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Rural hospitals’ lucrative rehab business

 

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The Associated Press reports that federal investigators have found that a law lets rural hospitals bill Medicare for rehabilitation services for seniors at higher rates than nursing homes and other facilities and cost billions of dollars in extra government spending.

Yet more reasons why Medicare spending is out of control.

Most patients could have been moved to a skilled-nursing facility within 35 miles of the hospital at about one-fourth the cost, the U.S. Department of Health and Human Services’ inspector general said.

The AP reported that hospitals ”juggling tough balance sheets have come to view such ‘swing-bed’ patients as lucrative, fueling a steady rise in the number of people getting such care and costing Medicare an additional $4.1 billion over six years.”

”Legislation passed by Congress in 1997 created the designation of ‘critical-access hospitals’ to help small facilities in remote areas survive. Rather than paying set rates for services as throughout the rest of the Medicare system, the federal government reimburses the hospitals for 101 percent of their costs. They also often receive state funding and grants.”

Congress, as now, was controlled by Republicans in 1997. Many represent rural areas in the South and West with many such “critical-access hospitals.”

The AP said that Alan Morgan,  chief executive of the National Rural Health Association, agreed  that Medicare could save money by modifying the system. But he told the AP that  dozens of rural hospitals have closed in the past five years, and nearly 300 others are very financially fragile. The Obama administration has already proposed  cutting all reimbursements  to critical-access hospitals, which  Morgan said would further accelerate the closures.

”Some hospitals received critical access designation under old rules and were grandfathered in. A previous report from the inspector general’s office found the vast majority would not meet the requirements if forced to requalify,” the news service reported.

 

 


Tenn. weighs changing Medicaid mental-healthcare

 

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Officials of TennCare, the Tennessee Medicaid program, seek to reform mental- and behavioral-health treatment under its 2016 budget.

The Nashville Tennessean reported that TennCare is proposing implementing ”an evaluation mechanism for people receiving mental health treatment under the bureau’s Level 2 case management classification. People under this categorization receive visits from case managers in addition to therapy or other treatments, such as medication.”

”The proposed changes would institute a review after three months to evaluate whether case manager visits are needed rather than everyone receiving visits, said Keith Gaither manager of managed-care organization (MCO) operations at TennCare.”

”Gaither said that the MCOs have been looking at this category of patients for more than two years to determine whether there was a way to tailor treatment on a case-by-case basis rather than extending the case management to everyone.”

It is unclear what impact all this might have on hospitals and Federally Qualified Health Centers.

 

 

 

 


Lethal variability in surgical outcomes

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An analysis shows that the probability of surviving any of four high-risk surgeries can vary by as much as 23 percent depending on the hospital,  Reuters reported today.

The report is by the nonprofit Leapfrog Group, a patient-safety organization supported by large employers, and Castlight Health Inc, which sells software for employers to manage healthcare spending.

Ashish Jha, M.D., of the Harvard School of Public Health, who was not involved in the Leapfrog report, told Reuters. “It’s amazing there is such variability in mortality from these common surgeries, and patients should know that.”

”Leapfrog asked 1,500 hospitals for 2013 data on four risky surgeries, including number of procedures and patient deaths. It adjusted the numbers to come up with a ‘predicted survival estimate for each,” Reuters reported.

”For pancreatectomy (removing all or part of the pancreas, usually to treat cancer), predicted survival rates ranged from 81 percent to 100 percent. Of 487 hospitals reporting data, 203 had rates of at least 91.3 percent, which Leapfrog chose as the benchmark for quality.”

”For esophagectomy (removing all or part of the esophagus), expected survival ranged from 88 percent to 98 percent. Only 182 of 535 hospitals had rates of at least 91.7 percent.”

”For repairs of abdominal aortic aneurysm, survival ranged from 86 percent to 99 percent; 268 of 792 hospitals met the benchmark of 97.3 percent.”

”For replacing the heart’s aortic valve, survival ranged from 92 percent to 97 percent; only 95 of 544 hospitals hit 95.6 percent.”

”The study didn’t analyze which kinds of hospitals – nonprofit or for-profit, in one region or another – excelled, but in general those that performed more procedures did best. National stalwarts such as Brigham and Women’s Hospital in Boston and the Mayo Clinic in Rochester, Minn.,  did well in all four surgeries, but so did Hoag Memorial in Newport Beach, Calif. and Morristown Medical Center, in New Jersey.”

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Marketing your hospital

 

A professor of management at Dartmouth looks at  what hospitals should think about when they market their institutions.


