Critics say the 'draconian' proposed rule would prompt legal residents to forego medical care for fear of losing their green cards, with the higher costs of delayed care borne by taxpayers.
The Trump administration's proposal to expand public charge designations to Medicaid and Medicare Part D subsidies and other benefits will jeopardize the healthcare access of millions of legal residents, critics charge.
The 447-page proposed rule, which was unveiled Saturday by the Department of Homeland Security, would create "a strong disincentive to seek care," said Bruce Siegel, MD, president and CEO of America's Essential Hospitals.
"This rule would force people to forgo medical visits and medications until they are sicker and costlier to treat. It would drive higher levels of uncompensated hospital care and, ultimately, higher costs for insured patients and taxpayers," Siegel said in a media release.
Rick Pollack, president and CEO of the American Hospital Association, echoed Siegel concerns about delayed care, and urged DHS "to rethink this policy that could affect the health of millions."
"America's hospitals and health systems have serious concerns that those legally in the country could choose to forgo health care benefits—and therefore delay accessing care—out of fear of repercussions for themselves and their families,"Pollack said.
In a statement on its website, DHS said it is "proposing to consider current and past receipt of designated public benefits above certain thresholds as a heavily weighed negative factor. The rule would also make nonimmigrants who receive or are likely to receive designated public benefits above the designated threshold generally ineligible for change of status and extension of stay."
DHS said it estimates that "about 382,264 aliens seeking adjustment of status annually would undergo review annually to determine whether they are ineligible on public charge grounds." The rule would not apply to families making less than 15% of the federal poverty designation.
Homeland Security Secretary Kirstjen Nielsen noted that the "public charge" dates back to the Immigration Act of 1882, and is designed to ensure that new immigrants are not a financial burden for the United States.
"Under long-standing federal law, those seeking to immigrate to the United States must show they can support themselves financially," Nielsen said. "This proposed rule will implement a law passed by Congress intended to promote immigrant self-sufficiency and protect finite resources by ensuring that they are not likely to become burdens on American taxpayers."
The proposed rule change does not require Congressional action, and DHS could impose the new rule after a 60-day public comment period is published in the Federal Registry, which is expected this week.
The Trump administration has made restrictions on immigration one of its top priorities, and the 60-day public comment period would extend through November's mid-term elections, likely making the proposed rule campaign fodder for Republicans and Democrats.
John Baackes, CEO of L.A. Care Health Plan, called the proposed changes politically motivated and said they could adversely affect more than 170,000 members of the nation's largest publicly operated health plan.
"The proposed change has already had a chilling effect, with anecdotal reports that people are choosing not to access benefits for which they currently qualify," Baackes says.
"The changes, once they become effective, are very likely to exacerbate serious problems that impact the health of the immigrant community," he says. "We are likely to see more hunger, child poverty, homelessness and a wide array of unmet health needs, as families may be unwilling to seek and maintain health care coverage, or enroll in other important programs, due to fear of the rule."
Frederick Isasi, executive director of Families USA, said the proposal was "cruel, shortsighted, and violates our nation’s values."
"Families should never be forced to choose between being able access the healthcare and medicine they need and being together," Isasi said.
"Under the administration's draconian proposal, lawfully-present immigrants who access lifesaving programs like Medicaid,or Low-Income Subsidies for the Medicare Prescription Drug benefit would be in jeopardy of losing their current legal status or attain permanent resident status," he said.
An Illinois law on tax exemptions for nonprofit hospitals was upheld by the state's high court, and hospital advocates there say the statute could be a model for other states.
The Illinois Supreme Court ruling upholding the constitutionality of a hospital tax exemption law is a win for nonprofit providers in other states too, Illinois stakeholders say.
"What our general assembly did in 2012, the statute that was upheld Thursday, potentially could be a model for other states that are grappling with the issue," Illinois Health and Hospital Association General Counsel Mark Deaton told HealthLeaders.
"Hospitals across the country are breathing a sigh of relief because, if this statute had been ruled unconstitutional, it had the potential for reopening a lot of chaos in Illinois. Our friends in other states are happy that the status quo is being maintained," Deaton says.
