The incidence of Clostridium difficile infections rose by 43% from 2001 to 2012, while the incidence of multiple recurring CDI rose by 189% over the same period.
Multiple recurring Clostridium difficile infections are becoming more common in the nation’s hospitals and researchers aren’t sure why.
In an analysis of a large, nationwide health insurance database, researcher’s at the University of Pennsylvania’s Perelman School of Medicine found that the annual incidence of multiple recurring C. difficile (mrCDI) increased by almost 200% from 2001 to 2012. During the same period the incidence of ordinary CDI increased by only about 40%. The study results were published this week in the Annals of Internal Medicine.
The reasons for the sharp rise in mrCDI incidence is unknown. Researchers said the finding points to an increased burden on the healthcare system, including increased demand for new treatments for recurrent CDI. The most promising of these new treatments, fecal microbiota transplantation—the infusion of beneficial intestinal bacteria into patients to compete with C. difficile—has shown good results in small studies, but hasn’t yet been thoroughly evaluated.
“The increasing incidence of C. difficile being treated with multiple courses of antibiotics signals rising demand for fecal microbiota transplantation in the United States,” said study senior author James D. Lewis, MD, professor of gastroenterology and senior scholar in the Center for Clinical Epidemiology and Biostatistics.
“While we know that fecal microbiota transplantation is generally safe and effective in the short term, we need to establish the long term safety of this procedure.”
In their analysis of CDI trends, the researchers examined records on more than 40 million patients enrolled in private health insurance plans. Cases of CDI were considered to have multiple recurrences when doctors treated them with at least three closely spaced courses of CDI antibiotics.
According to the analysis, the incidence of CDI rose by 43% percent from 2001 to 2012, while the incidence of mrCDI rose by 189% over the same period.
Compared to CDI patients whose infections cleared up after just one or two courses of therapy, patients with mrCDI were older (median age 56 vs. 49), more likely to be female (64% vs. 59%), and more likely to have been exposed, before their CDI, to medications such as corticosteroids, proton-pump inhibitors, and antibiotics, the researchers found.
The rapid rise in the incidence of mrCDI may be due in part to Americans’ increasing use of such drugs. However, according to Lewis, it is likely that other causes are also involved.
“An additional driver of this rise in incidence could be the recent emergence of new strains of C. difficile, such as NAP1, which has been shown to be a risk factor for recurrent CDI,” he said.
C. difficile can encapsulate itself within hardy spores, making it relatively resistant to normal sterilizing procedures. It is notorious for spreading among vulnerable patients within hospitals. Infection causes diarrhea and severe gut inflammation, and can lead to sepsis, especially among the elderly.
The antibiotics metronidazole, vancomycin, and fidoxamicin are commonly used to treat CDI, but recurrence after initial treatment happens in roughly a third of cases.
Because C. difficile appears to thrive in people whose normal, healthy gut bacteria have been killed off or diminished, gastroenterologists recently have begun using fecal microbiota transplantation (FMT) as an alternative to antibiotics for recurrent CDI. Long used in veterinary medicine, FMT involves infusions of fecal matter from healthy intestines. The aim is to help restore a normal gut bacteria population in the patient.
A small study in 2013 found that a single FMT infusion cleared up C. difficile diarrhea in 81% of the recurrent-CDI patients who received it, whereas a standard treatment with the antibiotic vancomycin worked for just 31% of patients. Lewis said more needs to be known about FMT’s long-term safety.
The American Gastroenterological Association recently set up a formal registry for doctors to report their results with FMT procedures. “It’s a way in which practitioners who are performing fecal microbiota transplantation can contribute data to help answer these critical questions,” Lewis said.
CareSpot says deal provides more resources when follow-up care is needed. Orlando Health seeks to expand care access points in its service area.
Orlando Health and CareSpot Urgent Care have formed a partnership.
Under the deal, CareSpot’s eight urgent centers in the Orlando area, and all future centers, will continue to be managed by CareSpot and co-branded CareSpot Urgent Care | Orlando Health, according to a joint media release.
The deal is expected to be finalized by the end of the summer. Financial terms were not disclosed.
