Patients connect with hospital staff via its website, which promises to provide speedy diagnoses for common ailments for a set fee.
St. Vincent's Medical Center in Bridgeport, CT has launched an online diagnosis and treatment service with the hopes that the technology will free up its clinicians. The hospital is promoting the service by telling patients to "skip the trip!" to the ED.
The website connects patients with St. Vincent staff and promises to provide speedy diagnosis and treatment for common ailments, such as colds, conjunctivitis, eczema, and bladder infections.
"With Myvirtualcare.com, patients can skip the trip to the doctor's office and still get the care they need, when and how they need it," Dianne Auger, senior vice president and chief strategy officer for St. Vincent's Medical Center, told local media.
"We are excited to be at the leading edge of this new technology, which is taking healthcare beyond bricks and mortar and into the virtual realm."
The service, which is powered by online diagnosis provider Zipnosis, will diagnose patients for a set fee of $35. Patients begin a virtual visit by filling out an online interview that is similar to what they would experience during an in-person visit. Then, the patient's symptoms and medical history are forwarded to a St. Vincent's provider for review and diagnosis.
Once that's complete—usually an hour later, according to the hospital—the patient will receive a text or email alert. If the clinician determines the patient needs a prescription or follow-up appointment, they can make the arrangements online.
"Not only have patients found it convenient and easy to navigate, they appreciate the relatively low cost for this care," said Frank Scifo, MD, medical director at St. Vincent's MultiSpecialty Group.
"It has enhanced both the patient and provider experience because care is available when physician offices or convenient care sites are closed or may not be easily accessible."
Telemedicine services are available to patients 24/7. St. Vincent's is promoting the service on its homepage and across social media.
The proposal puts the "nation's money where its mouth is," according to CMS Acting Administrator Andy Slavitt.
Primary care took center stage in the Centers for Medicare & Medicaid Services' proposed Physician Fee Schedule for 2017, announced July 7.
In particular, the new rules would improve payment for care coordination and planning, mental healthcare, and care for cognitive impairment.
"We conservatively estimate that these changes would result in approximately $900 million in additional funding in 2017 to physicians and practitioners providing these services," wrote CMS Acting Administrator Andy Slavitt on the CMS Blog.
"Over time, if the practitioners qualified to provide these services were to fully provide these services to all eligible beneficiaries, the increase could be as much as $5 billion in additional funding for care coordination and patient-centered care."
CMS has also proposed expanding its Diabetes Prevention Program as of January 1, 2018, marking the first time a preventive service model from the CMS Innovation Center would be expanded into the Medicare program.
A 2016 analysis of the program, which began in 2013, found that when compared with similar beneficiaries not it the program, Medicare estimated savings of $2,650 for each enrollee in the Diabetes Prevention Program over a 15-month period, more than enough to cover the cost of the program.
This success in cost savings, combined with participants' health improvements, made the ACA-created program eligible for expansion.
Other proposed payment changes affecting primary care include:
Increasing payments for routine office visits for treating patients with mobility-related disabilities from $73 to $119.
Increasing payments to geriatricians or family practice physicians treating eligible Medicare beneficiaries by at least 2% for providing all of the care outlined in the proposed rule. In his blog post, Slavitt indicated that these increases could amount to more than 30% over time.
Payment for behavioral healthcare using the Collaborative Care Model, which supports mental and behavioral health through a team-based, coordinated approach involving a psychiatric consultant, a behavioral health care manager, and the primary care clinician and which extends beyond the scope of an office visit.
"If this rule is finalized, it will put our nation's money where its mouth is by continuing to recognize the importance of prevention, wellness, and mental health and chronic disease management," said Slavitt a media statement.
Nearly one in four jobs created so far in 2016 is in the healthcare sector.
The healthcare sector created 234,600 jobs in the first half of 2016, including 39,000 new jobs in June, according to Bureau of Labor Statistics data.
The 2016 growth is outpacing the 225,300 healthcare jobs created in the first six months of 2015, a year that finished with a record 471,600 new jobs in the healthcare sector, according to BLS data.
Nearly one in four jobs created so far in 2016 is in the healthcare sector.
