Fewer than one in four hospitals are scheduled to hit the Obama Administration's 2018 goal of providing at least half their care through value-based structures, research shows.
Not only are few hospitals scheduled to meet the 2018 value-based goal set by the Department of Health and Human Services, but only 3% meet that goal right now.
Further, only 23% expect to meet it even as late as 2019. The survey of 190 U.S. hospitals was conducted by Health Catalyst, a healthcare data and analytics company.
Extrapolating findings from the non-scientific survey to the entire hospital industry can be perilous, but many of its conclusions confirm anecdotal information from hospital leaders about the slow pace of adoption of risk-based reimbursement.
The survey results mirror research from HealthLeaders Media, which found that while proficiency and access to analytics capabilities will be critical to success under these models, only 36% of organizations believe their clinical data analytics tools have predictive capabilities.
The majority of health systems (62%) have either zero or less than 10% of their care tied to the type of risk-based contracts identified by CMS as "value-based," including Medicare accountable care organizations (ACOs) and bundled payments.
Not surprisingly, small hospitals with fewer than 200 beds comprised the majority of those reporting no at-risk contracts.
A contributing factor may be that smaller hospitals are five times less likely than larger organizations to have access to sufficient capital to make risk-based contracting work, according to Health Catalyst data.
Survey results reflect the opinions of 78 healthcare professionals who responded to an online survey by Health Catalyst in May 2016. Some 51% of respondents were CEOs or CFOs of large hospital-owned physician groups and hospitals ranging in size from 15 acute care beds to over 1,000 beds.
The remaining respondents all held executive roles, including several Chief Medical Information Officers, Chief Medical Officers and Chief Nursing Officers.
The organizations represented include many multi-hospital and multi-state health systems with a cumulative 756 inpatient and outpatient facilities and 20,416 acute care beds.
The wide-ranging bill, supported by hospitals, addresses key reimbursement issues created with the passage of the Bipartisan Budget Act of 2015.
The U.S. House has passed on a voice vote sweeping legislation that would, among many things, ease payment restrictions for some outpatient services at hospitals and adjust 30-day readmissions penalties to account for socioeconomic disparities.
The Helping Hospitals Improve Patient Care Act (H.R. 5273) was introduced in May by Health Subcommittee Chairman Pat Tiberi (R-OH) and Health Subcommittee Ranking Member Jim McDermott (D-WA) and is full offset.
Among its several provisions, the bill would:
Extend for five years the Rural Community Hospital Demonstration Project;
Create a "mid-build" exception to the current law on increasing the number of beds for long-term care hospitals;
Modify the treatment of ambulatory surgery center patient encounters for the meaningful use program;
Delay in CMS authority to terminate contracts for Medicare Advantage plans failing to achieve minimum quality ratings while CMS conducts research and reports on socioeconomic status and quality ratings;
Require that CMS report Medicare enrollment data by Congressional district;
Create a "cross walk" of 10 inpatient surgical codes that will be linked to outpatient surgical codes.
The Congressional Budget Office estimates that the House bill would cost $50 million from 2017-2021 period but decrease direct spending by $14 million from 2017-2026 period. Pay-as-you-go procedures apply because enacting the legislation would affect direct spending.
The bill has the backing of the American Hospital Association, the Federation of American Hospitals, America's Essential Hospitals, and the Association of American Medical Colleges, all of whom lobbied Congress to act on the measure.
In a letter to House leaders last month, the American Hospital Association said the bill addresses Medicare reimbursement problems created with the passage of the Bipartisan Budget Act of 2015.
The EHR vendor solicited patient information without adequately explaining that the information would be made public, according to the Federal Trade Commission.
Practice Fusion, which claims to be the largest cloud-based electronic health records platform in the U.S., this week settled federal charges that it publicly displayed personal and medical information obtained from its clients' patients deceptively.
According to the settlement document filed by the Federal Trade Commission, Practice Fusion solicited patient reviews of providers intended for a public-facing directory via emails that appeared to be from their providers, and which did not disclose that their responses would be shared with anyone but patients' healthcare providers.
The emails, which the San Francisco-based company sent beginning in April 2012 for a planned 2013 launch of the directory, prompted patients to comment in a free-text box that would "help improve your service in the future."
Within that box, patients not only included their names and addresses but also were prompted for personal information. Among the responses garnered:
A request for information on dosing for "my Xanax prescription";
A request for help with a depressed child who expressed suicidal thoughts;
Self-diagnosis of a yeast infection
The bottom of the emails linked to a privacy statement about surveys, questionnaires, and polls that did not indicate until April 2013 that such responses would be posted publicly.
