IAG Healthcare Digest for April 2011


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A fast-read monthly summary of the vital news of ACO, Medical Homes and the hospital to consumer continuum.

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IAG Healthcare Digest for April 2011

  1. 1. Information Advantage Group’s Healthcare Digest is focused on the emerging deliverymodels for the hospital to consumer continuum. In a fast-read format, weprovide only the vital news that is essential to keeping you current on the latest andmost germane trends, ideas, results, technological developments and resources.Simply click on a category relevant to you below to jump to the news topics, click on thelinked topic title to be taken to the source article. Most sources are publicly available; youmay have to subscribe for others. Innovation Trend Drivers HIE ACO Trends Physician & Oversight & Medical Home Consumer Professional InfluenceInnovation Trends: Just as a he shift of medical costs to consumers is driving changes in financing the delivery of healthcare, disease specific concierge services and the development of innovative systems for patient recruitment, compliance and education is enabling cost-effective quality care to capture an increasing proportion of the $363 billion healthcare market that is not included in overall healthcare costs. The Bond Market Has Pinched Hospitals Options For Securing Debt - Plenty Of Alternatives Remain. Three crucial changes have occurred this year that have narrowed the choices that hospitals have for debt: • The Build America Bonds program that permitted government hospitals to receive a 35% reimbursement of their interest costs from the government has expired. • The annual debt limit on bank-qualified bonds was dropped down to $10M from $30M. • Bonds issued with a Federal Home Loan Bank credit may no longer be tax-exempt. So how should hospitals plan? It depends on the financial girth of the hospital itself - a hybrid of general obligation pledges and revenue pledges is the most likely the course - see article for ideas. (H&HN Magazine, March, 2011) TOC
  2. 2. $363 Billion Of Healthcare Costs Not Being Counted.Based on NHEA (Centers for Medicare and Medicaid Services), aDeloitte analysis estimated that the hidden cost of healthcare inthe U.S. in 2009 was $363 billion and represents expendituresthat fall outside of traditional areas such as doctors, drug coverage.prescriptions, hospitals and insurance coverag This amounts to 14.7%an additional 14.7% of health care spending that was notpreviously captured in the National Health Expenditure Accounts Accountsdata.data 55% of this is the cost of supervisory care of taking care of asick or disabled spouse, family member or friend with the rest forproducts, like nutritional supplements, mental health andsubstance abuse facilities, alternative medicine, certainambulatory and ambulance services and weight-loss centers.[Source: NHEA (Centers for Medicare and Medicaid Services) andDeloitte Analysis] Doc-In-Focused Factories, Doc-In-A-Box, Hybrid ACOs: Carve Outs -The Next Big Things? all-The next big thing in healthcare wont be large, all-purpose healthcare organizations -- it will "focused problems,be "focused factories" – bundles of care for treating very specific or expensive problemsaccording to Harvard Business School professor and health economist Regina Herzlinger,PhD. Her observations include: their• When consumers start spending $1,000 or more of their own money for healthcare, that opens up opportunities for retail medicine to be sold directly to consumers -- CVS and Wal-Mart are offering clinic services now.• Studies have shown these types of clinics are cheaper and better because they offer a limited menu of what they do as focused factories than emergency rooms or physicians offices.• Retail medicine is going to grow and will increasingly become the first point of contact for the self-care which is the critical component of patient participation in chronic disease management• In a consumer driven system, patient’s costs will drive the creation of narrow networks for chronic diseases and disabilities such as back pain because when people have to pay a greater share for those services, they will pick narrow networks that cost less than the ER.• These networks could be considered a type of accountable care organization (ACO) which can encompass a wide variety of things – ACO doesn’t necessarily mean “everything-for- everybody integrated delivery network.” (MedPageToday, March 30, 2011)67% Of Those Surveyed Said Watching The Patient-Centered TV (Online) After Discharge Those Patient-Made Them More Motivated To Stay On Their Treatment Plan.If you are viewing digital screens in pharmacies and doctor offices, you are seeing the Digital 2 TOC
