Healthcare News

Power Capital Consulting

Competitive and Business Intelligence Research & Analysis

Healthcare News

Healthcare News

Healthcare News
May 19, 2012 06:24AM

http://www.fiercehealthcare.com/feed

May 18, 2012 11:56AM

Fierce Q&A: MetroHealth gets patient-centric with outpatient care

As the industry shifts toward a patient-centered model, outpatient care is becoming more important to hospitals' missions and bottom lines. Hospitals across the country are increasingly investing in outpatient services, bringing cost-effective, patient-friendly and accessible care away from urban hospital campuses to local community settings.

One regional example of the trend is found in Ohio, where healthcare organizations have been seeing a growth in newly opened outpatient facilities and increased outpatient staff hiring this year. And less than two weeks ago, Cleveland's MetroHealth System broke ground on its newest suburban health center.

So FierceHealthcare caught up with MetroHealth's William R. Lewis (pictured), chairman of the market development campaign, leader of the network expansion initiative and chief of clinical cardiology at MetroHealth Medical Center, to talk about the system's expansion into outpatient care and how the new MetroHealth Middleburg Heights Health Center will work to provide quality care outside the main hospital walls.

FierceHealthcare: Why did MetroHealth decide to move primary and specialty care services out to the suburbs? What were the main factors in the outpatient planning process?

William Lewis: First of all, we believe this is the way healthcare is going to be delivered in the future. We need to deliver healthcare in the community because that's where patients are demanding healthcare be delivered. So while not everything can be delivered there--we're not going to do cardiac bypass surgery, for example--we want to provide those things that can be done in the community in the community. It's mostly because we are being patient-centric. Patients want care there, and that's what we're going to do.

Second, we believe this is an efficient way to provide healthcare. In a large hospital system, in a main campus-type hospital system, it's difficult to provide high-quality care efficiently. So the goal is to try to do that in the community.

The third thing that's really important about this is that MetroHealth has a narrow network healthcare plan (MetroHealth Select) that we have been offering to county employees, municipal employees and a variety of other entities. That plan involves the delivery of healthcare to its insured in Cuyahoga County, and we need to be convenient for individuals to whom were delivering the program. If we're going to offer companies a healthcare program like that, we're going to have to be present in the communities were their employees live. So we need to be in all parts of Cuyahoga County. So this building is really one of several that were looking to put in the county.

FH: How will the move benefit the health system and its patients?

Lewis: One of the things we've noticed is that MetroHealth is one of the best kept secrets in Cuyahoga County. We don't want it to be secret anymore; we would like people to know about all of the care we provide. Putting a building in a very visible location and having a specific design that will say to people "We are MetroHealth" will bring more patients into the MetroHealth system and let that secret out a little bit.

We believe patients will want to come to see our physicians there--they're faculty of Case Western Reserve University. They are outstanding physicians, and we've really kept them a secret from people in a variety of communities. So that's one advantage to both MetroHealth and patients.

Obviously, being in the community is an advantage to patients--it's very patient-centric. For example, if I'm seeing a dermatologist, I don't think I should have to go to a main campus to have my dermatological problems taken care of. I should be able to be seen by a physician in my community to provide that. If you're seeing a physical therapist three times a week, you really don't want to travel a long distance to do that. We would love to provide our care to our patients in their community. So we look at this as though we are the patient and we're figuring out. If we are the patient, what services would we want to have provided in our local community?

FH: What enables MetroHealth to deliver a range of healthcare services on an outpatient basis?

Lewis: There are three factors. One is the service needs to provided in ambulatory setting. For instance, we're not going to do major surgeries in the local communities. So the service has to be something that can practically be provided in the community.

The second thing is we have to have the physicians who are able to travel and be in those locations. We have high-quality physicians who are capable of providing care, and where they provide that care is really up to us. We decided as system that we're going to provide care in that location and those physicians are happy to oblige that.

The third thing is that you have to have the equipment needed to provide care. If I'm a cardiologist and a patient needs to have a stress test done, we need to be able to provide the stress testing equipment in that local area. We need to provide the range of imagine services, physical therapy and occupational therapy. We need to be able to provide all of those services to patients and there's equipment required to do that.

