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6 Features of CMS’s Redesigned Medicare Summary Notice

March 12th, 2012 by Cheryl Miller

In light of ongoing healthcare reform there is a push for clarity, as several of our stories illustrate this week. Medicare claims forms have been redesigned so that beneficiaries and their caregivers can better understand them, check for important facts and potential fraud. The subject of fraud is particularly timely given the story that has been circulating for the last week involving the arrest of a physician, the office manager of his medical practice, and five owners of home health agencies. They’ve been charged with allegedly participating in a nearly $375 million healthcare fraud scheme involving fraudulent claims for home health services.

When given the option of choosing a high or low cost health plan, consumers will most likely choose the higher cost plan because they associate it with better quality, says a new study funded by the AHRQ. But researchers caution that this isn’t necessarily true: higher costs could be attributed to unnecessary services or inefficiencies. A push is underway to simplify public physician and hospital report cards, and make them clearer for consumers to understand (not unlike the redesigned Medicare claim forms) so consumers can make better informed decisions about their health coverage.

The Robert Wood Johnson Foundation and Group Health Research Institute have launched a new national project intended to shed light on what makes a successful health practice tick. Designed in response to the burgeoning shortage of primary care practices, the project will identify successful practices that improve patient and practice outcomes, and share the information so they can be replicated.

And lastly, a study debunks the long held belief that HIT will improve cost savings by reducing the need for diagnostic testing; instead, the study shows that having computerized access to EHRs in the ambulatory setting could result in a 40 to 70 percent increase in testing.

Don’t forget to take our latest survey: Physician Reimbursement Models. Describe the physician reimbursement models in place at your organization by April 15th and you will receive a free summary of survey results once it is compiled.

These stories and more in this week’s Healthcare Business Weekly Update.

Posted in Affordable Care Act, Avoidable ER Use, Behavioral Health, Consumer-Driven Healthcare, Health IT, Uncategorized, e-Health | No Comments »

Forget About the Pizza, What About the Sodium?

December 7th, 2011 by Cheryl Miller

Pizza is not a vegetable.

That’s the word from the American Heart Association (AHA) on Congress’s much publicized perceived push for pizza to move to the top of the school lunchroom’s food pyramid, a decision sure to disappoint children everywhere.

But reports have since shown that what Congress actually did was to maintain that the tomato paste in pizza sauce is a concentrated form of tomatoes, and should be counted as such. So that an eighth of a cup of tomato paste, the amount often used in a serving of pizza, should be considered equivalent to a half cup of vegetables. According to a recent article by Sarah Kliff in the Washington Post’s Wonkblog, the United States Department of Agriculture (USDA) did not want to credit a volume of fruits or vegetables that was more than the actual serving, and Congress blocked this.

The USDA’s proposed changes were the first changes in 15 years to the $11 billion school lunch program, according to USDA officials, as cited in an article in the New York Times, and were meant to reduce childhood obesity by adding more fruits and green vegetables to lunch menus.

And while no one can debate the benefits of tomatoes, Kliff’s article goes on to compare the nutritional facts of tomato paste, no salt added, with fresh fruits, and they appear similar, except for the sodium, where tomato paste outweighs the fruit by 33 mg to 1 mg.

And so the real culprit here is not Congress or even pizza, but the amount of sodium in foods, and whether or not it should be regulated.

Sodium has been proven to cause cardiovascular (CV) disease, a relationship recently reaffirmed by the CDC. And CV disease keeps increasing, according to the CMS: “Heart disease causes one of every three American deaths and constitutes 17 percent of overall national health spending, costing $444 billion every year in medical costs and lost productivity in Americans.”

The statistics for diabetes, a preventable disease often caused by poor lifestyle and unhealthy eating, are equally staggering: 78,000 children develop type 1 diabetes every year. The problem is so severe that the United Nations recently held its annual summit on non-communicable diseases, namely cancer, chronic respiratory diseases, CV disease and diabetes. It was the second of its kind to focus on a global disease issue; the first health-related UN Summit addressed AIDs.

And according to a recent study from the Commonwealth Fund, 32 percent of children ages 10 to 17 are overweight or obese.

So, given the amount of calories, fat and sodium in the pizza that contains the pizza sauce that contains the tomato paste, one of the last things our school kids need is more pizza in their diets.

What they do need is to be offered the tools to learn and make independent decisions not only outside the classroom, but inside the classroom as well, and the lunchroom is a good place to start.

But if Kliff is right, the lunchroom just might be the last place for kids to get a good education.