  3. 3. Out Of Home (DOOH) market at work. A number of digital out-of-home networks have sprungup over the last few years targeting one of the more captive and engaged audiences there is -- patients in healthcare settings. A new study from GfK Research North America for theWellness Network, which owns two hospital-based DO networks, showed that TV plays amajor role in passing the time during a hospital stay:• Patients watched an average of 28 hours during their stays (five days average in 2008 for the U.S.).• Six hours were spent watching the Patient Channel, which reaches an average of 20 million hospital patients a year.This type of programming led to:• Hospitals receiving high evaluations from patients for the facility and its level of care for patients,• Patients ranking it ahead of TV news, support groups, and the Internet as a source of health information; unsurprisingly, it ranked behind doctors and family and friends, and patient-• 67% of those surveyed said watching patient-centric TV or online websites after discharge motivated made them more motivated to stay on their treatment plan.According to Magna Globals latest ad forecast, DOOH will show a 15.2% CAGR for the nextfive years and be one of the fastest-growing media around the world. That puts it behind justtwo hot media categories - online video (19.6% CAGR) and mobile (19.4% CAGR) for thesame period. This sets expectation for DOOH to grow about three times the rate for themedia business overall (5%-5.5% CAGR). (Media Post, January 11, 2011)Hospitals Not Using Social Media To Its Fullest.U.S. hospitals are missing an opportunity to engage patients and brand their communities byfailing to take full advantage of social media outlets, such as Facebook.According to a study of 120 hospitals by Verasoni Ah Ha Insights completed January 12,2011, only eight (6%) of hospitals had accrued 10,000 Facebook fans and most were notusing social media to its fullest potential. The most common shortages of efforts includedmost hospitals not posting daily, attempting to start discussions, or use the Facebookcalendar feature to promote their events. Only eight hospitals (6 percent) had accrued 10,000Facebook fans. Observations include, “While the numbers clearly indicate that patients areon Facebook, it is the job of the hospitals to find them and engage them in a meaningfulway,” said Abe Kasbo, CEO of Verasoni Worldwide and co-author of the study. “And, justbecause a hospital is on Facebook does not mean that they are building a meaningfulFacebook experience for both the hospital and the patient.” (Hospitals and Facebook: A CaseStudy, Verasoni, February 25, 2011) 3 TOC
  4. 4. Trend Drivers: Anxiety about healthcare permeates not just the consumer, with their increasing increasing concerns about higher cost, but is shared by physicians who are thinking of leaving. In the face of these pressures, Mark Frisse of Vanderbuilt offers some sober realities about what it will take to regulations transform healthcare…can you do it all with regulations (see first topic below)? Too Much Transformation – Can Regulations Do It All ? In an excellent overview article in Health Affairs by Mark Frisse, the Accenture Professor of Biomedical Informatics at Vanderbilt University, the challenge facing the new leader at ONC is to harness the momentum of the HITECH machine as goals, methods and public perception change. He sees its future being determined by: HITECH’s aggressive timelines ability to deliver; meaningful innovations; and the seasonal political and economic environment of Meaningful Use. His observations about realities faced include: • Transformation: To transform care you need to transform the culture - large enterprises have such skill and resources, but for many other smaller peers, such methods are not as abundant. • Innovation: Again large enterprises have the resources to deploy disruptive innovations like EHRs, while smaller or less sophisticated providers do not have the knowledge, time, and resources required for transformation and innovation. • MU Politics: The debate pivots on two poles - those who think you can push reform through by regulation verses those who believe that market pull is the best response to health reform initiatives and a more honest reality. Finally, entities large and small have a very full plate - HIPAA, ICD-10, Meaningful Use, HIE, EHR/EMR, are but a few pressing needs. Dr. Frisse urges ONC to shift its focus from how to spend stimulus dollars to how to help providers complete all of this in a time of growing fiscal restraint and not try to transform too much merely by regulation. (IAG Blog, March 26, 2011) Over 9% Of Medicare Budget Attributed To Fraud And Abuse The Government Accountability Office reports finding about $48 billion of fraud and abuse in Medicare’s $507 billion 2010 budget due to “pervasive internal control deficiencies in CMS’ management of contracts.” This has increased the risk of improper payments and kept “Medicare on a path that is fiscally unsustainable over the long term.” The report was prepared for a Congressional hearing on Medicare and Medicaid fraud. (Healthcare Finance News, March 3, 2011) 4 TOC
