SSM Health St. Mary's Hospital-Janesville has a new name, logo, and website, but it is sending a strong message that management and patient care have not changed.
St. Mary's Janesville Hospital and Dean Clinic in Janesville, WI, has changed its name to SSM Health St. Mary's Hospital-Janesville. The change is part of a system-wide rebranding by its parent company, SSM Health, based in St. Louis, MO.
The hospital's website also underwent a digital rebranding, changing over to a look that's in line with the SSM Health brand. The redesigned site features a clean layout and places the SSM Health logo prominently in the upper left corner.
SSM Health St. Mary's Hospital-Janesville's marketing team also aligned the hospital's Facebook page under the new brand, using the updated logo and colors that reflect its website.
To promote the changes, SSM Health uploaded a video to Facebook on September 2.
"Our name may be new, but SSM Health's Heritage of Healing began more than a century ago. #WeAreSSMHealth," they said in a message accompanying the video.
The goal of the rebranding initiative is to align all SSM Health hospitals and clinics under the health system's overarching brand and mission. The system is holding rebranding ceremonies unveiling each clinic and hospital's new name, all of which will come with the SSM prefix.
Hospital administration assured patients and the community that the name change is only that, just a name change. There will be no changes in patient care or ownership of the hospital.
"We already consolidated (with the acquisition of Dean Clinics in 2013), so this is just a way to signify that we are one, and it reinforces our promise to provide exceptional care no matter where you come to our system," Kerry Swanson, president of SSM Health St. Mary's Hospital-Janesville told local media at the sign unveiling.
"We've had a lot of changes in healthcare. As we continue to come together as an organization, the name just reinforces to our community and all the communities that we serve that we give coordinated care throughout our community."
Health insurance premiums still greatly exceed inflation, but employers are increasingly adopting new techniques to gnaw away at rising costs.
Despite increasing efforts by employers to engage in techniques to lower the cost of healthcare, more than half of U.S. companies experienced a 5% increase in health insurance premiums this year, and 25% saw increases of 10% or more, according to Arthur J. Gallagher and Co., which surveyed 3,107 employers for its annual 2016 Benefits Strategy and Benchmarking Survey.
That's clearly unsustainable in tandem with a rate of general inflation that averaged 1% over the 12 months between June 2015 and the same month in 2016.
Additionally, more than 77% of respondents said they expect their revenues to remain the same in 2017 or increase slightly.
Employers are beefing up the arsenal of tools they think will help bring down the rate of premium inflation over time. Those tools range from defined contributions for employee health premiums, to narrow network plans, to high deductible health plans to telemedicine.
Survey respondents noted the cost-containing tactics they are employing today as well as those they intend to employ within two years.
Telemedicine is one of the most prevalent cost control measures with 24% of employers adding that option to their health plan largely because they are lower cost than traditional visits. By 2018, based on the survey, 42% of employers plan to employ telemedicine as a viable option.
Narrow network plans, which restrict employees to a smaller group of providers that exchange higher reimbursement for volume certainty, are also gaining in popularity. Some 18% of employers already use narrow networks, and 27% expect to within two years, which would be a 50% increase.
Just 2% of employer use defined contributions, essentially providing employees with a lump sum to use in finding and buying their own insurance. The practice is expected to balloon by 650% within two years, as 15% of employers expect to use it by 2018.
This would be a dramatic shift, as defined contributions essentially get employers out of directly provisioning health insurance entirely by forcing employees to choose their own benefits. It also appeals to employers because it provides cost certainty.
Some 30% of respondents have offered employees access to private exchanges to choose their coverage.
Only 47% of employers expressed confidence in the effectiveness of healthcare cost management in their current benefit strategies.
Groups call on CMS to scrap the 'burdensome' proposal, which 40% of survey respondents anticipate will cost between $25,000 to $100,000 per surgeon.
CMS's global surgery data collection proposal is onerous, unfunded, and would "wreak havoc" on surgeons' practices, according to comments to CMS by the American Association of Neurological Surgeons (AANS) and Congress of Neurological Surgeons (CNS).
