Five hospitals will share as estimated $200 million in federal funding to help train additional advanced practice registered nurses (APRN) the Department of Health and Human Services announced on Monday.
The announcement comes amid growing concern that the demands of healthcare reform will exceed the ability of primary care practitioners to meet those needs.
The graduate nurse education demonstration project will help place additional APRNs such as nurse practitioners, clinical nurse specialists, certified nurse anesthetists, and certified nurse midwives "on the frontlines of our healthcare delivery system to further strengthen and grow our primary care workforce," said Secretary Kathleen Sebelius of HHS. The department declined to estimate how many additional APRNs will be trained as part of the four-year demonstration.
"Having more of these kinds of skilled nurses will increase access to essential healthcare services," Sebelius added during a press conference to announce the program participants. APRNs can diagnose illnesses, prescribe medication and treatment regimens, and perform procedures consistent with their scope of practice.
The Hospital of the University of Pennsylvania (Philadelphia), Duke University Hospital Durham, NC), Scottsdale Healthcare Medical Center (Arizona), Rush University Medical Center (Chicago), and Memorial Hermann-Texas Medical Center Hospital (Houston) were selected to participate.
Hospitals in the program must partner with accredited schools of nursing. As a condition of participation each hospital has committed to support nurse training in nonhospital settings such as community health centers and rural health clinics. "This program will bring talented nursing students into five communities that have a real need for additional primary care and healthcare access," Sebelius stated.
According to the program description, the Centers for Medicare & Medicaid Services will provide reimbursement for the "reasonable cost of providing clinical training to APRN students added as a result of the demonstration." Payments will be linked directly to the number of additional APRNs trained and will be calculated on a per-student basis, comparing previous enrollment levels in APRN training programs with enrollment under the demonstration.
The program is required by and funded through the Patient Protection and Affordable Care Act.
It is hoped that the program will relieve some of the barriers experienced by hospitals and colleges in providing APRN training. Last year nursing schools were forced to turn away more than 14,000 qualified APRN applicants, according to Polly Bednash, PhD and RN, CEO and executive director of the American Association of Colleges of Nursing, who attended the program announcement.
The primary reasons were the lack of clinical sites and budget cuts, explained Bednash, who added that the demonstration program addresses those specific concerns.
Sebelius noted that the program is the latest in about $1 billion in funding that the Obama administration has earmarked for nurse training, education, and job placement.
The Mayo Clinic announced on Friday that it has added a seventh member to it Mayo Clinic Care Network: The Dartmouth-Hitchcock healthcare system, which is known for its research into patient-centered healthcare.
Dartmouth-Hitchcock includes an academic medical center affiliated with Dartmouth College, an extensive clinic system, a children's hospital and a cancer center. It primarily serves northern New England.
The MCCN was created last year as part of a strategic effort by Rochester, MN-based Mayo Clinic to extend its brand and expertise without incurring the cost of new facilities or acquiring other hospitals. The addition of the New Hampshire-based health system mark's the network's first addition outside of the Mayo Clinic's core, mid-western market.
Dartmouth-Hitchcock, like the other hospitals in the network, will remain independent and maintain its own name.
As part of the MCCN, Dartmouth-Hitchcock will have access to Mayo's clinical expertise and clinical tools, as well as electronic physician consultations. David Hayes, MD, medical director for the network, told HealthLeaders Media that the initial focus will be cardiology and neurology services with the expectation that more disciplines will be added to the program over time.
Dartmouth-Hitchcock and the Mayo Clinic have several ongoing relationships. They have worked together on research projects and both are part of the High Value Healthcare Collaborative, which is a program developed by the Dartmouth Institute for Health Policy and Clinical Practice for health systems to share best practices and outcomes data. Those relationships will remain outside the MCCN agreement.
Hayes said the MCCN program is in expansion mode although at this time it has no particular goal for membership. "It really depends on how the project is going and the size of the organizations" that might want to join. He says Mayo is talking to a number of systems the size and sophistication of Dartmouth-Hitchcock but smaller groups are also interested.
