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Robert Whitcomb

Author Archives

Nurturing trust in pandemic

  • Ghazala Q. Sharieff, M.D., chief medical officer at Scripps Health, writes in NEJM Catalyst about senior management’s engendering of, and maintaining, trust among physicians, other staff and patients during the COVID-19 pandemic, and implementing several mechanisms for ensuring that communication is regular and transparent and addresses the needs of the community.

To read the article, please hit this link.


The future of the CMO

In a NEJM Catalyst conversation with Thomas H. Lee, M.D., Andrew Masica, M.D., chief medical officer of Texas Health Resources, discusses how the new generation of CMOs will need to be comfortable being innovative change agents as the market heads toward value-based care.

He describes three different kinds of CMO’s.

To read the dialogue, please hit this link.


Partly scary predictions for hospitals in 2021

Robert King of Fierce Healthcare has come up with five predictions for the hospital business in 2021. They are:

“Hospital consolidation likely to increase at a rapid pace.”

“Patient volumes will continue to be disrupted.”

“An unstable payer mix could roil finances.”

“Telehealth visits will continue to skyrocket.”

“Don’t expect a major new round of relief funding.”

To read the article, please hit this link.


How huge Providence Health chain got back to pre-pandemic volumes

NEJM Catalyst editor-in-chief Tom Lee, M.D., talked with Amy Compton-Phillips, M.D., executive vice president and chief clinical officer of Providence Health & Services, the huge Seattle-based chain, with 51 hospitals and more than 800 clinics in western states, about clinical leadership as the company navigated the health crises of the past year, including COVID-19, hurricanes and massive wildfires, and got back to pre-pandemic volumes.

Among her remarks:

“….{W}e have this large-scale change infrastructure of vision, trust, data, capacity, and alignment. In COVID, the vision was very clear: survive COVID… so everybody knew exactly where we were going — we were trying to get to the other side of a pandemic. Trust. We had all worked together and trusted that each was doing their own job and not try to manage it but allow it to happen. Data. We built an amazing data architecture that has allowed us to have not only insight into what the outcomes are that we’re seeing, but also predictive analytics, and now we can see with pretty good fidelity about 2 weeks into the future….  Capacity. We were very creative in creating capacity, and now that capacity generation is going to serve us well into the future. Alignment has been really essential for us to be able to flex people into the roles that we need [in order for us] to [provide] care in a new way. [In terms of] the platforming article, I’m really glad we had that model before COVID hit because it allowed us to go from 0 to 60 very rapidly when we needed it.

To read the whole interview, please hit this link.


Cross-hospital collaboration in response to pandemic in New York City

An article in NEJM Catalyst looks at lessons learned from hospital collaborations in response to the COVID-19 pandemic in New York City.

The authors conclude:

“As NYC became the epicenter for the COVID-19 pandemic, the hospitals of the Department of Medicine at NYU — BH, NYU-Tisch, NYU-Brooklyn, and the VA — developed multiple strategies for communication, surge capacity, clinical guidelines, and staff wellness. Despite these four hospitals being distinct, there were many uniform approaches that can be adapted by hospitals of any affiliation or size. Collaboration within academic affiliations and, more globally, across the country will be beneficial to leadership, staff, and patients. This overview can be used for diverse hospital systems that are currently facing, or are likely to experience, a surge of patients with Covid-19 or future disaster planning of any kind.”

To read the article, please hit this link:


Growing economic stress for many physicians

An article in Physician’s Practice looks at how “instability in compensation and the massive move of physicians from private practice to employed models could be indicators of trouble ahead for physician compensation.”

Actually, a lot of physicians, especially those in private practice, are already under growing financial stress. COVID-19, of course, has made everything worse.

To read the article, please hit this link.


Comparing value-based care in four countries

An article in NEJM Catalyst compares and contrasts value-based health-care systems in Massachusetts, the Netherlands, Norway and England, revealing structural differences and variation in programs’ emphasis. This provides insights on how policymakers and providers can speed up implementation of value-based care.