In Oswald v. Beard, the Illinois Supreme Court on Thursday unanimously upheld a lower court ruling that the law passed constitutional muster.
The Oswald case did not involve a hospital or an application for exemption or any decision by the state, and was based only on the language in the law. The plaintiff, Chicago resident Constance Oswald, said the law was unconstitutional because it did not expressly mention the constitutional requirements for exemption.
The seven justices on the Illinois Supreme Court rejected the argument.
"While [the statute] does not expressly provide that the hospital charitable property tax exemption is limited to applicants that satisfy the constitutional requirement of exclusive charitable use, section 6 of article IX of the Illinois Constitution does say so, and we presume that the legislature intended to comply with this constitutional limitation," Justice P. Scott Neville wrote.
"The legislature was certainly aware of section 6 of article IX of the constitution and its requirement of exclusive charitable use, and it intended to enact a constitutional hospital charitable property tax exemption," Neville wrote.
At its core, Deaton says the main contention in the case "was very simple."
"It was about the wording of the statute, and does this statute or any statute have to reference the Constitutional provision this grows out of," Deaton says. "In this statute, should they have said in addition to complying with the constitution, hospitals also have to do the following thing?' The Supreme Court said 'No.'"
Deaton says hospitals and local governments win with the ruling.
"The court decision benefits hospitals by maintaining property tax exemption in place," he says. "It benefits communities because now everyone knows what the rules are, what the test is, and it ensures that communities are getting value for the tax exemption they grant."
"This really maintains the stability and benefit of tax exemption that hospitals have enjoyed for over 100 years in Illinois. It stays the course," he says. "We had about seven or eight years of tumult in the early to mid-2000s around the question of property tax exemption, and the law that was upheld today was enacted in 2012 and worked to resolve that tumult."
While the constitutionality of the law is settled, Deaton says other challenges could emerge when hospitals apply for tax-exempt status.
"Someone could come in and say 'We don’t think St. Elsewhere satisfies the statute' or 'We don't like that the statute counts a certain type of service,' so you might see more granular focused challenges," Deaton says. "But the question of whether the whole statute is constitutional, yes, that is settled."
Post-recession spending growth is climbing towards pre-recession levels and is largely driven by brand-name drugs, ER visits, and outpatient surgeries.
Private-sector healthcare spending grew by 44% over the past decade, rising from $3,752 per person with employer-sponsored insurance in 2007 to $5,394 in 2016, according to a study by the Health Care Cost Institute.
The recession, the Affordable Care Act, and strategic shifts in care delivery slowed spending growth but it's since rebounded. Spending growth in 2015 and 2016 climb toward pre-recession levels seen in 2007 through 2009, according to the study, which was published online Wednesday in Health Affairs.
The study is the latest to suggest that healthcare spending is accelerating and straining budgets across the economy, from the federal government, to businesses and households.
HCCI researchers examined private employer-sponsored insurance claims for about 40 million people, and found the annual average growth rate was 4.1% over the decade, ranged from 6.3% in 2009 to 2.6% in 2014, and climbed to an average of 4.4% growth in 2015 and 2016.
"Retrospective studies like ours show that healthcare spending is cyclical," study co-authors Amanda Frost and Kevin Kennedy said in an email to HealthLeaders.
"We observed a period of fast spending growth, followed by a period of much slower growth during the Great Recession. More recently, healthcare spending is up, and NHE predicts that we may be entering a period of faster growth."
Adjusted for inflation, healthcare spending rose 23% from 2007 through 2016, the researchers said.
Brand-name prescriptions, ER visits, and outpatient surgery drove 48% of the per capita spending increase. Frost and Kennedy say these three high-cost growth areas "may be good targets for cost-saving measures."
"Though, we did find that spending grew across all four main categories of health services: inpatient, outpatient, professional, and prescriptions," they said.
The findings also provide more evidence of a fundamental shift by consumers away from inpatient settings in favor of lower-cost outpatient settings.
Per capita out-of-pocket spending on brand-name and generic prescription drugs declined, and researchers pointed to benefit design changes and patterns of service use.
