Program offered for medical students who'll commit to primary care at the Pennsylvania-based health system after graduating.
Geisinger and Geisinger Commonwealth School of Medicine have created the Geisinger Primary Care Scholars Programthat will offer debt-free medical school and living assistance to medical students who agree to work within primary care at the health system after they graduate.
Medical students often carry $200,000 or more in debt, which pushes them into higher-paying specialties. Geisinger President and CEO Jaewon Ryu, MD, says that removing the financial strain in exchange for a four-year commitment to practice at Geisinger will make it easier for more med students to pursue primary care.
"At Geisinger, we've been able to prove that by focusing on primary care we can improve outcomes, lower costs and improve satisfaction among patients and providers," Ryu said.
"We've built some innovative programs that expand upon the notion of what is primary care and where it is delivered. With all of these different offerings, we are thrilled to welcome anyone who shares this passion around new and exciting ways to deliver this core care," Ryu said.
"So, it's only natural that we extend that commitment to training the next generation of physicians. These scholars have the opportunity to learn and later work in Geisinger's innovative primary care environment without the worry of how they will pay for their education," he said.
The program will pick 40 first- and second-year students in each incoming medical class through a competitive application process. Selection criteria include demonstrated financial need, academic merit, diversity, passion for serving their communities, and predictors of whether the applicant is likely to stay in Geisinger's service area.
The program will provide full coverage of tuition and fees plus a monthly $2,000 stipend through the four years of medical school.
"I can't think of a better opportunity for these scholars to pursue their commitment to primary care than by providing debt-free medical schooling," said Steven J. Scheinman, MD, executive vice president and chief academic officer at Geisinger and Dean of the Geisinger Commonwealth School of Medicine.
Last year Geisinger started the Abigail Geisinger Scholars Program. Which gives 10 students in each class up to four years of tuition in the form of a loan, which is forgiven upon completion of a service commitment as a Geisinger physician in any specialty.
'D' and 'F' hospitals have nearly twice the risk of mortality of 'A' hospitals.
One third of the 2,600 general, acute care hospitals across the nation rated in The Leapfrog Group's fall 2019 Hospital Safety Grades got an 'A,' grade, while 1% flunked, the patient safety monitors said.
Leapfrog grades are based upon process and structural measures such as hand hygiene, risk mitigation, and discharge communication, as well as outcome measures such as falls, pressure ulcers, and infections.
The safety ratings' release coincides with the 20th anniversary of the Institute of Medicine's shocking report, To Err Is Human, which showed that nearly 100,000 people die every year due to preventable medical errors. Other research has shown that number could be twice as high.
"The findings of the IOM report, published two decades ago, laid the foundation of what The Leapfrog Group stands for today," said Leah Binder, president and CEO of The Leapfrog Group. "In stark contrast to 20 years ago, we're now able to pinpoint where the problems are, and that allows us to grade hospitals."
"It also allows us to better track progress. Encouragingly, we are seeing fewer deaths from the preventable errors we monitor in our grading process," she said.
Among the findings:
More than 2,600 hospitals graded with the breakdown as follows: 33% earned an "A," 25% earned a "B," 34% earned a "C," 8% a "D" and just under 1% an "F."
The five states with the highest percentages of "A" hospitals are: Maine (59%), Utah (56%), Virginia (56%), Oregon (48%) and North Carolina (47%).
There are no "A" hospitals in three states: Wyoming, Alaska and North Dakota.
Notably, 36 hospitals nationwide have achieved an "A" in every grading update since the launch of the Safety Grade in spring 2012.
Earlier this year, Leapfrog commissioned the Johns Hopkins Armstrong Institute for Patient Safety and Quality to update its estimate of deaths due to errors, accidents, injuries and infections at "A", "B", "C", "D" and "F" hospitals.
The study estimated that 160,000 lives are lost each year from the avoidable medical errors identified in the Leapfrog Hospital Safety Grade, down from 205,000 avoidable deaths in 2016.