The authors conclude:

“There is a general drive across all of the studied systems toward a more value-based health care, although there is a considerable variation in VBHC implementation status among the systems. Our study shows that strengthening government involvement in driving change, focusing on continuous IT improvements to ensure the availability of outcome data across the full care cycle, and instituting a VBHC culture among providers may prove to be pivotal in accelerating the implementation of VBHC across different health care systems.”

To read the article, please hit this link.


From alone to partner

This PhysiciansPractice article provides guidance on the opportunities and pitfalls of transitioning from a solo practice to a partnership. To read it, please hit this link.


Many hospitals to get lower Medicare payments because of readmissions

By JORDAN RAU, of Kaiser Health News

Nearly half the nation’s hospitals, many of which are still wrestling with the financial fallout of the unexpected coronavirus, will get lower payments for all Medicare patients because of their history of readmitting patients, federal records show.

Look Up Tool
Here are the hospitals hit with readmissions penalties for 2021. You can filter by location, hospital name or year.

Download
Download the 2021 Readmission Data (.csv)

Historical Data
Here are links to articles and data since 2015.

The penalties are the ninth annual round of the Hospital Readmissions Reduction Program created as part of the Affordable Care Act’s broader effort to improve quality and lower costs. The latest penalties are calculated using each hospital case history between July 2016 and June 2019, so the flood of coronavirus patients that have swamped hospitals this year were not included.

The Centers for Medicare & Medicaid Services announced in September it may suspend the penalty program in the future if the chaos surrounding the pandemic, including the spring’s moratorium on elective surgeries, makes it too difficult to assess hospital performance.

For this year, the penalties remain in effect. Retroactive to the federal fiscal year that began Oct. 1, Medicare will lower a year’s worth of payments to 2,545 hospitals, the data show. The average reduction is 0.69%, with 613 hospitals receiving a penalty of 1% or more.

Out of 5,267 hospitals in the country, Congress has exempted 2,176 from the threat of penalties, either because they are critical access hospitals — defined as the only inpatient facility in an area — or hospitals that specialize in psychiatric patients, children, veterans, rehabilitation or long-term care. Of the 3,080 hospitals CMS evaluated, 83% received a penalty.

The number and severity of penalties were comparable to those of recent years, although the number of hospitals receiving the maximum penalty of 3% dropped from 56 to 39. Because the penalties are applied to new admission payments, the total dollar amount each hospital will lose will not be known until after the fiscal year ends on July 30.

“It’s unfortunate that hospitals will face readmission penalties in fiscal year 2021,” said Akin Demehin, director of policy at the American Hospital Association. “Given the financial strain that hospitals are under, every dollar counts, and the impact of any penalty is significant.”

The penalties are based on readmissions of Medicare patients who initially came to the hospital with diagnoses of congestive heart failure, heart attack, pneumonia, chronic obstructive pulmonary disease, hip or knee replacement or coronary artery bypass graft surgery. Medicare counts as a readmission any of those patients who ended up back in any hospital within 30 days of discharge, except for planned returns like a second phase of surgery.

A hospital will be penalized if its readmission rate is higher than expected given the national trends in any one of those categories.

The industry has disapproved of the program since its inception, complaining the measures aren’t precise and it unfairly punishes hospitals that treat low-income patients, who often don’t have the resources to ensure their recoveries are successful.

Michael Millenson, a health quality consultant who focuses on patient safety, said the penalties are a useful but imperfect mechanism to push hospitals to improve their care. The designers of the penalty system envisioned it as a way to neutralize the economic benefit hospitals get from readmitted patients under Medicare’s fee-for-service payment model, as they are otherwise paid for two stays instead of just one.

“Every industry complains the penalties are too harsh,” he said. “if you’re going to tell me we don’t need any economic incentives to do the right thing because we’re always doing the right thing — that’s not true.”

Jordan Rau: jrau@kff.org@JordanRau


Female physician compensation report

See Medscape’s 2020 female-physician compensation report by hitting this link.


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