"In the case of brand-name prescriptions, recent spending trends did not correlate with utilization trends," Frost and Kennedy say. "Use of brand prescriptions has been falling each year, while spending has been increasing—suggesting price increases drove spending."
In addition, per capita out-of-pocket spending increased by 43%, driven by outpatient and professional services. The largest increase was seen in spending for ER visits.
Frost and Kennedy conceded some limitations in their study. While the sample data represents more than 25% of the population with employer-sponsored insurance, they said it may not be representative of the larger employer-sponsored insured population.
The study also excludes spending trends for patients with public insurance, and does not track health insurance premiums paid by employers and employees or information on drug rebates and coupons.
A new working paper recommends that long-term care hospitals lose their special reimbursement schedules under Medicare and instead get paid like cheaper SNFs.
Long-term care hospitals are paid too much for the care they provide, and should be stripped of their special reimbursement schedules under Medicare, a new study says.
Academics from the University of Chicago, Stanford University, and MIT in the joint study say most patients in long-term care hospitals would get the same or better care at less-costly skilled nursing facilities.
The study, released as a National Bureau of Economic Research Working Paper, estimates that Medicare could save $4.6 billion a year—with no harm to patients—by eliminating reimbursement schedules for long-term care hospitals, and instead paying them the same as skilled nursing facilities.
"As a result, they can and do treat patients that a SNF (which are sub-acute providers and that do not have the clinical infrastructure or staffing of a hospital) would not and should not," Lane Koenig, NALTCH's director of research and policy, said in an email to HealthLeaders.
"Because of this failure to recognize these differences, they mischaracterize the findings of their study in the abstract, introduction, and elsewhere in the paper," Koenig said.
The study calls for the elimination of a carve out for LTC hospitals that Congress created in the early 1980s that exempted them from payment reforms. As a result, LTC hospitals receive a substantially higher reimbursement than traditional hospitals, the study says.
That loophole has prompted the growth in the number of LTC hospitals, from a few dozen in the 1980s, to more than 400 today, and they account for $5.4 billion in annual Medicare spending.
"They are unique to the U.S. healthcare system, and, to the best of our knowledge, do not exist in any other country," said study co-author Prof. Neale Mahoney with the University of Chicago Booth School of Business.
The researchers examined new LTC hospitals entering the market between 1998 and 2014, and tracked patients leaving acute-care hospitals for the new LTC hospital. That transition triggered "a significant increase in Medicare spending and out-of-pocket costs for patients," the study found.
LTC hospitals cost the federal government three times as much as cheaper venues, such as SNFs, the study found, noting that in 2014, LTC hospitals were reimbursed at about $1,400 per day compared to about $450 at SNFs that provided medically similar care.
Despite the increased costs, the study said there was no evidence that LTC hospitals improved outcomes or reduced 90-day readmissions.
Even with the higher cost, the researchers found no evidence that long-term care hospitals increased the probability of patients going home, or reduced the chances of the patients dying within the 90 days after being admitted.
The researchers said that LTC hospitals likely will do their best to hobble any reforms to their reimbursements.
"The $4.6 billion of incremental spending generated by long-term care hospitals every year may look like 'waste' to the health economist, but to the (largely for-profit) industry it might more accurately be referred to as 'rents,'" the study said.
"This suggests a large financial incentive on the part of long-term care hospitals to block major regulatory changes, and may help explain their continued survival."
LTC Hospitals Refute Study
Koenig says the study fails to take into consideration several key points that invalidate the findings.
Specifically:
The study data are outdated and do not reflect the LTC hospitals Medicare patients or policies. The study covers LTCH market entrants between 1998 and 2014. Most of the growth examined in the paper happened prior to 2007. Today, the LTC hospital population has even higher acuity due, in large part, to a 2013 law that established patient criteria.
The study fails to recognize that LTC hospitals are acute-care hospitals and, as a result, can and do treat patients that a SNF (which are sub-acute providers and that do not have the clinical infrastructure or staffing of a hospital) would not and should not.
The study does not allow for the possibility that the clinical impact of LTC hospitals varies across types of patients. For some patient groups that spend three or more days in an intensive care unit or have multiple organ failure, LTC hospitals generate Medicare savings and improve mortality.