While the U.S. Department of Agriculture writes guidelines for what school meals should look like, few schools actually follow them. Just 20 percent of schools served meals that met federal guidelines for fat content, according to a 2007 USDA audit.

Posted in Behavioral Health, Case Management, Consumer-Driven Healthcare, Disease Management, Healthcare Costs, Healthcare Trends | No Comments »

Healthcare Industry Not Prepared to Protect Patient Privacy; Data Breaches Rising

October 3rd, 2011 by Cheryl Miller

As new uses for digital health information emerge and access to confidential patient information expands, a majority of healthcare organizations are not prepared to protect patient privacy and secure data, says a new report from the Health Research Institute (HRI) at PwC US. And medical identity theft is on the rise; according to a recent PwC HRI survey, theft accounted for two thirds of total reported health data breaches over the past two years. Healthcare organizations need to update practices and adopt a more integrated approach to ensure that patient information doesn’t fall into the wrong hands, the report advises. We report on this story at length in this week’s Healthcare Business Weekly Update.

Annual premiums for employer-sponsored family health coverage increased to $15,073 this year, up 9 percent from last year, according to a recent Employer Health Benefits survey from the Kaiser Family Foundation/Health Research & Educational Trust (HRET). Premiums increased significantly faster than workers’ wages and general inflation.

To help its members navigate healthcare services and costs, BCBSF has introduced a new transparency tool, “Know Before You Go.” Designed to help its members navigate through the healthcare system, it provides information based on hospital data reported by CMS. The tool is customized to a member’s benefits and takes into account deductibles, copays and/or coinsurance amounts and estimates how much a treatment or procedure will cost.

And we are compiling research for our second annual survey on tactics to reduce avoidable emergency room visits. We will e-mail all respondents a summary of results once they are compiled. To participate, click here.

Posted in Affordable Care Act, Avoidable ER Use, Behavioral Health, Consumer-Driven Healthcare, Healthcare Administration, Healthcare Costs, Healthcare Toolkits, Healthcare Trends, Uncategorized | No Comments »

New Transitions of Care Credential Program for Case Managers

September 14th, 2011 by Cheryl Miller

A timely new certification in care transitions recognizes skills and expertise in patient handoffs between sites of care.

The Case Management Society of America (CMSA) and the American Board of Quality Assurance and Utilization Review Physicians, Inc. (ABQAURP) are collaborating to create a sub-specialty certification for transitions of care (TOC.) According to the CMSA web site, this new credential is

“the first one to support professionals not only as a team, but also individually, who demonstrate competence and skills in providing the key elements of transitions of care.”

Successful transitions of care from one managed care environment to another are key to reducing hospital readmissions and improving overall healthcare costs and patient satisfaction. According to market research compiled in Healthcare Intelligence Network’s second annual Managing Care Transitions Across Sites survey conducted in May 2010, the hospital-to-home transition is the most critical transition in care, followed by skilled nursing facility (SNF)-to-home (49.2 percent) and ER-to-home transitions (45.9).

But until now, care transitions haven’t traditionally been part of medical education and training; according to the American Geriatrics Society:

  • Nearly 20% of Medicare patients readmitted to hospital within a month
  • Patients are frequently confused and dissatisfied by the discharge process
  • Communication between hospitalists and PCPs is equent

    • And patients are suffering: from those recently hospitalized who are often discharged without proper instructions on what medications to take or resume taking to faulty or incomplete handoffs of patients between provider shifts in teaching hospitals that may be responsible for more medical errors than overworked, sleep-deprived medical residents.

    The majority of HIN’s survey respondents said that post-transition patient contact, such as home follow-up visits and post-discharge telephone calls, were the most successful strategies to improve care transitions.

    And more than half of the respondents said that the case manager was most frequently charged with care transition management.

    Says Jan Van der Mei, continuum case management director at Sutter Health Sacramento Sierra Region:

    “One of the main focuses for care coordination is to avoid duplication of services when patients move from one site of care to the next. When someone is leaving the hospital, care coordination can help the patient get a follow-up appointment. When you are monitoring the patient, it may be helping them get to the office instead of going to the ED.

    “It is also many rounds of addressing the psychosocial issues and making sure that patients can actually make it to their appointments – that they have transportation and that when they get a new prescription, they are able to pick up the prescription and pay for it,” Van der Mei continues.

    Other elements for care coordination involve making sure when a PCP refers a patient to a specialist, that the specialist has the necessary information so they can provide the assessment that is being sought without actually duplicating tests that have already been done, recommends Van der Mei.

