Payers & Providers Midwest Edition – Issue of May 1, 2012

8/2/2019 Payers & Providers Midwest Edition Issue of May 1, 2012

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At a National Governors Association meetingin February, a handful of state leaders spokeabout a common effort to curb healthcarecosts and improve public health.

One of these programs is being piloted inIowa. Called the Healthiest State initiative,the goal is to move the state from its currentposition at number 19 on the Gallup-Healthways Well-Being Index to number oneby 2016. In doing this, state leaders hope tosave $16 billion in healthcare and lostproductivity costs over the next ve years.

The endeavor is privately led and publiclysupported. Partners in the program includeWellmark Blue Cross Blue Shield, which isproviding $25 million in funding, Hy-Vee Inc.and the Iowa Sports Foundation. The goal ofthe initiative is to highlight the current efforts

by these and other groups and make themreplicable across the state.

We have nutrition, tness, healthpromotion and prevention all of these thingsare going on throughout the state but arefragmented, said Mariannette Miller-Meeks,M.D., director of the Iowa Department ofPublic Health. Putting this under theumbrella of Healthiest State really tries tobring the focus on everything that is going onand develop alignment and synergy andintegration.

Miller-Meeks said there is going to be a centralocation where information is pooled onvarious health goings on like triathlons,prevention activities and what communities

are doing in the area of public health.We have been nding out things that are

going on that we didnt even know werehappening, she said. We want to embrace it,acknowledge it and let others know they canadopt it.

One of the cornerstones of the initiative isthe creation of Blue Zone communities. BlueZones came from the concept ofDanBuettner who teamed up in 2004 withNational Geographic to identify areas aroundthe world where people were living healthier,longer lives.

The original Blue Zone cities were

identied as Okinawa, Japan, Nicoya, CostaRica and Ikaria, Greece. Some of the thingsthat Buettner identied that create healthycities is movement not working out, butwalking and things like yard work positiveoutlooks, shedding stress, eating wisely andconnecting with loved ones and people whobring a positive inuence.

The three Blue Zone cities are allcommunities larger than 50,000 people. Inorder to replicate the concept, they have

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In Brief

AAHC ExpandsAccreditation Program

The trend of primary care practicesand ambulatory care settings beingpurchased by hospitals and healthsystems has spurred theAccreditation Association forAmbulatory Health Care to create anew accreditation program.

The program will focus onsmall hospitals in rural, urban andsuburban areas across the country.It will be offered through theAccreditation Association forHospital/Health Systems Inc. A pilotprogram will be launched this year.

The focus of the program willbe to evaluate hospitals usingspecific standards of care; offer aneducational, consultative program;help develop hospital staff skills;offer best-practice-basedopportunities for qualityimprovement; and use an on-sitesurvey by hospital leaders.

The movement to accountablecare organizations and other recenttrends have led to more healthsystems reabsorbing primary carephysicians and free-standingambulatory care settings back intothe hospital, said AAAHCPresident John Burke in astatement. With our experience asthe leader in ambulatory careaccreditation, AAAHC saw anopportunity to improve patient careby offering a program thataddresses both outpatient andinpatient hospital care and theambulatory care offered by smallhospital systems.

ICD-10 ComplianceDate Set

The U.S. Department of Health andHuman Services has set October 1,

Continued on Page 3

NEWS

Healthiest State (Continued from Page One)

scaled it back somewhat. Half of thecommunities in Iowa are have fewer than10,000 people, said Courtney Greene, public

relations manager for Wellmark Blue CrossBlue Shield.Overall there will be 10 pilot

communities which will work in schools,businesses, restaurants and the community asa whole to create campaigns to increasephysical activity, improve employee wellnessand change restaurant menus.

Greene said this is the rst time the BlueZone concept has been utilized on a statewidelevel.

Initially Wellmark received 84 statementsof interest from cities; that was narrowed to 54that applied for the project. In the next week

or so, the rst four pilot cities will beannounced.

Greene said the money Wellmark isinvesting is going to be used to helpcommunity leaders plan how to best impro

their built environments. They will work wvolunteer coordinators to determine if theywant to build parks, increase green spaceswalking paths or community gardens.Demonstration communities will create ablueprint and each community will havevolunteers and some staff to help keep itmoving and focused and on target, she saOne small example of a change they havealready performed is working with restaurato improve their menus. One restaurantchanged its menu from a three-egg omelethuge side of hash browns to a smaller omewith a default side dish of fruit.

The level of excitement has exceededeveryones expectations, Greene said.

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Creighton University is leaving the hospitalbusiness. Alegent Health is purchasing St.Joseph Hospital, of which the university has a26% stake; the rest is held by Dallas-basedTenet Healthcare Corp.

