The Medicare Advantage star ratings program is already risk-adjusted for clinical factors such as comorbidities. Now federal officials are considering adjusting the quality rating program based on beneficiary income levels.
Under pressure from healthcare industry stakeholders and Congress, federal officials are considering making adjustments to the Medicare Advantage star rating program for quality and bonus payments to reflect the impact of socioeconomic status.
In early September, the Centers for Medicare & Medicaid Services requested comments on whether the MA star rating program should be risked-adjusted for SES. The focus of the federal agency is on dual-eligible beneficiaries: low-income individuals who are eligible for both Medicare and Medicaid services. "CMS seeks analyses and research that demonstrate that dual status causeslower MA … quality measure scores," agency officials said in the "request for information" document.
In August, the National Quality Forum, which vets quality measures for healthcare payers, issued a report calling for reforms that account for SES. The organization had previously resisted changes to quality measures to account for the impact of SES, but announced a change of course last month.
"NQF's Board approved a change in its current policy to allow for SES risk adjusting of some appropriate performance measures during a robust, two-year trial. The results of the trial will guide NQF on whether to make this policy change permanent. To be launched on January 1, 2015, the trial will be directed by the soon-to-be-formed NQF Disparities Standing Committee," NQF officials said in a statement.
The organization already accounts for clinical factors in quality measures and says "growing evidence shows that socioeconomic status and other demographic factors may also influence patient outcomes."
In an interview last week, an NQF official said any adjustment to the set of measures in the MA star rating program should be carefully calibrated. "The outcome measures are more likely to be appropriate for adjustment," said Ann Greiner, the organization's VP of public affairs. "This is not a blanket recommendation to adjust all stars measures."
Joyce Chan
Assistant VP of Clinical Performance, Healthfirst
MA Plans Under Star Rating Pressure
New York-based Healthfirst Inc. has firsthand knowledge of the challenge of achieving MA star rating success while serving dual-eligible beneficiaries.
"It becomes a very vicious cycle," says Joyce Chan, assistant VP of clinical performance at Healthfirst.
MA health plans that have a high percentage of dual-eligible members face a "double whammy," she says, because it is difficult to cross the 4-star threshold that garners the highest bonus payments. "You don't get the quality bonus money… then services get cut. The members are the ones that suffer."
Healthfirst has posted a 4-star MA quality rating for the 2015 plan year, but it was a struggle for several reasons:
Cultural diversity: 53% of Healthfirst's MA beneficiaries speak English as a second language
Education level: 70% of beneficiaries have less than a high school education
Poverty and crime rates: The majority of beneficiaries reside in neighborhoods with nearly one-third of residents living in poverty
Physician gap: 66% of beneficiaries live neighborhoods federally designated as health professional shortage areas
The statistics are linked to concrete MA star rating challenges such as dietary restrictions for diabetics conflicting with cultural norms. "Telling a Chinese plan member not to eat rice is really hard," Chan says.
Healthfirst favors a two-stage approach to factoring SES into the MA star ratings. "Risk-adjusting is the appropriate long-term solution, but it will take time to establish the adjustment model," she says.
In the meantime, Healthfirst wants CMS to adopt other options such as the federal agency's value-based purchasing model for hospitals. Under the purchasing model, hospitals are rewarded for year-to-year improvement or achievement of set performance standards. "It's a great interim solution, but it's hard to sustain improvement year after year after year," Chan says.
CMS Feels Star Rating Heat
Members of Congress are pressuring CMS to adjust the MA star rating program to reflect the challenges of serving dual-eligible beneficiaries.
Four bipartisan House members—Rep. Diane Black, (R-TN), Rep. Earl Blumenauer, (D-OR), Rep. Cathy McMorris Rogers, (R-WA), and Rep. Mike Thompson, (D-CA)—wrote a letter to CMS Administrator Marilyn Tavenner on Nov. 14, urging her to act:
"The MA program plays an important role in helping 16 million beneficiaries access high-quality health care, including delivering coordinated care to dually-eligible beneficiaries and other low-income seniors who often experience higher rates of chronic illness, disability and mental illness."
"It is well established that social determinants of health, including socioeconomic status, are important drivers of health outcomes. Dually-eligible individuals are amongst Medicare and Medicaid's most vulnerable beneficiaries and those most in need of the additional benefits and services, care management, and coordination across providers that MA offers. We are, therefore, concerned that the current MA quality and resultant payment system does not capture the social determinants of health that these beneficiaries may face."
Health plans are definitely concerned.
On Nov. 3, Jeff Myers, president and CEO of Medicaid Health Plans of America, expressed his MA star rating misgivings in a letter to CMS Deputy Administrator Sean Cavanaugh.
"Unfortunately, current Star quality measures do not adequately take into account the significant issues that low socioeconomic status has upon the achievement of favorable and preferred health outcomes as well as adverse impact upon plan performance," Myers wrote.
He cited a study conducted from 2011 to 2014 by America's Health Insurance Plans, showing that "plans with greater than 50% enrollment of low-income beneficiaries achieve lower Star ratings than plans that enroll less than 50% of low-income beneficiaries. It also finds that this disparity is growing overtime. Health plans that serve a higher percentage of low-income beneficiaries achieve Star ratings that were found to be 0.5 stars less than plans that serve fewer low-income beneficiaries."
Medicare Watchdog on Alert
Officials at the New York-based Medicare Rights Center are resisting the push to adjust the MA star rating program for SES. "To our knowledge, there is no data proving a causal link between disadvantaged populations and lower plan quality scores," says Krystal Scott, the advocacy group's New York State policy director.
Scott says CMS needs to tread carefully as the agency weighs adjusting the MA star ratings for SES. "Dually eligible beneficiaries may well have health needs that are different from healthier, higher-income populations. Yet, this does not necessarily mean they are more difficult to serve—only that their service needs may be different from other populations. Further, there is data suggesting that dually eligible beneficiaries are more likely to receive poor quality care, but the data do not show that this substandard care is caused by the actions or circumstances of these patients."
CMS has options beyond adjusting the MA star ratings, Scott says.
"We would like to see CMS ensure that appropriate tools are used to encourage high-quality plans to enter and remain in the market to serve dually eligible beneficiaries. Another option would be to compare health plans with similar proportions of low-income patients to each other, rather than comparing them to all Medicare Advantage plans."
CMS is reviewing public comments and could announce a policy proposal as early as February.
Healthcare provider claims that mergers boost efficiencies are drawing intense scrutiny from regulators and provoking a market challenge from payers.
Old habits are hard to break.
