HealthLeadersMedia.com - Quality Pillar News & Analysis

Outside review of clinical data finds a spinal treatment's benefit overstated

Tue, 18 Jun 2013 13:04:00 GMT

Researchers have long argued that a heralded spinal treatment sold by the nation’s largest device maker, Medtronic, was no better than an older one and possibly more risky. Now with the company’s help, they have the proof. The evidence, published on Monday in a medical journal, is the first fruit of a movement aimed at helping doctors and patients make better treatment choices. Its goal is to have companies make clinical data about a drug or a medical device available to a wide range of researchers, not just a few handpicked ones.

PwC: Pace of Rising Medical Costs Slowing

Tue, 18 Jun 2013 12:21:00 GMT

Lower-cost healthcare options such as retail clinics and a decline in hospital readmissions are holding the projected increase in medical costs to 6.5%, a full percentage point lower than the 2013 projected rate, says PwC's Medical Cost Trend report.

ACOs Widespread, Yet Challenged

Tue, 18 Jun 2013 11:52:00 GMT

Two of the pioneering forces behind accountable care organizations say the model is gaining significance as it proliferates across the country, even though there are concerns over lack of uniformity in performance measures.

Supreme Court rules 'pay-for-delay' drug deals can be illegal

Tue, 18 Jun 2013 11:20:00 GMT

A divided U.S. Supreme Court ruled Monday that some "pay-for-delay" settlements between drug companies and their competitors violate antitrust laws. The 5-3 decision, a limited victory for the Obama administration, paves the way for federal regulators to challenge such deals in court. Pay-for-delay settlements typically occur when a company develops and patents a new drug to be released into the marketplace. Competitors that wish to introduce a generic version often challenge the patent. Rather than fight the challenge, patent-holding drugmakers have found it more lucrative to simply pay the competitor to keep generics off the market. The two firms then share monopoly profits that are, in some cases, much higher than open competition would yield, critics charge.

Mostashari asserts no more ICD-10 delays

Tue, 18 Jun 2013 11:15:00 GMT

NATIONAL HARBOR, MD – Farzad Mostashari, MD, the national coordinator for healthcare IT, asserted today there would be no extension of the deadline for switching from the ICD-9 medical coding system to ICD-10. The deadline for conversion would remain Oct. 1, 2014, Mostashari said in a keynote delivered this morning at the HIMSS Media ICD-10 Forum in National Harbor, Md. "There are no plans for any more extensions," he told attendees, repeating it twice, for emphasis. The current extension, from Oct. 1, 2013 to Oct. 1, 2014 was partly due to looking at the incremental changes needed in reforming healthcare, and realizing that "sometimes, extensions are needed," Mostashari said.

Opinion: Sharing EMRs still too hard

Tue, 18 Jun 2013 11:14:00 GMT

The average patient can't fathom why the sharing of electronic medical records is so hard. But those inside healthcare aren't thrilled either with the state of electronic record interoperability, as several smart discussions at this week's Digital Healthcare Conference in Madison, Wis., showed. "If we're this far into this implementation across the country, and we still have this level of discordance, shame on us," said Dr. Frank Byrne, president of Wisconsin's St. Mary's Hospital. "How did we get here and how do we get out? Because we've created barriers Epic CEO and founder Judy Faulkner highlighted some of the obstacles to data sharing, from patients wanting to control such sharing, to difficulty training clinicians, to the many technical challenges.

NC physicians group coordinate to improve care and avoid penalties

Tue, 18 Jun 2013 11:00:00 GMT

WakeMed Health & Hospitals and one of the state's biggest physicians practices announced a partnership Monday designed to minimize federal penalties and maximize financial rewards under the national health care law. Under the arrangement, WakeMed and Key Physicians will stay in regular contact with Medicare patients after they are sent home from the hospital, an approach long viewed as impractical because of the costs involved. Health assistants will call patients to make sure they take their medications and schedule follow-up doctor appointments to manage their health and limit the need for emergency care

Chicago safety-net hospitals face uncertain future

Tue, 18 Jun 2013 10:57:00 GMT

Like many of the Chicago area's 20 safety-net hospitals, which act as a stop-gap medical system for the poor, St. Anthony is facing unprecedented pressure to adjust its business model amid the most sweeping changes to the health care system in decades. While their larger and better-financed counterparts are investing millions in new facilities, equipment and physicians, many of Chicago's safety nets live day-to-day, week-to-week, much like their patients.Closure of such hospitals, often the largest employers in their neighborhoods, would have major implications on local economies but also could create health care deserts where major swaths of the city would be left without immediate access to health care.

Hospital price data—There's an app for that

Tue, 18 Jun 2013 10:56:00 GMT

Imagine this: You get a hospital bill in the mail and, before paying it, you plug its contents into a smartphone app. Up pops information on whether the prices you've been charged are in line with national averages, along with recommendations about how to dispute the bill if you choose. Or take this scenario: Your doctor recommends you get knee surgery. You key in your zip code and the type of surgery you need and immediately access a list of nearby surgical facilities and information about quality and cost metrics for each. As a bonus, you also get information on your own doctor, including how much he earns in Medicare payments every year and his complication rate for the type of surgery you need

CMS Issues Health Insurance Exchange Proposed Rules

Mon, 17 Jun 2013 12:07:00 GMT

Most of the proposal focuses on program integrity for state marketplaces and insurance companies offering coverage in the federally facilitated exchanges. The rule intends to safeguard federal money and consumers.

