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From the editor

Dear Healthcare Intelligence Network Client,

HIN Content Editor Cheryl Miller

Almost half of all healthcare organizations are using physician alignment criteria in their incentive plans, according to a new survey from Integrated Healthcare Strategies. The survey, which monitors trends in healthcare salary increases, incentive practices, and benefit changes, was expanded to include the prevalence of physician alignment goals, given the market’s increasing interest in it. The most popular goal is meeting CMS's quality standards, followed by physician use of electronic patient records and readmission rates.

What incentives are you providing your physicians? Describe the physician reimbursement models in place at your organization by taking our Physician Reimbursement Models survey by April 15th and you will receive a free summary of survey results once it is compiled.

Nurses play a key role in a new initiative from CMS. The agency is seeking up to five hospitals working with nursing schools to train advanced practice registered nurses (APRN). Recognizing that nurses are crucial to a strong primary care work force, but that the cost of training APRNs has limited many hospitals and other healthcare providers from doing so, CMS will provide up to $200 million in funds for clinical training to those hospitals selected to participate in the program, which is expected to run for four years. Applications must be submitted by May 21, 2012.

Nurses could play a key role in another story we cover on the use of anesthesia providers to monitor sedation during colonoscopies and other gastro-intestinal-related procedures. The practice has more than doubled from 2003 to 2009, and is costing the United States more than $1 billion a year, says a new study from the RAND Corporation. Of particular concern is that most of the increase is coming from low-risk patients, who may not need the service. Instead, researchers point to current treatment guidelines that show that these procedures can be safely administered by physicians and assisting nurses if the patients are not at risk for anesthesia-related complications.

And, where is Gloria Steinem when we need her? A new report shows that women are paying more for the same healthcare coverage as men; inequities include policies that charge female non-smokers more than male smokers, and that provide no maternity coverage to women of child-bearing age. Variations exist in each state and across the country, researchers state.

Your colleague in the business of healthcare,
Cheryl Miller
Editor, Healthcare Business Weekly Update

Please send comments, questions and replies to cmiller@hin.com.

HIN Associate Editor Jessica Papay
Associate Editor:
Jessica Papay, jpapay@hin.com

Publisher:
Melanie Matthews, mmatthews@hin.com

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March 26, 2012
Vol. XIV, No. 11

Sponsored by:
Leveraging Case Management Tools and Technology to Improve Outcomes

This week's industry news:

  1. Survey Finds Many Healthcare Organizations Use Physician Alignment Criteria in Incentive Plans
  2. Physician Pay-for-Performance
  3. Hospitals Working with Nurses to Receive Up to $200 Million for Advanced Training: CMS
  4. Transformational Leadership in Nursing
  5. Healthcare Business White Paper: Case Management in 2012
  6. Use of Anesthesia Providers to Monitor Sedation During Colonoscopies Has Increased
  7. New Chart: Top 5 Uses of Patient Satisfaction Survey Results
  8. Guide to Health Risk Assessment and Stratification
  9. 5 Operational Challenges of Participating in CMS’s ACE Demo
  10. Case Study in Bundled Payments
  11. Women Charged $1 Billion More Than Men for Health Insurance Coverage
  12. Health Insurance Exchanges
  13. Tackling 5 Care Barriers That Boost ER Use by Medicaid Patients
  14. HealthSounds Podcast: CMS Innovation Panel Looks to Medication Adherence as Potential Delivery Innovation
Please pass this along to any of your colleagues or, better yet, have them sign up to receive their own copy and learn about our other news services.

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This week's industry news

1.) Survey Finds Many Healthcare Organizations Use Physician Alignment Criteria in Incentive Plans

Nearly 40 percent of healthcare organizations are using some kind of physician alignment criteria in their incentive plans, according to a new survey from Integrated Healthcare Strategies.

Get the full story.

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2.) Physician Pay-for-Performance: Refining the Bonus Structure To Meet Market Realities

Physician Pay-for-Performance During this 45-minute webinar, Julie Hobson, manager of provider engagement, performance and partnership at Highmark Inc., described how Highmark's pay-for-performance program has evolved to meet today's healthcare market realities, including new developments slated for 2012 to reflect meaningful use requirements; bonus scoring algorithms currently in place that reward physicians across the measure set, and more.

Learn more about this resource.

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3.) Hospitals Working with Nurses to Receive Up to $200 Million for Advanced Training: CMS

Hospitals working with nursing schools to train advanced practice registered nurses (APRNs) can receive payments of up to $200 million over four years to cover the costs of APRNs’ clinical training if selected, according to CMS.

