Medicare fraud and abuse prevention and detection efforts are about the get tougher because of the new Zone Program Integrity Contractors (ZPIC), who began work in some regions on February 1.
CMS developed ZPICs to fix flaws in the current Medicare program integrity system, which protects the Medicare program by preventing and detecting fraud and abuse. Under the existing system, Medicare Drug Integrity Contractors (MEDIC) fight fraud and abuse in Medicare Part D, while Program Safeguard Contractors (PSC) are responsible for such efforts in either Medicare Parts A and B, durable medical equipment (DME), or home health and hospice, depending on the geographic region.
"The existing program integrity system is extremely fragmented, with multiple contractors investigating different types of Medicare fraud in a given state," says William Mahon, consultant at Mahon Consulting Group in Great Falls, VA, and past president and CEO of the National Healthcare Anti-Fraud Association. "Ultimately, the efficiency of the existing system is limited by is fragmented and complex nature."
CMS hopes to unify the system with ZPICs, who will eventually take on the work of PSCs and MEDICs.
The new program divides the country into seven jurisdictions, and in each jurisdiction one ZPIC will be responsible for program integrity oversight and functions for all Medicare-related claims. Because ZPICs will investigate cases of Medicare fraud involving all healthcare providers in a geographic region, they will have the ability to detect cross-billing and relationships among healthcare providers, which will lead to increased scrutiny of providers working across lines of business.
ZPICs will also compare data from Medicare and Medicaid claims to identify fraudulent activities between the programs, a process known as Medi-Medi data matching.
"For example, ZPICs will compare Medicare and Medicaid claims filed for dually-eligible beneficiaries to ensure the two programs are not paying for the same services," Mahon says. "The contractors will also look at the amount of services providers bill to Medicare and Medicaid to identify so-called 'time bandits,' whose services billed to both programs add up to seemingly impossible volumes of work."
ZPICS will perform the same types of investigations as PSCs, known as benefit integrity (BI) reviews, based on billing abnormalities identified by data analysis or allegations of fraud and abuse. ZPICs will conduct data analysis to determine normal practice patterns and then look for abnormalities, such as spikes in billing.
All BI reviews may not uncover fraudulent activities but can still result in significant overpayments because the documentation was missing or inappropriate. Some spikes in billing are completely legitimate, but, without appropriate documentation, a facility may be forced to return payments to Medicare.
"You never know when you will be audited, so facilities must be prepared to support the services they provide at all times," says Wayne van Halem, AHFI, CFE, president and CEO of The vanHalem Group, LLC, in Atlanta.
SNFs should be happy to know that ZPICs should simplify fraud and abuse investigations, especially for providers with multiple facilities.
"Previously, a benefit integrity review done on one facility could be completely different than one performed on another facility not far away," van Halem says.
Because ZPIC jurisdictions are large and the contractors are responsible for Medicare program integrity across all lines of business, there will be more consistency in the investigation process.
ZPICs are scheduled to transition in three cycles. The first cycle was scheduled to transition ZPICs for zones four, five, and seven, on February 1. Although the ZPICs for zones four and seven began work on this date, the transition for the zone five ZPIC was delayed because an unsuccessful bidder protested the award. CMS is months behind schedule in awarding contracts for the remaining zones and has yet to release transition dates for the second and third cycles.
Despite delayed implementation efforts, SNFs should understand how these new contractors expand the scope of fraud prevention and detection efforts and prepare for increased scrutiny of relationships between Medicare providers.
Healthcare executives are under enormous stress. Trying to improve quality and safety, increase access, and reduce costs is exhausting. There is great pressure to satisfy many conflicting and competing interests. One chief clinical officer says she feels that "the cliff is visible." Many people see the system as heading dangerously close to that precipice.
We all agree that deep systemic change is needed, and the gap between the current reality and where we want to be continues to widen. Yet many of the key parties behave as though they want their part in the current system to continue. This may seem counterintuitive. But our experience suggests the reason why people resist change is not from a lack of facts and analysis about the need for change; the resistance comes from strongly held values, beliefs, and practices within the various factions, precisely those who must engage if significant progress is going to be made.
Adaptive challenges and technical problems
Challenges fall into two categories. If the expertise to solve your challenges exists anywhere within the healthcare system, you are facing a "technical problem." To solve technical problems, you inform people about the priorities, define roles and responsibilities, and set standards for success. It's a matter of focusing existing competencies, aligning the participants, and holding them accountable for results.
