Organized cyber thieves that have stolen millions from corporations and schools recently defrauded several healthcare providers, including a number of non-profit organizations that cater to the disabled and the uninsured. The victims are the latest casualties of an online crime wave being perpetrated against U.S.-based organizations by "cyber thieves" thought to be based out of Eastern Europe. Last week, criminals targeted Medlink Georgia Inc., a federally qualified, not-for-profit health center that serves the uninsured and under-insured.
Nick Jacobs, president and CEO of Windber (PA) Medical Center, says he has always "lived on the edge" because the view is better from there, but he also finds life a lot more challenging when he's "driving a little bit ahead of my headlights."
However, in this instance, Jacobs isn't referring to his hospital's latest expansion effort or its trial vaccination program—he's talking about blogging.
While many hospitals still tend to avoid starting a blog for fear of sparking bad publicity, Jacobs has found in many cases that the opposite is true. When used appropriately, blogs can be an effective means of damage control for hospitals.
Jacobs, who was one of the first hospital CEO bloggers on the scene when he started "Nick's Blog" in 2005, says he has had a lot of experience with smoothing over controversial issues with the help of his blog. Last summer, when rumors of a split with Windber's then-affiliate Conemaugh Health System swirled, Jacobs helped quell patient and employee fears through a series of blog posts.
"The blog became the total source of very carefully worded encouragement throughout the process," Jacobs says. "In fact, at one point we had more readers from one of our sister hospitals coming to our Web site than we did from our own."
Although Jacobs couldn't reveal intricacies of the behind the scenes deal at the time, he says his blog readers were put at ease simply because he addressed the subject. "It helped to keep them engaged, and, most importantly, it helped to calm the nerves of those individuals who perceived that they were at risk," he says.
A blog can be a powerful way to get a hospital's message out to the public, says Mark Whitman, vice president of digital marketing at Ohio-based brand consulting firm Northlich. "A big advantage of blogs is that information can be shared quickly among all stakeholders," he says. "Quick response and sharing of information can help stop misinformation and rumors that can be very damaging during times of crisis."
The far reach of "Nick's Blog" (on Google, it is among the first 10 links for search terms, "nick's blog," and "hospital blog") has had a positive effect on Windber Medical Center, says Jacobs, who also blogs for Hospital Impact. Jacobs says "Nick's Blog" has around 100,000 regular readers, but he estimates that many more have read his posts because of local and national press coverage.
"We have patients coming to us from California, Virginia, New York, Iowa, and Canada for some of our vaccine trials, and 700,000-plus readers know that there is a Windber Medical Center," he says. The transparency that the blog provides also helps recruit new physicians and employees, as well as spreads the hospital's philosophy of patient-centered care, says Jacobs.
Who should blog
If a hospital is considering starting its own blog, Jacobs says that the caliber of the person doing the blogging is more important than that person's title. Each hospital must decide for itself if it wants a creative risk-taker or a conservative operations-based person at the keyboard.
Jacobs' views on which personality type would make for a better blogger are clear. "Remember, the outside of Australia's Great Barrier Reef, the side that is constantly dealing with the ocean waves, is the side where everything is alive," he says. "The back side, the calm bay side is dead."
Whitman says it is most important for a hospital blog to stick to one blogger so that the person can develop a trusting relationship with the audience. Then, when a controversy hits the hospital, "that author should stick to the facts and blogging policies that should be predefined in a crisis communication plan," he says. "All posts should be reviewed by [the hospital's] public relations experts before release."
To gain the audience's trust, a hospital must start its blog before a crisis hits, Whitman says. If a hospital blogger can build a community of stakeholders while waters are calm, that community will be an asset when the waves roll in.
"[The blogger] can leverage those relationships in times of crisis to help [the hospital] deliver honest, timely, trusted communications," says Whitman. "If [they] wait to establish a blog after a crisis, [they] will not have a trusted community to help you."
The agony of transparency
Of course, the problem with being on the alive-side of the reef is that, every once in a while, a destructive wave will come crashing down. A few times, Jacobs says he has used his blog to defuse a controversy that was a result of what he wrote in a candid post.
In February, Jacobs published a passionate post expressing his frustration that many doctors make late-night rounds so they can avoid interacting with patients. The blog ran in a local newspaper and created a "physician firestorm" because many doctors, including those affiliated with Windber and nearby facilities, took the post personally.
