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Payers & Providers National Edition – Issue of September 2012

Payers & Providers National Edition – Issue of September 2012

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Published by PayersandProviders
Payers & Providers is one of the nation's premier healthcare business journals.
Payers & Providers is one of the nation's premier healthcare business journals.

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Published by: PayersandProviders on Sep 21, 2012
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©2012, by Payers & Providers Publishing LLC and MCOL. All rights reserved
 
During the week of August 20th, The
Readmissions Web Summit 
,
Readmissions News 
 and
Payers & Providers 
jointly sponsored an online survey of health plan and healthcareprofessionals. This survey was conducted by
MCOL
and focused on hospital readmissionissues and trends. Survey participants typically have a more active interest in issuespertaining to hospital readmissions.We asked participants to respond to seven items:1. Please categorize your organization.2. I am devoting more/less/about the same amount of time and resources on readmissionissues than a year ago3. The current CMS definition of “all cause” readmission is4. The proper time frame for counting preventable readmissions is…5. To motivate providers to do a better job at preventing unnecessary readmissions weneed…6. We have analytics that helps us identify patients at high risk of readmission7. Before discharge from the hospital we do patient education that involves… (choose allthat apply): A physician, A nurse case manager, A pharmacist, A nutritionist, A socialworkerHere’s what we found:84% percent of respondents said that more time and resources are being devoted tohospital readmissions issues compared to last year. Of these respondents, 42.7% saidthere was significantly more and 41.3% said somewhat more. Only 4% of respondentssaid that there was a smaller amount of more time and resources devoted to readmissionissues than a year ago. The remainder of respondents (12%) said that the time andresources spent were at about the same level as a year ago.
How Much Time and Resources are Being Devoted on Readmission Issues Compared toa Year Ago
continued on page 2 
September 2012 
National
Edition
 
In this Issue 
A Survey of Hospital Readmissions
 
Where Are We in 2012
1.
 
News
A Survey of Hospital Readmissions
3.
 
Vitals
 
Results from the KFF/HRET 2012Employer Survey, U.S. HealthcareEmployees by Industry Sector, PercentUninsured in US by Year, UnnecessaryHealth Spending
4.
 
California
 
CDPH Fines 14 Hospitals $825,000,SCAN Pays $323.7M To Settle SuitBriefs - Arbitrator Says Marin GeneralWon Case, Rideout Health Rebrands
5.
 
Midwest
 
HealthPartners, Park Nicollet Merge,Illinois Hospital CEO ResignsBriefs - Michigan Researchers CautionAgainst Tight Insulin Control, HCSC,Lung Association Work On AsthmaInitiative
6.
 
Webinars•White
Papers
 
Recent and Upcoming Events
The Many Stories of One LitigiousPhysicianHealthcare and CampaignFinance in California
 
7.
 
Marketplace
 
EmploymentAdvertising OpportunitiesPaid Subscriptions
 
8.
 
Order Form
 
Payers & Providers Order Form
 
Volume 2, Issue 9August, 2012
www.payersandproviders.com
 
©2012, by Payers & Providers Publishing LLC and MCOL. All rights reserved
 
MARKETPLACE/EMPL
O
YMENT
 
Payers &
P
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Page
7 
There was slight variation in respondents’ answers when brokendown by organization category. Respondents from the healthplan and hospital categories both had over 50% responding thattime and resources spent were somewhat more while in overhalf of each category, other provider and other responded thatthere was significantly more.Those from the hospital category were the most likely to say thatsome degree of more time and resources were spent on hospitalreadmission issues, with 92.9% answering that way. On theopposite end, other providers were the least likely to say thateither somewhat or significantly more time and resources werespent on readmissions with 72.7% answering this way.A plurality of respondents, 47.2%, think that the current CMSdefinition of “all cause” readmission is OK, but could use sometweaking. A smaller amount, 30.6% think it needs serious e-work and a small contingent of 8.3% think it is totallyinappropriate. Only 13.9% of respondents had a fully positiveoutlook of the definition, saying it was right on the money.
The current CMS definition of “all cause” readmission is:
OverallRight on the money 13.9%OK, but could use some tweaking 47.2%Need serious e-work 30.6%Totally inappropriate 8.3%Respondents who categorized their organization as a health planwere the most accepting of CMS’s definition of “all cause”readmission with 82.4% saying it was either OK or right on themoney. Those who categorized their organization as a hospitalwere the least satisfied with the CMS definition, just over 50% of these respondents saying it either needed serious e-work or wastotally inappropriate.When asked what the proper time frame for countingpreventable readmissions is, respondents were mainly inagreement. 71.2% said that the proper time frame is 30 days and20.5% said 60 days. 2.7% of respondents each said that theproper time frame was 90 days, 6 months, or one year. Theseoverall numbers were consistent to those when broken down bycategory.When asked what is needed to motivate providers to do a betterjob at preventing unnecessary readmissions, respondents wereunanimous in saying that financial penalties alone will not work.There was not a single respondent who thought financialpenalties on their own could motivate providers.Other answers to this question, including when broken down bycategory did not have this kind of agreement.
 
