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.
Alexis C. Norman is already serving an eight-year prison sentence after pleading guilty in 2015 to one count of Medicaid fraud in connection with a false billing scheme.
A Texas inmate serving time for Medicaid fraud tried to bilk the healthcare program out of an additional $810,000 from inside the prison walls, federal prosecutors allege.
Alexis C. Norman, 46, of Midlothian, TX, was indicted this week on felony charges stemming from a healthcare fraud conspiracy that she allegedly ran from prison, according to the U.S. Attorneys' Office for the Northern District of Texas. Norman will make her initial appearance in federal court on Friday.
Norman is already serving an eight-year prison sentence after pleading guilty in 2015 to one count of healthcare fraud in connection with a false billing scheme she ran using two companies she owned: Greater Southwest Group, Inc. and Ellis County Community Services.
According to the new indictment, Norman ran a similar scheme while she was awaiting sentencing in her earlier case, and continued to direct it after she was imprisoned. The indictment alleges that Norman, who is not licensed as a mental health provider, operated two counseling companies, Janus Children Services, Inc. and Therapeutic Outreach Services.
As part of the scheme, Norman and an unnamed coconspirator -- who presumably was not in prison -- applied for and obtained group Medicaid provider numbers for Janus and Therapeutic. They obtained individual Medicaid provider numbers of licensed mental health professionals by soliciting applications for bogus job opportunities on Craigslist but not hiring the individuals who applied. Norman and her coconspirators used the provider numbers, together with the names, dates of birth, social security numbers, and Medicaid numbers of approximately 156 Medicaid clients—mostly minor children—to submit fake claims for services. Norman and the coconspirator opened a bank account and leased office space in Tyler, TX for Janus and opened a bank account and leased office space in Waco, TX, for Therapeutic to conceal the fraud from inspectors in the Dallas-Fort Worth area who investigated her prior fraud.
To conceal the scheme, Norman gave false testimony at her sentencing hearing on April 8, 2016, when she responded “No, sir.” to the question, “Have you ever submitted any claims to Medicaid or a Medicaid managed care organization under a business other than Greater Southwest Group or Ellis County Community Services?” In fact, Norman had submitted numerous false claims to Medicaid under Janus, including $1,575 in claims she submitted on April 7, 2016 – the day before her sentencing hearing, the indictment stated.
Norman now faces one count of conspiracy to commit healthcare fraud, four counts of healthcare fraud, and four counts of aggravated identity theft. The indictment also includes a forfeiture allegation that would require the defendant, upon conviction, to forfeit to the U.S. any property traceable to the crime. If convicted, each fraud count carries up to 10 years in prison and a $250,000 fine. The aggravated identity theft counts carry a mandatory statutory penalty of two years in federal prison and a $250,000 fine.
In her earlier scam, Norman used the identities of licensed counselors and Medicaid clients without their knowledge to submit claims to Medicaid for psychotherapy services that were not provided. In addition to the prison time, Norman was ordered to pay nearly $3 million in restitution to Medicaid.
The median opioid prescription was equivalent to 50 pills of five-milligram oxycodone, which is almost twice the amount proposed Minnesota state guidelines recommend for a maximum, researchers have found.
Clinicians at Mayo Clinic were routinely writing opioid prescriptions for surgery patients that exceed regulatory guidelines now being drafted by the state of Minnesota, an in-house review has found.
The research, published this week in Annals of Surgery, also found significant differences in opioid prescribing among Mayo Clinic’s Arizona, Florida and Rochester campuses, and within surgical procedures.
“In light of the opioid epidemic, physicians across the country know overprescribing is a problem, and they know there is an opportunity to improve,” said senior author Elizabeth Habermann, scientific director of surgical outcomes research at Mayo. “This is the first step in determining what is optimal for certain surgeries and, eventually, the individual patient.”
Since 2000, the number of Americans receiving an opioid prescription and the number of deaths involving prescription opioid overdoses have roughly quadrupled, according to the Centers for Disease Control and Prevention. More than 90 people each day died from a prescription opioid or heroin overdose in 2015.
“For the last two decades, there had been such a focus at the national level on ensuring patients have no pain,” said co-author Robert Cima, MD, a colorectal surgeon and chair of surgical quality at Mayo Clinic’s Rochester campus. “That causes overprescribing, and, now, we’re seeing the negative effects of that.”
Cima said there aren’t evidence-based guidelines for prescribing opioids after surgery.
“That’s the fundamental issue,” he said. “And because pain is very subjective, it makes it challenging.”
The study looked at 7,181 opioid prescriptions following 25 common surgeries from January 2013 to December 2015 at Mayo Clinic campuses in Arizona, Florida and Rochester. In particular, the researchers examined patients who weren’t taking opioids in the 90 days before surgery.
Within that group of 5,756 patients, they found the median opioid prescription was equivalent to 50 pills of five-milligram oxycodone. That’s almost twice the amount draft Minnesota state guidelines recommend for a maximum, which is roughly a seven-day supply or about 27 pills of five-milligram oxycodone.
Also, the prescriptions varied among the three campuses after adjusting for other factors. The Rochester campus median equaled 40 pills of oxycodone; whereas, the Arizona and Florida campus’ median equaled 50 and 60 pills, respectively.
Because different surgeries require different degrees of pain management, the researchers also compared the opioid prescribing ranges within each of the 25 surgeries. They found a wide variation ─ even after adjusting for individual patients.
The researchers say the results show there is room for improvement at Mayo, but that the draft Minnesota guidelines aren’t appropriate for all cases.
“For some of the procedures, the guideline is probably appropriate and we have an opportunity to reduce the amount prescribed,” Habermann said. “For some of the more painful procedures, in orthopedics, for example, the draft guideline is likely too low.”
Mayo’s Department of Orthopedic Surgery is using the data to improve its opioid prescribing practices, and is developing a tiered approach based on surgical procedure. Other departments plan to follow suit.
Cima said patients must adjust expectations on appropriate levels of pain after surgery.
“We actively support patients, but they also need to be educated that some discomfort is part of the process,” Cima said. “We want patients to be comfortable enough to function, but taking away all the pain isn’t an appropriate part of recovery.”
The Mayo findings are consistent with a study released this spring that found a “prevalence of chronic opioid usage in surgical patients is high with widespread disparity among different sex, age, ethnicity, BMI, and subspecialty groups” at large academic medical centers.