So Jacobs attacked the issue with the best communication tool he has—his blog. "I had to carefully explain to my own medical staff that, regardless of their rounding times, they were superior connectors, and it was not directed toward them," he says. "I apologized, wrote explanatory blogs about it, and sent a few letters of apologies to the physicians who were not part of the problem."
The risk of a blog post turning sour increases if the blogger and the hospital do not have a clearly thought-out plan of the blog's purpose, says Whitman. "If the blog is not thoughtfully planned and executed, as part of a larger communication plan, the wrong messages and reactions to those messages can spread just a quickly," he says.
The benefits of transparency
Despite all of the problems that a forthright blog could cause, Jacobs and Whitman agree that the benefits of that high degree of transparency far outweigh the detriments.
"When we take on issues in the blog, it is the ultimate form of transparency," Jacobs says. "How often do you really know if your quotes will be printed as stated? How many times has the reporter interpreted your explanations a little differently? The blog puts it out there, blemishes and all, in an open, honest way."
Whitman says the honesty that blogging produces helps show the human side of a hospital, which is crucial during emotional times of crisis. Additionally, "information can be shared quickly through a blog and the information can be shared virally throughout the Internet," he says. "In times of crisis a blog can be used to share information quickly and regularly."
Even though properly operated blogs could save hospitals some strife, Jacobs says many organizations still shy away from such transparency. "Maybe it's because there are one million attorneys who are looking for a way to feed their families," he says. "We are regulated, regulated, regulated, and many of my peers hold things close-to-the-vest so as not to expose themselves to litigation, criticism, or, as in my example, misinterpretation."
But Jacobs is happy clinging to the alive-side of the reef, and he hopes that others will join him.
"Maybe if there were more CEO bloggers, we would see a new system of wellness and optimal healing emerge from the ashes," he says.
Since its release in 2004, approximately 600,000 people in the United States have taken a free, online risk assessment called HeartAware through the Web sites of the 85 hospitals that offer it. The assessment, created by the HeartAware Network (a division of Byrne Healthcare) analyzes a person's risk for cardiovascular disease—the leading cause of death in the US.
Of those who have taken the survey, the company reports that about 20,000 individuals have been identified as at risk and, as a result, have received a free cardiovascular screening with a cardiac nurse at their hospital.
Advocates of the tool say it identifies those at risk for cardiovascular disease, provides them with education, and, in turn, prevents needless visits to the ER. Skeptics argue that the survey is an invitation for patients to enter the "medical mall" and purchase unnecessary services.
Program offers dose of prevention
According to Greg Gossett, president of Denver-based HeartAware Network (www.heartaware.org), a wave of non-invasive diagnostics in cardiovascular medicine was introduced around the time the tool was in development. He says the company saw this trend as an opportunity to begin identifying at risk individuals and educating them about the new resources that were becoming available.
The HeartAware assessment asks patients a set of 15 questions that revolve around known, major cardiovascular risk factors, such as blood pressure, cholesterol, weight, and family history. The company also gives hospitals the flexibility to ask additional questions if it lines up with what they want to know. For example, one hospital asks patients if they have seen a dentist recently, because physicians at the hospital were curious about the possible correlation between poor dental hygiene and heart disease.
Each hospital implements the tool a bit differently, some requiring more hand-holding than others to get up and running. HeartAware trains hospitals to use the tool and provides them with necessary resources. In return, the company receives a monthly fee to operate the program for them.
The majority of hospitals do not have outside funding, but Gossett says that he is starting to see this change. Some HeartAware providers have partnered with insurance companies to receive monthly reimbursements for offering the free screenings to their members.
Most of the facilities offering HeartAware target patients between the ages of 45 and 65 years old. Gossett says heart disease is more prevalent for patients in this age group, who have also been proven to be the most underserved.
"There's a subset of people out there who don't have symptoms and really need to get in front of a provider," he says.
Less than 10% of the respondents are over 65. Gossett theorizes that most patients in this demographic are already under the care of a physician or cardiologist.
The content of the completed assessments belong to the hospitals. HeartAware has a privacy policy and the hospitals that host the assessment each write their own disclaimer, according to their facility's policies.
"We only give out access to a few people within the hospital who need to know and access the data, such as the screener," says Gossett. "We have extensive measures to protect the data coming into this program."