One of the goals of the federally led drive to create a value-based healthcare industry is to increase cooperation between major stakeholders. As a wave of healthcare provider consolidation sweeps across the country, the new age of cooperation between providers and payers is starting to look a lot like the old age of adversarial relationships.
An antitrust case in Idaho is one of the hottest fronts in the ongoing cold war between providers and payers. This week in Portland, OR, a three-member panel of the US Court of Appeals for the Ninth Circuit heard oral arguments on a challenge to a federal judge's rejection of a merger deal featuring Boise-based St. Luke's Health System.
In January, the chief judge of the US District Court in Idaho ruled St. Luke's acquisition of the state's largest independent physicians practice, Nampa-based Saltzer Medical Group, violated antitrust law. Chief Judge B. Lynn Winmill ordered St. Luke's to "fully divest itself of Saltzer's physicians and assets."
In an amicus brief filed at the US Court of Appeals, attorneys for America's Health Insurance Plans, the national health plan trade association, delivered a scalding criticism of the St. Luke's merger:
Gerard Wedig, PhD
"An important issue before this Court is whether claimed clinical integration justifies the anti-competitive acquisition of a medical group by a hospital with an already significant medical group. The district court correctly required [St. Luke's and Saltzer] to show merger-specific efficiencies. Instead, [St. Luke's and Saltzer] made claims of clinical integration efficiencies and suggested that the policy goals of the Affordable Care Act overrode antitrust concerns. Those assertions are wrong."
AHIP attorneys claim the St. Luke's merger is unnecessary because healthcare efficiencies are best achieved through negotiations between payers and providers. "The efficiencies suggested by [St. Luke's and Saltzer] are being achieved through relationships between health plans and providers—in other words through market innovation—without the need for anti-competitive mergers by hospitals and providers."
A decision is expected sometime next year.
Provider-Payer Arms Race
In an interview this week, an associate professor at the University of Rochester's Simon Business School said healthcare provider consolidation is sparking a new adversarial struggle with payers. Gerard Wedig, PhD, said mergers are a "natural reaction" among providers as they seek to ensure their survival in a time of rapid change in the healthcare industry.
The main benefit of these mergers is a "stronger provider organization," but health plans are dusting off their health maintenance organization playbooks as a way to offset the surge in health system market power. Selective contracting through so-called narrow networks "seems to be coming back," Wedig said.
"Many provider mergers are based on the idea that insurers won't exclude a large health system," he said. "If you can get people to a point where they can accept a narrow network, then insurers can leave out a large health system."
Employers and consumers are reaching that point, Wedig said, noting that large employers are seeking to control costs in group insurance plans and individual consumers face the growing prevalence of high-deductible health coverage.
"Narrow networks are entirely consistent with consumers having more skin in the game," he said. "Sure, these health systems merge, but you may see them having to compete in a way that they haven't had to in the past."
ACOs Getting Antitrust Pass Earlier this week, the St. Luke's case was a hot topic during a webinar on provider consolidation hosted by Berkeley, CA-based Catalyst for Payment Reform.
One of the webinar's presenters, Carnegie Melon University Professor Martin Gaynor, said the contested St. Luke's merger "illustrates the issues that could arise in an ACO case."
Gaynor, a former director of the Federal Trade Commission's Bureau of Economics, said there have been no antitrust lawsuits involving accountable care organizations—yet. "The concern is whether ACO stands for Anticompetitive Organization," he quipped.
Gaynor said three of the objections that the FTC raised in the St. Luke's antitrust lawsuit could be applied in an ACO antitrust case:
St. Luke's ran afoul of antitrust law because the health system's physician groups were in direct competition with Saltzer physicians.
St. Luke's and Saltzer made claims about achieving healthcare efficiencies that were "plausible but speculative" such as the benefit of sharing an electronic medical record system.
The US District Court in Idaho found the efficiencies St. Luke's and Saltzer claimed were not "merger-specific" and could be achieved through other means that did not risk creating anticompetitive market conditions.
Wedig said ACOs are likely getting an antitrust pass—for now. "It's clearly a model of healthcare delivery that's under the Affordable Care Act that holds some promise," he said. "There's been some effort to get providers to sign on to ACOs. We're trying to nurture them to some degree to see whether they can help reduce healthcare costs. You can see why [regulators] would have some sympathy for ACOs."
Merger Mania Grips Nation
During the CPR webinar, legal officials from California and Pennsylvania said the pace of provider consolidation – and antitrust reviews – is quickening across the country.
Kathleen Foote, senior assistant attorney general at the California Department of Justice, said the National Association of Attorneys General has noted a significant uptick in provider consolidation deals.
She said there were AG representatives from 38 states at a recent NAAG meeting and 27 states reported they were reviewing healthcare industry transactions, including physician group mergers and M&A deals between hospitals and physician groups. "In every location, virtually, this is a topic of great significance," she said.
Tracy Wertz, who serves as deputy attorney general in Pennsylvania, said The Keystone State is experiencing a spike in healthcare provider mergers. "We see more and more healthcare cases... currently, we have eight healthcare transactions before our office," she said.
In past years, the Pennsylvania AG rarely had more than one or two provider merger cases to review.
Data Key Factor for Regulators
In an interview before this week's CPR webinar, the organization's executive director said the combination of nationwide healthcare reform efforts and provider consolidation is a potent mix. "We're really entering into unknown territory," Suzanne Delbanco said.
She said a key healthcare provider consolidation hurdle for state officials across the country is amassing sufficient data to assess merger deals.
The data challenge is two-fold. First, variation of state data resources poses a major antitrust enforcement obstacle. Second, several recent provider consolidation efforts have crossed state lines.
"Some of this consolidation that's happening now is not traditional. There really isn't a history of market analysis to examine the impact of multi-state consolidation," Delbanco said.
Healthcare organizations are discovering untapped value in providing mental health and substance abuse services to super-utilizers of medical services.
Health plans are starting to focus on finding and engaging hard-to-serve beneficiaries who have been falling through the healthcare industry's cracks for decades.
"We're increasingly aware of the impact of behavioral health conditions, whether they are mental health or substance abuse, on physical health issues," Ian Shaffer, executive medical director at New York-based Healthfirst Inc., told me recently.
A mountain of evidence, demonstrating that behavioral health conditions are a major driver of healthcare costs, is accumulating.
