The American Medical Association has sent the Centers for Medicare & Medicaid Services a list of "most burdensome" federal regulations that the physicians' organization says will interfere with patient care, drive up administrative costs, and add more paperwork.
In a letter to CMS Administrator Donald Berwick, MD, AMA President Cecil B. Wilson, MD, said the list -- and accompanying suggested solutions -- were compiled after an extensive survey of more than 2,000 physicians from an array of specialties, and from state and medical specialty societies.
"Thousands of physicians have answered the AMA's call to identify federal rules and regulations that create significant burden for their practices and take up time that is better spent with patients," Wilson said in his letter. "Physicians' top concerns, including unfunded federal mandates, elimination of Medicare payment for physician consultations, and incompatible and inconsistent quality initiatives, offer a road map for CMS to make strategic changes that benefit the entire Medicare system."
Among the top complaints were unfunded mandates for services such as translators, administrative burdens associated with drug plan authorizations, growing legal liabilities with the expansion of the Emergency Medical Treatment and Labor Act, and increasingly higher documentation and certification burdens
President Obama in January issued an executive order calling on all government agencies to complete an analysis of rules that may be ineffective, insufficient or excessively burdensome.
AMA said its survey was conducted earlier this year so it could give CMS with physicians' top concerns as they complete their analysis. The survey responses dealt primarily with issues under the purview of CMS, the government agency that administers Medicare and Medicaid.
Cogent Healthcare and Hospitalists Management Group are merging to form the largest private hospitalist company in the nation, the companies declared in a joint statement Wednesday.
The new company -- to be called Cogent-HMG -- will be headquartered in Nashville, TN, and will have nearly 1,000 affiliated hospitalists and extenders practicing at more than 100 healthcare facilities in 27 states, the two companies announced.
Financial terms were not disclosed.
"This combination is a direct result of our strategic outlook for the future of healthcare in the U.S.," Stephen Houff, MD, founder/CEO of Canton, OH-based HMG, said in the joint statement.
Houff, who will become CEO of the combined company, said the merger will create "a stronger platform to help hospitals meet healthcare reform demands mandating greater transparency, quality and cost efficiency."
"The combined company will focus on creating closer alignment between hospitals and physicians, which will be necessary in light of reimbursement changes and ultimately accountable care. Our scale will allow for the significant investment in clinical support, physician recruiting and technology to position us to better help our clients adapt to evolving market needs," Houff said.
HMG partners with small- to medium-sized hospitals in suburban and rural markets, while Cogent, based in Nashville, TN, partners with medium- to large-sized hospitals.
"This is a natural and complementary partnership that will enable our two similarly-sized companies to benefit from each other's expertise and success," said Gene Fleming, president/CEO of Cogent, who will be executive chairman of the new company.
"Both Cogent and HMG have adopted a strategy of partnering with hospitals to build and manage high-performing, on-site programs," Fleming said in the joint release. "We have historically focused on different segments of the hospital market and each of us has a proven ability to deliver value for our clients in hospital medicine and beyond. The merger will allow the combined company to better serve the full spectrum of hospitals and healthcare systems across the U.S."
While Cogent-HMG will be headquartered in Nashville, it will maintain offices in Canton. The leadership teams of the two companies will be combined, and specific assignments will be announced in the future. The merger is expected to be finalized this spring.
Healthcare fundraising recovered somewhat in 2010, but not enough to erase two years of recession-related losses and cutbacks, a new Association for Healthcare Philanthropy survey shows.
While 71% of AHP members who answered a January survey reported lingering negative effects on their programs in 2010 from the recession, the responses showed a 16% improvement over 2009. Year-over-year advances were noted for investment income, donations from hospital staff, and funds raised in special events, the survey found.
William C. McGinly, president/COO of AHP, told HealthLeaders Media that the results of the survey provide "good vibes" that the worst may be over. "It's not as large a recovery or as speedy as I'd like but we have turned a corner," he says. "The world is in a crazy mess now too. Let's hope we don't see any slippage in the economy because we will revert to the same situation if we aren't careful."
"We have seen this over the years. It is the economy that drives so much of philanthropy. We saw it in 1987. We saw it in 2002. This has been the worst and the most prolonged that I've ever seen. We are coming out of it but it is very tenuous and shaky," he says.
The more than 2,000 nonprofit hospitals and healthcare providers in the AHP reported that fundraising was down about 11% in 2009 – roughly $1 billion. That year 52% of fundraisers trimmed their budgets. In 2010, half of respondents made no changes in their budgets, and 12% increased them, the survey found.
