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3 Ohio systems create wider trauma-care network


The Cleveland Clinic.

Three major hospital  systems in northern Ohio are joining to create a trauma-care network in the region to, it is hoped, provide coordinated care.

The Northern Ohio Trauma System (NOTS), originally formed in 2010 as part of a partnership between MetroHealth System and Cleveland Clinic, has now added University Hospitals. The trauma-treatment system is meant to serve a seven-county region in northeastern Ohio, whose major city is Cleveland.

FierceHealthcare reports that “NOTS includes three Level 1 trauma centers, Cleveland Clinic Akron General Hospital, the emergency department at MetroHealth’s main campus and University Hospitals Cleveland Medical Center, which will accept the most severe patients. Pediatric patients will be sent to University Hospitals Rainbow Babies & Children’s Hospital’s pediatric trauma unit.Other patients will be sent to one of several Level 2 or Level 3 trauma centers across the three health systems.”

To read more, please hit this link.

Cleveland Clinic plans hospital in London


Buckingham Palace.

Cleveland Clinic plans  to convert a six-story office block in London into a 205-bed hospital overlooking Buckingham Palace, according to the Evening Standard.

This would be Cleveland Clinic’s  first  hospital in the United Kingdom. It’s part of a trend in which some of the most prestigious hospitals in the United States seek to profit from their  international fame by building hospitals abroad that cater to affluent patients.

To assuage neighborhood fears, Cleveland Clinic has guaranteed there will be no emergency department in the facility.

“I am delighted to submit our plans to Westminster City Council for determination. Since 1921 we have established a reputation as one of the most trusted and respected providers of healthcare. We are looking forward to the opportunity to provide our unique model of care to patients in London, one of the world’s great cities,” said Toby Cosgrove, M.D., president and CEO of Cleveland Clinic.

“After training in London as a cardiac surgeon, I know that the city offers a unique combination of world-leading medical research and some of the best and most respected healthcare professionals.”

To read the Evening Standard’s story on this, please this link.


5 ways to reduce hospital employees’ stress

STAT looks at five ways  in which some hospitals are trying to relieve employees’ stress:
They are:

Pressing reset

“At Hennepin County Medical Center, in Minneapolis, administrators created a ‘reset room’ where employees can grab a quiet moment to themselves or take a quick nap.”

Tapping the spiritual

“At M.D. Anderson Cancer Center, in Houston, physicians and nurses visit a prayer labyrinth to recover from a sad or stressful episode in the facility….”

Arts, craft, and live music“Hospital arts programs are going beyond pinning a few colorful paintings on the walls.

“At MedStar Georgetown University Hospital, in Washington, D.C., nurses and doctors listen to live music, dance, and work on a wide range of projects, from bracelet making to creative writing. Julia Langley, director of the hospital’s Lombardi Arts & Humanities Program, said it is crucial for front-line caregivers to have a creative outlet.”

Taking a deep breath

“Hospitals are also placing a greater emphasis on physical activity for staff members. Instead of just opening a gym in the basement, many administrators are finding ways to incorporate exercise into the work day.”

Relieving information overload

“Cleveland Clinic administrators are targeting a primary source of stress for physicians: the electronic medical records system.

Record-keeping requirements force most physicians to spend more time working on computers than treating patients, which is not why they joined the profession, said Dr. Sumita Khatri, of the Cleveland Clinic Pathobiology Department.

“Dr. Khatri is working with a panel of physicians to redesign daily workflow to help relieve the burden of record-keeping requirements. The effort involves creating customized software and delegating some EMR work to physician’s assistants, among others. ”

To read the STAT story, please hit this link.

8 systems that have successfully moved into value-based care


Dan Beckham, writing in Hospitals &  Health Networks, looks at eight systems that have followed consistent strategies to create value-based systems.

The systems are:

