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GOP should avoid Medicare third rail

January 11, 2017by Robert Whitcomb in Uncategorized tagged , , ,

rail

Rodney Whitlock writes in Health Affairs:

“Republicans have expressed interest in repealing and replacing the Affordable Care Act (ACA), restructuring Medicare to a premium support model, and reforming Medicaid through either block grants or per capita caps. Taking on all three programs is an extremely heavy lift — both politically and legislatively. If it is improbable to do all three, Republicans should openly acknowledge that they are taking Medicare restructuring off the table. This is not meant to belittle the importance of Medicare as a fiscal issue. The reality is that this election was in no way a mandate for major Medicare restructuring, and the President-elect came out rather strongly against the concept during the campaign.

“With premium support-style Medicare reform off the table, the political calculus changes dramatically for the Democrats. The Democrats have been revving up the Medicare privatization rhetoric that has been politically beneficial since 1995. Without Medicare as a rallying point, Democrats would be forced to defend the Affordable Care Act (ACA) which is relatively unpopular and in need of reconsideration. Refusing to engage might not be in their political interest. And while the Medicaid program is critical to the people it serves, it has not been shown to be the salient political issue that drives voters the way Medicare has.”

Of course Medicare has long since become a political third rail because elderly people vote at very high rates compared to younger and/or poorer folks.

To read Mr. Whitlock’s full piece, please hit this link.

What happens to community health centers after the ACA?

January 10, 2017by Robert Whitcomb in Uncategorized tagged , , , , ,

 

By SHEFALI LUTHRA

For Kaiser Health News

For the patients and the employees of Mary’s Center, a community health center that serves Washington, D.C., and its Maryland suburbs, the 2010 health law had a big impact on business. The facility has always promised care to anyone who walks through its doors. But since the Affordable Care Act’s implementation, the patient population and the quality of care they receive has changed.

“The first set of patients we saw — it was like, ‘Wow, I can see a doctor for the first time. I can afford to go to the doctor,’” recalled Maria Gomez, the center’s president. “There were patients that knew they had tumors, or knew they hadn’t had a pap smear in a long, long time.”

But it wasn’t just access to care, Gomez added. The law, which extended health insurance to more than 20 million people, also provided new streams of revenue. Since Mary’s Center was handling fewer uninsured patients, that financial security let it hire more specialists and operate more health education programs.

Similar stories played out at many of the nation’s more than 1,400 federally-backed community health centers, according to two studies in Health Affairs. The research offers evidence that in states that embraced the health law, community health centers — which play a key role in providing health care to low-income people, often in medically underserved areas — further extended their reach. It also quantified the types of clinic visits and health services provided that resulted from the expansion.

These findings, though, also highlight the uncertainties some of these clinics face as the incoming Trump administration and the GOP Congress advance plans to repeal and replace Obamacare.

“I’d love to think we can think of policies that will reduce harm, and make things better,” said Leighton Ku, director of the Center for Health Policy Research at George Washington University and an author on one of the studies. “But my crystal ball isn’t that clear.”

The two studies use data from the federal Health Resources and Service Administration to examine Medicaid, the federal-state insurance plan for low-income people. Under the law, states could opt into an expanded version of the program that covered more people. GOP plans to undo the 2010 law would likely include erasing that option. Many Republicans also want to change Medicaid from its current open-ended, entitlement status into a block grant, which would send a set, lump sum of funding to states and allow them more flexibility to tailor the program to address local health needs, potentially spurring innovation and more efficiency.

“There may be things that can done in the delivery of care for community health centers, which ultimately is more valuable and effective than the traditional Medicaid program,” said Tom Miller, a resident fellow at the American Enterprise Institute, a conservative think tank.

It’s too soon to say, Miller argued, how healthcare funding will play out, how money could be used and who will benefit. But other advocates of the law — including many leaders of community health centers — say that current discussions leave strong potential for funding cuts that would limit their ability to provide care. The Health Affairs findings play into that concern.

Ku’s paper, which used data from 2012 to 2015 to track visits to community health centers, compared how many patients visited the centers, their insurance, and whether they sought medical, dental or mental-health care. In states that opted into the expansion, health centers saw more patient visits, lower rates of uninsured patients — a financial boon for clinics that typically operate on thin margins — and an increase in patients specifically seeking mental health care.