The most common error is to apply existing protocols to "adaptive challenges," which are about values and beliefs, ways of being, and identity. Progress on adaptive challenges is not about prevailing logic or data. Instead, adaptive challenges require leadership behaviors that raise what practices and approaches you need to preserve and what you need to discard.
When you help people distinguish what is essential from what is expendable, you create space for the innovative approaches to take hold. However, this is dangerous.
Making this distinction generates resistance because it creates an experience of loss—the loss of what is familiar and comfortable, including expectations, priorities, rewards, or the values that guide everyday decisions. Diagnosing the type of challenge you are facing and identifying the potential losses in order to address the work directly is an essential first step of exercising leadership.
Here's one major adaptive challenge. The implementation of electronic health records or physician order entry systems is complex yet appears to be quite straightforward. The technology can be customized. However, it is not just a matter of data entry.
The information is most valuable when it conveys a story that cuts across specialties and transitions of care. Supporting these transitions is more about practices and communications than it is about converting paper into a digital format. You are dealing with a different kind of challenge. The work is about changing the mindsets, habits, and traditions of caregivers at each step in the patient experience with your system. This touches on deeply held beliefs and approaches about how care should be provided.
One medical director says "EHR is part of the solution, but not the solution. We need a cultural solution about the role of the clinician. We need to become more value oriented in how we approach the work."
Another framed it, saying "the adaptive challenge for IT is the coordination among clinicians, their responsiveness. It changes expectations and communication between the PCP and the specialists."
As the quotes above illustrate, the challenge is about changing the relationships, not just talking differently to each other, but interacting in new ways and identifying the type of medical care that is most effective and produces the greatest value.
Who should be delivering what kind of care? It is an exercise of leadership when doctors, nurses, and administrators figure out the right balance, discerning the essential activities that create value from the practices that don't. How can you help people address what is most important and face what they stand to lose? How can you identify and explain the loyalties and commitments that you are asking people to change? In the EHR example, the opportunity is to make choices about how caregivers will interact in the future. All involved face some potential loss: giving up patient contact, something that energizes them, or ways of working that are familiar.
For example, if pharmacists were to work more closely with patients to help manage the drug therapy, it would mean less patient contact for other clinicians. If these potential losses are left unexamined, then the status quo is held in place by the success patterns of the past, the values, and beliefs that are rooted in the organization's culture, preventing progress in the new context.
Orchestrating conflict
Engaging people to tackle their tough challenges defines the new leadership for healthcare. When you are dealing with adaptive challenges, you are engaging people to face up to the tough choices that improvement demands. Hold a stance of curiosity to explore what the key stakeholders care about and be prepared for the pushback. Relying solely on your authority to tell people what they need to do won't yield results. Any cardiologist, primary care physician, or nurse can attest to the success rate of "delivering the sermon" to their patients with heart disease about eating right, exercising, and quitting smoking.
The challenges right now for healthcare are daunting. When the situation calls for adaptive change, you are helping people navigate through a period of disturbance as they sift through what is essential and what is expendable. This disequilibrium can be a catalyst for you to ask people to operate beyond the default set of responses. With too much disequilibrium you will lose people's attention. Without enough disequilibrium, nothing happens.
No one faction owns the problem—not the administrators, specialists, hospitalists, payers, patients, employers, local governments, or the policy makers. While getting people to the table is important, no one will volunteer to give up the control, authority or expertise they now have. A significant part of adaptive work is getting people to focus and put consistent attention on the difficult issues at hand.
The system will begin to adapt when there is enough disequilibrium for all the salient factions to exhume and examine the conflicting priorities. Progress and adaptive change involves asking people to confront difficult issues in their domain and give up habits and beliefs they hold dear. Successful adaptation occurs when all factions participate, collaborate, and identify what they need to leave behind.
Progress on adaptive challenges requires the kind of leadership that breaks through the impasses, unveils the competing commitments, and confronts the legacy behaviors that prevent progress. This is a different kind of leadership for a system anchored in scientific training. Resist the temptation to tackle challenges by framing them to fit within a technical insight.
The cliff is near, and you are uniquely in a position to help and prevent your system from falling over it. You can develop the skills to diagnose the challenge and orchestrate the conflict. Adaptation is more than surviving; it is about mobilizing people and creating environments that are more robust and resilient, environments for people to thrive. With the right focus, you can engage people in adaptive work and nurture the new DNA that will promote wellness and healing that brings your organization into the future.
