Cooperating for better care.

Robert Whitcomb

Author Archives

Safety-net providers leading disruptive innovation

An NEJM Catalyst article and video  starring Frederick Cerise, M.D., president and CEO of Parkland Health & Hospital System, in Dallas, describes how safety-net providers are leading some disruptive innovations.

Among the remarks:

“‘The pressures of the system and the opportunities line up in a way to promote an approach to care that has been long advocated by health care policymakers,’ Cerise says. He notes how in the 1990s, Clayton Christianson {of Harvard Business School} described a model of disruptive innovation characterized by transformative changes that are lower tech, simpler, cheaper, and more convenient. These disruptive innovations are not pursued by mainstream firms focused on advancing newer technologies, but rather by those targeting a market less interesting to leading companies — in this case, the uninsured. Safety-net providers tend to focus on populations with basic needs struggling to be met.”

To read the article, please hit this link.

CMS sets plan to cut regulations

FierceHealthcare reported Sept. 17:

“CMS took the latest step in its Patients over Paperwork initiative on Monday, issuing a proposed rule that would eliminate or update a slew of regulations deemed ‘unnecessary, obsolete or excessively burdensome’ on providers.

“Should  the rule be finalized, the Centers for Medicare & Medicaid Services estimates that it would save providers $1.12 billion each year and eliminate millions of hours in administrative time. Through 2021, CMS projects $5.2 billion in total savings and 53 million hours of administrative burden eliminated.”

“Much of the rule focuses on streamlining CMS’s conditions of participation and conditions for coverage, which the agency says will allow providers to operate more fluidly and efficiently without impacting patient safety and care quality. Some of the key changes the rule proposes include:

  • “Allowing health systems to use an integrated quality assessment and improvement platform across all their member hospitals.
  • “Creating a simpler process for providers to order portable X-ray machines and updating the requirements for portable X-ray technologists.
  • “Easing requirements for hospitals and ambulatory surgery centers for conducting physicals and collecting patient histories ahead of procedures.”


To read the full article, please hit this link.

Fraud and abuse laws might undermine value-based care

In an NEJM Catalyst essay, Carmel Schachar, MPH, discusses whether fraud and abuse laws are suppressing value-based care. She concludes:

“To realize the true potential of value-based care, we must update the underlying assumptions in our fraud and abuse regulatory system. Broadly applying fraud and abuse regulations to all delivery models and only carving out limited exceptions makes no sense when we are trying to encourage innovative healthcare delivery structures. We should consider adopting the rule that so long as a healthcare delivery and finance structure is value-based care and not fee-for-service, it should be exempt from fraud and abuse laws, such as the Stark Law, that seek to penalize overutilization.”

To read her essay, please hit this link.


Proposed changes in Medicare reimbursement


Physicians Practice reports:

“CMS has proposed several new changes that can significantly affect physicians, clinicians, and their Medicare reimbursement. CMS reported from data collected in 2017 that 91 percent of physicians and clinicians who had to participate in MIPS did.

“This 2019 proposed rule for The Medicare Access and CHIP Reauthorization Act (MACRA)/Merit-based Incentive Payment System (MIPS) for the 2019 performance period makes it more difficult in some aspects for physicians and clinicians to comply, while other changes are actually going to make it easier. For example, those individuals, groups, or virtual groups that do not fully understand these potential changes—and prepare for them—can lose as much as 7 percent of their Medicare reimbursement in 2021, a reduction that could crush most medical practices.”

To read the article, please hit this link.

CMS said to understate ACO savings


FierceHealthcare reports:

“The Trump administration wants to make big changes to the way Accountable Care Organizations (ACOs) participate in the Medicare Shared Savings Program (MSSP). But that policy shift could be rooted in flawed data, according to a new report from the National Association of ACOs (NAACOs).

The Centers for Medicare & Medicaid Services (CMS) has said MSSP ACOs produced net savings of $954 million between 2013 and 2015. NAACOs, by contrast, says those same organizations saved $1.84 billion—nearly twice that amount.

NAACOs said its estimate is more accurate because it was calculated using a difference-in-difference regression analysis. This methodology compared beneficiary spending in the program to beneficiaries that weren’t assigned to an ACO.”

To read the whole article, please hit this link.


An assessment tool for measuring the health of healthcare workplaces


Med Page Today reports:

“According to the American Association of Critical-Care Nurses (AACN) {a good working environment} is a place where healthcare professionals can make their optimal contribution. For almost a decade, critical-care nurses have been able to evaluate the health of their work environment with the association’s online assessment tool based on its Healthy Work Environment standards.

“Now a new study finds that the tool has applications beyond critical care, and is effective for assessing the health of the work environment for interprofessional patient care teams throughout a hospital’s patient care settings.