A further breakdown of BLS data shows that ambulatory services created 127,000 new jobs so far this year, compared with 133,700 jobs for the first six months of 2015. Hospitals created 90,000 jobs so far in 2016, compared with 74,400 new jobs for the first half of 2015.
Nursing and residential care facilities, the third pillar of healthcare job growth, created 18,200 jobs in the first six months of 2016, compared with 17,200 new jobs in the first half of 2015.
June and May job numbers are considered preliminary by BLS and can be subject to considerable revision.
The 234,600 healthcare jobs created in the first six months of 2016 represent about 23% of the 1 million nonfarm jobs created in the overall economy so far this year.
There were 15.5 million jobs in the healthcare sector in June, including 7.1 million in ambulatory care, 5.1 million at hospitals, and 3.3 million in residential and nursing homes.
June job growth in the overall economy was robust, especially when compared with anemic numbers from May. BLS reported that total nonfarm payroll employment increased by 287,000 in the month, although the unemployment rate rose 0.2% to 4.9%.
In addition to healthcare, other sectors that saw strong job growth in June include leisure and hospitality, social assistance, and financial activities. Employment also increased in the information sector, mostly reflecting the return of striking Verizon workers.
The agency aims to remove 'even the perception that there is financial pressure [on hospitals] to overprescribe opioids,' says HHS.
The pressure to effectively manage hospital patients' pain while simultaneously reducing opioid prescribing has proven difficult for doctors, especially when Medicare payments are tied to patient experience scores.
Now, HHS wants to eliminate that catch-22 by removing pain management questions from the HCAHPS survey and from the hospital payment scoring calculation.
Even though HHS says that "those payments currently have a very limited connection to the pain management questions on the HCAHPS survey," HHS Secretary Sylvia M. Burwell's proposal aims to "mitigate even the perception that there is financial pressure to overprescribe opioids," according to an HHS announcement.
The proposal doesn't mean that hospitals would stop surveying patients about pain, but that they would stop getting paid based on answers about pain.
"Hospitals would continue to use the questions to survey patients about their in-patient pain management experience, but these questions would not affect the level of payment hospitals receive," HHS said.
The proposal was met with enthusiasm by the American College of Emergency Physicians (ACEP).
"ACEP commends Secretary Burwell's proposal to remove pain management questions from patient satisfaction surveys. These questions have been used to influence Medicare reimbursement rates and have resulted in unintended consequences in light of the nation's opioid epidemic," ACEP president Jay Kaplan, MD, FACEP said in a statement.
"The pursuit of high patient satisfaction scores can create incentives for medical providers to honor patient requests for unnecessary and even harmful treatments. The HHS proposal will align federal policies to be consistent with current efforts to reduce opioid use."
Details
The proposal to eliminate pain management scores from hospital payment scoring calculations is one of several actions from HHS designed to reduce opioid use. Others include:
The Buprenorphine Final Rule finalized by the Substance Abuse and Mental Health Services Administration, which allows practitioners who have had a waiver to prescribe buprenorphine for up to 100 patients for a year or more, to now obtain a waiver to treat up to 275 patients.
A new policy requiring Indian Health Service opioid prescribers and pharmacists to check their state Prescription Drug Monitoring Program database prior to prescribing or dispensing any opioid for more than seven days.
Launching more than a dozen scientific studies on opioid misuse and pain treatment, plus a report on and inventory of opioid misuse and pain treatment research being conducted or funded by its agencies
A request for information that seeks comment on current HHS prescriber education and training programs and proposals that would augment ongoing HHS activities
Medicare's proposed 2017 reimbursement rules for outpatients include a reduced payment rate for medical products and services provided at many hospital-owned outpatient facilities.
Proposed changes to Medicare's Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System are drawing jeers from hospitals.
"It appears that CMS is aiming to freeze the progress of hospital-based healthcare in its tracks," said the American Hospital Association in response to the proposal that would increase OPPS payments by 1.6% and boost ASC payments by 1.2% in 2017.
"The items in this proposal are designed to improve care and value when Medicare beneficiaries receive care in an outpatient setting," Andy Slavitt, acting administrator of the Centers for Medicare & Medicaid Services, said in a statement posted to the CMS website Wednesday.