The study does not report the effect of LTC hospital care on readmissions to acute-care hospitals. A close reading of tables in the appendices suggests the authors did find a noticeable decline in readmissions corresponding to LTC hospital care, which contradicts the study's claim that LTC hospital care is not associated with measurable clinical improvement.
It's not clear yet if initiatives to reduce healthcare spending will provide enough savings to bend the cost curve, which is expected to increase by about 5.5% annually over the next decade.
Continued growth in U.S. healthcare spending to care for an aging population is having a ripple effect across the economy, straining budgets and dampening growth in businesses and households, according to a new report from Moody's Investors Service.
"That has consequences for the U.S. economy as a whole," Moody's Assistant Vice President Rebecca Karnovitz says.
"Healthcare supports the economy through output and employment, but it is increasingly crowding out other productive investments such as infrastructure and education, and that could weigh on U.S. growth potential going forward," she says.
The United States spends about twice as much on healthcare as any other industrialized nation. Healthcare spending accounted for 18% of the nation's GDP in 2016, about $3.3 trillion, and businesses and households accounted for about half of that spending. Medicare and Medicaid already account for about 25% of federal government spending, and those numbers are expected to rise as baby boomers continue to age.
Centers for Medicare & Services actuaries project that national health expenditure growth will average 5.5% annually through 2026. That growth will easily outpace GDP growth over the same period, and healthcare spending is expected to consume close to 20% of the GDP by 2026.
Karnovitz says it's not clear if initiatives such as population health or value-based care will provide enough savings to bend the cost curve.
"It's very much a question mark. Even in the short term, it's a very, very slow shift," she says.
"If you look at the Medicare program, the first step is a transitional period where the government is essentially adjusting to payments based on their own criteria," she says. "In some cases they are giving providers bonuses and in other cases they are dinging providers for not meeting the value criteria established."
With no macro-economic fix for stemming healthcare cost growth, Karnovitz says businesses and individual households, are taking action on their own.
"Employers are following in the government's footsteps," she says. "We are seeing businesses offering employees plans with high-performance narrow networks with providers that have agreed to provide high-quality care at a reduced price, enabling business to offer plans with lower premiums but with high quality care."
"On the consumer levels, they don't have very much leverage, but we are seeing they are shifting away from high-cost settings to lower alternatives such as urgent care centers, and telehealth, in an attempt to reduce their expense," she says.
"Employer plans have become less generous as they resort to using high-deductible plans to shield their bottom lines from the high costs," she says.
Providers are adapting to the changing environment with a number of strategies, including consolidations, changing service delivery models and coordinating care along value-based networks to better capture revenues across the continuum as profit margins get squeezed.
The megamerger has been cleared by insurance regulators in 16 states. Some hurdles remain, but the two companies hope to complete the deal by year's end.
The U.S. Justice Department's Antitrust Division on Monday gave its approval to the $52 billion deal merging Express Scripts with Cigna Corp.
"The value that we deliver together will help put our society on a far more sustainable path—one that helps health care professionals close gaps in care and supports our customers along their health journey," Cigna CEO and President David Cordani said in a media release.
Brad Haller, director in West Monroe Partners' Mergers & Acquisitions practice, says the Cigna-Scripts deal "is doing what everyone else in the healthcare space is doing right now, just on a grander scale."
"They're reacting to continued cost pressures from market forces like the Affordable Care Act, consumerism, and other industry players building scale against each other," he says.
Haller says DOJ's approval of the deal suggests that federal antitrust regulators are more comfortable with vertical integration.
"Horizontal mergers like Cigna-Anthem and Aetna-Humana were previously blocked," he says. "So the vertical integration we are seeing with retailers (CVS) buying payers (Aetna), and health plans (Cigna) buying prescription benefit plan providers (Express Scripts), is the way industry is going."
"Now that the DOJ has approved and provided certainty, one would expect others to follow suit," he says.
The deal, which was approved by shareholders of both companies last month, required a waiting period and federal review under the Hart-Rodino Antitrust Improvements Act of 1976. The waiting period expired this week with no objections raised by federal regulators.
