New York Attorney General Andrew Cuomo said he has completed work in transforming health insurers' "conflict-of-interest-ridden system" for reimbursing patients who seek out-of-network medical care and announced a new state regulation codifying those changes. Insurer Health Net has agreed to stop using UnitedHealth's Ingenix database for used to calculate "reasonable and customary" fees for out-of-network payments. The company also agreed to contribute $1.6 million toward the creation of a new database. Cuomo called it the "final agreement" in the series of announcements about insurers agreeing to change the way they calculate payments for people who get healthcare from out-of-network providers.
St. Rose Hospital of Hayward (CA) will today celebrate a $42 million expansion that it funded with a state-backed bond sale. The offering, which closed at the end of May, is the first such deal in California since the financial crisis erupted in September. Plans include a seismic retrofit, 30 new hospital beds and equipment and technology upgrades at the hospital.
Atlanta-based WellStar Health System has sent 14,000 letters to patients saying it may terminate its relationship with Aetna insurance company. WellStar senior vice president of managed care Barbara Corey told the Atlanta Journal-Constitution in an email that the letter was intended "to ensure continuity of care and provide information needed to patients to make upcoming benefit decisions, if applicable."
The Florida Legislature's watchdog agency has recommended against expanding an experimental Medicaid program, once touted by former Gov. Jeb Bush as a national model, unless more data can be obtained. The Office of Program Policy Analysis & Government Accountability issued a final report saying little data is available to show the pilot program that uses private health management companies has improved access to medical care or its quality since its October 2006 launch.
Miami-based Jackson Health System is in "preliminary discussions" to transfer or sell its six primary care clinics to some other entity.
Thresia Gambon, interim associate chief medical officer, said that no details have been worked out about what entity might take over the clinics, but the primary motivation was to "continue to provide quality care."
Most key health-reform measures gaining momentum in Washington not only leave private health plans intact but also may give them a greater role. In addition, the health insurance industry got to ride the coattails of the attention brought by President Barack Obama's speech to the American Medical Association as he sought the physicians' support of his health-care reform initiatives. Throughout the AMA's five-day policy meeting, doctors maintained their support of the private health insurance system.
At least 81 U.S. healthcare workers have contracted laboratory-confirmed cases of the novel H1N1 influenza virus and about half caught the bug on the job, the Centers for Disease Control and Prevention announced. The finding suggests that hospitals and workers are not taking sufficient preventive measures to limit the spread of the virus. If a large-scale outbreak of the virus recurs this fall, the infected nurses, doctors, and others could transmit the virus to debilitated patients before their own symptoms become apparent.
Boston-based Beth Israel Deaconess Medical Center is about to begin a project called "open notes" in which about 100 doctors at the hospital and two other sites will allow 25,000 to 35,000 patients to read their physicians' notes for a year as part of their online medical record. Researchers hope to learn whether the notes prove more useful than objectionable. They hypothesize that access to doctors' notes will improve care partly because patients will become more knowledgeable about their treatment and about their doctors' instructions.
Leaders from Catholic Healthcare West, Intermountain Healthcare, and Harborview Medical Center told a rapt audience at HFMA's final conference keynote how they are making key quality changes and improving access to care while struggling with rising costs, climbing charity care numbers, and occupancies that are stretched to 100% at times.
While the crowds are usually halved by the last day of most conferences, the room was packed—more proof that with so many new financial challenges, healthcare leaders are looking to their peers for new information.
At San Francisco-based Catholic Healthcare West, Barbara Pelletreau, vice president of patient safety and clinical risk management, said the system, with more than 40 hospitals, has set aggressive metrics to improve quality. That includes implementing a sepsis prevention program in the last few years that has reduced mortality rates by 52%, saved more than 700 lives, and created $15 million in savings. "Quality, safety, and financial are coming together," she said.
Pelletreau said the system has drilled down to 60 key metrics on which hospitals focus. Another strategy has been to share a sentinel event report across all clinical areas that tells patient stories. "Every month, CMOs, chiefs of nursing, and patient safety officers go through the real stories and help facilities present the stories," she said. "This is the most effective strategy after doing the metrics approach."
Meanwhile, Lori Mitchell, CFO of Harborview Medical Center in Seattle, which is part of the University of Washington, said the system, which does $2.4 billion net revenue on an annual basis, had $150 million in charity care this year, up from $120 million last year. "We are focusing on areas that are the same—putting the patient first is what this is all about," said Mitchell.
