Cooperating for better care.

Robert Whitcomb

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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.

Technology to ‘save’ primary care


An article in NEJM Catalyst discusses how to use technology to “save primary care”. Among the authors’ remarks:

“{T}he provider would make the determination as to whether the patient could be treated virtually, would need to be evaluated face-to-face in an acute care environment (e.g., an urgent care center or emergency department), or could wait for a scheduled appointment with a generalist or specialist. …

“When we consider the current system, in which robust evidence and clinical decision support have been embedded into provider workflows, we can see that guideline compliance has increased dramatically, resource utilization and costs have decreased substantially, and, most importantly, patient outcomes have improved significantly.

“If we can take it a few steps further by (1) employing wearables and other devices (e.g., FitBit, Apple Watch, Amazon Echo) to passively collect waveform vital sign data; (2) allowing data science, machine learning, and prescriptive intelligence to monitor patients for physiologic distress well before it is symptomatic and even manage a portion of primary care; and (3) using providers sparingly and respectfully when human judgment or specialty or procedural care is needed, we will have done what every other industry has — we will have used technology to make our product better, faster, and cheaper. ”

To read the piece, please hit this link.

Esprit de corps essential for successful healthcare organizations


Esprit de corps is essential for well-functioning healthcare institutions, says Stephen Swensen, M.D., medical director for professionalism and peer support at Intermountain Healthcare. He is also a senior fellow of the Institute for Healthcare Improvement, where he co-leads their Joy in Work Initiative.

A NEJM Catalyst article (which includes a video link) about his talk includes this:

“Healthcare systems need esprit de corps to achieve high performance. But, as Swensen notes, ‘Most of you already knew this.’ He references a recent NEJM Catalyst survey, where respondents said the biggest barriers to high performance are unaligned goals and weak culture. Social capital, esprit de corps, helps us connect, align, and build a culture that focuses on the meaning and purpose of caring for patients and their families in the communities that we have the privilege of serving.”

“He references a recent NEJM Catalyst survey, where respondents said the biggest barriers to high performance are unaligned goals and weak culture. ‘Social capital, esprit de corps, helps us connect, align, and build a culture that focuses on the meaning and purpose of caring for patients and their families in the communities that we have the privilege of serving,”’ he said.

He notes that a third of the $3.2 trillion spent on U.S. health care is excess capacity, according to the National Academy of Medicine — approximately $1 trillion in waste every year.

“Six categories of waste build this excess capacity, and healthcare systems own the first three: overtreatment, failures of care delivery, and failures of care coordination. The ramifications of that waste, beyond money, are staggering. It hurts patients, the care team, and esprit de corps. ‘On a more positive note,’ he says, ‘this $1 trillion of waste, the excess capacity in this glass of water, is the funding opportunity for co-creating quality that will both address these defects of care and rebuild esprit de corps.”’

“How do you measure esprit de corps? By counting pronouns. When former Labor Secretary Robert Reich visited organizations to assess their vitality, he listened to the people doing the real work and counted how many times they used the pronouns “we, us  and ours.’ He also counted ‘they’ and ‘them.’ The organizations that used first-person pronouns were set up to thrive; the ones that used third person were set up for mediocrity. ‘We need to shift to the right pronouns, to have it reflect our engagement and our fulfillment in our purpose of the work we do.’

To read and hear Dr. Swensen’s remarks, please hit this link.

CMS chief says it’s time for ‘next step’ for ACO’s


FierceHealthcare reported:

“In a webinar with the Accountable Care Learning Collaborative (ACLC) on Monday, Centers for Medicare & Medicaid Services (CMS) Administrator Seema Verma reiterated that it’s ‘time to take the next step’ in Accountable Care Organizations (ACOs).\

She argued two-sided risk models lead to better outcomes and lower costs, but 82% of ACOs still haven’t made the transition. CMS wants to force those remaining ACOs to switch with a new rule that would limit upside-only models to just two years. ”

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

Roundtable discussion on physician burnout


This is from an article in  NEJM Catalyst about a round-table discussion about possible solutions for physician burnout.