  5. 5. IncreasesPer Capita Healthcare Costs Increases 6.29% for 2010Standard & Poor’s Healthcare Economic Composite Index reports the average per capitacost of healthcare services covered by commercial insurance (8%) and Medicare (3.4%)programs increased by 6.29 percent over the year ending in January. This marks the first ary. Januarytime since May 2010 that the combined growth rate has accelerated. (Healthcare FinanceNews, March 17, 2011)Per Capita Healthcare Costs $9,217 In 2009 – 15% Higher Than Government PredictionsAccording to a new Deloitte survey of over 1000 U.S. adults, per capita healthcare costsamounted to $9,217 in 2009 - almost 15% higher than official government predictions Elderly almost predictions.U.S. residents accounted for 36% of total health spending ($1.01 trillion) were elderly ofwhich 83% of the spending came from those with annual household incomes of $100,000 orless. Estimated for non-covered care totaled to almost $2.83 billion in 2009 including:• $199 billion for the estimated value of supervisory care provided by friends and relatives;• $144 billion spent on nursing homes;• $72 billion spent on home healthcare; and• $246 billion spent on prescription medications.(Deloitte, March, 2011)70% Of Patients Have Anxiety Is Rising Over Medical Bills, And 73% Expect TheirPhysicians To Be Accessible OnlineAn industry survey from Intuit Health showed that patients expect doctors to be online andrising anxiety over their medical expenses. As Americans are now so accustomed to payingbills online that they expect that same convenience and connectivity from their doctor’s office.The survey highlights include more than 50% of respondents stated that "anytime, anywhere"access is so important that they would consider switching doctors for a practice that doesoffer online services. (Healthcare Finance News, March 3, 2011) services.Medi/Medi Enrollment May Exceed PCP Capacity By 2019. healthGrowth of at least 16 million in Medicaid enrollment by 2019 under health reform will greatlyoutpace growth in the number of primary care physicians (PCPs) willing to treat newMedicaid patients, according to a study by the Center for Studying Health System Change(HSC). In the U.S:• 42% of PCPs in 2008 were accepting all or most new Medicaid patients• 61% of PCPs were accepting all or most new Medicare patients• 84% were accepting all or most privately insured patients.Concerned policymakers worry that primary care capacity may fall short in meeting theincreased demands from new Medicaid patients. It is thought that higher Medicaidreimbursement rates cause a greater probability of PCPs accepting all or most new Medicaidpatients - the effects are relatively modest, according to the study sponsored by the RobertWood Johnson Foundation. (CMIO, March 18, 2011) 5 TOC
  6. 6. 2010 – Running A Practice Has 40% Of Primary Care Physicians Thinking About LeavingTheir FieldPaperwork, reimbursement worries and bureaucracy, running an office and costs to do so areleading causes for physicians thinking about alternatives to primary care. Yet, face-to-facetime with patients has been the most rewarding part of the job for many, but this has beeneroding steadily.A late 2010 survey of 3,729 family care physicians found that about 40% had consideredleaving their primary care practices that year…16% said it was the first year they hadconsidered a career change.The survey also reported that three out of five physicians enjoy better job satisfaction thanthey anticipated on their first day in medical school. (CMIO, March 23, 2011)NEWLY RELEASED - HELPFUL RESOURCESThe Direct ProjectOffice of the National Coordinator for Health IT (ONC) has released “The Federal Health ITStrategic Plan: 2011-2015," an 80-page last published in 2008. 6 TOC
  7. 7. HIE As the HIE rollout proceeds, the Direct Project gains interest and the federally funded Alembic open source project gains momentum. Several new recourses for evaluating your HIE. The Direct Project Gaining Broad Support Over 65 IT vendors and integrated delivery systems, have planned support for the Direct Project, according to the Office of the National Coordinator for Health IT (ONC) in addition to twenty states having ONC-approved HIE plans that incorporate Direct as part of their health IT plans. Several key Direct Project specifications are now complete or in late-stage draft, late- and reference implementations are compete and production-tested (CMIO, March 22, 2010) production-tested. NEWLY RELEASED - HELPFUL RESOURCES Evaluating A Framework For Evaluating HIEs The CHIDS HIE Evaluation Framework for HIEs includes five performance measures for: business model sustainability and value, organizational structure and decision making, use of technology, engaging the community; and developed trust in the system. The center used the framework as it assessed the District of Columbia Regional Health Information Organization, see the report here. Alembic Foundation To Shepard The CONNECT Open Source Project – Access To All. Two leaders of the federally-funded CONNECT initiative to develop open source, downloadable health information exchange software now head a new foundation created to take the lead in promoting and expanding use of the technology that was released in April 2009 to the open source community. It was always the governments plan to see a private sector organization take over management of CONNECT to optimize the availability of the code to all participants in addition to federal agencies. The Alembic Foundation in Falls Church, Va., and Vanessa Manchester, COO, served as staff for CONNECT in the Office of the National Coordinator for Health Information Technology. As one of their first acts, the foundation has copied the latest version of the software, CONNECT 3.1, private-labeled it as Aurion 3.1 and released it to the open source market on March 21…Aurion 4.0 is to be released on May 3. More information on The Alembic Foundation and Aurion is available at alembicfoundation.org and http://aurionproject.org/. 7 TOC
