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Brigham announces big buyouts; layoffs come next

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Boston’s Brigham and Women’s Hospital, although it is profitable,  is offering voluntary buyouts to 1,600 workers to curb costs. And it says that layoffs are likely later this year, with the number depending on how  many employees agree to be  bought out.

Brigham officials said the institution, part of Partners HealthCare,  feels squeezed by flattening payments from insurers and Medicaid and Medicare as labor and other costs are growing. Those other costs include those stemming from  a $510 million new building  and a $335 million new software system.

Brigham said that employees must be 60 or older to be eligible for the offer, which includes one year of base pay. But 5,300 physicians, faculty (Brigham is a teaching hospital for the Harvard Medical School), and research staff — will be excluded from the offer.

 To read more, please hit this link.

Care New England wants Partners to acquire it

 

Rhode Island’s Care New England hospital system wants to be acquired by Greater Boston’s Partners HealthCare, which includes such famed institutions as Massachusetts General Hospital and Brigham and Women’s Hospital.  CNE’s plan is to  sell off Memorial Hospital, in Pawtucket, R.I., as part of being acquired. Ohio-based Prime Healthcare would buy Memorial.

Because of Massachusetts state regulators’ concerns about Partners’ pricing power, that system has found it difficult to expand more in Greater Boston.

CNE’s  current units are:

“Today’s announcement represents the positive results of an extremely careful and deliberate process intended to ensure the best clinical, financial, and strategic direction forward for CNE,” said board Chairman Charles R. Reppucci, in a release. “While we are taking the first steps in this process, we do so with the utmost optimism and dedication to ensuring the successful completion of this affiliation with Partners which represents a unique and compelling opportunity in the advancement of Rhode Island healthcare delivery.”

Care New England has struggled financially in recent years and has  long been wanting to merge with another entity.

The system had  a $68.3 million operating loss in fiscal 2016 and a $1.8 million operating loss in fiscal 2015.

CNE has had a  relationship with Partners since 2009 through a clinical affiliation with Brigham and Women’s Hospital. And McLean Hospital, also owned by Partners, has  sometimes worked with Care New England’s Butler Hospital in behavioral health and research.

How such a merger would affect the Alpert  Medical School at Brown University is unknown. Partners has very close links with the Harvard Medical School.

Presumably the acquisition would involve  big golden parachutes for CNE executives.


The man who would take on Partners

 

The Boston Globe profiles Kevin Tabb, M.D., who runs Beth Israel Deaconess Medical Center, in Boston, and is now trying to engineer a merger between his system and another prestigious one — in Greater Boston — Lahey Health. Such a combined entity would presumably be better able to compete with the elephant in the region — Partners HealthCare.

To read the profile, please hit this link.

 

 


Mass. report cites unnecessary tests

In a report,  the MassachusettsHealth Policy Commission criticized  physicians and hospital systems it said routinely overused  (lucrative) medical testing. Such tests play a major role in healthcare price inflation.

The report’s writers used insurance-claims data and information collected by the Center for Health Information and Analysis to study healthcare spending trends.

The report defined unrecommended  care as  tests and procedures beyond a patient’s needs.

Physicians at Boston-based Partners HealthCare, Boston-based Steward Health Care System and Burlington-based Lahey Health, among others, were found to “regularly order unnecessary tests and procedures.”

Providers in the report that had the  the lowest rates of unnecessary care were BostonMedicalCenter and the physician group affiliated with Cambridge, Mass.-based Mount Auburn Hospital and Cambridge Health Alliance.

 

“Screenings, surgeries and lab tests are all important aspects of keeping people healthy,” Partners spokesperson Rich Copp told The Boston Globe. “We’ll take a closer look at the data in this report, but decisions about medical care will always be made as part of the doctor-patient relationship.”

To read the report, please hit this link.

To read The Globe’s story on this, please hit this link.


Some hospitals send patients to nightmare nursing homes

 

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By JORDAN RAU

For Kaiser Health News

At age 88, Elizabeth Fee looked pregnant, her belly swollen after days of intestinal ailments and nausea. A nurse heard a scream from Fee’s room in a nursing home, and found her retching “like a faucet” before she passed out.

The facility where she died in 2012 was affiliated with a respected San Francisco hospital, California Pacific Medical Center, and shared its name. Fee had just undergone hip surgery at the hospital, and her family, pleased with her care, said they chose the nursing home with the hospital’s encouragement.

