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Minn. asks Mayo to explain patient-picking remarks


Minnesota state regulators  want more information from the   Mayo Clinic about its apparent plan to favor patients with commercial insurance over those with Medicare and Medicaid.

“I remain concerned that Mayo has yet to offer the community a strong, clear position on the equal treatment of patients on Medicaid,” Nathan Moracco, assistant commissioner of the state’s Department of Health Services, wrote.

Mayo Clinic was strongly criticized last month after John Noseworthy, M.D., urged his staff to prioritize patients with private insurance. Backing and filling,  the system later issued a  murky statement clarifying that Dr. Noseworthy meant that Mayo people should  consider the type of insurance if patients can receive comparable care elsewhere and  he asserted that medical need was still the main factor in its decision-making process.

Providers struggle to balance payer mix. The fact is that money from well-insured (and thus generally more affluent) patients helps pay for those with public insurance. The private insurance also helps hospitals and other providers offset bad debts and pay for charity care.

To read more, please hit this link.


Hospitals should use their histories

Dan Beckham writes in Hospitals & Health Networks:

Every hospital and health system has a history. Each underwent significant developments that occurred at critical junctures extending back to the organization’s beginning. Taken together, these developments lead to an array of institutional distinctions including core capabilities and points of differentiation. It is also out of that history that the values that constitute organizational culture emerge. Yet many, perhaps most, health care organizations remain ahistorical — they ignore a strategic asset of considerable importance.Every hospital and health system has a history. Each underwent significant developments that occurred at critical junctures extending back to the organization’s beginning. Taken together, these developments lead to an array of institutional distinctions including core capabilities and points of differentiation. It is also out of that history that the values that constitute organizational culture emerge. Yet many, perhaps most, health care organizations remain ahistorical — they ignore a strategic asset of considerable importance.”

“It behooves every hospital and health system to capture and consider its history. One way to do this is to hire a historian. A good historian can dig through documents, conduct interviews and write the organization’s story. Within many hospitals and health systems, there are often individuals with a strong sense of the past who may be willing to volunteer as historians.”

To read all of  Mr. Beckham’s piece, please hit this link.

A look at AI’s future impact on healthcare

Kapila Ratnam, a partner at NewSpring Capital, speculates in a Med City News piece about the possible impacts of artificial intelligence on healthcare.

Among her observations:


“In the short term, AI has immediate applicability within the administration and operation of a hospital or healthcare system. Think in terms of supply chain and inventory management within a hospital. For example, AI can be used to ensure a surgical room is correctly stocked with appropriate inventory based on the series of surgeries scheduled to be performed in the room that day. Additionally, inventory could be automatically tracked with an algorithm that is able to assess a surgeon’s needs and send instructions to a robot that can pick up and deliver appropriate supplies to the surgical room at the beginning of a day….”

“From a clinical care delivery perspective, AI is already presenting itself, albeit in the early stages, with the ability to provide clinical decision support (CDS) to physicians. With the amount of data, research and literature published on a daily basis, it’s humanly impossible for a specialist to digest it all. However, a sophisticated AI system can be designed to scan the latest and greatest data, combine research with known medical information on a patient, and provide the overseeing physician with options on optimum care for this patient – creating a truly personalized experience….”

”Additionally, we are now in a phase where technology has surpassed the ability of a human to diagnose disease accurately, so it’s very possible we will see the impact of AI in patient diagnoses within the next several years. ”

To read more, please hit this link.

Healthcare swims in a sea of conflicts of interests

conflict Painting by  Elihu Vedder (1836–1923). Photographed in 2007 by Carol Highsmith. 
Roy Poses, M.D., in his Healthcare Renewal site comments:
“The theme continues.  A recent prominent Health Affairs blog post on {physician} burnout omitted discussion of underlying causes, much less promote resistance to them.  Now it turns out that the lead author was not only the well-paid CEO of a very prominent non-profit health system, but had just been offered a board position at giant pharma company Merck.  A recent prominent National Academy of Medicine report on health care reform again omitted discussion of any underlying causes of health care dysfunction that might disturb the powers that be.  Many of its authors were also members of the boards of directors of health care corporations.  Now it turns out that one of them had long been on the board of Amgen, and may have had other complex relationships with the pharma industry.   Who, other than Health Care Renewal readers,  knew conflicts of interest in health care were so complicated …. ) ? These newly noted conflicts of interest underlined how current discussions of health care reform are influenced, if not dominated by people with strong ties to organizations, particularly large health care corporations, that benefit from the status quo.  What kind of reform would they produce?  True health care reform minimally requires discussions lead by health care professionals, unbiased policy experts, patients and the public at large.  Contributions – oral, written, or monetary – from those who personally are profiting from the status quo should be met with requisite skepticism.”
To read Dr. Poses’s site, please hit this link.
To read the Health Affairs piece on physician burnout, please hit this link.