  8. 8. ACO “Tip of The Day” and release of proposed rules reigns king around the early days of planning for an Accountable Care Organization (ACO). However, an evaluation of CMS data by VHA differs on needed margin (see last topic in this category). 10 Key Points in March 31, 2011 Release of Proposed Rules for ACOs The 10 key points in the proposal are generally described. 1. Projected savings. Overall Net savings may range $510 million to $960 million over the first three years. 2. Two payment tracks. In the first phase of the program, ACOs will be allowed to choose between two different tracks to get shared savings • "one-sided risk" model, an ACO that saves at least 2% of reimbursements would get 50% of the money above that threshold, but it would have no penalty if it spent more in the first and second year. • A second, more risky model would give an ACO 60 percent of the money above the threshold but also penalize the ACO if it spent more. 3. No start-up funding. The proposal reportedly lacks any start-up funding for ACOs and the start- average start-up cost for each participant in the Physician Group Practice Demonstration was in the seven figures. 4. Beneficiaries can limit data. Mandatory notification to beneficiaries that they are part of the ACO, they can opt out of sharing data and still get care from the physician or other providers. 5. Reporting quality data. ACOs would report a total of 65 quality measures in five domains - in the first year they have to only report quality data. Then in years two and three their quality data will be scored and affect their shared savings payments. 6. A single hospital can become an ACO… they have enough primary care physicians. ACO….if 7. Specialists cannot create an ACO. "Specialists cant lead in forming the ACO, primary care physicians or other providers, such as mid-level practitioners most lead. 8. Existing ACOs can join the program. Existing ACOs may qualify as a Medicare ACO as is, the if their governance structure includes Medicare beneficiaries. 9. Three levels of antitrust enforcement. The Federal Trade Commission and the Department of Justice have jointly issued a proposed statement of enforcement policy for ACOs, which mapped out the following three levels of enforcement. 50% trigger for automatic antitrust review. If providers in the ACO represent more than 50% of the market, they are subject to automatic review by the Department of Justice and the FTC. They will receive a 90-day expedited review. If either agency raises a concern, they could become part of the ACO program. 8 TOC
  9. 9. 10. Beneficiaries on ACO boards. To demonstrate a partnership with Medicare FFSbeneficiaries and meet patient centeredness criteria by including a Medicare beneficiaryserviced by the ACO on the ACO governing body, the proposal would require having aMedicare beneficiary on the governing board of the ACO. (Becker’s ASC Review, March 31,2011)CIGNA Pilot ACOs Early Returns Are PositiveBy sharing “gaps in care” data with care coordinators at two pilots and using this information,to ensure follow-up appointments are scheduled, prescriptions are filled or additional medicaltests are completed, two accountable care pilot projects shows both are achieving slowergrowth in healthcare costs and improving quality of care.• Dartmouth-Hitchcock Medical Center in New Hampshire shows the provider is closing gaps in care 10 times better when compared to physician practices without coordinated care.• Annual average costs per patient have been lowered by $336 at Cigna Medical Group in Phoenix, Arizona.(Healthcare Payer News, March 24, 2011)ACO Success Tips – Health IT Summit, San FranciscoThe success of accountable care models will hinge on engaging patient in their everyday theirlives and not only on the ability of all stakeholders to coordinate care across the continuum.Panelists comments at the Health IT Summit recently in San Francisco offered key concernsin successful building an ACO:• Identify at-risk patients early. “Get to them early...It could save millions if not billions of dollars," noted Glenn Keet, president of Axolotl.• Get the consumer to know your brand. Patients won’t engage if they don’t know who you are, noted family physician Katherine Schneider, VP of health engagement for Atlanticare.• Aggressive communication strategies are needed to identify and engage patients and cultivate mind share by all ACO stakeholders, noted panelist Scott Young, senior medical director at Kaiser Permanente.• Pay attention to the needs of the emerging younger generation of patients – they’re going to expect their care to be delivered differently. Things like providing digital consultations via email or instant messaging to meet the younger generations preferences and life style, said David Nace, McKessons VP and medical director.(Fierce Health, March 24, 2011)Five Way For Providers To Realign For ACOs.Here are five ways the hospital and physician relationship will evolve in the wake andpreparation of ACOs.1. A revised culture may mean the expiration of traditional bureaucracy and respectedgovernance and communication. 9 TOC