Critics say program may offer pound of cure
L. Gordon Moore, MD is a family medicine physician who believes in low-overhead, high-technology medical practices that provide patient-centered care that is efficient, effective, and accessible. He says that he is skeptical of tools like HeartAware.
"If people start to go through a survey, we can find something wrong with you and we have a solution," he says. "They are going to be drawn into the medical mall and they are going to get chewed up."
Carol Luscato, who has risk factors and a family history of heart disease, recently completed the HeartAware assessment offered by Edward Heart Hospital (www.edward.org) of Naperville, IL. She was identified as at risk and qualified for free screening and testing. The hospital also advised her to complete an additional test of her heart function, which is not covered under the program.
"I don't care," she says. "A hundred dollars is nothing to me when it means my heart and my life." Moore says that behind most health assessments is a business model that has little to do with quality and more to do with driving volume. "If you drive patients into specialty practices for analysis and intervention, you drive up costs, you drive up mortality, and you drive down quality," he says. "If you drive patients into primary care practices where they have an established relationship, you drive up quality and you drive down costs."
In response to critics, Gossett says that the company isn't in the business of driving up utilization. "That's not going to help prevention," he says. "We want to see prevention justified and working in this country. So to drive up utilization isn't going to do anyone any good."
He says that if 1,000 people take the assessment within a community, about 40% will have two or more cardiovascular risk factors. As a result, they would qualify for a "very beneficial" screening. Of the 60% who do not qualify, Gossett says that since they have not been identified as at risk, they are not brought in for screenings.
Obviously, from a business standpoint, hospitals need to generate money to stay afloat. For this reason, Gossett says that they need to remain ahead of their competition and improve their service line in order to become market leaders.
"It's a real valuable differentiator for the hospitals to be offering free educational services that are dedicated to the people who need the resources—at risk individuals," he says. "We believe the win-win situation is providing an educational service and developing an early relationship with a patient so that when the patient does need care you've done some good things for them."
By comparison, if a facility chooses not to take proactive measures to identify those at risk, Gossett says they will see the patient in the ER when they experience their first heart attack.
Hospital reaches out to those at risk
"Cardiovascular disease is the leading cause of death in Illinois and also in the county that we serve," says Vincent Bufalino, MD, medical director of cardiovascular services at Edward Heart Hospital. Bufalino says that he was initially skeptical that patients would actually go online and complete the HeartAware assessment. However, the hospital now has over 10,000 patients who have taken it in the three months it has been available. More than 80% of those completing the questionnaire are new patients.
"The success was unpredicted," he says. "We thought over six months we might get 8 or 10,000 patients completing the assessment."
"Edward is one of the best hospitals in the nation with HeartAware in terms of their numbers and the people they're educating," says Gossett.
Bufalino reports that a third of individuals who took the assessment were at moderate to high risk and over 2,000 patients have scheduled appointments for the free consultation.
"These are not people who have had events," says Bufalino. "These are all people who are looking to prevent an event. From a medical standpoint, it seemed to be a unique way for us to reach a community that we serve, that we frankly aren't serving because they aren't coming in—yet they're at risk." He says the free screenings offered by the hospital provide patients with a unique opportunity to sit down, go over their results with a healthcare professional, and provide them with some direction in terms of next steps. Patients also see value in the free heart scan that some randomly selected patients receive as part of the consultation.
Luscato says the assessment offered her an opportunity to speak with a nurse for about 20 minutes regarding her risk factors and what she can do to make changes that will reduce them, such as lowering her weight. The free heart scan she received revealed that her arteries and aorta were in good health. The news provided her with much reassurance that she is on the right path to improving her cardiovascular health, especially considering that her mother suffered from heart disease.
"I accepted this as good news and I conduct my everyday life the way I always have," she says. "I exercise, I bike, I play tennis. I do various things that contribute to my health and that was proven during the test."
She says she came away from the experience knowing what her direction and goals need to be, specifically in terms of losing weight. "Will I achieve my goals in a month?" she asks. "No, the weight didn't come on in a month. I know it will take perseverance."
Bufalino states that some of the patients who have taken the assessment have undergone bypass surgeries and stents as a result of the screening. Others have started receiving treatment to prevent future problems. The hospital plans to follow up with patients to determine how many are coming into the system and receiving care as a result of the assessment.
Edward has marketed HeartAware on television, in direct mailings, and through their offices. HeartAware helps facilities produce advertisements and word their message, but does not place advertising and media spots for them.