Payers & Providers
 
NEWS
 
Page 2
 
While 54.7% of overall respondents thought that financialpenalties, incentives and public reporting together wouldmotivate providers, respondents from the other providercategory did not agree. Only 18.2% of these respondentsthought that combination would work. Those from the otherprovider category were more inclined to say that financialpenalties combined with incentives were the proper way tomotivate with 63.6% responding that way, which was muchhigher than the 11.8% of health plan respondents and 21.4% of hospital respondents who answered as such. 9.3% of respondents said that incentives only would work and 5.3% saidpublic reporting alone would work, these percentages weremainly consistent when broken down by category.
What is Needed to Motivate Providers to Do a Better Job atPreventing Unnecessary Readmissions
A large majority of respondents (89%) said their organizationeither has analytics that help identify patients at high risk of readmission (38.4%) or are working on it (50.7%). Health planrespondents and other providers were more likely to currentlyhave analytics, with over 50% of each responding this way. Thehealth plan category was the only group to have no respondentssaying their organization did not have analytics and were notworking on it. Those in the other category were the most likelyto say that their organization does not currently and is notworking on putting in place analytics that help identify patientswith 17.6% of these respondents answering this way.Finally, respondents were asked, before discharge from thehospital patient education involves…, and were given theoptions; a physician, a nurse case manager, a pharmacist, anutritionist or a social worker, and told to choose all thatapplies. Nurse case managers were the most popular answerwith 71.4% of respondents saying their pre discharge patienteducation involves them. No other option had a majority of respondents saying their patient education involved them.24.7% said a physician was involved, 35.1% said a socialworker, 24.7% each said a physician or a pharmacist and only13% said a nutritionist. Hospitals were the only category tohave over 50% of respondents answer any other option besidesa nurse case manager with 51.7% saying their educationinvolved a social worker.
Health Benefit Exchange
continued
 
 
©2012, by Payers & Providers Publishing LLC and MCOL. All rights reserved
 
MARKETPLACE/EMPL
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Payers &
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Page
7 
 
Payers & Providers
 VITALS
Page 3
 
Results from the KFF/HRET 2012 Employer Survey
Results were released from the Kaiser FamilyFoundation/Health Research & Educational Trust(HRET) 2012 Employer Health Benefits Survey, their14th annual survey, which found annual premiums foremployer-sponsored family health coverage reached$15,745 this year, up 4 percent from last year, withworkers on average paying $4,316 toward the cost of their coverage.Average Annual Premiums for Covered Workers, forHMOs by Region, 2012
Region
 
Annual
 Northeast
$6,102
Midwest
$5,532
South
$5,478
West
$5,600
All Regions
$5,668
Source: 2012 Kaiser/HRET Employer Health Benefits Survey (EHBS),Kaiser Faimly Foundation, September 2012, http://ehbs.kff.org/  
U.S. Healthcare
 
Employees by Industry Sector
Change from: July 2012 - Aug. 2012
Industry (in thousands)Health care
16.7
Ambulatory health care service
14.2
Offices of physicians
0.7
Outpatient care centers
1.2
Home health care services
7.2
Hospitals
5.7
Nursing and residential care facilities
-3.2
Nursing care facilities
-2.6
Includes other industries, not shown separately. Includes ambulatoryhealth care services, hospitals, and nursing and residential carefacilities.Source: U.S. Bureau of Labor Statisticshttp://www.bls.gov/news.release/empsit.t17.htm 
LISTS
 
from
 
Percent Uninsured in US by Year
1
.2011
15.7%
2
. 2010
16.3%
3
. 2009
16.1%
4
. 2008
14.9%
5
. 2007
14.7%
6
. 2006
15.2%
7
. 2005
14.6%
8
. 2004
14.3%
9
. 2003
14.6%
10
. 2002
13.9%
Check out more healthsprocket lists at:www.healthsprocket.com 
Unnecessary Health Spending
 
MCOLBlog: Round Up the Usual Suspects
$210
unnecessary services
$190
excessive administrative costs
$130
inefficiently delivered services
$105
prices that are too high
$75
fraud
$55
missed prevention opportunities

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