The Johns Hopkins analysis found that "D" and "F" hospitals have nearly twice the risk of mortality of "A" hospitals, and that more than 50,000 lives could be saved if all hospitals performed at the level of "A" graded hospitals.
Trump administration's healthcare agenda delivered another setback in court.
A federal judge in Manhattan on Wednesday vacated "in its entirety" the Trump administration's so-called "conscience rule" that would have allowed clinicians to refuse to provide medical services, namely abortions, on moral or religions grounds.
In a 147-page ruling that consolidated three separate lawsuits challenging the law, U.S. District Judge Paul Engelmayer said that federal law already acknowledges the conscience rights of clinicians, and "accommodate(s) religious and moral objections to health care services provided by recipients of federal funds."
"The Court's decision today leaves HHS at liberty to consider and promulgate rules governing these provisions," said Engelmayer, an Obama administration appointee in 2011. "In the future, however, the agency must do so within the confines of the APA and the Constitution."
An HHS officials said they're reviewing the opinion.
Alexis McGill Johnson, Acting President and CEO, Planned Parenthood Federation of America – a plaintiff in one of the suits – cheered the ruling.
"Today, the Trump administration was blocked from providing legal cover for discrimination," she said. "As the federal district court made clear, the administration acted outside its authority and made false claims to try to justify this rule. This rule put patients' needs last and threatened their ability to access potentially lifesaving healthcare."
"No one should have to worry they will be denied the medical care they need simply because of their health care provider's religious, moral, or personal beliefs," she said.
U.S. Senator Ben Sasse (R-NE) called the ruling "absurd mush," and urged the Trump administration to "defend basic conscience rights all the way to the Supreme Court."
"The point of the First Amendment – especially the free exercise of religion – is to protect the conscience rights of Americans," he said. "In this country, government doesn’t get to tell you that your faith is fine on Sunday at church but not Monday at work.
The ruling was the latest setback for the Trump administration, which has seen its various attempts at healthcare reform – from Medicaid work requirements to hospital outpatient reimbursement cuts -- rebuffed by federal judges across the nation.
Last week, Health and Human Services Secretary Alex Azar announced that the government would forge ahead with site-neutral cuts under its outpatient prospective payment system, even though a federal court in September vacated the policy.
Azar said HHS would also push forward a 22.5% payment rate cuts for some drugs under the 340B program, even though that policy was vacated by a federal court in May.
The Trump administration's final rule that would require hospitals to disclose payer-specific negotiated ratesis also expected to see legal challenges from payers and providers when it's unveiled.
The failure to encrypt mobile devices results in a hefty settlement.
The University of Rochester Medical Center will pay a$3 million settlement to the federal government for losing an unencrypted flash drive and a laptop computer that contained patient information.
The flash drive was lost in 2013, and the laptop in 2017, and though URMC filed breach reports for both incidents, the Department of Health and Human Service's Office for Civil Rights said the hospital's response was inadequate.
OCR said the hospital "failed to conduct an enterprise-wide risk analysis; implement security measures sufficient to reduce risks and vulnerabilities to a reasonable and appropriate level; utilize device and media controls; and employ a mechanism to encrypt and decrypt electronic protected health information (ePHI) when it was reasonable and appropriate to do so."
URMC spokesman Chip Partner said the affected patients were notified at the time both incidents occurred.
"We have no reason to believe that any patient’s personal health information was misused," he said.
This was not the first HIPAA violation for URMC. OCR said the hospital failed to take sufficient corrective action in 2010 with a similar breach involving another lost unencrypted flash drive.
OCR said RUMC did not learn from that error and continued to permit the use of unencrypted mobile devices.
"Because theft and loss are constant threats, failing to encrypt mobile devices needlessly puts patient health information at risk," OCR Director Roger Severino said in a media release. "When covered entities are warned of their deficiencies, but fail to fix the problem, they will be held fully responsible for their neglect."
Along with the settlement, URMC will adopt a corrective action plan that includes two years of monitoring for HIPAA compliance.
Partner said URMC "is deeply committed to protecting patient privacy, and we continuously improve our IT security safeguards and staff training to reduce the risk of a privacy breach."
