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As patients worry, well-heeled attendees confer at luxury healthcare confab

The luxurious Westin St. Francis Hotel, in San Francisco.



For Kaiser Health News


There’s so much money floating around here this week, you can almost see it wafting through the air.

About 10,000 attendees, mostly confident men in well-cut suits and even nicer watches, are packing the elegant Westin St. Francis Hotel for the invite-only J.P. Morgan Healthcare Conference, which ends Thursday.

For many of these investors, health providers, insurers and entrepreneurs at the nation’s largest and most prestigious health investment conference, it’s all about the deal — and the after-hours parties.

In the first few days of what’s become known as J.P. Morgan Week, New Jersey-based Celgene announced it would spend up to $7 billion to acquire Impact Biomedicines. And Novo Nordisk, the world’s biggest insulin maker, bid $3.1 billion for a Belgian biotech firm.

For those who didn’t land a coveted invite, satellite conferences on digital health and biotechnology dot the city, offering lesser mortals an opportunity to network and make their own deals. Former Vice President Joe Biden even popped into town to keynote the StartUp Health Festival satellite conference, speaking about cancer-treatment costs and electronic health records.

The J.P. Morgan gathering comes at a jarring time when you consider that the other world of healthcare is flooded with uncertainty for the millions of ordinary Americans who inhabit it. They face a precarious political landscape in which the future of the Affordable Care Act remains uncertain and Republican leaders in Congress mull dramatic cuts to Medicaid and Medicare.

John Baackes, CEO of the nation’s largest public health plan, L.A. Care, which insures 2.1 million low-income patients, said if his enrollees wandered into the conference, “they’d think they were in a foreign land and that this has nothing to do with them.”

Much of U.S. healthcare is underwritten by public dollars, but people here didn’t come to talk about that or rising costs, particularly for prescription drugs. Only a few presentations at this year’s conference have touched on prices, including a J.P. Morgan study released Monday that found many Americans put off medical care until they get their tax refund — a clear sign that that they don’t have enough saved up to pay for care when they need it.

“It’s just so striking how much maneuvering and desire there is at this meeting for a piece of the 18 percent of GDP spent on health care,” mused Dr. Vivian Lee, the former leader of the University of Utah Health Care system, who made a point of tracking costs with pinpoint precision. “Is anyone here trying to decrease their share?”

Baackes, who comes to the conference to network and monitor the latest developments in health care, said he’s always skeptical of the well-heeled company officials who attend promising better health outcomes and cost savings. “In a way, there’s too much money walking around here,” he said. “Investors are thinking, ‘Health care is a $3 trillion sector of the economy; surely it will benefit from my genius.’”

Many attendees view the conference with a less critical eye.

“It’s a useful place for us to be,” said Amanda Cowley, strategy director of the quasi-governmental organization that produces the U.S. Pharmacopeia, a compendium of information and standards for producing medicines and food ingredients. Cowley said she and her colleagues need to learn about emerging health technologies so they can anticipate their future work products.

Cowley stood in a line of hundreds of attendees waiting to dine on tri-tip, vegetables and macarons while listening to Microsoft founder Bill Gates talk about how his foundation is helping improve the health of subsistence farmers and children in the developing world.

But there was little talk of America’s subsistence patients, who often cannot afford the expensive drugs and medical devices that are bought and sold in deals brokered at conferences like these, in private rooms guarded by phalanxes of staffers at tony hotels.

Those patients, however, were the focus of a Medicaid panel held Tuesday at Glide Memorial Church, in San Francisco’s troubled Tenderloin district, a few blocks and a world away from the Westin St. Francis. That event, which drew about 70 people, was sponsored by ConsejoSano, a Southern California-based startup that has raised $7.2 million to help Spanish speakers better navigate the health system.

Rallying the troops at Glide was former Medicare and Medicaid chief Andy Slavitt, a fierce critic of Republican efforts to repeal and replace the ACA. Slavitt recently invested in Cityblock Health, a public health startup focusing on Medicaid and other low-income patients.

