Consumers Union, the nonprofit publisher of Consumer Reports, is supporting the expansion of federal government efforts to restrict Medicare payments to hospitals for the cost of healthcare associated with certain infections and medical errors acquired during treatment. In comments submitted to the Centers for Medicare & Medicaid Services, Consumers Union said that a proposal by the agency to limit such payments would provide hospitals with a strong new financial incentive to improve patient care. Consumers Union also urged CMS to strengthen the proposed regulations by expanding the types of preventable hospital acquired conditions that would result in lower Medicare payments and to clarify protections to ensure patients are treated fairly and get the care they need.
Health plans and employers are well aware of the comorbidities associated with diabetes, obesity, and chronic heart failure, but a growing number of industry leaders is looking at another problem that faces almost one-third of Americans—insomnia.
One leader in the area is HealthMedia, Inc., an Ann Arbor, MI-based company that specializes in behavior change interventions. Its products have shown success in the areas of weight management, diabetes, and depression, and the company began promoting the impacts of insomnia earlier this year.
I spoke to Caren Kenney, HealthMedia's director of corporate communications, at the America's Health Insurance Plans conference in San Francisco on Wednesday. She says insomnia is both a productivity and healthcare issue.
For instance, those not getting enough sleep miss work twice as often as "good sleepers," are 2.5 times more likely to commit "serious work errors," and those who sleep six hours or less per night generate 15% more care visits than those who sleep seven or eight hours, according to HealthMedia.
Kenney says healthcare has responded to sleep problems by offering medications rather than exploring the cognitive behaviors associated with treating insomnia. That may soon change.
HealthMedia announced on Thursday that it's starting a new research study with health insurance giant Aetna. The health plan will offer HealthMedia's Overcoming Insomnia and Overcoming Depression online behavior change interventions to at least 400,000 eligible employees of Aetna's large employer members and will conduct a controlled trial to study the effectiveness of the online interventions in improving workplace productivity and reducing healthcare costs.
HealthMedia has taken the lead in promoting insomnia's health and productivity impact, and its program has shown financial and productivity impacts. Realization of insomnia's effect has been slow as health plans and disease management companies have instead focused on chronic diseases, but the partnership with Aetna and the subsequent study may go a long way in convincing others in healthcare that sleep issues deserve a higher profile.
"All you read is that people are working longer hours, are overcommitted, and stressed out. Insomnia is the result. The question is: What do we do about that?" says Kenney.
Les Masterson is senior editor of Health Plan Insider. He is blogging from America's Health Insurance Plans conference in San Francisco this week.
A study by the Leapfrog Group has found that hospitals that perform well on the Leapfrog Hospital Survey have lower mortality and better quality of care than those who either didn't perform as well on the survey, or who chose not to complete it. Additionally, the study, published in the Joint Commission Journal on Quality and Patient Safety, shows that hospitals that had begun to implement Leapfrog safety practices also had lower mortality rates.
There are two ways to improve your net income: increase your revenue and decrease your expenses. In theory, the potential to do the former is infinite, whereas the latter is limited by the minimum cash necessary to run your practice. But the reality many physicians face is that they can only see so many more patients, launch so many ancillary services, and so on. Therefore, overhead management is crucial.
To get the biggest return on your efforts, begin by analyzing what you currently spend in your two biggest expense categories, which are typically staff wages and rent.
Paying for people. Healthcare is not unique in that its No. 1 expense is generally payroll. As a result, staff layoffs are pervasive in most industries in tough financial times—leading to a misconception that eliminating positions is the only way to make a significant dent in practice overhead. But this is not always the case, says Jerry Hermanson, MBA, CHE, senior consultant at Healthcare Integration Consultants, Inc., in Highlands, NC. In fact, some situations cry out for more hands on deck.
For example, "if you want to invest in a practice administrator, many times that will improve your cost structure and profitability because you'll be able to keep track of the changes in practices, not only saving money but also on the revenue side," Hermanson says.
For the most part, you want to see your staffing ratio— the number of full-time equivalent (FTE) staff members per physician—in line with specialty-specific benchmarks, such as those provided by the MGMA.
