This Hospital Impact piece says: ”Effective collaboration between pharmacy and nursing has enabled us to identify and design medication management processes that create the most efficient workflows for both departments while keeping patient safety at the forefront. The result has been more nursing time at the patient bedside and cost reductions through greater efficiencies,” reports Hospital Impact.
The writers recommend that hospital and other healthcare leaders:
1. Provide top-down resource support for better nurse-pharmacy relations.
2. Improve workflow systems and patient care by leveraging automation.
”Kristen Miranda, vice president for strategic partnerships and innovation at Blue Shield California, said the changing payment landscape is resulting in some strange bedfellows….she cited the not-for-profit insurer’s partnership with competitor Anthem Blue Cross to launch the $80 million California Integrated Data Exchange as evidence of unique collaborations aimed at creating a more efficient healthcare system.”
Some argue that ”paying doctors more for services provided at hospitals than they get paid for the same care delivered in an office is driving up costs and driving consolidation. ‘The site-of-service differential has to go,’ said Simeon Schwartz, CEO of New York’s WESTMED Medical Group,” Modern Healthcare reported.
The iconic Broadmoor resort and hotel, in Colorado Springs.
As the goal of healthcare providers shifts from just caring for the sick and injured to improving their regions’ overall health, hospital design and services are rapidly changing.
Owned by Centura Health, the campus will open next Tuesday. It will have a birthing center, intensive-care unit, emergency department, surgery centers and a 92-bed hospital serving as hub for more than 50 primary- and specialty-care practices from the region.
She shared her insights at the 2015 OPEN MINDS Performance Management Institute event, according to an executive briefing on the Open Minds Web site, FierceHealthcare reported.
Primary Partners, with more than 40 independent practices and 65 provider organizations, was one of the 27 ACO’s to participate in the first cohort of ACO’s in April 2012. It runs under the advanced payment model, a variation of the Medicare Shared Savings Program (MSSP).
In its first year — the only one for which data are available –Primary Partners got a 22 percent decrease in the number of emergency department visits that result in hospital admission. But it didn’t meet some other MSSP performance measures and so didn’t benefit from any shared savings.
Ms. Fusé and her colleagues learned that a key cost-saving strategy was to identify the “high-utilizer group” in its population and use social workers to coordinate care for them. “One recent study indicated that these super-users’ complex health needs are complicated by their limited care access. However, Primary Partners is ‘still working on perfecting the model’ of data analytics it uses to identify these high-utilizers….”
“Primary Partners also has found that because ACO’s are not eligible for shared savings if they do not retain 70 percent of their populations, the organization’s success hinges on building strong patient-provider relationships to retain its patient base.
Enchanced medication management to reduce non-adherence as well as committing to tracking patient outcomes are also very important.
“The creation of specialized health courts is gaining new momentum on Capitol Hill. Earlier this month three prominent Members of Congress introduced an alternative to the Affordable Care Act, which includes the creation of health courts. While the future of that plan is unknown, the inclusion of health courts is significant, because health courts have previously been endorsed by President Obama. Health courts could thus emerge as a point of bipartisan agreement.
….”Included in the nine-page summary of its provisions is the following language: “States could also elect to establish a state Administrative Healthcare Tribunal, or ‘health court,’ presided over by a judge with healthcare expertise who can commission experts and make the same binding rulings that a state court can make.”
”The concept of health courts has been championed by Common Good—the nonpartisan government reform coalition—working in conjunction with experts at the Harvard School of Public Health. Under Common Good’s model, health courts would have judges dedicated full-time to resolving healthcare disputes. The judges would make written rulings to provide guidance on proper standards of care. These rulings would set precedents on which both patients and doctors could rely. To ensure consistency and fairness, each ruling could be appealed to a new Medical Appellate Court.
”Health courts are aimed not at stopping lawsuits but at restoring reliability to medical justice. Special courts have long been used in American justice in areas of complexity where reliability requires judges, who can make consistent rulings from case to case, rather than juries, which have no authority to set predictable precedents. In the early republic, America had special admiralty courts. Today, there are special courts for tax disputes, family law, workers’ comp, vaccine liability and a wide range of other specialized areas.”