The future role of the ONC

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John D. Halamka, M.D., chief information officer and dean for technology at the Harvard Medical School, ruminates in MedCity News on the future of Office of the National Coordinator for Health Information Technology (ONC):

“As Meaningful Use winds down and incentive dollars are fully spent, what is the optimal role for the ONC going forward?”

”Some pundits have suggested that ONC step aside and return all aspects of HIT policy and technology to the private sector.   Others have suggested top down command and control of HIT including centralized governance to ensure interoperability.

”…Here’s my view about the future of ONC that includes points from both sides.”

”The Argonaut initiative is a good exemplar of the private sector working to enhance interoperability in response to the market demands of accountable care organizations, which depend on data to succeed in a risk contracting world.”

”There is clearly a role for the private sector to lead innovation and standards adoption….”

”However, even the best innovations require a regulatory and ecosystem context to enable the marketplace to blossom.   The healthcare sector is the most fragmented industry in our complicated economy, both on the demand side (patients, insurers, employers) and on the supply side (physician practices and hospitals).  ONC can be a focal point for the discussion of regulatory barriers to data liquidity, novel workflows, and alignment of incentives.”


Push for IT to support population health

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“Crowding” (photo modified in PhotoShop), by DAVID STONE, at Alpers Fine Art, Andover, Mass. He shot this from a balcony overlooking the front plaza of the Museum of Fine Arts, in Boston.

A Peer60 report said that 60 percent of institutions plan to invest in IT infrastructure in 2015 that could help support population health and patient engagement.

MedCity News noted: “Not surprisingly, ICD-10 migration topped the list of planned issues for hospital IT staffs, with 58 percent of all hospital leaders indicating it was a priority. The number jumps to 70 percent among groups that will specifically be working with the transition.”

“The critical market for patient engagement is still forming as almost 40 percent of hospitals don’t have a solution yet,” the report said. “That isn’t stopping hospitals that already have patient engagement solutions from making changes, though.”

“In other words, the population health management market in 2015 is going to be absolutely gigantic,” the report states.

But only 25 percent of hospitals in the survey said they plan to buy  patient-data-security IT in 2015, according to the report — despite some very bad hacking in the past year.

 


Will FQHC’s avoid the federal funding cliff?

 

Despite their many successes, the future of Community Health Centers is uncertain, warns the National Association of Community Health Centers (NACHC) because they face a federal funding cliff. Without action by Congress to address the funding shortfall, Community Health Centers face up to a 70-percent reduction in federal support on Oct. 1, 2015, the organization says.

So next Tuesday, March 17, the NACHC will release a policy report, Community Health Centers Past, Present and Future: Building on 50 Years of Success.

We at Cambridge Management Group, which has worked closely with Federally Qualified Health Centers, predict that Congress and the Obama administration will find a way of averting going off this cliff because of the  impact it would have on millions of patients, the increased traffic it would force on hospital emergency rooms and other woes.

Whatever that cliff, the chaos associated with a U.S. Supreme Court ruling against certain subsidies under the Affordable Care Act would also cause a lot of problems at FQHC’s.

 

 


Happy Medicaid ACO stories in 3 states

 

The Commonwealth Fund reports:

”Although the results are preliminary, the experiences of Medicaid ACO programs in Colorado, Minnesota, and Oregon show that this model of coordinating care—and then sharing in the resulting savings with payers—holds real promise.”

 


Prime Healthcare drops bid for Daughters of Charity

 

Prime Healthcare Services is abandoning its bid for Daughters of Charity Health System, in Los Altos Hills, Calif., citing “onerous and unprecedented {300} conditions” set by the California attorney general for the takeover to happen.

It’s another sign of the growing pushback by officials in some states against hospital-system expansion.

 

 

 


‘Next Generation’ ACO’s: More risk and reward

 

FierceHealthcare reported that Patrick Conway, M.D., chief medical officer and deputy administrator for innovation and quality at CMS, said that the ”Next Generation Accountable Care Organization” model will give participants more predictable financial targets and greater opportunities to coordinate care and engage beneficiaries.

“The goal is to determine whether stronger financial incentives for ACOs can improve health outcomes and reduce expenses of Medicare patients, he said.”

“ACO’s will have more tools to manage patient care, he said, including additional coverage of telehealth and post-discharge home services as well as reward payments to beneficiaries for receiving care from ACO’s.”

“The new ACO model will have two risk tracks–one of which is ‘essentially near 100 percent risk,”’  Dr. Conway said. And there will be four payment systems.

 


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