Luscato is doing her own small part to spread the word. She hosts a local cable show in her community and discussed the program on the air. As part of the program, she took the assessment and was impressed that she got back results within five minutes of clicking Submit.
The hospital has no plans to pull the plug on the program any time soon. "Interest in the program sure hasn't stopped yet, so I think they're going to run with it for a while," says Bufalino. "It makes the community feel that their healthcare organization cares about what's going on in the community."
HeartAware continues to learn, grow
Gossett says there is no comparison between the HeartAware tool and the online risk assessments that consumers can take through Web sites like WebMD.com. "Those are a commodity, in my opinion," he says. According to Gossett the strength of the program lies in how the company has learned and continues to learn from the hospitals that implement it.
"If you take one of Barak Obama's recent quotes, he said we need to identify best practices, learn from them, and replicate them," says Gossett. "That's what we do. That's our role in this equation, to share best practices."
The company has plans to branch out in the future and offer risk assessments on other health-related topics such as various forms of cancer, weight loss, spine health, and joint pain, but the programs are still in their infancy.
"We believe that the process of stratifying the vulnerable individual and giving them educating resources is a benefit to the community," he says. "Our intention is to really promote early detection and prevention."
Cynthia Johnson is the editor ofMedicine On The 'Net, a monthly newsletter from HealthLeaders Media.
Not so long ago, determining how much to pay physicians required some educated guesswork.
Because doctors were mostly independent, private practitioners who paid themselves, there was a limited amount of data available on physician compensation. As physicians increasingly became employees, hospitals, medical groups, and other organizations developed greater interest in knowing what to pay them. A growing number of professional associations, benefits consulting firms, and physician recruiting companies now track physician compensation trends. It is now possible to get a fairly clear handle on what physicians are making nationally.
However, how much physicians should be paid is no longer the only salient question when it comes to creating physician compensation packages. How physician compensation should be structured is an equally important issue. When it comes to physician recruiting financial packages, one size does not necessarily fit all. Certain types of income structures may be more strategically advantageous than others, depending on the nature and objectives of the organization doing the recruiting.
For example, some healthcare facilities may choose to offer physicians a straight salary. In this option, the physician is listed as a W-2 employee on a hospital's payroll and benefits are included. The straight salary formula is not widely used in today's market, but it can make strategic sense in academic settings or in searches where relatively low income-producing physicians are being sought (pediatric sub-specialists and psychiatrists often fall into this category).
These and other types of doctors, though needed in a community, may not collect enough revenue to cover their respective overhead, benefits, and salary. A competitive salary offers candidates in these specialties the security of a fixed bottom line and can be considered a loss leader by the hospital to secure needed services and to support service lines that produce positive revenue. In the last year, 14% of Merritt Hawkins & Associates' recruiting assignments featured straight salaries.
More typical is the salary with production bonus model (in the last year, 65% of Merritt Hawkins' search assignments featured this model). This financial structure offers physician candidates both a clearly delineated income base and a mechanism for earning additional income predicated on their personal production. There are four primary ways that production can be arranged depending on the type of physician behaviors hospitals and medical groups wish to reward.
Some compensation models are based on gross billings generated in the practice. The intent of the gross billings formula is to alleviate candidate concerns over whether or not the hospital has a robust collection rate for the candidate's medical specialty. However, the hospital should monitor what candidates have established as their billable rate per CPT code with local payers, to ensure charge amounts do not exceed the probable reimbursement amount.
A second way to structure production bonuses is through net collections. In the net collections formula, income is based on all collections associated with the physician's provider number, and is relatively easy to track. There are two general ways in which physicians receive remuneration through net collections: a 100% of collections, minus overhead model, and a collections threshold model.
With 100% of collections (sometimes referred to as "eat what you treat"), physicians keep whatever they collect after their salary and overhead are paid for. Production is generally defined as collections for the professional component, but technical fees and revenue generated by non-physician providers can be used in the formula if the physician has these in the office and the associated expenses are factored in as overhead. In the collections threshold formula, a threshold is set high enough to cover the candidates' salary, benefits, and expenses. The candidate then receives a percentage of collections exceeding the threshold amount (usually 50%).
Production can also be based on practice volume measures, such as Relative Value Units, generated by physicians or on patient encounters. Finally, there is a growing movement to reward physicians not only on volume measures but on qualitative measures, such as outcomes data and patient satisfaction scores. These factors may be combined with volume measures to create a hybrid volume/outcomes based incentive model.