The good thing about J.P. Morgan Week, Slavitt told Kaiser Health News, is that it draws innovative people who want to invest. “The question is, should health care capital be focused on solving big problems and getting rewarded for them, or just focused on the status quo?”


Small improvements vs. care redesign


Three physicians write in NEJM Catalyst about whether healthcare organizations should  decide between small, incremental improvements or care redesign. Among their remarks:

“The shift from volume- to value-based payment may constrain revenue, forcing organizations to consider dramatic changes to care delivery. Doing this may require increasing their capacity for innovation relative to incremental improvement. Innovation and improvement are sometimes used interchangeably, but the distinction between them matters.

“Quality improvement methods are usually applied to refine existing care delivery processes. The way forward is relatively clear, and the returns are predictable and quick. Innovation, however, involves creating new products, services, or processes. The way forward is filled with uncertainty. Will the new approach work? When will it show results? Given the choice, most organizations are more comfortable with the predictability of quality improvement, labeling it innovation in some cases, but shunning the risk-taking that characterizes true innovation work.

“But incremental improvement in the absence of some degree of innovation is likely to produce limited gains.

They conclude:

“To thrive in a value-based care environment, organizations will have to be able to do the same things more efficiently and take advantage of the opportunities of digital health, patient empowerment, and integration across sectors to redesign much higher-value care. Organizations will need to decide how much money, time, or political capital they should expend to build structures and cultures that support both the goals of improvement and of innovation.”

To read their essay, please hit this link.

CMS soon to start new voluntary bundled-services plan


The Centers for Medicare & Medicaid Services (CMS) is implementing a new voluntary bundled services payment model for Medicare.

“BPCI [Bundled Payment for Care Improvement] Advanced builds on the earlier success of bundled payment models and is an important step in the move away from fee-for-service and towards paying for value,” CMS administrator Seema Verma said  Tuesday.

But the Trump administration has resisted  mandatory bundled care models. Indeed, last November CMS canceled mandatory bundled care payment models for hip fractures and cardiac care, and reduced the number of regions required to participate in a bundled-care payment system for joint replacement.

Carter Paine is chief operating officer of CBPCI Advanced, a Brentwood, Tenn.-based company that helps manage patients’ transition to post-acute care and has participated in the older model.  He told Med Page Today that the new bundled-care model, to  start in October, is different in important respects from the older one.

For one thing, he told the news service, CMS is, in Med Page’s paraphrase of his remarks, “incentivizing providers to reduce costs by 3 percent for each episode of care, rather than 2 percent as in the old model.”

In addition, “it lasts longer, up to 2023, which we think is a good thing.”

Mr. Paine added that the fact that CMS has fewer episodes of care to choose from may indicate that “of the 48 original [episode types], many of those weren’t being executed on, so probably they just bore down to episodes that actually have real volume.”

“I think BPCI 1.0 has proven to be successful for those participants that have hung in there. On the last go-round, people were sticking their toes in the water, and a lot of people were too nervous to get in — that felt more like a pilot, and this is more of a long-term commitment. Given the success we’ve had in BPCI 1.0 … I think people will participate more in this one, given there’s a game plan in hand.”

To read more, please hit this link.



Mass. taking its time on proposed Beth Israel-Lahey merger


Beth Israel Deaconess Medical Center and Lahey Health completed merger plans way back in  last July, but Massachusetts officials are still taking a very hard look at the deal.

Indeed, the state Department of Health organized a public forum  on the potential huge Greater Boston merger,  which includes 13 hospitals and would reshape the healthcare landscape in the area. The new system would unite under a new parent company, “NewCo.”

Research from across America suggests that the hospital sector’s seemingly relentless consolidation can boost costs for consumers and insurers, among  other potential downsides for patients. However, independent hospitals such as Anna Jaques Hospital, in Newburyport, Mass., affiliated with the Beth Israel Deaconess empire, that choose to stay on their own face financial challenges.