FH: What is MetroHealth's approach to running outpatient facilities? Does it use in-house management, partnerships with physicians, joint ventures?

Lewis: We're currently looking at options with respect to how we would staff those locations. Because we are a county institution, we are limited in terms of what we can do. But we're going to explore those opportunities to the fullest. There are a large number of physicians who want to partner with MetroHealth in the community to be able to provide care. Many of those physicians will want to be part of the MetroHealth system; many will want to partner with MetroHealth.

FH: Does the system have other plans to expand its outpatient presence?

Lewis: Absolutely. The first thing we need to do is expand our locations. We have done that with smaller facilities in the outreaches of Cuyahoga County where we have not really been in the past. We are now in the far western suburbs and the far eastern suburbs.

This building is replacing a very busy practice in Strongsville. So we are expanding, but we're doing it carefully by making these buildings an extension of programs that we already have in place in those locations. So we're not going to build this from scratch and say, "now we built this, let's fill it up." We're going to build the facility as a replacement for a practice that's already in place, and we began building those practices several years ago.

We also need to look at what we're doing in the inner potions of Cuyahoga County and make appropriate services available to them as well. So we're going to be looking to expand what we do in those locations too.

FH: As part of a larger shift toward outpatient care, how is MetroHealth dealing with increased competition from the dramatic growth in freestanding facilities and retail clinics?

Lewis: I think patients want to have their care delivered in a system. They want to know that this care is not just one-stop-shopping; it is going to be delivered as a part of their overall healthcare. Going to a doc-in-the-box, if you will, is not contiguous care with a primary care physician. It is care that's delivered on an interim basis and therefore the records are not stored in a singular location. There's no continuity of the physician care in those kinds of circumstances. Our proposal is to be able to provide that convenient care, but to do it as part of a continuous, collaborative relationship with a primary care physician.

FH: Are patients catching on to the trend of bringing care away from hospital campuses? How have they responded?

Lewis: Patients love this. They love to see a cardiologist in their community, they love to see specialists in their community and they like to see their primary care physician.

What people worry about in seeing physicians in their community is the quality of the care. They want to be sure that the quality of the care they're going to get is high.

MetroHealth has consistently provided and has been given awards for the type of quality care we provide. As I mentioned, our physicians are all faculty of Case Western Reserve University. Patients can walk into a MetroHealth facility with the confidence that the physician quality is going to be excellent. So I think that patients love to see their physicians in a location that is convenient, as long as they can be assured the quality is going to be high.

FH: What advice would you give to other healthcare organizations looking to use outpatient care to save money and improve access to care?

Lewis: They should look at the way healthcare is going to be delivered in several years, not the way it is delivered today. At MetroHealth, we're building for the future. And when you build for the future, you look and try to predict how healthcare is going to be delivered then. The old days of having monstrous hospitals and having patients come from all over the city or county to see you, those are going to be over very soon. And healthcare is going to need to be efficient, high-quality and also convenient for patients.

Editor's note: This interview has been edited for length and for clarity.

May 18, 2012 10:24AM

Nonprofit hospitals target increased spending on health IT

Most nonprofit hospitals plan to increase capital spending (45 percent) or stick to current spending levels (35 percent) over the next five years, according to new a Fitch Ratings survey. And the bulk of those growing investments will go towards health information technology.

Nonprofit hospitals rated health IT as 1.7 on a scale from 1 to 5 (the least important), as it would help them control costs, improve quality and adjust to new reimbursement models.

However, investment in inpatient facilities was considered the lowest priority (3.9), according to the ratings agency. In fact, 73 percent said their inpatient facilities and capacity are adequate for the next five years.

Amid the trend of healthcare consolidation, the survey also showed that nonprofit hospitals are teaming up with other healthcare organizations to better achieve strategic benefits like a wider range of operations and more diverse service offerings.

The ratings agency's findings are similar to a survey released earlier this month by Premier Inc., which found that most of the hospitals planning to increase capital spending this year are directing their biggest investments toward health IT and telecommunications.

