The 60,000 square-foot 'neighborhood hospital' located southeast of Baton Rouge in Prairieville, LA will include 10 inpatient beds, a 14-bed ER, a lab, and physicians’ offices.
Baton Rouge General on Tuesday announced plans to build a neighborhood hospital in Prairieville, La.
The $30 million project is now in the design phase, with groundbreaking expected for early 2018 and opening planned for 2019. When completed, the 60,000 square foot hospital will include 10 inpatient beds, a 14-bed emergency department, a lab, physician practices and office space.
Ascension Parish, where Prairieville is located, has seen its population increase by 13% since 2010. Census estimates predict an additional 40% growth by 2025. Last year, more than 22,000 patients from Ascension Parish came to Baton Rouge General for care, the health system said.
“Our new neighborhood hospital will make it more convenient for Ascension Parish families to get the care they trust closer to home," BRG President and CEO Edgardo Tenreiro said in a media release. "The smaller campus will make navigating the hospital faster and easier, while the BRG name means patients will receive the same safe and high-quality care they receive at our other facilities.”
When the doors open, the hospital will provide care 24 hours a day and will treat conditions including chest pain and heart attacks, broken bones, stroke, abdominal pain, burns, seizures, dehydration, and allergic reactions.
Baton Rouge General’s Bluebonnet campus serves as the critical care hub for General Health System’s two hospital campuses and 20 clinics. The Mid City campus has shifted its focus to post-acute care, offering behavioral health services, skilled nursing and rehab in the heart of Baton Rouge.
Some analysist believe that micro-hospitals are on the cusp of becoming more popular because they can come on-line much quicker than full-service hospitals, they can expand a health system’s footprint with a smaller investment, and they have comparatively low overhead.
The narrowly defeated bill had been strongly condemned by key physician, hospital, and health insurance interest groups, and they made known their pleasure at its demise shortly after Friday’s early morning vote.
The sense of relief was palpable in the statements issued by key healthcare sector lobbies in the hours after the Senate narrowly rejected another attempt to repeal the Affordable Care Act.
The surprise “no” vote of Sen. John McCain, R-NV, doomed the so-called “skinny repeal,” which failed early Friday morning on a 49-51 vote. McCain and Republican colleagues Susan Collins of Maine and Lisa Murkowski of Alaska joined unanimous Senate Democrats to vote against the bill.
The bill had been strongly condemned by major physician, hospital, and health insurance sector lobbies in the days and hours leading up to the vote, and they made known their pleasure at its demise shortly after the early morning vote. They also pledged to work with Congress and the Trump administration to improve the Affordable Care Act, and urged them to act quickly to stabilize health insurance markets.
“The Senate’s vote provides not a victory for one side or a loss for the other, but rather a new opportunity to reset and regroup,” said Rick Pollack, president and CEO of the American Hospital Association. “Working together, both parties in both chambers should utilize this opportunity to fix the very real problems facing our health care system. The result this morning shouldn’t mark the conclusion of the debate but should serve as a catalyst to restart it in a bipartisan manner.”
“Ultimately, any changes to the Affordable Care Act must ensure the continuity of access and coverage for all who currently have it. We are hopeful that, as this process moves forward, lawmakers will demonstrate their determination to meet these standards that the American people both expect and deserve,” Pollack said.
American Medical Association President David O. Barbe, MD, who on Thursday called the skinny bill “toxic,” cheered its defeat Friday morning.
“While we are relieved that the Senate did not adopt legislation that would have harmed patients and critical safety net programs, the status quo is not acceptable,” he said. “We urge Congress to initiate a bipartisan effort to address shortcomings in the Affordable Care Act. The first priority should be to stabilize the individual marketplace to achieve the goal of providing access to quality, affordable health coverage for more Americans.”
Health insurance companies opposed the removal of the individual and employer mandates under the skinny bill, and said it would destabilize the market. America’s Health Insurance Plans communications director Kristine Grow issued a terse release stating that AHIP “stands ready to continue to work with Congress and the administration on solutions to ensure that the American people have affordable, high-quality choices for their coverage and care.”
John Meigs, Jr., MD, president of the American Academy of Family Physicians, said primary care physicians are “encouraged that the U.S. Senate failed to pass healthcare reform legislation.”