Laura Rees, Fee’s elder daughter, said she was never told that the nursing home had received Medicare’s worst rating for quality — one star. Nor, she said, was she told that state inspectors had repeatedly cited the facility for substandard care, including delayed responses to calls for aid, disrespectful behavior toward patients and displaying insufficient interest in patients’ pain.

“They handed me a piece of paper with a list of the different facilities on it, and theirs were at top of the page,” Rees said in an interview. “They kept pointing to their facility, and I was relying on their expertise and, of course, the reputation of the hospital.”

Fee had an obstructed bowel, and state investigators faulted the home for several lapses in her care related to her death, including giving her inappropriate medications. In court papers defending a lawsuit by Fee’s family, the medical center said the nursing home’s care was diligent. The center declined to discuss the case for this story.

The selection of a nursing home can be critical: 39 percent of facilities have been cited by health inspectors over the past three years for harming a patient or operating in such a way that injuries are likely, government records show.

Yet many case managers at hospitals do not share objective information or their own knowledge about nursing home quality. Some even push their own facilities over comparable or better alternatives.

“Generally hospitals don’t tell patients or their families much about any kind of patterns of neglect or abuse,” said Michael Connors, who works at California Advocates for Nursing Home Reform, a nonprofit in San Francisco. “Even the worst nursing homes are nearly full because hospitals keep sending patients to them.”

Hospitals say their recalcitrance is due to fear about violating a government decree that hospitals may not “specify or otherwise limit” a patient’s choice of facilities. But that rule does not prohibit hospitals from sharing information about quality, and a handful of health systems, such as Partners HealthCare in Massachusetts, have created networks of preferred, higher-quality nursing homes while still giving patients all alternatives.

Such efforts to help patients are rare, said Vincent Mor, a professor of health services, policy and practice at the Brown University School of Public Health in Providence. He said that when his researchers visited 16 hospitals around the country last year, they found that only four gave any quality information to patients selecting a nursing home.

“They’re giving them a laminated piece of paper” with the names of nearby nursing facilities, Mor said. For quality information, he said, “they will say, ‘Well, maybe you can go to a website,’” such as Nursing Home Compare, where Medicare publishes its quality assessments.

The federal government may change this hands-off approach by requiring hospitals to provide guidance and quality data to patients while still respecting a patient’s preferences. The rule would apply to information not only about nursing homes but also about home health agencies, rehabilitation hospitals and other facilities and services that patients may need after a hospital stay.

“It has a substantial opportunity to make a difference for patients,” said Nancy Foster, a vice president at the American Hospital Association.

But the rule does not spell out what information the hospitals must share, and it has yet to be finalized — more than a year after Medicare proposed it. The rule faces resistance in Congress: The chairman of the House Freedom Caucus, Rep. Mark Meadows, R-N.C., has included it on a list of regulations Republicans should block early next year.

The government has created other incentives for hospitals to make sure their patient placements are good. For instance, Medicare cuts payments to hospitals when too many discharged patients return within a month.

“Hospitals didn’t use to care that much,” said David Grabowski, a professor of healthcare policy at Harvard Medical School. “They just wanted to get patients out. Now there’s a whole set of payment systems that reward hospitals for good discharges.”

But sometimes hospitals go too far in pushing patients toward their own nursing homes. In 2013, for instance, regulators faulted a Wisconsin hospital for not disclosing its ties when it referred patients to its own nursing home, which Medicare rated below average. In 2014, a family member told inspectors that a Massachusetts hospital had “steered and railroaded” her into sending a relative to a nursing home owned by the same health system.

Researchers have found that hospital-owned homes are often superior to independent ones. Still, a third of nursing homes owned by hospitals in cities with multiple facilities had lower federal quality ratings than at least one competitor, according to a Kaiser Health News analysis.

The Lowest Rating
But state inspectors found shortcomings in seven visits to the nursing home between August 2009 and October 2011, records show. Inspectors found expired medications during two visits and, at another, observed a nurse washing only her fingertips after putting an IV in a patient with a communicable infection. Medicare’s Nursing Home Compare gave the nursing home where Elizabeth Fee died one star out of five, meaning it was rated “much below average.” The hospital’s case managers told Fee’s family that the nursing home was merely an extension of the hospital and that “my mother would receive the same excellent quality of care and attention,” said Rees, her daughter.