The second study examined data from 2011 to 2014 and found that, in states that expanded Medicaid, patients were more likely to receive asthma treatment when it was needed, have their body mass index assessed, get pap smears and keep their blood pressure relatively stable.

“Achieving better quality in [these areas] requires medications — access to prescription drugs,” noted Amal Trivedi, an associate professor of health services, policy and practice at Brown University and an author on the second study.

Some clinic officials noted that these statistics illustrate tangible gains.

Community health centers in Michigan, which pursued the expansion, saw a double-digit increase in the percentage of Medicaid patients — from 44 percent to 54 percent — even as the overall number of patients served grew, noted Jen Anderson, a spokeswoman for the Michigan Primary Care Association, the trade group for the state’s centers. More of those patients were diabetic or asthmatic, she added, and now able to get previously unaffordable medications.

Without that coverage, Trivedi speculated, the improvements health centers made in treating these and other conditions could be reversed.

The studies found that the centers, too, benefited from the expansion, which has allowed them to staff up to do provide mental health and other types of care.

In Pennsylvania, for instance, which has been hard hit by the opioid epidemic, more clinics have been able to develop specialized addiction treatment programs, said Cheri Rinehart, president of that state’s health center association. Other clinics report that health law dollars have allowed them to hire case workers to follow up with patients to make sure they have stable housing and access to healthy food as well as transportation to doctors’ appointments.

Those kinds of efforts will be much harder if Congress acts on its proposed repeal without a meaningful replacement, Gomez said.

“We’ll have to cut services for everyone,” she said.

At Mary’s Center, she said, that would mean tamping down on dental care, cardiology or endocrinology to treat diabetes. The center would also likely downsize how many doctors and nurses it employs, making it harder to see as many patients in a timely manner.

These centers are often the only real option for care. If they can’t provide a service, people will likely go without until it’s an emergency, Pennsylvania’s Rinehart noted.

Without the coverage expansion, community health centers “will have to re-evaluate all the services they’re providing,” Rinehart said. “Just like a body in crisis, you focus on the core, and lose many of the ancillary services that are critical.”

3 healthcare changes that can outlast the ACA

January 5, 2017by Robert Whitcomb in Uncategorized tagged , ,

Whatever the Republican efforts to kill the Affordable Care Act, some healthcare changes encouraged by the ACA that have particularly developed over the past few years will almost certainly continue, predicts The New York Times.

Three of them are:

  • Early intervention through much expanded community-health efforts that address the social determinants of health.
  • Alternative payment models, such as bundled payments, in a continued move away from fee for service and to fee for value and outcomes.
  • More emphasis on care coordination and team-based care, including better coordination between clinicians and outside social services.

To read The New York Times piece, please hit this link.

CEO of Boise-based St. Luke’s Health System reports progress in drive to end fee-for-service care

December 30, 2016by Robert Whitcomb in Uncategorized tagged , , , , , ,

David C. Pate, M.D., a physician and lawyer who has been president and CEO of St. Luke’s Health System, based in Boise, Idaho, since 2009, spoke Dec. 14 as part of the Boise Metro Chamber of Commerce’s CEO Speaker Series. These remarks are edited for length and clarity from a transcript prepared by the chamber’s public-relations director, Caroline Merritt.

There’s a lot of discussion about healthcare, a lot of fear about what’s going to be happening with healthcare from a national level. I think there are answers — answers that healthcare providers are best prepared to implement, not Washington.

For the seven years that I’ve been here, we have been working at St. Luke’s, building the capabilities and competencies necessary to manage healthcare in a very different world than has existed.

Six months after I got here, the Affordable Care Act was enacted. We at St. Luke’s did not support the Affordable Care Act. Not because it doesn’t have a lot of really good features. It does. The discussion at the time was that if we add tens of millions of people to the newly insured in what was at the time, and still is, a broken healthcare delivery system, we’re going to end up saving money. We did not believe that. We have seen with the Affordable Care Act the continued growth and cost in healthcare. Something different has to happen.

Now the discussion is, “Let’s repeal and replace the Affordable Care Act.” I think it’s going to miss the mark as well. In both cases, Republicans and Democrats are coming up with the right answers to the wrong question.

Get a service, pay a bill

Most experts in healthcare would agree that the single biggest problem is our reimbursement model. It’s what’s called fee-for-service. You go to the doctor, you get a bill. You get a lab test, you get a bill. You go to the hospital, you get a bill.