CMS outlined key elements of the proposed rule changes:
Reimbursement at OPPS rates for medical products and services provided at many hospital outpatient facilities would be discontinued. Reimbursement would be at lower rates set under the Medicare Physician Fee Schedule, which governs payments for products and services rendered in physician offices. The payment differential "has encouraged hospitals to acquire physician offices in order to receive the higher rates," CMS says.
Removing pain management questions from the CMS Hospital Value-Based Purchasing program's patient survey would be omitted. Provider have voiced concerns that the questions "unduly influence prescribing practices," CMS says.
Reporting requirements for hospitals that participate in the Medicare EHR Incentive Program would be eased.
New quality measures would be added to the Hospital Outpatient Quality Reporting Program and Ambulatory Surgical Center Quality Reporting Program. The measures "are focused on improving patient outcomes and experience of care," CMS says.
Some medical products and services would be exempt from the proposed reimbursement change for hospital outpatient facilities. Include under the exemptions: All products and services provided at a "dedicated emergency department" as well as products and services billed before Nov. 2, 2015.
Hospital Groups React
America's Essential Hospitals, a Washington, DC-based advocacy group that represents more than 200 safety net hospitals, reacted harshly to the proposed reimbursement rate change for hospital outpatient facilities.
"The regulatory provisions CMS proposes for new off-campus hospital outpatient departments fail to recognize the practical challenges of establishing and sustaining healthcare facilities for vulnerable populations," it said.
The agency's decision to not only limit flexibility, but to withhold hospital payments altogether, will perpetuate healthcare deserts—urban and rural pockets of poor access to care that persist in all 50 states and the District of Columbia," Bruce Siegel, MD, MPH, president and CEO of America's Essential Hospitals, said in a media statement.
The American Hospital Association (AHA) also blasted the proposed rule changes for hospital outpatient facility reimbursements.
"It appears that CMS is aiming to freeze the progress of hospital-based healthcare in its tracks. We will submit detailed comments to the agency urging them to revise these misguided policies so that hospitals can continue to provide the highest quality healthcare to their communities," Tom Nickels, executive vice president for government relations and public policy at the AHA, said in a statement posted Wednesday on the group's website.
CMS will accept comments on the proposal through Sept. 6.
CMS says removing non-emergency services from the Hospital Outpatient Prospective Payment System would save $500 million a year. Hospitals say lower reimbursements will reduce access to care.
A proposed rule from the Centers for Medicare & Medicaid Services to remove most Medicare non-emergency off-campus health services from the Hospital Outpatient Prospective Payment System has drawn scorn from the hospital sector.
The proposed rule, made public this week, would implement Section 603 of the Bipartisan Budget Act of 2015, and is expected to save about $500 million a year, according to CMS, which claims the new rule would refocus the payments on the patient and not the setting.
"This payment differential has encouraged hospitals to acquire physician offices in order to receive the higher rates," CMS said in remarks accompanying the proposal. "This acquisition trend and difference in payment has been highlighted as a long-standing issue of concern by Congress, MedPAC, and the Department of Health and Human Services Office of Inspector General. This difference in payment also increases costs for the Medicare program and raises the cost-sharing liability for beneficiaries."
That thinking was echoed by CMS Acting Administrator Andy Slavitt, who said "the items in this proposal are designed to improve care and value when Medicare beneficiaries receive care in an outpatient setting. Today's proposed updates better support physicians in providing beneficiaries with the right care at the right time."
Hospital lobbyists say the proposed rule would greatly harm hospital-based care delivery and access and skews the intent of Congress.
"We are extremely dismayed by the short-sighted policies in (the) proposed rule," American Hospital Association Executive Vice President Tom Nickels said.
"Hospitals and health systems and more than half of the House and the Senate requested that CMS provide reasonable flexibility when implementing Section 603 of the Balanced Budget Act of 2015 in order to ensure that patients have continued access to hospital care. Instead, the agency is actually proposing to provide no funding support for outpatient departments for the services they provide to patients. This does not reflect the reality of how hospitals strive to serve the needs of their communities."