Just four months before Fee arrived, inspectors cited the nursing home for not treating patients with dignity and respect and for failing to provide the best care. One patient told inspectors that her pain was so excruciating that she couldn’t sleep but that nurses and the doctor did not check to see whether her pain medications were working.

“Nobody listens to me,” the patient said. “I was born Catholic, and I know it’s not right to ask to die, but I want to die just to get rid of the pain.”

Fee ate little and had few bowel movements, according to the state health investigation. Fee’s family had hired a private nurse, Angela Cullen, to sit with her. Cullen became increasingly worried about Fee’s distended belly, according to Cullen’s affidavit taken as part of the lawsuit. She said her concerns were brushed off, with one nurse declining to check Fee’s abdomen by saying, “I do not have a stethoscope.”

On the morning of her death, an X-ray indicated Fee might have a bowel obstruction or other problem expelling stool, the inspectors’ report said. That evening, after throwing up a large quantity of matter that smelled of feces, she lost consciousness. She died of too much fluid and inhaled fecal matter in her lungs, the report said.

Bills Of More Than $150,000
Sutter Health, the nonprofit that owns the medical center and the nursing home, emphasized in court papers that Elizabeth Fee arrived at the facility with a low count of platelets that clot blood. Sutter’s expert witness argued that the near-daily visits from a physician that Fee received “far exceeds” what is expected in nursing home care.In a court ruling, Judge Ernest Goldsmith of the San Francisco Superior Court wrote that Nancy Fee’s younger daughter, Nancy, “observed her mother drown in what appeared to be her own excrement.” Kathryn Meadows, the family’s attorney, said in a court filing that the nursing home’s bills exceeded $150,000 for the three-week stay.

The physician and his medical group have settled their part of the case and declined to comment or discuss the terms; the case against Sutter is pending. California’s public health department fined Sutter $2,000 for the violations, including for delaying 16 hours in telling the physician about Fee’s nausea, vomiting and swollen abdomen. Last year, Sutter closed the nursing home.

A week or so after Fee died, a letter addressed to her from California Pacific Medical Center arrived at her house. It read: “We would appreciate hearing about your level of satisfaction with the care you received on our Skilled Nursing Rehabilitation Unit, the unit from which you were just discharged.”

 


Medicaid population whomps Partners’ results

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Part of Partners’ Brigham and Women’s Hospital.

As is often the case, Medicaid populations pose big financial challenges.

Consider prestigious Partners HealthCare, which owns Massachusetts General Hospital, Brigham and Women’s and some other famed hospitals.  It had a  record $108 million operating loss and a $249 million net loss in fiscal 2016. Most of the operating loss came from Neighborhood Health Plan (NHP),  its insurance unit that primarily serves low-income people. It’s the biggest loss in the system’s history.

NHP provides coverage for more than 430,000 commercial and Medicaid members; it’s the largest Medicaid insurer in Massachusetts.

NHP has been quite a challenge, having had $322 million in losses in the past three years. So Partners is taking such actions as closing  enrollment to new Medicaid members to give it time to renegotiate the rates it pays some hospitals.

Partners’ income was also hurt by the very expensive preparation for a nurses strike that was averted at the last moment and the continuing expense of a new $1.2 billion Epic EHR system.

To read more, please hit this link.


A look at 3 systems battling housing insecurity

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Housing insecurity is  a major social determinant of public health, although the problem has been too often neglected. But now some hospitals across America are trying to address it, says a report by the Root Cause Coalition. It discusses efforts by three hospital systems.

The report‘s authors note that housing issues can include homelessness and/or housing options that are too expensive. Millions of Americans face these issues, which can lead to very serious physical and mental illnesses.

Patients with housing insecurity are less likely to get needed healthcare, saving their  very scare resources for housing and food.

And so, the report says, ” hospitals like those under Partners HealthCare (based in Boston) are screening patients more closely for housing insecurity and other social determinants of health…. Patients flagged by the health system as potentially at risk for or suffering from housing concerns are connected with community organizations that offer support like short-term rental assistance, financial coaching, job training and other potentially beneficial programs.”

Consider Boston Medical Center, which has partnered with community groups to identify children in families that have high rates of emergency department use.  ER ”superusers” are a heavy burden on the industry.