In a study of 2 million Medicare Advantage beneficiaries released last month, Bowie, MD-based Inovalon reported data showing that a range of mental health conditions inflate hospital readmission rates. The readmission rates for MA beneficiaries was:
15.5% overall
23.8% for those with anxiety
26% for those with schizophrenia
The report's lead author, Christie Teigland, PhD, wants federal officials to consider including behavioral health in MA's risk-adjustment factors. "They already adjust risk factors for age because older beneficiaries are more likely to end up back in the hospital. Our research shows mental health issues also increase the risk of ending up back in the hospital," she told me.
Red Ink
The CEO of Boston-based Commonwealth Care Alliance (CCA) says the legacy of de-institutionalizing behavioral health is splashing red ink on the Medicare budget and health plan balance sheets.
"For 40 years, we've underfunded the community capacity to care for these people," Robert Master, MD, says, noting that there is a nationwide shortage of community-based respite and transitional housing facilities for individuals with mental illness. "In some cases, they're not ready to be thrown out of the hospital… What is missing is the appropriate gradient of facilities."
Master says state governments have struggled to rise to the behavioral health challenge. "There is so much competition for state tax dollars. What you're doing is cost shifting to the federal government. Medicare pays for that hospitalization."
CCA has 16,000 enrollees, with severe mental illness or substance abuse conditions afflicting 2,000 beneficiaries. The staff at CCA, which Medicare classifies as a Fully Integrated Dual Eligible Special Needs Plan, views the organization as a "care delivery system" that has adopted reducing psychiatric hospitalizations as a core mission.
Master says the vast majority of people with behavioral health or substance abuse conditions do not need to be in a hospital, where Medicare pays $1,100 per day for a bed and psychiatric services. "Most would be better served in a community-based, lower-cost setting."
Transitional Housing 'Just the First Step'
To reduce costs and improve quality of care, CCA is stepping in where de-institutionalization of behavioral health left off. "We have to create the capacities that are missing," Master says.
Last month, CCA started leasing a "mothballed ward" at Carney Hospital in the Dorchester neighborhood of Boston to provide transitional housing for beneficiaries after their release from psychiatric hospitals. It immediately filled the 10 beds and plans to open at least three more similar facilities over the next year.
The transitional housing unit has living room and kitchen space, and "referrals come from the enrollees' own physicians," Master says. But "This doesn't solve the problem. This is just the first step."
Elsewhere, Shaffer says Healthfirst is tackling behavioral health through a new approach to primary care medicine. "Healthcare is a team sport now. We really need to look at it as a team effort to be effective."
Healthfirst is encouraging primary care practices to incorporate behavioral health screening and referrals into their workflow. "It's all driven around the concept of integrating all the services people need," he says.
"We need to get away from primary care physicians either spending two hours with a challenging patient or not spending any time… The [best] intervention may well be encouraging that individual to stick with the appropriate treatment."
Shaffer says the healthcare industry is "reaching a tipping point" on behavioral health. "We're learning more. We tended to bifurcate mental health services and kept them separate from physical health services. Now we're adding them back in."
Reaching Out to Engage Beneficiaries
Owings Mills, MD-based Integra ServiceConnect is also thinking outside the historical parameters of the healthcare box to help health plans engage beneficiaries who have behavioral health conditions.
"We start with the notion that [there is] a small number of people who are driving a large amount of healthcare services," Integra President and CEO Michael Yuhas says. "You need to be able to connect with people on their level."
One of the key ingredients in Integra's secret sauce is community coordinators who find and engage health plan beneficiaries where they live, which is often in disadvantaged neighborhoods.
"This is not a healthcare intervention we're talking about," Yuhas told me. "We've been taught historically that when something breaks, you bring the patient in to fix it. But once you find [a beneficiary with a behavioral health condition], that's not enough. You have to engage them. You have to let them know you're friend and not foe. We've created a science of finding people, engaging them, and connecting them to the services they need."
Integra looks for a set of qualities when it hires community coordinators, few of which are directly related to traditional healthcare industry skills. "It's in their fabric to help people," Yuhas says. Community coordinators live in the areas they serve and are persistent, compassionate, street smart, and resourceful. "We look for people who won't give up. We look for people who are just creative."
I asked whether someone like the rapper and actor Tracy "Ice-T" Marrow, known for his resourcefulness, would make a good community coordinator. "We'd hire Ice-T if we could, but we hire people who know where Ice-T is. We hire people who can find community ambassadors," Yuhas told me. "Mostly, it's the notion of not giving up. We connect with the people others have given up on."
Covering the Basics
Another ingredient in Integra's secret sauce is strictly business-related.
The company helps health plan beneficiaries meet basic needs, which the healthcare industry has long considered insignificant. A change in mindset is long overdue.
"We contract with our clients as a vendor, not as a clinical provider of care… We get paid on the basis of a monthly fee to make sure the member's needs are being met," Yuhas says. This kind of work "doesn't lend itself to the typical billing code."
For example, community coordinators have taken health plan beneficiaries to consignment shops to buy coats to stave off the chill of winter and hospitalizations linked to exposure. "When we buy a coat, we don't bill for a coat."
Yuhas says Integra's efforts are "life-changing" for many health plan members: "We're working with members who are not accustomed with people coming out into their neighborhoods and actually helping them."
As the second open enrollment period for health insurance exchanges kicks off, carriers face a range of challenges, from ongoing information technology woes, which may affect policy renewals, to potentially explosive growth.
For health plans, challenges in the second year of the public insurance exchanges feature something old and something new.
Chris Johnston
Associate VP of New Business
and Consumer Solutions,
Health Alliance Plan
Last fall's nearly disastrous rollout of the federal government's exchange website, HealthCare.gov, has carriers casting a wary eye on the 2015 open enrollment period, which is slated to begin Nov. 15 and end Feb. 15.
Chris Johnston, associate VP of new business and consumer solutions at Detroit-based Health Alliance Plan, says that technology remains a top HIX concern on several fronts. The performance of the revamped HealthCare.gov website is a prime worry, he says: "How stable is it?"
Last fall, the Centers for Medicare & Medicaid Services scrambled to fix dozens of major flaws in the website. The agency brought in a new chief executive, Kevin Counihan and has been fine-tuning HealthCare.gov ever since.
On Friday, CMS released a mammoth amount of exchange data, including detailed information on insurance policy premiums. A preliminary analysis conducted by Washington, DC-based Avalere Health LLC found premium rates vary widely across the country but the average premium increase is modest compared to historical rate hikes in the individual market.
Avalere examined premiums for a key benchmark policy, the second-lowest priced silver plan, in the 34 states that use HealthCare.gov as their exchange portal. For those silver plans, the average premium increase for a 50-year-old nonsmoker is 3%.
