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Hospital-practice subsidiary blends physician employment, independence

 

A FierceHealthcare story discusses a third option for physicians between becoming a hospital employee and staying completely independent.

It’s  called the group practice subsidiary (GPS) model, as explained by lawyer Curt Chase, J.D., a partner at Husch Blackwell LLP in Kansas City, Mo.,  during a presentation at the Medical Group Management Association annual conference.

Fierce reported: “The emerging model integrates independent practices with hospitals and healthcare systems while allowing physicians to keep their independence, Chase said. Rather than a hospital or health system owning a practice, it creates a subsidiary which employs the physician practice. The doctors are not employed by the hospital, but the hospital owns the subsidiary although it doesn’t subsidize it. The hospital has a certain level of control but the practice continues to operate much like it did before.

“For hospitals, the model provides a broader physician network, better positions them to work with community physicians to manage population health and gives them strategic, long-term affiliations with doctors.”

To read more, please hit this link.


ACOs taking on more financial risk

 

FierceHealthcare reports that new data suggest  that Accountable Care Organizations are adapting to the need to take on more   financial risk. But, the news service adds, “Reducing costs and managing population health remain key challenges, … prompting an investment in add-on technologies like population analytics.”

The National Association of ACOs and Leavitt Partners surveyed 240 organizations and found that ACOs across the board plan to participate in “at-risk arrangements.” Nearly half have chosen  shared savings and losses, with another 38 percent picking capitation-based agreements.

Meanwhile, the number and sophistication of ACO contracts have  expanded, the report says. This includes ACO providers following alternative value-based payment methodologies in parallel.  Fierce reports that ACOs seem to have been particularly attracted to the patient-centered medical home model, “present in 86 percent of the organizations surveyed. The survey also noted satisfaction with bundled payment models in some areas of care.”

To read the Health Affairs blog entry, please hit this link.

To read the FierceHealthcare article, please hit this link.

 

 

 


Case for clinical-integration accreditation

This FierceHealthcare piece looks at the case for earning clinical-integration accreditation, taking Phoenix Children’s Hospital and its Phoenix Children’s Care Network (PCCN) as a case study.

PCCN  became the first  U.S. pediatric network  to earn URAC accreditation as a clinically integrated network. URAC is a nonprofit organization that develops evidence-based measures and standards through inclusive engagement.  This  PCCN accreditation signifies a commitment to better care, processes and patient outcomes as well as  cost savings for patients, their families and the  wider community.

The  Fierce piece reports:

“PCCN’s first order of business was to develop one of the nation’s first pediatric-dedicated clinically integrated organizations (CIO). The PCCN pediatric CIO is rooted in the development of a robust quality-improvement program with accountability among independent physicians and the connected health system. It rewards and integrates physician members around a common commitment to quality measures based on scientific evidence and cost improvement.”

“In just a few short years, the PCCN model has grown to be Arizona’s largest children’s care coordination network and one of the nation’s premier pediatric CIOs.”

URAC’s basic clinical-integration accreditation standards are, as paraphrased by Fierce, are:

  • “A governing structure that provides compliance and oversight.
  • “Top-down organizational alignment that ensures business arrangements are patient-centric and structured around improving outcomes, quality and costs.
  • “Care coordination built around a population health mindset.
  • “An integrated IT infrastructure that enables information exchange and data aggregation.

To read more, please hit this link.

 


Population-health programs vs. hospitals

 

Eric Hunter, CEO of safety-net health plan CareOregon, said that if its population-health efforts were as successful as he’d like, hospitals would significantly cut back on their services.

“I tell hospitals, and they hate when I tell them this, ‘In my perfect world, I would never need you,’” Mr. Hunter told panelists at a Politico event. “My goal is to put you out of business. If we can do the right thing, all you’ll have is an ER for when somebody gets in a car wreck.”

But many  providers won’t have  access to strong community health programs such as CareOregon’s.

Karen DeSalvo, M.D., former national coordinator for health information technology at the the Department of Health and Human Services, pressed for culture changes that include breaking down data silos that block providers from seeing the full picture of a patient’s, or a  community’s, health.

Dr. DeSalvo said: “It means that we really have to rethink how we look at health.”