Though many hospitals are moving toward employing physicians, there are still circumstances in which hospitals may wish to recruit doctors into traditional, solo private practice settings. The solo practice model can be particularly appealing to established physicians with a strong entrepreneurial bent who value practice autonomy.
Compensation in this setting usually is structured in the form of an income guarantee provided by the hospital to the physician. The income guarantee acts as a subsidy for the first 12 to 24 months a physician is in practice, ensuring the doctor of a base of monthly earnings. The subsidy must be repaid to the hospital, but outstanding amounts the physician may owe on the subsidy can be "forgiven" provided the physician remains in the community for a stipulated period of time. In the last year, 16% of Merritt Hawkins & Associates' search assignments featured income guarantees.
Knowledge of these and other physician incentive structures will become increasingly important as physician practice models continue to evolve and as healthcare reform ushers in new physician payment systems.
Peter Cebulka and Tommy Bohannon are senior executives with Merritt Hawkins & Associates, a national physician search and consulting firm and an AMN Healthcare company. They can be reached at peter.cebulka@merritthawkins.com andtommy.bohannon@merritthawkins.com.For information on how you can contribute to HealthLeaders Media online, please read our Editorial Guidelines.
While much of the recent media attention on healthcare reform is focused on making changes at the point of care, the changes being discussed by the administration and large employer groups will also have an impact on how health plans operate. For example, they will affect how health plans construct their provider networks, contract with providers and reimburse providers.
There is mounting pressure from the government and employers to fundamentally change our healthcare system to focus on improving outcomes, lowering healthcare costs, and increasing overall access to medical care, while moving away from a pay-for-service model. Central to these changes is the request by the government and employers for a healthcare system that aligns incentives with behaviors from health plans, providers, and patients that focus on improving the continuum of care.
Definition of Value is Changing
Important to payment reform are the methods by which the meaning of value has changed in terms of the healthcare environment. There is movement toward payment models for episode-based care and population-based care, both of which focus on the longitudinal performance of the care plan delivered to the patient. The performance of these new models focuses on quality, which is based on improved outcomes and prevention. This is a shift away from the traditional payment model, which rewarded the volume of services provided rather than quality and outcomes provided.
Additionally, there is more emphasis on incentives for the proper collaboration, coordination, and patient satisfaction of the care delivery experience. As many of us know, the management and prevention of disease does not take place in just one office visit or with just one provider. The care experience should be a coordinated effort between primary-care and specialty providers to achieve the best results for the patient. In conjunction with the coordinated experience, there is emphasis on enabling patients to take an active role within their care plan and to be more satisfied with the care they are receiving.
This is a big change in the way that the traditional provider to patient to health plan relationship has been established. In the past, payments and incentives would be rewarded based on individual performance. The change in the reimbursement models will now reflect the quality within the continuity of the care program received by the patient.
Care Model is Evolving
We are moving away from a silo-based care experience system to a system that will use a form of team-based care, where each action of that team will be measured. Initiatives such as Patient Centered Medical Homes are good examples of this team-based model.
The PCMH model changes the role of the primary care provider to be more of an overall healthcare services coordinator and disease prevention entity, which helps the patient utilize other healthcare services more effectively. The PCMH model also provides additional incentives for actions once thought to be outside of the point care experience, such as secure provider-to-patient electronic communication, e-Visits and proactive patient involvement. While the PCMH model is not new, it is clear why it is gaining attention with the healthcare market; as we move away from a service-based care model, the PCMH has the right foundation in a team approach to the measurement of utilization, performance and quality of care.
Pressure to Transform the Contracting Process
All of these changes will have an impact on how insurers, either public or private, contract with their provider networks. The provider contract is the document that governs the relationship between a health plan, the provider, the services rendered and the fees agreed to for service. The contract is also the place where incentive measures for quality outcomes and medical best practice adherence will be recorded and operationalized.
Health plans realize that provider contracts and the information within them are critical to claims processing and correct provider service payments. Mistakes or errors within the health plans provider contracting process negatively affects their medical loss ratio, administration costs, and their provider and patient satisfaction.
With the growing complexity of provider contracts and the new requirements being driven by reform, it means that in order to have value-based provider contracts, the system and processes have to comprehend the performance and quality that will drive reimbursement methodologies. For example, health plans should have provider contract management systems and processes that allow for:
Codified data to drive analytics and automated contract claims translation.
