Last week, Google confirmed what had been rumored for quite some time: The company is pulling the plug on Google Health, the online personal health record system that they launched in 2008. The service never really took off, and here are five reasons why.
Payers are on track for the implementation of ICD-10 and do not anticipate problems with processing payments — at least according to Ian Bonnet, vice president leading the ICD-10 rollout at health insurer Wellpoint. Bonnet added that the same cannot be said for providers. Some payers that are ready, and large providers where they can, are helping small healthcare providers prepare for the broad change to avoid obstacles in payment processing when ICD-10 is required. Such collaborations will supply the "tipping point," he said at a June 28 healthcare payments conference. The conversion to ICD-10 will incorporate many more codes that will enable specific diagnoses and treatment procedure details on claims to produce more accurate payments and fewer reviews and denials. After Oct. 1, 2013, providers cannot submit claims using ICD-9 coding and expect to be paid. "We don't want to mispay providers," Bonnet said. "We are collaborating with physicians and re-coding with them."
As lawmakers and industry leaders toil over plans to fundamentally change how health care is paid for in Massachusetts, two leading consumer groups are asking them to give ratepayers a one-year reprieve from premium increases. At a noontime rally at the State House today, Health Care for All and the Greater Boston Interfaith Organization plan to call for a 2012 freeze on base premium rates that have jumped sharply in the past decade. The idea is to pressure decision makers, particularly insurers and hospitals, to hash out a long-term plan at a quicker pace. The Rev. Hurmon Hamilton, president of the interfaith group, said he expects industry leaders to say a freeze is impossible. From 2007 to 2009, premiums for private group plans in Massachusetts increased 5 to 10% annually, while benefits were reduced, according to a state report. Last year, state regulators fought off proposed increases in the teens and higher for small businesses and individuals. The state Division of Insurance has no authority to enact a cap on rates. That means a freeze would require cooperation from insurers and physicians.
As many as 12 percent of the drug prescriptions sent electronically to pharmacies contain errors, a rate that matches handwritten orders for medicine from physicians, researchers said. An analysis of 3,850 computer-generated prescriptions written over a four-week period found 452 contained errors, including 163 that could harm the patient, according to a report published today in the Journal of the American Medical Informatics Association. The rate was consistent with past studies reviewing the risk of errors when a doctor writes a prescription and hands it to the patient, the researchers said. The results undermine the expected safety benefits from computer-generated prescriptions, said the study authors led by Karen Nanji of Massachusetts General Hospital's anesthesia, critical care and pain department. The U.S. paid more than $158.3 million to doctors and hospitals in the first half of 2011 to encourage adoption of electronic health records, which President Barack Obama has advocated as a way to lower health- care costs and reduce medical errors.
Hospitals have always known that reducing readmissions should be a priority quality goal but, until now, the payment incentives have not been in place. Like it or not, health care reform has provided a new impetus to do the right thing.
Financial penalties on providers with "excess" readmissions will begin in fiscal year 2013, but claims data collection on those penalties starts this October. The Centers for Medicare & Medicaid Services (CMS) measures readmissions within a 30-day time frame after patients are discharged for their initial admission. A readmission to any acute care hospital, for any reason, regardless of whether it is to the hospital from which the patient was originally discharged, or whether the readmission has any relation to the original hospital stay, will be counted. This is the definition of an "all-cause" readmission and does not exclude elective or planned admissions.
CMS will risk adjust readmissions penalties based on comorbidities and other patient variables, and initial penalties will focus on excess readmissions for congestive heart failure (CHF), pneumonia and acute myocardial infarction (AMI). Additional readmission penalties for chronic obstructive pulmonary disease (COPD), coronary artery bypass graft, percutaneous coronary intervention and other vascular procedures will begin in fiscal year 2015. What these penalties really indicate, however, is a larger CMS goal to move to a value proposition in terms of what it will pay for. To make sure your organization is on the right side of that value proposition relative to readmissions, have your leadership team ask themselves the following 5 questions.
Question 1: What is our business exposure based on CMS penalties and future accountable care organization (ACO) quality reporting requirements?
Put another way, what is your strategy for managing readmissions based on your current readmission rates? How much of your revenue could be at stake?