Get the full story.

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4.) Transformational Leadership in Nursing, From Expert Clinician to Influential Leader

Transformational Leadership in Nursing This resource provides critical information and practical tools to enhance leadership, drawing from the works of experts in business and healthcare leadership. This book is an important resource for doctor of nursing practices (DNP) students, nurse practitioners, and current clinical leaders dealing with the challenges of healthcare for the next generation.

Learn more about this resource.

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5.) Healthcare Business White Paper: Case Management in 2012 — Half of Case Managers Embedded in Care Sites

To adequately prepare for 2012 and beyond, healthcare companies are utilizing case managers in greater numbers to help identify and manage high-cost, high risk patients. This white paper documents the efforts and contributions of case management from 153 healthcare organizations, with a concentration on three new areas: trends in embedded case management, including work locations of co-located case managers and the greatest challenges and benefits of embedding case manager at the point of care; clinical conditions targeted by case managers, and preferred case management certifications.

Download this complimentary white paper.

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6.) Use of Anesthesia Providers to Monitor Sedation During Colonoscopies Has Increased

Use of anesthesia providers to monitor sedation during screening colonoscopies and other outpatient gastroenterology procedures more than doubled from 2003 to 2009 in the United States, with most of the increase among low-risk patients who may not need this service, according to a new RAND Corporation study.

Get the full story.

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7.) New Chart: Top 5 Uses of Patient Satisfaction Survey Results

Top Uses of Patient Satisfaction Survey Results Patient satisfaction with the healthcare experience is influencing quality ratings and value-based reimbursement levels for hospitals, physicians and other providers. We wanted to see how healthcare providers use the results from patient satisfaction surveys.

Click here to view the chart.

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8.) Guide to Health Risk Assessment and Stratification

Guide to Health Risk Assessment and Stratification In this valuable resource, 12 industry thought leaders describe the processes of health risk assessment (HRA) and stratification as well as applications and benefits of health assessment in the workplace and various healthcare settings.


Learn more about this resource.

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9.) 5 Operational Challenges of Participating in CMS’s ACE Demo

Developing gainshare criteria, identifying quality metrics, and standardizing implant buying practices were some of the challenges Baptist Health System faced when participating in CMS’ Acute Care Episode (ACE) demonstration pilot, which aligned payment for services delivered across episodes or “bundles” of care, explains Michael Zucker, FACHE, senior vice president and chief devlopment officer for Baptist Health System.

Get the full story.

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10.) Case Study in Bundled Payments: The Baptist Health System Experience

Case Study in Bundled Payments This 24-page report documents the care payment experience of Baptist Health System in the CMS ACE demonstration pilot, which aligned payment for services delivered across episodes of care or "bundled" care. ACE focused on the cardiac and orthopedic diagnosis-related group (DRGs), two of the public payor's most frequent and largest cost disease areas.

Learn more about this resource.

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11.) Women Charged $1 Billion More Than Men for Health Insurance Coverage

Health insurers are charging women more than men for the same coverage, costing women about $1 billion a year, according to analysis of advertised premiums in a new report from the National Women’s Law Center.

Get the full story.

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12.) Health Insurance Exchanges: Preparing for the Brave New Marketplace Ahead

Health Insurance Exchanges In this resource you'll read about the hurdles state lawmakers and stakeholders are facing in developing models and establishing exchanges. You'll also gain insight from industry consultants, state lawmakers and regulators, scholars and other key industry observers on various topics, including how many insurers will participate, what have states done so far, how much will it cost states to launch an exchange, and more.

Learn more about this resource.

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13.) Tackling 5 Care Barriers That Boost ER Use by Medicaid Patients

Facing five specific barriers to timely primary care, Medicaid beneficiaries are twice as likely to visit the ER as their insured counterparts, according to a study published online in the Annals of Emergency Medicine.

Read this blog post.

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14.) HealthSounds Podcast: CMS Innovation Panel Looks to Medication Adherence as Potential Delivery Innovation

Dr. Janice Pringle Medication adherence rates for patients enrolled in a collaborative program developed by the University of Pittsburgh School of Pharmacy, Highmark, RiteAid and CE City, a technology company, was significantly improved and continued to improve over time compared to a control group, according to Dr. Janice Pringle, director of the program evaluation research unit at the University of Pittsburgh School of Pharmacy.

Listen to this podcast.

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