Cigna and Express Scripts say they've so far obtain clearances for the merger from insurance regulators in 16 states, but the deal is still subject to outstanding state regulatory approvals.
The two companies hope to complete the merger by the end of the year.
A new study examines 12 years of trauma records and finds high mortality rates for shooting victims, despite the volumes of blood and resources used in attempts to save them.
It's no surprise that gunshot victims require a lot more blood transfusions, cost a lot more to treat, and are more likely to die than other trauma patients.
Now, a new study this month in the journal Transfusion shows just how much.
Researchers at The Johns Hopkins University examined the Maryland state trauma registry from 2005 to 2017 and found that gunshot victims are five times more likely to require blood transfusions, require 10 times more blood units and are 14 times more likely to die than people seriously injured by motor vehicles, non-gun assaults, falls or stabs.
"Blood products cost a lot, come with a lot of risks for those transfused, and are scarce, so understanding what kinds of trauma are most likely to require more of them can help hospitals improve outcomes for trauma victims," study corresponding author Steven Frank, MD, professor of anesthesiology and critical care medicine at Johns Hopkins, said inremarks accompanying the study.
Frank and colleagues analyzed data from 23,422 Johns Hopkins Hospital trauma patients entered into the Maryland trauma registry over the 12-year timeframe.
The study found that:
The average age for GSW (gunshot wound) patients was 27 and the average for non-GSW patients was 38. Males made up 93% of GSW patients and 67% of non-GSW patients.
Of all patients in the trauma registry, 2,672 (11%) had GSW injuries and 20,750 (89%) had non-GSW trauma injuries resulting from motor vehicle, non-gun assaults, falls or stabs. GSW patients were five times more likely to require a blood transfusion (538 of 2,672, or 20%) compared to non-GSW patients (798 of 20,750, or 4%).
When comparing all patients, the researchers found that GSW patients needed 10 times more units of blood than non-GSW patients (3.3 units versus .31 units for non-GSW patients).
Frank and colleagues also found that GSW patients were more likely to die in the emergency department (69 of 2,672, or 2.6%) than non-GSW patients (17 of 20,750, or 0.08%). Overall, GSW patients were about 14 times more likely to die (653 of 2,672, or 24%) than non-GSW patients (352 of 20,750, or 1.7%).
"The most likely explanation for these findings is the dramatic degree of injury severity in gunshot victims compared to all other types of trauma, including stab wounds," Frank said.
More than 116,000 people are injured and 38,000 people are killed from gun-related injuries in the United States each year.
The financial burden of caring for gunshot victims is also heavy.
The researchers compared two types of costs for transfusions: acquisition costs, or the cost of the unit itself ($200 per unit of red blood cells, $500 per unit of platelets, $50 per unit of plasma and $250 per dose of cryoprecipitate); and activity based costs, which are acquisition costs plus a fourfold increase for overhead that includes storage, viral testing, transport, compatibility testing and the cost of giving the blood to the patient.
Although overall, only 11.4% of all trauma patients had GSW injuries, more money was spent on blood for these patients than for all non-GSW trauma patients combined: $1.5 million for GSW patients versus $1.1 million for non-GSW patients in acquisition costs, and $6.1 million versus $4.6 million for non-GSW activity costs.
"For emergency preparedness purposes, hospitals that treat trauma need to have a sufficient amount of blood in the bank in order to treat patients coming in with gunshot wounds," Frank said.
The ACT for Better Diagnosis initiative that launched this week wants to heighten awareness about diagnostic errors, and give stakeholders strategies to reduce them.
A coalitionof more than 40 healthcare and patient advocacy organizations this week launched a two-year initiative to improve medical diagnoses, which by some estimates kill as many as 80,000 people each year in the nation's hospitals.
ACT for Better Diagnosis, is led by the Society to Improve Diagnosis in Medicine. SIDM CEO and Co-founder Paul L. Epner spoke with HealthLeaders about the initiative. The following is a lightly edited transcript.
HLM: What are actionable steps that providers can take to reduce diagnostic errors?
Epner: It's a long list. Everything from closing the loop on test results, trying to make sure that test results are communicated to physicians, that they interpret them correctly and that they communicate that to the patient.