“This harmful legislation would have put the health of millions of Americans at risk through loss of coverage and destabilization of the health insurance market,” Meigs said. “By removing the individual and employer mandates and making health insurance optional, the Congressional Budget Office estimates that premiums would have risen up to 20% with each passing year, putting affordable coverage out of reach for millions of Americans. The Senate tried to pull the rug out from under the insurance market and failed.”
Bruce Siegel, MD, president and CEO of America’s Essential Hospitals, said the skinny bill’s defeat “is welcome news for millions of Americans and the nation’s essential hospitals, which care for people who face social and financial hardships.”
“Efforts to protect our hospitals and their patients must start now by averting damaging cuts to Medicaid disproportionate share hospital payments, set to start Oct. 1. Congress also must renew its commitment to the Children’s Health Insurance Program and other key elements of the safety net,” he said.
Darrell G. Kirch, MD, president and CEO of the Association of American Medical Colleges, also praised the skinny repeal’s defeat and urged Congress and the Trump administration to work with the healthcare sector to improve the Affordable Care Act.
“The most immediate concern is stabilizing the health insurance market through continued, predictable funding of cost-sharing subsidies. Without these subsidies, the markets will face significant strains that could be devastating for patients, especially those who are most vulnerable,” Kirch said. “Additionally, there are other issues that must be addressed for the benefit of patients, including reauthorization of the Children’s Health Insurance Program and Medicare extenders, and reducing the unnecessary regulatory infrastructure that drives up costs and inhibits the efficient delivery of patient care.”
Sister Carol Keehan, DC, president and CEO of the Catholic Health Association of the United States, said her organization “is pleased and relieved that we will now have an opportunity to work together in a bipartisan way to improve the ACA. Working together there are many ways that this landmark legislation can be much improved.”
The extended relationship broadens access to patient-centered care, improves care coordination and chronic disease management, and allows for sharing of treatment guidelines and protocols.
CVS Health and Cleveland Clinic announced that they are expanding their eight-year clinical affiliation across Northeast Ohio and Florida.
The expanded relationship builds on the clinical affiliation between MinuteClinic, the retail medical clinic of CVS Health, and Cleveland Clinic. Going forward, MinuteClinic, CVS Pharmacy and Cleveland Clinic will offer convenient clinical support, medication counseling, chronic disease monitoring and wellness programs at CVS Pharmacy and MinuteClinic to address high rates of chronic diseases, such as hypertension.
“Our clinical collaboration with Cleveland Clinic has successfully increased access to care for thousands of patients,” Sharon Vitti, senior vice president and executive director of MinuteClinic, said in joint media release.
“By expanding and enhancing our affiliation, we will broaden electronic communication between providers in both organizations and leverage population health data to help improve the health outcomes and reduce the cost of care for the patients we serve,” Vitti said.
CVS Health will join Cleveland Clinic’s Quality Alliance, a clinically integrated network collaborating on quality measures around chronic disease management. The two organizations will share standard protocols and quality metrics and review population health data through integrated, secured systems.
“This collaboration enhances the quality of care patients will receive and allows us to oversee their care more seamlessly than we do today,” said Michael Rabovsky, MD, chairman of the Cleveland Clinic Department of Family Medicine. “As part of our Quality Alliance, CVS Health joins our clinically integrated network which uniquely positions us to share treatment guidelines and protocols and puts the patient at the center of a larger system of care when they need it.”
MinuteClinic, CVS Pharmacy and Cleveland Clinic will streamline communications through their electronic health records, which will include electronic sharing of messages and alerts about patients’ prescription information, visit summaries, diagnoses and treatment protocol, with patient consent, directly between the treating physicians and CVS Pharmacy and MinuteClinic.
“The expanded collaboration with CVS Health also allows us to provide better access to quality care for patients in Florida,” said Hermann Stubbe, MD, chairman of the Cleveland Clinic Florida Department of Family Medicine. “The ability to share information, quality measures and protocols will reduce chronic disease and ultimately improve our patients’ quality of life.”
Over the past five years, the percentage of patients giving their hospital top-box scores for overall rating has increased steadily. From 2015 to 2016, providers, in aggregate, improved on nearly every HCAHPS measure.