PlushCare: We’ve launched first EMR system for telehealth


Inside a telemedicine center.

PlushCare, an online urgent-care company, has introduced ‘’Lemur,’’ what the firm calls the “first ever electronic medical record (EMR) system for the telehealth industry.”

The company says that Lemur requires fewer clicks to complete tasks than older EMR systems, which simplifies physicians’ workflow and lets them spend more time with patients. James Wantuck, M.D., the company’s chief medical officer and a co-founder, told Healthcare Dive that the time spent on the platform was only half that of a third-party EMR  systems telemedicine physicians used previously.

Dr. Wantuck told Healthcare Dive that physicians designed Lemur. With it, physicians can “establish this virtual relationship with someone where you’re not typing into a computer, there’s nothing between you and the patient.’’

The news service said that PlushCare currently operates in 16 states and plans to expand particularly in rural areas where access to care has been increasingly difficult because of the wave of rural hospitals being closed.

To read more, please hit this link.

The great healthcare economic contradiction


For Kaiser Health News

In many ways, the healthcare industry has been a great friend to the U.S. economy. Its plentiful jobs helped lift the country out of the Great Recession and, partly due to the Affordable Care Act (ACA), it now employs 1 in 9 Americans—up from 1 in 12 in 2000.

As President  Trump seeks to fulfill his campaign pledge to create millions more jobs, the industry would seem a promising place to turn. But the business mogul also campaigned to repeal the ACA and lower healthcare costs—a potentially serious job killer. It’s a dilemma: One promise could run headlong into the other.

“The goal of increasing jobs in healthcare is incompatible with the goal of keeping healthcare affordable,” said Harvard University economist Katherine Baicker, who sees advantages in trimming the industry’s growth. “There’s a lot of evidence we can get more bang for our buck in healthcare. We should be aiming for a healthcare system that operates more efficiently and effectively. That might mean better outcomes for patients and fewer jobs.”

But the country has grown increasingly dependent on the health sector to power the economy—and it will be a tough habit to break. Thirty-five percent of the nation’s job growth has come from healthcare since the recession hit in late 2007, the single-biggest sector for job creation.

Hiring rose even more as coverage expanded in 2014 under the health law and new federal dollars flowed in. It gave hospitals, universities and companies even more reason to invest in new facilities and staff.  Training programs sprang up to fill the growing job pool. Cities welcomed the development—and the revenue. Simply put, rising health spending has been good for some economically distressed parts of the country, many of which voted for Trump last year.

In Morgantown, W.Va., the West Virginia University health system just opened a 10-story medical tower and hired 2,000 employees last year. In Danville, Pa., the Geisinger Health System has added more than 2,200 workers since July and is trying to fill 2,000 more jobs across its 12 hospital campuses and a health plan. Out West, the UCHealth system in Colorado expanded its Fort Collins hospital and is building three hospitals in the state.

In cities such as Pittsburgh, Cleveland and St. Louis, healthcare has replaced such  industries as coal and heavy manufacturing as a primary source of new jobs. “The industry accounts for a lot of good middle-class jobs and, in many communities, it’s the single-largest employer,” said Sam Glick, a partner at the Oliver Wyman consulting firm in San Francisco. “One of the hardest decisions for the new Trump administration is how far do they push on healthcare costs at the expense of jobs in healthcare.”

House Republicans, with backing from Trump, took the first swipe. Their American Health Care Act sought to roll back the current health law’s Medicaid expansion and cut federal subsidies for private health insurance. The GOP plan faltered in the House, but Republican lawmakers and the Trump administration are still trying to craft a replacement for the ACA.

Neither the ACA nor the latest Republican attempt at an overhaul tackle what some industry experts and economists see as a serious underlying reason for high healthcare costs: a system bloated by redundancy, inefficiency and a growing number of jobs far removed from patient care.

Labor accounts for more than half of the $3.4 trillion spent on U.S. healthcare, and medical professionals from health aides to nurse practitioners are in high demand. But the sheer complexity of the system also has spawned jobs for legions of data-entry clerks, revenue-cycle analysts and medical billing coders who must decipher arcane rules to mine money from human ills.

For every physician, there are 16 other workers in U.S. healthcare. And half of those 16 are in administrative and other nonclinical roles, said Bob Kocher, a former Obama administration official who worked on the ACA. He’s now a partner at the venture capital firm Venrock, in Palo Alto, Calif.

