A non-profit organization is sending Oculus Rift head-mounted displays to pediatric patients for therapeutic virtual reality sessions.
Pediatric patients are leaving their hospital rooms without ever leaving their hospital rooms.
Summerlin Hospital in Las Vegas, NV, is piloting a virtual reality program that allows its children, teen and young adult patients put on a headset and mentally escape their hospital beds and explore beyond the hospital walls.
The virtual reality program is provided at no cost by VR Kids, a non-profit organization that sends volunteers equipped with Oculus Rift head-mounted displays and virtual storybooks to the hospital's pediatric patients each week.
The program is a hit.
Abrielle, an 8-year-old patient who had been in the hospital for more than a week because of a ruptured appendix, took a virtual reality flight over a lake.
"I felt like I was somewhere else," she told a local news station. "It felt like I was actually flying. It was like being in Aladdin!"
For patients with limited mobility due to injuries, illness, or just the many IVs and wires requiring them to remain still, the opportunity to virtually leave the hospital is a welcome reprieve.
The VR sessions last three to 15 minutes in duration and are customizable. They are intended to be therapeutic as well as entertaining. The benefits, according to VR Kids, include relief from stress and anxiety, relaxation, and positive mental / physical connections.
"I've seen smiles from kids who maybe haven't smiled in a couple days since they've been here," said Jacquir MaCloud, Summerlin Hospital child life specialist.
"We build worlds for kids to feel like they're exploring and meeting new people and we try to have a travel experience, that's more than watching a movie or reading a book," said R.J. Sampson, VR Kids' executive director.
The organization, which is dedicated to bringing therapeutic virtual reality to mobility impaired and hospital-bound children, hopes to expand the VR Kids program to all hospitals in the Las Vegas Valley.
The number of providers able to e-prescribe controlled substances spiked 359% in 2015, according to data from Surescripts.
E-prescribing for controlled substances (EPCS) over the Surescripts network zoomed more than 600% in 2015, the health information network provider reports.
Such electronic prescribing has been hampered by a variety of factors such as more rigorous security requirements and physician concerns about implementation issues.
According to a report in the Annuals of Internal Medicine, overdoses due to opioid abuse quadrupled between 2000 and 2014. Current fatalities due to such overdoses now top 28,000 annually.
As a result, providers such as Surescripts and other EPCS providers have made implementing the technology a top priority. According to the Surescripts 2015 National Progress Report, released Tuesday, the number of providers enabled to use EPCS increased 359% in 2015.
According to the Centers for Disease Control and Prevention, opioid overdose is the number one cause of preventable death in the nation's drug abuse epidemic. EPCS plays a major role in allowing public health officials and regulators to identify patterns of prescription abuse both by patients and by providers.
Surescripts processed 9.7 billion e-prescribing transactions in 2015, a 48% increase over 2014, according to the report. Based on National Council for Prescription Drug Programs' total number of prescriptions, 77% of all U.S. prescriptions were digital in 2015, up from 67% in 2014 and 58% in 2013. Since 2012, Surescripts e-prescriptions have nearly doubled.
The report also ranks each state by its providers' readiness to e-prescribe. New York state leads the ranking, followed by Nebraska, Rhode Island, Michigan and Oregon. At the bottom of the ranking were Alabama, North Dakota, Arkansas, Mississippi and Hawaii.
Surescripts estimates that hospitals have saved more than $400 million in costs since 2010 by electronically transmitting medication histories over its network, helping to prevent more than 25,000 patient readmissions and more than 15,000 adverse drug events in 2015 alone.
According to the report, state e-prescriptions for antibiotics vary widely and most states exceed the US rate for antibiotic prescriptions.
Other factors are at play, but researchers have found a correlation between hospital readmissions and "pharmacy density."
Hospital readmission rates are higher in Oregon communities with limited access to pharmacy services, according to a University of Oregon study.
Researchers compared Medicare readmission rates and what they called "pharmacy density" for hospitals in different primary care service areas. The sample included 507 pharmacies and 58 hospitals in 48 service areas.
The authors suggest that community pharmacists can reduce readmission rates because they are able to "assess medication adherence, provide education, and offer self-care recommendations."
They cite previous research which found patients who received medication therapy management, including dose adjustments and self-care recommendations, were less likely to be readmitted.