Alegent Health, part ofCatholic HealthInitiatives, has signed a deal expected to closeJuly 1. It will purchase the limited liabilitycompany that has operated the 334-bedhospital since 1995.

Creighton and Alegent, both based inOmaha, Neb., will contribution to a strategicinvestment fund and Alegent will make annualnancial contributions to CreightonUniversitys health sciences schools.

Creighton will continue to manage

academic components. Alegent will be theprimary teaching site for the universitys hesciences schools and will take over CreighMedical Associates, a physician group.

All three parties boards must approvedeal and due diligence will be performedbefore the transaction is nalized.

As Omaha has evolved and changedover time, we nd ourselves faced with machallenges that are impacting healthcare aacademic organizations across the countrysaid Gary Honts, president and CEO ofCreighton University Medical Center, in astatement. For this hospital and our patiethe best course of action is to become partan integrated regional system, and we beliAlegent is the right partner.

Creighton Exits The Hospital BusinessAlegent to Purchase Its Omaha Teaching Facility
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NEWS

In Brief

2014 as the deadline forcompliance to ICD-10.

The department changed theprevious deadline of October 1,2013 in order to allow ample timefor physicians, insurers and othercovered entities to prepare for thechange. The new system expands

the number of codes used from14,000 to almost 69,000.According to the Medical

Group Management Association,small practices will likely spendabout $83,000; medium groups$285,000; and large practices $2.7million to comply with themandate. HHS estimates that thechange from ICD-9 to ICD-10 willsave health care providers andhealth plans up to $4.6 billion overthe next decade.

Healthcare Mergers UpIn First Quarter

Healthcare mergers accumulatedconsiderable momentum during therst quarter of 2012, according to anew report by Connecticut-basedM&A tracking rm Irving LevinAssociates.

Altogether, 153 deals occurredduring the rst quarter of the year, up14% from the rst quarter of 2011,when 134 were consummated. Long-term care facilities had the mosttransactions with 39, although thatnumber was unchanged from the year-ago quarter. A total of 23 deals werereported in the hospital sector,compared to 22 during the rst

quarter of 2011. Home healthcarereported 11 deals, nearly double thesix reported during the rst quarter of2011.

Quarter over quarter, thevolume of healthcare M&A dealskeeps increasing as both strategic andnancial buyers invest more of theircapital in the various sectors ofhealthcare, said Sanford Steever, anIrving Levin editor. Despite rumors ofits demise in the general media, theM&A market for healthcare is aliveand thriving.

The American Lung Associations State of theAir Report in 2012 found that while energyconsumption, the population and miles drivenby Americans have increased, the air hasgotten cleaner.

Since 2001, ozone levels are 13% lower,year-round particles are 24% lower and short-term pollution is 28% lower. But while air

quality has improved, more than 127 millionpeople (almost half of the nation) still live inareas where pollution levels are too dangerousto breathe.

Some of the key ndings of the reportinclude that 38% of Americans live in areaswith unhealthful levels of ozone. Countieswith F grades for ozone levels house almost116 million people. This air quality placesthese individuals at risk for decreased lungfunction, respiratory infection, lunginammation and aggravation of respiratoryillness. The number of Americans living incounties that had too many unhealthy spikes

in particle pollution has decreased over timOver 5.7 million people live in six countieswith unhealthful levels of ozone, short- andlong-term particle pollution.

The report also found that nearly 2.5million U.S. children and 7.4 million adultswith asthma live in areas with very high levof ozone. More than 3.7 million people wit

chronic bronchitis and 1.6 million withemphysema live with unhealthy ozone leveAnd more than 11.6 million people withcardiovascular disease live where there areunhealthful levels of short-term particlepollution.

The cleanest cities for ozone andpollution include: Bismarck, ND; Duluth,Minn.; Honolulu, HI; Port S. Lucie, Fla.; andRapid City, SD.

Cities ranked cleanest for ozone andshort-term pollution are: Brownsville, TexasChampaign-Urbana, Ill.; Decatur, Ill.; andFlorence-Muscle Shoals, Ala.

ALA Releases Its Clean Air ReportDespite Improvements, Many Remain In Danger

GAO Slams Demonstration ProjectRecommends Ending Plan For Medicare Bonuses

The Government Accountability Ofce hasrecommended that the largest Medicaredemonstration project created since 1995 bescrapped.

The MA Quality Bonus PaymentDemonstration is expected to cost $8.35billion over a decade. The project is meant totest if a scaled Medicare bonus structureresults in better quality improvement than thebonus payments planned in the AffordableCare Act.

The GAO reviewed the design of thedemonstration (upon request by Congress),looking at cost estimates, if it is budgetneutral, how it compares with otherdemonstrations, and if it will achieve its goal.