For more:
- here's the Fitch statement
- check out the survey (registration required)

May 18, 2012 10:07AM

10 core measures to evaluate patient-centered medical homes

The success of patient-centered medical homes should be based on the two domains of outcomes--cost/utilization and clinical quality, independent research foundation Commonwealth Fund reported Wednesday.

With more than 90 commercial health plans, 42 states and three federal initiatives participating in medical homes, thousands of providers are experimenting with the model and offering a promising solution to primary and patient-centered care, the report explains. However, there are no standardized guidelines for how to measure the success of the new approach to care. Seventy-five researchers through the Commonwealth Fund PCMH Evaluators' Collaborative identified a core set of standardized measures to evaluate the patient-centered medical home.

The core measures look at utilization (measures for emergency department visits, acute inpatient admissions and readmissions within 30 days) and total costs per member per month, including high-risk patients. Focusing on preventive care, chronic disease management, acute care, overuse and safety, the adult quality measures include the following:

Adult weight screening and follow-up
Medication management with people with asthma
Breast cancer screening
Colorectal cancer screening
Cholesterol management for patients with cardiovascular conditions
Imaging use for low back pain
Pneumonia vaccination status for older patients
Annual monitoring for patients on persistent medications
Controlling high blood pressure
Comprehensive diabetes care

Many of the measures particularly focus on offering comprehensive care to diabetics, including hemoglobin testing, blood pressure control, eye exam and medical attention for nephropathy, among other measures.

For more information:
- read the Commonwealth Fund announcement and report (.pdf)

Related Articles:
Interview: Independence Blue Cross has big dreams for medical home model
Medical home beats P4P in quality improvement
Horizon medical home project cuts readmissions by 25%
6 best practices of patient-centered medical homes
Medical home cost savings questioned

May 18, 2012 09:43AM

Healthcare continues to face talent shortage

Healthcare has the most job openings for physicians in family medicine, emergency medicine and internal medicine, employers reported in the first quarter, according to healthcare recruiting firm HealtheCareers Network. While employers reported that doctor positions make up 45 percent of vacancies, nursing accounted for 20 percent. Five percent of job openings were for nurse practitioners and 6 percent were for physician assistants, the report states.

"The healthcare industry continues to endure a serious talent shortage that we expect to only grow should healthcare reform be signed into law and millions of newly insured Americans require care by qualified medical professionals," HealtheCareers CEO Mike Tansey said in an announcement yesterday. Report (registration required)

May 18, 2012 09:26AM

State medical boards disciplining more docs

State medical boards punished 6.8 percent more dangerous doctors last year, with disciplinary actions rising from 5,652 in 2010 to 6,034 actions in 2011, according to a new report from the Federation of State Medical Boards (FSMB).

The FSMB said the increased discipline likely stemmed from better training and accreditation of investigators, improved communication and reciprocity between states, and streamlined reporting between the National Practitioner Data Bank and various state physician licensing agencies, HealthLeaders Media reported.

But despite the uptick, a report from consumer watchdog Public Citizen noted that the state medical boards still are falling short on protecting patients from inferior care, thanks partly to shrinking state budgets.

While last year's rate of serious actions per 1,000 physicians (3.06) increased slightly from 2010, it is still significantly lower than the peak rate in 2004 of 3.72 serious actions, according to a Public Citizen statement yesterday.

The watchdog group also raised concerns that most states are underdisciplining physicians with less severe actions like fines and reprimands, as opposed revoking licenses for serious offenses.

Using FSMB data, Public Citizen found that South Carolina has done the worst job of disciplining doctors in the nation, only taking 1.33 serious actions per 1,000 physicians in 2011. Wyoming's board had the highest physician penalty rate, with 6.79 serious actions--five times as much as South Carolina.

"There's really no difference in the quality of doctors from state to state," Sidney Wolfe, director of Public Citizen's Health Research Group, told HealthLeaders. "What's different is the quality of the state medical boards," he said.

The watchdog group, in its report, recommends boards have high-quality leadership and conduct proactive investigations rather than react to complaints to efficiently protect patients.

