Professional Documents
Culture Documents
IAG Healthcare Digest For April 2011
IAG Healthcare Digest For April 2011
Simply click on a category relevant to you below to jump to the news topics, click on the
linked topic title to be taken to the source article. Most sources are publicly available; you
may have to subscribe for others.
Innovation
Trend Drivers HIE ACO
Trends
Innovation Trends:
Just as a he shift of medical costs to consumers is driving changes
in financing the delivery of healthcare, disease specific concierge
services and the development of innovative systems for patient
recruitment, compliance and education is enabling cost-effective
quality care to capture an increasing proportion of the $363
billion healthcare market that is not included in overall
healthcare costs.
The Bond Market Has Pinched Hospitals Options For Securing Debt - Plenty Of Alternatives
Remain.
Three crucial changes have occurred this year that have narrowed the choices that hospitals
have for debt:
• The Build America Bonds program that permitted government hospitals to receive a 35%
reimbursement of their interest costs from the government has expired.
• The annual debt limit on bank-qualified bonds was dropped down to $10M from $30M.
• Bonds issued with a Federal Home Loan Bank credit may no longer be tax-exempt.
So how should hospitals plan? It depends on the financial girth of the hospital itself - a hybrid
of general obligation pledges and revenue pledges is the most likely the course - see article
for ideas. (H&HN Magazine, March, 2011)
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$363 Billion Of Healthcare Costs Not Being Counted.
Based on NHEA (Centers for Medicare and Medicaid Services), a
Deloitte analysis estimated that the hidden cost of healthcare in
the U.S. in 2009 was $363 billion and represents expenditures
that fall outside of traditional areas such as doctors, drug
prescriptions, hospitals and insurance coverage.
coverag This amounts to
an additional 14.7%
14.7% of health care spending that was not
previously captured in the National Health Expenditure Accounts
Accounts
data.
data 55% of this is the cost of supervisory care of taking care of a
sick or disabled spouse, family member or friend with the rest for
products, like nutritional supplements, mental health and
substance abuse facilities, alternative medicine, certain
ambulatory and ambulance services and weight-loss centers.
[Source: NHEA (Centers for Medicare and Medicaid Services) and
Deloitte Analysis]
67% Of Those
Those Surveyed Said Watching The Patient-
Patient-Centered TV (Online) After Discharge
Made Them More Motivated To Stay On Their Treatment Plan.
If you are viewing digital screens in pharmacies and doctor offices, you are seeing the Digital
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Out Of Home (DOOH) market at work. A number of digital out-of-home networks have sprung
up over the last few years targeting one of the more captive and engaged audiences there is -
- patients in healthcare settings. A new study from GfK Research North America for the
Wellness Network, which owns two hospital-based DO networks, showed that TV plays a
major role in passing the time during a hospital stay:
• Patients watched an average of 28 hours during their stays (five days average in 2008 for
the U.S.).
• Six hours were spent watching the Patient Channel, which reaches an average of 20
million hospital patients a year.
This type of programming led to:
• Hospitals receiving high evaluations from patients for the facility and its level of care for
patients,
• Patients ranking it ahead of TV news, support groups, and the Internet as a source of
health information; unsurprisingly, it ranked behind doctors and family and friends, and
• 67% of those surveyed said watching patient-
patient-centric TV or online websites after discharge
made them more motivated
motivated to stay on their treatment plan.
According to Magna Global's latest ad forecast, DOOH will show a 15.2% CAGR for the next
five years and be one of the fastest-growing media around the world. That puts it behind just
two hot media categories - online video (19.6% CAGR) and mobile (19.4% CAGR) for the
same period. This sets expectation for DOOH to grow about three times the rate for the
media business overall (5%-5.5% CAGR). (Media Post, January 11, 2011)
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Trend Drivers:
Anxiety about healthcare permeates not just the consumer, with their
increasing
increasing concerns about higher cost, but is shared by physicians
who are thinking of leaving. In the face of these pressures, Mark Frisse
of Vanderbuilt offers some sober realities about what it will take to
transform healthcare…can you do it all with regulations
regulations (see first topic
below)?
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Per Capita Healthcare Costs Increases
Increases 6.29% for 2010
Standard & Poor’s Healthcare Economic Composite Index reports the average per capita
cost of healthcare services covered by commercial insurance (8%) and Medicare (3.4%)
programs increased by 6.29 percent over the year ending in January
January.
ary. This marks the first
time since May 2010 that the combined growth rate has accelerated. (Healthcare Finance
News, March 17, 2011)
Per Capita Healthcare Costs $9,217 In 2009 – 15% Higher Than Government Predictions
According to a new Deloitte survey of over 1000 U.S. adults, per capita healthcare costs
amounted to $9,217 in 2009 - almost
almost 15% higher than official government predictions.
predictions Elderly
U.S. residents accounted for 36% of total health spending ($1.01 trillion) were elderly of
which 83% of the spending came from those with annual household incomes of $100,000 or
less. Estimated for non-covered care totaled to almost $2.83 billion in 2009 including:
• $199 billion for the estimated value of supervisory care provided by friends and relatives;
• $144 billion spent on nursing homes;
• $72 billion spent on home healthcare; and
• $246 billion spent on prescription medications.
