Concordant has been chosen by Boston-based Beth Israel Deaconess Physicians Organization/Beth Israel Deaconess Medical Center to help build an EMR infrastructure for its independent physicians. Concordant is developing the scaleable IT infrastructure to securely connect this diverse healthcare community, starting with up to 300 BIDPO/BIDMC practices in 173 locations.
A tabletop device proved flawless in identifying the proper formulations of seven intravenous drugs, and helped avert five potentially serious medication errors during a test conducted at C.S. Mott Children's Hospital in the University of Michigan Health System. The device uses enhanced photoemission spectroscopy to determine if certain drug compounds are correct.
Electronic medical records are a big part of many proposed plans to cut costs and streamline delivery of healthcare. But while acceptance of EMRs is growing, Americans and their physicians still have some reservations, according to recent polls.
New Jersey's legislature recently passed a bill aimed to encourage the adoption of electronic medical records in the state. The bill creates a commission that could figure out statewide standards, and the assemblyman who sponsored the bill is a practicing internist.
Florida-based Lee Memorial Health System began putting its doctors online in August 2007, and soon introduced Cape Coral Hospital's emergency room to the technology. Since then, Lee Memorial Hospital and HealthPark Medical Center emergency rooms also have begun tracking patients electronically. The system so far has spent $6 million on hardware, software and implementation.
Pay-for-performance is a fundamental change in payment methodology that could transform how healthcare is delivered more than the current prospective payment system and managed care plans. Pay-for-performance programs, which are designed to align healthcare payments with clinical best practices and quality thresholds, are becoming commonplace across the country. Levels of adoption suggest that pay-for-performance is likely to stay and may eventually be rolled out across most payers.
The financial incentives related to pay-for-performance programs receive the lion's share of the focus. However, other indirect strategic benefits of these programs, such as improved clinical outcomes, greater alignment of physicians and hospitals, and opportunities to influence public perception, may have a far greater impact and value for healthcare organizations. In order to compete successfully in a pay-for-performance environment, providers must understand the direct financial incentives and indirect strategic benefits of these programs in addition to re-evaluating their human resource capabilities, processes, and information technology.
More than financial incentives
Pay-for-performance programs and initiatives exist in many forms. However, the underpinnings of most models are designed to provide financial incentives to healthcare providers for complying with clinically appropriate processes. The next generation of P4P initiatives is expected to go beyond compliance to reward improved health outcomes. Today, many of these programs create a small pool of at-risk payment funded by the participants. Program winners receive both the base payment plus a portion of the at-risk pool while program losers only receive the base payment.
A recent study by Premier exhibits the correlation between high levels of compliance with best practices and lower clinical costs. Two examples from this study were pneumonia and heart bypass surgery patients. Results from both groups of patients suggest that the more compliant the care received, as measured by adherence to patient process measures, the lower the average hospital costs for treating those patients.
Hospitals achieving high compliance, as defined by meeting 75 percent to 100 percent of the patient process measures for treating patients with pneumonia, saw an 18 percent decrease in average hospital costs compared to those hospitals in low compliance, as defined as meeting 0 percent to 25 percent of patient process measures. A similar trend was observed for heart bypass surgery patients.
In addition, this study demonstrated that adhering to the patient process measures reduced costs and decreased both patient mortality rates and the average length of stay. These metrics are easily measured and make participation in the pay-for-performance program attractive.
Increased positive public awareness
Many patients now take an active role in their care decisions by seeking a variety of information from disease-specific information (e.g., WebMD) to clinical outcome scores (e.g., HealthGrades) to the purely anecdotal (e.g., blogs). While some patients may not be educated or qualified to understand the information, perception matters--and may ultimately influence their care decisions.
Under pay-for-performance programs, patients can compare the care offered at various hospitals based upon clearly defined and standardized metrics. Payers will provide clinical outcome data to customers and encourage them to use it. Some pay-for-performance programs already use tiered services where co-payments are lower for using preferred providers. Such incentives will help increase the importance of the quality information being published. Hospitals that perform well on quality indicators can leverage their scores to differentiate themselves from their competitors, thereby resulting in improved public awareness and increased patient preference to obtain their care there.
Strengthening physician-hospital alignment
Physician-hospital relationships are as strained today as they have ever been. Pay-for-performance programs may give hospitals new opportunities to more closely align with their physicians.