"As part of the settlement with HHS, we will undertake a comprehensive audit of security practices and implement any corrective actions needed to ensure our safeguards are as strong as possible," he said.
Ozuah succeeds Steven M. Safyer, MD, who is retiring after 40 years of service.
Montefiore Medicine's search for a new CEO is over, and the Bronx-based health system has chosen one of its own.
Philip O. Ozuah, MD, president of Montefiore Health System and previously served as Physician-in- Chief of the Children's Hospital at Montefiore, will take over from long-serving CEO Steven Safyer, MD, on Nov. 15.
"It will be a privilege to lead Montefiore Medicine, an organization with a clear purpose – to heal, to teach, to discover and to advance the health of the communities we serve," Ozuah said in a media release.
"Ever since first joining Montefiore in 1989, I've been inspired by our institution’s commitment to excellence. We are an organization of exceptionally talented and compassionate people."
Ozuah, a pediatrician, said an area of focus under his tenure will be "to continuing to expand inclusive access to state-of-the-art care and to furthering Montefiore's role as a global leader in healthcare and biomedical research."
Safyer, who has been with Montefiore for more than 40 years, said that with Ozuah's appointment, "I know I am leaving our institution in the best possible hands."
"I have consistently been impressed by Dr. Ozuah's strategic vision for the Montefiore Health System," Safyer said. "His appointment as CEO will guarantee a smooth transition, and I know he’ll continue to uphold the standard of excellence on which Montefiore has built its reputation."
Montefiore Medicine includes the Albert Einstein College of Medicine, 15 hospitals in the New York City and Hudson Valley area, and 200 outpatient ambulatory care sites.
Harrison will remain CEO of the Salt Lake City-based health system while undergoing treatment.
Intermountain Healthcare President and CEO Marc Harrison, MD, announced this week that he will undergo treatment for multiple myeloma.
"Cancer is never good news, of course, but I have every reason to hope for a successful outcome," Harrison said in a media release.
"I am proud and grateful that my care will be provided by Intermountain caregivers – the best in the land. I look forward to their care and support as I continue to serve our communities as CEO of Intermountain," he said.
Harrison is expected to return to the C Suite in early 2020, and will remain CEO of the Salt Lake City-based health system while undergoing treatment, Intermountain said.
"While multiple myeloma is not yet fixable, it can be managed effectively with a range of medical therapies, and today can be treated as a chronic disease," Harrison said. "Many people live successfully with chronic diseases such as diabetes, high blood pressure, and asthma. This is my chronic disease."
Harrison has been president and CEO of Intermountain since October 2016. The not-for-profit health system has operations in Utah, Idaho and Nevada, and includes 24 hospitals, 215 clinics, a Medical Group with 2,500 employed physicians, and SelectHealth insurance company.
The final rule updates the longstanding E/M documentation and coding framework used by clinicians to bill Medicare.
The federal government's efforts to reduce physician paperwork and reward coordinated care for chronically ill patients are getting a warm reception from physician associations.
The Centers for Medicare & Medicaid Services says the final rule unveiled on Friday will feature red tape reductions that will save the nation's physicians about 2.3 million hours per year in burden reduction.
The changes update the longstanding evaluation and management documentation and coding framework used by clinicians to bill Medicare for routine office visits. CMS is also increasing payment for office and outpatient E/M visits and offering enhanced payments for chronic care management.
"Historic simplifications to billing requirements mean that clinicians will be able to focus on recording the information that’s most important to keeping a patient healthy," Health and Human Services Secretary Alex Azar said in a media release.
"As we move toward a system that pays more and more providers for outcomes rather than procedures, we look forward to freeing clinicians from even more of these burdens," he said.
Robert McLean, MD, president of the American College of Physicians, said Medicare has for too long undervalued E/M codes by primary care physicians.
"At the same time, physicians were faced with excessive documentation requirements to be paid for such services," McLean said. "ACP is extremely pleased that CMS’s final payment rules will strengthen primary and cognitive care by improving E/M codes and payment levels and reducing administrative burdens, in line with ACP's Patients Before Paperwork initiative."