It leads to a fragmented healthcare-delivery system. Everything is being paid by this unit-of-service or episode-of-care. Regardless of whether it helped you or not. Regardless of whether it provided value. Regardless of whether there was a less costly alternative.

An ideal reimbursement system ought to align the incentives of the payment with what we say are the important objectives that we want. You go places and you’re always having to repeat the same things because nobody seems to have all the information. You get bills from all the different ones.

It’s estimated that, at minimum, 30 percent of all healthcare spending in the United States goes to low-value or no-value services. So we are spending money on things that don’t help people. With fee-for-service, we pay for a lot of duplication.

One of the consequences is that we have these consistently rising premiums, and they have outpaced the growth in incomes. In Idaho this is particularly serious, because premiums as a percentage of average income [are] about 17 percent, and even the federal government with the Affordable Care Act said affordable is less than 9.5 percent.

High-deductible health plans don’t help

What has been a response is, “Let’s create really high-deductible health plans that make the patients have skin in the game and make them a little bit resistant to buy these services unless they really need them.”

Most of us can remember the day when we thought a high deductible was a thousand dollars for an individual. These high-deductible plans now are in the neighborhood of up to $6,000 for an individual, $12,000 for a family. Nearly half of Idahoans don’t have enough liquid assets to be able to pay the deductible.

So insurance is increasingly become more like a catastrophic health plan, not something that you can really use. People do avoid getting care, but they avoid getting the care they need as well as the care that you’d like to discourage. This isn’t working.

Now imagine a new world that I’ll call pay-for-value. Imagine that I’m getting paid $500 a month for people to provide all of their healthcare, and that’s all I’m getting,

The majority of the population [accounts for] a very small amount of the healthcare spending – 4 percent. In fee-for-service, Saint Al’s {Boise-based St. Alphonsus Health System} and St. Luke’s would go broke. They just don’t use many services.

Today, in fee-for-service, what I want to know when I come to work is: Are all our hospital beds full? Are our emergency departments full? Are women lined up down the hallway to give birth? Because this is how we get paid.

When [a patient is] ready to be discharged, we’re going to wheel [her] out in a wheelchair to the front sidewalk, and her family members are going to pull up, and we’re going to put her in the car and close the door. We’re done. Now, if anything else happens to her, that’s fine, come on back. We’d be glad to have you, and we’ll do it again. Re-admissions aren’t really a problem for us under fee-for-service. It’s just an opportunity to make more money.

New financial incentives for better care

Think about pay-for-value. I’m getting $500 per month. Is there any hospitalization that you can have for under $500 that you can think of? No.

Now don’t misunderstand me. We’re still going to have hospitalizations, even under pay-for-value. But we’re looking at them differently: Could we have prevented this?

Under pay-for-value, complications are very expensive, and now they’re our expense, because we’re just getting that $500. And we’re looking at two things. How can we give the right care 100 percent of the time? And how can we get to zero complications?

If you have a knee or a hip replacement, one of the dangers is that the prosthesis, the artificial part of it, can get infected. We figured that if someone got an infection from their knee or hip surgery, it added about $120,000 to the cost. That’s a lot of $500 premiums to pay for that complication. So what we’ve been doing is trying to figuring out how do we get to zero complications.

With hip and knee infections — I’m going to oversimplify — there are two ways you can get infected. One is: There can be bacteria on the skin that we don’t get off, so in the operation we put the bacteria in it. But today, the bigger problem is there’s particulate material in the air. We’ve got your wound open. That particulate matter can settle in your wound.

So we partnered with Micron and Boise State University to come into our operating rooms and to study about these particulate counts. Who knew there were such things as air engineers, but there are, and Boise State has one. And what we found is that every time the OR door opened, it stirred up the particulate count in the room. Just by us making sure everything is needed is in the room, and putting in new procedures about minimizing traffic through the OR, we have cut what was already a very good infection rate in half. These are the kind of things that you have got to do in this new world.

A very small percentage of the population accounts for a lot of the healthcare spending. [A man] has diabetes and heart failure and chronic kidney disease, and he’s a couch potato and he’s not very active. He is just a mess. People in [his] category, on average, are going to have six to eight doctors. In fee-for-service, they’re not talking to each other.