Defining Density
Regions with fewer than 350 outpatient pharmacy hours, the total number of hours pharmacies were open, were defined as a low-density. Areas with more than 1,000 cumulative pharmacy hours were considered high-density.
All rural hospitals fell into the low-density range, while most urban hospitals were in high-density areas. People in low-density areas were older, had less education, and were more likely than residents of high-density areas to be "non-Hispanic white."
Readmission rates dropped as pharmacy density increased, reaching a rate of 14.7% in areas with high pharmacy density. Overall, hospital readmission rates in Oregon ranged from 13.5% to 16.5%.
The researcher note that they could not identify whether pharmacy access or population characteristics were independently associated with readmissions. But they called for more research, noting that hospitals in Maine, Michigan, and New York have opened outpatient pharmacies to improve access to care.
They conclude by noting that "further studies should be conducted to determine if, and in what circumstances, increasing medication access can reduce hospital readmissions."
The government isn't handing over the money just yet. CMS says participants can't receive more than they paid into the program, no matter how big their losses.
Health insurance is a tough business, and some insurers who saw business potential in the Affordable Care Act are finding that their dreams aren't coming true. Requiring every American to buy insurance apparently is no guarantee that commercial insurers and co-ops will stay in the black.
The latest to cry foul and demand compensation from the government is Community Health Options, a health insurance cooperative in Lewiston, ME, that claims the government should hand over $22.9 million to offset its 2015 losses.
The co-op was profitable in 2014, its first year of operation, and it was the only ACA co-op to turn a profit that year. But then it reported a $31 million loss in 2015 and projects a $43 million loss for this year. The nonprofit co-op provides coverage in Maine and New Hampshire.
There are winners and losers in every industry, but under the ACA some insurers have a route for recouping some of their losses. The "risk corridors" program was included in the ACA as a way to help insurers manage costs, profits, and losses for the first few years of the law, and insurers in the red are saying the program should start writing some big checks.
In addition to CHO, several other insurers have sued the federal government for funds from the risk corridors program. They include big names, such as the Blue Cross and Blue Shield affiliate Highmark in Pittsburgh. Highmark is asking for $223 million.
The government isn't handing over the money just yet. The Centers for Medicare & Medicaid Services oversees the risk corridors program and has issued statements saying that participants can't receive more than they paid into the program.
Congress designed the risk corridors program so that in good times, insurers with lower costs pay a portion of their profits into the program, and in bad times insurers can receive payments to help offset their losses.
Budget-neutrality Not a Requirement, CHO Says
So CMS is likely to argue that CHO is only entitled to the $2 million it paid into the risk corridor program after making a $7 million profit in 2014. But when the CHO lawsuit was announced, CEO Kevin Lewis said the co-op should receive $22.9 million for its 2015 losses. That's a big disparity in expectations.
A written statement from Lewis indicates that the co-op leaders believe they were playing by the rules of the risk corridor program and that keeping the program budget-neutral was never a condition of participation.
"We at Health Options have followed the law and helped expand the Maine and New Hampshire markets and make them leaders in terms of individual coverage through the marketplace. It's important for the government to make good on its payment obligations."
Lewis is doing the right thing for his co-op, but it seems unlikely CMS is going to hand out the large sums that he and the other struggling insurers are demanding under the risk corridors program.
The ACA was not designed to underwrite the financial losses of insurers to this extent; the risk corridors program was only an acknowledgement that some insurers would struggle and need a boost until they could get better footing. It wasn't intended to make everyone whole again after a bad experience in the ACA marketplace.
If the government disappoints the insurers seeking large sums, health plan leaders are likely to remember that the next time the government promises to safeguard them from financial failure.
Vindell Washington replaces Karen DeSalvo as National Coordinator for Health Information Technology as she steps aside and continues her role as Acting Assistant Secretary of Health.
After nearly two years at the post, Karen DeSalvo on Friday stepped aside as national coordinator for health information technology but will continue to serve as acting assistant secretary for Health, U.S. Department of Health and Human Services Secretary Sylvia M. Burwell announced.
Vindell Washington, MD, will replace DeSalvo as national coordinator. Washington has served as the principal deputy national coordinator at ONC under DeSalvo, where he led initiatives around delivery system reform, precision medicine, and the opioid crisis, Burwell said in a memo to HHS staff.