In expanding the MCCN membership, Hayes stressed that the Mayo Clinic is looking for "like-minded facilities that share its culture and patient focus." Hayes said Mayo initially expected to develop MCCNs only around its Arizona, Florida, and Minnesota campuses, but Dartmouth-Hitchcock is "such a great cultural fit for us."
The initial MCCN contract is a one-year, renewable agreement. Membership is paid on a subscription basis that considers a number of factors such as the amount of physician engagement and the size of the organization.
In addition to Dartmouth Hitchcock the other MCCN affiliates are: Altru Health System (North Dakota and Minnesota), Arizona State University Health Services (Arizona), Kingman Regional Medical Center (Arizona), Heartland Health (Missouri), Sparrow Health System (Michigan), and CentraCare Coburn Cancer Center (Minnesota).
Acknowledging a fragmented system that has enabled "fraudsters to take advantage," the Department of Health and Human Services is again ratcheting up its efforts to uncover healthcare fraud.
HHS announced Thursday that more than 20 groups, including state and local officials, public and private payers, and federal law enforcement agencies, will be part of public-private partnership whose primary goal will be to share experiences in uncovering and thwarting healthcare fraud.
The partnership will share information on fraud trends and best practices to help law enforcement agencies more effectively tackle the fraud challenge. The initial focus is expected to be on specific schemes, billing codes, and geographic hotspots popular with fraudsters. A long-range goal is to use technology and data analytics to predict and detect Medicare and other fraud schemes.
Healthcare fraud costs the country an estimated $80 billion each year, according to the Federal Bureau of Investigation.
HHS Secretary Kathleen Sebelius and Attorney General Eric Holder announced the partnership at the White House with insurance executives in attendance. "This partnership puts criminals on notice that we will find them and stop them before they steal healthcare dollars," Sebelius said in a press statement.
Health insurers participating in the partnership include Amerigroup, Blue Cross and Blue Shield of Louisiana, Humana, Independence Blue Cross, Tufts Health Plan, UnitedHealth Group, and WellPoint. The Blue Cross and Blue Shield Association and America's Health Insurance Plans are also participating.
The partnership's operational structure and initial work plans are still being developed. In a nod to patient privacy issues that could derail the program, an HHS official noted that many "delicate technical and legal questions need to be worked through in ways that work for a whole complex of public and private organizations."
Work will be divided among three committees: executive, data analysis and review, and information sharing, which will begin meeting in September.
The budget for the program has not been set, although the monies will come from HHS's antifraud funds.
The Patient Protection and Affordable Care Act provides guidance for the partnership in identifying high risk providers and suppliers. According to an HHS official the highest level of risk includes new home health and new durable equipment providers and suppliers.
Buoyed by the addition of two blockbuster deals, the dollar value of healthcare services mergers and acquisitions tripled during the second quarter of 2012 compared with M&A activity during the comparable quarter in 2011, according to Norwalk, CT-based Irving Levin Associates Inc., which publishes a quarterly report on M&A activity in the healthcare industry.
Healthcare services, which includes physician groups, hospitals, and managed care, recorded 133 transactions valued at $23.1 billion in second quarter 2012 compared with 139 transactions valued at $7.3 billion for second quarter 2011.
The 2012 numbers, however, include a blockbuster $3.9 billion deal that involved two German hospital companies, Fresenius and Rhoen-Klinikuma. (Levin Associates includes foreign transactions in its M&A report, but these usually show up only in the medical device, biotechnology, and pharmaceutical categories.)
Omitting that mega-deal still pegs the value of healthcare services M&A at $19.2 billion, which is more than double the 2011 value.
The surge in M&A activity reflects increased pressure on the healthcare industry to reduce costs and increase the quality of care. Everyone is "trying to figure out what they need to do that," Steve Monroe, a Levin Associates editor, told HealthLeaders Media.
