"Take two tablets by mouth twice daily." This printed instruction, common on prescription pill bottles, might seem straightforward. Yet in a study, nearly half of patients misunderstood what it or other common label instructions meant. Now the nonprofit organization that sets quality and safety standards for drugs approved by the Food and Drug Administration is aiming to simplify, clarify and standardize the labels that are affixed to those drugs. The U.S. Pharmacopeia proposal, developed in conjunction with a group of independent experts, was released early this year for public comment. If adopted by state pharmacy boards nationwide, its developers hope it will help remove one of the many barriers that discourage people from taking their prescription drugs. Medication adherence is a big problem. Despite the fact that 87% of people in a recent survey said they thought prescription medicines were important to their health, only about half of them took their drugs as directed.
Advance directives, which allow people to plan ahead for end-of-life care, can be too vague to cover many medical situations. Now, a growing number of states are promoting another program to help guide physicians with a patient's specific instructions.The programs are known as Physician Orders for Life-Sustaining Treatment, or Polst. They are meant to complement advance directives, sometimes known as living wills, in which people state in broad terms how much medical intervention they will want when their condition no longer allows them to communicate. A Polst, which is signed by both the patient and the doctor, spells out such choices as whether a patient wants to be on a mechanical breathing machine or feeding tube and receive antibiotics. Polst programs are currently in use in 14 states and regions, including California, Oregon and New York. Three states, Colorado, Idaho and Pennsylvania, adopted Polst programs recently, and another 16 states and six regions are developing programs. Besides providing documents that meet local regulations, the programs train healthcare providers to discuss end-of-life treatment choices with patients with terminal illness or anyone wishing to define their care preferences.
Nashville-based Saint Thomas Health Services and two radiology groups are partnering to create what is being dubbed the largest network of imaging centers in Middle Tennessee. Beginning April 1, the joint venture called Saint Thomas Outpatient Imaging will provide services at eight Nashville-area locations with more than 40 radiologists. It's the latest in moves by the five-hospital system to expand its geographic reach in specific services even as providers are being told to collaborate more and offer care in lower-cost settings near where patients live and work."We're going to bring more affordable services to the market," said Tom Blankenship, vice president for business development with the Catholic-owned Saint Thomas Health. Six of the eight imaging centers — four in Nashville and one each in Cool Springs and Mt. Juliet — are part of Premier Radiology, a 30-member radiology group that is a partner in the new joint venture.
The Massachusetts medical community was there in force after Hurricane Katrina pummeled the Gulf Coast in 2005. About 40 local surgeons and nurses flew to Port-au-Prince, Haiti, after last year's devastating earthquake there. They even traveled to Bam, Iran, after an earthquake toppled buildings and killed thousands in 2003. But their phones have been largely silent since last week's twin disasters in Japan. Japan, a highly industrialized nation with a healthcare system that remains mostly intact, has little need for outside medical expertise, but it has requested more technical assistance after Friday's earthquake and tsunami. It has deployed search-and-rescue crews from overseas, consulted international scientists to try to stave off the threat of a meltdown at a nuclear plant, and received help from engineers with geo-mapping skills.
President Hugo Chávez is known to have expressed little patience for imported leisure pursuits like golf or Scotch whisky tippling. Now he has reserved some ire for another practice that is beloved in Venezuela: breast augmentation surgery. Blame for the boom in such surgeries here, Chávez said on state television over the weekend, rested with doctors who "convince some women that if they don't have some big bosoms, they should feel bad." He said it was a "monstrous thing" that poor women were seeking breast lifts when they had trouble making ends meet. "What is this, friend?" Chávez exclaimed to his viewers. Chávez's comments come at a time when Venezuela has emerged as one of the world's leading markets for breast augmentation. Between 30,000 and 40,000 women here undergo the procedure each year, according to estimates by the Venezuelan Society of Plastic Surgeons.
As the rising tide of health care reform rolls in, the time is now for health care organizations to zero in on reducing readmissions. Hospitals with risk-adjusted 30-day readmission performance in the lowest quartile will incur penalties against their total Medicare payments beginning in fiscal year 2013 (ie, starting October 1, 2012). The Centers for Medicare & Medicaid Services (CMS) will evaluate the prior year’s readmissions data, effectively starting the clock ticking on October 1, 2011. The imperative is clear and the timeline is brief—hospitals must start preparing for these penalties at once.
1. Understand the Penalty Conditions
CMS is authorized by the Hospital Readmission Reduction Program to start penalizing for excess readmissions for congestive heart failure (CHF), pneumonia, and acute myocardial infarction (AMI) in 2013. These conditions were chosen in part due to their high volumes and readmission rates, as well as their significant cost to Medicare. In 2015, the number of conditions will expand and will likely include chronic obstructive pulmonary disease, coronary artery bypass graft, percutaneous coronary interventions and vascular procedures. Again, penalties will not be limited to payment for the noted diagnoses, but will be levied against a hospital’s entire Medicare payment for the year. CMS defines readmissions as “all cause” with a few exceptions, such as hospital transfers and readmissions for hospice and radiation.
2. Calculate Your Revenue at Risk
There are 2 different methods for penalty calculation provided in the Patient Protection and Affordable Care Act (PPACA). The worse-case scenario is a 1% Medicare payment reduction across all DRGs in fiscal year 2013, increasing to 2% in 2014 and 3% in 2015. For example, if a hospital’s total inpatient payments from Medicare totaled $50 million in FY 2012, the hospital would lose $500,000 (1% of $50 million) of its inpatient operating payments in FY 2013. On the other hand, if the alternative calculation (described below) results in total excessive payments of less than the cap, Medicare payments will be reduced by that percentage.
To determine the potential penalty, the amount of excessive payments made for each of the 3 conditions must be calculated. The PPACA defines excessive payments as the product of the number of patients with the applicable condition, the base DRG payment made for those patients and the percentage of readmissions above the expected rate for that specific hospital.
Sample Hospital: (Number of patients with condition) x (Average reimbursement for condition) x (% Higher than expected) = Excessive payment for condition
Continuing with the example from the worst-case scenario, if the above sample hospital’s total inpatient operating payments from Medicare were $50 million in FY 2012, then their excessive payments were 1.4% of total operating payments ($705,000 divided by $50 million). However, the maximum penalty in FY 2013 is 1% of the total operating payments, which is less than this hospital’s total excessive payments. Based on this example, this hospital would lose $500,000 (1% of $50 million) of its inpatient operating payments in FY 2013. On the other hand, if excessive payments were determined to be 0.8% (instead of 1.4%), then the hospital would be penalized $400,000 (0.8% of $50 million).
3. Prepare for Penalties Now
Although many questions remain about how Medicare’s readmission penalties will play out, including expected readmission rates per hospital and how penalties will be levied in a bundled payment program, there are still clear actions all health care organizations can and should take immediately, including the following:
Know your readmission metrics including original discharge disposition and origin of readmission
Calculate readmission rates by condition, physician performance and post acute care facility
Regularly share readmission data with key stakeholders, including physicians, senior executives and case management
Identify opportunities based on patient demographics and common readmissions
Screen and target patients based on risk assessments
Compare disease-specific outcome measures to national and local competitor rates.