That's a very basic thing, but it is a very big issue; closing the loop on referral testing. Having physicians and other clinicians just think a little bit more about the alternatives that might be in involved with the patient's symptoms. There are really many steps, some of them quite simple, some of them more complex, but all very doable.
HLM: What is the status of the initiative?
Epner: It officially has been launched this week, but we've been working on it for months with our coalition partners. The whole movement to improve diagnostic safety and quality started a decade ago.
HLM: What do you hope to achieve?
Epner: One of the problems associated with diagnostic safety and quality is the lack of awareness and steps one can take to overcome obstacles in the system. We want to bring attention to that and make sure that people know that there are things they can do.
We have a coalition that numbers more than 40 organizations, and they work with us to identify those obstacles and to create a platform so that every organization can figure out strategies for working around those obstacles and improving diagnosis. Every organization in the coalition is taking action on their own within their own organizations to do something to work around those obstacles and improve diagnosis.
Each organization is working on the steps they can take, based on being aware of the obstacles that they have collectively assembled. There are many other things going on outside of this initiative that will also bring forth more information. There are already recommendations.
HLM: What is the most common reason for misdiagnosis?
Epner: I don't know that there's one reason. Diagnostic quality and safety issues are associated with both cognitive and systematic breakdowns. On the cognitive side, it's something we call premature closure. It's not ordering the right tests. It's not interpreting the results properly.
On the systematic side, it can be a variety of things having to do with timeliness issues; getting results back from imaging or testing. It could be just access; employers giving patients time off to go to the physician when they have symptoms that are unexplained and bothering them.
The system has plenty of issues and physicians and other care providers have the cognitive issues on top of that.
HLM: Is there a common denominator for diagnostic errors?
Epner: Each member of the coalition is representing different elements of the care delivery system, and there are steps that every one of them can take. There's a role for nurses, roles for physicians, roles for lab people and imaging. There are roles for payers and roles for patients and so that one common theme is that everyone can do something.
Even providing feedback—patients don't necessarily let their physicians know when things aren't getting better. They go to a different physician and the original physician is never aware that things didn't get better. Our systems are just not set up to be robust.
HLM: Who is funding this initiative?
Epner: There are two primary funders. There is a two-year grant from the Gordon and Betty Moore Foundation and the Mont Fund. Together they have given us $3.1 million.
HLM: What do you expect to have accomplished in two years?
Epner: We expect people to be much more aware. We expect conversations to be ongoing and on a more frequent basis, and for people to be taking action. Whether or not we can see a needle move in two years, I think that's going to be more difficult. But we will look for the indirect measures of engagement.
This problem is the No. 1 source of malpractice in the U.S., in terms of dollars paid out, in terms of claims, in terms of severity of claims. These are the kinds of things where over time we will see impact. Will we see in the next 18 months? Not necessarily.
HLM: How do you get buy in from clinicians?
Epner: No one wants to do a bad job. They all want answers. Clinicians are highly skilled, highly trained, and most often get it right. They know diagnostic errors are a problem. They know it's impactful and they know they can make a difference. We've had no problem engaging the more than 40 organizations. Not only will they lend their name, but they will take action.
It's not just the healthcare professionals. Patient organizations like the American Heart Association, the American Cancer Society, they've all gotten involved too. There are steps and engagement for both patients and healthcare professionals.
HLM: What metrics will you use to determine whether or not this initiative is successful?
Epner: The metrics will be more around media mentions, publications, individual institutions engaging, the steps of the organizations who are members, and the growth in the number of organizations that participate. It will be relatively indirect but important as a precursor to more objective measures of actual reduced harm.
HLM: It sounds like one of the primary functions of this initiative is to get people thinking and talking about diagnostic errors?
Epner: Absolutely. It's thinking about it. It's talking about it. It's doing something about it.
The plans will be offered nationwide, working with local providers who will funnel complex care to the Rochester, Minnesota-based health system.
Mayo Clinic and Medica on Thursday announced plans to launch jointly developed health insurance plans that will be sold nationwide.
The two nonprofit, Minnesota-based companies said in a joint announcement that the health insurance products will tap into one another's clinical, administration, and customer service expertise.
