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How U.S. healthcare cost structure is way out of whack


David A. Kindig and Bobby Milstein, writing in Health Affairs, discuss the extreme imbalances in the U.S. healthcare system. They conclude:

“The U.S. health investment portfolio is out of balance, with too much spent on some aspects of heath care and not enough spent on more influential determinants needed to produce equitable health and well-being. It is unreasonable to expect a robust culture of health to emerge without a different portfolio of investments. With costs rising throughout the health care sector and so many lives and livelihoods at stake, how long can Americans afford not to make smarter investments? There is an urgent need to balance the country’s total health investment portfolio, building on the policy and research opportunities we have highlighted here.”

To read their article, please hit this link.

Trump administration seems to support value-based care after all

Med City News looks at whether the Trump administration is pushing back against value-based care. The article notes:

“{T}he administration has shifted to a focus on voluntary bundles. CMS announced BPCI Advanced, the next-gen version of the original BPCI, in January. The first cohort will start participating in the model, which is voluntary, in October.” BPCI means Bundled Payments for Care Improvement.

“Via email, a CMS spokesman said the alterations to the mandatory programs ‘were made after a robust comment solicitation and were intended to encourage health system change while minimizing provider burden and maintaining access to care.’ The agency is examining the models started by the Obama administration ‘on a case by case basis’ to pinpoint opportunities to improve them.

“With all these cancellations and changes, is the Trump administration undermining value-based care? One industry expert said no, implying the genie can’t be put back in the bottle.”

“I think it’s clear that the principles of value-based care are still endorsed and appreciated industry-wide,” Dr. Charles Saunders,  M.D.,  of Integra Connect CEO, said in a recent phone interview. “I don’t think that there’s any backing off.” Integra provides solutions to optimize value-based patient care at individual, practice and population levels.

“Saunders noted that going forward, the models are likely to change and evolve, particularly as the culture of healthcare continues to adjust to value-based care,” Med City reported.

“I believe that we’ll continue on the course as an industry towards payment for value because the cost of healthcare is on an unsustainable growth path.”

“And perhaps he’s right. With Alex Azar taking the seat as HHS secretary earlier this year, the administration appears to be stressing the significance of fee-for-value. At his Senate confirmation hearing in January, Azar surprisingly expressed support of mandatory bundles.”

To read the whole article, please hit this link.

‘Our patients are not PowerPoint slides’


Structure of a EHR system.

“Why, in such a complex environment, have we allowed ourselves to become subject to an electronic health record that is not anywhere near as responsive as we would like, when it comes to making things better for patients and providers and the rest of the team taking care of all of these patients?”

“It seems strange that since healthcare providers across this country are paying thousands, tens of thousands, hundreds of thousands, and even millions of dollars to the EHR vendors, and since getting this right is so critical to being able to adequately care for patients in the challenging healthcare environment we are all practicing in, you’d think that the companies that make these things would be getting the message that what we have is just not enough.”

“As much as we’ve complained about these things through the years, it feels like we’ve been unable to move the needle away from the creators of the program controlling the content, how it looks, what we have to do to click the buttons to get through our day, rather than us, those of us who take care of the patients, who, believe it or not, probably know best what an EHR really should look like.”

“Our patients are not PowerPoint slides, and we are not presenters standing up in front of an audience where it’s okay if the slides don’t look exactly like you wish they looked.”

To read his whole essay, please hit this link.

Ascension, Providence St. Joseph Health end merger talks

The Wall Street Journal reports that Ascension and Providence St. Joseph Health have halted merger talks and that Ascension has embarked on a new strategic direction.

The WSJ reported in December that the two were discussing a merger, which, if approved, would create the largest U.S.  hospital operator in the U.S., with  191 hospitals across 21 states and total annual revenue of $44.8 billion.

The newspaper reported that Ascension’s new direction was in response to new competition from nontraditional sites of care, such as outpatient clinics, and payers’ pressure to cut reimbursements. The system’s operating margins have declined over the past year.

To read the WSJ article (subscription required), please hit this link.

To read FierceHealthcare’s take on this, please hit this link.



At Mayo, ‘forcing’ participants in ‘action-learning’ program to collaborate

The dramatic Plummer Building at the Mayo Clinic, in Rochester, N.Y.