    Says Mary Beth Newman, MSN, RN-BC, CMAC, CCP, CCM, as quoted on the CMSA web site:

    “…we have worked hard to design the credential to help identify best practices, as well as to assist case managers in making recommendations that balance the appropriateness of health care services with cost and quality as related to transitions. It is vital that the program address the need for effectiveness, efficiency, equity, safety, and timeliness in transitions of care.”

    Posted in Accountable Care Organizations, Affordable Care Act, Avoidable ER Use, Case Management, Consumer-Driven Healthcare, Disease Management, Healthcare Administration, Healthcare Costs, Healthcare Quality Ratings, Uncategorized | 2 Comments »

    Four Transitions for Back-To-School

    September 12th, 2011 by Cheryl Miller

    It’s back to school time, and the healthcare industry is undergoing its fair share of transitions.

  • NCQA is launching a new accreditation program for ACOs this fall. The organization worked with consumer advocates, purchasers and other healthcare and managed care experts to develop seven standards by which it will evaluate ACOs. Early bird adopters of the accreditation effort can get reduced rates on survey fees, online education tools and promotion. Order the NCQA ACO standards.
  • The one-year report card on Cigna’s ACO approach with Medical Clinic of North Texas (MCNT) is in; and both healthcare systems are reporting excellent grades in four key areas: reducing avoidable emergency room visits, following evidence-based medicine, lowering medical costs and better controlling diabetes. Since the accountable care program began, MCNT has received the highest level of recognition from NCQA for meeting national quality standards for physician group medical homes. Cigna helped by sharing patient-specific data that identifies individuals who could benefit most from additional outreach and follow-up care.
  • Medical students, rather than teachers, are getting apples this year: Apple iPads. Many universities, including Yale Medical School, profiled here, are downloading curriculum onto the tablets in an effort to be more “green,” save money, and protect patient confidentiality. Computer security has been a particular concern for the Yale School of Medicine, and the iPad is compliant with security and privacy laws and does not carry the same risk of information loss that a laptop might, Yale officials say.
  • And finally, a lesson that can’t be taught enough: smoking just a few cigarettes can kill. A new report from the CDC shows that smokers are smoking less: the percent of daily smokers who smoke nine or fewer cigarettes per day rose to nearly 22 percent in 2010, up from an estimated 16 percent in 2005. But smokers need not be heavy or long-term smokers to be affected with a smoking-related disease, or suffer a heart attack or asthma attack, CDC officials say. And states with the toughest anti-smoking campaigns, like like Maine, New York and Washington, have the fewest smokers. Which just goes to show that even the most resistant students can be taught to change their ways.

    • Posted in Accountable Care Organizations, Affordable Care Act, Avoidable ER Use, Behavioral Health, Case Management, Consumer-Driven Healthcare, Disease Management, HIN Blog, Health IT, Healthcare Costs, Healthcare Quality Ratings, Healthcare Trends, Hospital Readmissions, Telehealth & Telemedicine, Uncategorized, Wellness/Prevention, e-Health | No Comments »

    Warning: Winds of Healthcare Change Ahead

    August 29th, 2011 by Cheryl Miller

    As we go to press Friday afternoon, Hurricane Irene is threatening to pummel our eastern coastline with winds greater than 80 mph; store shelves have been emptied of bottled water and batteries and anyone searching for a generator is probably out of luck.

    Healthcare, too, is preparing for the winds of change as reform laws descend upon it, and many preparations are being made in its wake. HHS just announced it is awarding $40 million in grants to identify and enroll children eligible for Medicaid and the Children’s Health Insurance Program (CHIP). The two-year grants are authorized under the Children’s Health Insurance Program Reauthorization Act (CHIPRA) of 2009, and part of the administration’s push to ensure all eligible children.

    In a move to address shifting reimbursement plans, CMS is proposing four bundled payment plan models. These models are designed to align payments for services delivered during an episode of care, rather than paying for services separately. This new initiative will give providers the flexibility to determine which episodes of care and which services will be bundled together. Read more about this proposal in this week’s Healthcare Business Weekly Update.

    And lastly, nearly one of every 10 mid-sized or big employers might stop offering health coverage to workers after insurance exchanges begin operating in 2014, states a recent survey from Towers Watson. The survey, which involved more than 1200 companies, says that the companies are willing to risk the ensuing fees and tax headaches that could arise with such a move. Last year, the average annual health insurance premium for employer-sponsored family coverage was $13,770 per worker, with companies picking up most of that tab,
    according to the Kaiser Family Foundation and Health Research and Educational Trust. That cost has more than doubled since 2000.