"In his capacity as national coordinator, Vindell will continue to lead the administration's efforts to leverage health information technology to reform how we pay for and deliver care; transform health research and innovation to empower clinicians, individuals and communities to manage their health; and oversee implementation of the Federal Health IT Strategic Plan and the Nationwide Interoperability Roadmap to unlock digital health data and ensure it is widely accessible, usable, and transferable throughout the public and private sectors," Burwell said.
In a memo to colleagues, Washington said he anticipates "a very busy fall," at ONC as the Obama administration transitions toward its final six months in office.
"From our critical work on the Interoperability Roadmap and the Strategic Plan, to supporting the Administration's efforts on Delivery System Reform, MACRA, precision medicine, and the Cancer Moonshot, to empowering consumers to be better partners in their health and care through our certification program, the interoperability commitments, and so many other efforts, we have our work cut out for us," Washington said. "It will be a sprint to the finish—and I know we will need 100% from each and every one of you to achieve all that we have set out to do."
DeSalvo has led ONC since January 2014 and has served a dual role as assistant secretary for Health since October 2014, at the onset of the Ebola crisis.
"Under her leadership, ONC has advanced interoperability across the health system—which underpins progress on a wide range of Department and Administration priorities," Burwell said. "She has also made significant advances to the Health Information Technology Certification Program to promote and expand the safe and secure flow of electronic health information when and where it matters most for individuals and clinicians."
Burwell also credited DeSalvo with a number of accomplishments as assistant secretary at Health, including her work on the water crisis in Flint, in promoting nutritional and physical fitness through the development of the Dietary Guidelines for Americans and the events surrounding the 60th Anniversary of the President's Council on Fitness, Sports, and Nutrition, and in leading the U.S. Public Health Service Commissioned Corps.
Technology costs at physician-owned multispecialty practices have risen by more than 40% since 2009, MGMA survey data shows.
New data from the Medical Group Management Association shows that physician-owned multispecialty practices in 2015 were spending more than $32,500 per full-time physician on the staff, equipment, maintenance, and supply expense necessary to implement healthcare information technology and services.
While the largest increase in tech costs took place between 2010 and 2011, when the HITECH Act took effect, costs continue to rise at a slower pace.
In recent years, declining government incentives have required practices to bear more of the cost to upgrade and maintain health information technology, MGMA noted.
"While technology plays a crucial role in helping healthcare organizations evolve to provide higher-quality, value-based care, this transition is becoming increasingly expensive," said Halee Fischer-Wright, president and CEO of the Medical Group Management Association, in a prepared statement.
"We remain concerned that far too much of a practice's IT investment is tied directly to complying with the ever-increasing number of federal requirements, rather than to providing better patient care. Unless we see significant changes in the final MIPS/APM rule, practice IT costs will continue to rise without a corresponding improvement in the care delivery process."
Overall, since 2009, technology costs at physician-owned multispecialty practices rose by more than 40%, according to MGMA survey data during that period of time.
IT staff expenses rose at the faster pace of 47%. MGMA suggested that increased staff costs mean that larger tech investments do not yet result in significant administrative efficiencies at practices.
The continuing IT cost rise is not the only rising cost of operating a physician practice. Total physician-owned multispecialty practice operating costs increased by almost 15% in 2015, MGMA said. Total revenue at these same practices rose by only 10% last year, MGMA reported.
Physician-owned multispecialty practices that are part of an accountable care organization reported lower costs and higher total medical revenue after operating costs in 2015, versus comparable 2014 data, MGMA said.
Hospitals that use ICUs frequently are more likely to perform invasive procedures and have higher costs, but without demonstrable improvement in patient survival.
Intensive care unit patients underwent costlier invasive procedures but didn't have better mortality rates than patients with the same medical conditions who weren't in the ICU, according to a new study published in JAMA Internal Medicine.
The study, conducted by researchers at LA BioMed and UCLA, looked at records from 156,842 hospitalizations at 94 acute care hospitals for four medical conditions where ICU care is often provided but may not be medically necessary: diabetic ketoacidosis, pulmonary embolism, upper gastrointestinal hemorrhage, and congestive heart failure.