You should also determine how much you spend on staff wages relative to collections, broken down by category—administrative, billing, back office, front office, and so on. Divide each of these line items into your collections to arrive at their percent of collections. Phairas explains that this number, along with the number of FTEs in each category, can be analyzed according to the following rules of thumb: If both indicators are higher than the norm, you are probably overstaffed; if both indicators are lower than the norm, you are probably understaffed.
Save on your space. Most practices' second-highest expense is the lease on their office space, which accounts for 5%–10% of overhead relative to collections, Phairas says. Again, obtain benchmark data to determine what your peers are spending. Physicians are wise to have these data and a corresponding budget in hand when they first negotiate a lease, but it's not impossible to make changes at other times.
"You don't have to wait until the end of a lease to renegotiate," Hermanson says. "If economic situations have changed in your market—property values have gone down, interest and inflation rates have gone down—you may be able to renegotiate. We've seen a lot of that in the past year or so."
This story was adapted from one that first appeared in the June edition of The Doctor's Office, a publication by HealthLeaders Media.
The trend these days in health plans is to put physician performance under a microscope, going so far as to issue publicly-posted report cards that rank physicians relative to their peers.
Well, turnabout is fair play.
At its annual House of Delegates meeting this week the American Medical Association announced the release of its first health insurer report card, which is supposed to provide information about the "timeliness, transparency and accuracy of claims processing by health insurance companies."
Is this a jab at payer-issued report cards? No, says William A. Dolan, MD, an AMA board member. But it does reflect the poor state of physician-payer relations today and is the result of physician frustration (to put it mildly) with the bureaucracy and inefficiencies of managed care.
"What we'd like to do is bring transparency and accountability to these insurers," he says.
The AMA argues that the billing process eats up about 14% of physicians' annual revenue, and the report cards, which are part of a larger "Cure for Claims" campaign, aim to cut that number down.
"I use the analogy of an ATM," Dolan says. "What if you went to the ATM and 67%-82% of the time you would not get the amount of money you wanted to withdraw? Or, 3%-12% of the time, you wouldn't get anything."
The report card rates insurers on payment adherence, timeliness, denials, transparency, and compliance with pricing rules, but the overall campaign also recognizes physicians' role in the process and offers tips and education for improving claims processing and coding.
Will the pressure on insurers be effective in reducing the estimated $210 billion in billing-related annual healthcare costs? Not by itself.
A spokeswoman for America's Health Insurance Plans has already shifted the blame by arguing that it takes two parties—both insurers and doctors—to improve claims processing.
But the report card is just "one form of fighting back," Dolan says. Other arrows in the physician's quiver include more aggressive tactics such as class-action lawsuits.
If I were a major health insurer, I wouldn't be worried about the report card so much as the physician discontent—and growing willingness to "fight back"—that it represents.
Other issues that came out of this week's AMA house of delegates meeting to keep an eye on:
Guidelines on medical tourism. This is a first for the AMA, and the principles address "financial incentives, insurance coverage for care abroad, and care coordination." It sounds like the AMA has developed an acute awareness of medical travel.
Report on RUC recommendations. According to Dolan, the Relative Value Update Committee recommended ways to improve the valuation of primary care services, with no opposition from specialists.
Recommendations on "mystery shoppers." The AMA ethics council debated the benefits and drawbacks of medical mystery shoppers and issued a report on the matter. Many physicians are opposed to unidentified "fake" patients, but as Marketing Editor Gienna Shaw points out, mystery shoppers can improve quality and customer service.
Resolution against Ricki Lake. Well, not against Ricki Lake personally, but in a statement of opposition to homebirths performed by midwives (without doctor supervision) the AMA did mention Lake's public support for at-home deliveries. In another turf-defending resolution, the AMA sought to define who could rightfully use the terms "doctor" and "resident."
Elyas Bakhtiari is a managing editor with HealthLeaders Media. He can be reached at ebakhtiari@healthleadersmedia.com.Note: You can sign up to receive HealthLeaders Media PhysicianLeaders, a free weekly e-newsletter that features the top physician business headlines of the week from leading news sources.
More than 38% of consumers in the U.S., among those who participated in a recent survey conducted by PCR, are unsure which hospitals in their area provide the best quality of care, despite an increasing number of facilities that are providing consumers with healthcare data. A Hospital Compare Web site can help, too, but according to PCR, only about 8.9% of consumers are aware of its existence.