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From the editor

Dear Healthcare Intelligence Network Client,

HIN Managing Editor Patricia Donovan

The Senate's vote late Saturday to open discussions on healthcare reform promises a year-end full of passionate debate.

Also last week, the industry and public reacted strongly to recommendations from two separate groups to delay the starting age for mammograms and Pap smears and to reduce their frequency. While the recommendations are non-binding for providers and payors, they run contrary to traditional medical wisdom supporting aggressive testing and prevention.

The groups' recommendations were based on a review of evidence and research associated with the screenings. By definition, evidence-based medicine aims to apply the best available evidence gained from the scientific method to medical decision-making, seeking to assess the quality of evidence of the risks and benefits of treatments (including lack of treatment). Evidence-based medicine weighs heavily in healthcare reform proposals. It's built into the patient-centered medical home model, a requirement for wellness and prevention programs and part of how the government wants to define high-value care: "the efficient delivery of high quality, evidence-based, patient-centered care." Opponents fear that a reliance on evidence-based medicine will lead to healthcare rationing and controversial "death panels." But most of the time, each provider will have to weigh the value of the science for each patient.

Dr. Richard J. Baron is president and CEO of Greenhouse Internists, a five-doctor practice in Philadelphia that is adopting evidence-based guidelines. Here's what he said during a recent webinar on Evidence-Based Guidelines in the Medical Home:

"Thereís a cognitive shift that doctors have to make. Doctors are trained to see patients one at a time and thatís mostly what we do. Itís the way the reimbursement system pays us. We can think about Mrs. Jones who we saw this morning, but you want doctors to shift to think in terms of rate-based data. Not only did I advise a mammogram to Mrs. Jones this morning, but for all the women I saw between the ages of 50 and 65 last year, how many of them had mammograms? And when you start to get doctors to ask questions like that, they become interested in the results, because their first response when they see things they donít like is, 'Itís not my fault if the patients donít follow through.'

"...Also, we need to recall that the evidence base is a broad population evidence base. If a patient is dying of breast cancer, they probably donít need to worry about getting a colonoscopy even if itís due. You need to count on the doctors to critically evaluate the evidence and its relevance to this patient. And then perhaps one of the most important things that the doctors do is they start interacting with their own data."

Your colleague in the business of healthcare,
Patricia Donovan
Editor, Healthcare Business Weekly Update

Please send comments, questions and replies to pdonovan@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 23, 2009
Vol. XI, No. 44

Sponsored by:
Aligning Reimbursement To Reduce Avoidable Hospital Readmissions

This week's industry news:

  1. Providers Leverage ACOs to Boost Reimbursement, Beat Competition
  2. Healthcare Trends & Forecasts in 2010
  3. Millions in Area Hospital Dollars Being Directed to Uncompensated Care
  4. Reducing Uncompensated Care Costs for the Chronically Ill
  5. Healthcare Business White Paper: Moment of Force — Four Ways to Leverage Healthcare Costs
  6. Reports Highlight State Gender Differences in Substance Use, Mental Health for Adolescents
  7. Clinical Case Formulations
  8. New Standards Employed in Calculation of Improper Medicare Payment Rates for 2009
  9. Medical Home Reimbursement Models
  10. FDA and Everyday Health Collaborate to Expand Reach of Consumer Health Information
  11. The Business Case for Web 2.0 in Healthcare
  12. HealthSounds Podcast: Predicting Healthcare Reform's Biggest Losers and Winners
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.) Providers Leverage ACOs to Boost Reimbursement, Beat Competition

William DeMarco, president and CEO of DeMarco and Associates, explains the growing appeal of accountable care organizations (ACOs) to providers hoping to increase profits and efficiency while improving care.

We have physicians that are organized into accountable health organizations, also known as accountable care organizations (ACO). The ACO is seen throughout the House version of health reform as well.

Get the full story.

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2.) Healthcare Trends & Forecasts in 2010: Performance Expectations for the Healthcare Industry

Healthcare Trends & Forecasts in 2010 In HIN's annual industry forecast, two analysts predict the 2010 climate for physicians, hospitals and health plans, proposing strategies to close care and business gaps, likely areas for new products, and ways to rethink payment and benefit design to support changing healthcare delivery systems.

Learn more about this resource.

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3.) Millions in Area Hospital Dollars Being Directed to Uncompensated Care

In the midst of the economic downturn, Greater Cincinnati hospitals are continuing to provide an important safety net for those who need hospital care but are unable to pay for it. A study shows that 26 area hospitals provided more than $276 million in uncompensated care in 2008, a 15 percent increase over 2007 numbers.

