Health disparities are key drivers of readmissions in hospitals treating underserved populations, research shows.
Rather than medical treatments, health disparities disproportionately drive many hospital readmissions, leading to correspondingly high volumes of penalties for hospitals treating large numbers of underserved patients.
Factors such as race, income, and insurance status are large factors in readmissions, according to researchers.
Researchers at MedStar Georgetown University Hospital studied readmissions after colorectal surgery, which has a high risk for postoperative complications and hospital readmissions within 30 days of discharge.
The researchers examined outcomes and patient factors in more than 168,000 colorectal surgery patients treated in 374 California hospitals from 2004-2011.
Forty-seven of these hospitals were considered minority-serving hospitals, treating a high percentage of minority patients. Hispanic and black patients comprise 63% of the patient population in minority-serving hospitals, compared with 17% in other hospitals.
After accounting for a patient's age, gender, comorbidities, and year and type of procedure, the researchers found that, overall, 30-day, 90-day, and repeated readmission rates were 11.6%, 17.4%, and 3%, respectively.
In comparison, the rates in minority-serving hospitals were 13.6%, 20.1%, and 4%, respectively. Inpatient mortality was also significantly higher at minority-serving hospitals (4.9%) compared to non-minority-serving hospitals (3.8%).
Patient factors (race, low income, and insurance status) accounted for up to 65% of the observed increase in odds for readmission at minority-serving hospitals, the investigators found.
Hospital-level factors (such as procedure volume and procedure type) accounted for up to 40% of the increase.
CMS takes the view that all hospitals should be held to the same readmission standard, noted the study's senior investigator, Waddah B. Al-Refaie, MD, FACS, surgeon-in-chief at Georgetown Lombardi Comprehensive Cancer Center and chief of surgical oncology at (GUH).
That standard comes with a high price: So far, the Hospital Readmission Reduction Program has penalized more than half of the nation's hospitals for failing to meet expectations, imposing more than $500 million in fines to date.
Writing in the journal Surgery published online Oct. 28, the study's investigators say the federal government should take patient factors into account in their push to reduce hospital readmission rates.
"If these factors are not balanced out, we fear minority-serving hospitals will face substantial, crippling financial penalties, and may end up being selective about the patients they admit," Al-Refaie said in a statement about the study.
"These findings suggest that CMS should account for patient socio-economic factors when they compare readmission rates," he said.
"Minority-serving status of a hospital is important. These hospitals typically serve as a safety net in low-income communities; their patients tend to have more co-morbidities and less resources to support their health."
Safety-net hospitals—those providing healthcare to a large proportion of uninsured and patients with Medicaid—are more commonly penalized under the HRRP program.
"We worry that imposing unfair fines for surgery readmission on hospitals that are already financially vulnerable will have unintended consequences on patients," he says.
"These hospitals may become less inclined to take in sicker patients and reduce spending necessary for patient safety, and that puts more patients' health at risk."
ECRI Institute engineers, scientists, clinicians, and other patient safety analysts rank the top technology-related threats that healthcare providers are likely to encounter in the coming year.
Infusion errors, dirty scopes, and missed ventilator alarms are top threats to patient safety that healthcare providers will likely encounter in the coming year, according to ECRI Institute.
ECRI's annual Top 10 Health Technology Hazards for 2017list is offered to help hospitals and other healthcare facilities recognize the danger or difficulty that comes with health technology, and the steps needed to minimize adverse events.
"This list focuses on what we call generic hazards—problems that result from the risks inherent to the use of certain types or combinations of medical technologies. It does not discuss risks or problems that pertain to specific models or suppliers," ECRI said in an executive brief.
To compile the list, ECRI staff consider the thousands of health-technology-related problem reports receive through its Problem Reporting Network and through data that participating facilities share. The Top 10 List is drawn from recommendations submitted by ECRI Institute engineers, scientists, clinicians, and other patient safety analysts.
The top hazard in 2017 waves a red flag at infusion errors that can still occur when using large-volume infusion pumps. ECRI notes that modern pumps have safety mechanisms that reduce the risks of infusion errors, but they cannot eliminate all potential errors, and the mechanisms themselves have been known to fail.
"ECRI Institute continues to receive reports and investigate incidents of uncontrolled flow of medication to the patient—a potentially fatal circumstance known as "IV free flow"—and other infusion errors," the report said. "Fortunately, a few simple steps can help catch use errors and component failures before patient care is affected."
