Next stop? Making things quieter for patients in the usual freezing and noisy confines of a hospital. How about a blanket that actually keeps your warm?
Next stop? Making things quieter for patients in the usual freezing and noisy confines of a hospital. How about a blanket that actually keeps your warm?
“Work closely with physician leaders to help keep the practice groups stable, improve physician satisfaction and reduce turnover.”
“Create career paths for physicians to prepare them for leadership roles with increasing responsibility.”
“{S}hare with the physicians the financial and operational goals of the hospital. ”
“Make regular visits into the community to meet with the hospital’s constituents on their turf.”
“Openly share information about physician turnover and retention rates. ”
“Provide the physicians with more protected nonclinical time for engagement-related activities.”
Physicians should:
“Take the time to learn about the big picture: how the hospital aims to achieve its goals for each of its stakeholders.”
“Learn the basics of hospital accounting and finance. ”
“During patient encounters, seek opportunities to characterize your facility and the medical staff in a way that communicates confidence.”
“Balance the need for autonomy in treating patients with the responsibility to make systems-oriented decisions that benefit the facility as a whole. ”
“Concentrate work time at one facility and minimize part-time work at other facilities. ”
“Recognize that the hospital’s physician leaders carry significant responsibility in ensuring that engagement is successful and yields the intended results. ”
“This is a true merger of equals that is very unique,” said Reynold Jennings, WellStar’s CEO. “We’re really doing this to create a strong, vibrant, full-service healthcare system.” (In such cases, execs like to talk about “mergers of equals,” but that’s almost an oxymoron in reality; there’s almost always a dominant partner, and of course much can be explained by executives’ financial rewards in a merger.)
Modern Healthcare says: “The plan calls for creating a yet-unnamed company that will include Emory’s Atlanta-based hospitals and post-acute-care assets as well as WellStar’s hospitals and post-acute care assets in Atlanta’s northern suburbs.”
A study in the Health Services Research journal attributed 58 percent of the variation in hospital 30-day readmission rates to the demographics of the county where the hospital was located.
The biggest factors in identifying areas with higher readmission rates: larger percentages of the population eligible for Medicare, higher numbers who had never married and “low employment designation.”
Apple was their favorite company, — with ”its history of cannibalizing its own products before a competitor does and promoting disruption before being overtaken by it.”
This Medical Economics article provides some guidance.
“Because the PCMH and ACO share common goals of lowering costs and improving patient outcomes, physicians often think of them interchangeably. But they differ in that a PCMH is an approach to care for an individual practice, whereas an ACO is a method of reimbursing a network of providers. ‘Basically, the PCMH is a care delivery mechanism, while the ACO is a payment mechanism,’ explains David Gans, FACMPE, senior industry affairs fellow with the Medical Group Management Association (MGMA).”’
The ideas (some obvious!) include:
Remain calm and observe.
”Understand the pathophysiology.”
”Making the diagnosis is always the hardest step. Spending the time to look under every stone, ‘test’ as needed and look for the problem is always where the challenge lies. What may look alike on the outside may actually be representative of a more difficult underlying issue.”
Reconcile amidst workplace politics
“Empowering your staff to help you is paramount—just the same as empowering your patients.”
Plan and report
Don’t be afraid
Tie it all together
Be a servant leader
”For those afraid to take on the headache of administration or leadership: take the plunge! It’s much easier to make mistakes earlier in your career than later, so think of such opportunities as practice that will help you build towards perfection.” Dr. Freeman writes.
The bizarre Narrenturm (German for “fools’ tower”) built in 1784 in Vienna to house mentally ill people.
This Kaiser Health News article by Lisa Gillespie (lisag@kff.org) presents a Q&A on mental-health parity under Medicaid managed care:
The Mental Health Parity and Addiction Equity Act of 2008 is viewed as a landmark step in improving patients’ access to mental- health services. The effort was bolstered in 2010 by the Affordable Care Act. The bottom line: Individual and group insurance plans that choose to offer mental-health coverage now must do so at a level equal to that of medical coverage.
But the rollout has been slow. Federal officials didn’t release final rules for employer-based plans and policies offered on the health law’s marketplaces until November 2013. And how the law will affect Medicaid managed care plans that include both medical- and mental-health benefits is still unclear. Proposed regulations for those plans are being finalized by federal officials and expected to be released sometime this year.
There’s a lot at stake. The regulations from the Centers for Medicare and Medicaid Services will also likely determine the extent to which the law applies to Medicaid managed care “carve-out” mental-health plans that are frequently paired with separate medical insurance. In addition, experts suggest the proposed rule could, like the final regs issued for marketplace plans and employer-based coverage, do away with lifetime spending caps and other limitations that aren’t equal to those applied to medical services.