How can you take advantage of the opportunity to create enduring change in healthcare? Where will the leadership come from?
For many, the traditional paradigm of a "great leader" conjures images of famous CEOs, great presidents, or iconic battlefield commanders. That notion is not uncommon; and it is a dangerous assumption. Exercising leadership for adaptive work is not about directing others and telling them what to do. The work of leadership is both having the courage to face reality and helping the people around you to face three realities at once:
What values do we stand for, and are there gaps between those values and how we actually behave?
What are the competencies we have, and are there gaps between those resources and what the patient care demands?
What opportunity does the future hold, and are there gaps between those opportunities and our ability to capitalize on them?
You don't have to answer those questions yourself. What well-structured questions can you raise, rather than offering definitive answers? Imagine the differences in behavior if you believed the idea that leadership means influencing the organization to follow the CEO's vision or if you operated with the assumption that leadership means influencing the organization to face its problems and to live into its opportunities.
Kristin von Donop is a principal with Cambridge Leadership Associates, a leadership consulting firm. She can be reached at kvondonop@cambridge-leadership.com.For information on how you can contribute to HealthLeaders Media online, please read our Editorial Guidelines.
Michael Young was brought in as chief executive officer of Grady Memorial Hospital in Atlanta to work a similar turnaround that he accomplished with Erie County Medical Center in Buffalo, NY—a story I wrote back in 2006.
Cutting the outrageous deficits the troubled public hospital has been running for years was probably number one on his list of things to do. Wringing greater support from the communities that send their indigent and charity care patients to Grady was probably item number two. But changing the culture that allowed Grady to slip so far has to be third on his list.
If you talked to him, he would probably give a political answer, saying that all those facets of an effective turnaround are equally important. Each is one of the legs of a three-legged stool, and all that mumbo jumbo. But in this case, the political answer may be more right than you know, because without culture change, the cost-cutting initiatives and revenue-raising initiatives don't last.
Young recently cut about 140 employees from Grady. He's certainly not alone. I've counted about 40 layoff announcements from hospitals across the country of more than 100 positions since January—and that's just from the news on our Web site. Plenty more have occurred without fanfare. Patient volumes are dropping, reimbursement continues to be a major challenge, and investment portfolios have been hard-hit. Still, all of the staffing reductions have been accompanied by typical public relations blather about none of the layoffs affecting patient care, and that most of the positions eliminated were from "administration."
But what was interesting about the 140 layoffs from Grady was that Young made a special effort to mention that the cuts—which ranged from groundskeepers to top managers—weren't solely because of the poor economy, government cuts, or an increase in the uninsured, all of which are problems at Grady.
They were about culture.
Not only do layoffs that weed out poor performers in any organization get rid of many of the problems that hinderinnovation, but they put the rest of the staff on notice that someone's paying attention to who's on board with the turnaround and who's just collecting a paycheck—a move that's likely to inspire the achievers in the organization and frighten the rest of the low-performers into action.
In a story earlier this month in the Atlanta Journal-Constitution, Young mentioned that keeping such employees on board represents "an old and unsuccessful way to run a hospital." Critics of the hospital, according to the story, say the so-called "Grady culture" tolerates inefficiency and hampers patient care.
And it's not as though the problem workers weren't warned. In a memo last October, shortly after Young took the reins at the troubled public hospital, he sent a memo to staff complaining about the entrenched culture of getting by that many employees seemed to tolerate.
"This is an example of the dysfunctional operations of the Purchasing Department, lack of leadership, and the failure to meet Grady's goals and targets," Young wrote. "This lack of response is the old Grady way, making Grady a laughing stock."
He's making progress. I'm assuming that those on the newly created nonprofit Grady board knew he would make such tough decisions when they hired him. There was predictable opposition to the decision, but if they were smart, the board gave plenty of leeway to Young, who is the hospital's sixth CEO in three years. When you see a record of hiring and firing CEOs like that, I smell last chance for this hospital unless Young is allowed to do what he was hired to do. His record demonstrates that the turnaround everyone says they want for Grady stands a good chance under his watch.
Note: You can sign up to receive HealthLeaders Media Corner Office, a free weekly e-newsletter that reports on key management trends and strategies that affect healthcare CEOs and senior leaders.
A new federal study pointing to a dramatic decline in post-surgical bariatric complications–as well as the cost of the procedures–may pave the way for healthcare providers to attempt the procedure in even larger groups of sicker, older patients.