“Like the quality movement that has transformed health care over the past decade, solving the problem of physician burnout is a process, not a simple set of one-time fixes or action items. Think improving workflow, communication, and culture. A proper diagnosis is essential to a cure. Above all, engaged leadership is crucial to reducing burnout.

These were the takeaways from an extraordinary discussion at an NEJM Catalyst in-person roundtable, ‘Seeking Solutions to Physician Burnout,’ which brought together experts with different perspectives on this pressing issue: a medical group CEO, a chief wellness officer and leading researcher on burnout, a psychologist who created the leading survey instrument, and a consultant and executive coach for physicians and physician organizations. Sponsored by IBM Watson Health, NEJM Catalyst editors moderated the discussion, supported by survey results of the NEJM Catalyst Insights Council that point the way toward solutions to combat burnout and its causes.”

To read the discussion, please hit this link.



The personas needed for leaders of value-based care


Robert Pottharst, writing in NEJM Catalyst, discusses the personas that healthcare organizations need to move successfully into value-based care. He is chief operating officer of Cityblock Health and former  vice president for strategy and execution for Kaiser Permanente.

He identifies the key personas as:

Community connectors

Coordinated care champions

Trust-based Dyads.

Value evangelists

He concludes his essay:

‘The deliberate nurturing of specific types of leadership personas seems to be a critical factor in the successful leadership of value-based care organizations such as Kaiser Permanente and CareMore Health. The managers and clinicians who will be successful in guiding their organizations and this industry through the transformation to value-based care may consider emulating similar traits, capabilities and mind-sets. Moreover, healthcare organizations also may seek to emulate these personas when creating and filling key leadership roles. These leadership personas represent the types of magnetic leaders that young, aspiring future leaders can work with and learn from as they build their own careers.

Looking ahead, the Community Connectors, Coordinated Care Champions, Trust-based Dyads, and Value Evangelists will serve as important examples of the types of leaders who will enable organizations to succeed in a value-driven healthcare industry.”

To read his essay, please hit this link.

Study: Right kind of EHR alert might reduce complications and cut costs


From an article in FierceHealthcare:

“When physicians get the right kind of alert in an electronic health record—and actually follow its recommendation—it could result in fewer complications and lower costs among hospitalized patients, according to a new study.

Published in the American Journal of Managed Care, researchers from Cedars-Sinai Medical Center and Optum Advisory Services teamed up to examine alerts that popped up on physician computer screens inside their EHR {electronic health record} system when their care instructions deviated from evidence-based guidelines.

Those alerts were based on the ‘Choosing Wisely’ initiative in which different specialties have identified common tests and procedures in their respective areas of expertise that may not benefit patients and should be avoided.”

To read the whole article, please hit this link.

Hospitals start to address their energy-hog problem


For Kaiser Heath News

Hospitals are energy hogs.

With their 24/7 lighting, heating and water needs, they use up to five times more energy than a fancy hotel.

Executives at some systems view their facilities like hotel managers, adding amenities, upscale new lobbies and larger parking garages in an effort to attract patients and increase revenue. But some hospitals are revamping with a different goal in mind: becoming more energy-efficient, which can also boost the bottom line.

“We’re saving $1 [million] to $3 million a year in hard cash,” said Jeff Thompson, the former CEO of Gundersen Health System in La Crosse, Wis., the first hospital system in the U.S. to produce more energy than it consumed back in 2014. As an added benefit, he said, “we’re polluting a lot less.”

The health care sector — one of the nation’s largest industries — is responsible for nearly 10 percent of all greenhouse gas emissions — hundreds of millions of tons worth of carbon each year. Hospitals make up more than one-third of those emissions, according to a paper by researchers at Northeastern University and Yale.

