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5 steps to transform U.S. healthcare into a true ‘system


In a MedPage Today piece, Stephen Parodi, M.D.,  chairman of the Council of Accountable Physician Practices (CAPP), a coalition of multi-specialty medical groups and health systems,  presents five things needed to improve America’s mediocre medical-delivery world.

He notes that ”to improve the healthcare industry’s quality and costs, we need a true ‘system,’ with coordinated care delivered by teams linked by technology that closes the gaps in our current fragmented structure. ”

His five steps are, in an edited version:

More Value-Based Care

“First, we must continue the march toward value-based care and away from fee-for-service payments. Payment by service discourages the cooperation and collaboration each and every patient deserves. Fee-for-service payment increases the likelihood of poor communication. In contrast, when healthcare providers are paid based on their ability to improve the patient’s condition, the care team and the patient can come together to achieve common goals. Consequently, outcomes are better, and resources are used wisely.”


“Second, we need to accelerate the journey toward interoperability. Everyone on the care team needs the latest information on the patient’s condition, at their fingertips at all times. When everyone is connected to the medical record, the best, most timely decisions are made and errors avoided.”

Balance Digital and In-Person Care

“Third, we must rapidly move forward to leverage digital communication in patient care and in physician-to-physician consults.”

Address Drug Prices

“Fourth, high drug prices must be addressed and remedied. When patients can’t afford their medications, they can’t get the treatment needed. … Fortunately, there may be bipartisan support for solving this problem. We need better, independent data to assess new therapies so we truly understand which patients need a particular treatment. We need to subject high drug prices to public scrutiny and oversight and give Medicare, purchasers, and patients more tools to rein in escalating drug prices.”

Let’s Set Standards

“Finally, we must establish common consensus standards to measure quality care. Patients, health plans, providers, government entities – everyone needs clarity on the high-impact, minimum set of quality measures that capture outcomes and patient experience. We must leverage the electronic medical record to lower the administrative burden of collecting measures.”

To read his whole article, please hit this link.


Benefits of patient safety organization alignment


An article in Medical Economics discusses how providers can benefit from patient safety organization (PSO) alignment.

The article concludes:

“By aligning with a PSO, a provider’s internal deliberations and analysis conducted within its own patient safety evaluation system are also privileged and confidential PSWP (patient safety work products).  As a result, a provider can evaluate its own data before sending it to a PSO, and can also consider a PSO’s recommendations in a completely privileged and confidential setting that avoids the scrutiny of regulators and potential litigants.

“The other major benefit of alignment with a PSO for providers involves improvement of patient safety and clinical outcomes. By contracting with a PSO, providers gain immediate access to evidence-based recommendations on quality issues confronting their peers, as well as empirically-based recommendations on how their practices might be improved and made more efficient. ”

To read the article, please hit this link.


Opioid crisis helps energize leaderships and create partnerships


Three physician leaders in Michigan agree that it takes a health crisis, such as opioid-addiction disaster, for partnerships to form to try to adequately address the issue.

One of the three, John Ayanian, M.D., said, in an NEJM Catalyst conversation: “A crisis can often unmask deep, underlying disparities and disadvantage in the communities we serve.” Dr. Ayanian is the inaugural director of the Institute for Healthcare Policy and Innovation, which includes over 500 faculty members from 14 schools and colleges at the University of Michigan.

To read and hear the conversation, please hit this link.





2019 outlook for not-for-profit hospitals not that grim


The financial outlook for not-for-profit hospitals has sounded  dismal for the past several years. As FierceHealthcare reports:

“They face ongoing pressures of soft revenue growth, weak inpatient volumes and single-digit reimbursement increases, pushing margins down as expenses outstrip revenue—a trend that Moody’s called an ‘unsustainable path,’ earlier this year.

New reports from the two top rating agencies—Moody’s Investors Services and Fitch Ratings—offer, for yet another year for not-for profit hospitals, a gloomy outlook for 2019. But, Fierce reports:

“[W]hile these hospitals face a tough road ahead, the news is not as bad as it might seem, said Kevin Holloran, senior director at Fitch who just gave the sector a ‘negative’ outlook.

“‘We’re putting warning flags up, but no ones calling for disaster,’ Holloran said. ”

”He acknowledged operating margins have been on the decline while hospitals deal with nontraditional competition, new technology changing the way medicine is practiced and the continued shift from inpatient to outpatient care. ‘But pretty much, however, you want to measure it, balance sheet strength is pretty much at an all-time high.”’

“He pointed specifically to hospitals’ days’ worth of cash on hand, as well as their cash-to-debt and debt-to-capitalization ratios as measures in particular that had been improving over time, leading to stable ratings for the sector.