Medicaid is the largest payer of mental-health services, covering 27 percent of all mental-health spending in the United States, and 11 percent of people with Medicaid have a mental illness, according to the Department of Health and Human Services. Nationwide, 70 percent of Medicaid recipients are enrolled in managed-care plans, which are generally designed to reduce costs through improved coordination of primary care that stops unnecessary or inappropriate services. However, these plans also often have lower provider- reimbursement rates that can impact physician participation.
Emily Feinstein, the director of health law and policy at substance abuse and addiction center CASAColumbia, has been tracking the parity law’s implementation and works with states on improving mental-health and substance-abuse care. If mental-health and addiction services are not covered at the same level as medical, she says, there is the potential for more emergency room visits and acute care services that might not happen if people with Medicaid managed-care plans had access to a weekly counseling and other mental-health services.
Here’s an edited version of the Q&A with Ms. Feinstein:
Q: Why is this rule going to be so important?
A: Parity offers the promise to dramatically improve patients’ access to the full range of evidence-based mental health and addiction treatments, especially for people with more complex health problems. As chronicled by 60 Minutes in the recent segment, “Denied,” claims for intensive behavioral healthcare services are routinely denied. … The hope is that insurance companies will start to cover mental-health and addiction services for people as comprehensively as they cover care for other complex chronic diseases, like diabetes, heart disease or cancer.
Q: What’s an example of something that might change if parity was applied to Medicaid managed care?
A: A big problem right now is Medicaid excluding medications that treat opioid addiction –methadone, buprenorphine and naltrexone. Medicaid coverage for these medications is uneven and even in states that cover them, managed-care plans find ways to limit access. For example, they say you have to fail psychotherapy first before you can get buprenorphine, or that you have to fail first on a cheaper alternative before you can get to the more expensive treatment. Or they require prior authorization, so doctors can’t prescribe the drug right there. These policies have big consequences. If people can’t get the medication they need, they are at risk of dropping out of treatment and relapsing. For addiction, the “fail” in fail first means relapse. And for opioid addiction, relapse can be fatal. These kinds of policies violate the federal parity rule, unless insurance companies apply the same limitations to medical treatments, and we know they don’t. It’s really a cost containment strategy. If the parity rule for Medicaid addresses these issues, many more people will be able to access addiction medications, and many lives can be saved.
Q: Where – meaning in what states – might enrollees feel the most impact in terms of new regulations for Medicaid managed-care plans?
A: My sense is that there is huge variability among states. Some states have identified mental-health and addiction treatment as a way to improve cost savings [in their Medicaid programs] and healthcare outcomes, and they’re already trying to improve access to care. Other states, which for political reasons aren’t expanding Medicaid, will have less coverage for addiction and mental health, because they’re not doing everything they can provide care in the first place.
Q: Do you anticipate there will be opposition to such an effort?
A: There is resistance of course from the insurance industry, especially from managed-care companies that contract with Medicaid, who are concerned that parity requirements will increase their costs. For providers [such as doctors and hospitals], there are concerns about whether the rule will be clear enough and will provide enough protection when insurance companies deny care, either because the services aren’t covered at all, coverage is limited or because the insurance company claims the services aren’t necessary. Some parts of parity, for example — not imposing higher co-payments or number of visit limitations on behavioral healthcare — are very clear and easy to implement. Most insurance providers are already in compliance with these requirements. The more challenging issues are “non-quantitative treatment limitations” like the process for medical necessity review [where insurers determine whether or not a service is necessary] -this is where more clarity is needed.
Q: Could access issues increase as a result of the rule? We hear a lot about shortages of mental-health providers. How does this play into that discussion?
A: Ensuring that there are enough mental-health and addiction- treatment providers to meet patient demand will be a big challenge. Federal rules already require Medicaid managed care plans to ensure there are an adequate number of providers in their network, but states are allowed to define what adequate means. The result is huge variation. And there is little enforcement. One reason there aren’t enough providers in Medicaid plans is that the reimbursement rates in Medicaid are very low, and providers say they can’t afford to take many Medicaid patients.
Among the topics:
There are indications that the hackers who got into Anthem, the huge health-insurance company, were Chinese government-backed and were seeking, among other things, to steal data on individuals with defense or other sensitive jobs as well as operational information on health systems that might be useful to new Chinese health systems. The Chinese could also use the data to blackmail people into becoming Chinese spies.
China continues to show itself better at stealing new products and services than in developing them.