Amos Adler, president of Toronto-based Memotext, looks at how to improve the return on investment of increased patient engagement in a talk at this year’s MedCity ENGAGE conference, in San Diego.
One of the first steps, he said, is defining the value perspective.
“If we want to deliver ROI, we have to define that ROI at the onset. It can mean many different things to many different people”. But the key task is determining, and explaining, the immediate value to the patients of their increased engagement.
MedCity News reported: “Co-commercialization is one area {of patient engagement}in which the company has seen success. It worked with the Centre for Addiction and Mental Health, in Toronto, the largest hospital of its kind in Canada, on an app focused on predicting and ultimately reducing readmissions for behavioral health patients. It also teamed up with Massachusetts General Hospital on a family-specific pediatric ADHD intervention program.”
Adler concluded, “How can we use this stuff that’s around us to empower people to reach their goals and at the same time, improve the bottom line for stakeholders?”
Main entrance to Massachusetts General Hospital, the flagship of Partners HealthCare.
Partners HealthCare, the big and prestigious Boston-based hospital system, is reporting a profit after a year of losses. It says it had a $24 million operating gain for 2017’s first quarter.
The Boston Business Journal reports that the system’s finances are stabilizing “despite ongoing struggles which include a growing number of patients on government insurance, a new state assessment that cost Partners $7 million in the second quarter {of last year}, and drops in volume from some of the more lucrative service lines like surgery.”
In explaining the turnaround, Partners Chief Financial Officer Peter Markell told the publication:
“At the end of the day, when you have a heavily fixed cost structure capital base, you can become more efficient by growing and putting that through that same fixed cost base and by becoming more efficient about your use of space and variable costs that drive unit costs. This effort is focused on allowing us to improve our unit cost structure and to grow.”
The publication continued:
“Some of {Partners’} financial success came from its acquisition of Wentworth Douglass, a New Hampshire hospital that became part of Partners in January. Wentworth Douglass generated $1 million in operating income on its own. While that’s a small portion of Partners overall finances, Markell said it’s an example of how Partners can benefit from expanding to other states. Most recently, the health system announced plans to acquire three of Care New England’s four hospitals in Rhode Island.”
The Republicans’ promise to repeal the Affordable Care Act not only threatens to deprive millions of people of their health insurance; it could drive many hospitals deep into debt and destroy innovative programs created by the ACA aimed at improving patient care.
Timothy Ferris, M.D., an internist and medical director of the Mass General Physicians Organization, told FierceHealthcare that he worries that the “progress we’ve made over the past five years would be threatened.”
He said that includes programs through the Accountable Care Organization (ACO) at Massachusetts General Hospital, including experiments with video consultations and home hospitalization.
Dennis Keefe, head of Care New England, in Rhode Island, told NPR that he is concerned about the future for Integra, an ACO that includes primary- care physicians, specialists, urgent-care and after-hour providers, clinics, laboratories and inpatient facilities.
Hospitals and healthcare systems that have spent the last six years trying to create new value-based, patient-centered models as part of the ACA. And so 120 organizations sent a letter to President Trump and Vice President Pence urging them to not roll back progress they have made.
As is often the case, Medicaid populations pose big financial challenges.
Consider prestigious Partners HealthCare, which owns Massachusetts General Hospital, Brigham and Women’s and some other famed hospitals. It had a record $108 million operating loss and a $249 million net loss in fiscal 2016. Most of the operating loss came from Neighborhood Health Plan (NHP), its insurance unit that primarily serves low-income people. It’s the biggest loss in the system’s history.
NHP provides coverage for more than 430,000 commercial and Medicaid members; it’s the largest Medicaid insurer in Massachusetts.
NHP has been quite a challenge, having had $322 million in losses in the past three years. So Partners is taking such actions as closing enrollment to new Medicaid members to give it time to renegotiate the rates it pays some hospitals.
Partners’ income was also hurt by the very expensive preparation for a nurses strike that was averted at the last moment and the continuing expense of a new $1.2 billion Epic EHR system.
Partners HealthCare, whose properties include Massachusetts General Hospital and Brigham and Women’s Hospital, is stepping up efforts to commercialize research done at its labs and hospitals. Its latest tactic, reports The Boston Globe, is to offer as much as $1 million in grants (up to $100,000 each) for employees “who come up with promising ideas for new drugs, devices and other inventions that have the potential to improve patient care.”
“The grants are open not just to researchers, but to anyone in Partners’ workforce of 64,000 who has a good idea. The small sum is intended to help early-stage ideas get off the ground,” the paper reported.
“This funding is aimed at making an even stronger connection between the innovative ideas within our healthcare system and Boston’s biotech and life-sciences industry, which can bring those ideas to life,” Anne Klibanski, M.D., chief academic officer, said.
In wake of the controversy over “double booking” (or, in the hospital’s parlance “overlapping” surgeries) at Massachusetts General Hospital, MGH’s president, Peter L. Slavin, M.D.,and the chairman of the Massachusetts General Physicians Organization, Thomas J. Lynch, M.D., come to the defense of the practice, which is said to be common around America.
Erin Sheley, writing in The Weekly Standard, uses the controversy of “double booking” of surgical procedures at Massachusetts General Hospital as a launch pad for discussing the need for patients to ask questions of their physicians up and down the line.
