Tag Archives: Hospital

MIPS breakdown: 6 must-know parts of the MACRA final rule

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http://www.beckershospitalreview.com/finance/mips-breakdown-7-must-know-parts-of-the-macra-final-rule.html

OR Efficiencies

The Medicare Access and CHIP Reauthorization Act final rule is here. As industry experts begin to dig into the 2,400-page document released Friday, a few details are emerging that will be critical for providers who plan to practice fee-for-service medicine in 2017.

Physicians, physician assistants, nurse practitioners, clinical nurse specialists and certified registered nurse anesthetists who bill more than $30,000 a year or provide care for at least 100 patients under traditional, fee-for-service Medicare will be subject to MACRA’s Merit-Based Incentive Payment System beginning Jan. 1.

Becker’s caught up with two experts who have already started reading — Tom Lee, PhD, founder and CEO of SA Ignite, and Dan Golder, DDS, principal at Impact Advisors — to determine a few details providers should heed in preparation for MIPS next year.

Here are seven takeaways based on the initial findings of Drs. Lee and Golder.

The 10th Annual ReviveHealth Trust IndexTM reveals an alarming gap

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http://thinkrevivehealth.com/topic/trust/

Health system pie chart

13% VALUE • 87% VOLUME

During the course of calendar year 2016, what percentage of your total commercial revenues will be based on volume versus value?

Health plan pie chart

44% VALUE • 56% VOLUME

During the course of calendar year 2016, what percentage of your the total claims you pay for commercially insured patients will be based on volume versus value?

http://thehealthcareblog.com/blog/2016/10/18/the-trust-gap-in-healthcare-findings-from-the-2016-healthcare-trust/?utm_campaign=KHN%3A+Daily+Health+Policy+Report&utm_source=hs_email&utm_medium=email&utm_content=36101369&_hsenc=p2ANqtz-_H0Xd8-bph-4E1P_WuxQu3NWoe27IIu9jELumbhG553MdbewO3LayeOY_kls9URzaeO2A3QdFRz3z9QbtCg88S-9F-NQ&_hsmi=36101369

 

 

Four areas of unnecessary senior healthcare

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http://managedhealthcareexecutive.modernmedicine.com/managed-healthcare-executive/news/four-areas-unnecessary-senior-healthcare?cfcache=true&ampGUID=A13E56ED-9529-4BD1-98E9-318F5373C18F&rememberme=1&ts=19102016

The number of seniors in the United States is projected to nearly double over the next 34 years—from 43 million in 2012 to nearly 84 million by 2050. During that time period, the number of seniors 85 and older is expected to jump from nearly 6 million to 19 million.

“Our Parents, Ourselves: Health Care for an Aging Population,” a report issued by the Dartmouth Atlas Project, a program of The Dartmouth Institute for Health Policy and Clinical Practice, also reveals that the number of seniors in Medicare private health plans such as Medicare Advantage increased from 6.4 million beneficiaries in 1999 to nearly 12 million in 2011—and that number continues to rise.

Because seniors are likely to experience frequent, complex interactions across many providers in the healthcare system, often there’s no single healthcare provider coordinating all of their care, according to the report, which was released in early 2016.

In addition, the American Geriatrics Society’s Choosing Wisely guidelines, which were released in 2013 and updated in 2015, provide geriatrics-specific recommendations to the American Board of Internal Medicine Foundation’s Choosing Wisely campaign. The campaign advances a national dialogue on avoiding wasteful or unnecessary medical tests, treatments, and procedures.

Here are four areas of elderly care—highlighted in the report and guidelines—that healthcare systems and health plans should be aware of to ensure that elderly patients aren’t receiving unnecessary care.

FTC puts an end to Penn State-PinnacleHealth deal

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http://www.fiercehealthcare.com/finance/ftc-prevails-squelching-penn-pinnaclehealth-deal

FTC logo

Thanks to the Federal Trade Commission, the Penn State Health and PinnacleHealth merger will not go forward.

Plans to merge were called off late last week, according to PennLive.com. The Penn State Board of Trustees voted unanimously to call off the deal, which would have created a four-hospital system in the Harrisburg region, including Penn State’s Hershey Medical Center and the three PinnacleHealth facilities.