To learn more:
- check out the FSMB report (.pdf)
- here's the Public Citizen report (.pdf) and statement
- read the HealthLeaders article

May 18, 2012 08:49AM

AHA, HFMA: Withdraw Schedule H in nonprofit reporting

New rules that change the way nonprofit hospitals report to the Internal Revenue Service are burdensome and do not comply with the law, said the American Hospital Association (AHA) and the Healthcare Financial Management Association (HFMA), who called for the withdrawal of Schedule H on Wednesday.

AHA and HFMA, which represent 5,000 health organizations and 39,000 executive members, respectively, argue that Part V of Schedule H does not comply with the Paperwork Reduction Act.

Schedule H requires health systems to issue separate reports for each hospital instead of a system-wide report, among other excessive documentation, national collaborative for nonprofit healthcare organizations VHA testified at Wednesday's House Ways and Means Committee Oversight Subcommittee hearing.

Part V, specifically, contains "redundancies, inconsistencies, onerous reporting requirements and undefined terms," AHA and HFMA said in the 20-page letter to the IRS, which details line-by-line recommendations.

AHA and HFMA said they were troubled with the inconsistent messages in the IRS' intent to comply with the Act. "[T]he actions of the IRS remain at odds with PRA compliance," they state.

While the Paper Reduction Act allows for 60 days of public comments, the IRS only allowed for five days, the trade groups said. They urged the IRS to withdraw Part V Schedule H completely or at least make it optional until the Office of Management and Budget approves it.

For more information:
- see the AHA letter (.pdf)
- here's the AHA News Now brief

Related Articles:
Tax-exempt reporting too burdensome, nonprofit hospitals say
Stress return on investment to maximize charity benefits
Reviews of nonprofit hospital tax breaks resume
Hospitals and state unlikely to reach charity tax-exempt deal
Hospitals ask OMB to revise 'onerous' tax form

May 17, 2012 11:12AM

Safety experts, celebrities want aviation-like agency to protect patients

Patient safety experts and celebrities are calling for an independent agency modeled after the National Transportation Safety Board (NTSB) to better protect patients, American Medical News reported.

Having an NTSB-type entity to look into medical errors and submit deidentified reports to physicians, hospitals and the public could improve safety and save lives and money, according to an article in the Journal of Patient Safety co-authored by Charles R. Denham, founder and chairman of the Texas Medical Institute of Technology; US Airways Flight 1549 pilot Chesley B. "Sully" Sullenberger; actor Dennis Quaid; and aviation safety expert John J. Nance.

The agency would directly link accident investigation and preventive action, as NTSB "Blue Cover Reports" of aviation problems usually lead to direct changes in federal regulations, airline policies and in the cockpit, noted amednews.

A similar approach would not only curb medical harm but also the associated healthcare costs. For example, healthcare losses are equivalent to 20 Boeing 757 planes crashing each week, with $10 million in each cargo hold, according to the article research announcement.

Yet critics note that accident reports in healthcare significantly outnumber those in aviation, making it hard to duplicate the NTSB's success. "Some aspects of safety in health care … are fundamentally different," HHS Agency for Healthcare Research and Quality Director Carolyn Clancy told amednews.

However, the concept reinforces a Commonwealth Fund-supported study last year that identified 15 aviation safety measures not regularly used in healthcare that could improve the quality of care and save lives. They included the "sterile cockpit rule," which reduces unnecessary distractions during critical activities, and the "first-name-only rule," which promotes a work environment where healthcare workers feel comfortable questioning one another.

To learn more:
- read the amednews article
- here's the Journal of Patient Safety article
- check out the research announcement

May 17, 2012 10:25AM

Tax-exempt reporting too burdensome, nonprofit hospitals say

The Internal Revenue Service guidance, particularly the Schedule H amendment, on reporting for tax-exempt organizations is too burdensome and overly prescriptive, the national collaborative for nonprofit healthcare organizations VHA testified at yesterday's House Ways and Means Committee Oversight Subcommittee hearing.

Among other nonprofit issues, Ways and Means looked at reporting requirements for tax-exempt hospitals. VHA urged Congress not to go beyond the original intent and to work with charitable hospitals to reduce governmental burden.

Under the Patient Protection and Affordable Care Act, Schedule H mandates a community health needs assessment every three years and requires health systems to issue separate reports for each hospital instead of a system-wide report, among other excessive documentation, according to VHA.