American Medical Association President Patrice A. Harris, MD, said the nation's largest physician association worked with CMS to complete the first overhaul of E/M office visit documentation and coding in more than 25 years.
"Physicians spend a huge amount time meeting burdensome documentation requirements during patient interactions, which takes time away from patients and contributes significantly to burnout and professional dissatisfaction, Harris said. "This new approach is a significant step in reducing administrative burdens that get in the way of patient care."
The AMA said that key elements of the E/M office visit overhaul include:
Eliminating history and physical exam as elements for code selection. While significant to both visit time and medical decision-making, these elements alone should not determine a visit's code level.
Allowing physicians to choose whether their documentation is based on medical decision-making or total time. This builds on the movement to better recognize the work involved in non-face-to-face services like care coordination.
Modifying MDM criteria to move away from simply adding up tasks to focus on tasks that affect the management of a patient’s condition.
With the final rule in place, Harris said it is "time for vendors and payors to take the necessary next steps to align their systems with E/M office visit code changes by the time the revisions are deployed on January 1, 2021."
"In the coming months, the AMA will undertake an aggressive effort to ensure that EHR providers, coders, payors and other vendors implement simplified coding so physicians no longer labor under undue documentation complexity," Harris said.
While praising the E/M reforms, the AMA said it was also "concerned about significant payment reductions" anticipated for some clinicians, including psychologists and physical therapists.
"The Association will work through the course of the next year to convince CMS that all specialties' payment for office visits should be recognized as equivalent. This was demonstrated by the survey of 50 different specialties—a survey lauded by CMS," AMA said.
McLean says the reforms could also address the growing shortage of primary care physicians.
"Fewer physicians are going into office-based internal medicine and other primary care disciplines in large part because Medicare and other payers have long undervalued their services and imposed unreasonable documentation requirements," he said. "CMS's new rule can help reverse this trend at a time when an aging population will need more primary care physicians—especially internal medicine specialists to care for them."
Medicare's hospital outpatient prospective payment system rates will increase by a net 2.6% in 2020.
Despite successful legal challenges by stakeholders, hospitals will see continued cuts to the 340B drug savings program and reductions in reimbursements for off-campus clinic visits in 2020 under a final rule issued Friday by the Centers for Medicare & Medicaid Services.
In addition, CMS said it will issue a separate final rule on its requirement that hospitals disclose payer-specific negotiated rates, which was proposed under the Outpatient Prospective Payment System rule.
Overall, Medicare's hospital outpatient prospective payment system rates will increase by a net 2.6% in 2020, compared with 2019.
However, CMS will push ahead with its ongoing 22.5% payment rate cuts for some drugs under the 340B program, even though the policy was vacated by a federal court in May.
In addition, the second year of the two-year phase-in of the site-neutral cuts – which CMS says will save Medicare about $800 million in 2020 – will continue even though a federal court in September vacated the policy.
"I've never seen anything like what we are seeing now from CMS with OPPS payment policy, where the agency continues to double and triple down on cutting reimbursement to hospitals even when the legal system has spoken in favor of what providers have been saying for years," Jugna Shah, MPH, CHRI, president of Nimitt Consulting Inc., told Revenue Cycle Advisor.
“Given this, it is quite remarkable that the agency pushed its controversial price transparency proposals to a separate, yet-to-be released final rule,” Shah says.
Site-neutral Payments
The final rule completes the two-year phase-in of the site-neutral rate, which is 40% of the OPPS rate provided for grandfathered off-campus clinics in 2020.
CMS says the site-neutral policy will reduce cost-sharing by Medicare beneficiaries to $9, saving them about $14 for each off-campus clinic visit in 2020.
CMS may appeal the September ruling but said it will ensure that 2019 claims for clinic visits will be paid consistent with the court order.
"We do not believe it is appropriate at this time to make a change to the second year of the two-year phase-in of the clinic visit policy," CMS said. "The government has appeal rights, and is still evaluating the rulings and considering, at the time of this writing, whether to appeal from the final judgment."