Physician Group Deals
The value of physician group M&As climbed to $4.2 billion during second quarter 2012 thanks to another blockbuster, the $3.7 billion agreement between Davita, a Denver-based dialysis chain with 1,800 locations, and HealthCare Partners, which operates medical groups and physician networks with more than 2,500 employed or affiliated physicians in California, Florida, and Nevada.
There were 21 physician group M&As posted for the quarter compared with 27 transactions valued at $416 million for the comparable 2011 quarter.
The Davita-Healthcare Partners acquisition reflects the continuing effort by providers to position themselves to tightly control costs and to create alignments that enable the care continuum to be realized. This is happening across the healthcare industry, explains Monroe. "Everyone is trying to position themselves, and cover themselves, so they can deal in an environment that is still a bit unknown."
Managed Care Deals
Managed care M&A's posted nine deals valued at $730 million during second quarter 2012. Monroe reports that the largest deal was Towers Watson's $435 million acquisition of Extend Health, which operates a private Medicare exchange. The deal positions Towers Watson, which primarily consults on employee benefits, to capitalize on the growing interest in private health plan exchanges.
Managed care M&A activity for the 2012 quarter lags well behind the second quarter of 2011 when there were seven managed care deals valued at $1.7 billion. That quarter included WellPoint's $800 million acquisition of CareMore and Aetna's acquisition of Prodigy Health for $600 million.
Insurers have not been shy about moving into the M&A market to meet their needs for Medicare and Medicaid plans to meet anticipated enrollment increases. While several deals were completed in 2011, insurers are still on the hunt for acquisitions that will position them to capitalize on new enrollment opportunities presented as part of healthcare reform.
Excluding the German hospital deal, the dollar volume of hospital M&A activity for the second quarter 2012 totaled around $600 million for 21 transactions. The largest hospital M&A transaction reported in the quarter was Highmark Blue Cross Blue Shield's $275 million acquisition of controlling interest in Pittsburgh's Jefferson Regional Medical Center.
The quarter is well off the pace set for hospital M&As in second quarter of 2011 when 32 transactions valued at $3.5 billion were reported. Two blockbuster deals were the hallmarks of that quarter: The acquisition of West Penn Allegheny Health System by Highmark, with a value of $1.5 billion, and HCA Holdings' acquisition of the remaining interest in HealthOne, which was valued at $1.4 billion.
Levin Associates' Monroe expects to see an uptick in 2012 M&A activity now that the Supreme Court has upheld the individual mandate and "there is more certainty." But some uncertainty remains, particularly in relation to the upcoming elections, especially if Republicans take over Congress and the White House and try to disassemble healthcare reform.
Still. if the cost of capital remains low, Monroe says 2012 M&A activity could end up similar to that of 2011. He says the potential for tax increases could spur end-of-year activity especially in the long-term care category, which is dominated by small, private firms and individuals that may be more interested in cashing in rather than taking the tax hit.
The Levin report separates M&As in the healthcare industry into two segments: healthcare services and technology. Combined the two segments recorded 251 transactions valued at $61.2 billion for second quarter 2012. That compares with 243 deals valued at $73.5 billion for second quarter 2011.
The technology segment, which includes medical devices and pharmaceuticals, continues to dwarf the services segment in the value of its transactions. For second quarter 2012 the technology segment recorded 118 transactions valued at $38.1 billion compared with 104 transactions valued at $66.2 billion during the comparable quarter in 2011.
Think you know what's driving up healthcare costs? Hoards of uninsured patients seeking emergency department are? Unconscionable prices charged by pharmaceutical companies? The practice of defensive medicine?
Guess again.
The answer might be lurking in your own home.
According to a report from the Health Care Cost Institute, a Washington, DC-based research group, spending on healthcare costs for commercially insured children under age 18 grew faster than spending for adults from 2007 to 2010. HCCI had access to three billion health insurance claims from Aetna, Humana, and UnitedHealthcare.
Insurers and consumers spent nearly $88 billion on healthcare for children in 2010, up by 12% percent from 2007, according to the HCCI. Spending increased even though the number of children covered by employer-sponsored insurance dropped from 44 million in 2007 to 41.4 million in 2010.
