Cooperating for better care.

Robert Whitcomb

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Saving safety-net hospitals in the ACA age

March 16, 2015by Robert Whitcomb in Uncategorized tagged , ,

 

This piece in HealthAffairs looks at the future of safety-net hospitals. 

“N}national, state, and local government agencies historically have provided supplemental funding to these systems to offset unreimbursed and under-reimbursed care. Under the Affordable Care Act, however, that is changing. With the expectation that most people will be insured under the new law, policy makers have planned to reduce much of this supplemental funding. In this view, safety-net systems will either become financially independent or close.”

The authors write: “Our recent study of eight safety-net hospital systems indicates that while system redesign is needed to meet the demands of the current healthcare environment, the association between strategic system redesign and operating margins is weak. Critical additional factors affecting the safety-net systems’ operating margins are their business strategies and their competitive positions in local markets.”

 

U.S. cancer care looks weak compared to Europe’s

March 16, 2015by Robert Whitcomb in Uncategorized

 

U.S. cancer care looks pretty unimpressive compared to Western Europe’s. America spends more and get worse outcomes.

Data may suggest narrowing of ethnic disparities

March 16, 2015by Robert Whitcomb in Uncategorized tagged , ,

 

A report in The New England Journal of Medicine suggests that hospital may be making more progress than many had believed in reducing disparities among minorities in healthcare.

Between 2005 and 2010, disparities in care between white  and black patients fell for 13 of the 17 Centers for Medicare & Medicaid Services inpatient process measures. Those between white and Hispanics fell for 14 of the measures.

“But don’t get too excited,” says Hospitals & Health Networks. ”The results are not conclusive evidence that actual care is improving, says Marilyn Lynk, director of operations for Adventist HealthCare’s Center for Health Equity and Wellness. Outcomes measures would offer a better representation, and history indicates that improvement is still needed in reducing disparities found in outcomes data, Lynk says. There have been general findings that minorities are less than satisfied regarding communication with providers. It will vary widely by hospital, she says.”

”Lynk suggests that hospitals study their own data for signs of disparities in their care, a job that should be getting easier with the use of electronic health records.”

 

Greedy EHR vendors said to hold data ‘hostage’

March 16, 2015by Robert Whitcomb in Uncategorized tagged , ,

 

Niam Yaraghi, of the Brookings Institution, denounces EHR vendors:

He notes that the “the next step forward {in pushing EHR’s} is to connect these electronic silos together so that physicians can share their patients’ records. The billions of dollars in federal spending will only have any tangible benefit if this is done successfully. EHR vendors have taken patient data hostage and are not willing to release it unless they receive a big ransom. They typically claim that technical problems limit the interoperability of their products. This prevents physicians from sharing their patient records with other doctors. This is like T-Mobile claiming that its users cannot make calls to AT&T customers. The claimed interoperability limitation does not end here. The vendors are proposing hefty charges to allow data sharing between their own customers.”

 

Social-service agency’s woes may have wider lessons

March 16, 2015by Robert Whitcomb in Uncategorized tagged ,

 

Capital New York reports on the downfall of  Federation and Employment Guidance Services  amid a $19 million revenue shortfall. There may be lessons for other nonprofits.

“{T}he ruinous series of decisions that wrecked FEGS—a health and human services nonprofit that has long been one of New York’s largest, most well-regarded social services organizations—was years in the making, reports Capital New York.”

This was an agency “engaged in risky long-term behavior and slowly drowning in debt, seeking capital financing from an ever-widening array of sources to expand its operations and interests even as those operations failed to produce profit.

“As that behavior was intensifying, city and state governments continued to provide FEGS {with} grants and finance its debt, lending the organization money while it approached collapse.”

“The potential implications of the nonprofit’s collapse aren’t just financial and logistical—FEGS is responsible for running hundreds of city and state social-service programs—but also political, raising questions about how a host of well-connected directors, regulatory entities and elected officials failed to see the disaster coming.”

Colo. co-op grabs big market share, but….

March 16, 2015by Robert Whitcomb in Uncategorized tagged ,

 

The Denver Post reports that “aggressive price cut by Colorado’s nonprofit health insurance cooperative this year led to it capturing the biggest market share of the state exchange….”

But, “A similar co-op serving Iowa and Nebraska was shut down by regulators in January after heavy losses, and the Colorado HealthOP’s losses were even greater when compared to its remaining funds, according to one analysis report.”

“In the second year of the state exchanges, the Colorado edition of the federally created {under the Affordable Care Act} Consumer Operated and Oriented Plans, or CO-OPs, upended the local marketplace by undercutting other plans’ premiums and pushing down federal subsidies available on the exchange.

“Colorado HealthOP, one of 23 CO-OPs nationwide, reduced premiums on its middle-tier, or silver, plans by an average of 10 percent. Its customer count shot up from about 14,200 in late 2014 to about 75,000 this enrollment period.”

If such co-ops can get their pricing right, they could surge around America, acting as a variant of the “public option” that polls suggested  that most Americans wanted  during the debate over the Affordable Care Act but insurance company’ lobbyists stopped the Obama administration and the then-Democratic-controlled Congress from including in the ACA.

Video: Healthcare costs and the future of the ACA

March 16, 2015by Robert Whitcomb in Uncategorized tagged ,

 

 

Video: Avik Roy, of the conservative Manhattan Institute, looks at the slowing of some healthcare costs and the future of the Affordable Care Act.