Despite the battle raging in Congress over the future of the Affordable Care Act and other dramatic changes occurring in the healthcare sector, the quality of care delivered continues to improve across the board, according to new analyses from Press Ganey.
The healthcare analytics and consulting firm analyzed performance trends from 2013 to 2017 for the HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) Overall Rating global measure, and year-over-year performance on individual HCAHPS and Press Ganey survey items from 2015 to 2016.
They identified the top drivers of improvement, and looked at how hospitals in the Press Ganey database performed on these drivers from one year to the next and the impact that performance had on their likelihood to achieve top-box scores on the overall rating.
The analyses found that:
Over the past five years, the percentage of patients giving their hospital top-box scores for Overall Rating has increased steadily.
From 2015 to 2016, providers, in aggregate, improved on nearly every HCAHPS measure, with some providers showing greater improvement than others on certain measures.
During this period, most health systems stayed in the same quartile of performance for overall rating from one year to the next, and 15% moved up to a higher quartile.
The top drivers of performance on the overall rating measure included patients’ perception of nurse courtesy (quantitative and qualitative measures) and teamwork.
Of the health systems that showed improved performance on all three top drivers from 2015 to 2016, 86% also increased their overall rating top-box scores.
Emergency department visits in Maryland fell by 1% statewide in the months after Medicaid expanded. The number of Medicaid ED visits increased 6%, with a corresponding 6% drop in the number of uninsured emergency department visits.
Emergency department visits across Maryland declined slightly in the months after the state expanded its Medicaid population under the Affordable Care Act, Johns Hopkins researchers say.
In a paper published in the Annals of Emergency Medicine, the Johns Hopkins researchers said that the number of people covered by Medicaid in Maryland increased more than 20% percent, or 160,000, with the ACA, and the total number of ED visits in state fell by more than 36,000 during the study period.
“Thirty-six thousand may seem like a lot of visits, but, in Maryland, that only equates to about a 1% change,” said researcher Eili Klein, PhD, assistant professor of Emergency Medicine in the Johns Hopkins University School of Medicine. “So, the effect of expanding Medicaid seems to have had no effect on emergency department utilization at an aggregate level.”
The researchers analyzed ED visits across Maryland for the 18-months before the Medicaid expansion took effect and an 18-month period afterward using data from the state’s Health Services Cost Review Commission. The first six months of 2014 were excluded in the analysis, researchers say, to control for the initial expansion of insurance that year when people were still being enrolled in Medicaid.
The study also found that Medicaid visits increased by almost 6%, while the number of uninsured patient visits decreased almost 6%. Of the uninsured patients who visited an ED before the ACA, 37% made at least one visit to the ED during the post-ACA study period. About 28% of those patients remained uninsured for all visits, while 31% were consistently enrolled in Medicaid.
“It was unrealistic to expect emergency department visits to decrease immediately after the ACA enactment,” Gabor Kelen, MD, director of the Johns Hopkins Department of Emergency Medicine, said in remarks accompanying the study. “The ACA did not really address incremental primary care access for the newly insured. Many new Medicaid-insured patients are still dealing with serious conditions that require emergency hospital care. Also, a population who could only previously receive care in the emergency department is not likely to immediately change this tendency.”
While the ACA did not reduce the burden on ED, Klein said “it does protect many patients from expenses of health care services and gives hospitals increased financial security.”
The findings are consistent with a 25-state study published last month, also in Annals of Emergency Medicine. Vanderbilt researchers determined that states that expanded Medicaid coverage under the ACA saw 2.5 ED visits more per 1,000 people after 2014, while the share of ED visits by the uninsured decreased by 5.3%.
“Medicaid expansion had a larger impact on the healthcare system in places where more people were expected to gain coverage,” study lead author Sayeh Nikpay, PhD, of Vanderbilt University, said. “The change in total visits was twice as large in a state like Kentucky, where most childless adults were ineligible for Medicaid at any income level before 2014, as in states like Hawaii, where childless adults were already eligible for Medicaid above the poverty line.”
Nikpay analyzed patient visits in 14 states that expanded Medicaid coverage and 11 that did not and found that the share of visits covered by private insurance remained constant for expansion states and increased by several percentage points for non-expansion states. Gains in insurance coverage in non-expansion states were almost entirely in the form of private coverage, not Medicaid.