  10. 10. 2. Physician and hospital are not knife and fork – they are fighting for the same dollar andleaders need to have "crucial conversations" for ACOs to work.3. Independent physicians must form new affiliations with hospitals to maintain negotiatingstrength with the payors.4. Hospitals and physicians can strengthen ties through a variety of models other than fullacquisition.5. Shifting from fee-for-service to a culture focused on quality and outcomes will offerphysicians new opportunities for leadership.(Becker’s Hospital Review, March 28, 2011)New Models Of Integration For California ACOs.CaliforniasCalifornias prohibition on the corporate practice of medicine, which prevents hospitals fromemploying physicians, has providers increasingly implementing the medical foundationmodel.model This is a legal arrangement in which a tax-exempt organization contracts withphysician groups to create a non-profit foundation, allowing physicians and hospitals to worktogether on practice management and other elements of integrated care.Steve Geidt, CEO of Saddleback Memorial Medical Center in Laguna Hills and SanClemente, California says that in California, "The biggest challenge now is many physicianswant to be employed; they want the stability that a health system might provide them insteadof going into private practice." He went on to point out that Geisinger Health, Mayo Clinic,Kaiser Permanente in Oakland and Virginia Mason as examples of successful physicianintegration and ACO-like models – these enterprises are health systems, not hospitalsystems. Large multispecialty medical groups like these are more integrated than a networkof independent medical groups and often in a better position to manage the health of adefined populations. However, not every market has a Geisinger or a Mayo Clinic in it.Strong physician leadership is a key ingredient and one of the biggest challenges they will biggestface when integrating physicians to form an ACOs is adapting to change. Courage to trusteach other is another essential element for physician integration. Building trust requiresconsistent attention. "The evolution towards the healthcare delivery system of the future isone that will be littered with anxiety and challenges and a need for vision andcommunication," says Mr. Geidt. (Becker Hospital Review, March 21, 2011)ACOs Could Take More Time And Higher Margin To Break Even.Authors Trent T. Haywood, MD, JD, and Keith C. Kosel, PhD, MBA, from the VHA networkreviewed the previous government demonstration ACO data anticipating the governmentmodel would have produced promising results that warranted its rapid expansion - theiranalysis of the results from the demonstration suggests otherwise. The CMS report showed five-that with a five-year time horizon and a mean investment of $737 per PGP provider, the authorsrequired margin to break even is 13 percent. Using the same data, the VHA authorsconcluded differently and found that an ACO making the mean initial investment of $1.7 three-million will require the unlikely margin of 20 percent for the three-year period envisioned byCMS. (CMIO, March 24, 2011) 10 TOC
  11. 11. NEWLY RELEASED - HELPFUL RESOURCESAccountable Anesthesia Organization to download a free copy of "The Role of Anesthesia inAccountableAccountable Care Organizations And Beyond: IT Strategies For 21st Century Healthcare – anintroduction to trends models and architecture for the next generation of care delivery. ThereACOs How To Get There By H&HNThe ACO Learning Network Is Infused With Knowledge From The ACO Pilots, WhichComprise A Wide-Range Of Provider-Types Implementing Shared Savings Around The Wide- Provider-Country.Country. 11 TOC
  12. 12. MEDICAL HOME Strong attention to organization dynamics are essential for the 3-5 year journey of building a medical home practice. House calls, more nurse Practioners, patient involvement are vital. 3- AAFP Study: Organizational Learning And 3-5 Year Commitment Is The Road To An Medical Home In June 2006, the American Academy of Family Physicians selected 36 mostly small independent practices from 337 to launch the first large-scale demonstration of the patient- centered medical home. Practices in this group were randomized into two groups: “facilitated intervention” and “self-directed.” The authors were members of an independent evaluation team for the project. These practices that were included in the national demonstration project made efforts and attempted to implement as were charged with trying to implement as many model components as possible over the two-year life of the project, To become medical homes, practices must see themselves as organizations that apply the four pillars of primary care to the needs and preferences of patients in their communities, rather than as organizations that process patients for the convenience of physicians. The four pillars of teams, information, access and healthy living. patient- Overall conclusion: Physicians making the transition from conventional practices to patient- centered medical homes will need to master organizational learning and develop an awareness that they may need a three to five year commitment Many good lessons included commitment. in the article. (CMIO, March 24, 2011) Matching Fund For State Who Offer Medical Home Care Programs. According to a March 18, 2011 report by the Health Resources and Services Administration (HRSA): 57% of children in the United States have access to a medical home, and that children without a medical home are: • Nearly four times more likely to have unmet health care needs, • Three times more likely to have unmet dental care needs and, • Less likely to have had a preventive health care visit in the past year. The federal government will match up to 90% of state funds for two years when they offer to provide medical home models options for Medicaid enrollees with chronic conditions. National Committee for Quality Assurance (NCQA) is the leading provider of recognition programs with its Physician Practice Connections (PPC) recognition program. As of the end of 2010, almost 7,700 clinicians at more than 1,500 sites across the United States had received the organizations PPC-PCMH recognition. (Advance March 25, 2011) 12 TOC
