Posts in Category: value-based purchasing

Parts of Obama's Healthcare Legacy Will Likely Continue Under Trump 

President-elect cites popular provisions he'd like to keep

As the dust settles after the presidential election, it appears that Donald Trump is already softening some of his positions, especially his position on Obamacare. Media outlets have speculated that President Obama pushed hard for the continuance of his signature healthcare program when he met with Trump at the White House following the election.

During the presidential campaign, Trump disparaged the Affordable Care Act and called for its repeal, although he didn't spell out what he would put in its place. A wholesale repeal of the ACA could leave as many as 22 million people without health insurance--a prospect that industry insiders consider unlikely.

Healthcare attorney Michael P. Strazzella told FierceHealthcare that Trump will focus on the ACA on the first day of his presidency, but that he doesn't expect anything dramatic to happen immediately. (Strazzella is co-head of Buchanan, Ingersoll & Rooney's District of Columbia office.)

"Repeal is good campaign language, but it's a 2,000-plus page bill and not everything can be repealed," Strazzella pointed out. To actually repeal all of Obamacare would require a 60-vote Senate supermajority, which Trump could not get unless some Democrats crossed party lines.
Other factors to consider:

  • The Republican Party is far from united under Trump, whom some GOP leaders have distanced themselves from, so the new president may not be able to count on the party's backing his every move.
  • Republicans may be wary of taking away well-liked provisions of Obamacare, especially if that doesn't play well with their constituencies.
  • The ACA's mandate that patients must not be denied coverage due to pre-existing conditions is very popular with voters, as is the act's provision for young people to be kept on their parents' insurance plans till age 26.*

What other aspects of healthcare might change under the Trump presidency? The future of pilot programs such as the Accountable Care Organizations under the Medicare Shared Savings Programs--like so many other Obama administration healthcare provisions--is murky. But many in the healthcare industry maintain that value-based care is here to stay. 

The credit ratings and research company Fitch Ratings issued this prediction: "The shift toward linking pricing to patient outcomes will continue as patients and health insurers grapple with the growing burden of healthcare costs over the longer term." 

*UPDATE: Trump recently told "60 Minutes" that he is in favor of keeping at least two provisions of Obamacare: the requirement that insurance companies accept patients with pre-existing conditions, and the provision that allows young adults to stay on their parents' health insurance plans until they reach the age of 26. He also signaled that he would not end Obamacare without having some other program in place.

Will the election of Trump impact your organization? Share your thoughts in our comment section below.

Spotlight on Analytics, Part 5 

Q & A with Gus Gilbertson, Product Manager for LUMEDX

Predictive Analytics

Q: How much of the healthcare industry has adopted predictive analytics?

A: By definition, negotiations between providers and payers are a game of who can better predict patient outcomes. Win-win scenarios can certainly be devised, but a lack of predictive ability puts an organization at risk for poor contract structuring.

Clinical outcomes are increasingly a game of predicting outcomes and identifying the levers that affect those outcomes so providers are able to improve on future outcomes. Operational predictions are also important, as misunderstanding patient care needs can lead to expensive outlier care patterns or care variations that break capacity management efforts and budgets.

Q: How do you see predictive analytics having an impact on healthcare organizations, and specifically on heart hospitals?

A: Outcome prediction and risk profiling will increasingly guide care pathway selection and tailor care patterns to targeted patient profiles. Predicting and applying the care pathway that leads to the best health outcome at the lowest cost is the foundation of healthcare in the value-based purchasing era.

The dynamics of heart health are increasingly being researched and documented, leading to continued technical evolution and improved outcomes. Being able to predict which technology will lead to the best patient outcomes per dollar spent--whether it be a TVR, and VAD, or an aspirin—is a crucial skill for providers.

Q: What is the role of predictive analytics in affecting areas like heart failure readmissions?

A: Estimates continue to suggest that as much as 20 percent or more of care is wasted. Access to predictive models for identifying patients at risk for readmissions--and providing better targeted treatment up front--are the keys to reducing readmission. Those who best understand their care pathways and patient risk profiles will be the ones who can provide the best value in heart failure care. They will be the ones who can best explain the risk factors inherent in their readmission outcomes to stakeholders from patients to community groups and regulators.