Massachusetts’s Health Policy Commission is also taking a look at the merger, with their complete report due this summer.

The merger “represents the most significant change in the structure of the Massachusetts healthcare market in more than 20 years and will reshape the delivery of care for millions of patients,”  said Stuart Altman, Ph.D., chairman of the commission.

Lahey Health and Beth Israel, meanwhile, both asserted that the merger would  lower costs,  through, presumably, efficiencies of scale, noting that  healthcare costs in eastern Massachusetts are far higher than those in many other states.

To read more, please hit this link.

Despite ACA, tax-exempt hospitals slow to expand community benefits


For Kaiser Health News

The federal health law’s efforts to get nonprofit hospitals to provide more community-wide benefits in exchange for their lucrative tax status has gotten off to a slow start, new research suggests. And some experts predict that a recent repeal of a key provision of the law could further strain the effort.

The increased emphasis on community-wide benefits was mandated by the Affordable Care Act. The health law required hospitals that meet federal tax standards to be nonprofits to perform a community health needs assessment (CHNA) every three years, followed by implementing a strategy to deal with issues confronting the community, such as preventing violence or lowering the rates of diabetes.

study released Monday in the journal Health Affairs shows spending in these areas has remained relatively stagnant.

The research showed average spending by tax-exempt hospitals on community benefits in 2010 was 7.6 percent of total operating costs and bumped to 8.1 percent by 2014. But the bulk of that spending goes toward unreimbursed patient care, such as charity care. The ACA was trying to spur more spending on broader community initiatives, which have remained below 1 percent of operating costs at the hospitals.

“This is not easy for hospitals to do,” said Gary Young, the study’s lead author and director of the Center for Health Policy and Healthcare Research at Northeastern University in Boston. “By tradition, by the nature of their resources, hospitals have not been oriented to prevention, they’ve been oriented to treatment.”

New efforts by the Republican-led Congress may complicate the effort. The repeal last month of the ACA’s penalties for most people who don’t have health insurance has some experts questioning how some of these hospitals will be able to spend more on community benefits. The Congressional Budget Office has estimated that because of that change about 13 million people would give up their coverage by 2027, which could drive up costs for hospitals because there would be more uninsured patients.

“Anything that destabilizes the system and takes money out of the hospitals’ revenue stream is going to negatively impact them,” said Gregory Tung, assistant professor at the University of Colorado’s School of Public Health. “It’s tough for hospitals to be navigating that uncertainty.”

Jill Horwitz, a professor of law at UCLA who specializes in health issues, said hospitals have trouble planning community efforts when they are unsure of their finances.

“It’s a very difficult context in which to operate a stable system,” Horwitz said. “One day to the next, it’s hard to know what the rules are, what the reimbursement is going to be and what kind of insurance your patients will have.”

More than half of the hospitals in the United States are private, nonprofit organizations that are tax-exempt.

Lawrence Massa, president & CEO of the Minnesota Hospital Association, said the repeal of the ACA’s individual mandate penalties will change hospitals’ calculations.

“We certainly expect to see our uninsured rate go up as a result of repealing the individual mandate,” he said, “so that’s going to have an opposite type of effect of where we thought the trend was going to be because we changed the rules in the middle of the game.”

But it’s too early to tell how hospitals will respond, according to Massa. Many are still grappling with the new requirements.

The ACA was enacted in 2010, but the provision requiring community-based action did not come into effect until the end of March 2012, and enrollment in ACA marketplace plans didn’t begin until 2014. Hospitals began early investments for assembling the needs assessments in 2011 and 2012, Massa said.

“In the later years, they’ll be using that data and comparing and reporting to the IRS how they’ve changed their community benefits spending as a result of those community health needs assessments,” he said. “If everything stayed the way it was, I think we would know by 2020 whether this had the kind of impact that was anticipated.”