She acknowledged there is work to be done in customer service. "While it shouldn't be that hard to be nice, we run 100% occupancy and when people are running that fast, our service indicators are not as good as they could be."
Like CHW, Harbor View is working to find the right way to talk about patient safety. "We have adopted a way of talking about adverse events at the hospital that is personal. We are forcing ourselves to use words like 'last month four patients were harmed at Harbor View when they shouldn't have been.'"
At the same time, the hospital is also working with physicians to improve key quality indicators by taking advantage of their natural desire to be A students. Reporting indicators by individual service areas, such as orthopedics, creates competition among the chiefs to be the best, she says. Harbor View also reports by unit. "We are observing hand hygiene, which is posted up on the units and that has helped us improve our scores."
Gregory Poulson, senior vice president at Intermountain Healthcare in Salt Lake City, said the 21-hospital system serves as a safety net for Utah and covers 80% of the uninsured that receive hospital care in the state. Intermountain also has seen a big increase in charity care costs, climbing to $200 million last year, up from $140 million the prior year.
He said Intermountain is focused on providing care the same way across all of its facilities. This approach has "yielded improvements in quality and cost," he said.
Intermountain's history in electronic medical record technology has set the stage for improvements across the system. "We started one of the first electronic medical records in 1967," said Poulson.
Karen Davis, PhD, president of The Commonwealth Fund, who moderated the forum, asked how the group is addressing access to care, the uninsured, and underinsured while waiting for healthcare reform.
"For many of our hospitals, we have found it is more cost effective to offer free clinics than to figure out how to go after all of the insurance," said Pelletreau, with Catholic Healthcare West, noting that hospitals can also put in a request for seed money for special projects through the system's community benefit fund. For example, she said, one project offers diabetes education in largely Hispanic areas.
Harbor View, meanwhile, has taken a unique approach to the uninsured, said Mitchell, explaining that the issue is not so much about access, but rather helping patients move into financial assistance programs, such as Medicaid.
A few years ago, Harbor View began having workers who process Medicaid applications for the state of Washington set up shop at the hospital with nurses and social workers. "We get them processed quickly and we get paid for services we are providing, and it helps as they are discharged and need other assistance," said Mitchell.
The group of nearly a dozen healthcare CEOs that met in Washington last week to introduce a white paper supporting healthcare reform had a basic message: change is needed now.
"We as providers have a particular responsibility to step up to the plate right now and deliver care differently—and be conscious of not just cost or quality: We can do both," said Nicholas Wolter, MD, who is CEO of the Billings (MT) Clinic.
"However, we need help from policymakers. We need payment models that will drive this," Wolter said. Also needed were episode payments, capitation and bundled payments—combining separate payments for one procedure into one bundled category.
In the Health CEOs for Health Reform report, the leaders suggested that immediate steps can be taken now such as ending Medicare fee-for-service payments for individual services. Instead, it can move to "outcome-driven bundled payments" that encourage provider accountability through full and partial risk contracts within the next decade.
Moving in this direction will hold providers accountable to "reasonable cost and quality standards" at a specified date, the paper said. The overall purpose of this policy is not to punish providers but to guarantee that Medicare will slow its rate of cost growth.
Linking provider payments to quality and patient outcomes within and episode or continuum of care—and then allowing providers to share in potential savings (along with financial risk)—can increase quality and efficiency, the leaders noted.
In addition, the bundled payments could:
Help reduce hospital readmissions by aligning the interests of clinicians and hospitals.
Improve coordination of care for chronically ill by encouraging communications between a patient's care team.
Rationalized practice distortions that discourage time-intensive but high-valued services delivered by primary care providers.
The paper notes that many providers are prepared to coordinate extensively across sites of care and accept risks for the costs of patient care. Those situations could be addressed by developing bundled payment structures that allow providers to assume responsibility but bear risk for some—but not all of—the costs of a specific patient's care.
In the meantime, the leaders are calling on the Centers for Medicare and Medicaid services to work with high-quality integrated healthcare system to identify and develop specific bundles of payments in specific settings.
And, it might be necessary to adjust the bundled units and payment rates for use outside of the integrated delivery system—but today's higher-performing health systems may be good places to start to identify high-quality processes of care.
So what are we waiting for: those drawing up healthcare reform legislation need to look at where "victory" over high prices and poor quality can be achieved within a relatively short period of time.
Just ask those healthcare CEOs.
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