Cooperating for better care.

Robert Whitcomb

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Trump administration wants to ease regs for rural providers

“The Centers for Medicare and Medicaid Services (CMS) {has} released a vague rural health plan that vows to, among other things, advance telehealth and improve access to care through ‘provider engagement.’ But the most important line in the eight-page document, according to rural health advocates, says the federal government will ‘apply a rural lens to CMS programs and policies.”’

“That’s the most significant thing because that’s been the biggest issue for the past couple of decades,” Alan Morgan, CEO of the National Rural Health Association, told Governing. ”The [Feds] release a regulation, and nobody asked ‘what’s that going to mean for rural [areas]?'”

“This is the first time, according to Morgan, that CMS has said it will formally and consistently take into consideration how federal policies impact the nation’s smallest clinics and hospitals.”

To read the Governing article, please hit this link.

Readmission rates vary widely in bundled-payment program

FierceHealthcare reports:

“Participants in a new voluntary bundled payment model will have a lot of work to do to bring down high readmission rates for certain conditions.

But that won’t necessarily scare off prospective participants.

Analysis from Avalere Health found a wide variation of readmission rates among conditions covered under the Bundled Payments for Care Improvement (BPCI) Advanced model, which was announced by the Trump administration in January and will go into effect later this year.”

To read the article, please hit this link.

For a lean approach in joint replacements

Premier Inc. reports that hospitals have a lot of room in which to cut costs and improve efficiency in total joint-replacement procedures.

FierceHealthcare writes that Premier Inc. found significant variations in the price of medical devices and other supplies, “such as a $1,500 difference in the cost of knee implants between the highest and lowest performing hospitals and a $1,700 difference for hip implants.”

Perhaps most interestingly, Robin Czajka, R.N., service line vice president for cost at Premier,  told Fierce, in the news service’s words, that “hospitals that performed the best joint replacements also had lower operating room labor costs. High-performing facilities accounted for about $2,000 in OR labor spend, compared with $4,600 in lower-performing hospitals.”

And, “An operating room that follows a lean management style, or a systematic method for waste minimization, will be more efficient and ensure the number of people in the OR are those who are most needed, Czajka said.”

For instance,  Fierce  paraphrased Czajka as saying that a “lean approach can also reduce overuse of antibiotics—including pricey antibiotic bone cement—further reducing costs.”

To read the Premier report, please hit this link.

To read the Fierce article, please hit this link.

A struggling rural hospital’s success story

Read about how an innovative hospital executive turned a small Kansas town’s (Lakin) struggling hospital, Kearney County Hospital, into an institution that recruited enthusiastic young physicians, helped refugees and made money delivering babies.

From this Politico article:

“{Hospital} officials hired an innovative CEO who came up with a way to make their rural hospital appeal to talented young physicians who want to deliver babies in Third World countries. You can do that work right here in Kansas, Ben Anderson  {the new exec} told his new recruits, by serving immigrants and refugees. Once the new doctors arrived, Anderson applied for grants to upgrade the hospital’s equipment and fly in a specialist to see women with high-risk pregnancies. The skilled doctors and luxurious birthing suites attracted immigrants from neighboring Garden City and wealthier patients from out of town, and the baby boom they created padded the hospital’s bottom line. KCH went from delivering 187 babies in 2014 to 327 in 2017. In the span of five years, Anderson has turned the hospital into the county’s largest employer, with a profitable maternity ward that draws patients from as much as two hours away for its superior care. ‘I think it’s a huge success story,’ Kearny County Commissioner Shannon McCormick says. ‘When you’re alive and thriving and all your neighbors are not—you’re doing something good.”’

There are lessons here for troubled rural hospitals around America.

To read the piece, please hit this link.

Refusal by some states to expand Medicaid may play a role in hospital closings


FierceHealthcare looks at at how the refusal of rural, Republican-led state governments to expand Medicaid may be intensifying such problems as the wave of  hospital closings there. To read the piece, please hit this link.


Anthem to buy huge palliative-care provider


Indianapolis-based Anthem says it plans to buy, at a price it would not disclose, a large palliative-care provider.

The huge insurer agreed to buy Aspire Health,  what it called America’s”largest nonhospice community-based palliative care provider,” serving 25 states and Washington, D.C.

Anthem’s big move into nonhospital-based care follows similar steps  by rival insurers AetnaUnitedHealth and Humana. Humana, for example, has teamed  with investors to buy two large post-acute-care providers, including Kindred Healthcare and Curo Health Services.

To read more, please hit this link.

Setting bundled payments by condition, not procedure

Some experts are urging a far more holistic approach to bundled payments, saying  that they should be arranged by condition, not by procedure, with an “upstream” payment model that treats the whole patient.

To read an article about this in Med Page Today, please hit this link.

Healthcare price inflation speeding up


According to a report (PDF) from Altarum, healthcare prices grew 2.2  in April from a year earlier,  the highest rate since January 2012. Hospital price growth, the main culprit,  jumped 3.6 percent from a year earlier, mostly driven by a 4.6 percent price growth for Medicare patients and a 3.8 percent private-insurance price growth.

But Medicaid prices rose  only 1.6 percent.

More and more consumers are struggling to pay for the world’s most  expensive healthcare.

To read the Altarum report, please hit this link. To read FierceHealthcare’s take on the report, please hit this link.


Some pleasing deregulation for providers


The Department of Health & Human Services has announced more plans to give providers regulation relief.

FierceHealthcare reports:

“Long-term-care facilities, in particular, are likely to see their pile of regulatory paperwork shrink. One future proposed rule, among the nearly 150 in HHS’s regulatory list, includes the removal of ‘unnecessary, obsolete, or excessively burdensome’ requirements that such providers need to comply with to participate in Medicare and Medicaid.”

“{The department}  said the rule would ‘increase the ability of healthcare professionals to devote resources to improving resident care’ instead of paperwork. Hospitals and providers have been calling for paperwork reduction initiatives and appear to have found a friend in the Trump administration.

“HHS also plans to streamline the Medicare claims appeals process by fixing cross-references, unclear terms and definitions, and other errors that could be burdensome for providers and beneficiaries.”

The American Hospital Association seemed happy.

“We know that efficiencies can be found in many areas, such as streamlined quality reporting, administrative simplification, and less burdensome reporting on the use of electronic health records, among others,” Joanna Hiatt Kim, vice president of payment policy, told FierceHealthcare.

The new service went on: “Changes to Accountable Care Organizations are also expected. Some ACOs have been asking the agency for more time in non-financial risk-based contracts, instead of the six-year limit. However, the agency appears to be moving in the opposite direction, as one proposal on the Medicare Shared Savings Program includes ‘facilitating the transition to performance-based risk,’ signaling a greater push for risk-based arrangements.”’

To read more, please hit this link.



3 systems’ precision-medicine-program challenges

Health systems with precision-medicine programs have  faced  many challenges—including a lack of physician engagement with genomics and the need for new tech tools.

A study published  in the latest issue of Health Affairs looks at the precision-medicine efforts of three major health systems: Providence St. Joseph Health, Intermountain Healthcare and Stanford Health Care.

To read the Health Affairs abstract on the article, please hit this link.

To read Fiercehealthcare’s take on the  study, please hit this link.


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