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Year: 2017

The Four Things Keeping Hospital CEOs Awake at Night This Year (Hint: Donald Trump Isn’t One of Them)

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By PAUL KECKLEY

The Center for Medicare and Medicaid Innovation released a Request for Information (RFI) last week– “New Direction for the CMS Innovation Center.” It’s the latest chapter in the unfolding policy framework that will govern the health system for at least the next 3 years.

The RFI, which doubles down on value-based alternative payment models and consumer directed care, coupled with a proposed rule to cancel mandatory bundles by former HHS Secretary Price, the administration’s actions last week to weaken contraceptive coverage requirements in employer-sponsored health plans and Congress’ FY18 federal budget that include cuts in Medicare and Medicaid funding provide a sobering context for hospital and health system strategic planning. But hospital CEOs have adapted to the new normal from DC: uncertainty about the laws governing our health system is standard fare.

Last month, I interviewed 13 hospital CEO’s in preparation for their upcoming Board-Management strategic planning retreats. They lead organizations in 11 states with substantial differences in the scale, scope and strength of their operations and the dynamics in their markets. Two are academic medical centers, six are independent multi-hospital systems and five operate in multiple markets. When I asked “what’s keeping you awake at night” their answers were the same.

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Sorry. Health Care Reform Can’t Wait for Quality Measures to Be Perfect

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By BINDER, MARCOTTE, FILDES and THOMPSON

There’s a debate in the United States about whether the current measures of health care quality are adequate to support the movement away from fee-for-service toward value-based payment. Some providers advocate slowing or even halting payment reform efforts because they don’t believe that quality can be adequately measured to determine fair payment. Employers and other purchasers, however, strongly support the currently available quality measures used in payment reform efforts to reward higher-performing providers. So far, the Trump administration has not weighed in.

The four of us, leaders of organizations that represent large employers and other purchasers of health care, reject any delay in payment reform efforts for the following three reasons:

Even imperfect measurement and transparency accelerate quality improvement. One set of measures often questioned is the Agency for Healthcare Research and Quality’s (AHRQ) Patient Safety Indicators (PSIs) used by the Centers for Medicare and Medicaid Services (CMS) and others in value-based payment programs. These indicators measure surgical complications and errors in hospitals, which is critical given that one in four hospital admissions is estimated to result in an adverse event.

PSIs remain among the most evidence-based, well-tested, and validated quality measures available. CMS uses many in its value-based purchasing programs. Use and reporting of PSIs through AHRQ’s Medicare Patient Safety Monitoring System has measurably improved quality. For instance, CMS reported a reduction in inpatient venous thromboembolisms (VTEs) from 28,000 in 2010 to 16,000 in 2014, meaning that 12,000 fewer patients had potentially fatal blood clots in 2014.

In addition to using quality measures in payment programs and for quality improvement, making measures public is key to accelerating change. “If transparency were a medication, it would be a blockbuster,” concluded a multi-stakeholder roundtable convened by the National Patient Safety Foundation’s Lucian Leape Institute in 2015. The foundation’s report cited the Leapfrog Group’s first-ever reporting of early elective delivery rates by hospitals in 2010, which galvanized a cascade of efforts to curtail the problem and thus reduce maternal harms and neonatal intensive care unit (NICU) admissions. This was effective: The national mean of early elective deliveries declined from a rate of 17% to 2.8% in only five years.

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Building Better Metrics:  Immunizations and Asking the Right Question(s)

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By NIRAN AL-AGBA, MD

As policy experts cling to pay-for-performance (P4P) as an indicator of healthcare quality and shy away from fee-for-service, childhood immunization rates are being utilized as a benchmark.  At first glance, vaccinating children on time seems like a reasonable method to gauge how well a primary care physician does their job.  Unfortunately, the parental vaccine hesitancy trend is gaining in popularity.  Studies have shown when pediatricians are specifically trained to counsel parents on the value of immunizations, hesitancy does not change statistically. 

Washington State Law allows vaccine exemptions on the basis of religious, philosophical, or personal reasons; therefore, immunizations rates are considerably lower (85%) compared to states where exemptions rules are tighter.  Immunization rates are directly proportional to the narrow scope of state vaccine exemptions laws.  Immunization rates are used to rate the primary care physician despite the fact we have little influence on the outcome according to scientific studies.  Physicians practicing in states with a broad vaccine exemption laws is left with two choices:  refuse to see children who are not immunized in accordance with the CDC recommendations or accept low quality ratings when caring for children whose parents with beliefs that may differ from our own.   

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I’m 35 Years Old And I’m Realizing My Life May Be About to End. And I’m Panicking, Just a Little.