McGinly says healthcare providers that avoided cuts to their fundraising budgets and staffs are poised for swifter recovery. "In 2009 and 2010 the smart money was on our members who continued to cultivate their relationships with major donors, even though they gave less because of the uncertainty," he says. "The folks who are coming back strong are those who didn't have to reduce the number of people they had in any significant way and were able to hold on to them, because this is a knowledge business and once you lose those relationships and the knowledge they had it is a long curve building that back with new people."
The AHP survey also found that:
37% of respondents said annual fund direct-mail revenue was down in 2010, compared to 50% in 2009.
Declines in major gift revenue were reported by 44% of respondents in 2010, an improvement over the 59% who saw major gift revenue losses in 2009.
Less than one-third reduced their giving forecast in 2010, compared to 45% in 2009.
Even with the ship pointed in the right direction, McGinly said there are still plenty of icebergs out there to sink a recovery. "What is happening with reimbursements to Medicare and Medicaid, the hospital gets caught in a double whammy. That presents bigger challenges for us on the philanthropic side," he says. "Also with the budget slashing, the administration wants to reduce the tax deduction from 33% to 28% and that is going to hit major donors who are going to give us less, so there is another part of the double whammy."
Chronically ill Medicare patients spent fewer days in the hospital and received more hospice care in 2007 than they did in 2003. Patients who were hospitalized, however, got more aggressive, intensive, and costly care, according to a new Dartmouth Atlas Project report on end-of-life care.
The study -- Trends and Variation in End-of-Life Care for Medicare Beneficiaries with Severe Chronic Illness – was released Tuesday and found that Medicare patients diagnosed with severe chronic illness were less likely to die in a hospital and more likely to receive hospice care. They also had many more visits from physicians, particularly medical specialists, and spent more days in ICUs.
"In addition to its effects on patients' quality of life, unnecessarily aggressive care carries a high
financial cost. About one-fourth of all Medicare spending goes to pay for the care of patients in their last year of life, and much of the growth in Medicare spending is the result of the high cost of treating chronic disease," said David C. Goodman, MD, lead author of the report, in a media release.
"It may be possible to reduce spending, while also improving the quality of care, by ensuring that patient preferences are more closely followed," said Goodman, a co-principal investigator for the Dartmouth Atlas Project, and director of the Center for Health Policy Research at the Dartmouth Institute for Health Policy and Clinical Practice.
The report documents trends from 2003 to 2007 in the use of medical resources to treat Medicare patients at the end of life at hospital referral regions and at 94 academic medical centers.
Geography continues to play a huge role, the report found, noting that care patients received in the months before they died depended largely on where they lived, and widespread variations persist. Even at academic medical centers, patients' end-of-life experiences differ greatly. Most academic medical centers substantially changed the intensity of the end-of-life care they provided from 2003 to 2007, but not in the same direction. Some provided more. Some provided less.
The report found that:
From 2003 to 2007, the percentage of chronically ill patients dying in hospitals and the average number of days they spent in the hospital before their deaths declined in most parts of the country and at most academic medical centers. In 2003, 32.2% of patients died in a hospital; by 2007, the rate had dropped to 28.1%. In 2007, the highest rates of hospital deaths were in and around New York City, including Manhattan (45.8%), East Long Island (41.9%) and the Bronx (39.9%). Chronically ill patients were far less likely to die in a hospital in Minot, ND (12%), Fort Lauderdale, FL (19%) and Portland, OR (19.6%).
For patients using academic medical centers for most of their care, rates of hospital deaths also dropped. Several hospitals that had among the lowest rates in 2003 saw substantial decreases over the five-year period; one example is University of Utah Health Care in Salt Lake City, where the rate dropped from 31.5% to 21.3%. In comparison, in 2003, UCLA Medical Center and the Medical College of Georgia in Augusta had very similar rates, at 39.1% and 39.7%, respectively. Over five years, their rates moved in opposite directions. UCLA joined medical centers with the highest rates at 45.5%, while the rate at the Medical College of Georgia dropped to 28.7%.
Overall, the average patient spent slightly fewer days in the hospital during the last six months of life in 2007 than in 2003. The national rate dropped from 11.3 to 10.9 hospital days per patient. In 2007, chronically-ill patients in Manhattan spent, on average, 20.6 days in the hospital during their last six months of life, almost four times more than patients in Ogden, UT, where the average was 5.2 days.