‘We’re driving this forward’

In pay-for-value, that’s where we can reduce costs and make healthcare more affordable. Instead of concentrating all of my health systems’ resources on all of them, I’m going to focus my resources on this group, because there is so much we can do just by paying those doctors differently. They’re not just getting paid for the office visit. They are now paid to actually coordinate his care. You use other resources like care managers to help coordinate that care.

Starting Jan. 1,  25 percent of our revenue will be in this new model. We expect that sometime in 2018, it actually may be 50 percent. So we’re driving this transformation forward.

Now, the Boise/Meridian hospitals are five-star hospitals designated by CMS [the federal Centers for Medicare and Medicaid Services], the only one like that in the state of Idaho — in fact, in the surrounding six states. And our health system has been named, and that’s all of the hospitals, a top 15 health system for three years in a row. We’re showing that this can be done. We’re doing it.

The other piece is: Drive it at the lowest possible cost. That’s what we’ve got to deliver on.

We’re not counting on Washington to figure out how to fix healthcare.

Q: You’re talking about the transformation, but I’m wondering how that’s going to happen. You partner with SelectHealth, right? To deliver this model? Are you going to be able to work with the other insurance companies to make this happen? Or maybe it’s something bigger, like CMS changing from fee-for-service to pay-for-value. How are you going to get from 50 to 100 percent?

A: This is a great question, because the only way we can do it is if the payment system is transformed as well. It’s not going to work for us to transform the clinical model if the business model doesn’t change with it.

We have a great partnership with SelectHealth. That is certainly accelerating our efforts. One reason we went to SelectHealth was there wasn’t a lot of appetite for this in the market with the insurers at the time many years ago. Now other payers are getting aligned with this same concept.

In defense of my insurance-company colleagues, let me tell you, it’s really hard to change your business model. What we’ve gone through with our board to convince them that we should do this, and for them to understand you’re going to take 25 percent of our revenue and put it at financial risk? It’s a big step. And it’s hard for any business to transform their business when they’re doing well.

I think there’s going to be a competitive advantage to who can figure this out first. What I can do is: With the insurance companies that want to partner with us, we can now get by on a lower premium. So you can actually lower your premium, and we know that is what will shift market share.

As far as the federal government:

The current administration is all in favor of this, and they would applaud what we are doing.

I am concerned with the new pick for secretary of HHS [President-elect  Trump has chosen Rep. Tom Price,  M.D., a Georgia Republican congressman] because I’m not convinced based on what I’ve read about him that he believes in this. He’s a physician that came from the fee-for-service world and did well in that world.

I think the question is: How difficult is the new administration going to make it for us to do this? But I hope not.

This story appears in the December 21, 2016-January 17, 2017, edition of the Idaho Statesman’s Business Insider magazine.  To get to the magazine, hit this link.

 

 

How would GOP pay for an ACA replacement?

December 30, 2016by Robert Whitcomb in Uncategorized tagged , , , ,

By JULIE ROVNER

For Kaiser Health News

Leading Republicans have vowed that even if they repeal most of the Affordable Care Act early in 2017, a replacement will not hurt those currently receiving benefits.

Republicans will seek to ensure that “no one is worse off,” said House Speaker Paul Ryan, R-Wis., in an interview with a Wisconsin newspaper earlier this month. “The purpose here is to bring relief to people who are suffering from Obamacare so that they can get something better.”

But that may be difficult for one big reason — Republicans have also pledged to repeal the taxes that Democrats used to pay for their health law. Without that funding, Republicans will have far less money to spend on whatever they opt for as a replacement.

“It will be hard to have comparable coverage if they start with less money,” Gail Wilensky, a health economist who ran the Medicare and Medicaid programs under President George H.W. Bush, said in an interview.

“Repealing all the ACA’s taxes as part of repeal and delay only makes a true replacement harder,” wrote Loren Adler and Paul Ginsburg of the Brookings Institution in a white paper out this week. It “would make it much more difficult to achieve a sustainable replacement plan that provides meaningful coverage without increasing deficits.”

The health law’s subsidies to individuals buying insurance and the Medicaid expansion are funded by two big pots of money..

The first is a series of taxes, including levies on individuals with incomes greater than $200,000, health insurers, makers of medical devices, brand-name drugmakers, people who use tanning salons, and employer plans that are so generous they trigger the much-maligned “Cadillac Tax.” Some of those measures have not yet taken effect.

However, the Congressional Budget Office estimated in early 2016 that repealing those provisions would reduce taxes by an estimated $1 trillion over the decade from 2016-2025.