Increases in ED visits were largest for injury-related visits. There was also a large change in payer mix for dental visits, because dental ED visits are most prevalent among low-income, non-elderly adults on Medicaid. Out-of-pocket dental costs were reported as one of the more unaffordable types of care among the target population for Medicaid expansion under the ACA.
In the past six years, the actively licensed U.S. physician-to-population ratio increased from 277 physicians per 100,000-population to 295 physicians per 100,000-population.
Female physicians account for more than one-third of the nearly 1 million licensed physicians in the United States, according to a biennial census by the Federation of State Medical Boards.
The “2016 Census of Actively Licensed Physicians in the United States” said that there were 953,695 actively licensed physicians in the United States in 2016, up from 850,085 in 2010, an increase of 12%. In that time, the actively licensed U.S. physician-to-population ratio increased from 277 physicians per 100,000-population to 295 physicians per 100,000-population, the census found.
“Many parts of our country are feeling the effects of an increasing physician shortage,” said Gregory B. Snyder, MD, chair of the FSMB Board of Directors. “The wealth of data that this census provides can play a significant role in understanding the needs of our health care workforce and help to identify areas in which we can innovate and expand access to care.”
The census also found that:
The number of actively licensed physicians who are Doctors of Osteopathic Medicine increased by 39% between 2010 and 2016, compared with a 10% increase in the number of Medical Doctors during the same time period.
Female physicians now account for one-third of all actively licensed physicians. In 2010, 30% were female, rising to 34% in 2016.
The number of U.S. citizens who graduated from Caribbean medical schools increased by 95% since 2010. In 2010, there were 11,037 actively licensed physicians who were U.S. citizen Caribbean medical graduates and in 2016 there are 21,519.
The biennial census was first conducted in 2010, and again in 2012 and 2014.
The nonprofit Federation of State Medical Boards represents all medical boards in the United States and its territories that license and discipline allopathic and osteopathic physicians and other healthcare professionals.
The small survey of primary care physicians also found that nearly one-third of them were unfamiliar with the American Diabetes Association’s guidelines for prediabetes.
Nearly 90 million people have prediabetes in the United States, but the “vast majority” of 140 primary care physicians who were asked to identify the 11 risk factors for the condition could not do so, a new study shows.
The small survey was conducted by Johns Hopkins researchers during a retreat and medical update for primary care physicians. The findings, which are believed to be the first to formally test primary care physicians’ knowledge of guidelines for prediabetes screenings, were published this week in the Journal of General Internal Medicine.
“Although this survey was conducted among primary care providers from a large academically-affiliated practice and may not represent providers from other types of practice settings, we think the findings are a wake-up call for all primary care providers to better recognize the risk factors for prediabetes, which is a major public health issue,” Eva Tseng, MD, the study’s first author and an assistant professor at the Johns Hopkins University School of Medicine, said in accompanying remarks.
Of the providers who completed the survey, only 6% correctly identified all of the risk factors that the American Diabetes Association said should prompt prediabetes screening. Seventeen percent identified the fasting glucose and HbA1c, laboratory values for diagnosing prediabetes. On average, the physicians picked eight out of the 11 risk factors for prediabetes screening.
The survey also found that nearly one-third of the primary care physicians were unfamiliar with the American Diabetes Association’s guidelines for prediabetes.
An estimated 86 million adults in the United States have prediabetes; 70% of these individuals will eventually develop type 2 diabetes, according to the Centers for Disease Control and Prevention and ADA expert panel. Preventive measures such as changes in diet and physical activity and the prescription of metformin, an oral diabetes medication that helps control blood sugar levels, have proven effective in preventing the progression of prediabetes to type 2 diabetes, the ADA said.
An estimated 90% of people with prediabetes are unaware of their condition, according to the CDC. To better understand why so many with prediabetes go undiagnosed, the Johns Hopkins researchers created the survey to test awareness of expert prediabetes guidelines and beliefs regarding prediabetes management.
At an annual retreat and medical update held for Mid-Atlantic region primary care physicians in 2015, the researchers invited all 156 primary care physicians who attended the meeting to participate in the on-site survey, and asked them to select prediabetes risk factors from a list of factors recommended by the ADA guidelines for the screening of prediabetes.