Stay tuned for Part 6 of this series!

 

The Best of Cardio and Health IT News: 4/14/16 

News stories you won't want to miss!

Higher patient ratings equal fewer readmissions, lower mortality

The scores patients assign their hospitals appear to correspond with the quality of the hospitals' patient outcomes, according to a study published in JAMA Internal Medicine. Researchers analyzed the scores patients assigned to the Centers for Medicare & Medicaid Services' star-rating system for more than 3,000 hospitals. Hospitals' star ratings were inversely proportional to their rates of death within a month of discharge. 

Hospitals reap $1.6M from specialists, including cardiologists

While the average primary care physician is generating less income for hospitals ($1.4 million in 2016 versus $1.56 million in 2013), that’s offset by specialist doctors, whose contribution to hospital revenues jumped 14% to $1.6 million, compared with $1.42 million three years ago. Among specialists, orthopedic physicians bring in the most business ($2.75 million each), followed by invasive cardiologists ($2.45 million) and neurosurgeons ($2.44 million.

5 ways make employees happy in a healthcare workplace

Healthcare organizations named to Fortune's 20 Best Workplaces in Health Care share a sense of camaraderie and pride in their work, and offer lessons to other hospitals and systems that strive to create a positive work environment that can attract and retain the best talent. The winning organizations overcame the natural hierarchy of a healthcare organization to create a friendly, emotionally supportive workplace where coworkers feel as though everyone is equal and they can count on coworkers to support them.

Heart, vascular department at Aurora St. Luke’s receives top accreditations

Building on its rich history as the premier heart hospital in Wisconsin and a global destination for heart care, Aurora St. Luke’s Medical Center has received two prestigious accolades from the Accreditation for Cardiovascular Excellence (ACE). Both acknowledgments from ACE reinforce Aurora St. Luke’s positioning as a global leader in cardiovascular excellence.

Momentum building for national unique patient IDs

As digitization of the healthcare system increases, issues around data exchange and medical records exchange make patient identification more challenging than ever. In the absence of a unique patient identifier system, doctors use a patient’s name and birth dates to identify them, and there can be hundreds or thousands of identical or similar names and dates in EMR systems. Get it wrong, and a diagnosis or treatment may be missed — sometimes with dire consequences.

The Best of Cardio and Health IT News: Week of 3/7/16 

Readmissions, Obamacare, and more

CMS targets hospital readmissions after CABG 

A proposed rule from the Centers for Medicare & Medicaid Services (CMS) would penalize hospitals that perform an index coronary artery bypass graft (CABG) and then have an unexpected 30-day readmission, even if the patient was discharged from a different hospital. "The proposed CABG 30-day readmission measure includes Medicare beneficiaries who are 65 years old or older who at the time of the index admission had been enrolled in a Medicare fee-for-service program for at least 12 months," Cardiovascular Business reports. "CMS intends to add CABG to its readmissions reduction program in 2017."

Most support keeping, building on Obamacare

The Affordable Care Act (Obamacare) continues to have public support, with 36 percent of those surveyed saying it should be expanded, according to the latest Kaiser Health Tracking Poll. That's the position advocated by presidential candidate and former Secretary of State Hillary Clinton. Nearly a quarter of respondents would like to see a single government plan, as advocated by Vermont Sen. Bernie Sanders, while 16 percent would repeal the ACA and not replace it. Repealing the act and replacing it with a Republican alternative was favored by 13% of respondents.

Analysis: U.S. health spending wouldn't be substantially decreased by price transparency

"Menu-izing the costs of care doesn’t turn the average American into a skilled healthcare shopper, but don’t blame the consumer," says Health Exec. "While some 43 percent of U.S. healthcare spending does indeed go into 'shoppable,' non-emergent care—everything from flu shots and blood tests to colonoscopies and electively timed surgeries—only around 7 percent of out-of-pocket spending goes to such services. The result, according to a new analysis from the Health Care Cost Institute, is that the healthcare system as a whole wrings little cost benefit out of the push for price transparency."