— Photo by I, Jonathunder

A NEJM Catalyst report looked at an example of “action learning” for healthcare-leadership development at the Mayo Clinic. The authors write:

“In September 2015, Mayo Clinic embarked on an action-learning program called ‘Fresh Eye’  involving a group of 30 participants comprising physicians, scientists, administrators, and nursing leaders in the leadership succession talent pool. The program objectives were to develop strategic thinkers who would be able to effectively lead in the VUCA (volatile, uncertain, complex, and ambiguous) world of the healthcare industry.”

Among the article’s conclusions:

“We found that the Fresh Eyes action-learning program ‘forced’ participants to network and to collaborate with team members in ways that would not otherwise have occurred to them. During the course of the program, participants had the opportunity to talk about the guiding values and principles of the organization. Some physicians confessed that they initially felt uncomfortable having to share their individual development goals and engage in open reflection with people they did not know, but they also noted that they eventually became more comfortable as the team members built a level of trust with one another.”

To read the article, please hit this link.



Nurses group says Tenet slashed charity care at Detroit Medical Center

Part of the Detroit Medical Center.


The Michigan Nurses Association (MNA) has accused executives at Detroit Medical Center (DMC), owned by for-profit Tenet Healthcare, of cutting the hospital’s spending on indigent patients by 98 percent since 2013, when Tenet took over the hospital as part of its purchase of Vanguard Health System that year. Tenet had promised to maintain DMC’s historic commitment to charity care.

The MNA asserts that  DMC spent about $470,000 on charity care in 2016, down from almost $23 million in 2013.

DMC CEO Anthony J. Tedeschi, M.D., disputes the report’s conclusions, telling Michigan Radio that the MNA used  cherrypicked data. He also referred to contract negotiations between the hospital and the union, suggesting the report was an attempt to “distract us from what is most important.”

To read a FierceHealthcare article on this, please hit this link.

5 aspects of an effective hospital chief quality officer


David M. Williams, Ph.D., executive director at the Institute for Healthcare Improvement , writes in Hospital Impact about five things that make for an effective  hospital chief quality officer:

  • “Create the infrastructure to support quality. To succeed, a CQO must set up a strong quality department, develop strong physician leadership, align staff incentives to quality and link quality with financial goals—including those related to cost reduction, population health and value-based payments.”
  • “Understand and design services to meet the customer’s need. One of the central tenets of improvement science is to meet the needs of the customer. CQOs must lead organizations to understand their patients’ needs and translate that understanding into annual and five-year quality plans.”
  • “Create breakthroughs in quality improvement. No matter how robust the planning and design process is, there will always be aspects of services that fail to meet customer needs. Quality improvement is not only necessary to fix broken processes, but also to refine and innovate.”
  • “Sustain performance through predictable and reliable processes. Once stable processes have been developed, quality leaders must closely manage performance.”
  • “Foster a culture that turns every person in the system into an improver.  IHI’s framework for high-impact leadership describes a set of behaviors that result from a clear understanding of continual improvement and the leader’s role in promoting it across a system. These behaviors include an unrelenting focus on person-centeredness, the use of transparency as a lever and coaching to develop knowledge. CQOs can start right away on this last behavior by encouraging others to test their ideas.”
To read his entire essay, please hit this link. 




Ascension hints it will move away from hospital-focused system


Modern Healthcare (subscription required) reports:

“Ascension is restructuring as it pursues new strategic direction, hinting at transitioning from a hospital-oriented system to one that’s focused on outpatient care and telemedicine, the largest Catholic health system told its 165,000 employees early Friday morning via a video featuring Ascension President and CEO Anthony Tersigni that Modern Healthcare has exclusively obtained. ”

To read more, please hit this link.




Aetna CEO touts return to community-based healthcare


FierceHealthcare reports that Aetna CEO Mark Bertolini “is pushing for a return to community-based healthcare even as the insurance company prepares to merge with retail pharmacy giant CVS. ”

“Critics of the merger have said the deal will hurt competition and cut local services. But Bertolini said the $69 billion deal with CVS doesn’t change the fact that the healthcare industry is moving toward a renaissance of community-based care,” the news service reported.

“Everything is going back to community,” Bertolini said at a conference in California. “I think the best way to manage the kind of shift we’re in is to go back to community and build smaller and smaller governance models to help support the growth of this. What you’re in essence building is a marketplace in the community around health.” Aetna is based in Hartford and CVS in Woonsocket, R.I.

To read more, please hit this link.

Physician-coaching models



NEJM Catalyst recently published a very useful discussion about physician-coaching models, their potential and pitfalls. To read it, please hit this link.


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