Effectively answering this question starts with good analytics, going beyond inpatient numbers to take a broader view of system-wide performance and benchmarking yourself against peer organizations. The more you can "peel the onion" on where readmissions are happening, the better—and 30-day readmission rates are also a good proxy for how well your post-acute care setting referrals are performing. The Sg2 Value Index™ offers an excellent tool for measuring overall clinical performance within these parameters and assessing your penalty risk. Most likely, hospitals in the bottom quartile of performance will bear the brunt of CMS penalties.
Question 2: How can we reduce readmissions without adversely affecting our current financial goals?
This is an important question to analyze with your financial staff, since there is no question that readmissions do make money and if they are reduced in one area, the income needs to be made up in another. Sg2 analysis shows that non-30-day readmission discharges or, in other words, new admissions for conditions not facing penalties, could be one answer. Drilling down to find the best leverage points for readmission prevention allows for focused interventions that are financially feasible, whether by disease, physician or patient geographic origin. A related question might be: How can you craft a multifaceted readmission strategy with a wide range of post-acute care settings? Lower-margin readmissions can also be "backfilled" with higher-margin cases, but health systems must keep in mind that under new payment models, such as ACOs and bundled payment, they will have to pay for readmissions.
Question 3: How can we better manage AMI, CHF and pneumonia patients?
CHF and pneumonia drive 30-day readmission volumes, with CHF accounting for more than 6% of all 30-day readmits, seconded by pneumonia at 4.8%. Nearly 1 in 4 CHF patients (24%) return to the hospital within 30 days with unresolved CHF. Typically, this is because they did not have a follow-up primary care or cardiology exam within 2 to 5 days after discharge, were released to the wrong post-acute care setting, or did not have their medications reconciled with a nurse or pharmacist within the first day or 2 after discharge. Like CHF patients, 66% of AMI readmissions are usually related to recurrence of the same cardiac event or an attack in a new cardiac site.
AMI patients need to see their cardiologist within 7 days after discharge and should be enrolled in cardiac rehabilitation. Readmission rates for pneumonia patients, who typically return with unresolved pneumonia or COPD, vary significantly by hospital, ranging from 15% to more than 22%. Mortality rates are even more striking, ranging from 6.7% to nearly 21%. It is important to treat the elderly and immunocompromised patients further upstream with vaccines, and timely blood cultures and antibiotic treatments should begin within 2 to 4 hours of diagnosis. The majority of all hospital readmissions are usually due to the original admission or related conditions, but the reasons vary more widely between 7, 14 and 30 days postdischarge.
Question 4: What post-acute referral locations create our greatest readmission risks?
Regardless of whether or not a hospital or health system owns a post-acute care site, it will be held accountable for readmissions from that site. Readmission rates for post-acute care providers differ, with skilled nursing facilities and home health care typically showing the highest rates of inpatient readmission. Clinical leaders should meet with their post-acute care providers to discuss what kinds of patients they are seeing, how ill those patients are and how transitions can be improved. Post-acute data by disease and site of care need to be understood and managed with all stakeholders brought into the process.
Question 5: How can we more effectively manage readmissions overall?
This boils down to organizational strategy, moving from data to action to measurable results. Good analytics entail drilling down by physician, disease and service line to see where readmissions are happening and why. Benchmark yourself against peer hospitals and systems to know where to set and raise the bar and make measurement ongoing with monthly performance reports. Managing to better analytics works, as proven by the many health systems we have worked with to address readmissions and other performance issues. You can't improve what you can't measure—and you can't wait to do either, as penalties for readmissions begin in just a few short months.
Joan Moss, RN, MSN, is a senior vice president at Sg2.
The University of Michigan Health System's 4,000-member nurses union will go to work Friday without a new contract, though talks will continue through that day. Key differences remain to signing a new deal to replace the contract that expires Thursday, officials said. They include health insurance, retirement, overtime and paid time off usage, according to the Michigan Nurses Association, the collective bargaining representative for U-M's nurses."This employer has nothing to lose and everything to gain by taking their time in these negotiations," said John Karebian, MNA executive director, in a statement released by the group Wednesday. Members of the union include staff nurses and advanced practice nurses such as nurse practitioners, nurse anesthetists and certified nurse midwives. The average UMHS staff nurses pay rate is $33.74 per hour or $70,179 annually, according to the health system. The average UMHS benefits contribution to members of the nurses union is $15,852, including $8,217 for health insurance. The monthly health plan contribution paid by the average full-time MNA member is $127.47.