Cooperating for better care.

Robert Whitcomb

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Hospital-care prices fell

February 19, 2015by Robert Whitcomb in Uncategorized tagged , , ,

Are pressures from payers and more cost transparency finally starting to bring the world’s highest hospital charges under control?

New federal data show that  aggregate prices that prices paid by insurers to acute-care hospitals fell in January from the year-earlier month. That’s a first since  federal officials began to collect such data.  And experts said that public- and private-sector payer pressure to cut costs could explain the drop.

The overall price of acute-care hospital care —including for the uninsured— fell 0.1 percent from the year earlier. The data, which may be revised, included a 2.3 percent drop in Medicare hospital-care rates  and the weakest 12-month price growth, 1.6 percent among private health plans since July 1998. Medicaid prices fell  0.1 percent.
“This appears to be a combination of the public sector pressure, but an even more fierce change on behalf of the private payers,” said Paul Hughes-Cromwick, a senior health economist at the Altarum Institute Center for Sustainable Health Spending, told M0dern Healthcare.
“Insurers are trying to figure out how they can save healthcare cost by lowering the hospital bill, so they are more aggressively bargaining with hospitals and more aggressively investing in programs that lower hospital utilization rates,” Neraj Sood, director of research and associate professor in health policy and economics at the University of Southern California, told the publication.The hospital sector comprises about a  third of America’s $2.9 trillion medical bill.”Soft hospital price growth has continued to drag on overall healthcare inflation even as prices for home care, prescription drugs and nursing homes have risen, according to an analysis by the Altarum Institute that includes data from two federal measures of healthcare inflation. Healthcare inflation remained historically low through the end of last year, the analysis shows, though it did increase slightly as 2014 ended.”

Boardrooms and patient care

February 18, 2015by Robert Whitcomb in Uncategorized tagged

board

A piece by Austin Frakt on The New York Times Web site discusses how hospital board rooms are as important as operating rooms in patient care.

But, “'{B}oard members are community leaders, serving on the board to support fund-raising goals,’  Ashish Jha, a Harvard physician, told Mr. Frakt. “They don’t think it’s their job to hold management accountable for performance. Board members often feel like clinical quality is physicians’ jobs, and they don’t want to step on doctors’ toes.”

”The trouble with this perspective is that boards, and other hospital management, can influence care in ways that individual physicians cannot. They can promote protocols that ensure that crucial information is conveyed to the right people at the right time. They can establish systems so that equipment and supplies are available when needed. They can set expectations for a culture of high performance, not just from individuals but from teams of them that must work together. And they can require quality to be monitored against goals with incentives to push it toward those targets.”

Treatment, emotion and low probabilities

February 18, 2015by Robert Whitcomb in Uncategorized

hysteria

A piece in The New England Journal of Medicine says” “Even when there’s a very small chance that a healthcare service will benefit us, we usually opt to receive it. In part, that’s because we tend to assign too much weight to probabilities when they are low, a phenomenon that is exacerbated for emotional decisions.”

New cholesterol drug could be cost tidal wave

February 18, 2015by Robert Whitcomb in Uncategorized tagged , ,

tsunami

 

A HealthAffairs blog notes:

“{P}olicymakers and payers appear unwilling to undertake significant cost controls on medication pricing. Indeed the controversy over the $84,000 price tag for Sovaldi (sofosbuvir) has largely faded, suggesting a certain resiliency in our system’s ability to absorb costs.”

”We believe that resiliency is about to be challenged in a manner unlike we have seen in the past….in pharmaceuticals. A number of pharmaceutical manufacturers are developing a new class of medication to manage high cholesterol — the PCSK9 (proprotein convertase subtilisin/kexin 9) enzyme inhibitors.

”While this class of medications will no doubt lead to substantial clinical improvements in some patients, those improvements will be costly….The PCSK9 inhibitors will be specialty medications and likely priced as such.The PCSK9 inhibitors will be specialty medications and likely priced as such.”

“Given the number of people potentially eligible for treatment with the PCSK9 inhibitors will number in the millions, the potential overall expenditures by payers are huge.”

Long-term hospitals’ lucrative discharge ploy

February 18, 2015by Robert Whitcomb in Uncategorized tagged

exit

A Wall Street Journal analysis found that many long-term hospital companies ”discharge a disproportionate share of patients during that window when hospitals stand to make the most.”

It’s another sign that how financial incentives in the Medicare system affects patient care, and not always for the better.

”Long-term-hospital executives sometimes pursued that goal {of timing discharges} for financial reasons rather than medical ones, say doctors, nurses and former long-term-hospital employees interviewed by the Journal.”

”The Journal analysis of claims Medicare paid from 2008 through 2013 found long-term hospitals discharged 25% of patients during the three days after crossing thresholds for higher, lump-sum payments. That is five times as many patients as were released the three days before the thresholds.”

Hospital executives gain big bonuses from manipulating  these discharge times,  which cost taxpayers many billions of dollars a year.

They’re waiting to see how the Feds address/punish this phenomenon.

 

NYC hospital’s brilliant new marketing

February 18, 2015by Robert Whitcomb in Uncategorized tagged ,

 

Fierce Healthcare reports that, in a brilliant marketing move, the Hospital for Special Surgery, in New York City, has “decided to make it easier for potential patients to read first-hand recommendations from other patients who have experienced a similar condition or injury. The online forum, Back in the Game …already features more than 400 patient stories that patients can search by condition or treatment, doctor, patient name or location.”

