—held steady. Then, in 2009, they took off again. In 2012, adjusted, average private rates were about 75% higher than Medicare rates.*

Medicaid payments were about 90% of Medicare’s in most study years.

ACA repeal makes hospitals more vulnerable to closure

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http://www.fiercehealthcare.com/healthcare/hospital-closures-aca-repeal-makes-organizations-more-vulnerable?utm_medium=nl&utm_source=internal&mkt_tok=eyJpIjoiTldOaE1tUXlaRFUxTlRrMyIsInQiOiJVUFpNQ0tIKzF1c1pzU0gzbVpuaTNMdE8wbHUxY09LWW1mN1hoaHJ4QnVtVzdOWUExOXNqUXhPZkxTaUUwcFpHWW9ib21QdkRxanU1TzhRMXltUUNZN2dFdVdhSnpJWWpKbTVhMGkzSmlWT3R5UDVhMTJQUXhwSlF3eXNKT1VsRyJ9

hospital hallway

Millions of insured Americans could lose health insurance coverage if Congress and the new White House administration make good on their threat to repeal the Affordable Care Act. But they aren’t the only victims.

Many hospitals could also close as a result of the legislative action and the loss of government funds and increase in uninsured Americans who need care.

And these potential closures only add to the growing problem of vanishing hospital beds, according to a Bloomberg report. Indeed, more hospitals have shifted their focus from inpatient to outpatient care for financial reasons, acquiring or opening stand-alone facilities, physician practices and retail clinics.

“It’s been a very tough environment for hospitals,” Jason McGorman, a Bloomberg Intelligence analyst, said in the piece. “They have to get into other areas and businesses to free up cash and generate better margins than inpatient care, which has become a slow-growth business.

Drug companies to face fines for overcharging 340B hospitals: 4 things to know

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http://www.beckershospitalreview.com/finance/drug-companies-to-face-fines-for-overcharging-340b-hospitals-4-things-to-know.html

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HHS’ Health Resources and Services Administration has finalized a rule that sets civil monetary penalties for drug manufactures that overcharge healthcare organizations that are part of the 340B Drug Pricing Program.

Here are four things to know about the final rule.

1. The final rule requires drug manufacturers to calculate the 340B ceiling price on a quarterly basis. The rule includes the methodology manufacturers must use when estimating the ceiling price for a newly covered outpatient drug.

2. Under the final rule, drug manufacturers that intentionally overcharge a covered hospital will face civil monetary penalties. HRSA can fine a manufacturer up to $5,000 for knowingly and intentionally overcharging a 340B hospital for drugs purchased through the program.

3. HRSA clarified that a drug manufacturer that overcharges a hospital for drugs purchased through the 340B program would not face penalties if the manufacturer made an “inadvertent, unintentional or unrecognized error in calculating the ceiling price.” A manufacturer would also be deemed not to have the requisite intent if it “acted on a reasonable interpretation of agency guidance,” or “has established alternative allocation procedures where there is an inadequate supply of product to meet market demand, as long as covered entities are able to purchase on the same terms as all other similarly situated non-340B covered entities.”

4. The final rule is effective March 6. Since the effective date falls in the middle of a quarter, HRSA said it plans to begin enforcing the requirements of the final rule at the start of the next quarter, which begins April 1.