By comparison, healthcare costs for adults increased by 8%.
This is the first time researchers have been able study such a large number of claims from different carriers. The results of the study suggest that controlling healthcare cost over the long term may be tougher than anyone has imagined.
According to the report, healthcare spending on children increased despite a drop in the number of children covered and a drop in the use of expensive healthcare services, such as hospital stays and brand-name drugs.
So, if fewer children used fewer expensive services why has spending increased?
Health plans often cite utilization as a driver of increased healthcare costs, but in this case researchers discovered that regardless of the service category (inpatient or outpatient, professional or pharma) the price of the healthcare services themselves increased faster than either utilization or the intensity of those services.
The report points to a few trends that contribute to this outcome:
Inpatient and outpatient utilization is down, so fewer children are being admitted to hospitals or visiting EDs
Use of testing facilities has increased and services such as MRIs are more prevalent
At every physician visit more tests, consults, and procedures are performed
Over a three-year period between 2007 and 2010, the per capita expenditure for inpatient services increased by 13%, outpatient by 28%, professional services by 16% and prescription drugs by 19%.
By age group, payers and beneficiaries spent the most healthcare dollars on children who were age three and younger and between the ages of 14 to 18 years. Here are some of the study findings for those two age groups:
Children age three and younger:
Accounted for 17% of the children studied and 31% of healthcare spending
Posted the highest annual per capita spending rate ($3,896)
Incurred inpatient services totaling 38% of healthcare spending. For this study the cost of normal deliveries and inpatient perinatal services were evenly divided between mother and baby
Incurred outpatient facility services totaling 17% of healthcare spending
Children age 14-18:
Accounted for 29% of the children studied and 31% of healthcare spending
Posted the second highest annual per capita spending rate ($2,272)
Had one of the highest utilization rates of three central nervous system drugs, such as antidepressants, anti-anxiety drugs, and drugs used to treat attention-deficit hyperactivity disorder
Posted a 31% increase in spending on prescription drugs
Across all age groups the findings include:
Primary care visits, immunizations, and preventive medicines account for the biggest share (40.3%) of children's healthcare spending
Outpatient services account for 24% of spending
Inpatient admissions account for 22% of spending
Prescriptions drugs account for 14%
The study findings have serious ramifications for healthcare costs, explains David Newman, executive director for HCCI. "Think about these kids aging over time. If at each age they are more expensive than at an earlier cohort then it's going to be very difficult to bend that long-term healthcare cost curve."
Simply put: Spending could continue to climb.
"What happens when these kids become adults and enter the work force," asks Carolina Herrera, HCCI's director of research, "and they are still using a high level mental health services and expensive prescription drugs? What does that mean for employer healthcare costs?"
Those are excellent questions. In this age of the triple aim (better care, better health, and lower cost) insurers, providers, and parents need to know that these increased expenditures for childhood healthcare are yielding meaningful outcomes.
HCCI plans to continue looking into this issue to add to the understanding of what is driving the price increases. With three billion pieces of data at their finger tips, researchers may be able to make discoveries that will affect healthcare costs for generations to come.
The final rule for identifying potential benchmark plans to support the definition of essential health benefits as well the process for recognizing accrediting entities to certify qualified health plans for state health insurance exchanges, was quietly released earlier this week by the Department of Health and Human Services.
While this rule puts many of the components of EHBs in place, full implementation will require some additional rulemaking. HHS indicates within this rule that it will issue future rules to set criteria for health plan accreditation, as well as to "to align with the timeframe of other quality reporting requirements, including establishing a quality rating system."
The timeline for these additional rules is unknown at this time, although it’s clear that HHS is on a fast track to provide EHB details. This final rule was released only 11 days after the end of its comment period. HHS is committed to having EHBs in place in time for insurance issuers to use the information for plan design and rate setting for initial enrollment in Fall 2013.
According to this rule, data from insurers that offer the three largest small group products will be used to identify the benchmark plan for each state for establishing EHBs that must be offered beginning in 2014 by health plans in the online exchange marketplace as well as in individual and small group health insurance policies. Insurer size is gauged by total enrollment as of March 31, 2012.