"Even tax-exempt organizations spend millions of dollars to comply with IRS documentation and filing requirements. It's imperative to find that 'sweet spot' where the IRS can effectively perform its important oversight function while not requiring unnecessary paperwork," Michael Regier, senior vice president of legal and corporate affairs, general counsel and compliance officer for VHA Inc., said in a statement.

Both sides of the aisle agree that oversight for tax-exempt entities require greater attention, Ways and Means Chairman Charles W. Boustany Jr., M.D. (R-La.) explained yesterday, to avoid giving non-qualifying organizations a free pass on taxes. As of 2008, 1.85 million organizations qualified for tax-exempt status, and 1.18 million qualified as charitable organizations under section 501(c)(3); they had $2.5 trillion in assets. The goal is "to ensure that the tax-exempt sector is operating in an efficient manner and that the laws governing tax-exempt organizations are being applied fairly and evenly," Boustany said.

The American Hospital Association in its April report found that nonprofit hospitals put an average of 11.3 percent of their total spending toward community benefits, including free care, community health improvement programs and subsidized services.

For more information:
- see the hearing announcement
- see the announcement from VHA

Related Articles:
Stress return on investment to maximize charity benefits
Reviews of nonprofit hospital tax breaks resume
Hospitals and state unlikely to reach charity tax-exempt deal
Hospitals ask OMB to revise 'onerous' tax form
Hospitals reveal community benefits to discount tax-exemption critics
Hospitals praise IRS reporting of charity care

May 17, 2012 10:24AM

M&As: Reform uncertainty means proceed with caution

Healthcare mergers and acquisitions are active, but healthcare executives also are cautious with uncertainty surrounding health reform and national healthcare policy discussions, according to analysts at the Nashville Health Care Council on Tuesday.

Despite the caution, the analysts expect a lot of healthcare M&A activity involving private equity firms, healthcare IT companies and telemedicine, HealthcareFinanceNews reported.

"Opportunities for mergers and acquisitions are ripe as the healthcare industry changes to react to price pressure, payment reform and the need for new capabilities," J.P. Morgan Managing Director Ravi Sachdev told the audience. "Considering these factors, the growth in hospital M&A is not surprising, given the need for facilities to be more efficient in the face of anticipated reimbursement cuts and, of course, reform."

The analysts also cited innovation and creativity as ways to overcome challenging market conditions to hospital mergers and acquisitions.

Their outlook echoed sentiments from Sanford Steever, editor of "The Health Care M&A Report" by research publisher Irving Levin Associates, who said last month that the M&A market for healthcare is alive and thriving. However, Steever noted that increased scrutiny from the Federal Trade Commission could make hospitals more wary of deal making, FierceHealthcare previously reported.

For more:
- here's the NHCC news announcement
- read the HealthcareFinanceNews article

May 17, 2012 09:50AM

Hospitals get better insurer rates than docs

Hospitals and outpatient care centers have been more successful at bargaining for higher rates from employer-sponsored preferred provider organization (PPO) health plans than physicians so far this year, according to the 2012 Milliman Medical Index.

Analysts at Seattle-based Milliman Inc. examined the cost of inpatient hospitalization, outpatient care, professional services and pharmacy services, and concluded that some providers are seeing higher rates from PPOs than others, according to LifeHealthPro.

For instance, hospitals costs have gone up 7.6 percent since 2011, and outpatient care costs are up 8.6 percent, the analysts found. Physician costs, however, rose only 5 percent.

Moreover, the size of hospitals and services they provide also factor into negotiated rates with insurers. A study in this month's Health Affairs found that hospital systems are using their large size and market clout to demand hefty payment rates from insurers. The study also noted that hospitals offering specialized or unique services have increased market clout and can leverage higher prices, FierceHealthcare previously reported.

Meanwhile, to help patients choose lower-cost providers, insurers are using new tools to show the rates negotiated for hospitals and physicians, as well as the projected out-of-pock costs for patients based on their health plans, reported American Medical News.

To learn more:
- here's the index (.pdf)
- read amednews article