The other big pot of money that funds the benefits in the health law comes from reductions in federal spending for Medicare (and to a lesser extent, Medicaid). Those include trims in the scheduled payments to hospitals, insurance companies and other health care providers, as well as increased premiums for higher-income Medicare beneficiaries.

CBO estimated in 2015 that cancelling the cuts would boost federal spending by $879 billion from 2016 to 2025.

The GOP, in the partial repeal bill that passed in January and was vetoed by President  Obama, proposed to cancel the tax increases in the health law, as well as the health premium subsidies and Medicaid expansion. But it would have kept the Medicare and Medicaid payment reductions. Because the benefits that would be repealed cost more than the revenue being lost through the repeal of the taxes, the result would have been net savings to the federal government — to the tune of about $317.5 billion over 10 years, said  the CBO.

But those savings — even if Republicans could find a way to apply them to a new bill — would not be enough to fund the broad expansion of coverage offered under the ACA.

If Republicans follow that playbook again, their plans for replacement could be hampered because they will still lose access to tax revenues. That means they cannot fund equivalent benefits unless they find some other source of revenue.

Some analysts fear those dollars may come from still more cuts to Medicare and Medicaid.

“Medicare and Medicaid face fundamental threats, perhaps the most since they were established in the 1960s,” said Edwin Park of the liberal Center on Budget and Policy Priorities, in a webinar last week.

Republicans in the House, however, have identified one other potential source of funding. “Our plan caps the open-ended tax break on employer-based premiums,” said their proposal, called “A Better Way.”

House Republicans say that would be preferable to the Cadillac Tax in the ACA, which is scheduled to go into effect in 2020 and taxes only the most generous plans.

But health-policy analysts say ending the employer tax break could be even more controversial.

Capping the amount of health benefits that workers can accept tax-free “would reduce incentives for employers to continue to offer coverage,” said Georgetown University’s Sabrina Corlette.

James Klein, president of the American Benefits Council, which represents large employers, said they would look on such a proposal as potentially more damaging to the future of employer-provided insurance than the Cadillac Tax, which his group has lobbied hard against.

“This is not a time one wants to disrupt the employer marketplace,” said Klein in an interview. “It seems perplexing to think that if the ACA is going to be repealed, either in large part or altogether, it would be succeeded by a proposal imposing a tax on people who get health coverage from their employer.”

Wilensky said that as an economist, getting rid of the tax exclusion for employer-provided health insurance would put her “and all the other economists in seventh heaven.” Economists have argued for years that having the tax code favor benefits over cash wages encourages overly generous insurance and overuse of health services.

But at the same time, she added, “I am painfully aware of how unpopular my most favored change would be.”

Republicans will have one other option if and when they try to replace the ACA’s benefits — not paying for them at all, thus adding to the federal deficit.

While that sounds unlikely for a party dedicated to fiscal responsibility, it wouldn’t be unprecedented. In 2003 the huge Medicare prescription drug law was passed by a Republican Congress — with no specified funding to pay for the benefits.

Fines cut hospital readmissions rates

December 28, 2016by Robert Whitcomb in Uncategorized tagged ,

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Financial penalties under the Affordable Care Act’s Hospital Readmission Reduction Program reduced 30-day risk-standardized  readmission rates for acute myocardial infarction (AMI), heart failure and pneumonia compared with rates before the law’s passage, says an article in the Annals of Internal Medicine. The  readmission reductions were particularly  notable at the hospitals that had had the worst readmission rates before the ACA went into effect.

To read the article, please hit this link.

 

A regional look at how ACA has slashed uninsured rates

December 22, 2016by Robert Whitcomb in Uncategorized tagged

 

A Philadelphia Inquirer analysis of a Commonwealth Fund report on the Affordable Care Act finds big drops in Middle Atlantic states as  a result of the law, which the Republicans want to abolish.

To read the analysis, please hit this link.

Feds cracking down on hospitals over infections

December 22, 2016by Robert Whitcomb in Uncategorized tagged , , , , , , ,

bacteria

By JORDAN RAU

For Kaiser Health News

The federal government has cut payments to 769 hospitals with high rates of patient injuries, for the first time counting the spread of antibiotic-resistant germs in assessing penalties.

