In response to the global economic crisis, governments and central banks around the world invested aggressively to ease the flow of credit. Initial results are positive with a rally in global stocks yesterday. But in the face of these encouraging signs, economists say credit will still be pricey and hard to get, and for now they stand by predictions of a long-term global recession.
As I reported last week, private hospitals that depend on medical travel could take a hit. With consumer spending in the U.S. down last quarter for the first time since 1991 and rising unemployment, you can expect that consumers will be cautious to part with their money.
"There's more widespread individual concern about the economy than there has ever been," says Michael Taylor, a principal at Towers Perrin. With medical travel facilitating elective and cosmetic procedures, Taylor says consumers will likely delay even much-needed elective and preventive care.
"Traditionally, that's been the case: Elective procedures go down, preventive care goes down, and even cosmetic care will go down because consumers are trying to balance across increased mortgages, energy, food prices; there's no aspect of your market basket that isn't going up, so an elective thing can wait."
David Williams, cofounder and principal of MedPharma Partners, agrees that consumers will put off elective procedures, and he says emerging global hospitals that need to make investments to attract medical travelers will have a hard time accessing capital. On the other hand, more mature hospitals have less worry about new competitors entering their markets.
"There are a lot of hospitals that have good technology, good staff, and good services, and they're looking to leverage what they already have in the market to attract medical tourists," says Williams. "If you're an established facility, and you're worried about new entrants coming in, your worry just went down."
One bright light is that the price of oil has dropped recently, so travel costs are coming down. At the same time, employers here in the U.S. might be looking to medical travel to help slash the cost of healthcare. Taylor's gut reaction is that employers are going to be conservative for a while and won't want to do anything drastic with their current health benefits, but Williams says a recession could motivate employers to look for creative ways to cut health plan costs.
"When we're in an environment where the cost for other things will decline, it's not going to be acceptable that the cost of healthcare will continue to be so high," Williams says.
Tom Johnsrud, senior consultant in North America for ParkwayHealth, Singapore, predicts that employers will start looking at cutting costs wherever they can without cutting benefits. "Employers are going to push insurers," he says. "It's a grassroots movement, and insurers will be the last to go."
John F. Bonamo, MD, executive director of Saint Barnabas Medical Center in Livingston, NJ, spent a week in Beijing, China, earlier this year, teaching hospital CEOs and managers there how to be more effective leaders. The trip was part of an exchange program, through which several Chinese physician leaders will visit Saint Barnabas next month.
After studying the idea for more than a year, the city of New Orleans is negotiating to buy Methodist Hospital and open an emergency room that would serve residents of neighborhoods deprived of critical health services since Hurricane Katrina. State Sen. Ann Duplessis, whose district includes eastern New Orleans, said the city hoped first to re-establish emergency services at the hospital, which has stood vacant since Katrina flooding. Residents of the east have had to travel far during medical emergencies, distances that could prove catastrophic for those in critical condition.
It's not uncommon for patients with no insurance or poor insurance to receive different treatment: A 2006 study of 25 primary care private practices in the Washington, DC, area showed that in nearly one in four encounters, physicians reported adjusting their clinical management based on a patient's insurance status. Nearly 90% of physicians admitted to making such adjustments. For patients with no insurance, alterations occurred 43% of the time; and for the privately insured, just 19%.
Tens of thousands of Anthem customers could face higher healthcare bills or disruptions in service if they seek care from Indiana-based St. Francis Hospital & Health Centers after Nov. 2. That's when the hospital system plans to sever ties with the Anthem in a dispute over reimbursement rates. St. Francis' contract with Anthem does not expire until September, but the Catholic hospital system said it is prepared to sever ties with the insurer almost a year early.
Ascension Health is the country's largest nonprofit hospital system, and says its mission is to serve all. In 2007, an Ascension subsidiary closed Riverview Hospital, the third hospital it has shut down in Detroit in the past 10 years. Meanwhile, 30 miles away, in a suburb of multimillion-dollar homes, Ascension is opening a new $224 million hospital. The approach is an increasingly common strategy among nonprofit hospital systems: Close money-losing facilities in poor areas where a large share of patients are uninsured, and build or refurbish hospitals in affluent places where people have private insurance coverage.
The English government has struck a deal with doctors' leaders to reform the GP contract which MPs complained had led to "eye-watering" pay rises. The new deal with the British Medical Association will see the minimum income practice guarantee phased out by April 2011. MIPG was introduced years ago, alongside bonus payments for GPs helping people with conditions like diabetes or asthma better look after themselves. It soon emerged most practices came close to achieving the maximum bonus points, and the contract was also criticized for allowing GPs to stop offering out-of-hours care. Under the new deal, the amount GPs earn will be directly proportionate to the number of patients on their list and the health needs of their local populations, the Department of Health said.