The 2017 Medicare Physician Fee Schedule includes what the AANS and CNS called a "sweeping mandate" that would require surgeons to use a set of eight "new and untested G-codes" to document the type, level, and number of every pre- and postoperative visit furnished during the global period of every surgical procedure.
According to the proposal, surgeons would have to report on each 10-minute increment of services provided.
"The proposed time-based G-codes are not aligned with clinical workflow," the comments said. "The burden associated with physicians attempting to track their time in 10-minute increments is onerous and will result in underreporting of data."
Currently, Medicare pays neurosurgeons a single fee which covers the costs of the surgery plus all follow-up care within a 10- or 90-day timeframe.
In addition, the comments say that the proposal runs afoul of Medicare Access and CHIP Reauthorization Act (MACRA) directives, which directs CMS to gather data from a 'representative sample of physicians.'
"The AANS and CNS are extremely disappointed that CMS has proposed a policy to collect data on all 10- and 90-day global services from all physicians who perform these services," the groups stated in their comments.
The groups cited their survey of 7,071 surgeons and anesthesiologists, conducted in August, that demonstrated how burdensome and costly the new requirement would be.
"Nearly 40% of respondents anticipate it will cost them between $25,000 to $100,000, and another 30% estimate they will spend more than $100,000 on compliance," the survey stated.
If the CMS requirements were enacted, survey respondents said they would have to:
Modify EHR and billing systems (85.9%)
Incur additional physician (88.8%) and staff (75.7%) time spent on tracking and processing global surgery information into EHR and billing systems
Develop new methods for tracking and collecting global surgery visit work (82.8%)
Use additional technology, such as handheld devices or stopwatches, to document time spent providing global surgery services (46.4%)
"The claims-based data collection mandate is so burdensome that most physicians will not be able to comply by January 1, 2017, which will result in CMS being unable to collect accurate and usable data, particularly in light of the unfinished final rule at the time of this writing," they wrote.
Two studies point to higher demand, crowded EDs, and less access to specialists.
Emergency departments are experiencing higher demand from more patients, but lower availability of specialists, since the implementation of the Patient Protection and Affordable Care Act, according to two new studies published in the Annals of Emergency Medicine.
The studies were state-specific: One focused on Illinois and the other on Massachusetts.
"Emergency departments continue to be squeezed by pressures inside and outside the hospital," Scott Dresden, MD, MS, of Northwestern University Feinberg School of Medicine in Chicago, IL, the lead author of the Illinois paper, said in a statement.
The studies identify four ways the healthcare reform law is squeezing EDs:
Monthly Visit Volume is Up
When comparing the pre-ACA period (2011 to 2013) to the post-ACA period (2014 to 2015) in Illinois, the researchers found that the average monthly ED visit volume increased by 5.7%, or an additional 14,080 visits. Hospitalization rates were essentially unchanged, as was the size of Illinois' population.
"A large post-ACA increase in Medicaid visits and a modest increase in privately insured visits outpaced a large reduction in emergency department visits by uninsured patients," Dresden said. "We still don't know if these results represent longer-term changes in health services use or a temporary spike in emergency department use due to pent-up demand."
Annual Visit Volume is Up
Annual ED visit volume in Illinois increased from 2.9 million in 2011 to 3.2 million in 2015, an 8.1% increase statewide. In Massachusetts, from 2005 to 2015, the median number of annual ED visits increased on average from 32,025 to 42,000.
Specialist Access is Down
From 2005 to 2015, Massachusetts saw a significant drop in availability of specialists in surgery, neurology, obstetrics-gynecology, orthopedics, pediatrics, plastic surgery, and psychiatry. For example, availability of general surgeons declined by 15%, while 24/7 psychiatry availability declined by 23%.
There Aren't Enough Rooms
In Massachusetts, there was a 29% increase in EDs caring for patients in areas outside the ED, such as hallways—from 70% of EDs reporting this situation in 2005 to 89% in 2015. "That is obviously far from ideal and is indicative of an increasingly taxed emergency medical care system," Jason Sanders, MD, PhD, of the Department of Emergency Medicine at Massachusetts General Hospital in Boston, said in a statement.
In public comment letters on physician payment rules for next year, healthcare providers offer conditional praise for plans to reform reimbursement for primary care, preventive services, and care coordination.