The FTC and the Pennsylvania Attorney General intervened in the deal late last year, with both claiming that residents in Central Pennsylvania would have few alternatives for other healthcare providers, leaving the likelihood open that the merged entity would raise prices. Thetransaction was initially approved by a U.S. District Court in May, but the parties were dealt a blow when the ruling was reversed by the U.S. Third Circuit Court of Appeals last month.

The aborted deal cost Penn State an estimated $17.6 million in legal fees and other costs, according to PennLive.

The case is part of what has been heightened scrutiny of recent hospitals deals by both federal and state regulators. In November, the FTC intervened in a deal between two rural hospitals in West Virginia, Cabell Huntington Hospital and St. Mary’s Medical Center. The agency recently prevailed in a 2010 case where it intervened in ProMedica’s acquisition of St. Luke’s Medical Center in Toledo, Ohio. The agency is also fighting a proposed merger between Advocate Health Care and NorthShore University HealthSystem in Chicago, although as in the Penn State matter, it has lost at the lower court level.

FTC Chairwoman Edith Ramirez expressed concern earlier this year that ongoing hospital mergers will soon impact healthcare pricing around the U.S., but deal-making appears to go on unabated. That’s despite the fact that a recent analysis suggested that mergers even across markets can lead to double-digit cost increases.

Measuring What Really Matters

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http://altarum.org/health-policy-blog/measuring-what-really-matters

Image result for measuring

Not everything that is important for a person’s health can be measured and not everything that can be measured in health care is important to the average person.

For too long, value has been defined only for the benefit of regulators and purchasers. Our health care system is purpose-built to cater to their performance needs, oversight, and expectations, and as such has fostered the proliferation of all sorts of clinical quality measures by multiple organizations. The current state of quality measurement serves these audiences reasonably well.

However, the problem with evaluating quality using these tools is twofold. First as a physician, I still see too much variation in the technical quality of American health care. Second, clinical measures alone ignore how value is perceived through the eyes of those who actually use the delivery system. When we look at the highest users of health care – those with serious medical problems and functional limitations – we now have an abundance of technical measures for each condition on their problem list, and yet really no understanding of whether we are contributing to a person’s quality of life. Frankly, I care little about the fact that my 100-year-old grandmother has never had a screening colonoscopy, but I care mightily that no one seems responsible for her successful discharge and transition home after a bout of urosepsis.

We cannot improve what we do not measure…and it is time to start measuring health care from the vantage point of those needing care, not just for those who provide and pay for it. And if we are to achieve the dramatic improvements anticipated through new payment and service delivery models, the mushrooming of purely clinical measures must be thinned out to make room for a new generation of metrics that consider outcomes from the person’s perspective.

 

Biomarkers: Top challenges and opportunities in managed care

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http://managedhealthcareexecutive.modernmedicine.com/managed-healthcare-executive/news/biomarkers-top-challenges-and-opportunities-managed-care?cfcache=true&ampGUID=A13E56ED-9529-4BD1-98E9-318F5373C18F&rememberme=1&ts=13102016

Image result for Biomarker

 

What Recruiters Look for in a Clinician Executive

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http://www.healthleadersmedia.com/physician-leaders/what-recruiters-look-clinician-executive?spMailingID=9684843&spUserID=MTMyMzQyMDQxMTkyS0&spJobID=1021022376&spReportId=MTAyMTAyMjM3NgS2

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The ranks of physicians and nurses in the C-suite are growing, but aspiring leaders must be prepared for strategic roles.

Lack Of Medicaid Expansion Hurts Rural Hospitals More Than Urban Facilities

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http://khn.org/news/lack-of-medicaid-expansion-hurts-rural-hospitals-more-than-urban-facilities/

rural-hospital_770

It isn’t news that in rural parts of the country, people have a harder time accessing good health care. But new evidence suggests opposition to a key part of the 2010 health overhaul could be adding to the gap.

The finding comes from a study published Wednesday in the journal Health Affairs, which analyzes how the states’ decisions on implementing the federal health law’s expansion of Medicaid, a federal-state insurance program for low-income people, may be influencing rural hospitals’ financial stability. Nineteen states opted not to join the expansion.