  13. 13. TopsPatient Engagement, Diabetes, Medication Compliance, Strategic Content Are Tops OnPCMH List Of Needs And Goals.A March patient-centered medical home (PCMH) survey by Promidian, a managementconsulting firm, of 181 stakeholders, including physicians, medical directors, nurses, andadministrators and executives from medical group practices, health plans, pharmaceuticalcompanies, and employer groups found:• Patient engagement in care, access to care, and a team approach to care are viewed as PCMH, the top three most important goals of a successful PCMH• Diabetes, cardiovascular disease, asthma, obesity, and stroke top the list of priority disease states to be attended to,• Medication compliance is viewed as extremely important to the success of a PCMH,• Most are highly interested in receiving strategic information products that target maintaining accreditation (e.g., programs, tools and training).(The Street, March 29, 2011) AreArtisanal Healthcare – House Calls? Docs Are Doing More Of Them.Thanks in part to the Independence at Home provision of the Patient Protection andAffordable Care Act, more physicians are venturing out to make house calls. It is estimated practitionersthere are approximately 4,000 physicians, nurse practitioners and other medicalprofessionals nationwide who either specialize in in-home care or at least make it a part of in-their practice. As reported, the vast majority of patients are seniors on Medicare or low-income Medicaid patients.The American Academy of Home Care Physicians sums it up, "house calls are more likely toprevent unnecessary and far more costly [emergency room] visits and hospitalizations. At$1,500 per ER visit, the cost of 10 house calls is offset by one ER visit prevented." (GetHealthy, March 20, 2011)Institute of Medicine - More Nurses could take on more of the primary care load. practitionersCalifornia is one of 23 states that allow nurse practitioners to provide selected primary carewithout physician supervision. Six California regions have a shortage of primary care doctorsand as their health systems take steps to develop medical home models of care, nursepractitioners are expected to play a greater role in leading teams and providing primary careservices. Last fall, an Institute of Medicine report called for an expansion in the scope ofservice that nurse practitioners can deliver. The report found that health systems thatincreased nurses responsibilities generally provided "safe, high-quality primary care." (FiercePractice, March 30, 2011)Communication Perceptions Differ Between PCP And Specialists.Primary care and specialist physicians see things differently when they consider how theircolleagues communicate about patient referrals and consultations according to HSC communicate 13 TOC
  14. 14. research titled, "Referral and Consultation Communication Between Primary Care andSpecialist Physicians: Finding Common Ground" and funded by the Robert Wood JohnsonFoundation and published in the Archives of Internal Medicine. The results found:• 69% of PCPs reported regularly – "always" or "most of the time" – sending a patients history and the reason for the referral to the specialist, but only 35% of specialists said they regularly receive such information• 80% of specialists said they regularly send consultation results to the referring PCPs, but only 62% PCPs said they received such informationWhat improves communication, the study pointed out factors that can improvecommunication between specialists and PCPS.• Having adequate time to spend with patients was the most important factor to both groups of providers,• Practice supports for care management that included feedback reports on quality of care for patients with chronic conditions and nurse monitoring of these patients.• The use of health information technology (HIT) produced higher reports of receiving and sending communications by specialists but not by PCPs.Research compiled by MGMA, the Urban Institute and the American College of Physicians in2009 indicates that with each NCQA certification level, the median cost for personnel andinformation technology, per full-time-equivalent physician, progressively increases. Theresearch, funded by RWJF shows that costs per certification level add up to:Level 1 -- $145,000 for support staff, $5,000 for IT (no EHR)Level 2 -- $153,000 for support staff, $8,000 for ITLevel 3 -- $165,000 for support staff, $11,000 for ITIn most PCMH demonstrations, these costs were offset by management fees paid to thepractice for enrolled patients. (MGMA Blog, March 28, 2011)No Major Increase In Onsite Medical Home Accreditations Seen• Currently, only the Accreditation Association for Ambulatory Health Care requires an on- site surveyor visit in its medical home certification program and has certified more than 60 practices as medical homes. w up some time before the third anniversary of its last survey.• The Joint Commission is field-testing its "primary-care home" accreditation program, which is set to launch in July, 2011.• The Patient Centered Health Care Home program at URAC, formerly the "Utilization Review Accreditation Commission," is seen more of as an educational offering through a self-assessment tool kit. In the future, some level of on-site audits by practices seeking certification.• The National Committee for Quality Assurance (NCQA) has recognized some 1,800 practices as medical homes since 2008. 5% of recognized medical home are audited, mostly as "desk audits," a few visits are made with no plans to significantly increase inspections. 14 TOC