American Hospital Association Executive Vice President Tom Nickels said the site-neutral cuts "not only threatens access to care, especially in rural and other vulnerable communities, but it goes against clear congressional intent to protect the majority of clinic services."
"There are many real and crucial differences between hospital outpatient departments and the patient populations they serve and other sites of care," Nickels said.
"Now that a federal court has sided with the AHA and found that these cuts exceed the Administration's authority, CMS should abandon further illegal cuts," he said. "Instead, as we urged in a letter to the Department of Justice (Thursday), CMS should promptly repay the affected hospitals the full OPPS rate to support the work they do for the patients they serve. And CMS should pay the full OPPS rate for all clinic visit claims going forward."
340B Cuts Continue
In May, U.S. District Court Judge Rudolph Contreras again ruled that the 340B drug reimbursement rate under Medicare Part B that Health and Human Services set in the 2019 OPPS rule was unlawful and "in contravention of the Medicare Act's plain text."
CMS has acknowledged the ruling, which it has appealed, but said the cuts would continue even as it "solicited comments for a potential remedy for CYs 2018 and 2019 in the event of an unfavorable decision."
"We also announced in our intent to conduct a 340B hospital survey to collect drug acquisition cost data for CY 2018 and 2019, and data from that survey may be used to craft a remedy," CMS said.
After finalizing the policy without precise data regarding hospital acquisition costs for 340B drugs in this program, the agency is crowdsourcing ideas for how to reimburse hospitals as ordered by the court, though an appeal is currently pending, Revenue Cycle Advisor reports.
Health and Human Services Secretary Alex Azar says the cuts are needed because the 340B program has created a large profit margin between the price that hospitals pay for 340B drugs and the reimbursement paid by Medicare, which he said incentivizes hospitals to overprescribe the discounted drugs.
That concern was validated by a Government Accountability Office report in 2015 which showed that Medicare Part B drug spending was substantially higher at 340B hospitals.
Maureen Testoni, president and CEO of 340B Health, said CMS has for three years "ignored the needs of patients and the safety-net hospitals that care for them to pursue an unlawful reduction in Medicare payments to 340B hospitals."
"A federal court has ruled repeatedly that these cuts are inconsistent with the Medicare statute and must be reversed," she said. "A bipartisan majority in both houses of Congress has agreed. It's time to stop this unfunny version of 'Groundhog Day' and restore Medicare payments for 340B hospitals to their legal, statutory level."
Beth Feldpush, senior vice president of policy and advocacy at America's Essential Hospitals, blasted CMS for "plowing ahead with damaging cuts to hospitals in the 340B Drug Pricing Program and ignoring clear congressional intent by expanding cuts to grandfathered provider-based outpatient clinics.
"CMS undermines the foundation of care for the nation's most vulnerable people," Feldpush said. "The agency also prolongs confusion and uncertainty for hospitals by maintaining unlawful policies it has been told to abandon in clear judicial directives."
In the 2020 OPPS proposed rule, CMS solicited comment from stakeholders on methods to devise a remedy for hospitals if its appeal is denied. With CMS redistributing money saved from the reimbursement cut throughout the OPPS since 2018, the agency does not want to simply reimburse hospitals at the more traditional ASP plus 6%. CMS says it will consider stakeholder comments and the survey data as it weighs possible new policies and remedies, Revenue Cycle Advisor reports.
Therapy Services
CMS is also finalizing its proposal to change the required level of supervision for all outpatient therapeutic services provided in outpatient and critical access hospitals from direct to general, according to Revenue Cycle Advisor.
General supervision means that the procedure is furnished under the physician's overall direction and control, but that the physician's presence is not required during the performance of the procedure.
"This is one of the few things that CMS proposed and finalized that should receive three cheers from the hospital community," Shah told the publication.
Hospitals may choose to require higher levels of supervision for certain services as it deems appropriate.
The JOC would have extended to clinics and facilities owned by both religious nonprofit health systems in six Northern California counties.