The survey also asked the physicians to identify guidelines issued by the ADA about prediabetes screening; numerical values corresponding to the upper and lower limits of the fasting glucose and HbA1c laboratory criteria for diagnosing prediabetes; values corresponding to the ADA’s recommendations for minimum weight loss and minimum physical activity for patients with prediabetes; best initial management approach to a patient with prediabetes; prediabetes screening tests used; initial patient management approaches; and intervals used for repeat lab work and follow-up visits.
To evaluate attitudes and beliefs regarding prediabetes, the survey asked providers to rate, on a five-point scale whether they believe it is important to identify prediabetes and whether they believe that lifestyle modification and metformin can reduce the risk of progression to diabetes. A similar scale was used to evaluate what providers perceive as patient barriers to lifestyle modification and the use of metformin.
While only 11% of physicians selected referral to a behavioral weight loss program as the recommended initial management approach to prediabetes, 96% selected counseling on diet and physical activity. Behavioral weight loss programs are the recommended initial approach by the ADA. The survey also revealed that metformin use for prediabetes was uncommon: 25% of providers never prescribed metformin and 16% did not believe in prescribing metformin for patients with prediabetes. In the 2017 guidelines, the ADA is now recommending that metformin be considered in patients with prediabetes who have failed to decrease their risk of diabetes through lifestyle change.
Researchers and advocacy groups have raised concerns that hospitals might not readmit patients out of fear of financial penalties associated with HRRP, thus increasing post-discharge mortality.
A review of more than six million hospitalizations shows no linkage between reduced 30-day readmissions and increased post-discharge mortality, according to a new study today in JAMA.
Yale New Haven Health researchers, led by Kumar Dharmarajan, MD, wanted to see if the Affordable Care Act’s Hospital Readmissions Reduction Program had the unintended consequence of increasing mortality rates. Researchers and advocacy groups have raised concerns that hospitals might not readmit patients out of fear of financial penalties associated with HRRP, thus increasing post-discharge mortality.
Those concerns, apparently, are unfounded, the study showed.
“While concerns about unintended consequences of incentivizing readmission reduction have been frequently raised, study findings strongly suggest that mortality has not increased,” the study concluded.
The researchers examined the correlation of trends in hospital 30-day readmission rates and hospital 30-day mortality rates after discharge among Medicare fee-for-service beneficiaries 65 years or older hospitalized with heart failure, acute myocardial infarction, or pneumonia from 2008 through 2014. Approximately 6.7 million hospitalizations were identified, as were any changes in risk-adjusted readmission and mortality rates. The data showed that reductions in hospital 30-day readmission rates were weakly but significantly correlated with reductions in hospital 30-day mortality rates after discharge.
The study authors said their findings could be limited because they examined only three conditions, and the findings may not apply to readmission reductions for conditions not targeted by the ACA.
In an editorial accompanying the study, Karen E. Joynt Maddox, MD, an associate professor at Harvard Medical School, called the findings “certainly good news.”
“There is an emerging literature on strategies that hospitals are using to reduce readmissions, the majority of which relate to improving coordination, communication, and cooperation among physicians and other healthcare professions and across care settings Joynt Maddox wrote. “The fact that these strategies do not inadvertently increase mortality rate, and may even have some positive effects, is even more reason to continue this important work helping patients transition safely from hospital to home.”
Joynt Maddox said the study does not address another key concern – that hospitals are prioritizing readmissions reductions over lowering mortality rates. She noted that mortality for heart failure increased during the study period, held steady for pneumonia, and saw slight improvements for AMI.
The study findings are consistent with earlier research that appeared in JAMA.
However, a study last fall in Journal of Hospital Medicine examined nearly 4,500 acute-care hospitals' hospital-wide readmission rates and compared them with those hospitals' mortality rates in six areas tracked by the Centers for Medicare & Medicaid Services: heart attack, pneumonia, heart failure, stroke, chronic obstructive pulmonary disease, and coronary artery bypass. The researchers found that hospitals with the highest rates of readmission were more likely to show better mortality scores in patients treated for heart failure, COPD, and stroke. That led the study authors to question the use of readmissions as a valid quality indicator in CMS’ hospital rankings.