(Deloitte, March, 2011)
70% Of Patients Have Anxiety Is Rising Over Medical Bills, And 73% Expect Their
Physicians To Be Accessible Online
An industry survey from Intuit Health showed that patients expect doctors to be online and
rising anxiety over their medical expenses. As Americans are now so accustomed to paying
bills online that they expect that same convenience and connectivity from their doctor’s office.
The survey highlights include more than 50% of respondents stated that "anytime, anywhere"
access is so important that they would consider switching doctors for a practice that does
offer online services.
services. (Healthcare Finance News, March 3, 2011)
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2010 – Running A Practice Has 40% Of Primary Care Physicians Thinking About Leaving
Their Field
Paperwork, reimbursement worries and bureaucracy, running an office and costs to do so are
leading causes for physicians thinking about alternatives to primary care. Yet, face-to-face
time with patients has been the most rewarding part of the job for many, but this has been
eroding steadily.
A late 2010 survey of 3,729 family care physicians found that about 40% had considered
leaving their primary care practices that year…16% said it was the first year they had
considered a career change.
The survey also reported that three out of five physicians enjoy better job satisfaction than
they anticipated on their first day in medical school. (CMIO, March 23, 2011)
Office of the National Coordinator for Health IT (ONC) has released “The Federal Health IT
Strategic Plan: 2011-2015," an 80-page last published in 2008.
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HIE
As the HIE rollout proceeds, the Direct Project gains interest and
the federally funded Alembic open source project gains
momentum. Several new recourses for evaluating your HIE.
Alembic Foundation To Shepard The CONNECT Open Source Project – Access To All.
Two leaders of the federally-funded CONNECT initiative to develop open source,
downloadable health information exchange software now head a new foundation created to
take the lead in promoting and expanding use of the technology that was released in April
2009 to the open source community. It was always the government's plan to see a private
sector organization take over management of CONNECT to optimize the availability of the
code to all participants in addition to federal agencies. The Alembic Foundation in Falls
Church, Va., and Vanessa Manchester, COO, served as staff for CONNECT in the Office of
the National Coordinator for Health Information Technology. As one of their first acts, the
foundation has copied the latest version of the software, CONNECT 3.1, private-labeled it as
Aurion 3.1 and released it to the open source market on March 21…Aurion 4.0 is to be
released on May 3. More information on The Alembic Foundation and Aurion is available at
alembicfoundation.org and http://aurionproject.org/.
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ACO
“Tip of The Day” and release of proposed rules reigns king around
the early days of planning for an Accountable Care Organization
(ACO). However, an evaluation of CMS data by VHA differs on
needed margin (see last topic in this category).
10 Key Points in March 31, 2011 Release of Proposed Rules for ACOs
The 10 key points in the proposal are generally described.
1. Projected savings. Overall Net savings may range $510 million to $960 million over the
first three years.
2. Two payment tracks. In the first phase of the program, ACOs will be allowed to choose
between two different tracks to get shared savings
• "one-sided risk" model, an ACO that saves at least 2% of reimbursements would get 50%
of the money above that threshold, but it would have no penalty if it spent more in the first
and second year.
• A second, more risky model would give an ACO 60 percent of the money above the
threshold but also penalize the ACO if it spent more.
3. No start-
start-up funding. The proposal reportedly lacks any start-up funding for ACOs and the
average start-up cost for each participant in the Physician Group Practice Demonstration was
in the seven figures.
4. Beneficiaries can limit data. Mandatory notification to beneficiaries that they are part of the
ACO, they can opt out of sharing data and still get care from the physician or other providers.
5. Reporting quality data. ACOs would report a total of 65 quality measures in five domains -
in the first year they have to only report quality data. Then in years two and three their quality
data will be scored and affect their shared savings payments.
6. A single hospital can become an ACO….if
ACO… they have enough primary care physicians.
7. Specialists cannot create an ACO. "Specialists can't lead in forming the ACO, primary care
physicians or other providers, such as mid-level practitioners most lead.
8. Existing ACOs can join the
the program. Existing ACOs may qualify as a Medicare ACO as is,
if their governance structure includes Medicare beneficiaries.
9. Three levels of antitrust enforcement. The Federal Trade Commission and the Department
of Justice have jointly issued a proposed statement of enforcement policy for ACOs, which
mapped out the following three levels of enforcement.