Get the full story.

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4.) Reducing Uncompensated Care Costs for the Chronically Ill Through a Medical Home Approach: A Health System Case Study

Reducing Uncompensated Care Costs During this webinar, experts described how, with a small up-front investment, Baptist Health was able to manage its health system costs more effectively and provide care for chronic diseases in more appropriate settings. Youíll hear how Baptist stratified individuals for participation in their pilot, overcame challenges presented by patient distrust and engaged patients enrolled in the program. Youíll also learn about future plans for the program including how Baptist sees the program positioning itself for the future healthcare system.

Learn more about this resource.

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5.) Healthcare Business White Paper: The Moment of Force — Four New Ways to Favorably Leverage Healthcare Costs

By resting your financial lever on one of four new healthcare cost-saving fulcrums, you can reduce the burden of employee healthcare costs more easily and effectively than by brute force. In fact, the solution is less about muscle than it is about manipulating simple techniques to maximize employee health. Learn more about these cost-saving strategies in this white paper.

Download this complimentary white paper.

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6.) Reports Highlight State Gender Differences in Substance Use, Mental Health for Adolescents

SAMHSA has developed 52 new short reports providing key information about the level of substance use and mental health problems and treatment among adolescents (age 12 to 17 years) in each state, the District of Columbia and for the country as a whole. The reports provide first-of-a-kind, stateĖbyĖstate breakdowns by gender on substance abuse and mental health problems experienced by adolescents. In addition, the reports provide data on adolescent treatment facilities and admission factors for each state, the District of Columbia and for the country as a whole.

Get the full story.

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7.) Clinical Case Formulations: Matching the Integrative Treatment Plan to the Client

Clinical Case Formulations This innovative new guide addresses the essential question facing every therapist with a new client: How do I create a treatment plan that is the best match for my client? This unique resource provides a systematic method to integrate ideas, skills, and techniques from different theoretical approaches, empirical research, and clinical experience to create a case formulation that is tailor-made for the client.

Learn more about this resource.

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8.) New Standards Employed in Calculation of Improper Medicare Payment Rates for 2009

As part of the Obama administrationís goal of reducing waste, fraud and abuse in Medicare, HHS and CMS have significantly revised and improved its calculations of Medicare fee-for-service (FFS) error rates in 2009, reflecting a more complete accounting of Medicareís improper payments than in past years. These improvements will provide CMS with more complete information about errors so that the agency can better target improper payments.

Get the full story.

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9.) Medical Home Reimbursement Models: Funding Patient-Centered Care with Multi-Stakeholder Collaborations

Medical Home Reimbursement Models This report presents three ongoing medical home pilots built on a variety of reimbursement models. This 39-page special report provides an opportunity to evaluate three PCMH financial models and benefit from the experiences of multi-stakeholder collaborations. These case studies reflect early collaborations by Colorado, Ohio and New Hampshire providers, employers and public and private payors to build reimbursement structures that reward providers for care coordination and preventive efforts without adversely impacting healthcare costs.

Learn more about this resource.

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10.) FDA and Everyday Health Collaborate to Expand Reach of Consumer Health Information

The FDA and Everyday Health are collaborating to expand the delivery of the agencyís vital consumer health information to the 30 million unique users who visit Everyday Health each month. This joint effort reflects FDA's emphasis on using innovative, technology-based strategies to carry out its mission of protecting and promoting the public health.

Get the full story.

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11.) The Business Case for Web 2.0 in Healthcare: Building Brands and Redefining the Patient Experience

Business Case for Web 2.0 in Healthcare In this report, experts recount how strategic utilization of Web 2.0 tools is driving prospective patients to their Web sites and to their facilities in record numbers. Even recruiters are feeling the impact of these efforts. These experts also share their marketing and health IT successes and offer strategies for Web 2.0 adoption.

Learn more about this resource.

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12.) HealthSounds Podcast: Predicting Healthcare Reform's Biggest Losers and Winners

Predicting Healthcare Reform's Losers and Winners With the passage of the House healthcare reform bill and the Senate's version on the table, some industry experts worry that the nation may be so hung up on the public plan option that it's missing the gems buried in both versions. William DeMarco, president and CEO of DeMarco and Associates, and Jim Knutson, risk manager and human resources director for Aircraft Gear Corporation, predict reform's winners and losers as well as a delivery date for the much-debated package.

Listen to this podcast.

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