“Orlando Health is a widely respected healthcare system in Central Florida,” CareSpot CEO Eric Enderle said. “This partnership will allow us to seamlessly connect our patients in the greater Orlando area to the broader resources in the Orlando Health network when follow-up care is deemed necessary and if the patient chooses.”
“Additionally, it gives us a strong partner as we grow throughout the area,” he said. “We are excited to be aligned with Orlando Health and anticipate opening more centers to better serve the needs of the greater Orlando Health community.”
Orlando Health CEO David Strong said the partnership “position(s) both parties to offer our community many access points for a high-quality, full continuum of care serving all levels of acuity for a wide range of conditions.”
CareSpot Urgent Care, a division of United Surgical Partners International, Inc., is operated and managed with MedPost Urgent Care at 91 locations nationwide. Core services include urgent care, wellness, in-house lab work and x-rays, seasonal care, and occupational health.
Orlando Health is a six-hospital, not-for-profit teaching hospital system that includes a level-one trauma center, a cancer center, two pediatric hospitals and three community hospitals serving Central Florida.
CHRISTUS will be the majority owner of the not-for-profit entity and will manage the joint venture, including CHRISTUS St. Patrick Hospital and Lake Area Medical Center.
CHRISTUS Health and Ochsner Health System have signed a letter of intent to pursue a joint venture of CHRISTUS operations in the Lake Charles region of southwest Louisiana, the two health systems announced Wednesday.
The joint venture will have responsibility for all healthcare facilities and services operated by the two health systems in the region. In a joint media release, the health systems said the agreement will improve and expand local access to healthcare and specialties such as maternal fetal medicine, pediatric subspecialties, neurosciences and oncology.
Financial terms of the deal were not disclosed.
“With today’s announcement we are sharing our intentions of bringing together two vital, not-for-profit organizations,” said Ernie Sadau, president and CEO of CHRISTUS. “We’re also reinforcing our deep commitment to continue to provide high quality care and improve the health of the communities we serve.”
Ochsner President and CEO Warner Thomas said the two health systems have an “opportunity and in fact (a) responsibility to work even more closely together and do more to expand, innovate and improve healthcare in our region.”
Ochsner will assume management of the clinics and employed physicians in the CHRISTUS Physician Group and Lake Area Medical Group. A new joint board of directors will oversee strategic decisions for the integrated system in the Lake Charles area.
When the transaction is completed, CHRISTUS will be the majority owner of the not-for-profit entity and will continue to manage all other parts of the joint venture, including CHRISTUS St. Patrick Hospital and soon to be acquired Lake Area Medical Center.
Until then, Lake Area Medical Center will be called CHRISTUS Lake Area Hospital.
The deal is expected to be finalized by fall 2017 including the new structure, an anticipated name change and co-branding. When the deal is finalized, the new entity will expand specialized healthcare services in the Lake Charles area that are currently unavailable.
CHRISTUS Health, a Catholic, faith-based, not-for-profit health system, is headquartered in Dallas, TX and includes more than 60 hospitals and long-term care facilities, 350 clinics and outpatient centers and dozens of other health ministries and ventures in the U.S., Mexico, Chile and Colombia.
Ochsner Health System is Louisiana’s largest non-profit, academic, healthcare system and includes 29 affiliated hospitals and more than 80 health centers and urgent care centers.
The widely read list ranks hospitals on how they performed in three key areas: clinical outcomes, care coordination, and providing care-related resources.
U.S. News on Tuesday unveiled its 11th annual list of the nation’s Best Children’s Hospitals, and it bears a striking resemblance to the magazine’s 10th annual list.
The top four hospitals in 2016-17 held their rankings in 2017-18, led by Boston Children’s Hospital, which is a perennial list topper. Only one hospital on the 2017-18 list, Johns Hopkins Children’s Center in Baltimore at No. 5, was not on the Top 10 list the previous year.
In the 2017-18 rankings, 82 hospitals ranked among the top 50 in at least one specialty. Ten of those hospitals earned a place on the Best Children's Hospitals 2017-18 Honor Roll by racking up points for being highly ranked in many specialties.
