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From the editor

Dear Healthcare Intelligence Network Client,

HIN Content Editor Cheryl Miller

CMS has released a proposed final rule on the 2012 Medicare Physician Fee Schedule that puts provider payment cuts of 27.4 percent on the table for January 1, 2012. The reduction, based on the Sustainable Growth Rate (SGR) formula, reflects the fact that Medicare costs grew more slowly than expected, according to CMS. But many agencies, including CMS and the AMA, are voicing concerns that such a cut, or even a reduced one, will jeopardize access to care for seniors and pose financial burdens for physicians. They are calling on Congress to intervene. If it does, it wouldn't be the first time; in fact, it would be the 11th time that Congress did so. Since 2002, the SGR has triggered annual pay cuts for physicians; starting in 2003, each one has been postponed by an act of Congress. We will keep you posted on this story.

One way to offset Medicare costs in the coming year is to utilize more case managers, says Steven Valentine, president of The Camden Group in our recent webinar: "Healthcare Trends in 2012: A Strategic Industry Forecast." Embedding them in the physician practice and the emergency department will help to ease the increasing burden on physicians. Another way to further reduce costs and improve care would be to implement mini-medical homes, particularly for the chronically ill.

Our eighth annual healthcare trends event provides a first look analysis at the key trends and opportunities for healthcare organizations in the coming year. If you missed it, it is now available on demand here. With unprecedented economic conditions continuing to impact the industry, Valentine discusses new payment and delivery options available for healthcare providers and the ongoing implementation of the Patient Protection and Affordable Care Act.

In other news, hospital supply cart drawer handles, floors, infusion pumps, ventilator touch pads and bed rails were the surfaces most commonly contaminated in a recent study of how frequently patients' environments become contaminated. The study also found that nearly half of the hospital rooms of patients who tested positive for a multi-drug resistant bacteria were contaminated with the bacteria. More details in this issue.

And finally, an alarming statistic: more than 40 people die every day from overdoses involving narcotic pain relievers, a number that has more than tripled in the past decade, according to the CDC. In 2010, 1 in every 20 people in the United States age 12 and older — a total of 12 million people — reported using prescription painkillers non-medically. Sales of these drugs to pharmacies and healthcare providers have increased by more than 300 percent since 1999. In this story, the CDC proposes six ways states can help reverse this trend.

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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November 7, 2011
Vol. XIII, No. 41

Sponsored by:
Demonstrating the Value of the Embedded Case Manager for the Medicare Population

This week's industry news:

  1. Medicare Payment Rates to Providers Could Be Reduced by 27.4 Percent in 2012: CMS
  2. Guide to Physician Performance-Based Reimbursement
  3. 3 Goals of Bon Secours' Medical Home Clinical Transformation Project
  4. Case Management in Primary Care
  5. Healthcare Business White Paper: 2011 Benchmarks in Accountable Care Organizations
  6. Health Insurance Web Sites Lagging Behind Others in Customer Satisfaction Scores
  7. New Chart: Top 5 Success Metrics for ACOs
  8. 2011 Benchmarks in Patient Satisfaction Strategies
  9. Nearly Half of Hospital Rooms Infected with Drug-Resistant Bacteria
  10. Infection Prevention Manual for Long Term Care
  11. Prescription Painkiller Overdoses at Epidemic Levels
  12. 2011 Benchmarks in Improving Medication Adherence
  13. November 4 Deadline Looms for Certain CMS Bundled Payment Models
  14. HealthSounds Podcast: Improving Transitions of Care Between Hospital and SNF
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This week's industry news

1.) Medicare Payment Rates to Providers Could Be Reduced by 27.4 Percent in 2012: CMS

Without Congressional intervention, provider Medicare payments will be cut 27.4 percent, under a final rule published by CMS.

Get the full story.

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

Guide to Physician Performance-Based Reimbursement This guide 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 and program outcomes.

Learn more about this resource.

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3.) 3 Goals of Bon Secours' Medical Home Clinical Transformation Project

Improving patients' behaviors is key to successfully transforming into a medical home, explains Robert Fortini, vice president and chief clinical officer at Bon Secours Health System. Up to 70 percent of all healthcare costs in the country have been attributed to patient non-compliance.

Get the full story.