Nicholas Covino: Push innovation in psychologists’ training

March 15, 2015by Robert Whitcomb in Uncategorized tagged , ,

NEWTON, Mass.

We’ve heard the term “innovation” a lot lately. Boston’s Innovation District is booming. Life sciences and biotechnology companies throughout New England are creating innovative approaches to solve some of medicine’s most challenging problems. Companies across New England have “Chief Innovation Officers.”

The universities and colleges around New England are innovating daily. The tools, technology and research developed by these institutions will impact the world for generations to come. At the Massachusetts School of Professional Psychology (which is changing its name to William James College in May 2015) our faculty and staff also know of the importance of innovation. We practice a craft with more than 125 years of success, but our future will be bleak if we do not constantly think of new ways to prevent and treat mental illness.

Mental illness is a problem  that many people don’t want to discuss, yet it affects all of us. Today, one in four adults and one in five children have a diagnosable mental illness, and one of two Americans will suffer from mental illness at some point in their lives. Suicide will claim one American every 13 minutes, and 12 times that number will make an attempt each day. When this problem strikes your family, and it is highly likely to, you might be among the 70% of parents in this country who cannot obtain care for your child.

These statistics are shocking, yet mental illness is a subject we talk about only after a terrible tragedy, or an act of violence. This should not be the case, as talking about and treating mental illness leads to tangible results. A good deal of research supports the efficacy of #psychotherapy. Up to 80 percent of the time, people who avail themselves of treatment will improve.

 

That’s why our students spend about half of their time at William James College working in the field, learning their discipline from experienced professionals and encouraging people to open up about something that society has subtly suggested they should not talk about. However, with 50 percent of Americans likely to develop a mental illness in their lifetimes, we need to do more to start this conversation.

Mental-health professionals need to deliver information and care through electronic means. This involves embracing the latest tools and technologies available to them, and supplementing these technologies with the development of meaningful relationships with each patient. Technology alone cannot end the stigma associated with mental illness, but it can help to abate it.

At the same time, psychologists cannot be the only ones addressing mental illness. They are part of a multifaceted system. Teachers, medical practitioners and attorneys whose work touches the psychosocial lives of their students, patients and clients need to be educated to both attend to and intervene properly around emotional and behavioral issues that they see.

The future of mental-healthcare is not just in educating mental-health practitioners, but allied professionals to improve the quality of life of those affected by mental illness. These professionals are often the “first-responders” in a mental-health emergency. If they spot signs of mental illness early on, they can help the person suffering from mental illness to address the problems they face before they get out of control.

Conversations about mental illness should also be sensitive to our increasingly multicultural world. Students must be culturally informed and sensitive. Our role as innovators involves thinking about ways to meet the prevention and treatment needs of diverse populations. At William James College, faculty lead immersion trips to Haiti, Costa Rica and Ecuador each year to help students understand the mores, culture and healthcare system of diverse people. To talk about mental illness effectively, it is imperative to keep the diversity of the target audience in mind at all times.

Embracing experiential learning, having constant conversations about mental illness, educating colleagues in other professions, engaging technology, and encouraging a diverse approach to psychology education are concepts that our field has been slow to embrace. As innovators, we must champion these ideas, while also activating them.

I hope we can embrace the spirit of innovation and practical psychology that William James championed. William James was the founder of American psychology. He was an educator’s educator, one of the century’s greatest philosophers whose prolific writings and prodigious mentorship profoundly influenced the practice of applied psychology, experiential education, sociology and race relations in this country.

I think James would agree that psychology is about analyzing the past in order to look forward to a brighter future. If we all focus on innovating our field, our future conversations will revolve less around problems, and more on solutions.

Nicholas Covino is president of the Massachusetts School of Professional Psychology,  in Newton, Mass., which will be renamed William James College in May 2015. This piece originated on the Web site of the New England Board of Higher Education (#nebhe.org).

Physicians and the cost of hospital care

March 13, 2015by Robert Whitcomb in Uncategorized

 

This article in the Annals of Surgery asserts that:

“Few physicians can influence hospital overhead. Worse, most physicians lack a quick and reliable means to assess how their hospital accounting systems allocate specific costs to individual patients. To be successful, physicians must be given ready access to enhanced information systems, increased education, and more sophisticated economic data to make optimal decisions regarding appropriate practice modifications. Along with enhanced information, the physician of tomorrow will require the colocation of this information and appropriate decision rights.

”Understanding all the subtleties and nuances of a hospital’s complex accounting system is likely not worth the investment of time it would take to master it. However, a basic understanding of the cost structure and cost allocations is imperative for long-term physician survival. This understanding can be enhanced by working more closely with the hospital finance department and operations officers. Although they are seemingly odd bed-fellows for surgeons, these administrative personnel are part of the ever-evolving multidisciplinary trauma team.”

Fisher: One group could be a Medicare ACO

March 13, 2015by Robert Whitcomb in Uncategorized tagged , ,

 

In this interview, Dartmouth’s Elliott Fisher, M.D. often called “The Father of Accountable Care Organizations,” talks about the direction of healthcare. Among his observations:

”Can narrow networks or MA plans be aligned with ACOs? I think so. You can imagine a policy environment in which a single organization could easily be a Medicare ACO, part of a Medicare Advantage plan or offered on the exchanges. The key would be to align organizational requirements, performance measures and payment incentives.”

 

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