That may be one extrapolation from a survey just released by the Agency for Healthcare Research and Quality, which found that certain complications–particularly infections, which dropped 58%–fell from approximately 24% to 15% between 2001-2002 and 2005-2006. The drop was attributed to increased use of laparoscopy and banding procedures without gastric bypass, as well as increased surgeon experience. Laparoscopy decreased the odds of a complication by 30% and drove down hospital payments by 12%.
The complication rate fell despite the fact that surgeons now perform the procedure more often in older and sicker patients. The percentage of patients over age 50 who had the procedure increased from 28% to 44% in this timeframe, and the percentage of underlying illness, such as diabetes, high blood pressure, or sleep apnea, more than doubled.
The study also found that abdominal hernias, staple leakage, respiratory failure, and pneumonia complications all fell by between 29% and 50%.
“All surgeries involve risks, but as newer technologies emerge and surgeons and hospitals gain experience, as this study shows, risks can decrease,” said Carolyn M. Clancy, MD., AHRQ director.
Hospital payments for these procedures fell from $29,563 to $27,905 for patients who did not have complications. For patients who did, the price tag fell from $41,807 to $38,175. Payment for patients who had to be readmitted because of their complications fell from $80,001 to $69,960.
It remains unclear why other complications, such as ulcers, involuntary vomiting or defecation, hemorrhage, wound re-opening, deep-vein thrombosis and pulmonary embolism, heart attacks, and strokes remained relatively unchanged.
The survey, led by AHRQ senior economist William E. Encinosa, compared 9,500 patients under age 65 who had the procedure done at 652 hospitals between 2001 and 2002, and between 2005 and 2006.
According to the Society for Metabolic and Bariatric Surgery the number of such procedures has risen exponentially, from 145,000 in 2004 to 220,000 in 2008. And more are expected this year.
More than one in five American adults is reporting that they have a disability, a number that has increased by 3.4 million between 1999 and 2005 and which will most assuredly continue to grow over the next two decades, according to the Centers for Disease Control.
The CDC report, published in this week's Morbidity and Mortality Weekly Report, estimated that 47.5 million people, or nearly 22% of the population, report a disability, with heart disease, arthritis or rheumatism, and back and spinal problems among the leading complaints.
"It is likely we will see more dramatic increases in the number of adults with a disability as the baby boomer population begins to enter higher risk, older age groups over the next 20 years," says Chad Helmick, MD, CDC medical epidemiologist and coauthor of the study.
The report, gleaned from U.S. Census Bureau data, found that 24.4% of women reported having a disability, compared with 19.9% of men, regardless of age. The report also found that disability prevalence doubled with each older age group—11% for ages 18-44, 23.9% for ages 45-64, and 51.8% for ages 65 or older.
Helmick says CDC is working with state health departments and community health agencies to expand the availability of health self-management, education, and physical activity programs that could potentially reduce the impact and cost of the disabilities.
Hospitals and physicians looking to get a better understanding of what is meant by "meaningful use" of electronic health records (EHRs)—and how they could qualify for health information technology funds under the economic stimulus measure passed in March—got their wishes this week.
Expanded definitions by an industry group, release of a new consensus framework report, and two days of testimony before a federal panel by nearly three dozen experts got the ball rolling.
Under the new stimulus law, Medicare incentive payments can be made up to four years to hospitals and up to five years for physicians who meet "meaningful use" and "meaningful user" criteria of certified EHRs. The Healthcare Information and Management Systems Society (HIMSS), after input from its membership, released new definitions April 27 to specify what is meant by that term.
To be eligible for the incentive payments, the HIMSS definition said that hospitals and physicians must use the technology in a meaningful manner, exchange electronic health information to improve the quality of care, and submit clinical quality measures—and other measures—as selected by the Health and Human Services (HHS) secretary. Also, hospitals and physicians must meet the definition within a specified timeframe, which—as described in the stimulus bill—must be made increasingly stringent over time by the secretary.
On April 30, the Markle Foundation's Connecting for Health Collaborative released several key principles that outline an initial approach to achieving objectives with HIT under the stimulus package. The report containing the principles is supported by a group of individuals representing a diverse group of healthcare, business and consumer groups including the American Academy of Family Physicians, America's Health Insurance Plans, Consumers Union, and the Joint Commission.