“I find super-expensive drugs annoying and hospital market power is a big problem,” Kocher said. “But what’s driving our health-insurance premiums is that we are paying the wages of a whole bunch of people who aren’t involved in the delivery of care. Hospitals keep raising their rates to pay for all of this labor.”

Take medical coders. Membership in the American Academy of Professional Coders has swelled to more than 165,000, up 10,000 in the past year alone. The average salary has risen to nearly $50,000, offering a path to the American Dream.

“The coding profession is a great opportunity for individuals seeking their first joband it’s attractive to a lot of medical professionals burned out on patient care,” said Raemarie Jimenez, a vice president at the medical coding group. “There is a lot of opportunity once you’ve got a foot in the door.”

Some of these back-office workers wage battle every day in clinics and hospitals against an army of claims administrators filling up cubicles inside insurance companies. Overseeing it all are hundreds of corporate vice presidents drawing six-figure salaries.

Administrative costs in U.S. healthcare are the highest in the developed world, according to a January report from the Organization for Economic Cooperation and Development. More than 8 percent of U.S. health spending is tied up in administration while the average globally is 3 percent. America spent $631 for every man, woman and child on health-insurance administration for 2012, compared with $54 in Japan.

America’s huge investment in healthcare and related jobs hasn’t always led to better results for patients, data show. But it has provided good-paying jobs, which is why the talk of deep cuts in federal health spending has many people concerned.

Linda Gonzalez, a 31-year-old mother of two, was among the thousands of enrollment counselors hired to help sign up Americans for health insurance as the ACA rolled out in 2014. The college graduate makes more than $40,000 a year working at an AltaMed enrollment center, tucked between a Verizon Wireless store and a nail salon on a busy street in Los Angeles.

In her cramped cubicle, families pull up chairs and sort through pay stubs and tax returns, often relying on her to sort out enrollment glitches with Medicaid. As the sole breadwinner for her two children, ages 9 and 10, she counts on this job but isn’t sure how long it will last.

“A lot of people depend on this,” she said one recent weekday. “It’s something I do worry about.”

Calif. hospitals losing ground on quality


Entrance to San Francisco Chinese Hospital, one of California’s top performers.


For Kaiser Health News

Nearly half of California hospitals received a grade of C or lower for patient safety on a national report card aimed at prodding medical centers to do more to prevent injuries and deaths.

The Leapfrog Group, an employer-backed nonprofit group focused on healthcare quality, issued its latest scores last week. The report card is part of an effort to make consumers and employers aware of how their hospitals perform on key quality measures, so they can make better-informed health care decisions. The scores are updated twice a year, in spring and fall.

After steady improvement in recent years, California hospitals lost ground in last week’s report card. Two years ago, 37 percent of California hospitals received a C, D or F grade. That increased to 46 percent of the 271 California hospitals rated in the most recent report.

Many California hospitals still struggle to reduce preventable medical errors and infections in patients, despite industrywide efforts to remedy those problems. California accounted for 6 of the 10 hospitals nationwide that received an F grade.

California public health officials track a wide assortment of patient infections that can be acquired during a hospital stay. A recent state report noted progress in some areas, while other issues have been harder to address.

From 2014 to 2015, 56 California hospitals achieved “significant improvement” in preventing certain infections, including ones in the blood and those resulting from surgery, according to the California Department of Public Health. But diarrheal infections in California hospitals have increased 8 percent above a national benchmark since 2011.

The state has created an interactive map where the public can check infection rates by hospital.

Leapfrog, which has issued hospital scores in California and nationwide since 2012, analyzes information it collects as well as data reported to Medicare. Erica Mobley, a Leapfrog spokeswoman, said the group’s methodology compares all hospitals to each other on a national scale, so a mix of factors could be responsible for the lower scores statewide.

“This could represent California hospitals’ performance slipping in comparison to their peers across the country or could also mean that they may be staying constant in their performance while other hospitals are progressing,” Mobley said.

The percentage of hospitals in the Golden State that got the top rating also decreased in Leapfrog’s latest analysis. Twenty-five percent of California hospitals, 68 facilities, earned an A grade this year, compared to 43 percent, or 104, in 2015.

California ranked 28th nationally in the percentage of A-rated hospitals. More than half of the hospitals in states such as Oregon, North Carolina and Massachusetts achieved the highest score.

In Leapfrog’s report card, some performance measures are risk-adjusted for patient severity and income so hospitals aren’t penalized for admitting sicker, poorer patients.

Some hospital industry officials have criticized Leapfrog’s letter grades as too simplistic for a complex issue and as potentially misleading for patients.

Jan Emerson-Shea, a spokeswoman for the California Hospital Association, noted there are many different scorecards and said consumers shouldn’t put too much stock in any one ranking.

