Nancy Fabozzi, principal analyst for connected health at research firm Frost & Sullivan, noted in a video interview with MedCity News that 2016 might be the year of “patient enragement” about soaring drug prices and insurance premiums.
Further out, she says,“Technology will reshape the medical profession, in many cases, replacing physicians for routine care,” as she looks at what the “electronic doctor” might look like in a decade or two.
She says that an “electronic doctor” about the size of a first-aid kit could fairly soon become a staple in American homes. It will have biometric monitoring, diagnostic and other digital health technologies, and feed data to a cloud-based medical record, boosted by artificial intelligence.
In a 18-month project organized by the Aligning Forces for Quality program, hospitals cut their “discharged length of stay by 26 minutes, their admitted length of stay by 36.5 minutes and their boarding time by nearly 21 minutes,” FierceHealthcare summarized from the Joint Commission abstract.
The news service said that “the rate of patients who left without being seen also fell by 1.4 percent percentage points,” according to the Joint Commission abstract.
“Although most of the hospitals in the collaborative improved on at least one measure of ED throughput, 14 hospitals did not demonstrate improvement. The researchers said those hospitals that didn’t succeed may not have had C-suite leaders actively involved in the improvement teams, which may have stalled or even stopped some projects. They concluded that successful approaches to ED flow improvement require engaged leaders, staff buy-in and sufficient resources.”
CHI St. Vincent adjusted protocols for pre-surgical patient contact and post-surgical follow-up. It implemented pre- and postsurgical follow-up calls within 24-hour, 48-hour, 10-day, 30-day, 90-day and 120-day windows and improved workflow through patient-centered monitoring of patients’ care inside and outside the hospital. This let hospital staffers find such potential barriers to their recovery as their transportation gaps, lack of social support or financial obstacles.
Thus CHI St. Vincent’s readmission rate fell from 24 percent to under 4 percent.
Cincinnati-based Mercy Health, formerly Catholic Health Partners, and Akron-based Summa Health said that each system’s Accountable Care Organization would join a new organization, Advanced Health Select — a clinically integrated network.
Other large regional systems, such as, in Michigan, Ascension Health and Trinity Health, have been working to broaden their contracting in similar ways
The idea in the Ohio case is to build on ACOs’ success in the Medicare Shared Savings Program and the systems’ total of $100 million invested in the last four years in data analytics, information technology and care coordination.
Jordan Grumet, M.D., an internist, pleads for physicians to get more credit. After all, he says, they’re right 80-90 percent of the time and are far more reliable, than, say, Dr. Grumet’s refrigerators, which are much less complicated than the human body.
Be Practical: Jonathan Niloff, M.D., vice president and CMO for McKesson Connected Care & Analytics said. “If technology is being implemented, make sure the organization has actually aligned workflow to make the physician’s job easier. For example, in an EHR, does the workflow follow logical steps or does a physician have to exit the program to continue work?” he told the publication.
Cut red tape and bureaucracy: This would include simplifying organizational reporting structure to ensure, for example, that physicians are totally accountable to no more than five people. Reducing the number of layers is of the top ways that healthcare organizations can make working environments more pleasant.
Widen physicians’ horizons: They may want to work in an inter-professional community, such as with social workers or dieticians.
Video and text: Leslie Dach, a former Wal-Mart executive, is a senior counselor to Health and Human Services Secretary Sylvia Mathews Burwell. He discussed with The Wall Street Journal how how healthcare policy is evolving.
Among his remarks:
“{W}e want to incentivize the system to pay for quality and not quantity. We want to incentivize care to be integrated and organized.
“The hip-and-joint bundle is a perfect one announced in final form yesterday. Billions of dollars are spent every year in America under Medicare and private insurance on hip and joint [replacement]. These are operations that can be quite painful. Recovery takes time. Under the old system, we would reimburse for the operation. The concept here is to ask the provider to be responsible for a 90-day period, an episode of care, so that they integrate the care down through rehab. If they do that well, they make more money. If they don’t do it as well, they have an economic risk. And that’s been welcome, frankly, by the hospital system and others.”
This Institute for Healthcare Improvement (IHI) paper describes 10 “new rules” developed and being tested by members of the IHI Leadership Alliance as a set of guiding principles to help accelerate their progress toward delivering on the full promise of the Triple Aim. The authors provide examples showing how IHI Leadership Alliance member organizations are enacting some of these rules.’
Epic has counter-attacked Mother Jones magazine to try to rebut its allegations that Epic has done a bad job in connecting health records and optimizing healthcare digitization.