Increasingly, though, health systems are paying attention:

  • Gundersen Health System in Wisconsin employs wind, wood chips, landfill-produced methane gas — and even cow manure — to generate power, reporting more than a 95 percent drop in its emissions of carbon monoxide, particulate matter and mercury from 2008 to 2016.
  • Boston Medical Center analyzed its hospital for duplicative and underused space, then downsized while increasing patient capacity. Among other changes, it now has a gas-fired 2-megawatt cogeneration plant that traps and reuses heat, saving money and emissions, while supplying 41 percent of the hospital’s needs and acting as a backup for essential services if the municipal power grid goes out.
  • Theda Clark Medical Center in Wisconsin is saving nearly $800,000 a year — 30 percent of its energy costs — after making changes that included retrofitting lights, insulating pipes, taking the lights out of vending machines and turning off air exchangers in parts of its building after hours.
  • Kaiser Permanente aims to be “carbon-neutral” by 2020, mainly by incorporating solar energy at up to 100 of its hospitals and other facilities. One already in use — at its Richmond (Calif.) Medical Center — is credited with reducing electric bills by about $140,000 a year. (Kaiser Health News is not affiliated with Kaiser Permanente.)

While the environmental benefits are important, “what I’ve seen over the years is cost reductions are the prime motivator,” said Patrick Kallerman, research manager at the Bay Area Council Economic Institute, which released a report this spring outlining ways the hospital industry can help states such as California reach environmental goals by becoming more efficient.

Some of its recommendations are simple: replacing old lighting and windows. Others are more complex: powering down heating and cooling in areas not being used and updating ventilation standards first set back in Florence Nightingale’s day. Such tight standards “might not be necessary,” Kallerman said. Loosening them could help save money and energy.

When Bob Biggio was hired in 2011 to oversee Boston Medical Center’s facilities, hospital leaders were about to launch a broad redesign. Yet the hospital was also facing serious financial struggles. He put the move on hold while analyzing how the hospital was using its existing space, looking for unused or duplicative areas.

“My first impression with data I had gathered was our campus was about 400,000 square feet bigger than it needed to be, said Biggio. “A square foot you never have to build is most efficient of all.”

The new design is smaller but more efficient, handling 20 percent higher patient volume and eliminating the need for ambulance transportation between far-flung areas of the campus. It also cut power consumption by 42 percent from a 2011 baseline.

While the hospital sunk a lot of money into the renovation, the center was able to sell off some of its land to help offset the costs, leading to about a five-year return on investment, Biggio said.

“We are a safety-net hospital with a large Medicaid population,” he said. “So this is the last place people expect to see the type of investments and progress we’ve made.”

But how to sell that in the C-suite?

The environmental argument wasn’t how Thompson convinced executives at Gundersen.

“At no point did I mention climate change or polar bears,” said Thompson.

Instead, he focused on the organization’s mission to improve health — and the potential cost savings.

“There are multiple examples — at Gundersen and other places — where, if we’re thoughtful, we can improve the local economy, lower the cost of health care and decrease the pollution that is making people sick,” he said.

But hospitals’ energy efficiency efforts vary, with only about 10 percent attempting changes as dramatic as those done at Gundersen, estimated Alex Thorpe, a hospital energy expert at Optum Advisory Services, a consulting firm owned by UnitedHealth Group.

“About 50 percent are in the middle,” he added, perhaps because these investments are weighed against other capital needs.

“If you have a well-known doctor that wants a new cutting-edge piece of equipment, then it can be hard to make the business case [for investing in alternative energy],” said Thorpe.

Of the more than 5,000 hospitals in the country, about 1,100 are members of Practice Greenhealth, a nonprofit that promotes environmental stewardship. Fewer than 300 hospitals qualify as Energy Star facilities, an Environmental Protection Agency program that recognizes buildings that rank in the top quartile for energy conservation among their peers.

Greenhealth estimates its members average about a million dollars a year in savings, but it all depends what steps they take.

There are modest savings from such things as reducing the heating and air conditioning in operating rooms during hours they are not in use, with median annual cost savings of $45,398, a report from the group notes. Other energy reduction efforts net another median $53,599 in annual savings, while swapping older lighting for new LED bulbs in operating rooms saves another $3,329.

Individually, those savings are not even rounding errors in most hospitals’ total expenses, which are measured in the millions of dollars.

Still, within facility expenses, energy use accounts for 51 percent of spending, so even modest cuts are “significant,” said Kara Brooks, sustainability program manager for the American Society for Healthcare Engineering.

Ultimately, that may affect what hospitals charge insurers and patients.

“If hospitals can lower peak demand through energy efficiency efforts, that will directly impact their pricing,” said Thorpe.

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