The punishments come in the third year of Medicare penalties for hospitals with patients most frequently suffering from potentially avoidable complications, including various types of infections, blood clots, bed sores and falls. This year the government also examined the prevalence of two types of bacteria impervious to drugs.

Based on rates of all these complications, the hospitals identified by federal officials this week will lose 1 percent of all Medicare payments for a year — with that time frame beginning this past October.  While the government did not release the dollar amount of the penalties, they will exceed a million dollars for many larger hospitals. In total, hospitals will lose about $430 million, 18 percent more than they lost last year, according to an estimate from the Association of American Medical Colleges.

The reductions apply not only to patient stays but also will reduce the amount of money hospitals get to teach medical residents and care for low-income people.

Forty percent of the hospitals penalized this year escaped punishment in the first two years of the program, a Kaiser Health News analysis shows. Those 306 hospitals include the University of Miami Hospital in Florida, Cambridge Health Alliance in Massachusetts, the University of Michigan Health System in Ann Arbor and Mount Sinai Hospital in New York City.

Nationally, hospital-acquired conditions declined by 21 percent between 2010 and 2015, according to the federal Agency for Healthcare Research and Quality, or AHRQ. The biggest reductions were for bad reactions to medicines, catheter infections and post-surgical blood clots.

Still, hospital harm remains a threat. AHRQ estimates there were 3.8 million hospital injuries last year, which translates to 115 injuries during every 1,000 patient hospital stays during that period.

Each year, at least 2 million people become infected with bacteria that are resistant to antibiotics, including nearly a quarter million cases in hospitals. The Centers for Disease Control and Prevention estimates 23,000 people die from them.

Infection experts fear that soon patients may face new strains of germs that are resistant to all existing antibiotics. Between 20 and 50 percent of all antibiotics prescribed in hospitals are either not needed or inappropriate, studies have found. Their proliferation — inside the hospital, in doctor’s prescriptions and in farm animals sold for food — have hastened new strains of bacteria that are resistant to many drugs.

One resistant bacteria that Medicare included into its formula for determining financial penalties for hospitals is methicillin-resistant Staphylococcus aureus, or MRSA, which can cause pneumonia and bloodstream and skin infections. MRSA is prevalent outside of hospitals and sometimes people with it show no signs of disease. But these people can bring the germ into a hospital, where it can be spread by healthcare providers and be especially dangerous for older or sick patients whose immune system cannot fight the infection.

Hospitals have had some success in reducing MRSA infections, which dropped by 13 percent between 2011 and 2014, according to the CDC. AHRQ estimates there were 6,300 cases in hospitals last year.

The second bacteria measured for the penalties is Clostridium difficile, known as C. diff, a germ that can multiply in the gut and colon when patients take some antibiotics to kill off other germs. It can also spread through contaminated surfaces or hands.

While it can be treated by antibiotics, C. diff can also become so serious that some patients need to have part of their intestines surgically removed. C. diff can cause diarrhea and can be deadly for the elderly and other vulnerable patients.

C. diff has challenged infection control efforts. While hospital infections dropped 8 percent from 2008 to 2014, there was a “significant increase” in C. diff that final year, the CDC says. AHRQ estimated there were 100,000 hospital cases last year.

“The reality is we don’t know how to prevent all these infections,” said  Louise Dembry, M.D., a professor at the Yale School of Medicine and president of the Society for Healthcare Epidemiology of America.

The Hospital-Acquired Condition Reduction Program also factors in rates of infections from hysterectomies, colon surgeries, urinary tract catheters and central line tubs. Those infections carry the most weight in determining penalties, but the formula also takes into account the frequency of bed sores, hip fractures, blood clots and four other complications.

Specialized hospitals, such as those that treat psychiatric patients, veterans and children, are exempted from the penalties, as are hospitals with the “critical access” designation for being the only provider in an area. Of the remaining hospitals, the Affordable Care Act requires that Medicare penalize the 25 percent that perform the worst on these measures, even if they have reduced infection rates from previous years.

That inflexible quota is one objection the hospital industry has with the penalties. In addition, many hospitals complain that they are penalized because of their vigilance in detecting infections, even ones that do not cause any symptoms in patients. Academic medical centers in particular have been frequently punished.

“The HAC penalty payment program is regarded as rather arbitrary, so other than people getting upset when they incur a penalty, it is not in and of itself changing behavior,” said Nancy Foster, vice president for quality and patient safety at the American Hospital Association.

