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From the editor

Dear Healthcare Intelligence Network Client,

HIN Content Editor Cheryl Miller

There's been a 60 percent increase in ED visits for sports injuries over the last 10 years. Part of the reason for this alarming trend has been attributed to a concerted effort between the CDC and the National Football League: since 2001 they have raised public awareness about the dangers of traumatic brain injuries in children. Research indicates that young athletes with a TBI experience longer recovery times and are at greater risk of serious outcomes than adults. The injuries may appear mild but can lead to significant lifelong impairment, so it’s smart to take the proper precautions when they happen.

But the prevalence of avoidable emergency department use still continues, an issue we tackle in our second annual survey, Reducing Avoidable ER Visits in 2011. What are you doing to staunch the flow and expense of avoidable emergency department use? We are seeking input on organizations’ efforts in this area, and if you respond by October 31 you will receive a free executive summary of the results.

In other news, one third of people 65 years and older are undergoing surgeries in their last year of life, with 1 in 10 having surgery in their last week of life. Researchers from the Harvard School of Public Research, where the study was conducted, say the surgeries vary substantially with age and region, and express uncertainty as to the necessity of many of the surgeries. More details in this issue.

ACO regulations have entered the final stage of the review process. The CMS sent the final Medicare Shared Savings Program regulations to the Office of Management and Budget for review on October 5th, one of the last steps in the approval process. No word yet on when the final rule will be published; we will keep you posted.

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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October 17, 2011
Vol. XIII, No. 38

Sponsored by:
Evaluating CMS' Bundled Payment Initiative: Operational, Financial and Clinical Considerations

This week's industry news:

  1. Skilled Nursing and Post-Acute Care Has Improved in 9 of 10 Quality Areas: Report
  2. Comorbidity Care Models
  3. 1 in 3 Medicare Beneficiaries Getting End-of-Life Surgeries
  4. Identifying Functional Decline in Chronic Care Patients
  5. Healthcare Business White Paper: 2010 Performance Benchmarks in Tobacco Cessation
  6. 70 Percent of Hospitals and Health Systems Will Hire More Doctors
  7. New Table: 7 Care Coordination Challenges Met by an SNF Network
  8. Guide to Physician Engagement
  9. Keys to Successful Payment Reform
  10. Guide to Physician Performance-Based Reimbursement
  11. 60 Percent Increase in ED visits for Sports Injuries Among Children and Adolescents
  12. 2010 Performance Benchmarks in Reducing Avoidable ER Visits
  13. How to Survive and Thrive Under Bundled Payments
  14. HealthSounds Podcast: Healthcare Trends in 2012 — Eighth Annual Strategic Industry Forecast
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Reducing Avoidable Emergency Room Visits in 2011

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This week's industry news

1.) Skilled Nursing and Post-Acute Care Has Improved in 9 of 10 Quality Areas: Report

A report targeting quality improvement and transparency shows that America's nursing facilities are continuing to make quality improvements, including measurable improvements in nine out of 10 quality measures since 2009.

Get the full story.

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2.) Comorbidity Care Models: Integrated Action Plans for Complex Healthcare Needs

Comorbidity Care Models This guide presents emerging models of care for comorbidity, with a special focus on the needs of aging multi-morbid patients as well as those whose comorbidity encompasses physical and behavioral health conditions.

Learn more about this resource.

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3.) 1 in 3 Medicare Beneficiaries Getting End-of-Life Surgeries

Surgery is surprisingly common among elderly Medicare patients at the end of life, according to a new study led by Harvard School of Public Health (HSPH) researchers.

Get the full story.

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4.) Identifying Functional Decline in Chronic Care Patients To Reduce Preventable Healthcare Utilization

Identifying Functional Decline in Chronic Care Patients Two Fallon Community Health Plan (FCHP) leaders discuss how they identify Medicare Advantage members at risk of high utilization, the strategies they've implemented to reduce this utilization and the outcomes and cost savings achieved by FCHP in this 45-minute webinar.