"These are the expectations that have to be set from the start—that once you deploy technology, it's too late to start to come up with new and different goals," said Carol Diamond, MD, managing director of the Markle Foundation, about the report containing the principles.
She added that meaningful use is not about using technology for the sake of technology, but instead about improving health. The group agreed on seven principles of meaningful use and qualification and certification of EHRs. Several of these principles are:
The overarching nationwide goals of health IT investments are to improve healthcare quality, reduce growth in costs, stimulate innovation, and protect privacy.
These goals can be achieved only through effective use of information to support better decision-making and more effective care processes that improve health outcomes and reduce cost growth.
Meaningful use should be demonstrable in the first years of implementation (2011-12) without creating undue burden on clinicians and practices.
Also, during mid-week, the National Committee on Vital and Health Statistics heard more than two days from experts about what the definition of "meaningful use" should encompass.
Jonathan Perlin, MD, PhD, with the Hospital Corporation of America, which has 160 hospitals nationwide, told the panel that "it is imperative that we provide clear guidance on the desired outcomes at the end of the defined period."
He agreed with a recent editorial written by David Blumenthal, MD, the new national coordinator for health information technology, in the New England Journal of Medicine, that HIT was improving healthcare and value. "Thus, the desired outcomes of meaningful use must transcend technical specifications and include guidance addressing improvement in safety and quality that are intended."
Farzad Mostashari, MD, assistant commissioner of the Primary Care Information Project, within the New York City Department of Health and Mental Hygiene, said "the transformative potential of health IT is to provide the information necessary for organized care delivery and drive transparency in healthcare outcomes."
The endpoints for meaningful use can include incentive payments tied to measures "that matter and that will sustain improved clinical outcomes," such as blood pressure control, evidence based care (smoking cessation therapy and aspirin use), patient safety, continuity of care, patient satisfaction, and compliance with public health reporting, Mostashari added.
Elliott Fisher, MD, of Dartmouth University, said his personal history in healthcare as a physician, manager, and patient has "lead me to believe that meaningful use of HIT can best be realized through implementing systems that have basic functionalities that facilitate the care of patients by physicians, nurses and other providers," he noted. "These systems need not necessarily be extremely complicated."
As the rate of chronic disease skyrockets, health costs balloon, and physicians struggle with demands on their time, health officials have increasingly turned to pharmacists as a possible solution.
The latest example is the Diabetes Ten City Challenge, which the American Pharmacists Association (APhA) Foundation created to test whether the pharmacist coach model works in diverse geographies and various employer types.
The final economic and clinical results for the DTCC found that combining pharmacist coaches with value-based insurance design helped diabetic patients manage their chronic disease.
According to the study that was published in the May/June issue of the Journal of the American Pharmacists Association, average healthcare costs for those involved in the project were reduced by $1,079 per patient annually and the participants saved an average of $593 per year on their diabetes medications and supplies because DTCC employers waived copays.
The program also improved patients' key clinical measures, including lowering A1C and cholesterol levels to achieve American Diabetes Association and National Cholesterol Education Program goals; and lowering diastolic/systolic blood pressure levels to below the 130/80 goal. The project also fostered improvements in preventive care measures, including flu vaccinations, current foot exams, and current eye exams.
William M. Ellis, CEO of the American Pharmacists Association (APhA) Foundation in Washington, DC, and co-author of the study, says the results show that pharmacist coaches could impact chronic disease, reduce adverse drug events, and improve medication compliance.
Pharmacist coaches can meet with patients longer than doctors, who are stretched for time, and they can help fill a gap left by physician shortages.
"Physicians today are asked to do so much in an office visit in a really short amount of time," says Ellis. "The things they have to cover with a patient are really more than I think can be done in a lot of office visits. To have the extra support of a pharmacist to reinforce those things is valuable."
According to the study, the APhA Foundation found successful pharmacist coaching programs feature the following:
An employer that invests in incentives for patients and providers to improve health and lower costs
Employers who are involved in program implementation and have an open culture with their employees
Receptiveness of healthcare providers who support community-based collaborative care
A local network of pharmacists with the motivation, training, and time to help patients manage their care
Health plans willing to provide claims data for analysis
"This whole area, I think, is emerging from pharmacy networks that are based on drug distribution to the emergence of pharmacy networks that will be based on patient care," says Ellis.
The employers that took part in DTCC were self-insured so they were at risk for both medical and prescription costs for their employees and beneficiaries. The employers/health plans created incentives for patients and pharmacists, including waived copays for medications and certain supplies, and pharmacists were paid for their coaching services.