Key elements of proposed changes to Medicare's Physician Fee Schedule (PFS)—improved payments for primary care, preventive services and care coordination—have drawn scrutiny in public comment letters to federal officials.
The Centers for Medicare & Medicaid Services (CMS) released the 2017 PFS proposed rule in July, and CMS Acting Administrator Andy Slavitt heralded the payment changes as a significant boost to providers of primary care services. "We conservatively estimate that these changes would result in approximately $900 million in additional funding in 2017 to physicians and practitioners providing these services," Slavitt wrote in the CMS Blog on July 7.
Examples of the payment improvements for primary care, preventive services and care coordination include:
Increasing payments for routine office visits for patients with mobility-related disabilities from $73 to $119.
Removing barriers to payment for Diabetes Self-Management Training (DSMT) services.
Payment for behavioral health services through Medicare's Collaborative Care Model, a team-based approach to treatment with psychiatric consultants, behavioral healthcare managers and primary care physicians.
In the American Medical Association's public comment letter on the PFS proposed rule, Executive Vice President and CEO James Madara, MD, strikes a generally positive tone:
"The AMA supports CMS' proposals to improve payment accuracy for primary care, care management, and patient-centered services. Specifically, we support a separate payment for non-face-to-face prolonged Evaluation and Management (E/M) services, separate payments for services furnished using the Psychiatric Collaborative Care Model (CoCM), the implementation of other codes in the Current Procedural Terminology (CPT) family of Chronic Care Management (CCM) services, and a separate payment to recognize the work of a physician in assessing and creating a care plan for beneficiaries with cognitive impairment."
Madara's letter does mention several suggested changes to the PFS proposed rule, including the contention that CMS' plan to boost payments for patients with mobility-related disabilities is at odds with provisions of the Medicare Access & CHIP Reauthorization Act (MACRA).
"The AMA opposes CMS' plan to eliminate the 2017 physician payment increase Congress provided in MACRA in order to fund an add-on payment for services provided to patients with mobility-related disabilities. While the AMA supports payment policies that improve access to care for patients with these and other impairments, there is no justification for funding these services with an overall cut in physician payment rates. Following years of threats of significant payment reductions under the SGR formula, physicians had expected to receive a 0.5 percent update in 2017, as provided in MACRA."
In its comment letter, the American Medical Group Association praised CMS for boosting payments for CCM services, but also criticized plans to increase patient co-payments.
"By proposing to recognize and pay for other codes in the Current Procedural Terminology (CPT) family of CCM services, CMS has acknowledged AMGA's concern that the 20 minutes per month, per patient may not sufficiently recognize and reimburse all CCM services delivered," President and CEO Donald Fisher, PhD, wrote.
"We do remain concerned that use of the CCM codes requires beneficiaries pay a 20% copayment for the service. AMGA medical groups have repeatedly stated that they have found it difficult to make known or enforce the copay requirement because these services had been previously provided for free. AMGA members feel that the chronic care management code should be considered a preventive service."
The 2017 PFS final rule is expected to be released by Nov. 1.
One-in-four medical practices is now owned by a hospital or health system, and hospitals employed 38% of all U.S. physicians in 2015.
Hospitals have gone on a physician feeding frenzy, with the number of practices owned by hospitals and health systems rising 86% from 2012-15, a study from the Physicians Advocacy Institute shows.
The acquisitions are occurring in all regions of the country over the three-year span, according to the report, which also found that 38% of U.S. physicians were employed by hospitals and health systems in mid-2015.
That's a 50% increase between 2012 and 2015, growing from 95,000 employed physicians in 2012 to more than 140,000 employed physicians in 2015.
A further analysis found that hospitals acquired 31,000 physician practices from 2012 to 2015 and now own one-in-four practices nationwide. The acquisitions typically include the services of multiple physicians through employment contracts, as well as the practice's physical building and equipment.
Regionally over the three-year span, employment of physicians rose
59% in the South
58% in the Northeast
49% in Alaska and Hawaii
44% in the Midwest
33% in the West
Over that same time frame, hospitals' ownership of practices rose
"Regardless of where they live, physicians who want to remain in private practice are under tremendous pressure," said Robert Seligson, PAI president and CEO of the North Carolina Medical Society, in remarks accompanying the study.