U.S. News said the 2017-18 rankings were created from data collected through a clinical survey sent to nearly 200 hospitals and a reputational survey sent to about 11,000 doctors who are pediatric specialists. RTI International, a North Carolina-based research and consulting firm that also generates the Best Hospitals rankings, administered both surveys and analyzed the results.
Data collected and analyzed included survival rates for children who underwent surgery for serious congenital heart defects, infection rates in neonatal intensive care units, complications from kidney biopsies and other care outcomes. Data about the adequacy of each hospital's nurse staffing and infection-prevention programs were among many other factors also considered, U.S. News said.
Rankings also depended on how well a hospital performed in three broad respects: clinical outcomes, such as maximizing cancer survival and minimizing rates of various infections; efficient coordination of care as demonstrated, for example, by complying with accepted "best practices"; and providing sufficient care-related resources such as nursing staff and outpatient programs tailored to particular conditions. Each of these three major areas determined up to one-third of a hospital's score, U.S. News said.
The rankings also considered responses to a survey of more than 3,000 pediatric specialists, who were asked to name up to 10 hospitals they consider best in their specialty for children with serious or difficult medical problems, U.S. News said.
The Better Care Reconciliation Act would cut health insurance coverage for 22 million people by 2026, but that number could change with news that the Senate will now include a penalty for going uninsured in its repeal plan.
The nonpartisan Congressional Budget Office on Monday said that 22 million people would lose health insurance coverage under the Senate plan to repeal and replace the Affordable Care Act.
The Better Care Reconciliation Act of 2017 would also reduce direct spending by more than $1 trillion and reduce revenues by $701 billion over the next decade, with a net reduction to the federal deficit by $321 billion. The CBO said that is about $202 billion more than the estimated savings in the House American Health Care Act, the companion legislation that passed in early May on a strict party line vote.
The CBO noted that:
The largest savings would come from reductions in outlays for Medicaid—spending on the program would decline in 2026 by 26% in comparison with what CBO projects under current law—and from changes to the ACA’s subsidies for non-group health insurance.
Those savings would be partially offset by the effects of other changes to the ACA’s provisions dealing with insurance coverage: additional spending designed to reduce premiums and a reduction in revenues from repealing penalties on employers who do not offer insurance and on people who do not purchase insurance.
The largest increases in deficits would come from repealing or modifying tax provisions in the ACA that are not directly related to health insurance coverage, including repealing a surtax on net investment income and repealing annual fees imposed on health insurers.
The CBO scoring also notes that in 2018 15 million more people would be uninsured under the Senate plan mainly because the penalty for not having insurance would be eliminated. However,several media outlets are reporting that the Senate has added the penalty back into the BCRA, so that could affect the CBO scoring.
Later in the decade, CBO says, lower spending on Medicaid and substantially smaller average subsidies for coverage in the non-group market would also lead to increases in the number of people without health insurance.
By 2026, among people under age 65, enrollment in Medicaid would fall by about 16% and an estimated 49 million people would be uninsured, compared with 28 million who would lack insurance that year under current law.
The BCRA was unveiled last week, the culmination of weeks of secrets meetings by a handful of Republican Senators. There will be no open committee meetings on the legislation, and Senate Majority Leader Mitch McConnell, R-KY, is pushing for a floor vote in the Senate before the July 4 recess. No Democrats are expected to vote for the bill, which means that McConnell will need near-unanimous support from his Republican colleagues. So far, at least four Republicans have expressed opposition to the bill.
American Medical Association CEO James L. Madara, MD, on Monday joined the long line of major health industry lobbyists to rail against the Better Care Reconciliation Act, bluntly telling Senate leaders: “Medicine has long operated under the precept of Primum non nocere, or ‘first, do no harm.’ The draft legislation violates that standard on many levels.”
Madara complained that the smaller subsidies for individual insurance coverage and waivers of required benefits, actuarial value standards, and out-of-pocking spending limits will expose low- and middle-income people to higher costs and unaffordable care.