Nor was the intention to publicly share the information mentioned elsewhere in the company's privacy policy during that timeframe.
Agreement Open to Public Comment
As a result of the settlement, Practice Fusion is prohibited from making deceptive statements about the privacy or confidentiality of the information it collects from consumers.
It is also required, prior to making any consumers' information publicly available, to clearly and conspicuously disclose this fact and obtain consumers' affirmative consent.
The company is also banned from posting reviews it obtained during the timeframe of the complaint. The agreement will be subject to public comment until July 8.
"Practice Fusion's actions led consumers to share incredibly sensitive health information without realizing it would be made public," said Jessica Rich, Director of the FTC's Bureau of Consumer Protection, in an annoucement.
"Companies that collect personal health information must be clear about how they will use it—especially before posting such information publicly on the Internet."
Federal and state officials claim that the healthcare system used its market power to leverage steering restrictions in its contracts with major insurers, resulting in higher costs for consumers.
Federal and state officials in North Carolina on Thursday filed a civil suit against Charlotte, NC-based Carolinas HealthCare System, alleging that the state's largest healthcare system used its market power to dictate "steering restrictions" in contracts with commercial health insurance companies that ultimately led to higher costs for consumers.
In a complaint filed in U.S. District Court in Charlotte, the U.S. Justice Department Antitrust Division and North Carolina regulators allege that CHS used the 50% market share of its nine acute care inpatient hospitals in the Charlotte area "to require steering restrictions in its contracts with every major insurer. "
"These provisions," the complaint continues, "have prevented insurers from, among other things, introducing health plans that encourage patients to use medical providers that offer lower-priced, higher-quality services."
"Americans should be able to choose a healthcare provider that gives them and their families the most cost-effective and appropriate treatment," Principal Deputy Assistant Attorney General Renata B. Hesse, head of the Justice Department's Antitrust Division, said in prepared remarks.
"This lawsuit will stop a dominant hospital from using its market power to undermine its smaller competitors' efforts to attract patients by competing on the price and quality of their services."
CHS Responds
In a statement released to the media Thursday, CHS said it will contest the allegations, which the health system characterized as "a dispute over certain language" in contracts with insurance companies.
"Our arrangements with insurers are similar to those in place between insurers and healthcare systems across the country. We have neither violated any law nor deviated from accepted healthcare industry practices for contracting and negotiation," CHS said.
"In fact, we have been applauded by the United States government for the quality care and cost reduction programs we've implemented, programs it hopes to model in other parts of the country."
"Carolinas HealthCare System is strongly committed to providing accurate and useful information to consumers and patients as it relates to cost, quality and overall value of the care they receive. We remain dedicated to making healthcare more affordable, while ensuring that we fulfill our mission. We provide financial assistance to patients in need, as well as medical education and research in the communities we serve. These and other mission-based service totaled over $1.65 billion or 19% of total operating expenses in 2015," CHS said.
In March, 2015, a contract between CHS and UnitedHealth expired, effectively rendering all Carolinas HealthCare facilities and physicians "out of network" for United Healthcare customers. They agreed to a new contract the following month.
CHS is the largest healthcare system in North Carolina and one of the largest not-for-profit healthcare systems in the United States. The health system operates 39 hospitals in North Carolina and South Carolina and reported net operating revenues of $8.7 billion in 2014.
Data linking high anxious arousal and inflammation with an increased risk of developing type 2 diabetes further highlights the importance of treating behavioral and physical health in concert.
In further evidence that behavioral health cannot be excluded from the focus on improving population health, a recent study from Rice University details the link between anxiety, stress, and type 2 diabetes for the first time.
Published in the journal Psychoneuroendocrinology, the study establishes what it calls a "metabolic chain reaction" that starts with low attention control, leaving a person vulnerable to tempting or distracting information, objects, thoughts, or activities.
Individuals who perform poorly on measures of the executive function of inhibition have higher anxious arousal in comparison to those with better performance. High anxious arousal is associated with a pro-inflammatory response, according to the study abstract.
Such vulnerability leads to more frequent anxiety and anxiety is known to activate a metabolic pathway responsible for the production of a pro-inflammatory cytokines, or signaling proteins.
IL-6 is a biomarker of acute and chronic stress that has been associated with a higher likelihood of diabetes and high blood glucose.
The Rice study further highlight the importance of treating behavioral and physical health in concert, measured levels of both blood glucose and interleukin 6, a protein the body produces to stimulate immune response and healing.
Researchers have suspected a link between anxiety and poor health, including diabetes, for many years but until now, none has detailed the biological pathway responsible, says study lead author Kyle Murdock, a postdoctoral research fellow in psychology at Rice.