Those academic medical centers where patients spent less time in the hospital in 2007 than in 2003 included the University of Texas Medical Branch Hospitals in Galveston (-5.0 days), the University of Iowa Hospitals and Clinics in Iowa City (-5.0 days) and Tufts-New England Medical Center in Boston (-4.6 days). Ten academic medical centers had increases of at least two days, including Hahnemann University Hospital in Philadelphia (+6.8 days).
Chronically ill patients were significantly more likely to be treated by 10 or more doctors in the last six months of life in 2007 than they were in 2003, as the national rate increased from 30.8% to 36.1%. In 2007, patients in Royal Oak, MI received the most intensive care by this measure, with 58.1% of patients seeing 10 or more doctors in the last six months of life. Other regions with high rates included Ridgewood, NJ (57.6%) and Philadelphia (57.2%). Regions with low rates included Boise, ID (14.2%), Salt Lake City (15.0%) and Medford, OR (16.4%).
From 2003 to 2007, among the 35 academic medical centers for which data are available, 22 had increases in the percentage of patients seeing 10 or more doctors in the last six months of life. Emory University Hospital saw the largest growth in this rate, from 40.4% to 63.2%, while the University of North Carolina Hospitals in Chapel Hill had the largest decrease, from 45% to 35.2%. In 2003, the likelihood that a patient at Emory University Hospital would see 10 or more doctors was similar to that for a patient at the University of North Carolina Hospitals. Over the next five years, the percentage of patients seeing 10 or more doctors increased 22.8 percentage points at Emory, while the percentage dropped 9.8 percentage points at UNC Hospitals.
"The differences observed across regions and academic medical centers in the approach to caring for patients with chronic illness underscore important opportunities to learn how to improve end-of-life care," said Elliott S. Fisher, MD, report author and co-principal investigator of the Dartmouth Atlas Project, in a media release. "While current trends demonstrate that change is occurring in many regions and at many institutions, it is not always in the direction that patients may prefer."
Fisher, who is also the director of the Center for Population Health at the Dartmouth Institute for Health Care Policy and Clinical Practice, said more work needs to be done "to ensure that future variation in care reflects the well-informed preferences of patients."
The researchers said variations in the treatment of chronically-ill Medicare patients dependlargely on the systems of care within different regions and hospitals. For example, declines in the rates of death in a hospital and of death associated with admission to intensive care may also be evidence of attempts to provide care that aligns more closely with many patients' preferences. But not all hospitals changed at the same pace.
Furthermore, the number of ICU days in the last six months of life increased both nationally and in most hospitals and regions; so, too, did the amount of physician labor used.
John W. Bluford was officially inducted as the chairman of the board of directors at the American Hospital Association on Sunday at the group's annual membership meeting in Washington, DC, the nation's largest hospital group announced.
Bluford, president and CEO of Truman Medical Centers in Kansas City, MO, told colleagues that the effect of their leadership would be judged not only by the care administered inside their hospital walls, but also by the overall health of the communities they serve. "Your community has its own dynamics that create its own barriers – solid walls that stand between people and the health that will allow them to achieve their full potential," Bluford said. "Tearing down those walls will be painfully slow. But we will never get to the destination – if we don't start the journey."
Bluford assumed the AHA board chairmanship -- the organization's highest elected position -- in January and will serve a one-year term, AHA said.
Truman Medical Centers created a Passport to Wellness program that targets at-risk populations and their families for lifestyle changes to better manage their health and reduce hospital visits. The program uses guided protocols and team-oriented case management that includes physicians, nurses, pharmacists, and social workers.
Since its inception, Passport to Wellness has seen: sickle cell readmissions fall by 26%; a 25% collective reduction in the number of asthma-related patient days; a 23% reduction in emergency department visits, Bluford said.
"Every community, from the most urban to the most rural, has social and health disparities," Bluford said. "It's our job to know our communities, our schools, our community gathering places, our churches, and in general the overall human circumstance of our neighborhoods so that we can address those disparities with passion."?
Bluford also urged his fellow hospital leaders not to overlook employee wellness and pointed to AHA's "A Call for Action: Creating a Culture of Health" report that provides a wide variety of creative programs from hospitals across the country.
Tenet Healthcare Corp., embroiled in a hostile takeover attempt by Community Health Systems Inc., has filed a federal complaint alleging that its bitter rival overbilled Medicare by as much as $377 million using medically unnecessary admissions that improved its bottom line and appeal to investors.
Franklin, TN-based CHS fire back that: "Tenet's allegations are completely without merit and we intend to vigorously defend ourselves against these unfounded and irresponsible claims."