“The AMA is particularly concerned with proposals to convert the Medicaid program into a system that limits the federal obligation to care for needy patients to a predetermined formula based on per-capita-caps,” Madara said.
“Per-capita-caps fail to take into account unanticipated costs of new medical innovations or the fiscal impact of public health epidemics, such as the crisis of opioid abuse currently ravaging our nation.”
The National Association of Medicaid Directors’s 56-member board of directors issued a unanimous “consensus statement”on Monday that vigorously opposed the proposed cuts to Medicaid, which add to about $800 billion over the next decade or so.
“No amount of administrative or regulatory flexibility can compensate for the federal spending reductions that would occur as a result of this bill,” NAMD said. “Changes in the federal responsibility for financing the program must be accompanied by clearly articulated statutory changes to Medicaid to enable states to operate effectively under a cap.
The Senate bill does not accomplish that. It would be a transfer of risk, responsibility, and cost to the states of historic proportions.”
“While NAMD does not have consensus on the mandatory conversion of Medicaid financing to a per capita cap or block grant, the per capita cap growth rates for Medicaid in the Senate bill are insufficient and unworkable,” the statement read.
The NAMD board rejected setting aside funds specifically for public health issues such as the opioid epidemic and noted that "earmarking funding for grants for the exclusive purpose of treating addiction, in the absence of preventative medical and behavioral health coverage, is likely to be ineffective in solving the problem and would divert critical resources away from what we know is working today.”
NAMD also called for prioritizing the stabilization of marketplace coverage before attempting to repeal the ACA. “Medicaid reform should be undertaken when it can be accomplished thoughtfully and deliberately,” NAMD said.
Richard Besser, MD, president and CEO of the Robert Wood Johnson Foundation, said that “every member of Congress must weigh the policy and moral implications of taking insurance from 22 million people. The impact extends well beyond the health and welfare of their own constituents. This bill would negatively affect the most vulnerable Americans regardless of where they live.”
“This bill puts the protections and peace of mind that come with comprehensive health insurance out of reach for millions of people—including children, the elderly, and those with disabilities,” Besser said. “It rolls back expansion of coverage under the Affordable Care Act, which helped millions of people become insured. It shifts responsibility to cash-strapped states for covering health care for the poor. It turns the financial support that made health insurance affordable for millions of people into tax cuts for the wealthiest among us.”
Hospitals and health systems looking for a blueprint for fighting the deadly disease should look to Ohio, where an aggressive campaign is being waged and mortality rates are falling.
The fight against sepsis is back in the news, but for those clinicians who spend their days combatting the deadly epidemic, the story never went away.
Health systems across the nation wrestle with a problem that the Centers for Disease Control and Prevention says is responsible for $24 billion in hospital costs each year.
Sepsis kills 258,000 people each year in the United States and costs more than $24 billion. It represents 6.2% of all hospital costs across the nation, which makes it the most expensive condition in the nation's healthcare system, according to the federal government's Healthcare Cost and Utilization Project.
HCUP analysis showed that while total hospital care expenditures have remained fairly stable, spending for sepsis rose 19% from 2011 to 2013, more than double the rate for all hospitalizations.
The study revealed that the mean expense per stay associated with those hospitalizations was over $18,000 in 2013, making hospitalizations from sepsis 70% more expensive than the average stay.
Sepsis resulted in nearly 1.3 million discharges that year from U.S. hospitals, an increase of 19% from 2011. Sepsis was also the most expensive hospital condition billed to Medicare, accounting for 8.2% of all Medicare costs incurred in 2013.
Hospitals and health systems that are looking for a blueprint for fighting the deadly disease should look to Ohio, where an aggressive campaign is being waged.
In 2015, Ohio's hospitals began a campaign to reduce sepsis encounters and related deaths by 30% by 2018. Less than one year after the initiative began, the Ohio Hospital Association reported an 8% reduction in mortality.
In 2012, the Buckeye State's 220 hospitals reported 26,299 encounters with severe sepsis and septic shock, resulting in 6,250 deaths. In 2015, those numbers had ballooned to 38,487 reported encounters and 7,478 deaths.