She writes: “Patients must recognize that they, too, have important information relevant to their treatment and should generally not accept treatment unless they have communicated everything to their physician.”
Second, she notes, “{P}atients should realize that quite frequently there is no single ‘correct” medical answer and that — to the extent their coverage and the severity of their condition allow it — they have an opportunity to seek out second opinions and compare the proposed treatment plans of multiple doctors.”
John Mandrola, M.D., writes about The Boston Globe’s investigation of double-booking of lucrative surgeries by star surgeons at Massachusetts General Hospital, which has resulted in malpractice cases.
He says four aspects of this story stand out: hubris, greed, transparency and patient consent and the “near impossibility of questioning authority in mainstream medicine.”
Physician-owned hospitals are often vilified in America’s health care system, accused of siphoning the most profitable operations away from other hospitals while leaving them with the sicker and poorer patients. Congress has banned new ones from opening.
But an independent study released Wednesday argues physician-owned hospitals have gotten a bad rap. The study, published online by the British medical journal, The BMJ, concluded that overall, physician-owned hospitals are not cherry-picking patients or limiting themselves to the most lucrative types of procedures and operations.
Some of these hospitals specialized in a narrow set of procedures, but they treated only 20 percent of patients who went to physician-owned hospitals, the study found. The rest sought care at doctor-owned hospitals that offered a range of services similar to those at community hospitals.
“By and large, physician-owned hospitals have virtually identical proportions of Medicaid patients and racial minorities and perform very similar to other hospitals in terms of quality of care,” said Dr. Daniel Blumenthal, the lead author and a clinical fellow at Massachusetts General Hospital.
The 2010 federal health care law not only banned new doctor-owned hospitals but also limited growth of existing ones. Legislation introduced in May in Congress that proposes to lift these restrictions is opposed by the main industry group, the American Hospital Association (AHA).
The study disputes more than a decade of previous research into the topic. In 2005, Congress’s independent Medicare Payment Advisory Commission, or MedPAC, examined 48 specialty physician-owned hospitals and found evidence that they took the easier and better paying cases. The inspector general of the Department of Health and Human Services reported in 2008 that specialty hospitals owned by doctors often lacked emergency rooms and around-the-clock staff who could respond to medical emergencies. Hospitals with emergency rooms tend to take care of more low-income patients and people with chronic ailments, like heart failure, which aren’t as profitable as elective surgeries.
Thomas Nickels, an executive at the hospital association, called the BMJ study “incomplete and somewhat flawed.” He noted that the researchers had not examined whether physicians were more likely to refer patients to their own hospitals. Such self-referrals are one of the main reasons the AHA has cited in asking Congress to retain the health law’s restrictions.
“They refer patients to their hospital that they want and they don’t take others,” Nickels said. “These institutions are enormously profitable, and they’re profitable because they’re choosing what kind of patients to take.”
But the new study concludes it was a mistake to judge physician-owned hospitals by just looking at those that specialize in narrow types of services. Of the doctor-owned hospitals the researchers identified from data provided by the Physician Hospitals of America, a trade group, 99 were specialty hospitals, but the majority, 120, were general acute hospitals. Those hospitals had sicker patients and more low-income and minority patients than did the specialty hospitals, even though both types were owned by doctors. Together, patients at physician-owned hospitals were slightly healthier than those at hospitals doctors did not own, but patients had similar death rates and faced the same numbers of chronic diseases.
“Overall, the differences, if they exist at all, are tiny,” said Dr. Ashish Jha, the study’s senior author and a professor at the Harvard School of Public Health. “There are much bigger differences between public hospitals and nonprofit hospitals, but we don’t go around banning all nonprofit hospitals.”
The study found that 6 percent of Medicare hospital admissions in the areas studied were at doctor-owned hospitals, suggesting that those facilities are not having a “meaningful impact” on the finances of other hospitals. “Our work suggests that some of the major criticisms of [physician-owned hospitals], including that they select more profitable patients, provide lower value care, and threaten the financial viability of surrounding hospitals, may no longer be valid,” the study said.
Dr. R. Blake Curd, president of Physician Hospitals of America, applauded the study, saying it backs up what they have been arguing for years. “This is a great look at the physician-owned hospital industry as a whole,” said Curd, a hand surgeon in South Dakota. “You can’t paint us with one broad brush stroke, which is what the American Hospital Association is always trying to do.”
The legislation to lift the ban on new physician-owned hospitals is in the House, but Nickels said no companion bill has been introduced in the Senate. “There seems to be very little interest in the Senate to pursue it,” he said.
But Curd said he expected a Senate bill would be introduced and said lawmakers were receptive. “It’s fine for Congress to reevaluate the policy decision they made in 2010,” he said.
The Boston Globe reports that a group of Boston doctors proposes to join research that would involve “emergency treatment for brain-injured patients without obtaining the trauma victims’ consent, arguing that they often arrive at the hospital unconscious or without family members who can speak on their behalf.”
“Federal law and the generally accepted ethics of medical research require that patients or their surrogates be told about any risks of participating in a study and have the chance to refuse enrollment. But the law allows for an exemption in certain cases involving emergency care.”
“The study team, from Boston Medical Center and Massachusetts General Hospital, wants to join a national trial looking at whether giving the hormone progesterone to patients in the hours immediately after a traumatic brain injury could prevent further neurologic damage.”