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By SCOTT RIDDLE

It’s been a while since I put a piece of writing in the public domain, but suddenly I have a lot to get off my chest, well my colon actually.

Just three weeks ago life was good. Correction. It was awesome. The newest edition to our family had arrived on Christmas Eve, joining his two sisters aged 5 and 3. A month later we were on a plane home to Sydney, having spent four great years working for Google in California. My beautiful wife had been working at a startup on NASA’s Moffett campus and was worried about finding something equally interesting in Australia, but she managed to land a very similar gig with an innovative logistics start-up in Sydney. We’d come back primarily to be closer to family, but also to pursue a dream of setting up a family farm in partnership with my parents — intended as a great place to bring up our three kids but also as a new sideline income stream. We’d spent every weekend scouring Sydney for areas that met our criteria (good schools, commutable, cost of land etc) and we were settling on Kurrajong in Sydney’s west. I was just getting into a training routine for the CitytoSurf run having done the Monteray Bay half marathon a few months prior.

I’m 35 years old.

On July 19th I went for what I thought would be a routine GP visit. In my mind it was primarily to re-establish a GP relationship in case my kids needed an urgent care visit (the practice is literally around the corner from our place). I’d also noticed a bit of unusual bleeding from, well, my back passage and very recently a change in bowel habit. I wasn’t alarmed by either of these symptoms but my GP was concerned enough to refer me for a colonoscopy. So began the roller coaster.

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AARP Caregiver Quality of Life Challenge Winners Announced!

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By CHELSEA POLANIECKI AND TIFFANY HSIUNG

Roughly one out of every three people in the United States serves as a caregiver for a chronically ill, disabled, or aging loved one at some point in their life*. Not only do most caregivers dedicate a significant amount of time to these duties, 

but they often also work full or part-time jobs to make ends meet. These stresses result in 40-70% of caregivers exhibiting clinically significant signs of depression*. Fortunately, there is an increasing focus on caregiver well being, and now, more than ever, innovation in caregiving has the opportunity to make real change and improve tens of thousands of lives.

The AARP Caregiver Quality of Life Challenge, supported by AARP, and administered by Catalyst @ Health 2.0 in partnership with Mad*Pow, aimed to find tech-enabled solutions designed to help caregivers identify as caregivers, find available resources to ease their burden, and connect with others who can build and strengthen their support systems.

The Challenge, launched at HxRefactored in June 2017, received over fifty applications, with solutions ranging from AI solutions to podcasts and mobile apps. Submitted solutions were judged by our panel of experts, and scored based on how innovative they were, their potential for scalability, the strength of their design, and the potential for impact in the caregiver community. Winners were announced live this morning at Health 2.0’s 11th Annual Fall Conference.
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CMS Should Play the Role of Virtual Group Matchmaker

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By MANU UPPAL and DAVID INTROCASO

In the 2018 proposed Medicare Access and CHIP Reauthorization Act’s (MACRA’s) rule, published earlier this year, HHS has again proposed to exclude two-thirds of physicians, or 900,000, from participation in the Merit-based Incentive Payment System (MIPS).  MIPS was created under 2015 MACRA legislation to incent financially Medicare physicians and other Medicare Part B clinicians to improve care quality and reduce Medicare spending growth.  HHS is choosing to exclude smaller-sized physician practices because, it is believed, MIPS reporting requirements place too high a burden on less resourced practices.  However, MACRA legislation includes a “virtual group” provision that allows for solo and small group practices to partner in meeting MIPS reporting requirements.  For technical reasons the Centers for Medicare and Medicaid Services (CMS) was delayed in implementing the provision.  The first year in which providers can participate in MIPS as a virtual group will be 2018.  Designed correctly, virtual groups offer substantial advantages that include greater MIPS participation, more competitiveness, higher financial reward and more opportunity for small practices to keep their independence.  

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Adapting Behavioral Health Integration to 21st Century Needs

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BY MANUEL CASTRO                       SPONSORED POST

At the start of my career, the standard of care for behavioral health integration was in-person, face-to-face interaction. As new ways to communicate have surfaced, the way we deliver care has also evolved. Today, both as a result of access but also now convenience, behavioral health treatment is often done virtually.

To keep on top of the trends, and in light of the access challenges inherent in our region, at Carolinas HealthCare System, we turned to technology to help alleviate these problems and reach more patients. Through a virtual care platform and telehealth services, patients from North and South Carolina can connect with a behavioral health provider from the comfort of home or during a visit with a primary care physician. By moving beyond the walls of the hospital and into the home and primary care setting, our dedicated team of behavioral health experts is able to help thousands of people access the quality behavioral health support they need.

