Cooperating for better care.

Robert Whitcomb

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HCA news may presage good year for hospitals

 

That  the  huge  national hospital operator HCA has raised its earnings guidance for the fourth consecutive quarter suggests that the sector as a whole will have a very good year as demand  for hospital care  surges with aging Baby Boomers and insurance expansion under the Affordable Care Act.

Of course, everyone wonders what will happen if the U.S. Supreme Court whacks the ACA in a June ruling. Will the outlook for hospitals then rapidly darken?

 


Pressed by Feds, EHR vendors to waive sharing fees

Road_block

 

EPIC and other electronic health record vendors have agreed to waive record-sharing fees after the Feds warn them about “data blocking.”

The fees have long irritated hospital executives. Now it appears that all EHR vendors will agree to absorb providers’ usage costs in sharing patient records.

It’s another advance for the much desired  and long overdue full interoperability  of EHR systems

 


WSJ: Another way for hospitals to overcharge Medicare

 

This devastating investigative piece show how Medicare grossly overpays some hospitals for treating “complicated cases known as ‘cost outliers.”’

The WSJ explains:

“Medicare allows hospitals to collect for such patients based on the actual costs of treating them. But because hospitals don’t provide cost data until many months after patients are treated, the government has to estimate costs using a formula that relies heavily on list prices.

”When prices rise faster than actual costs, the government overpays. Medicare can seek to claw back overpayments when it gets fresher information about costs, but it rarely does, hospital records show.”

”A Wall Street Journal analysis of Medicare claims data and financial filings from medical facilities shows that many hospitals increased prices faster than costs rose, affecting outlier payments.”


Hope and anxiety from new Medicare law

 

Physicians are generally happy, or at least relieved, about the new Medicare payment reforms, which assure them of higher reimbursements from the Feds.

Some worry that the drive to federally standardize treatment-outcomes measurements will put undue  record-keeping pressure on them. And, yes, it’s often difficult to measure outcomes, and what about uncooperative patients?

But, of course, the drive to fee for value from fee for service is already well underway, if far too complicated because of the turgid role of the insurance companies.

The new law seems sure to speed the absorption of physician groups into hospital systems where  big back offices and economies of scale make it easier to  measure and record outcomes.  And it will be a big stimulus for expansion of Accountable Care Organizations and patient-centered medical homes.

 


Deluxe nursing homes with bad care

 

Even as many nursing homes offer luxury amenities, many of them fail quality standards.


Happy news for community health centers

The National Association of Community Health  Centers very happily reports:

“The Senate has passed H.R. 2, and the President has signed into law, the Medicare and CHIP Reauthorization Act of 2015. This follows House passage by a vote of 392-37 last month.  The law includes a 2 year extension of critical mandatory funding for Community Health Centers, as well as for the National Health Service Corps (NHSC) and the Teaching Health Centers Graduate Medical Education (THCGME) Program.

“’America’s Health Centers and the more than 23 million patients they serve are extremely grateful that this bipartisan legislation recognizes and invests in the health center system of care’ said Tom Van Coverden, President and CEO of the National Association of Community Health Centers (NACHC). ‘Health centers have been living under the uncertainty of the Primary Care Cliff, and, now that this legislation has passed,  our dedicated clinicians and staff can  get back to the daily work of providing high quality primary and preventive care to underserved patients and communities. In particular, health centers are grateful to the Congressional champions who led the fight to invest in the health center model and bring stability to federal funding.”’


A call for ‘good data hygiene’

 

poolside

 

This editorial in JAMA reflects on the growing need for “good data hygiene.” As it is, no one’s personal health data are safe from hackers or leaks caused by inattention or incompetence.


Ill health of poor imperils health of affluent

minnesota

Minneapolis, with some rich suburbs and many poor people, too.

Minnesota Health Commissioner Ed Ehlinger, M.D., has challenged his fellow state healthcare leaders to stop “’admiring the problem’ of health inequity — the troubling gap between the excellent health of Minnesota’s {more affluent} white majority and the poor health of {low-income} minorities” and do something about it.  And, the Minneapolis Star Tribune reports, he noted that the health of the middle-and-upper-income white majority can be jeopardized by the ill health of the poor.

He said, the paper paraphrased, ”that solutions go beyond medical treatment and health insurance coverage. Everything from affordable housing to education to workplace leave policies and fresh produce can influence a person’s well-being — so addressing gaps in health means addressing gaps in those areas as well.”

That’s what Cambridge Management has found in its community-health work, especially in the Pacific Northwest.

The paper, paraphrasing his remarks, said that “Getting the healthy white majority to care sufficiently about inequities will take work. In a system that has been described as ‘structural racism,’ the healthy people might be sympathetic, but also loathe to give up advantages that have ensured their superior health.”

Dr. Ehlinger told a state Health Department forum:  “In the societies with the biggest disparities, the people at the top are not as healthy.”

“We are affected by who serves our food, who takes care of people in the hospital, people in the nursing homes, people in our child care centers. They are increasingly people of color and people with lower incomes. Their health is going to have a direct impact on the health of the people they are working with.”


For a national framework for measuring Medicaid

 

This HealthAffairs blog entry notes that “despite {Medicaid’s} vital importance and nearly 50 years in existence, there is currently no comprehensive, standardized framework for measuring the quality of care provided to Medicaid patients.” That’s in large part because it’s designed and implemented on a state-by-state basis and most quality reporting is voluntary.

And “Without a standardized measurement framework, states have few ways to compare their program with others.”

So  The Partnership for Medicaid proposes creating such a framework, by:

  1. “Developing a succinct, common reporting set of quality measures. Reporting would be phased in, beginning with a limited number of measures to guarantee reporting is manageable for providers, plans, and states.
  1. “Completing the federal reporting infrastructure, much of which the Centers for Medicare & Medicaid Services has already developed.
  1. “Implementing federal incentives for states to report.
  1. “Requiring mandatory, meaningful reporting by all states soon thereafter.”

 

 

 


How public-health officials, hospitals should team up

 

“Driven by the increasingly shared vision of managing population health, officials for hospitals and public health departments are working together more closely,” notes Hospitals & Health Networks.

“These two types of health organizations do not have a tradition of working as true partners, but resources are available to aid in the process from such organizations as the Institute of Medicine, the Institute for Healthcare Improvement and the Robert Wood Johnson Foundation.”

This article also takes you to  11 recommendations stemming from 12 successful hospital-public health collaborations.

 


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