The list for 2017:
1. Infusion Errors Can Be Deadly If Simple Safety Steps Are Overlooked
2. Inadequate Cleaning of Complex Reusable Instruments Can Lead to Infections
3. Missed Ventilator Alarms Can Lead to Patient Harm
"Most of these hazards persist, and hospitals should continue working toward minimizing them," the report said. "Rather, our experts determined that other topics should receive greater attention in 2017."
The redesigned site offers a better mobile experience and easier-to-use navigation tools.
Nyack Hospital, a 375-bed facility in Rockland County, NY, launched a more user-friendly website last month. Now it's promoting the site with a new breast cancer awareness campaign.
The website design includes tools that make navigating a complex site easy for Nyack Hospital's audience, said Melissa Behrens Lipovsky, vice president and creative director for The Byne Group, the New York creative marketing agency that redesigned the website.
"Nyack Hospital's website is a crucial communication channel for marketing to current and potential patients, visitors, and the community," Lipovsky said. The site can be accessed via computer or mobile device, and is optimized to build trust, she said.
One of the hospital's first initiatives on the re-launched website was an area celebrating Breast Cancer Awareness month in October.
The breast health awareness campaign—"Feel Empowered"—has a designated page on the site, where users can learn about breast cancer, find out how to reduce their risk of developing the disease, check out services offered by The Breast Center at Nyack Hospital, and read how to prepare for a mammogram.
"The Breast Center at Nyack Hospital exceeds New York State, The ACS Eastern Division and the Middle Atlantic Region in high performance rates in all categories analyzed and reported," the web copy states.
"These outstanding statistics are the result of the Nyack Hospital's outcomes in cancer treatment and in our exemplary patient satisfaction scores."
Patients and prospective patients can also use the site's "send a reminder" function to remind a friend to get a mammogram. The revamped website provides an improved mobile experience, which visitors can use to find a physician, get directions, and contact the hospital.
Duracell uses a Star Wars-themed ad to launch a million-battery donation drive to power toys children can play with during their hospital stay.
Duracell announced last week that it will donate 1 million batteries to 147 Children's Miracle Network Hospitals across the United States with the release of a Star Wars Rogue One-themed commercial.
The 60-second spot, which features rebel kids trying to fight stormtroopers in order to deliver a toy R2-D2 to a sick patient at a children's hospital, generated a good deal of media buzz for the battery company and the health system.
"The sheer power of Star Wars has been igniting imaginations for decades so we felt like it was a great fit for a holiday campaign," Ramon Velutini, marketing director for Duracell, told Mashable.
"Duracell and Children's Miracle Network Hospitals are powering imaginations of brave rebels everywhere," a voiceover states at the end of the action.
After the ad ends, a call to action plays. "Join Duracell in donating to Children's Miracle Network Hospitals to power imaginations of kids throughout the holidays," the voiceover says, while a link to the donation microsite is displayed.
The donated batteries will be used to power toys for children to play with during their hospital stay, according to Children's Miracle Network. Because play is outside of typical medical treatments, toys are almost always funded by individual and corporate donations.
"Tapping into our imaginations during the healing and recovery process reduces stress, pain, and anxiety," Charlotte Reznick, PhD, an internationally recognized child educational psychologist, said on the Duracell donation microsite.
"I'm delighted that Duracell has embraced the fact that letting kids be kids through imaginative play is healthy—mentally, emotionally and physically."
Since the video was posted on YouTube on October 17, it has been viewed more than 950,000 times. Children's Miracle Network shared the post on Facebook, writing "Powering the healing power of play, Duracell is."
Horizon Blue Cross Blue Shield of New Jersey's episode-of-care pilot for Crohn's disease is its first bundled-payment program that includes behavioral health treatment.
A Blue Cross Blue Shield affiliate that has played a leading role in developing commercial insurance bundled-payment models is launching an episode-of-care pilot program for Crohn's disease that includes a behavioral health component.
Last month Horizon Blue Cross Blue Shield of New Jersey announced that the Crohn's disease bundled payment program will start with about 50 patients in partnership with Hillsborough, NJ-based Digestive Healthcare Center (DHC).
Horizon and DHC launched The Garden State's first colonoscopy bundled-payment program in 2014.
The behavioral health component in the Crohn's disease pilot program aims to have a positive impact on patient outcomes and help control costs, according to a prepared statement from Horizon.
The goal of the one-year pilot is to identify Crohn's patients who may benefit from behavioral health support and to ensure that they receive those services.
