Cooperating for better care.

Robert Whitcomb

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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 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:

Female physician compensation report

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

Self-awareness key to physician leaders’ success

An article in Physicians’ Practice reports on how organizational psychologist Tasha Eurich sees how physician leaders with self-awareness can help their teams to thrive even in difficult circumstances.

The crucial thing is self-awareness, built on two forms of self-knowledge: leaders’ understanding of who they are internally and how well they understand how others see them.

The article says that according to her research, self-aware people are:

  • “Better performers at work”
  • “Receive more promotions”
  • “More effective communicators”
  • “More engaging and motivating leaders”

She says that self-aware health-care leaders tend to:

  1. “Have higher well being”
  2. “Lower burnout”
  3. “And organizations they are a part of deliver higher-quality care and have higher patient satisfaction.”

To read the article, please hit this link.

Veterans health: A surprising place for innovation

An article in NEJM Catalyst reports: “The U.S. Veterans Health Administration’s vast size and complexity suggest that it would be an improbable environment for nimble innovation, but it has created an Innovation Ecosystem that leverages its resources and expertise to generate a steady stream of new ideas, projects, and programs that have made significant improvements for the organization and the veterans it serves.”

To read the article, hit this link.

Complexity science in COVID-19 crisis

James W. Begun, PhD, and H. Joanna Jiang, PhD, both of the University of Minnesota, tout complexity science in presenting six cases that show how health-care leaders and clinicians can respond well to the COVID-19 pandemic with extensive communication, collaboration and innovation.

The authors conclude:

“Complexity science, with its emphasis on simple rules, open discussions, and building connections, provides an orienting framework for response to major surprise. The perspective provides an evidence-based foundation for management during disasters. During the Covid-19 crisis, health-care organizations that have emphasized communication, connection and innovation have effectively addressed the challenges to adjust capacity, redesign care models, redeploy staff and overcome financial loss.

“Complexity science also provides a framework for learning from disasters. Any future disasters will require health-care organizations to face challenges that will be different in detail, even while similar in pattern. Health-care organizations, particularly those that have entered the recovery and rebuild stage, can use the COVID-19 pandemic as an opportunity to transform into more agile and resilient learning systems.”

To read the article, please hit this link.

Keeping physician practices stable in the pandemic

In a Physicians Practice essay, Sachin Gupta, CEO of IKS Health, discusses how independent physician practices can remain administratively stable during the COVID-19 pandemic and after, and he discusses the key determinants of success for new and growing practices.

To read the article, please hit this link.

Connected care in time of crisis

Using a model of Dallas-based Parkland Center for Clinical Innovation, two experts write about connected communities of care:

“The integration and cooperation among health care organizations that provide clinical care and community-based organizations that address social determinants of health, especially for vulnerable populations, is of growing importance generally, and can be especially useful during the Covid-19 pandemic.”

To read the whole piece, please hit this link.

Time to curb measurement mania in health care?

In the light of the COVID-19 pandemic, an article by J. Michael McWilliams, M.D., in NEJM Catalyst notes how the pace of health-care quality improvement in the United States has been slow, and so he writes: “After two decades of efforts relying largely on quality measurement and performance-linked payment incentives, we need new ideas and new conversations. As revealed by health care workers’ response to the Covid-19 pandemic, professionalism in health care may be an underused resource.”

He suggests that “Reframing quality improvement around the linchpin of care delivery — physician agency — could provide much-needed direction by elucidating strategies that address problems of information or motivation when professionals act as agents on their patients’ behalf. These strategies need not rely on measures.”

To read the article, please hit this link.

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