“That’s because when times were good and the markets were rebounding several years ago, hospitals were building up their reserves and shrinking their capital expenditures.

“‘Until a significant market dislocation, we expect those balance sheets to remain kind of robust which is going to balance out the negatives from operations.”’

To read the whole article, please hit this link.

Relying on ’15-minute huddles’

Marc Harrison, M.D.,  CEO of  Salt Lake City-based Intermountain Healthcare, based in Salt Lake City,  writes in the Harvard Business Review about his system’s intense use of “15-minute huddles” to maximize care and efficiency.

“At Intermountain, the 15-minute huddle is the key. It enables knowledge from activities throughout the organization in the previous 24 hours to escalate up to executive leadership — Tier VI in our model — and be addressed.

“Using that 15 minutes effectively requires structure: Each huddle has a leader; the participants are designated, as is the recorder of the data; the huddle is scheduled; and the categories of reported information are captured on a prepared chart. We have four fundamentals of extraordinary care that are covered in our daily huddles: safety, quality, access, and stewardship of resources so they are used to provide the best possible care. Across those fundamentals, eight key topics are reported every day. They include potential serious safety events that could have harmed a patient, caregiver injuries, and reported downtimes (of equipment, elevators, systems or processes, for example).”

To read the article, please hit this link.

The transformation of Ohio’s healthcare


Governing Magazine looks at how a small state office in Ohio has transformed healthcare in that state. The article concludes:

“When he ran for president in 2016,  {Ohio Gov. John} Kasich took heat from his Republican primary opponents for his health-care decisions. He was assailed for expanding Medicaid, which many Republicans see as an unsustainable financial proposition that merely increases the size of government. These days, Kasich says he’s not interested in pleading his case to other Republicans about why he believes expanding and transforming health care works. He says he’s convinced history will show he made the right decision. ‘Tell me how [else] you’re going to go about meeting the needs of people. Tell me what you’re going to do to help the drug addicted and mentally ill. I haven’t heard of a better solution,’ he says. Everything else ‘is all smoke and mirrors.”’

To read the article, please hit this link.


Mount Sinai to provide services to Taikang Healthcare

New York City-based Mount Sinai Health System  has reached an “historic agreement” with Taikang Healthcare, in China, to provide clinical and management knowledge transfer services.

FierceHealthcare reports:

“Under the agreement, Mount Sinai will also provide education and training programs for Taikang’s Xianlin Drum Tower Hospital in Nanjing, the capital of Jiangsu Province in east-central China. Officials said Mount Sinai will also provide guidance in implementing medical care delivery standards, as well as developing clinical centers of excellence and best practices in hospital management.

“‘Our mission is to enable our international partners to raise the standards of healthcare delivery in their communities by leveraging Mount Sinai’s repository of medical knowledge, cutting-edge clinical innovations, and educational resources,”  said Arthur Klein, M.D., president of Mount Sinai Health Network.

To read more, please hit this link.


Using blockchain to speed credentialing


FierceHealthcare reports:

“Two national insurers and a Michigan health system are joining a new pilot project aimed at simplifying physician credentialing with blockchain technology.

“WellCare and Spectrum Health are among the founding participants in a pilot project launched by ProCredEx, a new company backed by Hashed Health, which specializes in blockchain and distributed ledger technologies for healthcare.

“National Government Services, an Anthem-owned federal contractor that processes Medicare claims for the Centers for Medicare & Medicaid Services (CMS), has also joined the pilot program alongside The Hardenberg Group and Accenture.”


To read the whole article, please hit this link.

How established physicians relate to new ones


An article from Medscape looks at how established physicians look at working with new ones. The article starts:

“Younger professionals entering into any workplace have doubts and concerns about how their established peers feel about them. That’s especially true for freshly minted doctors. Having just finished the debt-laden, stressful grind that is medical school, they are eager to be seen as the medical professionals they are. But what do the doctors whose staffs they are joining actually think about them?

“We asked 10 doctors across eight different specialties to share their thoughts on their younger peers. Their candid responses suggest healthy amounts of respect, but also surprising insights that point not only to generational differences but also to potential changes on the horizon for medicine. Here’s what they had to say.”

To read the piece, please hit this link.


The changing role of the CMO


An article in NEJM Catalyst examines the evolving role of the chief medical officer. Among the observations:

“The CMO has been described as the Influencer in Chief, functioning to facilitate change and build resilience. To be effective, the CMO must not only perform as a leader within the hospital C-suite, but must also mentor leadership capacity among the medical staff. CMOs are frequently involved with organizational cultural change, including the transition from volume to value. Focus on value creation may bring about increased scrutiny on CMOs to ensure return on investment.”

To read the whole article, please hit this link.


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