The rule also establishes the two-phase approach to be used in the quality health plan accreditation process. Phase one identifies the National Committee for Quality Assurance and the URAC as interim accrediting agencies. The two are already responsible for most health plan accreditations.
Phase two, which will be detailed in another rule, will establish the criteria-based review process to be used.
The Patient Protection and Affordable Care Act requires HHS to define EHBs, which are 10 general categories of service that must be offered beginning in 2014 by health insurance exchanges, as well as individual and small group health insurance policies. In December, 2011, HHS announced that it would leave that job up to the individual states.
HHS, however, reserved the right to establish the process that states must use to identify their EHBs. According to the final rule, "HHS will also publish the state-specific benchmarks for notice and comment" and make final approval of the EHBs.
The EHB categories are
ambulatory patient services,
emergency services,
hospitalization,
maternity and newborn care,
mental health and substance use disorder services (including behavioral health treatment), prescription drugs,
rehabilitative and habilitative services and devices,
lab services,
preventive and wellness services and chronic disease management, and
pediatric services (including oral and vision care
In response to comments received when this rule was first proposed, HHS has made several changes in the final rule, including:
Clarifiying that riders (optional or required benefits available for an added premium) should be included in data collected to identify benchmarks.
Excluding collecting data on prior authorization and/or step therapy for drug coverage.
Amending the definition of treatment limitations and data collection to include only quantitative limits.
Permitting NCQA and URAC to review policies and procedures at the issuer level provided they are uniform across the issuer's product line.
Clarifiying that network adequacy and access accreditation standards include "maintaining a network that is sufficient in number and types of providers to assure that services are accessible without unreasonable delay."
Removing essential community providers from the network adequacy standards for accreditation.
Modifiying data sharing requirements between accrediting entities and exchanges to specifically exclude personally identifiable data.
Establishing Sept. 4, 2012 as the submission deadline for insurers that are eligible to be the benchmark plan for EHBs.
Health insurance exchanges remain a political hot potato as some states balk at the federal mandate. Under PPACA, states must have insurance exchanges in place by 2014. According to the Kaiser Family Foundation at least 15 states are participating in the process while 18 are still studying their options.
If a state declines to set up its own exchanges, then HHS will step in and run the exchange. Alaska, Florida, and Texas are among a handful of states that plan not to operate their own exchanges.
Rep. Michael Burgess (R-TX) said on Wednesday that he will submit legislation this week to delay for one year the implementation of the sustainable growth rate formula (SGR). Without the delay, or other action, physicians face a 28% cut in Medicare reimbursements in January 2013.
Burgess made the announcement at a meeting of the House Energy and Commerce Committee called to discuss innovations to reform Medicare physician payments.
He said that the SGR delay would allow Congress to get past the uncertainties presented by the upcoming elections, the expiration of existing tax policy, the extension of unemployment insurance, as well as potential debt limit debates.
The SGR formula was put in place as part of the Balanced Budget Act of 1997 to help control Medicare spending. It soon became apparent that significant cuts in physician reimbursements would be required to help reduce spending but since 2003 Congress has routinely declined to make those cuts.
In 2011, SGR was the focus of the debt reduction debate. Although stakeholders and others supported its repeal, Congress instead enacted a series of short-term extensions before finally agreeing in early 2012 to delay the SGR implementation through 2012.
Although Burgess didn't specifically mention the lame duck status of Congress after the November election, he did characterize December as "an uncomfortable month for so many reasons. We know we aren't likely to end up doing something that provides long-term relief with a long term replacement for the SGR by Dec. 31."
Burgess, who practiced medicine as an OB/GYN before he was elected to Congress in 2002, noted that during the last round of SGR discussions earlier this year he and other members of the House had supported a two-year extension but settled for the one-year extension.
He said his proposed delay would "give us the time we originally wanted" to allow House Energy and Commerce Committee members time to "fully vet and evaluate" SGR replacement proposals and present them to physicians across the country for feedback.