50% trigger for automatic antitrust review. If providers in the ACO represent more than 50%
of the market, they are subject to automatic review by the Department of Justice and the
FTC. They will receive a 90-day expedited review. If either agency raises a concern, they
could become part of the ACO program.
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10. Beneficiaries on ACO boards. To demonstrate a partnership with Medicare FFS
beneficiaries and meet patient centeredness criteria by including a Medicare beneficiary
serviced by the ACO on the ACO governing body, the proposal would require having a
Medicare beneficiary on the governing board of the ACO. (Becker’s ASC Review, March 31,
2011)
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2. Physician and hospital are not knife and fork – they are fighting for the same dollar and
leaders need to have "crucial conversations" for ACOs to work.
3. Independent physicians must form new affiliations with hospitals to maintain negotiating
strength with the payors.
4. Hospitals and physicians can strengthen ties through a variety of models other than full
acquisition.
5. Shifting from fee-for-service to a culture focused on quality and outcomes will offer
physicians new opportunities for leadership.
(Becker’s Hospital Review, March 28, 2011)
ACOs Could Take More Time And Higher Margin To Break Even.
Authors Trent T. Haywood, MD, JD, and Keith C. Kosel, PhD, MBA, from the VHA network
reviewed the previous government demonstration ACO data anticipating the government
model would have produced promising results that warranted its rapid expansion - their
analysis of the results from the demonstration suggests otherwise. The CMS report showed
that with a five-
five-year time horizon and a mean investment of $737 per PGP provider, the
required margin to break even is 13 percent. Using the same data, the VHA authorsauthors
concluded differently and found that an ACO making the mean initial investment of $1.7
three--year period envisioned by
million will require the unlikely margin of 20 percent for the three
CMS. (CMIO, March 24, 2011)
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NEWLY RELEASED - HELPFUL RESOURCES
Accountable Anesthesia Organization to download a free copy of "The Role of Anesthesia in
Accountable
Accountable Care Organizations And Beyond: IT Strategies For 21st Century Healthcare – an
introduction to trends models and architecture for the next generation of care delivery.
ACOs How To Get There
There By H&HN
The ACO Learning Network Is Infused With Knowledge From The ACO Pilots, Which
Comprise A Wide-
Wide-Range Of Provider-
Provider-Types Implementing Shared Savings Around The
Country.
Country.
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MEDICAL HOME
Matching Fund For State Who Offer Medical Home Care Programs.
According to a March 18, 2011 report by the Health Resources and Services Administration
(HRSA):
57% of children in the United States have access to a medical home, and that children
without a medical home are:
• Nearly four times more likely to have unmet health care needs,
• Three times more likely to have unmet dental care needs and,
• Less likely to have had a preventive health care visit in the past year.
The federal government will match up to 90% of state funds for two years when they offer to
provide medical home models options for Medicaid enrollees with chronic conditions.
National Committee for Quality Assurance (NCQA) is the leading provider of recognition
programs with its Physician Practice Connections (PPC) recognition program. As of the end
of 2010, almost 7,700 clinicians at more than 1,500 sites across the United States had
received the organization's PPC-PCMH recognition. (Advance March 25, 2011)
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Tops
Patient Engagement, Diabetes, Medication Compliance, Strategic Content Are Tops On
PCMH List Of Needs And Goals.
A March patient-centered medical home (PCMH) survey by Promidian, a management
consulting firm, of 181 stakeholders, including physicians, medical directors, nurses, and
administrators and executives from medical group practices, health plans, pharmaceutical
companies, and employer groups found:
• Patient engagement in care, access to care, and a team approach to care are viewed as
the top three most important goals of a successful PCMH,
PCMH
• Diabetes, cardiovascular disease, asthma, obesity, and stroke top the list of priority
disease states to be attended to,
• Medication compliance is viewed as extremely important to the success of a PCMH,
• Most are highly interested in receiving strategic information products that target
maintaining accreditation (e.g., programs, tools and training).
(The Street, March 29, 2011)
Institute of Medicine - More Nurses could take on more of the primary care load.
California is one of 23 states that allow nurse practitioners
practitioners to provide selected primary care
without physician supervision. Six California regions have a shortage of primary care doctors
and as their health systems take steps to develop medical home models of care, nurse
practitioners are expected to play a greater role in leading teams and providing primary care
services. Last fall, an Institute of Medicine report called for an expansion in the scope of
service that nurse practitioners can deliver. The report found that health systems that
increased nurses' responsibilities generally provided "safe, high-quality primary care." (Fierce
Practice, March 30, 2011)
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research titled, "Referral and Consultation Communication Between Primary Care and
Specialist Physicians: Finding Common Ground" and funded by the Robert Wood Johnson
Foundation and published in the Archives of Internal Medicine. The results found:
• 69% of PCPs reported regularly – "always" or "most of the time" – sending a patient's
history and the reason for the referral to the specialist, but only 35% of specialists said
they regularly receive such information
• 80% of specialists said they regularly send consultation results to the referring PCPs, but
only 62% PCPs said they received such information
What improves communication, the study pointed out factors that can improve
communication between specialists and PCPS.