Of course, the reason why sepsis numbers are rapidly rising is because reporting systems such as ICD-10 have improved the ability to accurately report the infections, especially upon admission, which is where 80% of sepsis cases are traced.
But even with the proper context, the numbers are alarming and demand a response.
"Because we are encouraging people to identify it, we are not surprised that we have a more honest assessment of the problem in our state," says OHA President and CEO Mike Abrams.
"If we could go back and apply today's identification standards to the previous years, those numbers would be higher as well. The fact that we are better at identifying it is not the same as saying the problem is worsening."
Abrams says Ohio's hospitals in 2015 decided to "confront the brutal truths" and begin a campaign to reduce sepsis encounters and related deaths by 30% by 2018. Nine months into the initiative, OHA is reporting an 8% reduction in mortality. That's 353 lives saved.
"At every level of healthcare in our state, from CEOs to EMTs, ambulance workers and everything in between, we are trying to make sure that everyone in the system is more capable of identifying sepsis," Abrams says.
"We want to make sure they are curious about whether a patient is septic or becoming septic, and once that status is ascertained that they know what to do. It is a condition that we know how to treat, but it is time-sensitive."
Ohio's Two-pronged Approach
In 2015, the OHA board adopted two sets of interventions for sepsis; one for leadership commitment, the other for organizational strategies.
Among the recommendations, hospital leaders are asked to provide the resources and visible, vocal promotion of an accountable culture of safety in support of sepsis reduction.
Organizationally, hospitals are asked to develop early identification and intervention processes for sepsis, and coordinate sepsis prevention across the care continuum.
"A lot of it is just a conscientiousness about the process. It is identifying these patients earlier," Abrams says. "This is not like we don't know what to do. This is a condition that lends itself to certain interventions that work. Get the proper antibiotics to these patients in a timely way."
Abrams says hospital leaders respond more assertively when they're shown how their sepsis numbers compare with competitor and peer hospitals.
"Just that act alone raises awareness and identifies it as something that merits leadership level attention," he says.
"Once they understand that 'this is a problem in our facility' and there are interventions that work, that clinical science tells us the three-hour bundle is an actual intervention that clinicians have identified, the hospitals can learn for themselves where things break down."
Ultimately, Abrams says OHA "wants to do for sepsis what we did for ventilator-associated pneumonia: Make them rare."
"Raise everyone's awareness that this is a condition that you need to be intellectually curious about. Once you have identified it, here is a known intervention that works," he says.
"There are all kinds of reasons why you should be curious about sepsis. One is the number of lives you are saving, but the other is the true economic cost to our system that this condition presents. We all need to be interested in this."
The hospital sector offers unanimous thumbs down to the Senate’s proposal to repeal and replace the Affordable Care Act.
The nation’s largest hospital associations united in rejecting the Senate’s proposal to repeal and replace the Affordable Care Act, and urged lawmakers to “hit reset” and “go back to the drawing board.”
The response to the Senate plan released Thursday was virtually identical to the unanimous disdain shown this spring for the House Republicans' American Health Care Act.
That is not surprising because the two bills are fundamentally the same on key points. They both eliminate the individual mandate, slash Medicaid, and eliminate a 3.8% tax on investment income above $200,000 that is a key funding source for Obamacare.
Moody’s Investors Service said Thursday the Senate bill would hurt hospitals.
“Under the proposed Senate bill, both for-profit and not-for-profit hospitals would face weaker demand for services and higher rates of uncompensated care expense, with the most significant impact on the sector occurring after 2020 when the changes to federal Medicaid funding are phased in,” said Daniel Steingart, a vice president at Moody’s.
“Transitioning federal Medicaid payments to a per-capita, or block grant system, and freezing Medicaid expansion would reduce the number of people with insurance and increase hospitals’ exposure to bad debt and uncompensated care costs.”
The nonpartisan Congressional Budget Office has yet score the bill, but by some estimates as many as 11 million people who gained coverage under the Medicaid expansion would be booted from the rolls under the Senate plan.