"That support can prove essential to optimizing the benefits of their medical care by increasing the likelihood that patients adhere to their treatment plans, better manage their disease, and avoid unneeded emergency room visits and hospital admissions," Horizon stated.
Seven physicians at DHC's clinics in Hillsborough, Somerville and Warren, NJ, will be providing treatment through the Crohn's program, according to the statement.
Crohn's disease is associated with inflammation of the digestive track's lining, with symptoms including abdominal pain, severe diarrhea, and malnutrition, according to the Mayo Clinic.
With the launch of the Crohn's disease episode-of-care pilot program, Horizon has developed more than a dozen bundled-payments programs.
"Horizon continues to break new ground in our collaborations with doctors, hospitals and specialists who share our commitment to transform New Jersey's healthcare delivery system to be more patient-centered and value based," Lili Brillstein, MPH, Horizon's episodes of care director, said in the statement.
"Bringing a behavioral health component into this episode can help us understand how to improve care for the whole person, which can ultimately enhance the patient experience, improve patient outcomes and reduce costs."
Horizon offers healthcare providers shared-savings payments as part of its bundled-payments programs.
In 2014, fifty-one medical practices earned $3 million in shared-savings payments in five specialty areas, including colonoscopy and pregnancy, according to the not-for-profit's 2015 annual report.
Horizon is New Jersey's largest health insurer, with more than 3.8 million members. Last year, it reported total revenue at $11.4 billion.
Data from a social network for physicians reveals that millennials are increasingly likely to challenge doctor recommendations and less likely to build relationships with physicians.
Consumers of all ages are finding fewer physicians to choose from on the health insurance exchanges. And when millennial customers do line up a doctor, they are changing the relationship.
Those are two conclusions from research by Sermo, a social network that bills itself as the "virtual doctors lounge" where physicians speak freely.
Sermo polled its network of U.S. physicians recently and found that 57% of physicians participate in health insurance plans offered in the federal or state exchanges under the Affordable Care Act, down from 61% who reported participating last year ahead of 2016 open enrollment.
The doctors are also talking about how millennials—the young people so eagerly sought by health plans now—are changing the traditional doctor/patient relationship, keeping their distance and working the system to better satisfy their needs.
Chatter on the network suggests millennials are more likely to challenge doctor recommendations, more comfortable discussing healthcare costs, and less likely to build relationships with physicians.
The millennial generation usually is described as people born between 1980 and 2000, and they often are described as more self-centered and less ambitious than previous generations of Americans. But that's not how physicians describe them.
Doctors on the social network are more likely to say millennials are better at involving themselves in care decisions and questioning the costs of treatment. In other words, they're no pushovers.
Forty-five percent of doctors polled by Sermo said the top difference between millennial patients and others is that millennials are more likely to challenge treatment recommendations than other patients. An additional 16% identified millennials' cost-consciousness as the biggest differentiator between them and other generations.
Younger patients also don't go for the traditional relationship with their doctors.
Booking one-off appointments appears to be a common habit of millennial patients, with 57% of physicians reporting that millennial patients are likely to seek a one-time appointment instead of developing a relationship with a physician.
Only 43% of physicians polled said their millennial patients return at the same rate as others.
When asked what other effects millennials might have on the healthcare system, respondents offered the following expectations:
28% said they expected millennials to drive the increased use of telemedicine
27% said millennials would spur the proliferation of walk-in clinic settings
24% said millennials would boost online scheduling and extended hours
11% said this group would drive greater transparency for out-of-pocket costs
10% said they would hasten the use of easily portable electronic health records
Millennials tend to be more careful than most patients with their healthcare dollars. Fifty-four percent of the physicians reported their millennial patients were more up-front about asking for lower-cost alternatives than other patients.
The pay regulations for 2017 are expected to increase Medicare payments to hospitals for outpatient services by 1.7%.
Details about the 2017 Outpatient Prospective Payment System (OPPS) final rule, which also finalizes changes to the Ambulatory Surgery Center (ASC) Payment System were announced by the Centers for Medicare & Medicaid Services Tuesday.
The final rule includes new Medicare Physician Fee Schedule (MPFS) rates for items and services rendered to Medicare beneficiaries at off-campus outpatient departments owned by hospitals.
Under the 2017 OPPS final rule, CMS is raising OPPS payment rates 1.65%, according to a fact sheet. "The change is based on the projected hospital market basket increase of 2.7 percent minus both a 0.3 percentage point adjustment for multi-factor productivity (MFP) and a 0.75 percentage point adjustment required by law."