Positive patient outcomes require a collaborative effort on the part of doctors and hospitals. Doctors will realize that in order to provide quality and efficient care, they will need to closely work with members of the hospital staff. Likewise, hospitals will have incentives to provide physicians with the necessary information and resources to ensure the care delivered to patients meets or exceeds best practice measures. Pay-for-performance programs will help bridge the gap between physicians and hospitals to create a unified team.
Good outcomes can be used as a strong recruiting tool. Hospitals with superior outcomes should find it easier to recruit top physicians. As pay-for-performance programs proliferate, physicians will find it beneficial to align themselves with those hospitals that have superior outcomes. Pay-for-performance will enhance recruitment of physicians and improve hospital-physician alignment.
The strategic imperatives for pay-for-performance are many, with financial incentives (or penalties) being a small component. Providers that understand the implication of this new environment and embrace the necessary changes will succeed under pay-for-performance.
Isn't there a way to allow the good of physician-owned hospitals (good customer service, modern facilities) while regulating the bad (limited services) and the ugly (poor or nonexistent emergency departments)? A report that was just released from the Health and Human Services' Office of the Inspector General seems to provide but one answer to that question: No.
The report shows that a quarter of such hospitals don't have physicians on site at all times and some do not have a registered nurse to provide critical emergency care. Further, a quarter of such facilities do not have a policy to handle emergencies that happen within their own facilities. What makes it too hard, economically, for such hospitals to provide what they're required to provide? Simple. It's too expensive.
Both major hospital associations have long lobbied against such facilities, mainly on the premise of self-referral. The primary problem created by self-referral is a conflict of interest for physicians who may refer their patients to hospitals in which they stand to benefit financially rather than where they think their patients will get the best care for their conditions. With all due respect, that little issue has not historically been enough to move legislators to consider an outright ban. Sad as it may be that more drastic evidence is needed, patient deaths that result from such facilities' lack of physician coverage or emergency policies has attracted legislators' attention. And that outcome, among others, is in this report--including two recent patient deaths in which the limited-service hospitals, incredibly, called 911 when the patients experienced serious problems on the operating table.
Several years ago, Congress passed a stopgap measure--an 18-month moratorium on reimbursement for new such facilities--to provide time to study the issue. Existing specialty hospitals were grandfathered in. That moratorium expired in June 2005, and limited-service hospitals have continued to proliferate in states that have no certificate of need law.
Doctors, in general, whether they own a piece of a so-called limited-service hospital or not, want what's best for their patients. But like any other profession, medicine has its share of unscrupulous individuals--in this case, physicians who count on luck, a lick and a promise in the hopes that bad things won't happen to their patients because they scrimped on their hospital by not building a money-losing emergency room or full physician and nursing coverage into their business model. These physicians are the proverbial bad apples that spoil the whole barrel.
The weight of Congressional scrutiny is once again bearing down on such facilities, and they might not get off so easy this time. Sens. Charles Grassley and Max Baucus, the ranking member and chairman, respectively, of the powerful Senate Finance Committee, seem ready to strike.
From Grassley: "My primary concern with [specialty hospitals] is the inherent conflict of interest that exists when physicians have an ownership interest in the facilities to which they refer patients. . . I strongly support a competitive marketplace and free market forces, but not at the expense of decreasing access to healthcare for the poor and uninsured or decreasing the quality of care for and safety of patients."
I couldn't have said it better myself. Traditional full-service hospitals shouldn't be expected to clean up others' messes, and patients shouldn't be exposed to physician self-dealing at the expense of their health or lives. It will be interesting to see whether any forthcoming ban on such facilities amounts to closing the barn door after the horse has already escaped.
Thousands of people in eastern Wisconsin face changing doctors or paying a much larger share of their medical bills because of a legal dispute between Aurora Health Care and Wisconsin Physicians Service Insurance Corp. The dispute comes less than a year after WPS and Aurora settled a previous lawsuit and counterclaim that touches on some of the same issues in the new lawsuit.
A study has found that the administrative costs and profits of health maintenance organizations in the Milwaukee area were roughly in line with those of other metropolitan areas in the Midwest. However, healthcare costs are higher in the Milwaukee area simply because hospitals and doctors charge more for their services, according to the study.
Progress East, an Illinois-based affiliate of BJC Healthcare, has bought a 111-acre property in Shiloh, IL. The hospital system has no plans for the site, but BJC described the purchase as a long-term investment that will allow it to be ready for growth in the area. The purchase comes after a yearlong analysis of the population trends and the accompanying demand for healthcare services.
