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Trying to get buy-in from PCPs for integrated care


An NEJM Catalyst article and video looks at the challenges of primary-care physicians engaging in truly integrated care, especially for low-income patients with addiction and other behavioral-health issues.

The article says:

“True integrated care in a true collaborative space — not just a consult — is still a foreign concept to a lot of clinicians. San José Clinic, in Houston, is a unique environment that serves uninsured patients who face numerous challenges, particularly with social determinants of health — folks who may not make it back for follow-up care in a timely manner. For this reason, they aim to help patients with as many issues as possible within one visit.

”’Every clinician, every specialist is 100 percent willing to do whatever it takes in that visit to make it happen,’ says the clinic’s president and CEO, Paule Anne Lewis.”’

“’I’ve seen some really interesting things on getting the buy-in from a recruiting perspective,’ adds Corey Waller, Senior Medical Director for Education and Policy at Camden Coalition of Healthcare Providers’ National Center for Complex Health and Social Needs.”

“’For physicians, our job is really changing. We’re not just seeing patients all day anymore,’ says Waller. ‘Our role is only to see the sickest and then to run teams of people who see patients. That’s where the future of being a doctor is going, which is super scary since we have no training in it.”’

To read the article and see the accompanying video, please this link.


Survey: Physicians don’t feel accountable for cost of patient care

The cost of care and physician responsibility is the main theme of the first of three NEJM Catalyst Buzz Surveys focused on value in healthcare. Sponsored by University of Utah Health, the survey was conducted with the NEJM Catalyst Insights Council. Among other findings, the survey suggests that physicians feel responsible for the cost of care to a patient, but not accountable for it.

To read the report, please hit this link.






Millennials look to tear down hierarchy in medicine

Anesthesia residents being trained with a dummy.

Joshua Goldman, M.D., writes in Doximity about the rise of Millennials  and the fall of hierarchy in medicine. Among his observations:

“As an acute sense of the value of business and industry has crept into the hearts and minds of Millennial medical students, and disruptive innovation enters the algorithm, management, consulting and administrative careers have come to be viewed as lucrative non-clinical opportunities to have large, hospital-wide effects on patient care, an earlier path to professional-level compensation, and a potential route that avoids the negative aspects of residency and physicianship, in general. Medicine and law are no longer the prevailing paths of the intelligentsia; the startup mindset replaced that rigid, professional mentality and the generational zeitgeist has evolved accordingly.”

“Whether you want to classify them as millennials or demean them as snowflakes, there is a palpable change in the attitude of incoming medical students and residents. I can only speak from personal experience and that of many discussions with peers and colleagues, but there is an unprecedented sense of entitlement based on prior accomplishment, or sometimes just potential, and an unwillingness to ‘pay dues’ simply because their bosses did before them. They pay limited, if any, heed to tenure and offer minimal deference to title. They truly do not care if you hiked uphill, both directions, in the snow….  In a society that swiftly traded a ‘time-served’ promotion system and reward model, for one of ‘value-added,’ who can blame them. Medicine has lagged in this respect and many others.”

To read his essay, please hit this link.

Study: Health-system mergers don’t necessarily mean better interoperability

This is from FierceHealthcare:

“A common refrain from health systems justifying the acquisition of another provider has been that consolidation will make data-sharing an easier task. But new research shows horizontal hospital consolidation itself doesn’t always translate to improved interoperability.

Using data from the 2014 American Hospital Association (AHA) annual survey and the 2015 IT supplement that included more than 2,000 hospitals, researchers found that only those systems with a specific business model, centralized physician arrangements and an integrated insurance offering were more likely to achieve key measures of interoperability.

In other words, consolidation alone wasn’t enough to incentivize data sharing. Centralized organizational governance coupled with diverse service offerings in hospitals throughout the system was a bigger influence on data sharing than common ownership alone, according to the study published in the Journal of the American Informatics Association.”

To read the study, please hit this link.

To read the FierceHealthcare report, please hit this link.


Video/text: Knocking down barriers to behavioral change

Kevin Volpp, M.D., discusses, in an NEJM Catalyst program, how to knock down barriers to behavioral change in health care. He is patient- engagement theme leader for NEJM Catalyst and founding director of Penn Medicine’s Leonard Davis Institute Center for Health Incentives and Behavioral Economics.

Among his remarks:

“To help people change behavior, we can think about either pushing them harder or lowering barriers to make it easier. My philosophy is, we should start by lowering barriers whenever possible.”

Dr. Volpp highlights seven ways to knock down or least at lower these barriers. In NEJM’s words:

  • “Changing defaults
  • “Simplifying complicated processes
  • “Reducing out-of-pocket costs
  • “Using technology in supportive ways
  • “Raising taxes on unhealthy items
  • “Using social support

“Making it fun’’

To read and hear his remarks, please hit this link.




The move to inpatient behavioral health

Inova Fairfax Hospital, Inova’s flagship institution.

Falls Church, Va.-based  Inova Health System has joined the hospital sector’s trend toward establishing inpatient behavioral-health units.

