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How huge NYC safety-net system made its ACO a success

Headquarters of NYC Health + Hospitals.

A Health Affairs blog entry looks at how the  huge safety-net system NYC Health +Hospitals has built a highly successful Accountable Care Organization   since 2012 to participate in the Medicare Shared Savings Program (MSSP). Indeed, the authors report that NYC Health + Hospitals’ ACO has cut costs to Medicare by more than $31 million and generated $14 million in shared savings payments. The organization has cut costs by  4-12 percent  each year compared to benchmarks, and, they write, is New York City’s   only ACO to earn shared savings each year in MSSP.

To help achieve this success,  it collected  claims data to track the histories of 12,000 Medicare patients, many of whom are dual-eligible with Medicaid. It then used that information to chart future  care.

The data  suggested that the ACO should  focus on the chronically ill needing complex care, and less on overuse of healthcare services.

The  ACO  integrated clinicians into the initiative,  and sought to develop physician leaders for it. Clinicians got wide  autonomy to shape the program to fit patient needs within a shared  goals

The authors wrote that  NYC Health + Hospitals  is applying the lessons learned to other populations,  particularly Medicaid and uninsured patients.

To read more, please hit this link.


Patient-mortality rates: Foreign-educated physicians in U.S. hospitals do better


A study in the journal BMJ says that Medicare patients in  U.S. hospitals had lower mortality rates when cared for by foreign-educated physicians than by graduates of U.S. medical schools.

Harvard University researchers examined data for Medicare fee-for-service beneficiaries admitted to hospitals with  medical conditions between 2011 and 2014 and treated by general internists who were foreign or U.S. medical graduates.

Becker’s Hospital Review reported: “After adjusting for patient and physician characteristics and hospital fixed effects, they found patients treated by foreign-educated physicians had lower mortality (11.2 percent) compared to patients treated by U.S. medical school graduates (11.6 percent).

“‘We found no evidence that patient outcomes for graduates who had trained outside of the U.S. were worse than for graduates from a U.S. medical school. If any, patients treated by the international graduates had lower 30-day mortality than those treated by the U.S. graduates. These differences persisted across a broad range of clinical conditions, and even among hospitalists, where patient selection might be less of a concern.”

“Researchers said patients treated by foreign-educated physicians also had slightly higher costs of care per admission ($1,145) compared to patients treated by U.S. medical school graduates ($1,098). According to the study, readmission rates remained similar between foreign-educated physicians and U.S. medical school graduates.”

To read more, please hit this link.


Consistency of ties with physicians said to reduce their patients’ visits to ERs


Seniors who consistently see the same physicians in  outpatient settings are more likely to avoid  emergency-room visits, according to a study  by CMS and Dartmouth researchers and published in the Annals of Emergency Medicine.

The researchers measured continuity of care based on two risk scores and found that patients who saw the same physician consistently were 20 percent less likely to go to the ER.

Those who did go to the ED were slightly more likely to be admitted to the hospital. The study suggested that  patients with more continuity of care receive more appropriate ED referrals.

“Visits with the same physician or a small number of physicians fosters long-term relationships for Medicare patients, which is ultimately good for their health,” said David Nyweide, Ph.D., a researcher with CMS and lead author of the study,  said in an announcement from the American College of Emergency Physicians (ACEP).

FierceHealthcare noted that the  number of ER visits has grown considerably in the past several years, blamed partly on an increasing number of non-emergency patients showing up there.

“Previous studies have shown that improving continuity of care could save Medicare as much as $600 billion each year by reducing frequently overused medical procedures, and limiting the rate of mortality linked to cardiovascular events,” Fierce reported.

To read the study, please hit this link.

To read a Fierce overview of the study, please hit this link.

Sutter, UHC renew network relationship; push performance incentives

Sacramento-based Sutter Health and UnitedHealthcare have renewed their network relationship. This gives people enrolled in the latter’s employer-sponsored and Medicare Advantage plans access to Sutter Health facilities and physicians through 2017.

Importantly in  the new world of health care, moving by fits and starts to pay for value from fee for individual service, both organizations said the renewal expands the use of performance-based incentives designed to reward Sutter Health physicians for the quality (as opposed to quantity) of care while better managing medical costs.

This includes providing some Medicare patients with access to Sutter Health’s Advanced Illness Management program. This is a home-based approach to provide chronically ill patients with physical and emotional support.


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