Cardiovascular risk increases with heavy alcohol consumption

Drinking alcohol is associated with higher cardiovascular risk immediately after consumption, according to systematic review and meta-analysis. "After 24 hours, there was a lower risk for moderate drinkers," Cardiovascular Business reports. "But the risk increased in heavy drinkers for the following day and week."

Major markets could see mega-regional healthcare systems

Consolidation is a trend expected to continue in the healthcare industry, according to Fierce Healthcare. The trend, with increased leverage and revenues, has led to the creation of super-regional system in several large markets. "In Chicago, consolidation reached a crescendo in 2014 when fully integrated health system Northwestern Memorial HealthCare and Winfield, Illinois' Cadence Health finalized a merger, with Northwestern expanding to include four hospitals under the deal," reported Becker's Hospital Review. Since then, Northwestern has expanded its reach, finalizing a deal with KishHealth in Dekalb, Illinois. The system now boasts six hospitals and more than 4,000 workers.

The Best of Cardio and Health IT News: Week of 2/15/16 

Don't miss out on this week's top stories


CMS and health insurers announce alignment and simplification of quality measures

The Centers for Medicare & Medicaid Services (CMS) and America's Health Insurance Plans (the health plans' trade group)  announced that they have agreed on seven sets of clinical quality measuresThe standardized measures are designed to help payers and consumers shopping for high-quality care. "These measures support multi-payer alignment, for the first time, on core measures primarily for physician quality programs," according to the CMS. This work is informing the CMS’s implementation of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA).

Supreme Court: What will happen to healthcare cases after Justice Scalia's death?

A number of healthcare-related cases are in limbo following the death of conservative U.S. Supreme Court Justice Antonin Scalia, who died on Feb. 12. "The court is weighing a case about data sharing with potential implications for insurers and state healthcare reform efforts," Modern Healthcare reports. "Another case has the potential to reduce—or increase—the number of False Claims Act suits brought against healthcare providers and other companies." Also before the court is a case involving the contraception mandate in the Affordable Care Act. 

CMS anticipates giving out $7.7 billion in ACA reinsurance payouts

Healthcare insurance companies could receive as much as $7.7 billion as part of the Affordable Care Act's reinsurance program. Reflecting data from the 2015 benefit year, the payouts are to be issued this year. "The Affordable Care Act created the temporary, three-year reinsurance program to protect insurers during the early years of the new individual marketplaces," according to Modern Healthcare"Insurers pay into the reinsurance pool, and those funds are then paid out to health plans that had members with extremely high medical claims." 

Still stalled: Federal healthcare rule that ties Medicare, Medicaid payments to disaster-preparedness plans

A proposed federal rule that would require healthcare facilities and hospitals to create emergency-preparedness plans in order to receive Medicare and Medicaid funding is stalled in the Office of Management and Budget, undergoing a legally required review. It would affect more than 68,000 providers, according to a New York Times news analysis."Industry groups have been critical of the time and expense they said would be involved in steps such as test backup power generators more frequently and for longer periods, or to pay staff overtime during drills," according to FierceHealthcare.com.

Harvard researchers say PCI readmission metric could be model

A model for improving the quality and value of cardiology care may be found in a pilot program from the Centers for Medicare and Medicaid Services and the National Cardiovascular Data Registry (NCDR), according to Harvard researchers. The program evaluated and reported risk-adjusted 30-day readmission rates after PCI. "The researchers noted that preventing readmissions could improve the quality of care and reduce costs for cardiology patients," according to CardiovascularBusiness.com.

 

The Best of HealthIT News: Week of 2/8/16  

Population health, Obamacare, and cost containment

Did you have a chance to check out the latest news from the healthIT community? Let us help keep you up to date on the stories you won't want to miss.