The allegations by Dallas-based Tenet are the latest chapter in a very public bare-knuckle brawl between the two for-profit hospital chains, who have exchanged charges and countercharges since November, when Tenet rejected what it said was CHS' "grossly undervalued" $6-a-share buyout offer.
"We filed this complaint because our due diligence revealed that Community Health has been systematically overbilling Medicare and likely other payers by causing patients to be admitted to its hospitals when industry practice is to treat them in outpatient observation status," Tenet spokesman Rick Black said in a statement. "We believe this unsustainable strategy has resulted in Community Health overstating its inpatient admissions, revenues and profits and has created substantial financial and legal liability. We are seeking to provide Tenet stockholders with the information they need to make an informed decision by asking the court to compel Community Health to correct its false and misleading statements and omissions."
According to the 70-page complaint filed Monday morning in U.S. District Court in Dallas, Tenet claimed that "CHS has for many years systematically billed cases as higher-paying inpatient admissions that would have been billed as lower-paying outpatient observations in most U.S. hospitals."
"CHS' strategy of driving up admissions and driving down observations is unsustainable," Tenet said. "It depends on a continuing pipeline of acquisitions of hospitals with normal observation rates that can be driven down." Tenet said its research shows that after CHS acquired Triad in 2007, Triad's observation rate dropped 52%.
Tenet said it identified 63,000 Medicare fee-for-service inpatient admissions from 2006-2009 at CHS hospitals that would have been outpatient observations if CHS was within the national average. The high volume and lowest acuity Medicare inpatient admissions paid on average more than $3,300 per patient than for outpatient observation.
Medicare FFS patients generated 27% of CHS' net operating revenue in 2010, Tenet alleged in the complaint. As a result of the alleged unnecessary admissions, Tenet said it identified between $280 million and $377 million in overbillings in 2006-2009.
If Tenet's allegations are true, CHS could be liable for triple damages under the False Claims Act that would be in excess of $1 billion.
CHS insisted in its statement that it "conducts its business with the utmost integrity and adheres to the highest business practice standards. The bottom line is that these self-serving allegations are an attempt by Tenet's management and board to continue their entrenchment strategy and to distract Tenet shareholders from CHS's pending offer. Its actions today prove that Tenet has adopted a 'scorched earth' defense without regard for the best interests of shareholders. CHS remains committed to its offer to acquire Tenet and both Credit Suisse and Goldman Sachs have reaffirmed their confidence in financing the transaction."
Tenet said it filed the federal complaint to "compel CHS to disclose fully its unique and non-industry standard patient admissions criteria and billing practices and the financial and legal implications arising from them. The allegedly unusually high admissions at CHS hospitals have resulted in "materially misleading financial reports and statements" that included overstated admissions, revenues, profits, and cash flow, Tenet said.
Regular readers of this column know that when it comes to unions, my mantra has been "management gets the union it deserves." If your healthcare organization has a union, or is in the midst of organizing activity, chances are that poor management or some sort of management-labor communications breakdown played a role. Ultimately the responsibility falls on management.
That came to mind when I read a recent item in the management-friendly HR Daily Advisor entitled: Warning Signs – Unions Organizing Behind Your Back.
The item was a synopsis of observations made by Mark Ricciardi, a Las Vegas attorney specializing in labor issues. While the observations were not specific to healthcare, Ricciardi's telltale signs included:
Employees are unusually busy and excited
Talking stops or groups break up when supervisor nears
Employees request information about policies and benefits
A new "spokesperson" emerges
Employees who typically talk to supervisors no longer do so
Employees no longer look you in the eye
Employees question managerial authority
New employee alliances form
Changes in nature/frequency of employee complaints
Increases in argumentative questions at meetings
Increases in unauthorized "group" complaints
Employees seem increasingly divided
Poor performers show improvement
According to the Advisor, Ricciardi said HR should establish an "early warning system" that includes training managers to report all signs of labor activity, no matter how "trivial."
I believe these "warning signs" and "early warning systems" – however valid the advice – raise more questions about management than they do about workers. If working conditions at your healthcare facility have deteriorated to the point where "busy and excited" employees arouse suspicion and concern, you need new management. In fact, the very idea that a union could organize "behind your back" – as the title states -- positively screams that management has failed to engage employees.
Let's be clear. I'm not rapping Ricciardi or the Advisor, which I browse every day. What they're saying is exactly right. In fact, Ricciardi has also said on the Advisor that the best way to keep union organizers out is to "consistently practice good, solid, fair employee relations," which he believes can only be accomplished by thorough management training. Bingo!