The researchers listed several possible interventions, including mindfulness therapy, stimulant or anti-inflammatory medications and cognitive behavioral therapy. "Research shows that people who practice mindfulness do better on the inhibition tests over time," Murdock said.
In the five years since Bill Thompson has been CEO, the health system's revenue has doubled to $6 billion.
William P. Thompson is handing over the reins, but it might be a while before he steps down.
The president and CEO of St. Louis-based SSM Health, with 20 hospitals in four states, announced plans to retire as soon as a new CEO can be found. He'll stay on until that happens.
Thompson has spent the majority of his career, 36 years, with SSM, and though he's only been CEO for five, the system has achieved arguably its biggest spurt of growth with him at the helm.
In 2003, SSM Health became the first health system in the country to win the Malcolm Baldrige National Quality Award.
"It has been an honor and a privilege to lead one of the largest and most respected mission-based healthcare systems in the country and serve alongside so many talented, compassionate and dedicated individuals," said Thompson in a press release.
"This was not an easy decision. However, after much reflection and deliberation, I feel it is time to begin transitioning to the next chapter in my life."
During his term at the helm, the system's revenue has doubled to $6 billion, partially under the strength of SSM's acquisition of Wisconsin's Dean Health, which included 60 clinics, a large multispecialty physician group, and a health plan.
Also during Thompson's term, the system acquired
St. Anthony Shawnee Hospital and St. Anthony Shawnee Physicians group in Oklahoma
SSM Health St. Mary's Hospital – Audrain, along with 9 rural clinics, and the Audrain County Health Department's Home Health and Hospice Division
And SSM Health Saint Louis University Hospital (SSM Health's first adult academic medical center), which gave SSM Health the opportunity to help train future clinicians in partnership with Saint Louis University School of Medicine.
Thompson was a long-serving chief operating officer at SSM before being promoted to CEO. In 2011 he succeeded Sister Mary Jean Ryan, who had served as CEO since the system's founding in 1986.
The system will conduct a national search for Thompson's successor, but no timetable has been determined.
Practices are giving primary care physicians significant new responsibility for coordinating care among specialists.
Primary care provider compensation rose at a faster rate last year than did specialist pay, according the Medical Group Management Association's) 2015 Physician Compensation and Production Survey.
Specifically, primary care physician pay increased more than 4% over 2014, to more than $250,000 annually.
Meanwhile, specialist pay rose by less than 4%, to about $425,000. Notably, non-physician pay also grew by almost 4%, bringing median compensation up to approximately $107,000 in 2015.
"Practices are giving primary care physicians significant new responsibility for coordinating care among specialists, managing patient medications, and helping patients and caregivers manage chronic conditions," said Halee Fischer-Wright, MD, in a prepared statement.
She is president and CEO of the Medical Group Management Association.
"As we shift toward value-based payment, practices will continue to look to primary care and non-physician providers to lead efforts to improve patient experiences and the quality of care they provide."
In addition, the survey of more than 80,000 healthcare providers revealed that PCP compensation has risen faster than specialist pay over the last five years as well, at 18% compared to 11%.
Surgeons, however, reported the highest total compensation last year.
Those practicing pediatric cardiovascular and neurological surgery, Mohs surgery, orthopedic spinal surgery, and neurological surgery ranked among the five highest-compensated specialties.
In general, physicians who took more weeks off also commanded larger compensation packages. Pathologists were the only exception to this rule; they also reported receiving the highest median retirement benefits of any specialty in 2015.
A new name and new logo give the 100-year-old system a brand refresh, but individual hospital names will remain the same.
Lee Memorial Health System, a six-hospital system in Fort Myers, FL, is undergoing a rebranding effort in order to emphasize the organization's multispecialty services in addition to its hospital care.
In advance of its 100th anniversary, the organization now has a new name—Lee Health.
A new logo, featuring a blue/green palm frond, will appear on its hospitals and clinics in October, coinciding with the organization's centennial. A newly designed website will roll out in 2017.
In addition to focusing on the health system's multispecialty services, Lee Health's administration and board decided to move ahead with rebranding because they perceived that the Lee Memorial Health System name had a "cold, impersonal feel," Chief Strategy Officer Kevin Newingham said in a media release.
All told, the rebranding effort is expected to cost $2 million. Newingham broke down the cost of the rebranding effort:
$500,000 – $700,000 to redesign the website
$700,000 to install new signage
$400,000 to advertise the new name
Much of the work will be done using existing department budgets and will not require additional funding from the organization's board.