During regularly scheduled appointments, pharmacists "applied a prescribed process of care that focuses on clinical assessments and progress toward clinical goals and work with each patient to establish self-management goals. In addition, they worked with other healthcare providers and could recommend adjustments in the patients' treatment plans when appropriate," according to the study.
These private visits allowed patients to ask questions, and the pharmacists were able to identify problems and teach self-management skills.
One of the 10 DTCC sites was led by the Northwest Georgia Healthcare Partnership (NGHP), based in Dalton, GA. The nonprofit includes healthcare providers, businesses, payers, government, and educators, who look to improve the health of residents in Whitfield and Murray counties.
Nancy Kennedy, executive director of NGHP, says an important part of the DTCC is that pharmacists are not replacing doctors or diabetes educators. Instead, they are there to help patients between doctors' appointments and update the physicians about their patients' health.
Similar to many parts of the nation, Northwest Georgia is facing a primary care physician shortage. Through visits with patients, the pharmacists are able to provide face-to-face case management.
She says patients feel a close bond with pharmacists and aren't afraid to ask them medical questions. Having that friendly relationship also allows for more honest communication.
"That accountability, face-to-face accountability, with someone in your community that you know, that you see on a regular basis to me is what makes this program so phenomenal and strong," says Kennedy.
One of the businesses that participated in Northwest Georgia, Hamilton Health Care System, made sure the project was not just a freebie for diabetics. The patients had to follow their prescription regimen, exercise regularly, and maintain a proper diet to remain in the program.
"We both have skin in the game so to speak," says Jason Hopkins, director of human resources at Hamilton Health Care System, about the employer and employee. "That helps both the investment we put forth to these individuals, but also in theory motivates them to comply."
Hopkins says Hamilton did not achieve great financial savings and probably broke even in the DTCC, but added that the health system should realize preventive savings through diabetics taking better care of themselves.
Hopkins says many businesses are reactive when it comes to tackling rising health costs. They pass costs onto employees by increasing copays and deductibles. That works to a certain extent, but employers must draw the line eventually, he says.
"I think what this tells the healthcare community is that one, you can incentivize your associates to take better care of themselves, that's what the healthcare providers want to see, but from the industry standpoint I think this proves to them that they don't have to push off more cost onto their employees. They can actually pay more, but ultimately in the long run see better financial outcomes because [employees] are taking better care of themselves," says Hopkins.
Though DTCC showed positive results, many pharmacies could not offer the same level of coaching services at this point. In order to have more pharmacist coaches, Ellis says the following should happen:
Pharmacies will need to redesign their areas to create private consultation rooms
Healthcare will need to improve health information systems, such as electronic health records, which could lead to better data exchange
Employers will need to understand pharmacy coaching programs bring long-term savings and not view them solely as an expense
Payers will have to change the way they reimburse pharmacists to include payment for providing coaching services
Ellis says pharmacists add value to the healthcare system by providing evidence-based treatments that can improve patients' health. Better health means lower employer costs and increased productivity.
"We're at a point now in healthcare that a lot of people are looking at the healthcare system in total and looking at how can we revitalize it, how can we change it, how can we improve it? This is an example of the promising practices that could lead to a reformed healthcare system in this country," says Ellis.
The APhA Foundation is now looking to expand the tenets of the DTCC to other disease states, including hypertension, low back pain, asthma, and chronic obstructive pulmonary disorder.
The widening outbreak of swine flu, also known as H1N1 flu, is exposing a potentially critical hole in the nation's defenses. Across the country, emergency care facilities are straining at the seams even though the swine flu outbreak is relatively small and the federal government has launched a mammoth disease-control effort.
This Statistical Brief from the Agency for Healthcare Research and Quality presents national data from the Healthcare Cost and Utilization Project on rates and total costs of potentially preventable hospitalizations. Distribution of the total costs by payer is also examined. The study found that in 2006, nearly 4.4 million hospital admissions, totaling $30.8 billion in hospital costs, could have been potentially preventable with timely and effective ambulatory care or adequate patient self- management of the condition.
The legislation to reform healthcare of the U.S. economy will turn on just 51 votes cast (or perhaps not) in the Senate over the next several months. The race to this 51 votes was launched as Congress approved a final budget resolution this week. Now the real work of lawmaking begins, says Sg2 analyst Stephen Jenkins.