Reaction among the committee members and witnesses scheduled to speak before the committee was mixed. Rep. Henry Waxman (D-CA) stressed that he wants to see something permanent happen to the SGR this year. "This problem needs to be resolved and not just kicked down the road. We need to get on with the job of doing what is responsible."
Rep. Frank Pallone (D-NJ) appeared receptive to an SGR delay. "We all agree that the SGR needs to be replaced. Is there political will to do that? Can it be done effectively by the end of the year with all these other problems that need to be addressed?"
Pallone asked how Rep. Burgess would pay for the extension and suggested that the large "pay for" could be covered by raiding the funding for overseas contingency operations (OCO), which are the discretionary funds used for the wars in Afghanistan and Iraq. The idea is popular with groups like the American Medical Association and has gained some traction in Congress although several Republican members of the committee made it clear that they would not support such a move.
"You're not going to use OCO money," stated John Shimkus (R-IL). "That's not going to happen."
Pallone said his Republican colleagues could forget trying to take funding away from the Patient Protection and Affordable Care Act to fund the SGR delay. "It's useless politically to try to do that." He added that taking funding away from other parts of the healthcare system also isn't the answer. "The healthcare system is in crisis and other healthcare providers share the same problems as physicians."
In an e-mail exchange after the committee meeting Bob Doherty, senior vice president of governmental affairs and public policy for the American College of Physicians, said Congress "shouldn't decide now that an extension is the best it can do. The goal should be to enact legislation that eliminates the SGR and begins the transition to a better payment system."
He said the group supports the Medicare Physician Payment Innovation Act (HR 5707) because it makes progress toward that goal.
The delay proposal by Rep. Burgess seemed to catch by surprise the witnesses, who were there to tout various payment innovations to the House committee. The witnesses, who represented insurers and physician groups, all stated their support for repeal of the SGR but didn't directly address the Burgess proposal.
Don Berwick, MD, may no longer be the administrator for the Centers for Medicare & Medicaid Services, but he's still very much involved in the business of healthcare reform.
Berwick, now a lecturer at Harvard Medical School's department of healthcare policy, spoke at a recent Health Affairs briefing on the Patient Protection and Affordable Care Act. He has long championed changes in healthcare delivery, and says that with the Supreme Court decision to uphold the PPACA now behind us, healthcare stakeholders need to be vigilant in making sure that real healthcare reform continues.
With much of the national focus now on the November elections, Berwick explained that no matter which party wins the White House, he has seven worries about the continued implementation of healthcare reform.
1. Will healthcare change? Berwick offered a story about the auto industry's reactions in Japan and the US after the passage of auto emissions legislation. In Japan the industry responded by mobilizing to reduce emissions. In the US, the industry mobilized to change the law. "This is the strategy choice that we're going to face" in healthcare, Berwick explained.
2. Will we actually reduce cost? Berwick says we are in a rhetorical phase of cost reduction; we're talking about it, but not yet accomplishing it. He points to Massachusetts, which is now grappling with the costs of implementing near-universal coverage. Berwick's concern is that "as you watch the rhetoric play out, it's a playing field in which the authenticity of reducing costs remains in question."
He says he has considered promoting a national project that he calls the "15% projection" to keep healthcare spending at 15% of the GDP. "That would solve the problem, but is the authenticity there to reduce costs?"
3. Mechanics of coverage. Berwick believes health insurance exchanges are among the most difficult aspects of the PPACA. States are struggling with the mechanics of setting up this new "creative and agile element" of the healthcare coverage system. "It's a serious challenge. We can do it, but we have to be serious about it." The difficulty of the task is "compounded by political polarization."
4. The safety net. Berwick says "we must preserve the commitment and mechanics to make healthcare a human right." He notes that there are "real people really at risk" living at the poverty line. Unfortunately, he says, middle class politics are at the foreground and the political will to maintain the commitment to healthcare for the most disadvantaged is vulnerable.