Young and his research colleagues acknowledged in their study that “certainly, more time is needed” to assess the full impact of the law’s requirements on spending for community benefits.

Nonetheless, Young said, many hospitals lack the means to provide greater preventive care in the community.

They don’t have the necessary infrastructure, “the personnel or the knowledge to develop those strategies,” he said. “They don’t have the resources to necessarily invest in those areas.”

Horwitz agreed. “If we’re going to require this high level of spending on community benefits and paying for patients who can’t afford care, something else has to give,” she said.

Patients, families must speak up in hospitals


For Kaiser Health News

My dad was in excruciating pain over Labor Day weekend, so my mom rushed him to the emergency room of a renowned university hospital.

Doctors determined that he needed surgery that night, and luckily I was able to fly in and see him before he was wheeled away. “Take care of your mom if anything happens to me,” he said as my mom and I wept.

Thankfully, my dad made it through. But he had to spend 11 days recovering in the hospital, a place he now equates with prison.

One night, he suffered for five hours, desperately calling for help after his pain meds had run out. A nurse’s aide stationed in his room had fallen asleep.

“I called on the intercom so many times, and nobody showed up,” he recounts.

That was just one of the many failures in care that we encountered during my dad’s stay. Others included inconsistent nursing quality, waiting all day for doctors to respond to pages, insensitive communication of bad news, trying in vain to reduce noise levels so my dad could sleep, and so much more.

My job is to give you advice on health care and insurance issues. My mom is a registered nurse. Yet we both felt frustrated that we couldn’t make things better for my dad.

Unfortunately, this happens to a lot of people. “Everything you hear these days is about patient-centered care, this and that,” says Terry Bay, who owns a Casper, Wyo.-based business that provides advocacy services to older patients. But “we don’t live in a patient-centered health care environment.”

Today I’m going to offer advice for you in case you or a loved one lands in a hospital.

There are state and federal laws that cover, among other things, your rights to privacy, nondiscrimination, language interpretation and visitation, says Lois Richardson, vice president and legal counsel of the California Hospital Association.

But beyond legal protections, there are people you can talk to and steps you can take to improve your situation if you feel you’re not getting the care you deserve. And patients’ opinions do count.

“All hospitals increasingly are being scored and paid based on patient and family satisfaction scores,” says Rebecca Kirch, an executive vice president with the National Patient Advocate Foundation. “There is power in the peopl

That power starts with a few simple things.

First, make sure a spouse, child, family member or friend — anyone concerned for your well-being — can spend time with you in the hospital and be your advocate. You cannot do it by yourself while you’re in pain, medicated and not thinking clearly.

“It’s having someone else in your court, someone who can check in and make sure your questions are being answered,” says Dr. Rebecca Sudore, a geriatrician and palliative care physician at the University of California-San Francisco.

Before you or your advocate speaks to your nurse or doctor, write down your questions. Keep track of your glasses, hearing aids and dentures — the personal belongings that most often go missing in hospitals, Sudore says.

“How can someone speak up for themselves if they can’t see someone? Or can’t hear?” she asks.

When the time comes to ask questions — or express frustration — don’t be afraid to speak up. You have every right, even though it can feel intimidating to question your doctors or complain about your nurses.

“You can say, ‘No, I don’t want to go for that test. I want to speak to my daughter first,’” Bay says.

If you’re getting jostled out of sleep for a blood draw or blood pressure check in the middle of the night, ask your doctor the next day if it’s really necessary. Often, it can wait till early morning, says Julianne Morath, president and CEO of the Hospital Quality Institute.

“It’s up to us to put our own humanity back into decisions,” Sudore says.

But here’s where speaking up can get thorny.

Let’s say you don’t feel you’re getting adequate care or you’re unhappy with how you’re being treated. You can start with your nurse, but if that’s uncomfortable — perhaps because that nurse is the source of the problem — approach the charge nurse, who manages the staff in your unit.