The news service says  the hospital  says that it’s  the largest public online forum of orthopedic and rheumatological patient stories so far.

Measuring, alleviating medically caused suffering

February 18, 2015by Robert Whitcomb in Uncategorized tagged , , ,

suffer

There are new initiatives underway to measure and alleviate  the all-too-often ignored suffering of patients at hospitals caused by medical care itself.  Hospitals involved include Beth Israel Deaconess, in Boston, Yale-New Haven and the University of Utah system.

 

Jim Hightower: Aetna the insurance apostate

February 17, 2015by Robert Whitcomb in Uncategorized tagged , ,

Business schools preach a strict, anti-social doctrine of corporate management that comes down to this: CEO’s must be idiots.

By that I mean the original Greek word idiotes, which applied to people who care only about themselves and the prosperity of their immediate family. They’re the ones who reject any responsibility to the larger society, civic affairs, and the common good.

That selfish ethos is what prevails in today’s corporate suites, where it’s claimed that the only responsibility of executives is to maximize profits for the “family” — that is, for themselves and their major shareholders.

If they have to stiff workers, sidestep environmental rules, and shaft consumers to do it, well, that’s the lot of idiotes.

But now comes an apostate to this doctrinal idiocy.

Mark Bertolini,  chief executive of the Hartford-based health-insurance giant Aetna, says CEO’s should raise the minimum wage their companies pay to a level approaching minimal fairness. Rather than just calling for it, though, he actually did it. He lifted Aetna’s lowest wage to $16 an hour, plus improved health benefits.

Then Bertolini really gave up the game: He publicly revealed that these increases aren’t so financially painful after all.

The total cost to Aetna will be about $26 million a year. That’s nothing for a company with annual revenues of $62 billion.

The only pain that Bertolini might feel is loneliness when he enters the CEO Club and sees other insurance chieftains turn their backs and shun him over his leadership on the moral matter of shared prosperity.

Indeed, the CEO’s of Humana, Anthem and other insurers say “no” to raises for their employees, sniffing that they pay “competitive wages” — which is just a dishonest way of saying “low wages.”

Whether those idiotes like it or not, Aetna just lifted the national standard for competitive wages.

Moreover, the insurer has thrown open the doors of the executive suites to an honest public conversation about the morality of the suits inside jacking up their compensation while holding down everyone else’s pay.

Jim Hightower is a columnist for otherwords.org, where this originated.

Species thrown together

February 17, 2015by Robert Whitcomb in Uncategorized tagged , , , ,

 Hieronymus Bosch-899659

From “The Garden of Earthly Delights,” by Hieronymous Bosch.

Jeff Goldsmith,  president of Health Futures Inc. and associate professor of public health sciences at the University of Virginia, writes in Hospitals & Health Networks:

“I have believed for years that healthcare management programs have underprepared their graduates for the complexities of even understanding, let alone managing, medical professionals,” who are, he half-jokingly says,  different species.

He suggests that hospital executives learn this about the new class of physicians:

“For their entire training, they’ve been supervised by other physicians: the faculty ‘officer corps’ and the ‘noncoms,’ i.e., senior residents and fellows. They saw folks in suits in the halls {such as hospital executives}, but had the dimmest notion what the ‘suits’ actually did for a living. ”

And:

Younger physicians ”remain fiercely competitive and empirical.”
 
”They actually care about the people they are taking care of.”

”{W}with the possible exception of the pediatricians, they will never (a word I don’t use often) care about the people they are not seeing as much as they do about the patients in front of them. They will work hard to help their patients understand their role in their own health. But your physicians have been trained to take care of patients, not the rest of the community.” {Translation: Don’t get your hopes too high about physicians embracing population health.}
 
”They have learned a lot from watching their elders. There is a lot of discussion in medicine right now about how Generation Y doctors are different from their workaholic elders. Most younger physicians don’t want to practice 100 hours a week. …. Striving for work-life balance looks like wisdom derived from closely studying their {burned out} elders.”

”Don’t expect the best of them to stick around if you cannot adequately support their practices.”

“Don’t expect a lot of help reducing patient care costs.”

”If we expected employed physicians to actually reduce the cost of care, we’re learning sadly that their training has pointed them in a very different direction. Even younger hospitalists and intensivists have had trouble with more resource-sparing clinical decision-making. They will need to be retrained, and that will happen only with effective physician leadership.”

”Younger physicians are, however, team players, and far more comfortable practicing as part of a team than all but a handful of their elders. This bodes well for their willingness to adopt and practice evidence-based, protocol-driven medicine….But don’t expect them to practice protocol-driven medicine unless they feel the outcome is defensible based on available science.”

 

 

 

 

Nurses addressing the ‘Silver Tsunami’

February 17, 2015by Robert Whitcomb in Uncategorized tagged , ,

 

The latest issue of the Robert Wood Johnson Foundation’s Charting Nursing’s Future discusses nurses’ role in addressing the “Silver Tsunami” of plus-65-year-old patients in the next few decades.

The piece looks at successful nurse-led initiatives in various parts of the country, such as a  transitional-care model that uses advanced practice registered nurses to coordinate care for high-risk older adults across healthcare venues and the  Program of All-Inclusive Care for the Elderly. That program  helps patients stay at home and out of the hospital  by bringing them to PACE centers two or three days a week, to see primary-care providers, get physical therapy,  refill prescriptions and engage in social activities.

It cites nine Centers on Aging in Arkansas — each owned and managed by a local hospital and each employing a geriatrician, an APRN and a social worker — to provide primary care and chronic-condition education.

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