5. Commitment to science. Healthcare should be science-based, Berwick says. Patients should get what works and they shouldn't be subjected to what doesn't work. "All the rhetoric about death panels and rationing has distorted the important issue of whether we will commit to healthcare that works." Berwick says that will require a "reconnection of the healthcare agenda to the scientific agenda."
6. Prevention. If the US is going to pursue the storied triple aim (better care, better health, and lower costs) then it needs to invest in the causes of illness, says Berwick. "This is always vulnerable. It's the easy target, the budget you can cut." It's time, he says, to get very serious about reducing risk factors in healthcare. "This is a huge challenge to grapple with. Will our country prevent illness?"
7. Communication. "Somewhere at the beginning of healthcare reform we lost the opportunity to make the case for healthcare as a human right," Berwick said. While he contends that it's an easy case to make, he says work needs to be done to "build a bridge to public sensibility and a dialog about the healthcare we really want."
Berwick wrapped up his comments by calling for fewer pilots and a "more wholesale change" in the delivery of healthcare. He also alluded to state demands to have more say in healthcare reform and more independence in developing their own programs.
He described the states as "true laboratories of democracy. If we're smart and keep our wits about us we will learn a ton." Berwick also seemed to endorse the idea of more state independence. "If we have the wisdom to give states the license to move ahead…I think we're going to see an era of great learning."
States that sit on the sidelines waiting for the results of the November election before they commit to healthcare reform and health insurance exchanges will face a "herculean effort" to establish their exchanges and implement reform says Anthony Brown, the Maryland lieutenant governor. "We've been at it for 18 months in Maryland."
Brown pointed to consensus building with legislators about the role of healthcare reform and health insurance exchanges. "We worked with them over three separate annual legislative sessions. Legislators weren't under the gun. They had time to carefully consider and revisit issues."
Brown says Maryland has used the time to successfully compete for federal dollars available to fund the exchanges and other components of healthcare reform. No matter what political or legal outcomes are presented, Brown said, "we are committed to implementing as much of the Affordable Care Act as we can."
The lieutenant governor spoke during a daylong briefing on the Affordable Care Act hosted by Health Affairs.
He asked for a show of hands from attendees representing states where there is public/political/legal opposition to the ACA. Then he asked that group if they had noticed executive departments working clandestinely with private sector and nonprofit participants to lay the foundation for the eventual implementation for the ACA. The show of hands confirmed, he says, that even in states where the ACA is opposed, progress is being made to implement healthcare reform.
Maryland was among the early adopters of provisions of the Patient Protection and Affordable Care Act. Brown says that on the day President Obama signed PPACA into law, the governor of Maryland established the Healthcare Reform Coordinating Council to help implement the PPACA. "I can say that there was a significant amount of anxiety among stakeholders who wondered what the Affordable Care Act meant for them."
Brown notes that while some states have voiced concerns about the exponential increase in healthcare costs that may come as part of healthcare reform, Maryland officials are convinced that the state has more to gain than lose.
An early study by the University of Maryland indicated that implementing the ACA would help the state save $700 million in its budget and reduce the number of uninsured by 50%. A follow up report released last week confirms the savings and estimates that the ACA will generate more than $3 billion in economic activity for the state, an create 26,000 healthcare jobs by 2020.
Brown says Maryland has elected to create its own health insurance exchange because the state has no interest in being part of the default federal exchange. "We believe our exchange must be designed to address Maryland's specific healthcare needs."
He challenged states to take the lead on their own exchanges. "Each state is unique and this is an opportunity to tailor your exchange to meet the specific needs of your state residents."
Brown credits the Maryland legislature with being a key supporter of the effort. "The real action and success of the ACA will happen in state capitals around the country." Because the ACA doesn't guarantee healthcare cost control, one big step is for states to "affirm or strengthen their commitment to implement serious and sustained efforts to bend the cost curve."
For Maryland, that has entailed the development of state and local health improvement plans to identify priorities and set measurable targets, the creation of a model for patient-centered medical homes, and increased adoption of health information technology.