Once all of the outpatient payment rule changes announced Tuesday are accounted for, CMS estimates next year's Medicare payments to hospitals for outpatient services will be slightly higher than 1.65%. That is "before taking into account changes in volume and case mix" for hospitals paid under the OPPS, the fact sheet says.
New Payment Rules for Off-Campus Outpatient Departments
Under the interim final rule for PBDs, CMS is establishing "a billing mechanism for hospitals to report and receive payment under the MPFS" for items and services rendered to Medicare beneficiaries at PBDs. This new billing mechanism is set to be implemented Jan. 1.
Most items and services rendered at PBDs will receive reimbursement at 50% of the OPPS rate, according to CMS. There are PBD items and services that will be exempt from the new payment mechanism, including payment for separately payable drugs, which will not be subject to the lower payment rate.
The interim final rule for PBDs establishes three exemptions for the new payment rules that will keep some off-campus outpatient departments under the OPPS reimbursement regulations:
Dedicated emergency departments
PBDs that billed for services under the OPPS before Nov. 2, 2015, and have not "impermissibly relocated or changed ownership."
PBDs that are located within 250 yards of a hospital or a "remote location" of a hospital.
Other Payment and Quality Measure Changes
The payment rules also revise the Medicare inpatient-only (IPO) list, which designates medical procedures that must be paid under the Inpatient Prospective Payment System (IPPS).
Services rendered under the IPPS are reimbursed at higher rates than services rendered under the OPPS. For next year, CMS is removing seven procedures from the IPO list: five spine operations and two laryngoplasty procedures.
One of the most significant quality-measure changes is removal of "pain management dimension questions" from the Hospital Value-Based Payment (VBP) Program. CMS made this change based on concerns "that the linkage of these particular questions to the Hospital VBP Program payment incentives creates pressure on hospital staff to prescribe more opioids in order to achieve higher scores on this dimension."
CMS plans to accept public comments on the 2017 OPPS and ASC final rule as well as the interim final rule on MPFS rates for off-campus outpatient departments through Dec. 31. The 2017 OPPS and ASC final rule is slated for publication in the Federal Register on Nov. 14.
The two companies will operate home health and hospice centers located near LifePoint hospitals. The deal is expected to be operational by the end of 2016.
LHC Group, Inc. and LifePoint Health are forming a joint venture that will operate home health agencies and hospices near LifePoint hospitals, the two companies announced Wednesday.
Under the deal, the joint venture will shift day-to-day operations of LifePoint's home health agencies and hospices, and future home health and hospice acquisitions, to LHC Group. LifePoint's home health agencies and hospices will continue to operate under their existing names.
The joint venture will be governed by a board with equal representation from both companies, the two companies said in a joint media release.
"This partnership further demonstrates our commitment to making communities healthier beyond the walls of our hospitals and across the continuum of care," said LifePoint CEO and Chairman William F. Carpenter III.
"Post-acute services are an increasingly important part of our business and our communities' healthcare needs," he said. "By leveraging LHC Group's expertise, we will gain access to the resources and the infrastructure needed to enhance our existing home health and hospice services, invest more in care coordination across our network, and expand access to these services in all our communities."
Lafayette, LA-based LHC Group operates 133 hospital and health system-partnered home health and hospices, and more than 300 post-acute care locations across 25 states. Brentwood, TN-based LifePoint operates 20 home health and 10 hospices in its network of more than 70 hospitals in 22 states.
"This partnership brings together two culturally aligned companies that are driven by a vision of expanding home health and hospice care, ensuring that patients and families in need of these services have access to them, and improving the health of communities." said Keith G. Myers, chairman and CEO of LHC Group
The joint venture is expected to begin by the end of 2016, subject to regulatory approval.
Efforts go beyond treatment to recovery and ERs are increasingly offering patients who seek help for overdoses additional resources for drug addiction and recovery therapies.
The opioid epidemic presents in hospital emergency rooms in different ways. Addicts show up asking for prescription opioids for pain. Or patients who are overdosing on heroin and other opioids arrive for treatment.
Prescription monitoring programs and guidelines from the Centers for Disease Control and others aim to limit unnecessary prescribing of opioid drugs.
Now emergency rooms are developing programs to get patients help not only if they've overdosed, but also if they want addiction treatment. Boston Medical Center (BMC) last month announced the launch of its "Faster Paths to Treatment Opioid Urgent Care Center.