"Payment policies from governmental agencies and health insurance companies heavily favor large health systems and make it challenging for independent physician practices, especially smaller practices, to survive," Seligson said.
"Just like what's happened with local book stores and corner grocers, it is increasingly hard for local physicians to own their practice. The incentives are stacked against them."
Another PAI analysis earlier this year found Medicare payments for three common services are up to three times higher when performed in a hospital outpatient department instead of a physician-owned office.
"Medicare spends less when patients receive treatment in a physician's office, yet the number of physician-owned medical practices is rapidly shrinking," said Kelly Kenney, PAI executive vice president.
"The shift toward more physicians employed by hospitals could mean higher costs for the entire healthcare system. For patients, it impacts both where they receive and how much they pay for care."
Using data drawn from 17 national sources, researchers assess states based on the ability of their healthcare sectors to provide access to high-value medical services.
Minnesota leads the nation in delivery of healthcare services based on cost, access and health outcomes, while Alaska ranks last based on these metrics, according to a study released this week by WalletHub, a personal finance site.
The study applied 29 healthcare metrics split into three equally weighted categories: cost, access and health outcomes. Cost is the most concentrated survey category, with four metrics: cost of a medical visit, cost of a dental visit, average monthly insurance premium, and out-of-pocket medical spending for Americans under 65.
Data for the study was drawn from 17 government, nonprofit, and private sources, including the U.S. Census Bureau, the Centers for Medicare & Medicaid Services, eHealthInsurance, and Kaiser Family Foundation.
Top States for Healthcare Delivery
States total healthcare scores were ranked on a scale of 1 to 100, with Minnesota earning the top honor:
Minnesota, 67.37
Maryland, 64.36
South Dakota, 63.98
Iowa, 63.89
Utah, 63.85
Kansas, 63.16
Hawaii, 62.71
Vermont, 62.44
District of Columbia, 61.56
Nebraska, 60.95
Minnesota scored well across all three metrics categories, placing 11th nationally in healthcare costs, sixth in healthcare access and third in health outcomes. Maryland ranked first in healthcare costs, but The Old Line State's total score was deflated by ranking 19th in healthcare access and 29th in health outcomes.
In other top honors, Hawaii ranked first in health outcomes, and the District of Columbia ranked first in healthcare access.
The country's most rural and economically disadvantaged states dominate the field that posted the worst total scores in the WalletHub study:
In addition to posting the worst total score, Alaska ranked worst in the country for healthcare costs. Louisiana ranked worst for health outcomes, and Hawaii ranked worst for healthcare access.
Overall Rankings
The WalletHub study shows states that have expanded Medicaid under provisions of the Patient Protection and Affordable Care Act appear to have a healthcare edge over states that have resisted Medicaid expansion, which increases the number of low-income adults who are eligible for the program.
Among the top 25 ranked states in the study, 17 have embraced Medicaid expansion. Among the bottom 25 ranked states, 13 have enacted Medicaid expansion.
A trial at the University of Washington Medicine Burn Center aims to find out if the game is more stimulating and engaging than the pain patients are experiencing.
Hospitals and health systems have been grappling with how to deal with Pokémon Go since the mobile gaming phenomenon hit earlier this summer.
Massachusetts General Hospital banned staff from playing the game on its campus, warning of possible privacy violations, and Allegheny Health Network asked the game's maker to remove all of its locations from the app.
But some hospitals are finding that there are upside to patients using Pokémon Go.
Getting Patients Out of Bed
C.S. Mott Children's Hospital in Ann Arbor, MI, has been urging its young patients to play the game in an effort to get them out of bed and socialize with other kids.
"It's a fun way to encourage patients to be mobile," J.J Bouchard, the hospital's digital media manager and certified child life specialist, told USA Today. "This app is getting patients out of beds and moving around."
Helping Burn Patients' Pain Management
A trial that University of Washington Medicine Burn Center researchers are conducting at Harborview Medical Center in Seattle, WA, is looking at how playing Pokémon Go may help keep patients moving while also taking their minds off the pain.