Learn more about this resource.

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5.) Healthcare Business White Paper: 2010 Performance Benchmarks in Tobacco Cessation

This white paper summarizes results of the Healthcare Intelligence Network’s second annual Tobacco Cessaton & Prevention e-survey conducted in November 2010, revealing the efforts of 84 healthcare organizations to curb these trends, including program availability, program components and reimbursement trends.

Download this complimentary white paper.

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6.) 70 Percent of Hospitals and Health Systems Will Hire More Doctors

70 percent of national hospitals and health systems plan to employ more physicians in the next 12 to 36 months, according to a survey from the HealthLeaders Media Hospital-Physician Alignment survey, sponsored by MedSynergies Inc.

Get the full story.

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7.) New Table: 7 Care Coordination Challenges Met by an SNF Network

Care Coordination Challenges Through a growing number of community partnerships with skilled nursing facilities, the Summa Health System Care Coordination Network has reduced hospital readmission rates and average length of stay for patients transferred to these SNFs and has positioned themselves well for development of an accountable care organization (ACO). We wanted to see the care coordination challenges of acute care settings addressed by the SNF Care Coordination Network.

Click here to view the chart.

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8.) Guide to Physician Engagement

Guide to Physician Engagement This special report deconstructs the physician culture and suggests tactics for converting reluctant physicians into champions for healthcare improvement. A Q&A chapter answers more than 40 questions on the engagement of physicians.

Learn more about this resource.

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9.) Keys to Successful Payment Reform

Current payment models are not effective in encouraging care coordination or creating incentives for physicians to improve their performance. A more comprehensive payment strategy that aligns financial incentives and improves physicians’ potential earnings is needed, says Bruce Nash, MD, MBA, senior vice president of medical affairs and chief medical officer for CDPHP.

Get the full story.

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10.) Guide to Physician Performance-Based Reimbursement: Payoffs from Incentives, Data Sharing and Clinical Integration

Guide to Physician Performance-Based Reimbursement This 68-page special report explores newly minted reimbursement formulas at two health plans and two independent practice associations (IPAs), providing payor and provider perspectives on the formula development process; clinical, quality and efficiency measures in use; physician incentive payments, program outcomes and more.

Learn more about this resource.

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11.) 60 Percent Increase in ED visits for Sports Injuries Among Children and Adolescents

ED visits for sports-and recreation-related traumatic brain injuries (TBI), including concussions, among children and adolescents increased by 60 percent during the last decade, according to a recent report from the CDC.

Get the full story.

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12.) 2010 Performance Benchmarks in Reducing Avoidable ER Visits

2010 Benchmarks in Reducing Avoidable ER Visits This guide provides actionable information from 90 healthcare organizations on their efforts to reduce inappropriate use of the ED. This 50-page resource documents trends and metrics from emergency departments across the country that are successfully managing ER utilization.

Learn more about this resource.

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13.) How to Survive and Thrive Under Bundled Payments

Time in the trenches with Acute Care Episode (ACE) pilot participants qualifies Jim Reilly to comment on CMS’s latest Bundled Payments initiative specifically and bundled payment trends in general. The managing partner of TRG Healthcare Solutions shares three lessons CMS learned from the ACE pilot and more in this interview with the Healthcare Intelligence Network (HIN).

Read this blog post.

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14.) HealthSounds Podcast: Healthcare Trends in 2012 — Eighth Annual Strategic Industry Forecast

Steve Valentine While hospitals might find CMS's pure Medicare bundled payments initiative too restrictive, it won't prevent them from addressing their costs in a bundled payments fashion, predicts Steve Valentine, president of The Camden Group. In advance of HIN's eighth annual industry forecast, Valentine weighs in on the expected growth of bundled payments, a surprising new trend in case management, why the proposed ACO rule disappointed, and the industry segment where accountable care is thriving.

Listen to this podcast.

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