The plan is to partner with local healthcare systems, to ensure easy patient access to care venues. When rare and complex care is required, however, providers will have the option to send patients to Mayo Clinic.
"Mayo Clinic and Medica share a commitment to collaboration, compassion, customer service and innovation. Together, we’ve worked diligently to advance health care, improve the consumer experience and make healthcare delivery more efficient," Medica President and CEO John Naylor said in a media statement.
"This expanded relationship will benefit not only both organizations, but also the people in the communities we serve," he said.
In growing numbers over the past several years, hospitals have been offering health insurance plans, in large part as a bulwark against the consolidation of the health insurance industry. The private exchanges created under the Affordable Care Act have made it easier for health systems to enter the insurance market and compete with established payers.
Allan Baumgarten, a veteran observer of healthcare trends in the Midwest, said the deal "strikes me mostly as a marketing strategy."
"It's not described as a real joint venture health plan, like Aetna has with five provider systems or Oscar has with Cleveland Clinic," Baumgarten says. "It sounds more like a Bright Health model of narrow networks with key provider groups, but putting out the marketing message that your doctor can refer you to Mayo Clinic—not that you can self-refer to Mayo Clinic."
"Those provider groups probably do not include prominent academic medical centers or other large systems, because they wouldn't want their patients to leak to Mayo Clinic," he says.
Mayo and Medica have a history of collaboration. They've developed accountable care organizations for commercial group and individual markets in Southeastern Minnesota and Southwestern Wisconsin. Mayo is also a center of excellence for many of Medica's other insurance plans.
In 2017, Medica acquired Mayo Clinic's third-party administrator business, MMSI, Inc., which does business as Mayo Clinic Health Solutions. Customers, including Mayo Clinic staff, will transition to Medica's technology platform and customer service model in January 2019.
"Our relationship with Medica and future product offerings support a collaborative model of care delivery and coordination of services with better outcomes for patients with complex and serious illness," Mayo Clinic CFO Dennis Dahlen said.
Poor handoffs, lack of feedback, limited support, and a complex diagnostic process contribute to the thousands of misdiagnosis-related hospital deaths each year.
A coalition of more than 40 patient and provider advocacy organizations on Thursday unveiled a two-year initiative to identify and address diagnostic errors in hospitals, which by some estimates kill as many as 80,000 people each year and are the leading cause of malpractice lawsuits.
"Providing an accurate medical diagnosis is complex and involves uncertainty, but it’s obviously essential to effective and timely treatment," said Paul L. Epner, CEO and co-founder of the Society to Improve Diagnosis in Medicine.
"Nearly everyone will receive an inaccurate diagnosis at some point in their life and for some, the consequences will be grave," Epner said. "Major improvement is needed to systematically identify how to improve diagnostic quality and reduce harm to patients."
SIDM's ACT for Better Diagnosis initiative has identified what it says are the six most common obstacles that impede diagnostic accuracy.
Incomplete communication during care transitions—When patients are transferred between facilities, physicians or departments, there is potential for important information to slip through the cracks.
Lack of measures and feedback—No standardized measures exist for providers to understand their performance in the diagnostic process, to guide improvements, or to report errors. Providers rarely get feedback if a diagnosis was incorrect or changed.
Limited support to help with clinical reasoning—With hundreds of potential explanations for any one particular symptom, clinicians need timely, efficient resources to assist diagnoses.
Limited time—Patients and providers report feeling rushed by appointment times, which poses risks to gathering a complete history for diagnosis, and allows scant opportunity to discuss further steps in the diagnostic process.
The diagnostic process is complicated—There is limited information available to patients about the questions to ask, or whom to notify when changes in their condition occur, or what constitutes serious symptoms. It’s also unclear who is responsible for closing the loop on test results and referrals, and how to communicate follow-up.
Lack of funding for research—The impact of inaccurate or delayed diagnoses on healthcare costs and patient harm has not been clearly articulated, and there is a limited amount of published evidence to identify what improves the diagnostic process.
The coalition is identifying tactics to improve the diagnostic process, such as providing online tools that help physicians recognize and avoid diagnostic pitfalls and improve medical education for new practitioners.