As FierceHealth reports:

Inova is joining “a growing number of hospitals around the country that are adding or growing such units after years of efforts to deinstitutionalize mental health care led to shortages of inpatient behavioral health beds.”

For example:

“Children’s Hospital of Richmond at Virginia Commonwealth University recently redesigned its behavioral health center, boosting its inpatient bed count from 24 to 32 beds. San Francisco just opened a 54-bed inpatient facility, Mercy Medical Center recently announced plans to build a proposed 100-bed psychiatric hospital in Iowa and multiple psychiatric hospital projects have already been built or are underway in Massachusetts and New Jersey.”

To read the Fierce article, please hit this link.

Time pressure on physicians makes teamwork more important

Fred  N. Pelzman, M.D., writes in his Med Page Today column that physicians’ short time with physicians means teamwork is essential.

Among his suggestions:

  • “Consider scheduling an appointment with PCP for medication review.
  • “Consider scheduling an appointment with PCP for pain assessment in older adults.
  • “Consider scheduling an appointment with PCP for functional status assessment.
  • “Consider scheduling an appointment with PCP for advance care planning.
  • “Consider scheduling an appointment with PCP for use of high-risk medication.
  • “Consider educating member/caregiver regarding cardiovascular and respiratory symptoms.”



Calif. physician sues, asserting hospital poaching killed his practice

— Photo by Etan J. Tal

Old warning in Cornwall.


Becker’s Hospital Review reports:

“A California OB-GYN physician filed a lawsuit against Covina, Calif.-based Citrus Valley Health Partners, claiming the hospital negotiated in bad faith to buy his practice and proceeded to lure away and hire several other physicians at the practice, forcing its closure, according to San Gabriel Valley Tribune.

“Here are five things to know:

1. “Carlos Beharie, M.D., owned and operated West Covina-based Citrus Obstetrics and Gynecology since 2002. During that time period, the practice grew to comprise a total of five physicians and delivered between 80 and 100 babies per month, Dr. Beharie told the publication.

2. “According to the lawsuit, Citrus Valley Health Partners offered to purchase Dr. Beharie’s practice in early 2017, but offered $1 million for the practice, despite the fact the practice brought in revenues of at least $1.4 million annually.

3. “Negotiations between the two organizations reportedly stalled in August 2017. Two months later, three physicians employed by Dr. Beharie informed him they planned to leave the practice and instead work for Citrus Valley Health Partners, the lawsuit states.

4. “Dr. Beharie said he was forced to close the practice in January. A lawyer for Dr. Beharie told the San Gabriel Valley Tribune Citrus Valley Health Partners used information made available in negotiations to subvert the practice, essentially causing it to close.

5. “Citrus Valley Health Partners did not comment on the pending litigation, but said one of its hospitals had worked closely with ‘physician groups’ to provide care to residents in the San Gabriel Valley.”

To read the whole article, please hit this link.


Highmark: Value-based program saved $260 million

Highmark headquarters, in Pittsburgh.

Pittsburgh-based Highmark Inc. said its value-based payment program saved the insurer more than $260 million within its first year.

The nonprofit insurer said that  its value-based program for primary-care physicians cut hospital readmissions 16 percent last year, which potentially saved $224 million. Further, it reported, an increased focus on prevention, including screenings and vaccinations, helped saved an estimated $38 million in avoidable emergency room visits.

This seems to be a trend. For instance, UnitedHealthcare expanded its bundled-payment program in May after it netted $18 million in savings from a total of 115 employers in the program since 2016.

To read Highmark’s press release, please hit this link.

To read FierceHealthcare’s report, please hit this link.


Study: Hospital-at-home might be good for some acutely ill people at ED

Med Page Today reports:

“Hospital-at-home (HaH) care may be a good replacement for traditional inpatient services among some patients who arrive at the emergency department (ED) with an acute condition, a health system reported.

“In 2014, the Icahn School of Medicine at Mount Sinai in New York City was given a Health Care Innovation Award by the Centers for Medicare & Medicaid Services to demonstrate the clinical effectiveness of HaH care bundled with a 30-day postacute period of home-based transitional care. Since then, the institution’s Albert Siu, MD, MSPH, and colleagues observed that several measures did favor HaH care over inpatient hospitalization:

  • “Acute period length of stay: 3.2 versus 5.5 days (weighted P<0.001)
  • “All-cause 30-day hospital readmissions: 8.6% versus 15.6% (weighted P<0.001)
  • “ED revisits: 5.8% versus 11.7% (weighted P<0.001)
  • “Admissions to skilled nursing facilities: 1.7% versus 10.4% (weighted P<0.001)
  • Rating their hospital care highly: 68.8% versus 45.3% (weighted P<0.001)

“Yet rates of referral to a certified home healthcare agency yielded no difference between groups, Siu’s group reported online in JAMA Internal MedicineEven so, they maintained that that their findings justify creation of a new payment model within Medicare’s current portfolio of shared savings programs.”

To read the entire Med Page Today article, please hit this link.

To read the stud in JAMA InternaL Medicine, please hit this link.



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