Archive for November, 2011

Medicare Payment Rates to Providers Could be Reduced by 27.4 Percent in 2012

November 7th, 2011 by 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.

These stories and more in this week’s issue of the Healthcare Business Weekly Update.

New Wellness Coach Profile: Meet Jessy Hamawi

November 4th, 2011 by Jessica Fornarotto

Here we take an inside look at a wellness coach, the choices made on the road to success, and the challenges ahead.

Jessy Hamawi, wellness coach, nutrition consultant, and certified personal trainer.

HIN: What was your first job out of college and how did you get into wellness coaching?

Jessy Hamawi: I went to Bradley University hoping to go to medical school right after. It wasn’t until my senior year that I realized I had a passion for nutrition and fitness. I started working as a personal trainer and fitness instructor at major health clubs in Peoria, Ill. Currently, I am the club manager and nutritionist on site at Club Fitness. Being in the health field has definitely made me aware of and conscious about one’s health. There are many diseases that can be prevented and even controlled if we take better care of our bodies. There is an alarming rise in obesity, hypertension, diabetes, heart disease, and other controllable diseases. I believe that if you eat healthy by cutting out the unhealthy fats, excessive sugar and salt from your diet, and make exercise part of your daily life, you can make a difference in your overall health and prevent diseases.

Have you received any health or wellness coaching certifications? If so, please list these certifications.

I am a certified personal trainer as well as a kick-boxing instructor. It wasn’t until I almost graduated with my nutrition bachelor’s that I decided the importance of combining my love of exercise and healthy eating. I am currently a grad student concentrating on human and sports nutrition. Coaching comes naturally with the support and guidance of a personal trainer in order to make positive changes and bring balance to your life.

Has there been a defining moment in your career? Perhaps when you knew you were on the right road?

Every time I talk to my clients, whether it is during a consultation for weight loss or fitness training, I know that I am on the right path.

In brief, describe your organization.

Club Fitness is a multi-personal training facility where our certified trainers provide customized workout plans. Our personal trainers choreograph and oversee the entire workout routine to ensure proper form and goal achievement. We also teach the proper way to fuel the body, whether for weight loss or an athletic event. The members learn the proper combination of complex carbohydrates and lean protein to speed up the metabolism.

What are two or three important concepts or rules that you follow in wellness coaching?

Listening and helping my clients in achieving their nutrition and fitness goals and desires.

What is the single-most successful thing that your company is doing now?

Our club is successful at its multi-personal training approach. Also, we have a great weight loss program called “25 to 3,” in which our members are encouraged to lose 25 pounds by following a healthy well-balanced meal plan along with three personal training sessions per week.

Do you see a trend or path that you have to lock onto for 2012?

Focusing on health and decreasing or preventing chronic diseases such as diabetes, hypertension or other cardiovascular diseases, through combining exercise and nutrition.

What is the most satisfying thing about being a wellness coach?

Educating others about what it takes to achieve a healthier lifestyle, the importance of fitness and healthy eating. It’s not just about what a person looks like and what they need to do to be a certain way, but about what I can do to help others feel better about themselves. I want to help everyone in any way that I can. In regards to training, I’m most proud of reaching my goal to become a more fit and healthy person. About three years ago, I was not happy with how I looked and felt. I decided to start dedicating my time to taking better care of myself, and within a year, I had made drastic changes to my physique. Since then, I’ve had a positive and rewarding journey.

Where did you grow up?

I was born and raised in Beirut, Lebanon. I attended high school in Lawrence, Mass. and college in Peoria, Ill.

What college did you attend?

I obtained my Bachelor of Science from Bradley University and my master’s from Eastern University.

Are you married? Do you have children?

I am not married and do not have children.

What is your favorite hobby and how did it develop in your life?

I have a few hobbies, one being hiking. Besides it being an amazing outdoor exercise, I enjoy the scenery. I also love cooking. My favorite part is substituting ingredients to make the recipe healthier.

Is there a book you recently read or movie you saw that you would recommend?

One of my favorite documentaries is “Dear Zachary: A Letter to a Son About his Father.” This movie has left such an impact on me.

Any additional comments?

There is a beginning point for everyone. All it takes is for that switch to flip to begin your journey. Take it one day at a time and do not beat yourself up if you have the occasional “slip-up.” It’s not about having fitness consuming your entire life, but it’s about enhancing it. Realize that self-love improves not only your life, but also the lives of others around you.

November 4 Deadline Looms for Certain CMS Bundled Payment Models

November 2nd, 2011 by Patricia Donovan

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.