  1. Advocate Health Care:  Mr. Beckham cites how it turned its physician-hospital organizations “into a super-PHO, becoming the national benchmark for clinically integrated networks.”
  2. Banner Health: “Banner centralized leadership and governance, and standardized care and management processes.”
  3. Baylor Scott & White Health: “Scott & White brought its highly integrated multi-specialty group practice model and its health plan to the merger, while Baylor brought a robust network of hospitals, surgery centers and entrepreneurial partnerships.”
  4. Cleveland Clinic: ”A pioneer in transparency related to demonstrated value and bundled contracts, Cleveland Clinic has combined one of America’s premier multi-specialty group practices with community hospitals and independent physicians to produce a powerful economic engine.”
  5. Geisinger Health System: “It is internationally recognized for innovating at the interface between health insurance, inpatient care, outpatient care and physician practice. Few organizations have positioned themselves as purposefully as Geisinger for the transition from volume- to value-based payment.”
  6. Intermountain Healthcare: “The late W. Edwards Deming, a quality icon, was a central inspiration for Intermountain’s relentless battle to drive out variation. While many health systems treated total quality management and its variants as a passing fad, Intermountain dug in and made it a way of life. The presence of Intermountain contributes greatly to Utah’s position as one of America’s healthiest places to live.”
  7. Mayo Clinic: “Its strength flows, to a great extent, from the team-based multispecialty group practice model that has been central to its operations since its founding, along with its unwavering focus on putting patient interests first. The ‘Mayo way’ is well-engineered and nonnegotiable. No organization has deeper, better-connected data.”
  8. Sentara Healthcare: “When other systems experimented with ownership of health plans, then exited in the face of losses, Sentara persevered. When physician employment became too big a financial burden for others, Sentara doubled down. Because it persisted when others folded, it was able to put more than two decades of experience into its intellectual bank vault. It learned to meld a managed care enterprise, a hospital enterprise,  and a physician enterprise into a formidable integrated delivery system.”
    To read all of Mr. Beckham’s piece, please hit this link.

Here’s the latest in CMS’s hospital-rating saga



For Kaiser Health News

Over the past decade, the federal government has publicized 115 different ways to measure medical quality in hospitals, from assessing wait times in emergency rooms and noise levels outside hospital rooms to tracking blood clots in surgical patients. But the latest effort, to combine dozens of metrics into one patient-friendly quality indicator, has proven the most contentious.

The Centers for Medicare & Medicaid Services recently postponed its plan to release the new rating system, which would award one star to the worst-quality facilities and five stars to those with the best marks. The delay came after a majority of members of Congress signed a letter supporting the hospital industry’s concerns.

Hospital leaders who previewed the preliminary rating system say that the formula seems skewed against institutions that treat the poorest or toughest patients, meaning those with complex illnesses. The number of stars would be based on 64 different measures, which are posted on Medicare’s Hospital Compare Web site. The metrics on mortality, readmission, patient experience and patient safety are the most influential, each representing 22 percent of a facility’s rating.

Steven Lipstein, president of BJC HealthCare, a St. Louis-based nonprofit that runs 14 hospitals, said the ones in his organization that earned five stars were smaller, located in affluent areas and handled less complicated cases. “They don’t have comprehensive cancer centers, they don’t have major cardiovascular disease, they don’t have neuro-specialties,” he said.

BJC’s more advanced hospitals did worse, he said. “That’s not surprising when you look inside the ratings and see how they’re built,” he added.

Consumer advocates defend the rating system, saying that while not perfect, it correctly reflects higher rates of problems in some big institutions despite their lofty reputations. They worry that delay and congressional resistance are undermining Medicare’s attempt to help consumers select a hospital based on something more substantive.

“The star ratings hopefully will get quality into that decision-making process,” said Andrew Scholnick, a lobbyist for AARP, the advocacy group for seniors.

Medicare officials initially said they hoped to release the ratings to the public in July. But in a presentation to hospitals and other interested parties on May  12, they did not set a firm date.

Medicare already has made minor tweaks in the formula to calculate the stars, but it remains a tough grader, the presentation shows. If Medicare releases the star ratings in July, nearly half of the 3,658 hospitals being evaluated would be getting three stars, according to Medicare’s preliminary calculations. Just 100 hospitals would receive five stars, while 135 would receive a single star.

Officials indicated they were standing firm in their intention to eventually release the scores. “The Overall Star Rating represents a performance summary designed to facilitate patient and consumer use of Hospital Compare,” the presentation said. Officials plan to update the scores every three months through the end of this year and then twice thereafter.

The broader debate about the government judging hospitals has been going on since Medicare began publishing quality ratings in 2005. But it has intensified since passage of the Affordable Care Act, which instructed Medicare to use quality metrics in setting payments.

Teaching hospitals as a group have tended to fare poorly from some of these financial incentives. This year, for instance, nearly half of major teaching hospitals are losing 1 percent of their Medicare payments because of high rates of infections and surgical complications. Facilities with more low-income patients, who often face difficulties affording medication, following complicated recovery instructions and getting to doctors regularly, typically have higher readmission rates.

Some health care researchers are also skeptical. “If you come out with a rating that says Cleveland Clinic is terrible but podunk hospital in North Carolina, they’re the bomb, there’s a disconnect,” said Ashish K. Jha, a professor at Harvard’s public health school. “If it completely contradicts everything you’ve known, you need to ask yourself, ‘Did I not understand the way hospital care works, or is there a problem with the metric?’”