Study author Dong W. Chang, MD, a researcher at LA BioMed, said hospitals that use ICUs more frequently were more likely to perform invasive procedures and incur higher costs. Chang said, however, that those hospitals demonstrated no improvement in mortality among these ICU patients when compared with other hospitalized patients with the four conditions.
"We found that hospitals that have high ICU utilization for one condition generally do so for other conditions as well," Chang said.
"This suggests that there are systematic institutional factors that affect whether hospitals over-use their ICUs. Importantly, hospitals that utilize ICUs more frequently were more likely to perform invasive procedures and have higher costs, but without] improvement in patient survival."
Smaller hospitals and teaching hospitals used ICUs at higher rates for patients with the four conditions studied than did larger hospitals.
Additional Hospital Costs
The difference in the average costs ranged from $647 more for upper gastrointestinal hemorrhage care in the ICU to $3,412 more to care for a patient with congestive heart failure in the ICU when compared with hospital care for the same conditions outside the ICU, according to the study.
Chang said optimizing ICU care will require assessments of institutional factors that may lead clinicians to over-utilize ICU care.
"In addition, overuse of ICUs among patients who can likely be treated in non-ICU settings may lead to inappropriately aggressive care and misallocation of resources away from patients who may truly need critical care services," he said.
"This study begins to tell the story of how the inappropriate use of ICUs can be harmful for patients and costly for the healthcare system," Chang said.
"But the story is incomplete, and we need more information on the mechanisms that drive some hospitals to use their ICUs more readily. In the meantime, hospital policies and institutional protocols in non-ICU settings that lead to overutilization of ICU care should be examined because they represent the best opportunities for reducing invasive procedures and lowering costs while ensuring the best possible care for the patient."
Through its blog, Facebook page, and Pinterest board, the Texas-based freestanding emergency center operator is promoting and supporting its expansion.
Neighbors Emergency Center in Longview, TX, took a neighborly approach to its grand opening on Saturday.
The family-friendly event featured free food, several giveaways, and activities. The organization promoted the event in the local media and on its Facebook page, which has nearly 8,000 likes.
The Longview center, which officially opened on June 28, is the newest location for the rapidly expanding Neighbors Health System, which runs a series of 24-hour freestanding emergency centers throughout Texas.
"We are proud to serve the Longview community," Chief Nursing Officer Lauren Cotton said in a media release when the center first opened. "Neighbors' focus is to make lives better for patients by providing them with a more personalized 24-hour emergency care experience while offering the same level of access and services as a hospital-based emergency room."
Neighbors Emergency Center also promoted the new location on its "Best Neighbors Ever" blog, which features content geared toward health families. Topics include healthy recipes, health and fitness, content for kids, contests, news, and staff picks.
"Download coloring sheets for the kids, learn the proper post-run stretches, or see where our doctors like to go for lunch in your city. There is truly something for everyone here. We are excited to welcome you to the NEC family, a group of individuals committed to your health, well-being and community."
NEC provides even more digital engagement on its Pinterest page, where it has aggregated posts on topics such as "Texas Hiking" and "Houston Foodies," in addition to typical health and wellness topics.
Neighbors has more than 25 in Texas, in cities including Houston, Austin, El Paso, Beaumont, and the Permian Basin. The health system says it plans to open more centers College Station and Colorado in 2016.
Overreliance on the ICU for cardiac patients leads to worse outcomes, study finds. "We still have an open question of what to use the ICU for," says one researcher.
Hospitals that rely the most heavily on the ICU to treat their heart patients had higher 30-day mortality rates for those patients than hospitals with the lowest ICU heart admissions, researchers have found.
Data shows that heart attack patients treated in high-ICU hospitals were 6% more likely to die within 30 days of discharge than patients admitted to low-ICU hospitals, and the difference was about 8% for heart failure patients.
The study, published online in the journal CHEST, is also a reminder that it's often unclear when and why patients should actually be admitted to the ICU, and that usage of ICUs varies widely from hospital to hospital.
More than 150,000 hospitalizations for acute myocardial infarction at nearly 1,700 hospitals were identified, and 46% of them included care in an ICU. More than 400,000 hospitalizations were for heart failure at 2,199 hospitals, and 16% of them included an ICU stay.