The author of the article, Patrick Caldwell, wrote, “Epic has helped create a fragmented system that leaves doctors unable to trade information across practices or hospitals. That hurts patients who can’t be assured that their records…will be available to the doctors who need to see them.”
In response, Epic asserted:
“Epic customers can access their EHR almost anywhere, at any time, and our customers connect to and share patient records with thousands of organizations using other vendors’ products, including those used by the Department of Defense and the Veterans Health Administration. According to the eHealth Exchange, Epic shares more records with these government agencies than any other vendor.”
The incentive program began in 2011 and was designed to address disparities in Medicare reimbursements between primary-care physicians and specialists. It distributed $664 million in bonuses in 2012, the most recent year that figures are available, to roughly 170,000 primary care practitioners, awarding each an average of $3,938, according to a 2014 reportby the Medicare Payment Advisory Commission.
Although that may sound like a small adjustment, it can be important to a primary-care practice, says Dr. Wanda Filer, president of the American Academy of Family Physicians. “It’s not so much about the salary as it’s about the practice expense,” she explains. “Family medicine runs on very small margins, and sometimes on negative margins if they’re paying for electronic health records, for example. Every few thousand makes a difference.”
Doctors who specialize in family medicine, internal medicine and geriatrics are eligible for the bonuses, as are nurse practitioners and physician assistants.
Medicare generally pays lower fees for primary-care visits to evaluate and coordinate patients’ care than for procedures that specialists perform. The difference is reflected in physician salaries. Half of primary-care physicians made less than $241,000 in 2014, while for specialists the halfway mark was $412,000, according to the Medical Group Management Association’s annual provider compensation survey.
The impact of the bonus program is larger on practices with a substantial number of Medicare patients. Dr. Andy Lazris estimates 90 percent of the patients that his five-practitioner practice in Columbia, Md., treats are on Medicare.
“When the bonus payments started, it was a pretty big deal for us,” Dr. Lazris says. The extra $85,000 they received annually allowed them to hire two people to deal with the administrative requirements for being part of an Accountable Care Organization and to help the practice incorporate two new Medicare programs related to managing patients’ chronic diseases or overseeing their moves from a medical facility to home.
Next year, if they can’t make up the lost bonus money by providing more services, it’ll mean a pay cut of $17,000 per practitioner, Lazris says.
Although in some practices, doctors try to see more patients to make up for cuts in reimbursements, that is harder for a group focusing on the elderly. “Part of what we do in geriatrics is spend a lot of time with our patients,” he says. “We have to, when someone has five conditions and takes five minutes to get into the room. The basic office visit is 30 minutes.”
The incentive program was an effort to address shortcomings in Medicare’s system of paying providers mostly a la carte for services, which tends to undervalue primary care providers’ ongoing role in coordinating patients’ care. Earlier this year, Medpac proposed that Congress replace the expiring primary care incentive program with a per-beneficiary payment to primary care physicians that would be paid for by reducing payments for non-primary care services. That proposal hasn’t made any headway. Meanwhile, physician trade groups have lobbied unsuccessfully for an extension of the Medicare bonus program.
The expiration of the Medicare incentive program is particularly painful because it comes on the heels of a similar bonus program for Medicaid primary care services that ended in 2014, says Dr. Wayne J. Riley, president of the American College of Physicians, a professional organization for internists.
“There will be some physicians who say they can’t take any more Medicare patients,” Riley predicts.
An attorney for an advocacy group for Medicare beneficiaries says they support the bonus payments and hope that physicians won’t shut them out.
“We don’t have any evidence to show that primary care docs will stop seeing Medicare beneficiaries without the payment bump,” says David Lipschutz, a senior policy lawyer at the Center for Medicare Advocacy.
The vast majority of non-pediatrician primary-care doctors accept patients who are covered by Medicare, according to a national survey of primary care providers by the Commonwealth Fund and the Kaiser Family Foundation. But while 93 percent take Medicare, a smaller percentage, 72 percent, accept new Medicare patients. [Kaiser Health News is an editorially independent program of the foundation.]
Not all primary-care practitioners will miss the incentive program, according to the Commonwealth/KFF survey. Only 25 percent of those surveyed said they received a bonus payment; half didn’t know the program existed.
Of physicians who were aware of and received Medicare bonus payments, 37 percent said it made a small difference in their ability to serve their Medicare patients, and 5 percent said it made a big difference. However, nearly half — 48 percent — said it made no difference at all.