To see the Politico event, please hit this link.

 


Panel asks for changes in MIPS

The Medicare Payment Advisory Commission (MedPAC) has proposed proposed changes in the Merit-based Incentive Payment System (MIPS) aimed at strengthening advanced alternative payment models and creating a prospective payment system for post-acute-care  settings.

The commission also suggests that MIPS should be based on population- health measures.

The commission notes that growing consolidation of  hospitals and physicians has generally increased prices without improving care. So, in response, the report’s authors recommend restraining Medicare prices to address  horizontal consolidation and imposing site-neutral pricing in response to vertical consolidation.

The panel has also asked policymakers to consider cutting payment rates for emergency departments that aren’t on hospital campuses and ending exemptions to site-neutral payments for ambulatory services.

To read more, please hit this link.


Hospitals promote on-demand, multi-venue access for patients

brand

— Leinad8989

Here’s a look at hospitals finding new ways to get and keep patients.

“What people really want is on-demand access,”  David James, M.D., CEO of Memorial Hermann Medical Group, in Houston, told Hospitals & Health Networks. “Particularly those who are well or have conditions that are stable — they just need to get things done, and time has become really important for them.”

Memorial Hermann is  adding new types of facilities in high-traffic locations “that can make it as easy to choose Memorial Hermann as it is a nearby freestanding urgent care center or emergency department,” H&HN reported.

“Two years ago, we opened our first convenient care center, and today we have four of them,”   James  told H&HN.  “We have one urgent care fully deployed, two coming out of the gate.”

”’Convenient care centers’ are one-stop shops that include primary care offices, fast-track primary care clinics open 12 hours a day, seven days a week, an ED, sports medicine and physical therapy, outpatient imaging and laboratory services, and swing spaces available to specialists on a rotating basis,” the news service reported.

“Everything is moving toward the home,” says Mike Waters, senior vice president of physician services at Renton, Wash.-based Providence Health & Services.

“We shifted our thinking from these more traditional access points into creating a menu of different products so that consumers have choice,” Waters told H&HN. “A lot of people get hung up on whether we can provide same-day access. Frankly, what we’re hearing from consumers is they want care when they want it, where they want it, how they want it. So we need to provide them options.”

“Novant Health, a 13-hospital system serving more than 4 million patients in North Carolina, South Carolina, Georgia and Virginia, considers its access strategy in terms of three broad categories of venues: acute care hospitals, ambulatory facilities — and everything else. ‘Whenever the patient is not inside our four walls, they are in what we would term a virtual venue of care,”’ R. Henry Capps Jr., M.D., chief operating officer of Novant Health Medical Group, told H&HN.

The news service reported that “virtual venue includes e-visits and video visits, population health initiatives that proactively reach out to high-risk patients, an inbound/outbound call center that supports patient engagement, and online interactions via Novant’s patient portal.”

To read more, please hit this link.

 


Some more skepticism about Lean-based approaches for healthcare institutions

lean

Lean-based system as made famous in Japan.

Michael I. Harrison, Ph.D., of the Agency for Healthcare Research and Quality, writes in NEJM Catalyst about the limitations of Lean-based approaches to healthcare institutions’ management.

He writes that “according to current research, Lean promises more than it has delivered. It is possible that published research studies are lagging practice, where there are some reports of Lean-driven breakthroughs in quality and value and even Lean-based culture change. But a positive publication bias may actually be leading the research literature to overestimate Lean’s potential.’’

Among his other observations:

  • “To ensure appropriate care for chronically ill patients, and to promote population health, organizations need to redefine some traditional operating objectives and performance standards and develop new or radically redesigned care processes, such as team-based primary care. As Lean experts and users concentrate on making current processes more efficient, they may devote insufficient attention and energy to developing new goals and care delivery designs.
  • “Except in tightly integrated systems, coordination of medical care requires cooperation across fragmented medical services. Health promotion calls for joint action by medical, social, and educational services. It takes time and concerted effort to build teams that bridge boundaries between care sites and entire organizations. But Lean projects typically rely on teams made up of members of the same organization, who already share objectives and operating assumptions.
  • “Radically transforming taken-for-granted assumptions, values, and work procedures goes far beyond targeting selected processes for improvement. To change culture, leaders must articulate an overarching organizational change strategy and align diverse programs and improvement initiatives with that strategy. Strategic and behavior change must be implemented and reinforced through the appropriate use of performance measures, incentives, training, and staffing. Lean thinkers call for culture change, but popular Lean improvement techniques alone do not provide sufficient change levers to promote it.’’