CMS recently announced a "window-shopping tool" designed to help individuals review information about HIX insurance policies offered in their state before open enrollment begins. The tool enables consumers to compare plans, covered benefits, and physician and hospital networks.
Even if HealthCare.gov performs well for new enrollees, Johnston says CMS is facing a new technological challenge—policy renewals.
"We are on daily and weekly calls with CMS [along with] other plans across the country. They are new to this; we've been at this for years. They are learning. They're going to have to figure out how to renew people."
There are big issues for consumers who opted to authorize automatic renewals when they signed up last year, Johnston says. The problem is "they don't remember if they selected anything."
HAP is urging individuals who purchased 2014 health insurance policies to go back to HealthCare.gov and shop for new 2015 policies. Johnston says changes in income could affect subsidies available to individuals through the exchanges and there are new plans being offered in exchanges across the country, which "could be a better fit," Johnston says.
New York-based PricewaterhouseCoopers has been tracking 2015 HIX premium rates since the summer, featuring the consultancy's findings with an interactive map. Ceci Connolly, managing director at PwC's Health Research Institute, echoed Johnston's advice to consumers. "Simply auto-enrolling in your existing plan may not be the best choice in 2015. We are seeing wide variation in premiums, so it really pays to shop around," she said this week.
Enrollment is just one side of the HIX technology challenge, data is another. Health plans are still getting shaky information on beneficiaries from CMS, he says. "We need accurate information on who was enrolled in our plan. We're still having some problems."
Aetna is also highlighting "back-end" technology concerns.
"Certain functionality gaps still exist, adding to member confusion as they seek out other ways to make changes to their information. For example, members are using CMS Customer Service to request effective date changes that should be able to be processed through the website," the insurer said in an email exchange.
Consumer Education Efforts
This year, health plans are taking new approaches to educating consumers. "Last year, because it was the first year, we really didn't know what to expect," Johnston says, and HAP focused much of its consumer education efforts on Michigan's low-income population.
"This year, we're doing more with advertising," he says, citing newspaper, radio and television campaigns.
Minneapolis-based United Healthcare has launched its own online tools to help individuals navigate HIX enrollment, a company spokeswoman said this week. "Our tools, Health4Me and myHealthcare Cost Estimator, are available to help individuals navigate open enrollment and understand how to use their health insurance benefits to become and stay healthier, as well as how to save on their healthcare costs."
The industry's trade association, America's Health Insurance Plans, has circulated two infographics to help its members explain the enrollment process to consumers. One infographic is targeted at new enrollees and the other is designed to help individualsrenew their HIX health coverage.
Reading the 2015 Tea Leaves
Growth appears to be the key word in the 2015 HIX market.
"This will be a growth year, so for the exchanges and the plans and healthcare providers, the challenge in 2015 is serving many millions more newly insured," PwC's Connolly says. "Health insurers and clinicians need to get a deeper understanding of this new customer base, their health status, and how they interact with the healthcare system."
Health plans are banking on HIX growth, she says. "What is perhaps most notable in the second year is the growth in participation by health plans. We count 77 new carriers competing in 2015. At least four states have double the number of offerings from last year. This suggests that the industry sees real opportunity in the exchanges and is pursuing these new customers."
UnitedHealth says it has doubled its participation in the public exchanges from about a dozen exchanges last year.
Private health insurance exchanges also are poised for growth, Johnston says, noting that HAP is participating in several private exchanges such as iSelect and Michigan's Insurance Marketplace.
"This has really opened up a whole new market as far as the [private] exchanges go," he says, which generally target the group market. "You can feel the momentum starting to ramp up," he says. "New ones are calling us every day."
Most private exchanges feature a "defined contribution" model in which an employer caps the amount of money it gives workers to spend on health insurance premiums. Then workers get a choice of policies with a range of premiums. "It's one way you can control the healthcare 'spend,'" Johnston explains.
Aetna says private exchanges appear destined to outpace the public exchanges. "Public exchanges can play a vital role in increasing access for individual consumers; however, the sustained success of HealthCare.gov depends on a fully functioning website that can support consumers through the enrollment process and for ongoing changes that occur during the plan year."
"When that happens, we believe public exchanges can complement the existing competitive marketplace, including private exchanges, which we believe, over time, will serve a much broader portion of the population."
In a high-stakes gamble, the biggest health system in Massachusetts is trying to get bigger, but its merger plan is in the hands of a Superior Court judge.
I expected a showdown at the court hearing this week on Partners HealthCare's quest to acquire three more hospitals in eastern Massachusetts. Instead, I witnessed a clash of constitutional titans.
MA Attorney General Martha Coakley
in Suffolk County Superior Court Monday
On Monday, Judge Janet Sanders was scheduled to hear from lawyers representing Partners and the commonwealth's attorney general's office about why their settlement deal on the merger plan is in the public interest. The hearing was slated to last less than four hours. It took all day.
The Suffolk County Superior Court chamber in downtown Boston was packed to capacity. At least 50 people, including Attorney General Martha Coakley, sat on the pew-like wooden benches in the gallery. The jury box was filled with journalists. The lawyers representing the AG, Partners, and the hospitals slated for acquisition were seated at two tables in the center of the room.
One lawyer each was present for South Shore Hospital and Hallmark Health System, which owns two hospitals in the North Shore region of the commonwealth that Partners covets.
And an attorney for a coalition of hospitals and physician groups opposed to the settlement sat alone on a document-strewn bench across from the jury box.
The only empty seat was in the witness stand next to the judge.
'I Have to Look at the Harm Alleged'
The hearing started calmly. Sanders said she wanted answers to two primary questions: first, whether there is a basis to conclude that the settlement deal would remedy the harms alleged in the AG antitrust lawsuit that had prompted the pact and whether the settlement was enforceable.
"I have to look at the harm alleged in the complaint," Sanders said. The judge referenced passages in the AG's lawsuit, including a claim that Partners' acquisition of South Shore Hospital, Lawrence Memorial Hospital and Melrose-Wakefield Hospital would "substantially reduce competition" as well as a claim that health plans need competing providers to negotiate affordable prices for healthcare services.
The judge then quizzed the AG's legal team on her second question: why the settlement deal proposes "conduct" remedies such as price controls rather than "structural" remedies such as health system divestments to offset reduction in competition.
"A structural remedy would have required litigation," replied Assistant AG William Matlack, chief of the state agency's antitrust division. He said the AG had to weigh "the risk we would litigate and lose versus settlement."
Sanders and Matlack went back and forth on the advisability of conduct remedies in the settlement deal several times. "I'm apparently not supposed to inquire [about] your likelihood of winning [in litigation]," the judge said.