“I believe … in March we’ll come up with a patch, likely for 4 to 6 months, and then come forward with full-scale repeal,” most likely tied to the reauthorization of the Children’s Health Insurance Program (CHIP), which expires Sept. 30.
Republican efforts to replace the federal health law have been given new urgency by the U.S. Supreme Court.
As soon as this spring, the court could invalidate health insurance subsidies available to millions of Americans if it rules for the challengers in a case called King v. Burwell.
Republicans who hate the Affordable Care Act are rooting for the court to do what they have been unable to accomplish – dismantle a key part of the law. But as the party that controls Congress, some Republicans also fear the potential for a backlash if they don’t have a plan to help those who would effectively be stripped of coverage, many of whom are voters in Republican-led states.
There’s another reason to agree soon on a replacement for the law, instead of continuing their long campaign to repeal it. If Republicans present a reasonable alternative, it could help swing a justice or two who might otherwise worry about the possible ramifications of cutting off the subsidies. Or so the reasoning goes.“The Republicans would love to give the justices some comfort that if they rule against the Obama administration, there will be something there to deal with the fallout,” says Dean Clancy, a Republican strategist and former aide to former House Majority Leader Dick Armey.
Those pushing the case argue that language in the law limits help to pay for insurance to residents of states that have established their own health insurance exchanges. So far only 13 states have – the rest use the federal healthcare.gov exchange. The administration contends that Congress clearly intended that the subsidy — tax credits based on income — be available in all states, and has declined to discuss any possible contingency plans.
If the court rules against the administration, the impact will fall heavily on Republican-led states, such as Florida and Texas, that didn’t create their own exchanges, increasing pressure on Congress to act. free
“I really do believe that this situation has concentrated the minds of many people on [Capitol] Hill,” says Avik Roy, a senior fellow at the Manhattan Institute and a former health adviser to GOP presidential candidate Mitt Romney. If the Supreme Court rules that subsidies cannot be provided through the federal health exchange, he says, Republicans in the House and Senate “realize if they don’t do something, they will be held accountable for that. Because they are running Congress now, so they can’t blame it on the Democrats.”
Still, putting something on the front burner does not guarantee it will get done. Republicans have been vowing to “repeal and replace” the Affordable Care Act almost since it became law in 2010. So far, the GOP-controlled House has held more than 50 separate votes to repeal or otherwise cancel parts of the law. Replacing, however, has been another story.
“Republicans are united around repeal. And they’re united around replace. But obviously they’re not united around ‘replace with what,’” says Dean Rosen, a health-policy consultant who was a top aide to former GOP Senate Majority Leader Bill Frist and to the House Ways and Means Committee.
Republican health strategist Terry Holt, a former aide to the GOP House leadership, agrees. He says Republicans “are serious about a replacement” for the Affordable Care Act, “but it’s the law, and it’s harder to change law than to make it.”
There are several efforts underway to come up with a consensus Republican alternative to the health law. The repeal bill the House approved Feb. 3 includes language requiring the four main committees that handle health legislation in that chamber to approve a replacement, but no time limit is specified. Separately, three of those committee chairmen were tasked by House Majority Leader Kevin McCarthy in January to come up with a health bill, again with no specific deadline.
Across the Capitol, two GOP senators with deep backgrounds in health — Finance Committee Chairman Orrin Hatch (R.-Utah) and Richard Burr (R.-N.C.) — along with House Energy and Commerce Committee Chairman Fred Upton (R.-Mich.) have unveiled the outlines of a plan that was first floated last year.
And House Ways and Means Committee Chairman Paul Ryan (R.-Wis.) has said Republicans in the House are working on a short-term “bridge” for those who could get stripped of their insurance subsidies, although again, no specifics have been offered.
Even with new incentives, getting to specifics won’t be easy, says Clancy, for much the same reasons that have kept Republicans from being able to agree on a health overhaul for the past five years.
“There are pro-business Republicans and pro-market Republicans, and you see the divide on lots of issues, including healthcare,” he says.
For example, the more pro-market, libertarian types “would say let’s get the federal government out of the health insurance business altogether if possible, or at least create a much more voucher-like system with as little centralized control as possible,” he says. But the more traditional pro-business Republicans “are not going to be keen on blowing up the employer-based system.” Currently a majority of Americans still get their insurance through their or a family member’s job.