“While these scorecards often serve as a good starting point for patients to ask questions of their health-care provider, they should not be viewed as being a definitive source for determining the quality of care provided by any hospital,” Emerson-Shea said.

The Leapfrog data show that some of the top performers in California include San Francisco Chinese Hospital,  Mercy General Hospital, in Sacramento, Hoag Memorial Hospital Presbyterian, in Newport Beach, and Inglewood’s Centinela Hospital Medical Center.

Health giant Kaiser Permanente consistently posts some of the highest scores and shows little variation across its 35 hospitals in the state. Thirty-three Kaiser hospitals received A or B grades; two got C grades.

The University of California health system fared well across seven hospital campuses, with five A ratings and two B grades.

Some large institutions lagged further behind. Providence St. Joseph Medical Center, in Burbank, received a D, as did the Zuckerberg San Francisco General Hospital and Trauma Center.

Leapfrog cited San Francisco General, a public safety-net hospital, for being below average at preventing surgical site infections after colon surgery and for allowing dangerous objects to be left in a patient’s body, among other factors. Providence’s Burbank hospital had a higher-than-expected rate of patients who developed serious breathing problems and caught antibiotic-resistant infections, according to Leapfrog.

A spokesman for San Francisco General didn’t comment directly on the hospital’s results, other than to say it didn’t participate in Leapfrog’s optional survey on safety procedures and training.

Providence said in a statement it takes patient safety seriously and respects efforts to help consumers make an informed choice. However, “it is important to understand that health care data are extremely difficult to compare as each patient is unique,” the hospital said. “Often information is a few years old before it is analyzed and aggregated for the public.”

California’s Office of Statewide Health Planning and Development also offers data on hospital quality and patient outcomes. And Medicare posts star ratings for hospitals nationwide, which are another resource for patients and policymakers.

PCPs have lost quarterback position on hospital patients’ teams


Stephen C. Schimpff, M.D., writes in Medical Economics:

There is a crisis in primary care and it’s now flowing over into the hospital when a primary care physician’s (PCP) patient is admitted.

 “No longer cared for by the PCP, the role has largely fallen to the hospitalist. There has been a loss of the long time primary care physician-patient relationship and the trust that comes with time. There has been a frequent loss of satisfactory communication when the patient is admitted and again when discharged. At a time when the patient most wants and needs the comfort of a long-time trusted professional friend, the patient instead is confronted with a stranger at the helm. What has happened to create this state of affairs?”

To read all of his remarks, please hit this link.

For better performance management in bundling


The American Hospital Association recommends these steps to support performance management in bundling:

  • “Develop a system to identify patients likely to qualify for bundled episodes early and assess their risk for complications, and track their progress through the bundle episode.
  • “Develop multidisciplinary teams, led by physician champions, in the implementation of standard care processes to reduce variations in care to improve patient outcomes and reduce costs.
  • “Develop a high-functioning discharge planning process.
  • “Enhance data analytics and information sharing capabilities.”

Meanwhile, says a piece in Hospitals & Health Networks, Burlington, Mass.-based Lahey Health has partnered with xG Health Solutions,  in Columbia, Md., to help guide it through its bundled-payment adoption, as well as to provide analysis of CMS data from procedures using bundled payments.

Thus Lahey now knows the analytics of where and when  patients get care within 90-days after discharge,  when patients visit  emergency departments, and whether they’re  readmitted to the hospital other than at Lahey. This information helps to identify patterns the knowledge of which can be used to improve care quality.

The H&HN piece reports:

”{D}ata showed patients participating in the total joint {replacement} bundle were being readmitted with wound infections. After assessing various options, the hospital adopted seven-day dressings, which reduced infections and enhanced patient and staff satisfaction by eliminating multiple dressing changes per day while in-house and associated hospital readmissions post-discharge.”


“One of the keys to success under the bundled-payment model is developing ongoing communication with other providers within the community. Bringing together representatives from the hospital, including physicians, along with home health, acute rehab, and skilled-nursing providers, has helped build trust and understanding of what role each group serves.”

But ”it is critical that physicians have dedicated time to focus on process improvement initiatives under bundled payment.”

To read more, please hit this link.


U.S. healthcare: A lot of spending for a few


In  a reminder of how  so much of U.S. healthcare resources are spent on a relatively small number of chronically ill people,  and  on older people at the end of life, read a new article in Health Affairs, whose abstract is:

“The distribution of healthcare expenditures remains highly concentrated, but most Americans use few healthcare resources and have low out-of-pocket spending. More than 93 percent of ‘low spenders’ (those in the bottom half of the population) believe they have received all needed care in a timely manner. The low spending by the majority of the population has remained almost unchanged during the thirty-seven-year period examined.”

To read the whole article, please hit this link.

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