Matlack replied that the AG's office had exercised its "prosecutorial discretion" in crafting the settlement deal and advised Sanders that the court is only supposed to determine "whether the enforcement action is reasonable."
The seed of confrontation had been planted.
Antitrust Remedies Probed
Before Sanders suspended the hearing for lunch, she started digging into the specifics of the settlement deal.
Her questioning focused on price caps Partners had accepted over a period of six-and-a-half years as well the health system's concession on "component contracting." The latter provision of the settlement deal would allow payers to accept pricing arrangements that apply to the entire health system or to cut pricing deals with separate Partners bargaining units over a period of 10 years.
Matlack contended that the price caps and component contracting amount to significant counterweights to the anticompetitive impact of Partners' proposed mergers. "The combination of the price caps and the component contracting fundamentally changes the negotiation dynamic," he said.
Sanders pressed for explanations of how the price caps and component contracting would work in practice. In an exchange with Partners' lead attorney, Washington, DC-based Bruce Sokler, she asked, "Why is a price cap going to be effective here?"
"The answer is, this is an antitrust consent decree, and antitrust is about price," the attorney replied.
The judge asked the AG lawyers about the likely market outcome after the price caps were lifted. "Once the time cap expires, Partners is unfettered. They are free to do whatever they want to do," Sanders said. "It is more likely there is going to be less competition in six-and-a-half years."
Matlack revisited the specter of litigation. "The comparison is what happens if we litigate and lose. We have nothing," he told the judge, adding that no one could predict the composition of the market years into the future. "It's not a foregone conclusion [that] there will be less competition in six-and-a-half years."
The questioning reached a fevered pace. As the lunch hour approached, Sokler attempted to draw a bottom line on the settlement deal. "What happened was, there was a negotiation and a compromise," he told Sanders, "and this is what has come out. Others don't like that."
Sokler said the AG's office had the authority to cut the deal. "That's why we negotiated with them," he said.
Then the confrontation sprouted.
Coakley rose from the gallery and asked for permission to address the court, which Sanders granted.
"We have come to this really over the last eight years," the AG said, gripping either side of a small wooden podium in front of the gallery. "We set up a healthcare department in the office. We have been the only agency in this state to shine light on healthcare disparity."
Coakley made a spirited defense of the settlement deal. "We worked very hard, very diligently at it. This is about what is in the best interest of leveling the playing field given where it stands now," she told the judge. "I believe the work has been done. I believe you have the information before you to make a decision."
Sanders decided it was a good time to break for lunch.
Clash of the Titans
Although fatigue was setting in, the afternoon session had a high-stakes edge.
After finishing her probe of price caps and component contracting, Sanders turned to questions about whether the settlement was enforceable. "I think it is admittedly very complicated," she said.
As the light pouring through the courtroom windows started to fade, the judge began a line of questioning she probably regrets. Referring to the results of last week's election, she said "We do have a new attorney general [set to take office in January]. Should that new attorney general have an opportunity to look at this?" she asked the AG legal team.
Coakley, who ran an unsuccessful gubernatorial campaign, will be handing over the AG's office to fellow Democrat Maura Healey.
First Assistant AG Chris Barry-Smith all but accused Sanders of usurping the executive branch's authority. "It's critical that there not be a precedent… that work cannot continue and work cannot be finished," he told the judge.
"There's a political dynamic," Sanders insisted. "Surely, we should make sure the incoming attorney general is behind this."
Barry-Smith stood his ground. "It's the institution that is the steward of the public interest," he said.
Coakley was soon on her feet again. "I want to be clear that the decision we made had nothing to do… with the office I was running for," she said.
Sanders replied that she had not meant in any way to "impugn the integrity" of the AG.
"I think you have," Coakley quickly shot back.
After a rhetorical dance that mirrored two gladiators circling one another in a coliseum, the judge returned to an apologetic tone. "The courts try to function in a political vacuum, but there are real life things that happen," Sanders said. "I am not in any way trying to impugn your integrity."
The judge adjourned the hearing moments later. Based on comments Sanders made during the proceeding, she is not likely to issue a ruling on the settlement deal until December at the earliest.
As Coakley and her legal team headed for the lobby, I asked her whether she had planned on addressing the court. "I felt that at the end… it was important for [Sanders] to hear from me," she replied.
The Bay State is leading the country in establishing price transparency for healthcare services, but setting quality standards and wariness among providers are significant obstacles.
A recently adopted state law has moved Massachusetts to the front of the national class on price transparency.
Suzanne Delbanco
The price transparency provision of the 2012 law, Chapter 224, went into force last month making Massachusetts one of the first states to require healthcare providers and payers to make medical service prices accessible to the public.
In March, The Bay State and Maine earned the highest national grades for price transparency from Berkeley, CA-based Catalyst for Payment Reform. Forty-five states received failing grades.
"CPR believes price transparency is a fundamental building block of a higher-value healthcare system," says Suzanne Delbanco, the organization's executive director. "We will be evaluating any new laws to produce an updated 2015 Report Card. My sense is these two states likely continue to lead the nation, along with a small number of others like New Hampshire and Colorado."
Barbara Anthony, Massachusetts undersecretary of consumer affairs and business regulation, says her agency has high hopes for the impact Chapter 224 will have on healthcare in the commonwealth. "This is going to drive down costs over time at providers," she said. "This is how markets work."
Anthony says states are facing several challenges establishing healthcare price transparency, such as building websites that are capable of providing consumer-friendly access to medical service price information. The biggest challenge is changing mindsets, she said.
"This is more than just a website, this is an effort to change attitudes," she says. "We wouldn't think about buying a car, a television, or any sophisticated piece of equipment without doing our homework… You have to feel comfortable taking charge, which is a challenge."
The mindset hurdle extends beyond consumers to a key healthcare stakeholder, Anthony says. "We don't hear resistance from insurers. Where we hear resistance is from some provider groups. Not everybody is at the same level yet. This is a collaborative situation. When the insurers and providers are willing to have a discussion about value, [pricing] is not going to be a secret discussion anymore."
Provider and Payer Perspectives Differ
Chapter 224 requires both providers and payers to make pricing information available to the public, but they apparently have varying enthusiasm for the new law.
"Our industry [and its members] have been strong advocates for price transparency," said Eric Linzer, senior VP of public affairs and operations for the Massachusetts Association of Health Plans. "It allows consumers to shop and compare prices across different service types… These are tools to encourage individuals and employers to really engage. Without that information, it makes it really hard for health plans to expect people to make informed choices about where they get their care."