The effort, supported by a $2.9 million grant from the Massachusetts Department of Public Health, "rapidly links patients to an enhanced and integrated system of addiction healthcare delivery through inpatient and outpatient treatment services, detoxification, and follow-up care," according to an announcement from BMC.
The program will involve intake triage, referrals to addiction treatment and primary care, overdose education, "naloxone rescue kits," as well as transportation and community support services.
BMC also offers medication treatment for "appropriate patients… After these patients are stabilized, they are enrolled in maintenance programs at their local community health centers or at BMC," according to the release.
In 2015, 1,379 people overdosed in Massachusetts. Boston Emergency Medical Services transported 2,601 patients with "narcotic issues" to area hospitals and nearly 37% of those patients went to BMC.
Other emergency room programs are emerging nationwide. Starting November 1, "recovery coaches" will be on call at the emergency room of SSM Health St. Mary Hospital in Madison, WI.
Under the voluntary program, patients treated for overdoses will be offered a meeting with a counselor, according to The Badger Herald, a student paper for The University of Wisconsin.
A July report from the National Governor's Association called for the establishment of "peer-based recovery programs in emergency departments." And others programs are coming on line.
In Manchester, NH, those in need of help can look to pre-hospital providers. The state's Safe Station program encourages those looking for help to go to any city fire station. Firefighters have been trained to connect addicts with support and services.
Stagnating incomes make even modest premium increases more damaging to families and there are significant differences in premium costs among states, says a Commonwealth Fund report.
Employees' contributions to their health insurance premiums grew at a slower pace than might have been expected between 2010 and 2015 in 30 states and Washington, DC, but U.S. families are spending a bigger share of their income on healthcare because income increases have not kept pace with rising healthcare costs.
Although consumers on the open market are being hit with sometimes double-digit premium increases as their deductibles continue to climb ever higher, employers appear to be absorbing more modest increases with little difficulty, according to a Commonwealth Fund state-by-state analysis that compared the cost of employer health insurance between 2006 and 2015.
The vast majority of people under age 65 in the country, 154 million, get their health insurance through an employer, the report notes.
The report found that families spent an average of 10.1% ($6,422) of their income on health insurance premiums and deductibles in 2015. There were differences among states, sometimes significant.
Mississippi, for instance, has the lowest median income and among the highest health insurance contribution levels, with families spending an average 14.7% of their income on health insurance costs.
Families in Arizona, Florida, Mississippi, New Mexico, Oklahoma, Tennessee and Texas pay an average of 12%. The lowest health insurance costs as a share of income were found in the District of Columbia (6.8%) and Massachusetts (7.3%).
Stagnating incomes make even modest premium increases more damaging to families, the study's lead author, Sara Collins, said in a statement announcing the report. Collins is vice president for healthcare coverage and access at The Commonwealth Fund.
"The good news is that premiums in employer plans are growing more slowly on average, as is the amount employees are being asked to contribute," she said.
"Unfortunately, many employees with moderate incomes aren't feeling the benefits of these slowdowns, because they haven't yet experienced the sustained growth in their income needed to keep up with health costs."
When looking at total premium costs in employer plans, combining employer and employee contributions, both employer and employee, annual premium growth rates for single policies have slowed down in 33 states and the District of Columbia since 2010, the researchers found.
The largest slowdown was in Louisiana, where the average premium growth fell from 7.8% a year between 2006 and 2010 to 2.4% from 2010 to 2015. However, premiums have continued to grow by at least 5% per year in Alaska, Hawaii, Idaho, Kentucky, Maryland, New Hampshire, New York, and Utah.
The Commonwealth Fund report suggests that the ACA provisions affecting employer plans, such as covering preventive care without cost-sharing and allowing young adults to remain on a parent's plan until age 26, do not appear to have increased employer health insurance premiums significantly and have been absorbed relatively easily by U.S. employers.
Average deductibles for employer-provided single-person plans grew 8.5 % a year between 2010 and 2015, with deductibles growing at a slower pace in 27 states and at a faster pace in 22 states and the District of Columbia.
Employee premium contributions grew more slowly, but still accounted for a larger share of people's income than in earlier years, an average of 5.8 %t of median income nationally, compared to 4.2 percent in 2006.
There was wide variation between states, as employee contributions ranged from 4.2% of median income in Hawaii to 9% in Mississippi.
The researchers note that in addition to increased incomes, the cost of healthcare in the United States must be kept in check to keep employer-provided premiums and deductibles from rising as much as commercial health plans on the open market.