With the prohibitive and rising cost of healthcare, there has never been a greater need for accountable care organizations, according to Mark McClellan, MD, former administrator for the Centers for Medicare and Medicaid Services. McClellan's comments came at the National Health IT and Delivery System Transformation Summit, held in conjunction with Second Annual National Accountable Care Organization Summit June 27 and 28 in Washington, DC. The challenge of achieving better care at lower costs has never been more important or more urgent, he said, and the serious challenges of getting from here to there have never been more daunting. McClellan, who is now the director of the Engelberg Center for Health Care Reform at the Brookings Institution, said in the past year the Centers for Medicare and Medicaid Services has identified many of the challenges faced by providers when starting an ACO, and there are now some successful ACOs from which to draw experience. "ACOs are about fundamental changes," he said. "The main emphasis is to get away from fee-for-service payment structures."
The rule that details the requirements for stage 2 of meaningful use will "look a lot like" the measures that the Health IT Policy Committee recently endorsed, said Farzad Mostashari, MD, the national health IT coordinator. The measures focus on patient-centered, safe and coordinated healthcare, he added. The Office of the National Coordinator for Health IT and the Centers for Medicare and Medicaid Services anticipate releasing their proposed rules on meaningful use of electronic health records and standards and certification criteria by the end of the year or early 2012, accepting public comments about it, and finalizing it next summer.
Aspen Valley Hospital will give its employees an average pay increase of 2.4% this month, while the Vail Valley Medical Center laid off 22 people less than two weeks ago. The difference in fortunes between the two facilities illustrates the challenges in an industry that is grappling not only with the effects of a recession, but looming changes posed by national healthcare reforms. In Vail, hospital administrators cited a drop in Medicare and Medicaid reimbursements coupled with an increase in the number of patients in those two programs for the need to cut staff. In addition, the medical center has seen a 27% drop in births this year, another revenue source, according to a report in The Vail Daily. The layoffs and other moves trimmed $4.2 million from the Vail facility's budget. In Aspen, it's a different story on several fronts, and not just because births are up so far this year. The resort hospital has not been forced to cut positions during the recession, and has managed to give its workforce ? currently about 275 full-time employees ? annual pay raises that are based what's happening in the regional and national market.
Gov. Peter Shumlin is considering going in a new direction than his predecessor regarding the future of the Vermont State Hospital. Under the Gov. Jim Douglas administration, planning to replace the state hospital had focused on developing acute care capacity at private hospitals, but state officials and executives at various hospitals -- including Fletcher Allen Health Care in Burlington -- never figured out how those partnerships would work. After Shumlin took office in January, he pulled the plug on the planned construction of a 15-bed secure residential unit that would have addressed the needs of a small number of state hospital patients. He directed Mental Health Commissioner Christine Oliver instead to focus on solving the bigger problem -- replacing the intensive care function of the state hospital.
A Deerfield Beach doctor has been suspended for his role helping a company peddle imitation Viagra to men who didn't need it and whom he never examined, state health officials said Tuesday. David M. Kenton, MD, pleaded guilty to a federal felony charge of conspiracy to commit fraud and was sentenced to three months of house arrest in November, federal court records show. The state Department of Health said it is required to suspend him for the fraud conviction. The state also suspended the licenses of two doctors accused of overprescribing narcotic pills at a Boca Raton pain clinic raided this month and a doctor in Delray Beach found to have mental health issues. The state is "committed to identify and investigate people illegally practicing medicine or revealing unbecoming conduct," said Frank Farmer, MD, the department's director and state surgeon general. Farmer said he suspended the doctors because of the severity of their actions. They can contest the suspensions before the Florida Board of Medicine, which will make final decisions on their disciplinary cases.
Does McHenry County, Illinois need a new hospital?
The Illinois Health Facilities and Services Review Board is expected to address the question this month when it considers certificate-of-need (CON) applications submitted by Mercy Crystal Lake Hospital & Medical Center and Centegra Health System.
Mercy proposes to construct a hospital in the community of Crystal Lake, while Centegra plans to build in Huntley. Meanwhile, the Review Board’s data indicates that McHenry County may need a new hospital soon, but not this year.
Moreover, the Board’s data suggests McHenry County will need, at most, one new hospital in the coming years. Therefore, the race is on as Mercy and Centegra vie to be the first to cross the finish line and obtain the coveted CON. Many factors could determine the outcome of this race.
1.The Odds The odds of either hospital receiving a CON are not favorable. Historically, the Board has been reluctant to approve new hospitals. Since 1976, the Board has granted only one CON for a new hospital. However, Adventist Bolingbrook Hospital, approved in 2004, obtained its CON with much less favorable Board data when compared with the need data applicable to the McHenry County projects.
Adventist’s planning area had a surplus of 263 medical/surgical (M/S) beds. McHenry County, in comparison, needs 83 M/S beds. Despite this stated need, each Hospital proposes 100 M/S beds, which is 17 beds over the projected need. Board regulations provide that proposals for new hospitals within metropolitan statistical areas must be for no fewer than 100 M/S beds. As a result of this rule, Board staff will likely conclude that a need for the project does not exist at this time.
2.Timing
Because two hospitals cannot be justified, the order of Board consideration could be critical. Generally, the Board considers CON applications in the order they are received, although the Board may not follow this rule when competing applications aim to satisfy the same projected need. The main problem in this situation is that once one project is approved, the other is essentially unnecessary. Expect the Board to address this concern before it considers these two applications. 3.Construction Timeline
The average amount of time to construct a new hospital is five years. Both hospitals could argue that failing to start construction now may create patient access issues in the near future, especially if a hospital is not operational when patient need surpasses the 100 bed benchmark. The hospitals have a good point here—McHenry County’s M/S bed need could exceed 100 in just one or two years.
4.Population Growth
The Hospitals may need to explain how new population information released by the U.S. Census Bureau in March 2011 affects their CON applications. The key question is whether McHenry County’s population growth will continue at a rapid pace.
5.The Economy
A slow economy creates public policy considerations that support approval of at least one CON. Hospital construction projects will create good-paying jobs now and in the future, and greatly benefit the local economy. Furthermore, construction costs and interest rates are down and securing labor contracts and loans at today’s rates could save millions of dollars and reduce project costs.
6.Access to Care
A recent applicant was granted a CON even though the Board’s need data indicated the project was unnecessary. The applicant provided evidence that the project would improve access to care for underserved populations. Mercy or Centegra may find similar success if they can demonstrate that their hospital will enhance access to care.
Although Mercy and Centegra cannot justify all 100 M/S beds, several other factors support a decision for CON approval now. CON observers will have a great race to watch if the Board determines that McHenry County needs only one hospital. Only time will tell if Mercy or Centegra end up in the winner’s circle.
Joseph Hylak-Reinholtz is an Attorney, McGuireWoods LLP in Chicago. He formerly served as an ex-officio member on the Illinois Health Facilities and Services Review Board and can be reached at jhreinholtz@mcguirewoods.com.