“‘Although AACN’s assessment tool has been used primarily among acute and critical-care nurses, our findings support consideration of wider use in multiple healthcare settings’  said the study’s principal investigator, Jean Anne Connor, PhD, RN, CPNP, director of nursing research, cardiovascular, and critical care patient services at Boston Children’s Hospital. ‘Clinical leaders understand that to safeguard the quality of patient care, attention must be focused on the performance of healthcare teams.”‘

“The assessment tool is an 18-question survey designed to help organizations or departments identify areas for improvement. It assists in measuring the health of a work environment against AACN’s six Healthy Work Environment standards:

  • Skilled communication
  • True collaboration
  • Effective decision-making
  • Appropriate staffing
  • Meaningful recognition
  • Authentic leadership

“The study, published in the American Journal of Critical Care, reports the results of a two-phase administration of the tool to 2,621 patient-care employees at Boston Children’s Hospital.”

To read the full Med Page article, please hit this link.

Successful medicine is now all about teams

Harvard Business School Prof. Michael Porter writes in a NEJM Catalyst piece headlined “What 21st Century Health Care Should Learn From 20th Century Business”:

“{The} variability in patients will always persist, but what has disappeared is the ability of any individual physician to deliver excellent care on his/her own. In today’s sophisticated medicine, the patient needs a team. The ability to personalize care lies in the ability of experienced groups of clinicians working together in treating patients with similar conditions to understand how to deal with individual differences. An IPU {Integrated Practice Unit} team is far better equipped to deal with exceptional cases and deliver personalized care than the traditional model — just as SBUs {Strategic Business Units} were better able to respond to their customer needs for their product than traditional functional structures. Health care needs real teams and real IPUs that are dedicated to meeting the needs of particular groups of patients, with the same focus that SBUs allow in meeting the needs of their customers for their product.”

To read the piece, please hit this link.

Some big providers launch nonprofit generic-drug company


Intermountain Healthcare’s headquarters in Salt Lake City.

FierceHealthcare reports:

“Some of the largest providers in the U.S. have officially joined forces to launch a nonprofit generic drug company.

Civica Rx was formally established Thursday after it first announced in January. The idea, which was spearheaded by Intermountain Healthcare, drew plenty of interest from hospitals and health systems; more than 120 healthcare organizations—including one-third of U.S. hospitals—have signed on.

The company’s initial governance will include seven health systems, each of which will contribute a member to the board: Intermountain, Catholic Health Initiatives, Mayo Clinic, Trinity Health, SSM Health, HCA Healthcare and Providence St. Joseph Health.”

To read the article, please hit this link.

Future physician supply amidst the growing ranks of NP’s and PA’s


An article in NEJM Catalyst looks at future  physician supply in relation to increased use of nurse practitioners and physician assistants.

The writers conclude:

“It is unlikely that the physician supply will grow more rapidly than we project: the AAMC projects even slower growth, the number of GME slots is constrained, and even an immediate expansion of medical school capacity and training opportunities wouldn’t substantially affect the physician supply for many years. Growth in the NP and PA workforces is more uncertain. Although shorter, more flexible training requirements for these providers have facilitated an unprecedented increase in new entrants, growth rates could fall if demand for nonphysician providers is lower than anticipated and job-market prospects worsen. Major changes are unlikely, however, given the expected increases in demand for care, growing use of team-based and interprofessional practice, and the fact that NPs disproportionately serve rural and underserved populations, whose needs would otherwise go unmet.”

To read read the article, please hit this link.

3 congressmen ask for study of hospital consolidation and higher costs

Three Republican congressmen have written to the Medicare Payment Advisory Commission (MedPAC) to express  concern about whether hospital consolidation raises costs for Medicare beneficiaries. They asked the commission to begin researching the matter.

The 340B program, in particular, they said,  ”appears to be having an unintended secondary effect in encouraging consolidation.”

“Bipartisan concern over the degree to which Medicare payment policy may be accelerating hospital consolidation and negatively impacting the Medicare program has been present in Congress for some time,” wrote Reps. Greg Walden, R-Ore., Michael C. Burgess, M.D., R-Texas, and Gregg Harper, R-Miss., in the letter to MedPAC (PDF).

The legislators were worried about more than just hospitals buying up other hospitals. They also said they’re worried about hospitals buying up so many physician groups, which many experts say is driven by federal payment policies.

FierceHealthcare says that some reports have found” that consolidation can increase costs by as much as 20 percent—and one particularly concerning study found that merging hospitals had 40 percent higher prices than nonmerging hospitals.”

To read the Fierce article on this, please hit this link.

Page 1 of 358123...Last

Contact Info

(617) 230-4965

Wellesley, Mass