To read Mr. Harrison’s article, please hit this link.

 


Seeking new specialists for the C-Suite

 

How do hospitals respond to the need for experts in value-based reimbursement,  population health, cybersecurity and systems’ consolidation in hospital C-Suites?

“Healthcare organizations are becoming larger and more complex,” says Lydia Ostermeier, vice president for senior executive search at B.E. Smith, told Becker’s Hospital Review. So “C-suite leaders’ roles have grown tremendously in scope. Adding additional members to the team helps take some of that load off their plate.”

Several new roles are becoming especially familiar and popular, according to Ms. Ostermeier. These include chief experience officer, chief population-health officer, chief medical-information officer, chief nursing-information officer, chief strategy officer and chief safety officer.


Ms. Ostermeir said that  when an organization needs an executive to focus exclusively on population-health management, cybersecurity, patient satisfaction or any other concentration, they should first consider the following five questions, in Becker’s words:

1. “How will the new role create value?”

2. “What will be the new leader’s primary duties?”

3. “How will the new position change the current organizational structure?”

4. “What skill sets must the leader in the given role possess?” 

5. “How will the organization communicate the change to the staff?”

To read the article, please hit this link.


Community paramedicine in value-based care

 

paramedics

Paramedics on bicycles in Los Angeles.

Kenneth W. Kizer, M.D.,  is an expert on the expanding potential of community paramedicine. As a former director of the California Emergency Medical Services Authority, he wrote the regulations for paramedicine in the state.  More recently, he has become a  thought leader in population health — and an advocate for community paramedicine in value-based care.

Hospitals & Health Networks recently interviewed him.

Among his remarks:

“Community paramedicine is an important component of population health management and the new emerging value-based health care economy because it fills gaps in the typical health care delivery infrastructure that are especially relevant to value-based payment.

“The focus of CP programs varies widely — from paramedics providing directly observed treatment for tuberculosis patients at their homes to providing transportation to health care facilities other than emergency departments and many other concepts.”

“The programs that respond to the 9-1-1 superusers hold a lot of promise for better utilizing scarce emergency care resources, including ambulances and hospital emergency departments. We know that in many communities some people call 9-1-1 multiple times per week when what they really need is help with basic primary care or other support services. Many of these persons may be homeless or have mental health needs or other problems that are not always better managed in the ED.”

“Another type of program that I think is going to prove to be very helpful is one that provides follow-up care after a hospital discharge or an ED discharge. These programs serve patients before they can get in to see their usual provider or — probably more often — until they can establish a relationship with a regular health care provider.”

To read the whole interview, please hit this link.

 



Population health in a community hospital ACO

An article in Health Affairs asks:

“{W}hen it comes to actual operations, what does ‘population health’ look like in an ACO, particularly in ACOs led by community hospitals? Do ACOs see their role in population health management as caring for their patient populations as a whole? Patients in their catchment areas? In their communities? And how do those views ‘sync’ with the care delivery and partnership approaches that hospital-based ACOs are actually using?”

“But when ACO leaders were asked what sorts of community health programs and services they were either employing or planning to employ within six months, the top three answers were, instead, related to care coordination, chronic-disease management, and health education.

“Similar to the aforementioned reasoning, this suggests that many ACOs may be taking a ‘walk before they run’ approach, establishing basic ACO infrastructure first before tackling more targeted community needs. It also implies that an additional focus may be needed on helping ACOs to expand their view—and services—beyond their current patient population.

“Likewise, while 71 percent of ACO leaders are either offering, or plan to offer, integrated physical and behavioral health services … fewer than 25 percent believe their ACOs will have adequate numbers of behavioral health staff to meet their populations’ needs.”

To read the Health Affairs article, please hit this link.


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