A proposed joint operating company that would manage Adventist Health System/West and St. Joseph Health System facilities in Northern California has been rejected by the state's attorney general.
In aletter Thursday to leadership at the two health systems, Chief Assistant Attorney General Matthew Rodriquez said regulators had concluded "among other things, that the proposed transaction is not in the public interest, including, but not limited to the potential for increased health costs and concerns over access and availability of healthcare services."
Adventist Health and St. Joseph Health issued a joint statement saying they're "very disappointed in the outcome of this decision."
"Our intent has always been to better serve our communities, increase access to services, and create a stronger safety net for families in Northern California. At this time, our organizations will need to take a step back and determine implications of this decision. The well-being of our communities remains our top priority," the health systems said.
The JOC would have extended to clinics and facilities owned by both religious nonprofit health systems in Humboldt, Mendocino, Sonoma, Lake, Napa, and Solano counties.
Under the proposal put forward in April 2018, Adventist Health and St. Joseph Health would have retained existing hospital names, licenses, capital assets and employees. The two systems hope to have the deal finalized by the end of the year. Financial terms were not disclosed.
In an interview last year with HealthLeaders, Jeff Eller, Adventist Health president of the Northern California region, said the JOC "really is about a population health strategy and securing and strengthening healthcare access in these smaller rural communities."
"We are coming together to form an organization that will manage the day-to-day operations, that will help develop strategies, and ultimately help us to create value back in the communities that we both serve," he said.
Among the allegations, former executives at Outcome lied to outside auditors about revenue for 2015 and 2016 in order to secure debt financing.
Outcome Health, the Chicago-based healthcare digital advertiser, will pay $70 million to resolve allegations that it lied to drug companies and investors about the reach of its advertising inventory, the Department of Justice said.
The privately held company – which provides physician waiting rooms with video screens featuring health tips and drug ads – admitted that from 2012 to 2017 former executives and employees perpetrated a scheme that under-delivered on its advertising campaigns, but continued to bill its clients, mostly drug makers, as if it had delivered in full.
To conceal the fraud, Outcome employees falsified affidavits and proofs of performance to make it appear the company was delivering advertising content to the number of screens in its clients' contracts, DOJ said.
The company also inflated patient engagement metrics with Outcome devices, and altered studies given to clients to make it appear that the campaigns were more effective than they were.
To cover their tracks, the former executives at Outcome lied to outside auditors about revenue for 2015 and 2016. The auditor signed off on the numbers because the schemers fabricated data to conceal the fraud.
In the resolution agreement, Outcome admitted that former executives used the bogus revenue figures to raise $110 million in debt financing in April 2016, $375 million in debt financing in December 2016, and $487.5 million in equity financing in early 2017.
Outcome Health co-founders Rishi Shah and Shradha resigned in 2018 after the company reached a fraud settlement with investors.
"Outcome Health deceived its lenders and investors, and overbilled its clients, by fraudulently misrepresenting both the quality and quantity of its advertising services and concealing those misrepresentations from auditors," Principal Deputy Assistant Attorney General John P. Cronan said in a media release.
As described in the agreement, after reviewing the Company's cooperation and remediation efforts, among other considerations, the DOJ determined not to prosecute Outcome Health for the past misconduct of the Company's founders and select former employees, all of whom are no longer affiliated with the Company.
Outcome CEO Matt McNally said the company is "thrilled to resolve this matter, as it enables us to move forward and focus on our mission to be the indispensable partner to patients, providers and industry partners during moments of care."
For the past two years, Outcome has overhauled its compliance and campaign-reporting policies, McNally said.
"These actions included engaging third-party auditors to ensure reporting accuracy, investing in partnerships with organizations like BPA Worldwide to validate key performance indicators, overhauling internal controls to improve the reliability of reporting, and forming an all-new leadership team, myself included," he said.
Outcome has already repaid drug makers about $65.5 million using cash payments and in-kind services, and has set aside $4.5 million to compensate any other claimants.
The resolution doesn't require Outcome to compensate scammed lenders and investors because many of them now own the company.