Companies Form New Alliance to Target Healthcare Costs

Hoping to hold down the cost of healthcare benefits, 20 large companies—including American Express, Macy’s  and Verizon—have come together to use their collective data and market power. Members of the new alliance will share data about employee healthcare spending and outcomes, possibly using the data to change how they contract for care. "Some members say they could even form a purchasing cooperative to negotiate for lower prices, or try to change their relationships with insurance administrators and drug-benefit managers," Yahoo news reports.

Federal Insurance Marketplace Signs Up Millions of New Obamacare Users

The Obama administration reports that approximately 12.7 million new patients signed up for health insurance under the Affordable Care Act, or automatically renewed their policies during Obamacare's third annual open enrollment season. Sylvia Mathews Burwell, the secretary of the Department of Health and Human Services, told the New York Times that the signups show that “marketplace coverage is a product people want and need.” Most of the plan selections were for people in the 38 states—more than 9.6 million—who used the federal website, HealthCare.gov, the Times reported. The other 3.1 million people were enrolled in states that run their own marketplaces.

Healthcare Economics: Court Allows Some Hospitals to Save Money by Classifying Themselves as Both Rural and Urban

While an earlier Health and Human Services (HHS) rule had barred both urban and rural classifications at once, a new federal appeals court ruling removed the barrier for dual hospital classification. The recent court decision applies only to hospitals within the 2nd U.S. Circuit Court of Appeals, but some hope that—combined with an earlier similar decision in a different circuit—the 2nd Circuit Court's ruling will inspire HHS to change the regulation across the country. "The Center for Medicare & Medicaid Services allows hospitals to classify themselves as rural (which providers typically leverage for discounts on drug purchases) while also classifying themselves as urban, (an important factor to attract qualified clinicians)," according to Reuters. 

Population Health: Hospital-based Wellness Centers Are Changing the Healthcare Model

Wellness centers housed in hospitals are helping communities prioritize preventive care and management of chronic conditions. The centers are part of the population health management model that focuses on preventing illnesses rather than simply treating them when and if they occur. The idea is to get patients to seek treatment before their conditions worsen, thus easing the burden on emergency rooms and acute care centers—and saving money.

Cost Control: Surgical Safety Checklists Can Save Lives and Reduce Hospital Stays

Surgical safety checklists—if implemented correctly—can save time, lives, and money. After the checklists were implemented, one study found, the average length of a hospital stay dropped from 10.4 days to 9.6 days. In addition, the checklists led to a 27 percent drop in the risk of death following surgery. Proper and consistent implementation is critical, however, for the checklists to work.

The Best of Cardio and Healthcare News for the Week of 1/4/16 

Did you have a chance to check out the latest news from the cardiology and healthIT communities? Let us help keep you up to date on the stories you won't want to miss.

2016 may bring slower patient growth, higher wages, more expensive drugs

Late 2015 data support health systems' anticipation that the demand surge from patients newly insured under the Affordable Care Act would fade this year. Economists with the Altarum Institute say spending acceleration from the coverage expansion may have peaked last February. 

FDA clears Biotronik's peripheral stent 

The FDA has cleared Biotronik's Astron Peripheral Self-Expanding Nitinol Stent System, a device for improving luminal diameter in patients with iliac atherosclerotic lesions. The stent system is described as a self-expanding stent loaded on an over-the-wire delivery system. 

Patients increasingly turning to mobile health apps

More than 30 percent of consumers last year said they have at least one health app on their smartphones, and 60 percent are willing to have a video visit with a doctor through a mobile device, according to an online survey of 1,000 U.S. adults. An increased use of telehealth apps is one of the predictions for 2016 from the PwC Health Research Institute.

Diagnostic errors, measuring performance among top healthcare quality issues for New Year

Zeroing in on individual doctor performance, reducing diagnostic errors, standardizing performance measures, and rethinking the patient experience may be among the top agenda items for healthcare quality and safety leaders this year. There could also be a greater focus on individual doctor performance as it relates to value-based payment and quality reporting.

Family satisfaction increases when ICUs relax their visiting hours

A survey published in the American Journal of Critical Care shows patients benefit when families visit throughout the day and night. "These findings support open and patient-centered visitation guidelines in critical care settings," the researchers wrote.
 

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