The researchers used the federal government's Hospital Compare website to examine how well each hospital did at providing high-quality care, and what percentage of their patients died or ended up back in the hospital within a month of the hospital stay. They divided all the hospitals into five groups, from lowest ICU use to highest.
Hospitals in the lowest quintile had ICU admission rates of less than 29% for acute myocardial infarction (AMI) or less than 8% for heart failure. However hospitals in the top quintile had ICU admission rates of greater than 61% for AMI or greater than 24% for heart failure. Hospitals in the highest quintile had higher process measure failure rates for some but not all process measures.
There were no differences in the odds of being hospitalized again, or in total spending on care.
More ICU Use, Poorer Quality Care
Researchers also found evidence of lower quality of care among hospitals that used the ICU more often.
The hospitals with high ICU use were less likely to give heart attack patients aspirin when they arrived. They were also less likely to give other drugs that are known to improve outcomes after heart attacks.
In heart failure cases, the hospitals with high ICU were less likely to give some important medications, perform key tests of heart function, and counsel patients to stop smoking.
The authors also found that hospitals with the highest percentage of patients admitted to the ICU tended to be those with the smallest numbers of heart attack and heart failure patients over all, suggesting a lack of institutional familiarity with these conditions.
These were also more likely to be for-profit hospitals. Patients treated in them were more likely to be from low-income ZIP codes.
According to the authors, the study results suggest a need for more standardization in deciding which patients need an ICU, as well as a greater focus on quality of care in hospitals with the highest ICU use.
"In this country, we still have an open question of what to use the ICU for, and when, and very little evidence to guide physicians," first author Thomas Valley, MD, MSc, said in a statement.
"Is it for those who were already sick and got worse, or is it a place to send people proactively when we think they might get sicker? And the answer can vary on different days, or based on how many beds are available right then. We hope to build a body of evidence about how to use this valuable resource in the most effective way."
Co-author Michael Sjoding, MD, MSc, previously led a study that showed a similar pattern among patients hospitalized for pneumonia. The hospitals that sent the most such patients to the ICU had the lowest quality performance on that condition, too.
"These studies suggest that hospitals using the ICU frequently could be targets for improvement. If we find out why hospitals are using ICU beds more often for these patients, we could intervene to improve care overall," Valley said.
The Catholic nonprofit is creating a new business unit to find partners in regions and countries "where we can bring value and, in turn, receive value."
Ascension Health is going international in an effort to diversify its financial platform.
The new business unit will enable the health system to gain knowledge and deliver a return on investment through exposure and early access to the growing environment of innovative ideas and thinking from other parts of the world, said Anthony Tersigni, EdD, FACHE, president and CEO of Ascension, in a press release.
The initiative, which follows several years of exploration by the health system's board of directors on how best to expand its international presence, will be a subsidiary of the St. Louis-based healthcare system, called Ascension Holdings International.
The unit will be led by John Doyle, president and CEO of Ascension Holdings, the health system's innovation arm, which includes several companies that range from providing medical equipment and device management services to services that centralize and streamline internal processes for health systems.
"As we expand our engagement with international markets, Ascension Holdings International will focus on select regions and countries based on population size, safety and stability, rule of law, and business environment," Doyle said.
No specific regions or countries were named.
"We will begin by taking advantage of existing Ascension strengths and capabilities that can benefit healthcare providers in those markets. We expect this approach to open the door to further opportunities to engage with local partners where we can bring value and, in turn, receive value."
Another important focus will be to collaborate with Catholic healthcare providers internationally to explore ways to work together in regional or national arrangements.
The Managing Directors
Jim Bonnette, MD, will serve as managing director of international relationship development at Ascension Holdings International, and Phoebe Yang, JD, will serve as managing director of international strategic design and implementation.
Bonnette comes to the new Ascension unit from the Advisory Board Company, where he was head of strategy consulting, and where he recently has been consulting with government agencies and health organizations in the U.K., France, Switzerland, Spain, Poland, Saudi Arabia, Singapore and Southeast Asia.
Yang joins the unit from MissionPoint Health Partners, part of Ascension's health management arm, where she led development of new solutions and capability enhancements to diversify the organization's revenue base and move into alternative risk-based offerings.
Ascension is the largest nonprofit health system in the U.S. and the world's largest Catholic health system.