Massachusetts health plans have launched pricing websites crafted to individual beneficiaries such as EmpowerMe at Watertown, MA-based Tufts Health Plan and SmartShopper at Worcester, MA-based Fallon Health.
"In partnership with Compass Healthcare Advisers, the Fallon SmartShopper program provides real-time cost transparency for all Fallon commercial plan members and incentive rewards for many commercial group members," says David Przesiek, VP and chief sales officer for Fallon Health.
"We believe that [the tool] is a way to reward members for taking a proactive approach to their own healthcare. Not only will the tool educate and empower members to choose the care that is right for them, but it will help members to save money on procedures while earning incentives."
Karen Granoff, senior director of managed care at the Massachusetts Hospital Association, has a more cautious perception of the commonwealth's price transparency push.
"The Massachusetts Hospital Association is in favor of price transparency, but it's important to keep in mind that price is just one factor to consider in deciding where to receive care. Other considerations include quality, the ability to share information via electronic medical records, and whether a particular facility promotes patient-centered medical homes; for example, by allowing primary care physicians to help determine where care can be provided so it can be integrated effectively with all of the providers caring for a patient," she says.
Price transparency is a laudable goal, but it has the potential to undermine other healthcare initiatives, Granoff says. "On the one hand, the state is promoting integrated care, including accountable care organizations and patient-centered medical homes, while at the same time encouraging patients to shop for the best price. This 'shopping' paradigm may not always be consistent with promotion of care integration."
Quality Data Poses Challenge
In economic terms, the value of a service can be boiled down to a consumer's assessment of cost and quality. While there is widespread agreement in Massachusetts that Chapter 224 has made a giant leap forward in publicizing healthcare service costs, there is an equally broad consensus that greater strides must be made on the quality side of the healthcare value equation.
Anthony says most Bay State health plans include "some kind of quality metrics for providers" on their websites, but she acknowledges that more work needs to be done. "This is an area that needs attention. This is an area where we are lagging a little bit," the undersecretary said.
Linzer says an arduous effort will be required to reach the point where Bay State consumers can make fully informed decisions about healthcare value. "These tools are in their initial stages. These websites will mature. These websites require a significant amount of work and significant information technology build."
Granoff says making healthcare service quality data easily accessible to Massachusetts consumers is a work in progress.
"Payers and providers are trying to incorporate quality information with the pricing information that's provided, and hospitals and insurers alike agree this is critical. However, there are not always good metrics available for all types of procedures or for comparing physicians, and different payers may use different metrics, so it's not always comparable. It is evolving."
Delbanco says the quality factor in defining healthcare service value remains a daunting hurdle. "Most health plan tools these days do incorporate some quality information, but not in a way that is very useable by most consumers."
The largest health plan provider in Pennsylvania is exploring opportunities to diversify beyond the insurance market. Its latest innovation is a retail concept for consumers with sleep disorders.
One of the largest Blue Cross Blue Shield-affiliates in the country is seeking growth opportunities outside its core health plan business line.
Pittsburgh-based Highmark Inc. offers health insurance products that provide coverage for 5.2 million lives in Delaware, Pennsylvania, and West Virginia. But the Business Innovation and Development department Highmark created three years ago is thinking outside the BCBS box.
"Our fundamental purpose is to develop new products and services that meet a consumer need and drive growth for the company," says Paul Puopolo, VP of business innovation and development for Highmark. "We are not looking at insurance. We are an innovation group, with a heavy emphasis on going to market."
Puopolo's innovation and development crew has helped launch two new Highmark business lines. "Our group has only been in existence for three years," he says. "Two new businesses in three years is a pretty good rate."
The first was CaregiverHQ, a home-based caregiver support service that the company started marketing in April. Individual consumers pay a subscription fee for the service, which includes emotional support and stress management strategies for friends and family members who are serving as caregivers.
The second is set to launch next month, with the opening of a REMWorks Sleep Store retail business in Homestead, PA. It seeking to fill an unmet market niche, says Amy Phillips, director of the new business. "There are nearly 80 million people in the United States who have sleep disorders of one kind or another."
A rendition of Highmark's new sleep store
The Sleep Store will be staffed with three respiratory therapists, a nurse, and a polysomnographic technologist. Rather than conducting overnight sleep studies, a questionnaire will be used to "[identify] whether the level of your sleepiness during the day is normal," she says.
The Sleep Store will offer counseling and sell durable medical equipment that requires a doctor's prescription. Market differentiators of the Sleep Store include a direct-to-consumer business model and "an environment that is not focused on disease," she said. "It will be a soothing environment; you won't see tubes when you walk in the door."
Puopolo says development of the Sleep Store followed a four-step process that Highmark has adopted for growth opportunities: intake, conceptualization, business case formation and commercialization. "It came in as an idea because of the market," he said. "We met with consumers, and we saw there was a gap."
The development process for the Sleep Store has taken about two years, Phillips said. "Once we put the business case together, we had to go through Highmark for approval," she said.
Highmark is poised to develop retail business lines because of the company's experience with Highmark Direct, nearly a dozen brick-and-mortar sites in Pennsylvania that help individuals and families purchase health insurance products. "They blazed the trail," Puopolo said.
Highmark Direct's branded storefronts have given the company critically important institutional knowledge to succeed in retail ventures, he says. "We have people in this company who have experience now. It's not a heavy lift. If you don't have that experience, it could be daunting."
Highmark is dreaming big for the Sleep Store.
"We want to see this one be successful and get off the ground," Puopolo said of the Homestead location. "We're taking it one step at a time, but it could be national. We have a lot of other Blue plans we work with."
An appropriate reduction in the number of diagnostic lung biopsies "has the potential to reduce costs and improve patient outcomes," says a researcher who has studied diagnostic costs associated with Medicare beneficiaries who had abnormal chest CT scans.
The research focused on a random sample of nearly 9,000 Medicare beneficiaries who underwent diagnostic tests after an abnormal chest computed tomography scan. The study found 43% of the total diagnostic workup cost after the abnormal CT scans was linked to biopsies with negative results for patients who ended up not being diagnosed with lung cancer.
The total diagnostic workup cost for patients in the study was pegged at $38.3 million, with Medicare spending at $16.5 million on biopsies for patients who did not have lung cancer.