Flexible contract definitions to drive standardization and reporting.
Transparency to show the intent of the contract and strong audit capability.
Codified performance criteria and measurement methods.
Multi-stakeholder contracts that embody episodes of care.
Automated workflow capabilities to support internal review and approval.
Access to actual provider performance and real-time network intelligence to dynamical adjust payment models to align with actions taking place in the care environment.
The government and employers' continued pressure regarding payment and healthcare system reform will drive health plans to change how they operate. It will no longer be sufficient for a contracting system to simply manage documents; it will need to evolve into a system that incorporates intelligence from the network, provides transparency to providers and members, and integrates performance metrics from the field.
Vik Anantha is general manager and vice president of Portico Systems Contracting Solutions, Portico Systems. Anantha can be contacted atvanantha@porticosys.com. For more information, visitwww.porticosys.com.For information on how you can contribute to HealthLeaders Media online, please read ourEditorial Guidelines.
An influential Medicare advocacy group has called out a large skilled nursing home corporation for going into its facilities and scaring elderly residents into thinking their healthcare benefits will be worse if health reform provisions in H.R. 3200 are voted into law.
"The nursing home industry is scaring residents, telling them that healthcare reform will lead to poorer quality of care and the loss of the staff who provide them with essential care each day," says the Center for Medicare Advocacy's senior policy attorney Toby S. Edelman. "This outrageous misinformation campaign must stop."
Her organization called on Health and Human Services Secretary Kathleen Sebelius to put an end to the campaign, as it has in an effort to stop alleged misinformation perpetuated by the Medicare Advantage industry.
The Washington, D.C.-based Center for Medicare Advocacy's director, Judith Stein, pointed specifically to efforts by Genesis HealthCare as an example of the orchestration of the misinformation campaign. Genesis owns more than 200 skilled nursing homes and assisted living communities serving 26,000 patients in 13 eastern states.
"Year after year, multiple reports by the Government Accountability Office and the Medicare Payment Advisory Commission have shown that the Medicare program overpays skilled nursing facilities by billions of dollars. For seven years in a row, MedPAC reported that aggregate profit margins for freestanding nursing facilities exceeded 10%. In 2007, the profit margin was 14.5%.
"Worse yet, despite enormous overpayments, the Centers for Medicare and Medicaid Services documents that nursing facilities have not increased their staffing.
"Where do these billions of dollars go? The overpayments go to profits to corporate nursing homes and to excessive executive compensation, not to the care and services needed by residents," Edelman says.
She emphasized that in H.R. 3200, America's Affordable Health Choices Act of 2009, that the changes in the bill would "correct fraud and abuse in reimbursement, while recognizing that Medicare rates need to be increased for the small number of nursing home residents with special care needs, including those who use ventilators."
According to a report earlier this month in the The Day, of New London, Conn., a Genesis vice president, Laurence Lane, told a roomful of residents at Genesis' Groton Regency, that they should sign petitions and send letters to Congress opposing HR 3200.
He reportedly held up a thick black binder containing the 1,118-page bill and said it would cut $2 billion per year in federal payments for nursing home care to help pay for other provisions in the bill, or about $40 per day per nursing home, and would directly affect staffing levels and quality of care.
"To cut skilled nursing home care, skilled home care and hospice care at a time when our population is changing and those services are needed is downright dumb," Lane reportedly told many of Groton Regency's 162 residents.
Contacted last week, Lane acknowledged the visits and the concern about Medicare reductions and said the visits by him and other Genesis representatives to their patients is "our version of 'town hall' meetings" to explain that H.R. 3200 indeed would slice value from their daily care.
In an interview late Friday, Lane says Medicare payments for a skilled nursing home beneficiary would be reduced by approximately $6 a day. He adamantly denied that there is that much fraud or excess that could be cut from nursing home care.
He elaborated in a lengthy e-mail:
"If you take these CBO calculations and tabulate them, you will find that CBO estimates that over the course of the coming decade, Medicare is projected to spend $7.4 trillion. H.R. 3200 displaces $539 billion, or about 7.3% of projected outlays.
"Of that sum, about $320 billion is reallocated back to Medicare outlays (primarily a shift in spending to support physician fee schedules) and $219 billion, or about 3% of total projected outlays, is cut.