    But survey officials stress that these results aren’t written in stone, and that employers could change their minds given all the unresolved variables, not unlike the hurricane headed our way. We’ll just have to see what path the storm takes.

    Posted in Accountable Care Organizations, Affordable Care Act, Consumer-Driven Healthcare, HIN Blog, Healthcare Administration, Healthcare Costs, Uncategorized | No Comments »

    U-M’s Care Strategies Save Medicare $22 Million, Demonstrate ACO Benefits

    August 22nd, 2011 by Cheryl Miller

    Improving preventive and chronic care helped the University of Michigan (U-M) to save Medicare more than $22 million during a five-year Physician Group Practice Demonstration (PGPD), which was designed to show the potential benefits of ACOs. A new transitional care program assisting patients with hospital discharge and follow-up was one of the ways the health system successfully achieved savings.

    HHS has awarded $185 million in grants to 13 states and the District of Columbia to help them establish new state-based health insurance
    marketplaces. The agency is hoping that individuals, families and small businesses will be able to use the exchanges to purchase private health insurance beginning in 2014.

    And lastly, don’t forget to participate in our second annual survey on medication adherence. You’ll receive a free executive summary of the survey results once they are compiled. To take the survey, please click here.

    These issues and more in this week’s Healthcare Business Weekly Update.

    Posted in Accountable Care Organizations, Affordable Care Act, Avoidable ER Use, Consumer-Driven Healthcare, HIN Blog, Healthcare Costs | No Comments »

    Less is More When it Comes to Healthcare

    August 19th, 2011 by Cheryl Miller

    Less is more, at least when it comes to certain medical procedures.

    That was the conclusion of a recent study by the American Heart Association (AHA) and reported here in a recent issue of Healthcare Business Weekly Update. Researchers compared the use of drug-eluting stents (DES) in 2004-06 to 2007, when their use decreased by nearly 25 percent. Using data from the Evaluation of Drug-Eluting Stents and Ischemic Events registry, the study found that limiting the use of DES did not increase the risk of death or heart attack, and only slightly raised the need for repeat angioplasty procedures. In fact, because the stents were reserved for use on higher risk patients, healthcare costs were reduced by an average of $410 per patient. When multiplied by the estimated 1 million angioplasty procedures performed annually, the United States is able to save nearly 400 million a year.

    A recent story in Newsweek corroborates this research, and suggests that the use of DES weren’t the only medical procedures being overused. The article goes on to state that some common tests and procedures aren’t just expensive, but can do more harm than good.

    “There are many areas of medicine where not testing, not imaging, and not treating actually result in better health outcomes,” says Dr. Rita Redberg, professor of medicine at the University of California, San Francisco, and editor of the Archives of Internal Medicine.

    The problem is that “in otherwise healthy people,” screenings can lead to false positives, and cascading tests and procedures for possible problems that might have been harmless, or gone away on their own, the article says.

    From PSA tests for prostate cancer (which more than 20 million U.S. men undergo every year) to surgery for chronic back pain to simple antiobiotics for sinus infection, a remarkable number and variety of tests and treatments are now proving either harmful or only as helpful as a placebo.

    The article doesn’t dismiss the benefits of progressive medicine; instead, it lists the procedures that have saved lives and eased suffering for millions:

    Screening tests like mammograms…can lead to early treatment of breast cancer, especially for women with hereditary risk or a strong family history of the disease. For cancer patients who report back pain, MRIs can prove invaluable for spotting tumors that have metastasized to the bones, allowing doctors to intervene before it’s too late. The years between 1980 and 2004 saw a 50 percent decline in the death rate from coronary heart disease thanks to better treatments and drugs that reduce cholesterol and blood pressure. At least 7,300 lives are saved every year thanks to colonoscopies.

    But the flip side is that procedures are being overprescribed, like colonoscopies for the elderly, which can often harm them, and CT scans for the injured. A study published by John Hopkins noted the rise in MRIs and CT use in emergency departments over a 10 year period, from 1998 to 2007. The Hopkins team found that patients with injury-related conditions were three times more likely to get a CT or MRI scan in 2007 than they were in 1998. But the team also found that diagnosis of life-threatening conditions, such as a cervical spine fracture or liver laceration, rose only slightly.

    Part of the problem is compensation: according to the Newsweek article, Medicare pays physicians more than $100 million a year for screening colonoscopies; still other procedures, like angioplasty, bypass surgery and stenting are not improving cardiac patients’ lives; but instead costing Medicare more than $1.6 billion a year.