Hospitals Say ‘Hit Reset’
Rick Pollack, president and CEO of the American Hospital Association, said the Senate Better Care Reconciliation Act “moves in the opposite direction” from “key principles” the AHA had set down to protect health insurance coverage, particularly for vulnerable patients.
“The Senate proposal would likely trigger deep cuts to the Medicaid program that covers millions of Americans with chronic conditions such as cancer, along with the elderly and individuals with disabilities who need long-term services and support,” Pollack said in a statement issued shortly after the Republican plan was made public.
“Medicaid cuts of this magnitude are unsustainable and will increase costs to individuals with private insurance. We urge the Senate to go back to the drawing board and develop legislation that continues to provide coverage to all Americans who currently have it.”
Those sentiments were echoed in a statement by Sister Carol Keehan, DC, president and CEO of the Catholic Health Association, who said the Senate proposal “will have a devastating impact on our nation's most vulnerable populations.”
“After weeks of working behind closed doors, and despite claims that the Senate would start over and develop its own legislation, there is very little that differs from the House bill,” Keehan said.
“The small tweaks made in the newly released Senate bill do not change the fact that millions will lose their health care especially through a complete restructuring and deep federal funding reduction to the Medicaid program.”
Bruce Siegel, MD, president and CEO of America’s Essential Hospitals, accused Senate Republicans of putting “ideology ahead of lives with a plan that puts health and home at risk for millions of working Americans and that would badly weaken essential services for everyone in communities across the country.”
“For the hospitals that protect millions of Americans and their communities — our essential hospitals — this bill might even accelerate decisions by some to reduce services or close their doors,” Siegel said.
“Particularly troubling is the opaque process senators have followed to reach this point. Legislation of this scope and with such potential for harm demands a fair and public hearing, but Senate leaders so far have rejected that. This is a slap in the face to the democratic process and bad policymaking for the country.”
Federation of American Hospitals President Chip Kahn said the Senate still has time “to hit reset” and make critical revisions in the bill.
“FAH has been explicit about our health reform core principles: maintain coverage levels, reasonable Medicaid structural reforms, sustain affordable, high quality individual coverage, protect employer-sponsored insurance and roll back untenable cuts to hospital reimbursement,” Kahn said.
“At this time, the BCRA draft does not sufficiently meet those principles which are so important to those Americans our community hospitals serve and our employees who care for those patients every day. Now is the time for the Senate to hit reset and make key improvements to this legislation.”
Association of American Medical Colleges President and CEO Darrell G. Kirch, MD, said his members “are extremely disappointed by the Senate bill released today.”
“Despite promises to the contrary, it will leave millions of people without health coverage, and others with only bare bones plans that will be insufficient to properly address their needs,” he said.
“As the nation’s medical schools and teaching hospitals see every day, people without sufficient coverage often delay getting the care they need. This can turn a manageable condition into a life-threatening and expensive emergency. Rather than stabilizing the healthcare marketplace, this legislation will upend it by crippling the Medicaid program while also placing untenable strain on states and providers.”
Payers Peeved
Compared to the hospital lobby, the health insurance industry was restrained in its criticism of the Senate plan. America’s Health Insurance Plans spokeswoman Kristine Grow said it would “continue to analyze the bill, consistent with our previous positions.”
In May, AHIP CEO Marilyn Tavenner urged the Senate “to ensure the continued strength of the Medicaid program, which delivers real value to more than 70 million Americans.”
After weeks of secret meetings, Senate Republicans have released a ‘discussion draft’ of their proposal to repeal and replace the Affordable Care Act, and hope to rush the sweeping legislation to a Senate floor vote before the July 4 recess.
Senate Republicans today released their version of a bill to repeal and replace the Affordable Care Act.
On key points the Senate bill essentially copies the American Health Care Act, which was passed by House Republicans last month on a strict, party line vote.
The Senate bill:
Eliminates the individual mandate.
Eliminates Obamacare’s 3.8% tax on investment income on income above $200,000.
Phases out Medicaid expansion by 2023, potentially putting at risk health insurance coverage for more than 10 million Americans.