"Our challenge is to find something that's more stimulating and engaging than pain they're experiencing, so something like virtual reality that's new or Pokémon Go that's new, it's more exciting and takes attention away from the pain," Shelley Wiechman, attending psychologist in the Burn and Pediatric Trauma Service and Pediatric Primary Care Clinic at Harborview, told the local media.
The Pokémon Go trial isn't the first time the hospital has tested augmented and virtual reality games for pain management, but it's the first that allows patients to use their legs and keep their infected areas mobile.
Weichman said if patients using the game continue to show progress, the staff may begin using Fitbits to track patients' steps.
Exeter Hospital has sued several staffing agencies for placing a technician linked to a hepatitis C outbreak.
Lawyers for a medical staffing agency are scheduled to argue in federal court this week that the company is not liable for payments to patients who were not infected during a hepatitis outbreak at Exeter Hospital.
In 2013, a cardiac catheterization technician in New Hampshire was convicted and sentenced to 39 years in prison on charges related to stealing drugs and exposing patient to contaminated needles.
Exeter Hospital has sued several staffing agencies since 2014 for continuing to find job placements for a technician David Kwiatkowski even after it claims they knew about his drug addiction.
The New Hampshire hospital has settled numerous lawsuits with patients who were not infected during the outbreak, but who claimed that the anxiety of being tested for hepatitis C and waiting days or weeks for the results caused them "diverse physical and emotional injuries."
Now the hospital is suing the American Registry of Radiologic Technologists and Triage Staffing for help paying those settlements.
The August 30 hearing will consider the companies' argument that they are not liable for settlements to patients who did not test positive, according to a story in the Manchester Union Leader.
David Kwiatkowski tested positive for Hepatitis C in June of 2010 and began working at Exeter Hospital in April of 2011, according to court documents.
After three of his former patients tested positive for hepatitis C, the infection was traced back to Kwaitkowski. He had allegedly stolen intravenous drugs, injected them himself, filled the syringes with saline and returned them to the hospital inventory.
More than 3,000 patients were tested for the virus; 32 tested positive.
The hospital alleges that the registry and staffing agency failed to act on previous problem reporting with Kwiatkowski.
Exeter Hospital received a 4-Star quality rating from the Centers for Medicare & Medicaid Services this summer, placing it in the top quartile of the nation's hospitals.
One of the largest studies of its kind finds that care teams comprised of mental health and primary care providers improve outcomes and reduce costs. ER visits were seen to drop 23% for patients in team-based practices.
Integrating mental health into primary care settings improves patients' clinical outcomes, lowers healthcare utilization, and decreases costs, according to a large 10-year study from Salt Lake City-based Intermountain Healthcare.
The study, published this month in the Journal of the American Medical Association, measured 113,452 adult patients who received care from 2003 through 2013 in 113 primary care practices at Intermountain. Care was provided by 27 team-based medical practices and 75 traditional practices.
At the team-based practices, mental health staff, including psychiatrists, psychologists, psychiatric advanced practice registered nurses, social workers, and others, are available on site to support primary care physicians.
"The intention is not to co-locate a mental health provider at a location and have patients coming there specifically for mental health," Jeremy Hernandez, regional assistant operations officer for the North Salt Lake region of Intermountain Medical Group, told HealthLeaders previously.
"Instead the intention is to integrate the mental health provider into the primary care team where patients can have their medical and mental health needs met at the same location."
While the value of integrated team delivery models was not previously well quantified, Intermountain researchers found the following:
Thanks to higher screening levels, 46.1% of patients in team-based practices were diagnosed with active depression compared to 24.1% in traditional practices.
Nearly half (48.4%) of patients in team-based practices had a documented self-care plan to help them manage their health conditions, compared to just 8.7% in traditional practices.
Per 100 person years, the rate of emergency room visits dropped 23%, from 23.5 visits for patients in traditional practices to 18.1 for patients in team-based practices.
"The study reinforces the value of coordinated team relationships within a delivery system and the importance of integrating physical and mental health care," Intermountain Healthcare scientist Brenda Reiss-Brennan, PhD, APRN, one of the study's authors, said in a news release.
"The study provides further evidence—from a mental health perspective—of Intermountain Healthcare's hypothesis that better care costs less," she added.