Employee engagement is not an exact science, thank God, because human beings aren't robots. Each employee brings to the job his or her own personality, skills, values, demands, concerns, and pet peeves. Nonetheless, there are some universal truths that apply to the vast majority of people. For example, treat your employees with courtesy and respect. Make yourself available. Give them your time. Learn their names. Encourage them to voice their concerns and listen when they do. Try to act promptly on those concerns, and if you can't resolve the problem, explain why you cannot.
If management demonstrates a genuine belief that employees are valuable team members on a shared mission, then managers have nothing to fear when their backs are turned. We talk a lot about employee engagement. We should concentrate more on management engagement.
Two medical office workers in south Florida have been indicted on HIPAA violations and related charges for their alleged roles in an identity theft ring that used stolen patient information to access to their bank and credit card accounts, federal prosecutors said.
According to the indictment, defendants Erica Hall, 27, and Sharelle Finnie, 22, worked as office assistants at two separate medical offices in Coral Springs and Fort Lauderdale, respectively. The pair allegedly swiped patient information, including names, dates of birth, social security numbers, and other medical information, and sold it to co-conspirators. If convicted of the HIPAA violations, Hall and Finnie each face a maximum statutory term of 10 years in prison, federal prosecutors said.
Ten other alleged members of the theft ring – all Florida residents -- also were indicted on bank fraud, identity theft, and related charges, including:
Jasmin Rembert, 33, of Miramar;
Rufus Bethea, 30, of Hollywood;
Bianca Cook, 21, of Lauderhill;
Courtney Gissendanner, 28, of Hollywood;
Brandi Johnson, 39, of Miramar;
Demarcus Hough, 30, of Ft. Lauderdale;
Darren Baldwin, 43, of Ft. Lauderdale;
Aaron Hough, 30, of Hollywood;
Minnie Powell, 49, of Pembroke Pines;
Eloise Sermons, 24, of West Park
Sermons, Cook, and Hough remain at large.
Gissendanner was identified by prosecutors as the alleged ringleader. He would use the stolen information to illegally add himself and others as “authorized users” on the victims’ credit card and bank accounts. The defendants then used the stolen personal identification information to empty their bank accounts and run up credit card charges as high as $128,000 in one case.
Prosecutors said Rembert worked at the Broward County School Board in the teacher certification department, where she had access to – and allegedly stole and sold -- sensitive personal identification information from teacher certification databases.
If convicted of conspiracy to commit bank fraud, the defendants each face a maximum statutory term of 30 years’ imprisonment. If convicted of conspiracy to commit access device and identity theft, the defendants each face a maximum statutory term of five years’ imprisonment. If convicted of the substantive counts of access device fraud, the defendants each face a maximum statutory term of 10 years’ imprisonment.
Farzad Mostashari, MD, has been named National Coordinator for Health Information Technology, effective immediately. He replaces David Blumenthal, MD, who is returning to Harvard University after leading Office for the past two years, the Department of Health and Human Services announced.
Mostashari joined the Office of the National Coordinator in July 2009, serving as deputy national coordinator for the office, which is within the Department of Health and Human Services, said ONC in a media release.
Before that, Mostashari served at the New York City Department of Health and Mental Hygiene as assistant commissioner for the Primary Care Information Project, where he helped adopt prevention-oriented HIT used by more than 1,500 providers in underserved communities, ONC said.
Mostashari also led the NYC Center of Excellence in Public Health Informatics and an Agency for Healthcare Research and Quality funded project that focused on quality measurement at the point of care. Before that he established the Bureau of Epidemiology Services at the NYC Department of Health, charged with providing epidemiologic and statistical expertise and data for decision making to the health department, ONC said.
Trained at the Harvard School of Public Health and Yale Medical School, internal medicine residency at Massachusetts General Hospital, Mostashari completed the Centers for Disease Control and Prevention's Epidemic Intelligence Service.
Mostashari was among the first developers of real-time electronic disease surveillance systems and acted as a lead investigator in the outbreaks of West Nile Virus and anthrax in New York City, ONC said.
The pacing, the toe tapping, and the finger drumming ended last week for an anxious and expectant healthcare industry when the federal government – two months overdue – finally delivered its much anticipated 429-page proposed guidelines for accountable care organizations.