Adopts the House plan for a per capita cap on Medicaid spending, and in 2025 shifts the growth in spending away from the consumer price index for medical care to the lower CPI for all goods, which could result in significantly smaller annual federal funding increases to account for inflation.
Maintains Obamacare subsidies to help pay for individual coverage.
Provides $2 billion to help states deal with the opioids abuse crisis.
The nonpartisan Congressional Budget Office has yet to score the bill.
Republican Senate leaders have come under intense criticism, even from within their own party, for drafting the legislation in secret. Senate Majority Leader Mitch McConnell, R-KY, has said he hopes to have the bill up for a floor vote before the Senate’s July 4 recess.
President Donald Trump has pushed hard for the repeal of Obamacare, a pledge that was a centerpiece of his campaign. He initially praised the House AHCA when it passed this spring, but later called the legislation “mean.”
Last night, Trump told supporters in Cedar Rapids, IA that the Senate plan would have “heart.”
"I think and I hope, I can't guarantee anything, but I hope we're gonna surprise you with a really good plan," Trump told the crowd.
"I've been talking about a plan with heart," Trump said. "I said, 'Add some money to it!' A plan with heart."
Early reaction from within the healthcare sector to the Senate draft was fiercely negative.
“Senate leaders today have put ideology ahead of lives with a plan that puts health and home at risk for millions of working Americans and that would badly weaken essential services for everyone in communities across the country,” Bruce Siegel, MD, president and CEO of America’s Essential Hospitals, said in a media release.
“Today’s Senate bill makes few material improvements to the deeply damaging House legislation, and might be worse overall. For the hospitals that protect millions of Americans and their communities—our essential hospitals—this bill might even accelerate decisions by some to reduce services or close their doors,” he said.
Teledoc CEO Jason Gorevic says the acquisition of Best Doctors will create a combined company that can offer a range of virtual care options for markets that include employers, health plans and health systems. The deal also allows Teledoc to develop global expansion plans.
In an interview with HealthLeaders Media, Teledoc CEO Jason Gorevic detailed the Purchase, NY-based telehealth company’s $440 million acquisition of Best Doctors. The following is a lightly edited transcript.
HLM:Why did you make this acquisition?
Gorevic: The combination opens up a tremendous set of possibilities for the healthcare consumer, ultimately providing a comprehensive platform of virtual healthcare delivery services. Teledoc came at the telehealth market at the low end of the acuity spectrum, focusing on high-frequency, low-severity conditions. Best Doctors came at it from the top of the pyramid, focusing on the most-costly and complex issues. Together we can provide a single, centralized resource for the consumer, regardless of what their healthcare issue is.
HLM: Who can access Teledoc? Is it open to the general public?
Gorevic: Most of our businesses are distributed through sponsoring organizations; employer health plans, health systems, insurance companies, financial service companies. Together we have millions of members around the world.
HLM: How will Teledoc be different after the acquisition is finalized.
Gorevic: Historically, our business has been focused on providing care for consumers across the country who are experiencing episodic conditions such as flu symptoms, allergies, pink eye, urinary tract infections, things like that. This year, we will do that almost 1.5 million times for our 20 million members. Over the last 18 months, we added additional clinical specialties, such as behavioral health, dermatology, a sexual health program, a tobacco cessation program, the ability for our consumers to get on a three-way interaction with a doctor for an aging family member who they are providing care for, and themselves, and help to facilitate the delivery of care. We’ve been consistently expanding the scope of our clinical services.
Once the Best Doctors transaction closes we will be able to direct consumers to their network of more than 50,000 Best Doctors around the world, provide a specialist who can answer detailed medical questions, and be able to provide an in-depth expert second opinion for someone who’s been diagnosed with a musculoskeletal issue, and maybe surgery has been recommended, or has a heart condition, maybe was diagnosed with cancer and is being recommended for chemotherapy. By leveraging Best Doctors in more than 450 specialties we will be able to collect the medical records, assemble a summary of the case, and provide for an expert opinion.
HLM: What are the limitations of tele-medicine?