I have always said that if we can save one life through this program, it is worthwhile. Two recent stories from our team prove to me that this approach is working:Continue reading…

Why Competition In the Politics Industry Is Failing America

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By DANNY STERN

Year after year, Congress fails to reach consensus on important issues, the electorate screams for change, and voters become more polarized along party lines and ideology. These struggles aren’t causes of America’s political malaise, says Michael E. Porter, co-chair of the U.S. Competitiveness Project at Harvard Business School; they’re symptoms of a much larger problem. U.S. “democracy” is a weak, uncompetitive industry controlled by a duopoly that pursues private interests at the expense of public good.

“To fix our political system, we must see politics as the major industry it has become, the major economic benefits it provides for its participants, and how today’s political competition is not serving the public interest,” as Porter explains in “Why Competition in the Politics Industry Is Failing America,” a just-released groundbreaking study co-authored with business leader and former CEO Katherine M. Gehl.

Experts in the benefits and drawbacks of competition in the private sector, Porter and Gehl describe the four fundamentals of a healthy political system:

  1. Practical and effective solutions to solve our nation’s important problems and expand opportunity
  2. Legislative action to advance those solutions
  3. A reasonably broad-based public consensus on policy
  4. Respect for the Constitution and the rights of all citizens

Measured by these success factors alone, America’s system has already failed. But Porter and Gehl are adamant in their belief that we can recover our former sense of bipartisanship and dynamism.

Read Porter’s and Gehl’s paper to learn more about their poignant perspective on our nation’s most urgent problems and how business, strategy and competition can help solve them.

Danny Stern is Managing Director of the Stern Strategy Group

Lessons From Massachusetts’ Failed Healthcare Cost Experiment

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By SOUMERAI, KOPPEL & BOLOTNIKOVA

Massachusetts passed a massive medical cost control bill in 2012, a “Hail Mary” effort to make health-care more affordable in the nation’s most expensive medical market. The problems of the Massachusetts’ law offer invaluable lessons for the nation’s health-care struggles.

Driven in part by a Boston Globe investigation that exposed the likely collusion of the Partners Healthcare hospital system (including several Harvard Medical School teaching hospitals) with Blue Cross/Blue Shield, the largest healthcare insurer in the state, the law marked the biggest health reform since Romneycare in 2006. While most agree Massachusetts needed cost controls, there’s no evidence that the 2012 law has accomplished its goal—and these same failed policies have been folded into the national Affordable Care Act.

Romneycare, Massachusetts’ universal health-care law, already lacked effective rules to control the rapid growth of state medical costs. That, paired with the Boston Globe’s exposure of the likely collusion between Partners Healthcare, the largest hospital system in New England, and Blue Cross Blue Shield to raise health care payments to hospitals and doctors by as much as 75 percent, led to passage of a hefty, 349-page cost-control law in 2012. The legislation included a dizzying number of committees, an uncoordinated “cost containment” process, and dubious quality-of-care policies, like “pay-for-performance,” a program that pays doctors bonuses for meeting certain quality standards, like measuring blood pressure. These incentives might make sense in economic theory, but have failed repeatedly in well controlled studies. They’ve even created perverse enticements, such as some doctors avoiding sicker patients. The cost control law also encouraged widespread use of expensive electronic health records, even though there’s no evidence that they save any money.

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Hi, I’m Rob. I’m a Recovering Doctor

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By ROB LAMBERTS, MD

Yeah, I know I used that line once before, but it’s a special day for me today.  Humor me.  Five years ago today I earned my last money from an insurance company.  Yep, today is my five year sobriety date.

Five years.

That was before the Affordable Care Act, before the Cubs won the World Series.  Before anyone knelt for the national anthem, and if they had, people would’ve probably not minded.  It was before the election of a reality TV star to our highest office, before “fake news” became a thing (there was plenty of it, but nobody called it that).  It was before half of the rock legends died, before Anthony Wiener went to jail, back when Hamilton was a guy nobody knew much about who was on the 10 dollar bill, when the world wasn’t quite this warm, when Oprah hated me.  Actually she still does.  I’m not sure why.

I left my old practice because of “irreconcilable differences” with my ex-partners.  Instead of going to the VA, joining another practice, or moving to New Zealand, I started a different kind of practice.  My Yoda, Dave Chase (who wrote a book that you MUST read) told me about “Direct Primary Care,” where doctors don’t charge a lot, but are able to see a lot of people and give good care because they are paid by their patients.  It made sense to me.  There were a few folks doing it, and I talked to a couple (I’m looking at you, Ryan) who made it sound possible.

So I did it.  I dumped all insurance and started charging people a flat monthly fee.  People were skeptical and only my most loyal patients followed me (about 200).  It took a while, but we figured out how to make it work, and my patients figured out that this was the best experience they ever had in healthcare.

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