The combined company will offer a range of virtual care options for markets that include employers, health plans and health systems. The deal also allows Teladoc to develop global expansion plans.
Telehealth platform Teladoc Inc. has finalized its $440 million acquisition of the medical consulting company Best Doctors.
“Today we take a tremendous step forward as we continue to deliver on our promise to transform the healthcare experience; to provide an unprecedented, single-point of access for resolution to the widest spectrum of medical conditions, delivered via a virtual platform,” Teladoc CEO Jason Gorevic said Monday in a media release.
The deal, which was announced last month, was touted by the two companies as a “marriage” of Purchase, NY-based Teladoc’s technology, engagement capabilities, and scalable platform with Best Doctors’ network of medical experts, analytics, patient decision-support, and regional expertise. The combined company will offer virtual care services for markets that include employers, health plans, and health systems. The deal also allows Teladoc to develop global expansion plans.
Under the definitive agreement announced on June 19, Best Doctors shareholders will receive $375 million in cash and $65 million in Teladoc common stock from the issuance of 1.9 million shares.
Best Doctors CEO Peter McClennen will become president of the Best Doctors division under Teladoc. He will also receive a stock option award covering 123,320 shares of Teladoc common stock and a restricted stock unit award covering 58,824 shares of Teladoc common stock. The stock option awards each have an exercise price of $35.45, the company said.
Privately held Best Doctors was founded in 1989 by Harvard Medical School professors and now claims more than 40 million members globally. In 2014, Best Doctors acquired Rise Health to expand of its digital health services. Best Doctors generated $92.2 million in 2016, $23.7 million in the first quarter of 2017, and is expected to generate more than $100 million this year.
The bill is scheduled for a floor vote next week, but it’s not clear if this latest version of the Better Care Reconciliation Act of 2017 has enough support to pass the Senate. It will require near-unanimous support from Republicans because no Democrats support it.
Senate Republicans on Thursday unveiled their revised plan to repeal and replace the Affordable Care Act that now scraps a tax cut for the wealthy, increases subsidies for individual coverage, drops the individual mandate and allows insurers to offer no-frills plans.
The revised bill retains a contentious provision for a per capita cap on Medicaid spending and a decade-long phase out of the ACA’s Medicaid expansion that could mean a loss of coverage for millions of people.
The bill is scheduled for a floor vote next week, but it’s not clear if the latest version of the Better Care Reconciliation Act of 2017 has enough support to pass the Senate. It will require near-unanimous support from the majority 52 Republicans because no Democrats support it.
Republican Sens. Rand Paul of Kentucky and Susan Collins of Maine have already said they will not support the BCRA for completely different reasons. Paul says the BCRA remains too much like Obamacare, which he had pledged to repeal. Collins said she can’t support the Medicaid cuts.
The nonpartisan Congressional Budget Office has yet to score the latest proposal, and it’s not clear if the actuaries will be able to do so before next week’s planned floor vote.
In an effort to address criticism that their plan is primarily a tax cut for the rich while slashing services for the poor, the Republicans’ revision scuttled a plan to eliminate Obamacare’s 3.8% tax on investment income and a 0.9% surtax for Medicare, both of which target high earners with incomes in excess of $200,000. Some smaller taxes were eliminated, such as the tax on tanning salons.
The new bill also includes a modification of a provision pushed by Sen. Ted Cruz, R-TX, that would allow health insurers to offer bare-bones, discount policies that don’t comply with minimum coverage mandates under the ACA for mental health services, maternity and pediatric care, addiction treatment, prescription drugs and emergency medicine. The bill also provides $70 billion to create a high risk pool to help offset the costs of people with pre-existing conditions who buy the bare-bones plans.
The original BCRA provided $2 billion to help states deal with the opioids abuse crisis. That funding was increased to $45 billion in the revised bill in an effort to gain support from Senators in rural states that have been particularly hard hit by the epidemic.
The revised bill adds another $70 billion to a $112 billion state stability fund that was proposed in the original bill, which is designed to help states create and coordinate programs that lower coverage costs for consumers and insurers.
The new BCRA also includes a provision that allows people to use their tax-exempt health savings accounts to pay for insurance premiums.