And even though the ACO program is voluntary and will be limited to only about five million Medicare beneficiaries when it opens on Jan. 1, 2012, there remains a sense among supporters and detractors that there is no going back – that no matter what happens during the ensuing public comment period, the healthcare world has changed forever.
When the proposed guidelines were released last Thursday, Health and Human Services Secretary Kathleen Sebelius boldly stated that ACOs will put patients and their doctors “in control” of their own healthcare. “For too long, it has been too difficult for healthcare providers to work together to coordinate and improve the care their patients receive,” Sebelius said, in the HHS media presentation. “That has real consequences: patients have gaps in their care, receive duplicative care, or are at increased risk of suffering from medical mistakes. Accountable care organizations will improve coordination and communication among doctors and hospitals, improve the quality of the care their patients receive, and help lower costs.”
The major healthcare lobbying groups offered noncommittal – and possibly prefabricated – immediate reactions to the guidelines – saying just enough to appease befuddled journalists asking fuzzy questions about a concept that many clearly do not yet understand, and careful enough to avoid aggravating the federal policyholders they’ll attempt to sway during the coming public comment period, but also reasserting their longstanding concerns about the impact of ACOs on their corner of the healthcare market.
“This is an historic effort among government agencies to achieve the goal of better coordinated care," said Linda Fishman, senior vice president for Policy at the American Hospital Association, in a statement issued soon after the guidelines were made public. “However, it does not go nearly far enough to eliminate the barriers to clinical integration among caregivers.”
From the payer perspective, America’s Health Insurance Plans President and CEO Karen Ignagni also expressed concerns about antitrust provisions needed to protect insurers from “the trend of provider consolidation that drives up medical prices and result in additional cost-shifting to families and employers with private coverage.”
As for providers, before they can begin to create ACOs, they have to realize who such entities are accountable to. "The accountability is not unilateral; it's trilateral, for the management of care across locations and time," Tom Enders, managing director of CSC's Health Sector Group in New York told HealthLeaders Media last fall. Then they must decide whether the potential cost savings worth the effort to establish an ACO.
Among the potential pitfalls recognized by the federal government are the legitimate antitrust concerns from payers and providers. So the feds piggybacked onto the ACO guidelines a separate proposal calling for expedited antitrust reviews and designated antitrust "safety zones" for some ACOs. “The Administration has led an unprecedented, collaborative effort among all of the agencies responsible for developing guidance for ACOs," said Federal Trade Commission Chairman Jon Leibowitz. "This guidance will help ensure that ACOs meet their goals of improving quality and lowering costs while minimizing the regulatory burden on healthcare providers."
Paul Keckley, executive director of the Deloitte Center for Health Solutions, said he was impressed by the federal government’s “deliberate process” of crafting guidelines for an extremely complex proposal that has the potential to revolutionize healthcare delivery and outcomes. “The amount of effort they built into calibrating the quality metrics, the indices of the five domains, the waivers, the safety zones, the antitrust issues. They were pretty thoughtful about balancing all of those moving parts of what is a pretty complicated concept," he told HealthLeaders Media.
"I read carefully the discussion of antitrust safety zones, how primary service areas are defined, the 30% threshold," he said. "The language in the guidance suggests that they have been very thoughtful about waivers and antitrust. And, they have maybe been cautious thinking about what will happen if commercial health plans piggyback the ACOs and use them as their contracting organizations. Does that consolidate power? Does it create cartels? I was impressed by the granularity of the language in that section."
Keckley said the overarching theme from the government is the emphasis on physician-hospital alignment. “You have value-based purchasing, and episode-based payments and avoidable readmissions, and the medical home, the ACO, physician quality reporting initiative and the physician self-referral language and you step back and see they are compelled by the vision of integrated systems," he says. "That to me is the big cake here."
And, like any sweeping government program, ACOs come with their own language. Soon, healthcare wonks and consultants who last week couldn’t tell a “Safety Zone” from a “Primary Service Area” will be tossing out eye-crossers like “Precompetitive,” “Retrospective Assignment,” “Dominant Provider Limitation,” and “Group Practice Reporting Option” (which will undoubtedly morph into the catchy GPRO) in dozens of forums, webcasts, seminars, and retreats from coast to coast. That’s the first thing you do when you’re in a new culture -- you learn the language.
One thing is clear—technology will play a huge role. "Clearly, health IT is the backbone, the enabler to an ACO," says Warren Skea, PhD, director, health industries advisory practice at PricewaterhouseCoopers, which sponsored HealthLeaders Media's Breakthrough's report, The Bridge to Accountable Care Organizations.