Federal records show that 347 hospitals penalized last year will not have payments reduced because their performance was better than others. Those include Harbor-UCLA Medical Center in Los Angeles, the Johns Hopkins Hospital in Baltimore and the University of Tennessee Medical Center in Knoxville.

Over the lifetime of the penalty program, 241 hospitals have been punished in all three years, including the Cleveland Clinic; Intermountain Medical Center in Murray, Utah; Ronald Reagan UCLA Medical Center in Los Angeles; Grady Memorial Hospital in Atlanta; Northwestern Memorial Hospital in Chicago; and Brigham & Women’s Hospital in Boston.

The penalties come as the Centers for Medicare & Medicaid Services also launches new requirements for hospitals to ensure that the use of antibiotics is limited to cases where they are necessary and be circumspect in determining which of the drugs are most likely to work for a given infection. Hospitals will have to establish these antibiotic stewardship programs as a condition of receiving Medicare funding under a regulation the government drafted last summer.

Lisa McGiffert, who directs Consumers Union’s Safe Patient Project, said that as a result of Medicare’s penalties and other efforts, “more hospitals are thinking more about appropriate use of antibiotics.” However, she said, “I think most hospitals do not have effective antibiotic stewardship programs yet.”

 

A place to train very collaborative, tech-savvy nurses

December 8, 2016by Robert Whitcomb in Uncategorized tagged , , , , ,

 

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Artist’s rendition of part of the Union Square Campus.

Hospitals & Health Networks reports on the recently opened Union Square Campus, in Greensboro, N.C.,  where the latest technologies and an emphasis on teamwork  are used to train student and practicing nurses.

The mission is to address the growing need for nurses at all levels and promote collaboration among nurses and other health professionals. The facility  will educate nurses from the associate (two-year) level through the bachelor-(four-year) and doctoral-degree level.

“The Affordable Care Act requires health care to be accountable for patients across the healthcare continuum,” Jean Reinert, R.N., director of education and training at Cone Health, a partner in Union Square Campus, told H&HN. “We’re training nurses at all levels.”

The $34 million campus, completed in August, has such state-of-the-art training tools as high-fidelity simulation mannequins.”They have vital signs,” says Ms. Reinert. “You can do almost anything you can do on a real patient.”

Ms. Reinert told H&HN that research shows that nurses with advanced degrees provide better patient care. “So there is a push to have more BSN {bachelor of science in nursing] nurses at the bedside. We need more nurses as we move into the 2020s, and this is a way to grow more nurses with higher skill levels.”

H&HN reported that Union Square Campus “will include a simulated home environment, simulated outpatient area and simulated acute area with hospital beds, operating rooms and intensive care units, Reinert says. ”

“Reinert would like to see Union Square Campus eventually bring together a multidisciplinary team that could include physicians, medical students, physician assistants, nurse practitioners, occupational therapists and physical therapists. This would create a training environment in which health professionals from different disciplines ‘work together in the same environment, the way we would in the real world.”’

Other partners in Union Square Campus include Guilford Technical Community College, North Carolina A&T State University and the University of North Carolina at Greensboro.

To read the H&HN article, please hit this link.

 

Berwick: Push for the Triple Aim will continue under Trump

December 6, 2016by Robert Whitcomb in Uncategorized tagged , , , , , ,

 

Ilene MacDonald, of FierceHealthcare, writes about the views of former CMS Administrator Don Berwick, M.D., on health policy under the Trump administration.

She writes:

“Trump’s pre-election healthcare platform called for complete price transparency, and elements of the Affordable Care Act also call for transparency to help make the healthcare system easier to understand, creating a more competitive market. That meant CMS had more authority and responsibility to make data more available to the public. That was a difficult journey, Berwick says, because historically CMS kept the data guarded and tightly controlled for research. Over time data has become more available but he’s unsure what the future holds with the new administration.”

‘Tom Price, M.D. [Trump’s pick for the new head of the Department of Health and Human Services] is a fan of doctors and doctor practices. And doctors are uncomfortable with transparency so I’m not sure which way he will call this,’ Berwick says.”

“Although Berwick isn’t sure what will happen to the star ratings system under the new administration, he says he is certain quality improvement in healthcare and the goal of the Triple Aim to improve individual care, boost the health of patient populations and reduce overall costs, will continue.”

To read all of Ms. MacDonald’s piece, please hit this link.

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