Rural hospitals have long argued they were hurt by the lack of Medicaid expansion, which leaves many of their patients without insurance coverage and strains the hospitals’ ability to better serve the public. The study suggests they have a point.

Specifically, the researchers, from the University of North Carolina Chapel Hill, found that rural hospitals saw an improved chance of turning a profit if they were in a state that expanded Medicaid — while in city-based hospitals, there was no improvement to overall profitability. Across the board, hospitals earned more if they were in a state where more people had coverage and saw declines in the level of uncompensated care they gave.

To put it another way: All hospitals generally fared better under the larger Medicaid program, but there’s more at stake for rural hospitals when the state expands coverage.

 

A 20-year lookback: Has the hospitalist movement actually improved patient care?

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http://www.fiercehealthcare.com/healthcare/a-20-year-lookback-has-hospitalist-movement-actually-improved-patient-care

doctor

http://www.nejm.org/doi/full/10.1056/NEJMp1607958?query=featured_home&

http://www.nejm.org/doi/full/10.1056/NEJMp1608289?query=featured_home

In the last 20 years the healthcare industry has welcomed a new type of specialist that focuses on the general medical care of hospitalized patients. Since the concept was first introduced in 1996, 75 percent of U.S. hospitals now employ these hospitalists and the field has grown to 50,000 physicians.

And the specialty continues to expand with more physicians becoming post-acute care hospitalists and laborists.

But is hospital care better for it? That’s a question The New England Journal of Medicine explores in two new articles in recognition of the 20th anniversary of the field.

In many instances, hospitalists do add value to improve quality, safety and innovation,writes Robert M. Wachter, M.D., a professor at the University of California, San Francisco School of Medicine, and Lee Goldman, M.D., who works for the College of Physicians and Surgeons, Columbia University, New York, in the first commentary. And they believe that the model is the best way to guarantee hospitals provide high-quality, efficient inpatient care.

The model has led to reductions in length of stay, cost of hospitalization and readmission rates, but there are challenges.

“Although hospitalists have been leaders in developing systems (e.g., handoff protocols and post-discharge phone calls to patients) to mitigate harm from discontinuity, it remains the model’s Achilles’ heel,” they write.

7 ways Stark and Anti-Kickback laws hurt hospital care coordination

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http://www.fiercehealthcare.com/healthcare/7-ways-stark-and-anti-kickback-laws-hurt-care-coordination

congress

Click to access barrierstocare-full.pdf

http://www.finance.senate.gov/imo/media/doc/Stark%20White%20Paper,%20SFC%20Majority%20Staff.pdf?utm_medium=nl&utm_source=internal

Anti-kickback and anti-fraud regulations, such as the Stark Law, have the unintended consequence of major barriers to care coordination, according to a new report from the American Hospital Association (AHA).

The passage last year of the Medicare Access and CHIP Reauthorization Act (MACRA) removed one regulatory barrier to care but called on legislative groups to make recommendations for removing other similar obstacles. The AHA report identifies seven barriers created by the Anti-Kickback Statute and Stark Law. These barriers, according to the report, obstruct:

  • The sharing of electronic health records
  • Incentives for efficiency and effective treatment
  • Collaboration to ensure coordinated care at discharge
  • Assistance for patients to keep themselves healthy after returning home
  • Assistance with discharge planning
  • Alignment of incentives in services of better outcomes
  • Rewards for team-based care that incorporates non-physician clinicians

The report also calls for numerous legislative solutions to these obstacles. For example, Congress should develop “safe harbors” under the Anti-Kickback law, both to protect shared savings and incentive programs and to develop the assistance patients need to recover. Current rules on safe harbors and exceptions, the report states, “are not in sync with the collaborative models that reward value and outcomes.” Legislators should also refocus the Stark Law to align it with its original purpose of regulating compensation agreements, report authors write.

The report comes around the same time as a report from the Senate Finance Committee on ways to improve the Stark Law. The suggestions range from establishing new exceptions and waivers for risk revenue to loosening current restrictions on waivers. Others consulted for the report, however, argued that expanding exceptions would only further complicate the regulatory framework and repealing the law entirely would be a better option.