Healthcare Business Week in Review: Urgent Care Growing; Medical Overuse; Pioneer ACOs, Readmissions

Friday, July 26th, 2013
This post was written by Cheryl Miller

Urgent care centers alternative care centers for time-challenged patients, or costly care convenience centers?

That’s the debate in a new study by the Center for Studying Health System Change (HSC) on the rapid growth of these centers throughout the country. Once an occasional independently-owned, standalone facility, there are now 9,000 urgent care centers.

Three key factors are driving the surge, among them, their accessibility. Urgent care centers fill a gap by providing walk-in care, especially during evening and weekend hours, when primary care physician (PCP) offices are generally closed. They are particularly appealing to those patients unable to schedule a PCP appointment during weekday hours, or for those patients without a PCP.

There is little debate over a series of recommendations that could reduce five medical interventions that are commonly used but not always necessary, according to a paper released by The Joint Commission and the American Medical Association-Convened Physician Consortium for Performance Improvement® (PCPI).

Left unchecked, overuse, described as the provision of medical interventions that provide zero or negligible benefit to patients, is a leading contributor to problems with quality and patient safety, can affect millions of patients, and can drive up healthcare costs.

Researchers estimate that $1 billion is spent annually on unnecessary antibiotics for adults with viral upper respiratory infections (URIs) alone, one of the five areas of overuse. Strategies to reduce this include developing clinical definitions for viral and bacterial URIs, aligning contradictory national guidelines, partnering with the CDC and initiating public awareness. Other strategies and treatment areas are outlined inside.

Developing consistent guidelines is key to another set of recommendations tackling an equally common and costly healthcare problem: heart failure readmissions. Researchers have identified six steps hospital staff can take to help heart failure patients avoid readmittance to the hospital within 30 days after they’re discharged, according to research in the American Heart Association’s journal Circulation: Cardiovascular Quality and Outcomes.

While each step alone has had some impact on patients’ recovery, researchers found that if all six recommendations were followed, readmissions could drop as much as two percent. This translates to a savings of more than $100 million a year.

A lack of savings is prompting seven of 32 provider groups that signed up for the Pioneer Accountable Care Organizations (ACOs) program sponsored by CMS to switch to the Medicare Shared Saving Program (MSSP), according to the CMS.

Two other Pioneer ACOs are leaving the program completely, CMS officials say. Overall, more than 250 organizations participate in the Pioneer ACO Model and the MSSP, serving 4 million Medicare beneficiaries.

CMS said in a statement that 13 out of 32 pioneer ACOs produced and shared savings with CMS, generating a gross savings of $87.6 million in 2012 and saving nearly $33 million to the Medicare Trust Funds.

One of the key features of the Pioneer program, and one that differentiates it from the Medicare Shared Savings Program, is that it is accountable for all Medicare A and B benefits, so it includes end stage renal disease patients, hospice patients, and dual-eligibles.

How is your organization meeting the unique care coordination needs of dual eligibles? Share your organization’s approach by July 31st by participating in our online survey and you will receive a free summary of survey results once it is compiled.

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