You can also ask to talk to a hospital-based social worker, who can intercede or help you figure out who to talk to, Kirch says.

If that doesn’t help, take your complaints to the next level.

Every hospital that participates in the Medicare program — which is most — must have an ombudsman or patient rights advocate, Richardson says. My mom and I eventually complained to the patient rights advocate. It helped, and we wish we had done it sooner.

If you can’t go to the patient rights advocate yourself, “you can call them or ask your nurse to call them and have them come up to your room,” Richardson says. Hospitals must acknowledge patient complaints immediately, she says, and must respond in writing once they are resolved.

As part of this process, no matter whom you talk to, there are some phrases that can spur quick action, Kirch explains. One is “This doesn’t feel like quality care to me.” Another is “I see my loved one suffering.”

If you have a serious illness and you’re suffering from symptoms that aren’t being managed correctly, you can also request a consultation with a palliative care team. Palliative care isn’t only about end-of-life issues, it’s about quality of life, Kirch says.

Most large hospitals have a multidisciplinary team of doctors, nurses, social workers, chaplains and others who can provide added support on top of the medical treatment you’re receiving, especially if you’re getting shuffled among medical specialties.

“They can help tremendously to fill in the blanks. … It can be pain management. It can be spiritual or psychological distress,” Kirch says. “The palliative care team treats the person beyond the disease.”

If you have done all that and still have concerns, Kirch’s organization has case managers who provide free, one-on-one support for patients. Call 800-532-5274 for more information or visit

To be clear, I’m not suggesting you complain about every little thing. Be realistic. For instance, a hospital doctor may see up to 30 patients a day. So you might have to wait for your page to be answered unless you have a serious, potentially life-threatening problem, Sudore says.

“It may not be that you’re being ignored. It might be that someone has to figure out the competing priorities,” she says.

And don’t forget that your caregivers are human too, Morath advises. “They get tired, they get stressed,” she says. “Very often, just letting them know you’re not getting what you need and asking for their help … is a very powerful act.”

Study suggests increasing VA hospital coronary-procedure capacity

The VA Medical Center in Boston.

A study in JAMA Cardiology compares accessibility, cost and quality of coronary procedures at Department of Veterans Affairs (VA) hospitals and  non-VA hospitals.

They posed the question: “Does the Veterans Affairs Community Care (CC) Program, which allows veterans to receive care at non–Veterans Affairs sites, increase the accessibility and value of their elective coronary revascularization procedures?

They found: “Among 13 ,237 elective percutaneous coronary interventions and 5,818 elective coronary artery bypass graft procedures in this veteran cohort study, use of the Community Care Program reduced aggregate veteran travel distance for revascularization. Community Care Program hospitals had higher mortality and costs for percutaneous coronary intervention and had equivalent mortality and lower costs for coronary artery bypass graft surgery.

“The higher mortality of CC-provided PCIs was not necessarily due to lower quality of care at CC hospitals,” the authors wrote. “Other possible factors include delay in making care arrangements, incomplete coordination of care between VA and CC hospitals, or failure to refill medications prescribed by CC clinicians. These are obvious areas for future research and quality improvement efforts.”

The study reaffirmed earlier studies showing  that quality of VA care is similar to non-VA care.  The authors suggested that since many VA hospitals perform these  coronary procedures below recommended minimum annual procedure volumes, increasing capacity at high-performing VA hospitals to improve outcomes would make more sense than expanding access at non-VA community facilities.

To read the JAMA report, please hit this link.


AMGA chief presents 5 big issues for 2018


Jerry Penso, M.D., president and CEO of the American Medical Group Association, laid out in FierceHealthcare five key issues for healthcare leaders this year:

1. “Efficiency will become a top priority. Revenues are flat while expenses continue to rise for most medical providers, so medical groups and health systems must continue to make their practices more efficient. Practices will look for workflow and staffing efficiencies and ways to cut costs that don’t impact the patient experience, access or physician burnout.”