Medicare’s move toward using star ratings is part of a greater focus on easy-to-grasp composite judgments of hospital quality. The Leapfrog Group, a nonprofit patient-safety group, uses report-card letter grades to characterize hospital safety based on many of the same individual measures as Medicare. Healthgrades, a Denver-based company, judges hospital quality with one, three or five stars. Consumer Reports calculates a safety score on a 100-point scale.

Medicare hopes that a star rating from the government will carry even more credibility.

“People need this information now,” Scholnick said. “Trying to wait until everyone’s 100 percent happy with everything just delays it further than it needs to be.”

Retail clinics get ever bigger role

MedCity News reports that CVS MinuteClinic will offer customers access to Cleveland Clinic physicians through American Well’s video interaction technology. Internationally famed Cleveland Clinic also provides on-demand care through its Express Care Online service. The service will be available to CVS MinuteClinic customers in Ohio and West Virginia.

2015 results of 4 big systems


Herewith 2015 financial results of four big systems:

1. Chicago-based Presence Health had an operating loss of about $186 million on $2.5 billion in revenue, a huge widening from the 2014  operating loss of $12.7 million on nearly $2.6 billion in revenue.

2. Intermountain Healthcare had revenue of $6.1 billion in 2015, up 9.6 percent from a year earlier. But the Salt Lake City-based system’s operating income of $228.5 million was down  24.1 percent from $301.4 million a year earlier.

Rochester, Minn.-based Mayo Clinic‘s revenue rose 5.7 percent to $10.3 billion. But operating income fell 36.9 percent to $526 million.

4. Cleveland Clinic had  revenue of $7.2 billion, up 7 percent from 2014. The hospital network recorded operating income of $481 million, up 3 percent.

Hospitals trying to flag high medication costs


Hospitals around America are looking for new and creative ways to control spiraling drug costs.

For instance, as this Washington Post story reports:

“Doctors at the University Hospitals of Cleveland see an immediately recognizable symbol pop up alongside certain drugs when they sign in online these days to prescribe medications for patients: $$$$$.

“The dollar signs, affixed by hospital administrators, carry a not-so-subtle message: Think twice before using this drug. Pick an alternative if possible.”

“Here’s the thing that makes it more challenging: The patient doesn’t initially see the price increase,”  Scott Knoer, chief pharmacy officer at the Cleveland Clinic, which has built an algorithm to monitor drug prices, told The Post. “But it raises the cost for the hospital. Eventually, it catches up and it raises the cost for insurance companies, which is passed on to employers, employees and taxpayers through higher premiums and co-pays.”

The paper said that “Last year’s headline-grabbing spikes appear to have waned in recent months, perhaps because the issue has come under such an intense public spotlight.”

“I don’t think you’re going to see these 300, 400, 500 percent increases, at least for a while,” Mr. Knoer said, “even as he noted one 120 percent hike flagged by the hospital’s new algorithm.”

“We’ll still see significant increases, but it won’t be so obvious. Prices are not going down,” he said.

Mo. hospital links with Cleveland Clinic


In another example of marketing-obsessed healthcare facilities around America linking up with the most famous institutions, St. Luke’s Hospital in Chesterfield, Mo., has  set up an exclusive affiliation with the Cleveland Clinic Heart and Vascular Institute. Chesterfield is an affluent suburb of St. Louis.  Quite rationally,  such prestigious institutions as the Cleveland Clinic, the Mayo Clinic, Johns Hopkins and the Harvard-affiliated Partners HealthCare seek out connections with affluent places where patients have generous private insurance plans.

Becker’s Hospital Review reports that under the five-year deal, Cleveland Clinic will contract directly with payers and employers to create incentives for employees to seek cardiac care from St. Luke’s.

The affiliation will  give St. Luke’s access to Cleveland Clinic clinical trials, new technology, reviews of complex cases and continuing medical education, St. Luke’s hospital officials said. St. Luke’s specialists will be able to consult with Cleveland Clinic physicians to obtain a second opinion.

Cleveland Clinic will be a consultant for the 493-bed hospital, and St. Luke’s will pay the world-famous institution for its “expertise and guidance,” said St. Luke’s CEO Christine M. Candio. Operating as a group purchasing organization, Cleveland Clinic will also help St. Luke’s buy the latest technology at a lower cost.


Cleveland Clinic clinicians to shadow patients



Cleveland Clinic’s executive chief nursing officer, K. Kelly Hancock, R.N., discusses in MedPage Today a new program this year at the Cleveland Clinic in which providers, such as nurses and physicians,  shadow patients during their inpatient stay or outpatient visit to better understand, she says, “what their experience is through their lens…. {It’s} important enough that it’s clearly worth the investment to take those caregivers offline.”
“….We know the best feedback is from the patient. We think it really will lend itself to some great feedback to develop stronger interventions.”

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