Another complication, says Rosen, is the impending presidential campaign, and the possibility that several sitting members of the Senate may run. “And you can see that the people who are posturing to be candidates … don’t just want to do Obamacare light,” he said.
Still, the prospect of millions of people in states run by Republican governors and Republican legislatures losing their insurance could be the deciding factor, says Holt. “These are people who have been promised something and are expecting it to continue, and it’s hard to see how you cut people off,” he says.
The justices are expected to rule by the end of June on whether residents in at least 34 U.S. states are eligible for federal tax subsidies. Oral arguments are scheduled for March 4.
Some states are madly scrabbling to address what could be a chaotic and angry situation if millions lose their insurance. The Republicans fear that they’ll be blamed more than would the Democrats.
Republican plaintiffs argue that the federal funds cannot pay for insurance in states that didn’t create their own insurance exchanges and instead rely on the Feds’ HealthCare.gov Web site.
The sleek hospital tower that Johns Hopkins Medicine built in 2012 has the frills of a luxury hotel, including a meditation garden, 500 works of art, free wi-fi and a library of books, games and audio.
As Dr. Zishan Siddiqui watched patients and some fellow physicians in Baltimore move from their decades-old building into the Sheikh Zayed Tower, the internist saw a rare opportunity to test a widespread assumption in the hospital industry: that patients rate their care more highly when it is given in a nicer place.
For decades, hospital executives across the country have justified expensive renovation and expansion projects by saying they will lead to better patient reviews and recommendations. One study estimated $200 billion might have been spent over a decade on new building. Hopkins’s construction of the tower and a new children’s hospital cost $1.1 billion.
Patient judgments have become even more important to hospitals since Medicare started publishing ratings and basing some of its pay on surveys patients fill out after they have left the hospital.
Siddiqui’s study, published this month by the Journal of Hospital Medicine, contradicts the presumption that better facilities translate into better patient reviews. Siddiqui examined how patient satisfaction scores changed when doctors started practicing in the new tower, which has 355 beds and units for neurology, cardiology, radiology, labor and delivery and other specialties.
Siddiqui discovered that for the most part, patients’ assessments of the quality of the clinical care they received did not improve any more than they did for patients treated in the older Hopkins building, which had remained open. Units there were constructed as early as 1913 and as late as 1980, Hopkins officials said. They functioned as the control group in the study, since a hospital’s satisfaction scores often change over time even when a hospital’s physical environment remains constant.
The study used the responses both to Medicare-mandated surveys and private ones from Press Ganey, a consulting company that administers surveys. In the study, Hopkins patient ratings about the cleanliness and quiet in new tower’s rooms — elements Medicare uses in setting pay — soared, as did views on the pleasantness of the décor and comfort of the accommodations. But patient opinions about their actual care — such as the communication skills of doctors, nurses and staff — did not rise any higher than they did in the older building.
“Despite the widespread belief among healthcare leadership that facility renovation or expansion is a vital strategy for improving patient satisfaction, our study shows that this may not be a dominant factor,” Siddiqui and his fellow authors wrote.
Newer buildings allow for some medical benefits, such as better organized nursing stations and private rooms that protect against the spread of infectious bacteria and diseases. But the Hopkins researchers said “hospitals should not use outdated facilities as an excuse for achievement of suboptimal satisfaction scores.”The study’s results were startling because previous studies have found that patients in older hospital buildings give lower scores on the quality of their care.
Hospital executives have noticed it anecdotally as well; for instance, when NYU Langone Medical Center relocated its cardiology unit to a renovated floor, its patient experience scores rose.
A nationwide survey from 2012 conducted by the consultants J.D. Power and Associates reached similar conclusions to the Hopkins paper about the influence of the physical environment on satisfaction scores. That survey found that communication by doctors, nurses and other staff was most important, while the facility accounted for a fifth of patient satisfaction.
After reading the Hopkins study, Dr. Bradley Flansbaum, a physician at Lenox Hill Hospital, in Manhattan, wrote on the blog of the Society of Hospital Medicine that “it just might be that what doctors do and say matters, and a first-class meal and green gardens cannot paper over, or in the converse, sully our evaluations.”