2. “(Addressing) physician burnout will be a strategic imperative. Addressing physician burnout will become a priority in the boardroom as leaders will demand initiatives to stem this epidemic. Many will add burnout metrics to their dashboards. Concerns about the stability of the critical primary care workforce, early retirements and productivity will drive increased attention to personnel issues including physician frustrations with their EHRs, the need for more comprehensive care redesign and the lack of adequate leadership training.”

3. “Competition for convenience will heat up. Patients—especially millennials—will continue to drive the demand for quicker, more accessible options to receive care. Growth in urgent care centers, pharmacy-based care, Uber-like home care delivery and virtual medicine will provide increased ways for patients to bypass hospitals and physician offices. Medical groups and health systems will find new ways to remain competitive in their markets.”

4. “Scope-of-practice issues will become more acute. The underutilization of many healthcare professionals―including pharmacists, nurses, physician assistants or behavioral health specialists―will lead to increased demands to expand their ability to treat patients more autonomously.”.

5. “Practices will form more community partnerships. The move to value-based payment systems and the accountability for an attributed population means that healthcare systems will need to work with community partners to address some of the root causes of poor outcomes and resultant higher costs.”

To read all of Dr. Penso’s remarks, please hit this link.

Providers’ biggest challenges in 2018


Kevin Lathrop,  president of TriZetto Provider Solutions, a Cognizant Company, writing in Physicians Practice, looks at the big challenges facing providers in 2018. Among his observations:

“The big question coming in 2018 is how will providers respond to the growing financial squeeze in the healthcare industry? The increasing pressure is political, economic and patient-based.

“Politics, value-based reimbursement, and patient collaboration will be important to providers in 2018. There will be ongoing financial challenges caused by shifts in politics and healthcare consumerism. More provider payments will be derived from patients, who are sometimes difficult to collect from, while payers likely will decrease payments through new and changing methodologies.

“Patients will continue to exert more pressure on providers as they advocate for new ways to pay bills, including user-friendly mobile and online payment options. Providers who respond swiftly may benefit from the political uncertainty and continued, increasing patient involvement in 2018.”

“Recently, the administration canceled payments to insurers intended to defray some costs for low-income Americans. In turn, many state attorneys general got involved to challenge what they viewed as a potentially negative impact.

“The payments were intended to help fund premiums and other healthcare-related expenses for some low-income Americans. The result could be more insurers leaving the ACA marketplace, increasing costs for taxpayers, fewer healthcare choices, and more changes.

“One immediate concern is that the financial crunch could trickle down to physicians who already contend with non-payment pressures.”

“Will these numbers increase as ACA subsidies decrease? It certainly seems possible, but only time will tell.”

“Value-based reimbursement (VBR) remains of interest to payers as they work with providers to make the shift from fee-for-service. Fostering quality care and positive health outcomes bode well for payers, providers and patients. For participating providers, VBR offers an opportunity to continue utilizing high-quality, outcome-driven treatments. VBR can also help providers address healthcare consumerism, when working closely with patients to promote and communicate positive health outcomes and encouraging patients to become part of the process.”

“Understanding of and acting on incoming and outgoing communications can help improve the efficacy of the provider practice and can play well with VBR.”

To read his whole essay, please hit this link.


Partners, Care New England extend merger talks

Partners HealthCare,  based in  Boston, and Care New England Health System, based in  Providence, have extended their merger talks through Jan. 31

Massachusetts’s largest health system and Rhode Island’s second-largest announced  last April that they were working on a deal for Partners to acquire financially stressed Care New England. But their negotiations have taken longer than initially expected.

Part of the process is that Care New England has been closing down inpatient operations at Memorial Hospital of Rhode Island, in Pawtucket, a huge money loser for Care New England.\

To read  more, please hit this link.




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