BMC’s program offers housing prescriptions to patients and links them with care-coordination services to prevent or at least reduce unneeded ED visits.

In Cleveland, University Hospitals  has a local economic-stimulus program with  a housing component.

Finding stable housing for the currently homeless has been good for hospitals, too, in that it can cut the costs of care for patients  with chronic conditions who require inpatient stays.  Homeless patients are more likely to be readmitted than people with secure housing.

To read the report, please hit this link.

 


Urgent-care centers seen continuing to surge

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A 2014 whitepaper from McGuireWoods and the Urgent Care Association of America predicted that the urgent-care industry will continue to surge,   estimating that some large metropolitan areas could support two to three times the number of current urgent-care providers than they do now (or at least in 2014).

There’s a sign of this  in Revelstoke Capital Partners’ recent acquisition of SCP Urgent Care, doing business as Fast Pace Urgent Care.

From Becker’s Hospital Review, here are  seven things to know about the transaction in particular and  urgent-care centers’ growth in general.

“One of the players in the transaction is Brentwood, Tenn.-based Fast Pace, a provider of urgent-care and primary-care services. Since 2013, the company has grown from seven clinics in Tennessee to 36 clinics in Tennessee and Kentucky. The growth came primarily through opening 26 new locations and acquiring three locations. Fast Pace is a portfolio company of Shore Capital, a Chicago-based private equity firm focused exclusively on microcap healthcare investments. The other player in the transaction is private-equity firm Revelstoke, which focuses on building healthcare and business-services companies.”

In other notable recent transactions:

Last November, Nashville-based Hospital Corporation of America bought Urgent Care Extra’s Nevada operations, which include 14 urgent-care centers in Las Vegas.

In February, San Francisco-based Dignity Health said it was teaming with Atlanta-based  in a  venture to bring consumer-focused urgent care to the Bay Area.

In August 2015, Boston-based Partners HealthCare announced plans to open as many as 12 urgent-care clinics.

Becker’s noted that these investments are driven partly by the large numbers of  active patients older than 50 who want more convenient care for injuries and illness while being linked to larger systems where their regular physicians may practice and where visits to urgent-care clinics can become part of their medical record.

To read a McGuireWoods white paper on this, please hit this link.

To read a Becker’s Hospital Review overview on this, please hit this link.

 

 

 


Baystate Health to lay off 300

 

The Boston Business Journal reports that Springfield, Mass.-based Baystate Health will lay off about 300 people because of a projected $75 million budget shorfall.

Its problems can be blamed in part on a math error regarding Medicare payments made by  giant Boston-based Partners HealthCare but that also affects most other hospitals and health systems in the state. The Partners mistake will result in Baystate losing $23 million in Medicare payments. Baystate’s budget shortfall’s causes also include lowered reimbursement from Medicaid.

The Baystate layoffs,  aimed at cutting about $40 million in expenses, represents 2.4 percent of Baystate’s 12,500-person workforce. The health system will still face a $15 million budget gap after the layoffs.

“We’ll continue our work to address this gap and do all we can to preserve jobs,” Mark A. Keroack, M.D., president and CEO of Baystate Health, said in a press release.

To read the Boston Business Journal article, please hit this link.


Partners gets no relief from its big Medicare snafu

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Nantucket from a NASA satellite.

The Centers for Medicaid & Medicaid Services will not let Boston-based Partners HealthCare  resubmit paperwork for 19-bed Nantucket (Mass.) Cottage Hospital that, if it had been filed correctly, would have resulted in higher Medicare payments to  hospitals across Massachusetts

CMS’ decision to deny Partners’s resubmission request was included in CMS’s Inpatient Prospective Payment Systems rule.  CMS  refused to allow the corrections because the hospital missed the original submission deadline.

Becker’s Hospital Review reports: “Under hospital payment rules, Medicare is required to reimburse employee wages at urban hospitals at the baseline set at rural hospitals in the state. Nantucket Cottage Hospital typically sets the floor for wages at hospitals across Massachusetts because it is the only rural hospital in the state.”

“Last year, the Nantucket-based hospital provided data that underestimated its wages, dragging down payments for the entire state. Partners identified the errors in mid- to late March, and sent corrected numbers April 5, almost two months after the deadline for submitting corrections.”

To read the Becker’s article, please hit this link.

 


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