Brown acknowledges that states are right to worry that federal funding, especially for Medicaid expansion, is committed only until 2020. He refers to 2021 as "hitting the cliff" but says that's why bending the cost curve is so important.
He says time is of the essence and states should "use this time to develop programs that benefit their residents."
Five of the six top leadership positions at troubled Parkland Health & Hospital System are now filled with interim appointees following a reorganization of the Dallas facility announced Friday.
The interim designations reflect Parkland's "aggressive search" for a permanent CEO, Debbie Branson, chair of the hospital's board of managers told HealthLeaders Media during an interview Friday.
"We want to provide the new CEO with maximum flexibility to choose his or her own team," explained Branson. The new team also provides the hospital with much needed turnaround experience as Parkland works its way through a federally mandated corrective action plan (CAP).
While Branson says the safety net system has made "significant strides" on the 400+ action items required by the CAP, she acknowledged that Parkland is at a point where it "needs to step it up a bit."
The safety net hospital has until April 2013 to become compliant with the rules and regulations of the Centers for Medicare & Medicaid Services or risk the loss of an estimated $417 million in annual Medicare and Medicaid contracts.
She notes that the new team has "significant turnaround experience in the healthcare industry. We feel like this is the appropriate team to make the changes we need to make at this point." Now it's time, Branson says, to start auditing the policies and procedures put into place for the CAP and this team will make sure the changes "are hardwired into the system."
Parkland's senior leadership team includes:
Thomas Royer, MD, who was named interim CEO in November 2011. His contract expires September 1. He succeeds Ron Anderson, MD, who was the CEO for 29 years before the board of managers removed him from that position in August 2011. Anderson remains under a one-year contract with Parkland as senior advisor to the CEO.
Ron Laxton and Sharon Phillips, RN, now share the interim COO title. The COO spot had been empty since the September 2011 departure of John Haupert, who was named president and CEO of Grady Health System in Atlanta. Laxton will focus on hospital operations. He joined Parkland in March as the chief implementation officer for the CAP and reports directly to the hospital's board. Sharon Phillips will focus on off campus operations, including ambulatory care and behavioral health services. She has been with Parkland since 1985 and has held several executive positions.
Ted Shaw, an accountant, has joined Parkland as interim CFO. He replaces John Dragovits who announced in June that he was leaving to become president and COO of a Dallas healthcare information technology company. According to Parkland Shaw has served as CEO and CFO at both public and private healthcare organizations. He was until May 2012 the CFO of the University of Miami medical school.
Christopher Madden, MD, was named interim chief medical officer following the Friday resignation of John Jay Shannon, MD, who had served as CMO since 2007. Shannon's resignation "was voluntary" following good discussions, according to Branson, who added that Shannon will help with the CMO transition. Madden, a neurosurgeon at University of Texas Southwestern Medical Center, has since December serviced as UT Southwestern's assistant vice president for Parkland Health & Hospital System affairs.
Mary Eagen, executive vice president and chief nursing officer, joined Parkland in January 2012 to restructure Parkland's nursing organization. Systemic issues in the role and organization structure of nursing and nursing practices have been identified as contributing to many of the Parkland deficiencies identified by CMS. Eagen was previously regional chief nurse executive at Christus Health Southeast Texas in Beaumont.
Branson says a nationwide search for a permanent CEO is underway. The Parkland board hired Korn/Ferry International in June to conduct the search. Branson is hopeful that potential CEO candidates will view the reorganization as positive. "I'm hopeful that we will have made significant progress toward the completion of the CAP and that will be a plus for anyone looking at the job."
Although no timeline for the hire has been released, Royer's current contract as interim CEO is set to expire in September. Royer has come under fire for taking action without board support. His hire for chief implementation officer was reversed by the board. Ron Laxton, who was ultimately hired as an interim COO, reports directly to the board.
Meeting CMS requirements is estimated to cost $25 million. Branson says that while the board is cognizant of its responsibility to be fiscally responsible with the taxpayer's money "we need to do what it takes to make the changes required."