Gorevic: Obviously, we are not setting broken bones or suturing lacerations. There are certain things that need to be seen in person. Both organizations share a focus on quality and so Teledoc is able to send the consumer for a lab test if it is necessary and similarly Best Doctors will retake pathology or testing if necessary to get a clear view and ensure the accuracy of their second opinion.
HLM: Will the consumers do this out of their homes, or will they do it in a physician’s office?
Gorevic: The consumer should be able to access the highest quality care from wherever they are. They don’t have to be in a facility or a physician’s office. The Best Doctors expert opinion report is delivered to both the consumer and the treating physician. It’s complementary to the local delivery system, regardless of where the patient is.
HLM: Provide an example of how this might work.
Gorevic: Let’s take the example of a shoulder injury. The patient has gone to see an orthopedic surgeon who is recommending surgery. In that case, it would be common for the patient to come to Best Doctors and ask ‘I’d like a second opinion so I know whether surgery is the best course of treatment.’ The member will work with the Best Doctors case manager, who is usually a nurse, and the specialist, who will first interview the patient, then go through an extensive medical records collection process, including collecting the actual films from an MRI, or something like that. If the films are inconclusive, they will order a new set of films to be taken so that they can ensure that they have all the information they need.
That information will be put into a summary report that is sent to a subspecialist, who in this case would be not just an orthopedic surgeon, but an orthopedic surgeon who specializes in shoulders. That specialist will review the record and either confirm or refute the diagnosis, and either confirm or recommend a modification to the treatment plan. Once that report is completed, it is delivered to both the patient and the original treating orthopedic surgeon, who will get continuing medical education credits for reviewing that information.
HLM: How are Best Doctors compensated?
Gorevic: They are paid on a case-by-case basis. They are consultants to Best Doctors. It’s important to understand that Best Doctors assembles this network of experts by going out to the physicians in the community and asking them to nominate and vote on the best physicians in their peer groups. Again, the advantage here is bringing together two organizations with a common focus on ensuring that consumers can access the highest quality care from wherever they are in a virtual environment that will be able to delivery across the healthcare spectrum.
HLM: Are there regulatory issues related to using international doctors, or specialists from other states?
Gorevic: This is an expert consultation that is being provided to local treating physicians. The Best Doctors expert isn’t treating the patient. They are acting as a consultant to the treating physician.
HLM: Are you developing a global network of physicians?
Gorevic: We talk about global because 40% of Best Doctors business comes from outside the United States. About half of that comes from Canada. They have members around the world in more than 100 countries.
HLM: What percentage of Best Doctors physicians are US-based?
Gorevic: About 80%.
HLM: What is your outlook for the telemedicine industry?
Gorevic: We’ve seen our utilization increase significantly year-over-year. Our first quarter utilization was up 127 basis points over the same time last year. And, while I wouldn’t say that we’ve yet achieved the ultimate potential, we’ve certainly hit the inflection point of adoption for telemedicine.
Awareness among consumers continues to be the biggest obstacle to expansion. This combination of the two companies who are both leaders, both have market leading brands, with complementary attributes, I believe will help to increase awareness and increase adoption.
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. will purchase medical consultation company Best Doctors in a deal valued at $440 million, the two companies announced this week.
In a joint media release, the two companies said the deal marries 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.
The purchase price includes $375 million cash and $65 million of Teladoc common stock, and the deal is expected to close in July, subject to regulatory approvals and routine closing conditions.
“When you think about what these two industry leaders have been able to do independently, it’s clear that the potential impact that we can make together is truly inspiring,” said Jason Gorevic, CEO of Purchase, NY-based Teledoc. “What you can expect to see with these two companies coming together is a comprehensive, virtual healthcare environment that will help consumers find resolution across a wide spectrum of healthcare needs.”
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.
“By combining data and analytics with a focus on nothing but the highest standard for care, we’ve successfully created a better way for patients and their families across the globe to get resolution to the most life-changing medical conditions,” said Best Doctors CEO Peter McClennen, who will be president of the Best Doctors division under Teladoc. “Now aligned as one greater organization under Teladoc, the impact we can make together is tremendous, delivering a paradigm shift in care access that comes with a phenomenal patient experience, unprecedented outcomes and cost savings.”