    The solution? The study published by the AHA didn’t directly identify which patients are the best candidates for DES, although other studies are currently underway using similar patient registries to address it. And research shows that low risk heart patients can benefit more from noninvasive treatments like drugs (beta blockers, cholesterol-lowering statins, and aspirin), exercise, and a healthy diet.

    With the push for reducing healthcare costs while improving care, it’s an issue that will most probably continue to be explored.

    Posted in Affordable Care Act, Avoidable ER Use, Behavioral Health, Consumer-Driven Healthcare, Disease Management, HIN Blog, Healthcare Costs, Healthcare Trends, Hospital Readmissions, Medication Management, Reducing Readmissions, Transitions in Care, Uncategorized, Wellness/Prevention | No Comments »

    New Study Documents Dissatisfaction with Patient Satisfaction Scores

    August 1st, 2011 by Cheryl Miller

    Almost 85 percent of healthcare executives are dissatisfied with their patient satisfaction scores, according to our “Improving Patient Experience and Satisfaction” survey conducted in May 2011. But more than 80 percent of survey respondents said they have programs in place to improve satisfaction levels. We surveyed 146 healthcare organizations, and identified areas for improvement, providing details on patient satisfaction surveys, estimating the impact of programs designed to improve patient satisfaction, among other areas. Download an executive summary of the results.

    Healthcare costs for U.S. employers have slowed from last year. According to the Thomson Reuters Healthcare Spending Index for Private Insurance, medical costs for people in employer-sponsored health plans decreased by nearly 3 percent from the previous year. Hospital costs showed the steepest growth, with physician costs reflecting a 3 percent year-over-year hike, and drug costs increasing by less than one percent. More in this issue of the Healthcare Business Weekly Update.

    By 2015, more than 500 million smartphone users worldwide will be using mobile health and medical applications, research studies show. So it’s not surprising that the FDA is taking a closer look at some of these apps; specifically, those whose misuse could endanger their users. The FDA is currently seeking public input on its proposed approach.

    It’s not too late to complete this month’s e-survey on patient registries. Respond by August 15 and you’ll receive a free executive summary of the survey results once they are compiled to learn key benchmarks and metrics for using registries to improve reimbursement and patient outcomes. You may complete the survey online. Thanks for participating!

    Posted in Consumer-Driven Healthcare, Healthcare Costs, Hospital Readmissions, Telehealth & Telemedicine, Wellness/Prevention, e-Health | No Comments »

    One Third of Medical Homes Will Join an ACO

    July 18th, 2011 by Cheryl Miller

    New market research shows that one third of medical homes will join an ACO in the next 12 months. And more than half of those interviewed by the Healthcare Intelligence Network for our fifth annual survey on patient-centered medical homes said they had already established a medical home for their population. The PCMH is a favored model of integrated care delivery and a cornerstone of accountable care — two core elements of healthcare reform. More in this issue.

    About $216 million nationally is spent each year managing drug
    shortages in the hospital setting, with three drugs in particular
    affecting over 80 percent of health systems, says a new study
    released by the American Society of Health-System Pharmacists
    (ASHP). The problem is not only increasing hospital costs but
    harming patient care: nearly a third of the 353 pharmacy directors
    surveyed said they had to pull clinical staff to manage the crisis.

    More than $300 billion each year is spent on care for dual-eligibles,
    the 9 million Americans currently receiving both Medicare and
    Medicaid benefits. HHS hopes to lower these costs — and improve
    care — with three new initiatives: financial models to better align
    finances between the agencies; a quality care program for nursing
    home residents, and a resource center program.

    Telemedicine continues to serve the underserved. A new remote
    monitoring pilot project from the University of Utah seeks to help the
    chronically ill who are unable to reach traditional care facilities easily
    on a regular basis. The project will feature a centralized care
    coordinator, four clinics monitoring 15 to 20 patients each and two
    locations using kiosks to monitor another 30 patients each. Read more in this week’s Healthcare Business Weekly Update.

    Posted in Accountable Care Organizations, Affordable Care Act, Behavioral Health, Case Management, Consumer-Driven Healthcare, Disease Management, Health IT, Healthcare Costs, Healthcare Quality Ratings, Healthcare Trends, Patient-Centered Medical Home, Prescription Drugs, Telehealth & Telemedicine, Uncategorized, Wellness/Prevention, e-Health | 1 Comment »

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