Almost two-thirds of the patients getting basic medical care from the Cincinnati Health Department's primary care centers in 2008 are uninsured, according to city health officials. In 2005-06, that figure stood at 57%, and by the end of this year it will be about 64%, officials said. Given the nation's troubled economy the increase isn't a surprise, said Hirsh J. Cohen, assistant health commissioner for the city. But it does illustrate the need for better "safety net" health services, Cohen added.
Only half of New Mexico residents under 65 years old are covered by health insurance through their employers, according to an Economic Policy Institute report. The 50.7% figure is the lowest percentage of any state, and is much lower than national figures. New Mexico ranked second from the bottom in the percentage of children insured by an employer-sponsored health plan. Only Mississippi ranked worse.
The practice of prescribing medications electronically has been getting a good amount of attention recently. Everyone from CMS Acting Administrator Kerry Weems to Senator John Kerry and Former House Speaker Newt Gingrich are pushing hard for greater adoption of e-prescribing among providers. During last week's National E-prescribing Conference in Boston about 1,400 people gathered to hear Centers for Medicare & Medicaid Services acting Administrator Kerry Weems outline an e-prescribing incentive payment program that promises physicians and other eligible professionals incentive payments of 2% or less of their billing fees from Medicare. That program gets underway in 2009, and by 2012 Medicare will start deducting a financial penalty to those doctors who fail to e-prescribe.
For those providers who either remain baffled by how e-prescribing works or aren't convinced the switch is worth the trouble, the eHealth Initiative last week announced the publication of a "how-to" guide for clinicians looking to make the switch. The group worked in collaboration with the American Medical Association, the American Academy of Family Physicians, the American College of Physicians, the Medical Group Management Association, and the Center for Improving Medication Management to help providers make the decision about how and when to transition from paper to electronic prescribing systems, says Janet Marchibroda, eHI's chief executive officer. "One of the things we learned when we were putting this together is that making this transition is not a cakewalk. It's challenging and support is needed. The incentives are terrific, we believe they are exactly what's needed to jump start adoption, but we also recognized that without some help and guidance, even that wouldn't be enough," says Marchibroda.
The 43-page guide is broken into to two distinct sections. The first section is designed for clinicians and practices new to e-prescribing. It provides some basic information as to what exactly e-prescribing is, how it works, and who could benefit from it. The second section is geared toward office-based clinicians who have made the decision to transition to electronic prescribing, but aren't quite sure how to do it. What's interesting about the guide is that, although it was created by proponents of e-prescribing, it still spends a good amount of time preparing the reader for the inevitable pitfalls that will come with making the switch. In fact, there are nearly three pages dedicated to spelling out the barriers new adopters can expect to face.
The first (and probably one of the biggest) challenges listed are cost and ROI. "Even physicians receiving free e-prescribing systems may face financial costs in the areas of practice management interfaces, customization, training, maintenance, and upgrades as well as time and efficiency loss during the transition period," the guide says. Next up is the problem of change management, "It is important not to underestimate the change management challenges associated with transitioning from paper prescribing to e-prescribing. . . if some of the providers and staff are particularly technology averse, it can be difficult to get everyone onboard with such a dramatic change." The guide goes on to list 11 other potential stumbling blocks in a pretty straightforward way.
"What's different about this guide is that it was created with input from a number of different stakeholders. We consulted with health plans, the AMA, and AARP, just to name a few. It is not a marketing piece, it really reflects the insights of clinicians," says Marchibroda.
And, from what I can tell, she's right. Yes, the groups clearly want you to switch to e-prescribing, and the guide spends a good amount of time outlining the benefits. But it also offers up a step-by-step process for how to choose an e-prescribing program, when to do it, how to get buy-in from the rest of the staff, and a number of strategies and tools for integrating e-prescribing with current healthcare delivery practices.
The hope, says Marchibroda, is that this guide and the new incentives just around the corner will bump adoption up from its current paltry numbers. Of the 1.47 billion new and renewal prescriptions eligible for electronic routing, only about 2% or 35 million were transmitted electronically in 2007, with 35,000 clinicians using this technology, according to Marchibroda. Those numbers are expected to nearly triple in 2008, with e-prescriptions rising to 100 million, and the number of e-prescribers increasing to 85,000, or about 14% of office-based prescribers, she says.
If your hospital is considering making the big switch to e-prescribing and you have any questions about just how it all works, it is probably worth your time to download the guide and give it a quick read.
Kathryn Mackenzie is technology editor of HealthLeaders magazine. She can be reached at kmackenzie@healthleadersmedia.com.
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