Healthcare Leaders Seek Strategic Sweet Spot

Mon, 17 Jun 2013 11:57:00 GMT

Hospitals and health systems are getting squeezed at both ends of the revenue spectrum. To survive they must effectively integrate a number of healthcare services and add value. But how?

Hospital CEO bonuses reward volume and growth

Mon, 17 Jun 2013 11:15:00 GMT

Like hospital leaders everywhere, the people running Valley Medical Center in Renton, Wash., talk frequently about the need to control soaring medical costs. "We are working to reduce the overall cost of health care and to transform health care delivery," Lisa Jensen, chairwoman of the hospital's board of trustees, said last year. Experts believe that's a good prescription for the entire U.S. health industry, which costs the economy far more than systems in other developed countries, delivers mediocre results and is widely seen as unsustainable at its current growth rate.

FBI: Chicago hospital kept patients too sedated to breathe on their own

Mon, 17 Jun 2013 11:08:00 GMT

WASHINGTON – A surgeon at Chicago's Sacred Heart Hospital cut a hole in Earl Nattee's throat on Jan. 3, the day before he died. It's not clear why. The medical file contained no explanation of the need for the procedure, called a tracheotomy, according to a state and federal inspection report that quotes Sacred Heart's chief nursing officer as saying it happened "out of the blue." Tracheotomies are typically used to open an air passage directly to the windpipe for patients who can't breathe otherwise. Now, amid a federal investigation into allegations of unneeded tracheotomies at the hospital, Nattee's daughter, Antoinette Hayes, wonders whether her father was a pawn in what an FBI agent called a scheme to defraud Medicare and Medicaid.

Opinion: What Sweden can tell us about Obamacare

Mon, 17 Jun 2013 11:05:00 GMT

Last month, for the 37th time, the House of Representatives voted to repeal Obamacare, with many Republicans saying that its call for greater government involvement in the health care system spells doom. Yet most other industrial countries have health care systems with far more government involvement than we are ever likely to see under Obamacare. What does their experience tell us about Republican fears? While in Sweden this month as a visiting scholar, I've asked several Swedish health economists to share their thoughts about that question. They have spent their lives under a system in which most health care providers work directly for the government.

Obamacare rollout seen slowed by confusion over benefits

Mon, 17 Jun 2013 11:00:00 GMT

Judith Mayer Lynn, uninsured and battling breast cancer, should be a fan of the Affordable Care Act. Instead, she barely knows about it. The 56-year-old Nevada woman was unaware of subsidies in the law that will help people like her buy coverage in 2014, she said in an interview. Lynn didn't know the act requires insurers to pay for prescription drugs, hospital stays and other services she's spent the last two years scrimping to afford. Nor did she realize she can no longer be denied a policy due to her illness. Told of the benefits, Lynn remained unconvinced, skeptical of insurers and government alike. "It's a joke," she said. "There's going to be loopholes in all of these provisions."

For timely access to care, patients may seek a new path

Mon, 17 Jun 2013 10:57:00 GMT

Although about half of U.S. consumers prefer physicians for primary health care, patients are willing to be treated by physician assistants and nurse practitioners to secure timely access to care, says a study by the Association of American Medical Colleges. About 60% of study respondents preferred seeing a physician assistant or nurse practitioner to address a worsening cough if they could be seen the same day. Twenty-five percent preferred an extra day's wait to see a physician, according to the study published in the June edition of the journal Health Affairs.

Cellphone photos of surgery prompt inquiry

Mon, 17 Jun 2013 10:54:00 GMT

URBANA — If you've had surgery at Carle Foundation Hospital, you signed a consent form that included an OK for the surgical team to take pictures of you during the operation. Carle says the photos are to share with you, include in your medical records and sometimes for research and education purposes — not for what prompted an internal investigation recently: That is, surgery staff members sharing pictures they took on their own cellphones with other surgical employees because the injuries involved were so amazing.

Walk-in clinics gaining popularity

Mon, 17 Jun 2013 10:52:00 GMT

Tabitha Smith had been sick for about a week last November with what she thought was just a cold. When she didn't get better, her mom pushed her to see a doctor. "I told her I can't afford the doctor," says Smith, a 31-year-old social media manager who has been uninsured for five years. Ultimately Smith decided that Mother knows best. She headed to an urgent care clinic near her home in La Puente. Last time she saw a doctor in private practice it cost her $200. At the urgent care center, she spent just $70, a fee that included the cost of the medication for what turned out to be a case of walking pneumonia.

After patent ruling, availability of gene tests could broaden

Fri, 14 Jun 2013 12:28:00 GMT

Almost immediately after the Supreme Court ruled that human genes could not be patented, several laboratories announced they, too, would begin offering genetic testing for breast cancer risk, making it likely that that test and others could become more affordable and more widely available. The ruling in effect ends a nearly two-decade monopoly by Myriad Genetics, the company at the center of the case. "It levels the playing field; we can all go out and compete," said Sherri Bale, managing director of GeneDx, a testing company, which plans to offer a test for breast cancer risk. "This is going to make a lot more genetic tests available, especially for rare diseases."

Physician Pay Will Soon Depend on Outcomes

Thu, 13 Jun 2013 17:47:00 GMT

The Centers for Medicare & Medicaid Services is seeking feedback from doctors as it builds a model for reimbursing physicians based on actual outcomes rather than process measures.