The study was presented at the 2014 Chicago Multidisciplinary Symposium in Thoracic Oncology. The lead author of the report, Tasneem Lokhandwala, PhD, a research analyst at the Xcenda subsidiary of Chesterbrook, PA-based AmerisourceBergen Corp., drew a three-fold conclusion for the conference attendees:
Biopsies are a significant proportion of the overall cost of diagnosing lung cancer
To reduce lung cancer diagnostic costs, oncologists need to develop "more precise risk stratification tools to better identify patients who require referrals for lung biopsy"
An appropriate reduction in the number of diagnostic lung biopsies "has the potential to reduce costs and improve patient outcomes"
Bearing Down on the Numbers
In an interview this week, Lokhandwala said her research team's data was drawn from Medicare beneficiaries across the country.
"This is a nationally generalized sample," she said of the 8,979 Medicare beneficiaries who had abnormal chest CT scans from January 2009 to December 2011. "They all could have been diagnosed with lung cancer."
She said more research would have to be conducted to determine the potential annual savings for the Medicare program if unnecessary lung biopsies could be eliminated. "You would need extensive analytical modeling to get that number," she said.
To conduct a study on the potential annual savings linked to elimination of unnecessary biopsies, Lokhandwala said researchers would have to consider focusing only on patients at high risk for lung cancer and weigh murky factors including cost estimates for new diagnostic tools.
Tradeoffs in High-Stakes Cancer Battle
The moderator of the conference, Laurie Gaspar, MD, MBA, a professor at the University of Colorado's School of Medicine in Denver and longtime clinical oncologist, says Lokhandwala's research highlights the benefits of improving lung cancer diagnostics.
"It is always possible to develop more precise risk-stratification tools for lung cancer so that we have more accuracy in our diagnosis of lung cancer as opposed to benign lesions."
"The areas that appear most promising are in the ability to diagnose early lung cancer from blood samples, referred to as liquid biopsies sometimes; the use of new imaging modalities such as new types of PET and CT scans; or the use of exhaled breath to detect chemicals that are correlated with early lung cancer," she says.
A key finding of Lokhandwala's research is relatively low utilization of positron emission tomography compared to biopsy in lung cancer diagnosis. PET scans were performed on less than 1% of patients. Lung biopsies were performed on about 19% of patients. This finding suggests oncologists are not following diagnostic guidelines for lung biopsies.
"From this analysis, it was found that the National Comprehensive Cancer Network (NCCN) lung cancer screening guidelines were not followed, which resulted in many patients who ultimately had a negative lung cancer diagnosis undergoing unnecessary biopsies. The NCCN guidelines call for low-dose computed tomography of the chest followed by a PET scan to identify patients for biopsy," says a statement accompanying the release of the report.
In Lokhandwala's study, the average cost to Medicare for a complication-free lung biopsy was $8,869 and the average cost of a PET scan was $624. She notes that the average cost of a PET scan in her study only covered the procedure, but Medicare spending on lung biopsies included all incidental costs.
"It's not just the cost of the procedure," she says. The incidental costs for biopsies in her study accounted for "everything that could happen" such as length of stay in a hospital and the cost of managing adverse events linked to a biopsy.
Gaspar says oncologists and researchers will have work carefully as they seek to refine lung cancer diagnostics.
Developing more cost-effective diagnostic tests involves a large measure of uncertainty and "the cost of these tests is not yet known. The ultimate cost depends on whether the new tests replace the traditional biopsy or are just done to avoid some biopsies. The latter sounds more likely at this point."
Lung cancer is among the most deadly diseases afflicting the Medicare population, so the stakes will be high in any effort to reduce the number of lung biopsies, Gaspar says. "Money would be saved as long as we are not missing the early detection of lung cancer in the vast majority of patients."
The office of the Massachusetts attorney general responds to public comments on a settlement pact between the state and its largest employer, Partners HealthCare. The agreement, it concludes, is better than the likely outcome of a lengthy court battle.
The showdown is set.
Massachusetts Attorney General Martha Coakley has filed her office's response to the final set of public comments filed on a merger and acquisition settlement between Partners HealthCare and state officials.
Partners HealthCare, the largest private employer in Massachusetts has been on a years-long quest to expand further and consolidate its holdings. The contentious matter reached a pivotal point in a Boston courthouse last week with the filing of the AG's response.
Coakley and Partners reached the settlement pact earlier this year to resolve an antitrust case the AG had pressed in Suffolk Superior Court over the health system's M&A plan, which features the acquisition of three suburban hospitals.
In the response document Coakley's office file last week, the AG calls on the state court to approve the settlement deal on several grounds:
The settlement advances the public interest, including measures such as a healthcare service price cap over a period of several years that helps address "the harms threatened by Partners' acquisitions."
Broad policy concerns raised in public comment letters filed by foes of the settlement deal are beyond the state's authority. "Most of these comments are grounded in advocacy about important healthcare matters, but the issues raised by these organizations are often outside the antitrust principles and analysis that supports the Commonwealth's Complaint," Coakley's office wrote.
The settlement deal is clear and enforceable. "The price cap cannot be gamed in any meaningful way," the AG's office wrote, adding, "Partners' ability to negotiate different price increases for different services is unlikely to materially cause its revenues to increase at a rate greater than the price cap."
The conclusion of the AG's response letter claims the settlement pact is better than the likely outcome of a lengthy court battle. "Accounting for all the fully investigated facts, the realities of litigation risk, and the broad, immediate and effective remedies contained in the settlement, this Consent Judgment is superior to uncertain and prolonged litigation," Coakley's office wrote.
On Nov. 10, Suffolk Superior Court Judge Janet Sanders is set to hear oral arguments from the AG and Partners on why their proposed settlement deal is in the public interest. After that hearing, the fate of the settlement pact is expected to be in Sanders' hands.
Opposition Remains Entrenched
The last round of public comment letters filed on Partners' M&A plan focuses on revisions to the proposed settlement deal between the health system and Coakley's office. The comment letters, which were submitted by a court-ordered Oct. 21 deadline, include expressions of stiff opposition.
Laura Pellegrini, president and CEO of the Massachusetts Association of Health Plans, filed a direct but polite comment letter on behalf of the group's 17 insurers, which provide healthcare coverage for 2.6 million Bay State residents. "We recognize the effort that has gone into the investigation and proposed judgment, but believe the amended provisions fail to address our overriding concern that the proposed judgment will not remedy the market dysfunctions it seeks to correct and could have the unintended effect of increasing healthcare spending," she wrote.
Attorneys for the Washington, DC-based American Antitrust Institute are equally skeptical in their comment lettersubmitted on Oct. 21. "We ultimately conclude, as we did in our original comments, that the proposed consent should be rejected as not in the public interest because it does not adequately remedy the competitive harms alleged in the complaint and it will be difficult and costly for the judiciary to enforce," the attorneys wrote.