  15. 15. See recently released medical-home principals list of guidelines. (Modern Physician, March17, 2011)NEWLY RELEASED - HELPFUL RESOURCES"Better to Best: Value-Driving Elements of the Patient Centered Medical Home" (PDF), a Value alue-collaborative 48 page effort by the Patient-Centered Primary Care Collaborative andsponsored by the Commonwealth Fund and the Dartmouth Institute for Health Policy andClinical Practice. Includes five consensus statements—each accompanied with a set ofrecommendations—that participants in the Sept. 8, 2010, meeting said could build on medical-home demonstration project findings and synchronize innovations to create a moresustainable healthcare system.To become a PCMH, practices must be certified by one of three organizations:National Committee for Quality Assurance (NCQA) – which recognizes three PCMH levelsAccreditation Association for Ambulatory Health CareThe Joint Commission Primary Care Home Standards To Be Released July 2011Other: Patient-AAFM Patient-Centered Medical Home ChecklistA PCMH Standards And GuidelinesHRSA Initiative For FGHS To Gain PCMH RecognitionHRSCMH Initiative Program Assistance Letter (Pal)Intro To NCQA PCMH Recognition Program (Teleconference & Text)NCQA 2011 Standards And Guidelines For PCMH Recognition MedicalPCCDC “Patient Centered Medical Home: A How To Manual”Safety Net Medical Home Initiative RemoteThe Connected Patient: Charting the Vital Signs of Remote Health MonitoringThe American College of Physicians Tool - Medical Home BuilderInstitute of Medicine - The Future of Nursing: Leading Change, Advancing HealthPatient Centered Primary Care Collaborative – An excellent listing of free publications 15 TOC
  16. 16. PHYSICIAN & PROFESSIONALS Phone Physicians Trying To Charge For Phone Calls Just Like Attorneys Complete Childrens Care in Lincoln, Neb., has told patients that a $20 "telephone care" charge will apply to calls over five minutes that aren’t part of the appointment process or follow up on a previous weeks visit. Two arguments for and against prevail: • Attorneys have long charged their clients for phone calls without any argument. • Telephone calls are already built in to the fee schedules for other physician services, such as office visits, and therefore not separately billable for most government and commercial insurers.(Fierce Practice, March 13, 2011) 16 TOC
  17. 17. CONSUMER Consumers will increasingly demand online services, devices and media choices to match the way they want to get their healthcare. Social media is not high on the list as a way to get healthcare Physicians Need To Be Online To Allay Patients Concerns And To Be Paid Better. A new survey from Intuit Health found two major trends when it comes to Americans and their healthcare: they expect their healthcare providers to be easily accessible online and they are : concerned about their medical bills. Part of this is that we are rapidly getting more accustomed to paying our bills online and are expecting the same convenience with all parts of or lives including our healthcare and the people who provide it. The study found: • 20% of Americans feel they cannot easily connect with their doctor’s office to ask questions, make appointments or obtain lab results. • 73% of Americans would use a secure online communication solution to make it easier to get lab results, make appointments, pay medical bills and communicate with their doctor’s office, the poll finds. • 81% would schedule their own appointment via a secure Web service and fill out medical/registration forms online prior to their appointment. • 78% of respondents would use a secure online method to access their medical histories and share information with their doctor. • 59% of Gen Y respondents said they would switch doctors for one with better online access compared with only 29% of Baby Boomers. • Almost 50% of patients would consider switching to a physician that offered online services such as those. • 70% are somewhat or very concerned about managing their health care bills and costs, no change from last year, • 41% of consumers do not have confidence that the billed amount is correct. • 20% are unsure whether to pay their doctor or the insurance company. Gen Y respondents were most unsure whom to pay – 28% as compared to 8% of Baby Boomers. • 57% have had at least one medical bill go to a collection agency. Women are twice as likely as men to let a medical bill go past due. • 45% of patients wait more than a month to pay their doctor bill, and when they pay, half still send a paper check in the mail. • 66% think their healthcare will cost more in the future; only 59% of Gen Y and GenX thought the same • 62% saw a rise in their healthcare cost in 2010; only 59% of Gen Y and GenX thought the same 17 TOC