The demonstration, which is scheduled torun from 2012 to 2014, will consist of a setbonus structure for high performing physiciansnationwide. Compared to the ACA, the projectwill extend bonuses to Advantage plans withthree-star ratings, has larger bonuses andaccelerates bonuses for plans with four ormore stars.

When examining the project, the GAOfound that, in 2014, plans with four and fourand-a-half stars will receive the same bonuses

as ve-star plans. Also that a majority of the$8.35 billion will go to plans in the middle those with three or three and-a-half stars.

The GAO also found that thedemonstration payments do not consistentlyoffer better incentives to achieve higherratings. That the plan does not have acomparison group to adequately measure iteffectiveness. And nally, thought thedemonstration is expected to generateMedicare savings, the GAO does not expecto be budget neutral.

The Medicare Advantage benchmarks amore closely aligned with fee-for-servicespending, according to the GAO. Thebenchmarks are scheduled to phase in from2012 to 2017 and would reduce payments plans by $145 billion over nine years.

The GAO recommended that HHS cancthe demonstration project and allow theAffordable Care Act to take effect.If, at a future date, the Secretary nds thatthis system does not adequately promotequality improvement, HHS should determinways to modify the system, which couldinclude conducting an appropriately designdemonstration, the GAO said in its report.


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Payers & Providers Page

Id never consider trying a new restaurant orhotel without reading the on-line ratings ofTripAdvisor or Yelp. I seldom even bother withprofessional restaurant or travel critics.Until recently, there was little patient-generatedinformation about doctors, practices orhospitals to help inform patientdecisions. But that is rapidlychanging, and the results may beevery bit as transformative asthey have been in traditionallyconsumer-centric industries likehospitality.

Even if one embraces the

value of listening to the patient,several questions arise. Shouldwe care about the patients voicebecause of its inherent value, orbecause it can tell us somethingimportant about otherdimensions of quality? How bestshould patient judgments becollected and disseminated through formal surveys or thatelectronic scrum known as theInternet? And what are some of theunanticipated or negative consequences ofmeasuring patient satisfaction and experience?

All of these questions are being debatedactively.

For the past few years, Medicare has beenadministering the Hospital ConsumerAssessment of Healthcare Providers andSystems survey to a random sample of300-1,000 patients discharged from every U.S.hospital. Results are now posted on MedicaresHospital Compare website. Starting in late2012, hospital payments will be at risk as partof Medicares pay-for-performance program,known as Value-based Purchasing.When I lecture about VBP, I often ask audienceswhat weights they believe should be given to

clinical quality data vs. HCAHPS survey results.Physicians invariably give answers like 80-20 or90-10. Ive even heard some say 100-0 thepatients voice should carry no weight.Medicare has chosen a 70-30 ratio. Fully 30%of a hospitals bonus or cut under VBP willbe determined by patient survey responses. Fora large hospital like mine, our score on a singleitem (rate the quality of nursecommunication) could be worth over $60,000a year.

The knowledge that patient experience

scores now carry real weight has providedtangible focus to efforts to promote patient-centeredness.

For example, UCSF Medical Center now employees bonuses based on patient satisfactscores and these scores have improved

markedly since this practice begaOn my own medical service, thpatient satisfaction committee nscours our results and has launca program to observe ourphysicians as they interact withpatients, then provide feedbackThere is even a communication

checklist that offers something script, with items such as KnocAsk (Hi, is it ok if I come in),Concerns (Id like to review a fthings with you, but rst, is theanything youd like to be sure wtalk about today?) and CheckUnderstanding (To be sure Ivebeen clear, can you just repeatback to me your understandingthe plan?).

While the idea of scripting can seem inauthenit can be extremely useful. I now use a script omy own when introducing myself to a

hospitalized patient.Since many patients and families still don

quite understand what a hospitalist is or doesoften say something like, You may get a surveafter you leave, asking did you have any sensthat someone was in charge of your care in thhospital. I hope youll answer yes, because thprecisely my job to be your orchestra condwhile youre here. Patients seem to get it.As we work our way through this new world opatient surveys and ratings, there will be somhazards to overcome and some unfair results contend with. Well need to anticipate theseproblems and mitigate them, and to try to brin

some order to a chaotic marketplace. These selike surmountable issues, and I am condent the outcome of capturing the patients voice agiving it some real weight is better care.

OPINION

Keeping Score On Patient RatingsDespite Provider Misgivings, They Carry More Weigh

Robert Wachter, M.D, is the associate chairm

of the department of medicine at the Univer

of California at San Francisco.

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By

Robert Wachter, M.D.

Op-ed submissions of up to 600 words are

welcomed. Please e-mail proposals to

[email protected]


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Payers & Providers Midwest Edition – Issue of May 1, 2012