"Our primary concern, and the concern that was expressed in our meetings with our constituents, is that a disproportionate share of the cuts impact post-acute skilled nursing and skilled home care. In aggregate, when you calculate what would be spent under current Medicare law with what would be spent under H.R. 3200, Medicare post-acute services – skilled nursing, skilled home care and hospice services – are reduced nearly 16%."
"I raised the question of whether with the fastest growing population over the next decade being 85 plus were these reductions in resources reasonable and fair?
"The overwhelming response was that these were the wrong cuts, at the wrong time, to the wrong patient population."
"The simplistic notion that all this legislation does is weed out fraud and abuse, and that it only impacts providers, not beneficiaries, falls short of reality."
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Many individuals traditionally get wellness information from their physicians' offices, clinics, or hospitals. However, moving away from the four walls of a healthcare organization and into the community can have an impact as well, according to Patrick Quinlan, MD, CEO of Ochsner Health System, a nonprofit healthcare organization that includes seven hospitals and 35 health centers in southeast Louisiana.
Quinlan is behind a new partnership initiative—called "Choose Healthy"—with Rouses, a supermarket chain with 35 locations in Louisiana, to educate individuals about better food and lifestyle choices, disease prevention, and regular medical checkups.
“Part of our community involvement—our job—is to take care of people's health. And, we recognize that so many of the diseases that we suffer from are the result of choices people make around their lifestyles—particularly around what they eat," Quinlan said. "And unless we got to the root causes of these problems, we could not really deal with this problem successfully."
Obesity now is a nationwide problem, and its effects have been felt in Louisiana. According to the Centers for Disease Control and Prevention, Louisiana is the eighth most obese state in the U.S., with about 30% of all residents considered medically obese.
"There's something about the way we're eating that is making people really fat. We need to change that," Quinlan said. "Most people want to eat the right thing, but there is just so much partial information, misinformation, or at least confusing information out there.”
With traditional healthcare, hospitals and providers generally deal "with the symptoms of diseases that grew out of things that are much more fundamental in nature around behaviors," he said. "Until we deal with those behaviors, I don't think we'll ever catch up with the problems. We need to shrink the problems."
One way to reduce the problem is draw up grocery lists, available on the Choose Healthy website, of healthy foods that individuals can purchase when they shop. Another is using "shelf talkers"—tags attached to the grocery store shelves that indicate which products are healthy, said Molly Kimball, a registered dietician with Ochsner who is helping set up the program.
She said they focus on those products for instance, with whole grains and low-saturated fat. "We tried to steer clear of things such as—generically speaking—100-calorie packs. They might be low in fat. But they don't really offer anything nutritious," she said.
There's also a focus on locally grown and produced products such as fresh local vegetables and seafood that are good for both weight reduction and local economy promotion, according to Quinlan.
In addition to finding Ochsner endorsed eating recommendations on the supermarket aisles, customers will able to obtain Ochsner education materials and free health screenings, including for blood pressure, cholesterol, glucose, and body fat. Also, the store's "Chef Nino" will be incorporating lighter and heart healthy recipes into his cooking demonstrations. Customers will also be able to access recipes and information on smart food choices, proper meal planning, and disease specific diet alternatives online at the Choose Healthy site.
"Unless we get to where people actually buy their groceries, our success rate [in addressing obesity] is going to be pretty low," Quinlan said. "We want to get into their homes where they use their groceries—and help them develop strategies where they eat well, eat inexpensively, and eat conveniently. Right now they don't know what to do—and they don't have the time to do it. We need to solve those problems for them."
John J. Buckley has been named Chief Administrative Officer for Geisinger Northeast. Before joining Geisinger, Buckley was a member of the executive management team at Temple University Health System in Philadelphia and CEO of Temple East/Northeastern Hospital. He was previously president/CEO of Pottstown Healthcare Corp. in Pottstown, PA, which included Pottstown Memorial Medical Center and Pottstown Imaging and Cancer Treatment Center, and also served in various leadership positions with HCA/Quorum Health Resources.
PricewaterhouseCoopers, LLP has expanded its Health Industries Advisory Practice in the metropolitan New York area with the addition of 11 professionals across the payer, provider, and pharmaceutical & life sciences sectors. The expansion "is a reflection of significant growth in the New York market, the impact of anticipated health reform, and the economic stimulus on health industry participants," according to a release.