  18. 18. Clearly, the trend is that patients want some measure of control, convenience and bettercommunication with their doctor. (Intuit, March 2, 2011) HealthcarePatient Not Fond Of Social Media For Healthcare But Love Online Service Options.Despite the buzz and adoption, another study showed that Americans are not embracingsocial media as a way to communicate with their providers, according to a national Capstrat-Public Policy Polling survey which found:• 85% would not use social media or instant messaging channels for medical communication if their doctors offered it. • 11% said they would take advantage of social media such as Twitter or Facebook to communicate with their doctor, • 20 percent said they would use chat or instant message, • Only 21% of Millennials (18 to 29 years old), an age group that seems ripe for electronic health communication, would use an online forum for healthcare.Traditional online was much more palatable to respondents:• 52% were favorable toward conferring with their doctor via e-mail,• 56% online appointment setting, 50% online access to their medical records,• 48% online bill payment.Nurse staffed help lines was the preferred form of communication across all demographicand ages:• 72% said they would take advantage of a nurse help line if it was offered by their doctor,• 55% would be interested in online advice from nurses.(Health IT News, March 24, 2011)Fitness Device Vendors Are Interfacing With Each Other To Unify DataSome of the leading fitness device and application companies are working together to openup their APIs and share their own data with each othe This amalgam is bringing together other.much of the same data that Google Health has promised to host. Wellness servicesincluding Zeo, RunKeeper, FitBit, WiThings and Digifit are all sharing data now…we canexpect more of this in this sector. (Run Keeper, March 30, 2011)Interactive Monitors Increases Patient Satisfaction With Education MaterialsA study of patient’s use of interactive television monitors located in their rooms in six differenthealthcare systems saw overall increase in patient satisfaction of 10% and a 42% increase insatisfaction with educational materials The monitors allowed patients to communicate with materials.staff and access information about their care from their beds to:• Access and review post-discharge instructions before they leave,• Ask clinicians questions• Check meal menus 18 TOC
  19. 19. • Access educational materials about their conditions, and• Request assistance and• Caregivers to respond.(Jackson, Sara. Use of Interactive Technology Boosts Patient Satisfaction, FierceHealthcare, March 9, 2011) 19 TOC
  20. 20. OVERSIGHT & INFLUENCE fraud; Home Health coming under fire for medical fraud; telemedicine gaining some traction and trying for new regulations…again. REGULATORY Crackdown On Home Health Fraud. Effective April 1, 2011, Medicare beneficiaries, receiving home health services will have to see a doctor 90 days before or 30 days after starting home health services for home health agencies to get reimbursed. Services can be prescribed up to 60 days at a time and there are no deductibles. This crackdown is the result of Medicare home health costs have doubled to $19 billion in 2009, since 2002 and an increase in Medicare fraud during the same period. (Kaiser Healthcare News, March 24, 2011) Telemedicine Bill For Home Health Introduced Sen. John Thune (R-S.D.) introduced a bill (S 501) that would create pilot programs through incentive payments to home health agencies that use telehealth technology to improve health outcomes for Medicare beneficiaries and reduce spending. This is essentially the same bill introduced in 2005, 2007 and 2009 and targets rural and underserved areas with greater access to care and allow seniors to stay in their homes longer. None of the previous bills made it past the Senate Finance Committee.. According to American Telemedicine Association, the lack of Medicare reimbursement is the biggest barrier to telemedicine adoption. "Its less than $3 million a year. It only does videoconferencing for 21% of the Medicare beneficiaries. Things like remote monitoring essentially arent covered by Medicare at all, " according to Gary Capistrant, senior director of public policy at the American Telemedicine Association. According to the Bureau of Labor Statistics, nursing homes cost about $662 a day, as compared to a one-day stay at a hospital costing about $6,200, accounted for more than 20% of Medicare payments in 2009 — a total of about $28 billion, according to the Centers for Medicare & Medicaid Services. Home care is a cheaper alternative to other forms of care as it costs an average of $135 per visit. (iHealthbeat, March 17, 2011) Credentialing New Speedier Telemedicine Credentialing On Its Way CMS has sent to the Office of Management and Budget a final rule to streamline credentialing for healthcare providers of telemedicine services. This is one of the last steps services before a rule is officially published in the Federal Register. (Health Data Management, March 24, 2011) 20 TOC
  21. 21. If you’ve read this far then we have been successful in giving you some value. Pleasereciprocate and let me know your thoughts or if you don’t see something that you would liketo, then just drop a line to - jim@iag.co – thank you.Jim BloedauManaging PartnerInformation Advantage Group 21 TOC