• Having adequate time to spend with patients was the most important factor to both groups
of providers,
• Practice supports for care management that included feedback reports on quality of care
for patients with chronic conditions and nurse monitoring of these patients.
• The use of health information technology (HIT) produced higher reports of receiving and
sending communications by specialists but not by PCPs.
Research compiled by MGMA, the Urban Institute and the American College of Physicians in
2009 indicates that with each NCQA certification level, the median cost for personnel and
information technology, per full-time-equivalent physician, progressively increases. The
research, funded by RWJF shows that costs per certification level add up to:
Level 1 -- $145,000 for support staff, $5,000 for IT (no EHR)
Level 2 -- $153,000 for support staff, $8,000 for IT
Level 3 -- $165,000 for support staff, $11,000 for IT
In most PCMH demonstrations, these costs were offset by management fees paid to the
practice for enrolled patients. (MGMA Blog, March 28, 2011)
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See recently released medical-home principals list of guidelines. (Modern Physician, March
17, 2011)
Other:
AAFM Patient-
Patient-Centered Medical Home Checklist
A PCMH Standards And Guidelines
HRSA Initiative For FGHS To Gain PCMH Recognition
HRSCMH Initiative Program Assistance Letter (Pal)
Intro To NCQA PCMH Recognition Program (Teleconference & Text)
NCQA 2011 Standards And Guidelines For PCMH Recognition
PCCDC “Patient Centered Medical
Medical Home: A How To Manual”
Safety Net Medical Home Initiative
The Connected Patient: Charting the Vital Signs of Remote
Remote Health Monitoring
The American College of Physicians Tool - Medical Home Builder
Institute of Medicine - The Future of Nursing: Leading Change, Advancing Health
Patient Centered Primary Care Collaborative – An excellent listing of free publications
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PHYSICIAN & PROFESSIONALS
Physicians Trying To Charge For Phone
Phone Calls Just Like Attorneys
Complete Children's Care in Lincoln, Neb., has told patients that a $20 "telephone care"
charge will apply to calls over five minutes that aren’t part of the appointment process or
follow up on a previous weeks visit. Two arguments for and against prevail:
• Attorneys have long charged their clients for phone calls without any argument.
• Telephone calls are already built in to the fee schedules for other physician services, such
as office visits, and therefore not separately billable for most government and commercial
insurers.
(Fierce Practice, March 13, 2011)
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CONSUMER
Consumers will increasingly demand online services, devices and
media choices to match the way they want to get their
healthcare. Social media is not high on the list as a way to get
healthcare
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Clearly, the trend is that patients want some measure of control, convenience and better
communication with their doctor. (Intuit, March 2, 2011)
Nurse staffed help lines was the preferred form of communication across all demographic
and ages:
• 72% said they would take advantage of a nurse help line if it was offered by their doctor,
• 55% would be interested in online advice from nurses.
(Health IT News, March 24, 2011)
Fitness Device Vendors Are Interfacing With Each Other To Unify Data
Some of the leading fitness device and application companies are working together to open
up their APIs and share their own data with each other.
othe This amalgam is bringing together
much of the same data that Google Health has promised to host. Wellness services
including Zeo, RunKeeper, FitBit, WiThings and Digifit are all sharing data now…we can
expect more of this in this sector. (Run Keeper, March 30, 2011)
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• Access educational materials about their conditions, and
• Request assistance and
• Caregivers to respond.
(Jackson, Sara. Use of Interactive Technology Boosts Patient Satisfaction, Fierce
Healthcare, March 9, 2011)
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OVERSIGHT & INFLUENCE
Home Health coming under fire for medical fraud;
fraud; telemedicine gaining
some traction and trying for new regulations…again.
REGULATORY
Crackdown On Home Health Fraud.
Effective April 1, 2011, Medicare beneficiaries, receiving home health services will have to
see a doctor 90 days before or 30 days after starting home health services for home health
agencies to get reimbursed. Services can be prescribed up to 60 days at a time and there are
no deductibles.
This crackdown is the result of Medicare home health costs have doubled to $19 billion in
2009, since 2002 and an increase in Medicare fraud during the same period. (Kaiser
Healthcare News, March 24, 2011)
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If you’ve read this far then we have been successful in giving you some value. Please
reciprocate and let me know your thoughts or if you don’t see something that you would like
to, then just drop a line to - jim@iag.co – thank you.
Jim Bloedau
Managing Partner
Information Advantage Group
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