"One could argue there's really no cost other than speeding up the timing of some of the expenditures," said Lee Health President and CEO Jim Nathan.
"Because we do replace signs on a regular basis, we do need to have a new website and we do marketing and communications materials all the time."
While all hospitals will soon bear the new logo, individual hospital names will remain the same. Health system leadership hopes this will help the public differentiate between Lee Memorial Hospital, a 355-bed facility, and the health system that oversees it.
While the name change coincides with federal regulators recently awarding the hospital one out of five stars for safety and quality, Nathan said there was no correlation between the low rating and the rebranding effort.
Michigan's Henry Ford Health System hopes to boost physician and hospital referrals and the Kroger supermarket chain aims to sell more natural and organic foods.
When a Kroger's human resources manager reached out to Henry Ford Health System about aligning the grocery store chain with a healthcare provider, the metaphorical light bulb appeared above Rose Glenn's head.
The Henry Ford Chief Marketing Officer had recently seen a presentation by a South Dakota health system's collaboration with a local a grocery store chain.
The two events sparked an idea, which turned into a partnership that will bring health system registered dietitians to four Kroger's stores in Southeast Michigan, and healthful recipes to the supermarket's other 122 locations in the state.
While no revenue will be shared nor payments made in the deal, both organizations stand to benefit from the LiveWell Wednesdays program, which launched June 1.
Henry Ford hopes to boost physician and hospital referrals, and Kroger is aiming to see more of its Simple Truth-branded natural and organic foods when people purchases ingredients for the recipes to be distributed.
"We are so excited to be working with a wonderful community partner like Kroger," said Kimberlydawn Wisdom, MD, in a media release.
Wisdom is Henry Ford's senior vice president of community health and equity and chief wellness and diversity officer.
"We view wellness as a lifelong journey—a daily commitment to making the right choices when it comes to things like healthy eating. Having a presence inside every Kroger in the state of Michigan is a great way to reach the people in the communities we serve."
According to Glenn, the dieticians will be on hand to help shoppers understand food labeling and educate them on making healthy substitutions.
They will also be available to counsel shoppers on cooking for people with food allergies, on current food trends, and on safe food storage.
Kroger has agreed to place posters with a Henry Ford LiveWell weekly recipe at the front doors of all of its stores in Michigan. The first recipe will be a fruit pizza.
"Health systems that want to impact health outside of four walls of hospital and physician offices have to broaden care beyond illness and injury and contribute to people's health," Glenn said. "If we are going to wait for people to come to us, we are not doing all we can."
A program addressing the technical and cultural aspects of catheter-associated urinary tract infection prevention has led to declines in urinary catheter use and infection rates.
Newly published results from a recent national effort to reduce CAUTI show it is possible to decrease urinary catheter use and UTIs by targeting the technical, behavioral, and cultural components of CAUTI prevention.
The push to decrease rates of catheter-associated urinary tract infections has been ongoing since 2008 when the Centers for Medicare and Medicaid Services picked CAUTI as the first hospital-acquired complication for which payment would be denied to hospitals.
Yet despite increased attention, national data shows that CAUTI rates rose 6% from 2009 to 2013.
But, according to data published June 2 in the New England Journal of Medicine, all hope should not be lost when it comes to improving CAUTI rates.
According to the study authors, at the end of the 18-month national effort, the eliminating CAUTI portion of the Comprehensive Unit-based Safety Program (CUSP), the first four cohorts of the program (926 units in 603 hospitals across the country) saw improvement in CAUTI rates, including:
A 14% overall drop in CAUTI rates (after adjusting for differences in patients and hospitals)
A 32% reduction in infections rates in non-ICUs
Urinary catheter use dropped from 20.1% of patients to 18.8 % of patients in non-ICUs.
ICUs, however, did not see a substantial change in either urinary catheter use rates or CAUTI rates.
Lead author Sanjay Saint, MD, MPH, said in a media release that the program "shows we can make a difference in catheter-associated UTI rates," and acknowledged that "there's more work to be done."
Saint, who is the George Dock Professor of internal medicine at the University of Michigan Medical School and chief of medicine at the VA Ann Arbor Healthcare System, has studied catheter use and UTI prevention in hospital patients for two decades.
The combination of protocols, checklists, training modules, and data sharing practices that teams can tailor for their hospital units is known as a "bladder bundle." The tools encourage:
Daily checks on patients who have a catheter and assessment of whether they need it
Less indwelling catheter use by implementing other urine collection means
Training on urinary management for all care team members
Regular use of infection-prevention techniques for catheter placement and maintenance
Feedback to clinicians about their unit's catheter use and UTI rates