The four models included in the new CMS initiative are:

  • Model 1: Retrospective bundled payment for all inpatient hospital stays;
  • Model 2: Retrospective payment model for the acute inpatient hospital stays AND post-acute care;
  • Model 3: Retrospective payment model for post-acute care only;
  • Model 4: Prospective payment for select acute care hospital stay only – Providers select which MS-DRGs to include

Providers interested in participating in Models 2 through 4 have until Friday, November 4 to submit letters of intent to participate. Model 1’s deadline has already passed, Reilly noted, and interest in Model 2 is limited due to associated risk from post-acute care.

The veteran of previous CMS forays into bundled payments walked through the four models and timelines during last month’s webinar on “Evaluating CMS’ Bundled Payment Initiative: Operational, Financial and Clinical Considerations.”

Hospitals are more familiar with bundled payments than physician practices, who are traditionally paid by CMS on a fee for service basis, noted Reilly. CMS hopes the new bundled pricing initiative will incentivize hospitals and physicians to work more closely together to improve outcomes.

Reilly reported a “neutral to positive” assessment of CMS’s Acute Care Episode (ACE) pilot from the five participants in that recent CMS bundled payments trial. Reilly worked with all five health systems on the ACE project, including Baptist Health System. Model 4 is also most like the ACE model, and offers a prospective payment, in that CMS will pay one fee after the care is delivered.

Reilly posed several questions for providers to consider before committing to participate, including whether bundled payments will effectively align physicians, result in financial gain, improve quality benchmarks and inspire innovation and change in the healthcare industry.

His advice to potential participants? Start educating your physicians on the payment process, and start now: the application is extremely labor-intensive.

Aetna Case Managers and Emory Healthcare Physicians Collaborate on Medical Home Program

November 2nd, 2011 by Melanie Matthews

Healthcare costs for various segments continue to increase. In fact, according to recently released figures from S&P Indices, commercial insurance and Medicare programs increased by nearly 6 percent for the 12 months ending August 2011. While commercial insurance rates rose for four months in a row, Medicare costs actually declined from their all time high rate of 8 percent in 2009.

Costs for long-term care also rose; according to MetLife, rates for those requiring care in nursing homes, assisted living facilities, and adult day services rose from four to 5 percent; with nursing home rates doubling those of assisted living. The survey, collated from 2,003 nursing homes, 1,492 assisted-living facilities, 1,644 home-care agencies and 1,341 adult-day services in all 50 states and Washington, D.C., presents a breakdown of rates according to region, gender and age.

The trend of embedding case managers in primary care continues. Aetna is embedding case managers in six Emory primary care practice facilities. The new patient-centered medical home program will provide care for both Aetna Medicare members and Emory’s employees and family members. Key goals of the collaboration are improved patient care, increased follow-up visits, and better quality and efficiency.

And CMS has launched a new initiative designed to help federally qualified health centers transform into advanced primary care practices. Five-hundred participants have been selected from 44 states around the country and will receive a portion of the $42 million allocated for the program. FQHCs will be assessed on their efforts to improve patient care and delivery.

These stories and more in the latest issue of Healthcare Business Weekly Update.

6 ADA Guidelines to Transition Diabetes Patients into Adulthood

November 1st, 2011 by Jessica Fornarotto

To ensure continuity of care for patients with diabetes transitioning from pediatric to adult providers, the ADA has outlined six strategies to effectively transition patients between 18 and 30 years of age.

Despite existing guidelines, physicians are often confronted by many obstacles in the management of diabetes during this time period, when young people experience going to college or beginning to support themselves. The ADA guidelines include:

  • At least one year before the transfer to adult healthcare providers, pediatric providers should collaborate with the patient and family to prepare for the upcoming transition in healthcare delivery.
  • The pediatric provider should provide the patient and adult provider with a written summary including an active problem list, medication list, diabetes self-care skills evaluation, summary of past glycemic control and diabetes-related comorbidities, summary of any mental health problems and referrals during pediatric care.
  • Pediatric and adult care providers should both offer support and referrals to resources that may assist the patient in case there is a loss of consistent healthcare or in case they become lost to follow-up.
  • To prevent acute and long-term complications of diabetes, adherence to and consistent use of glucose-lowering medications must be emphasized.
  • Emerging adults with diabetes should be assessed and treated for disordered eating behaviors and affective disorders, with referral as needed to a mental health provider familiar with diabetes care.
  • Pediatric and adult clinicians should discuss with emerging adults how diabetes may affect birth control, pregnancy planning and risks, prevention of sexually transmitted illnesses, alcohol and drug use, smoking and driving.