The president of the American Medical Association, Andrew W. Gurman, MD, said in statement Thursday, "Providing similar payments for similar professional services located outside of a hospital campus, regardless of facility ownership, could lead to a more level economic playing field and help preserve independent practice. The new policy is more equitable for patients, who, CMS notes, often pay more for the same service provided in an off-campus department of a hospital."
'Urban and Rural Pockets of Poor Access'
Bruce Siegel, MD, president and CEO of America's Essential Hospitals, called CMS's reading of Section 603 "narrow" and said the proposed rule "threatens to reduce access to badly needed healthcare services in the nation's most underserved communities."
"The regulatory provisions CMS proposes for new off-campus hospital outpatient departments fail to recognize the practical challenges of establishing and sustaining healthcare facilities for vulnerable populations," Siegel said.
"The agency's decision to not only limit flexibility, but to withhold hospital payments altogether, will perpetuate healthcare deserts—urban and rural pockets of poor access to care that persist in all 50 states and the District of Columbia."
Siegel said the proposed rule exceeds the statutory language of Section 603 and ignores Congress's intent to apply an alternative payment system for services delivered in new facilities.
"Hospital systems that otherwise would seek to enhance access by establishing new clinics in underserved areas will not do so, as this damaging payment policy makes new outpatient centers economically unsustainable," Siegel said.
"Essential hospitals support efforts to reduce healthcare costs, but only when savings can be achieved without harming access and quality."
The University of Pittsburgh Medical Center and IBM have announced the formation of an independent company to tackle one of healthcare's fastest-growing expenses.
It has been enlisted to work on Vice President Joe Biden's cancer moonshot, has been tapped by the American Diabetes Association to address the prevention and care of diabetes, and it has beaten humans at Jeopardy.
Now the cognitive computing capabilities of IBM's Watson will be applied to the challenges of the healthcare supply chain.
The University of Pittsburgh Medical Center and IBM announced on Thursday the formation of an independent company, Pensiamo, to tackle one of healthcare's fastest-growing expenses, supply chain costs.
Under pressure to control costs, a vital element of the move to value-based care, providers need to understand costs down to individual patients the companies said.
IBM's Watson technology may help by analyzing vast quantities of data and generating insight. The name, Pensiamo, means "we think" in Italian.
IBM took a minority ownership interest in the venture, while UPMC took the lead in forming the new company, according to a joint statement:
"At a time when patients are demanding higher quality and value, traditional approaches to providing health care supply chain services are no longer sufficient," said James Szilagy, who will move from his role as UPMC chief supply chain officer to become Pensiamo chief executive officer.
"The new company will combine the best of UPMC's health care supply chain experience with IBM's expertise in non-medical procurement services, as well as IBM Watson capabilities infused with UPMC's domain expertise."
"The aim is to offer providers a supply chain management approach tailored to each institution's specialties, patient population and other unique needs, and which will learn and respond over time to the changing needs of the business."
UPMC will be Pensiamo's first customer.
The analyst firm Gartner regularly ranks UPMC in its annual list of the top 25 healthcare supply chain organizations. Gartner makes this determination based on improved patient outcomes and lowered costs as a result of supply chain efficiencies.
This is not UPMC's first supply chain venture. Previous developments out of UPMC initiatives include Prodigo Solutions, Health Care Pharmacy Center, and BigTronics.
Qualified entities are permitted to provide or sell claims data to healthcare providers and suppliers, as long as they adhere to strict privacy, security, and reporting requirements.
The market for analyses of Medicare and private sector claims data is getting a boost from the Centers for Medicare & Medicaid Services, which finalized new rules July 1, to allow such data to be confidentially shared or sold.
The new rules, required by the Medicare Access and CHIP Reauthorization Act (MACRA), affect qualified entities, which the Patient Protection and Affordable Care Act defines as those entities permitted to see claims data for the purpose of evaluating the performance of providers and suppliers.
Qualified entities are also permitted to provide or sell claims data to healthcare providers and suppliers, such as doctors, nurses, and skilled nursing facilities.
The new CMS rule requires entities that receive data identifiable to patients, as well as de-identified data or analyses, to adhere to strict privacy and security requirements, as well as annual reporting requirements.