The AAI attorneys raise several criticisms of the price caps in the proposed settlement deal, including the ability of the court to enforce the price caps; the likelihood that the price caps "provide, at best, only temporary relief;" and "concerns that the price caps do not apply to Medicaid Managed Care or Medicare Advantage."
Rigorous M&A Review Process
To boost coordination of care and shore up their finances, health systems from coast to coast have launched a wave of M&A efforts. Partners has faced a particularly arduous journey in its attempt to acquire South Shore Hospital in South Weymouth, MA and two other suburban hospitals.
Partners has been in acquisition talks with South Shore Hospital for three years, according to a health system official. In May, Coakley struck a settlement deal on Partners' proposed M&A plan, sparking a legal inferno in Suffolk Superior Court.
An aspect of the court battle that is unique to Massachusetts is a new state healthcare law adopted in 2012: Chapter 224. In a comment letter filed at the attorney general's office on Oct. 21, Stuart Altman, PhD, chairman of the state Health Policy Commission, describes a critical provision of Chapter 224 that establishes Cost and Market Impact Reviews for healthcare organization transactions.
The CMIR process includes "public assessment of a broad spectrum of potential impacts from healthcare market changes, ranging in changes from cost, quality, and market performance to impacts on the availability and accessibility of services," Altman wrote.
Under Chapter 224, the Health Policy Commission bears responsibility for conducting CMIR investigations. If the CMIR process raises any red flags, a report is filed with the attorney general's office. After conducting a CMIR probe of Partners' M&A plan, the Health Policy Commission filed two reports with Coakley's office: one on the proposed South Shore Hospital acquisition and the other on Partners' proposal to acquire Hallmark Health System, which includes a pair of hospitals in Medford and Melrose.
Coleen Elstermeyer, chief of staff at the Health Policy Commission, says Massachusetts is leading the nation in conducting rigorous reviews of health system mergers and acquisitions. "To our knowledge, Massachusetts' CMIR process is unique; no other state has authorized such broad, policy-oriented reviews that enable the public and policymakers to assess the cost, quality, and access impacts of health care transactions. Such reviews are distinct from, but may complement, administrative determinations of need and law enforcement reviews," she says.
Rich Copp, Partners' VP of communications, says opponents of the health system's M&A plan have turned the CMIR process to their advantage. "Judge Sanders is being asked to approve a settlement agreement arising out of a complaint filed by the AG alleging antitrust violations. These allegations are being asserted based on extensive antitrust investigations that were conducted by the AG and the federal Department of Justice into Partners' past contracting practices and proposed acquisition of SSH and Hallmark."
"The Health Policy Commission's findings, pursuant to Chapter 224, are merely part of the input that the DOJ and the AG considered in reaching their conclusions. But the public nature of the HPC's process has allowed competitors and payers to express their opposition in a forceful way."
Copp says the CMIR process has placed Partners' M&A plan under unprecedented scrutiny. "Thus far, the judge has opted to continue to let those voices be heard as she considers whether to approve the settlement. Most courts would yield to the judgment of the DOJ or a state AG to settle a case, given the well-established legal principle of prosecutorial discretion."
Orthopedics is all they do at New England Baptist Hospital, and they do it very well, drawing patients from across the Northeast to a new outpatient surgical care center outside Boston. "We are a focused factory," explains one senior executive.
John Richmond, MD
The struggle for survival is presumably ingrained in the genetic code of all organisms on Earth.
Whenever I look for journalistic partners, I seek organizations that have excellence present in their collective DNA.
New England Baptist Hospital in Boston has the excellence gene. When alerted earlier this year that I would be moderating an orthopedic medicine webcast, I immediately targeted NEBH, which has a world-class main campus in Boston's Mission Hill neighborhood. Next week's webcast will focus on NEBH's new outpatient surgical center in Dedham, MA, one of Boston's southwestern suburbs.
The first time I crossed paths with one of the webcast's two speakers was more than a year ago. John Richmond, MD, is NEBH's medical director for network development, and the description he provided of his employer during our first encounter resonated with my inner economist. "We are a focused factory," he told me.
Orthopedics is all they do at NEBH, and they do it very well. The organization has amassed awards and honors, including recognition from Healthgrades for Patient Safety Excellence and Outstanding Patient Experience and high hospital rankings from U.S. News and World Report.
NEBH draws patients from across New England, other Northeast states, and beyond. Serving that far-flung patient population was one drivers behind NEBH's decision to open the Dedham outpatient surgical center, which is located near Route 128, the main bypass highway that rings Boston.
Convenient access to NEBH orthopedic services is a plus for patients who live outside the city and allowed NEBH to strengthen its organization, broaden its market reach, and establish a new revenue stream. Payers benefit from orthopedic services being delivered in a lower-cost setting.
The Dedham facility has been developed and operated through two joint-venture companies: one focused on management and the other on real estate. Ownership of the facility is spread between three entities: NEBH and Quincy, MA-based Shield HealthCare have 25% stakes, and physicians associated with NEBH have a 50% stake.
The outpatient surgical center is not a new concept. Way back in January 2007, HealthLeaders magazine forecast the growth of ambulatory surgical centers. One of the many prescient points made in that article is directly applicable to next week's webcast: "In the future, general outpatient care may lose business to centers offering more directed services."
That future is playing out at the New England Baptist Outpatient Care Center in Dedham.
The second member of next week's webcast presenter duo is Rachel Rosenblum, NEBH's VP of ambulatory operations and program development. She describes NEBH's facility in Dedham, which opened last fall, as a "musculoskeletal care center" and "a destination for care across the orthopedic spectrum."
"One-stop shopping" has become a catch phrase in the marketing of outpatient care facilities, and it is an apt description of the patient experience at the New England Baptist Outpatient Care Center.
The 66,000-square-foot structure houses a wide array of professionals and equipment under one roof, including offices for surgical practices and an MRI-equipped imaging center. The range of services includes several state-of-the-art operating rooms paired with dual-use pre-operative and post-anesthesia care unit bays, an interdisciplinary pain center, rehabilitation services, a spine center, and occupational health programs such as firefighter and police exams.
When it comes to outpatient surgical centers, NEBH has provided an excellent model for others to follow: high-quality care, convenience for patients, and a business model that spreads the risks associated with building and operating a world-class facility.
Webcast: Join leaders from New England Baptist Hospital as they share best practices and host an interactive Q&A around contemporary strategies for orthopedic success in the ambulatory environment in a webcast on Nov. 12, from 1:00–2:30 PM ET.