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4.) Case Management in Primary Care: Benefits of Colocated Care Coordinators

Case Management in Primary Care This resource examines two parallel East Coast efforts in embedded case management: Nurse Navigators in Bon Secours Health System's Advanced Medical Home program, and Nurse Case Managers at the heart of CDPHP's Enhanced Primary Care effort.

Learn more about this resource.

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5.) Healthcare Business White Paper: 2011 Benchmarks in Accountable Care Organizations

A significant segment of the healthcare industry is reframing its care delivery structure as an accountable care organization (ACO) or will do so in the near future, according to new market research by the Healthcare Intelligence Network. This white paper summarizes awareness of and readiness for ACOs at 228 healthcare organizations, based on their responses to a February 2011 ACO Readiness Assessment. This research was conducted before CMS released its proposed rule governing ACOs.

Download this complimentary white paper.

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6.) Health Insurance Web Sites Lagging Behind Others in Customer Satisfaction Scores

Health insurance Web sites vastly underperform other kinds of healthcare sites, including health information Web sites and hospital and health system Web sites, according to ForeSee's fourth annual healthcare benchmark.

Get the full story.

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7.) New Chart: Top 5 Success Metrics for ACOs

Top 5 Success Metrics for ACOs Accountable care organizations (ACOs) create integrated delivery systems that encourage teams of physicians, hospitals and other providers to collaboratively coordinate care for ACO members. We wanted to see which metrics organizations use to measure ACO success.

Click here to view the chart.

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8.) 2011 Benchmarks in Patient Satisfaction Strategies: Improving the Healthcare Consumer Experience

2011 Benchmarks in Patient Satisfaction Strategies This 60-page analysis presents new market research on industry efforts to enhance the patient experience and levels of satisfaction with their care. Based on the responses of 146 organizations to the Healthcare Intelligence Network May 2011 survey on Improving Patient Satisfaction and the Patient Experience, this resource presents the all-new data in more than 45 easy-to-follow graphs and tables.

Learn more about this resource.

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9.) Nearly Half of Hospital Rooms Infected with Drug-Resistant Bacteria

Nearly half of the hospital rooms of patients who tested positive for a multi-drug resistant bacteria were contaminated with the bacteria, according to a new study by researchers from the University of Maryland School of Medicine.

Get the full story.

>>Return to this week's industry news


10.) Infection Prevention Manual for Long Term Care

Infection Prevention Manual for Long Term Care This manual is designed so the policies may be used as written or they may be easily adapted to a specific facility by using the disk that is provided with the manual. The content is written taking into consideration JCAHO standards, federal regulations, and current standards of practice for infection control. The manual includes a detailed table of contents and numbered tabs for ease in finding specific policies. The manual format includes: the infection control program, surveillance of infections, infection control education, and more.

Learn more about this resource.

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11.) Prescription Painkiller Overdoses at Epidemic Levels

More than 40 people die every day from overdoses involving narcotic pain relievers, a number that has more than tripled in the past decade, according to the CDC, which is proposing six ways states can help.

Get the full story.

>>Return to this week's industry news


12.) 2011 Benchmarks in Improving Medication Adherence

2011 Benchmarks in Improving Medication Adherence This guide provides actionable information from 162 healthcare organizations on their efforts to improve medication adherence and compliance in their populations. This second annual analysis of medication adherence programs documents the impact of these programs on adherence levels, medication costs, ER visits, hospital and nursing home admissions, risk of death and other areas of concern.

Learn more about this resource.

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13.) November 4 Deadline Looms for Certain CMS Bundled Payment Models

Model 4 of the new CMS bundled payments program offers “the best balance of risk and reward” as well as opportunities for gainsharing, advises Jim Reilly, managing partner with TRG Health Care Solutions. This option appears to have the highest level of interest among providers Reilly has communicated with.

Read this blog post.

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14.) HealthSounds Podcast: Improving Transitions of Care Between Hospital and SNF — A Collaboration Supporting the Accountable Care Vision

Carolyn Holder Working with a network of 40 skilled nursing facilities to hone the hospital-to-SNF transfer of care has accomplished two goals for Summa Health System: readmissions and lengths of stay for patients released to SNFs have been reduced, and the experience has made hospitals and SNFs more accountable for both the quality and cost of care they provide. Carolyn Holder, manager of transitional care for Summa Health System, describes what had to happen before this critical care transition could improve and why physicians had to rethink their approach to hospital-to-SNF transfers.

Listen to this podcast.

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