Once certified, qualified entities may:
Enter into a Data Use Agreement committing the organization to the highest levels of data security and privacy protection.
Pay a fee equal to the cost of making the data available.
Receive data for one or more specified geographic areas.
Combine claims data from sources other than Medicare with the Medicare data.
Use valid and reliable measures for evaluating the performance of providers and suppliers.
Produce and make publicly available reports on individual providers and suppliers in aggregate form.
CMS believes qualified entities will be an important driver of improving quality and reducing costs in Medicare, as well as for the healthcare system in general.
The agency also believes this program will increase the transparency of provider and supplier performance, and provide beneficiaries access to information that will help them make more informed decisions about their healthcare.
For purposes of protecting patient-identifiable data, CMS is holding these qualified entities to the same data protection bar as covered entities and their business associates are expected to exercise for protected health information under HIPAA.
Out of 15 organizations which have applied for qualified entity status, two have completed public reporting while the other 13 are preparing for public reporting.
Michael D. Williams has led the Plano, TX-based, not-for-profit hospital chain since its formation in 1996. A national search is underway to find his successor.
The founding president and CEO of Community Hospital Corporation will retire in 2017 after spending the last 20 years leading the organization he helped create.
The Plano, TX-based not-for-profit hospital chain made the announcement on Tuesday, and the company's board of directors has hired executive recruiters Witt/Kieffer to conduct a nationwide search for Williams' replacement.
The transition is expected to be completed by mid-2017, at which time Williams will step down.
"Mike created a solid foundation for CHC and we will continue along the path he has set forth in growing the organization and fulfilling its mission to 'guide, support and enhance the mission of community hospitals and healthcare providers' across the country," CHC Board Chairman Ken Gordon said in remarks accompanying the announcement.
Williams was already a veteran hospital administrator in 1996 when he was named president and CEO at CHC, which began as an alignment of 13 not-for-profit and community-owned hospitals in Texas that want to preserve their nonprofit status and avoid being acquired.
CHC now owns, manages or consults with nearly 30 hospitals across the United States that serve mostly smaller communities and rural areas.
New Hampshire's only academic medical center has appointed a veteran from its leadership team to the organization's top financial post.
Daniel Jantzen, CPA, is returning to the CFO role at Lebanon, NH-based Dartmouth-Hitchcock.
Jantzen was CFO of the health system from 2007 to 2010. For the past six years, he has been serving as executive vice president of operations and chief operating officer of Dartmouth-Hitchcock.
He is set to succeed Robin Kilfeather-Mackey, MBA, CPA, later this month, according to a statement released by the health system Tuesday.
Jantzen has served in senior leadership roles at the health system since 1990. In addition to his three-year stint as CFO, he served as vice president of finance and senior vice president of finance.
Prior to joining the leadership team at Dartmouth-Hitchcock, he worked in Boston as a senior manager in the audit department at the international accounting firm KPMG.
President and CEO James Weinstein, DO, said in the statement that Jantzen has the depth of experience required to excel as CFO during a time of rapid and far-reaching change at Dartmouth-Hitchcock and the entire healthcare industry.
"Dan Jantzen is uniquely qualified to lead the increasingly complex financial functions of this $1.9 billion enterprise. Navigating today's healthcare environment—with multiple payers, numerous payment models, changing regulations, and challenges at the state and federal level—requires deep knowledge and a thorough understanding of all aspects of the health system and its path to the future. Having served as CFO and then diving deeply into operations for six years, Dan is a perfect choice for this critical role."
Kilfeather-Mackey, who has served in multiple roles at Dartmouth-Hitchcock over the past two decades and led environmental initiatives there, is stepping down to concentrate on earning an environmental sciences degree, Weinstein said.
Dartmouth-Hitchcock features Dartmouth-Hitchcock Medical Center as well as affiliated hospitals in Lebanon, Keene, and New London, NH, and Windsor, VT.
The health system has developed a reputation as a leader in the national drive to adopt population health and value-based care initiatives, including the Dartmouth Atlas Project, which has documented variations in the distribution of healthcare resources across the country for more than two decades.