Healthcare Business Week in Review: Hospital Readmissions, State-by-State Scorecard, PHOs, HRAs

Friday, September 27th, 2013
This post was written by Adam Ghosh

It looks like good surgeons are, literally, a cut above the rest, at least according to a new study from Harvard School of Public Health.

Quality surgical care is strongly linked to hospital readmission rates, a somewhat surprising new statistic given that much of policy focus has been on reducing readmissions after hospitalizations for medical conditions, such as heart failure and pneumonia.

Readmissions for medical conditions are primarily driven by how sick the patients are and whether they live in poor or better-off communities; the link between hospital quality and readmissions is less clear. The study sought to find out if there was a relationship between readmission rates after surgery and the quality of surgical care in that hospital; more details inside.

Poor healthcare quality does not discriminate. According to a new study from the Commonwealth Fund scorecard, access to affordable, quality healthcare varies greatly for low and high-income people based on where they live.

The report finds that higher-income people living in states that lag far behind the top scoring states are often worse off than low-income people in states that rank at the very top of the scorecard. The scorecard provides the first state-by-state comparison of the healthcare experiences of the 39 percent of Americans with incomes less than 200 percent of the federal poverty level, and compares their experiences with higher income families.

Lower-income families, particularly those on Medicaid, have grown increasingly more dependent on using the emergency room, despite widely held assumptions that uninsured patients are high ER utilizers, according to a study from the University of California, San Francisco. In order to investigate recent trends between insurance coverage and ED use, researchers analyzed California ED visits by adults aged 19 to 64 years old from 2005 to 2010, and found that the number of visits to California EDs by adults overall increased by 13.2 percent, with Medicaid beneficiaries leading the pack. This study has wide implications with upcoming ACA reforms; many uninsured people are expected to transition to Medicaid, and as a result, overall ED use may increase because Medicaid patients have higher rates of ED use.

Physician-hospital organizations (PHOs) have taken the accountable care organization (ACO) reins from physicians over the last year, according to our 2013 market data. PHO leadership of ACOs almost doubled in the last 12 months; in 2012, one-quarter of ACOs were

physician-led, a trend that replaced the hospital-administered ACOs that dominated in 2011.

As ACOs continue to evolve, the composition of the care delivery model will shift as well, with hospice, long-term care and home health entering the fray.

Lastly, don’t forget to take our Health Risk Assessments in 2013 survey – sophisticated analytics behind today’s health risk assessments or health risk appraisals (HRAs) provide employers, payors and providers an aggregate view of population health and the raw

material to develop prevention and lifestyle change programs. Tell us how your organization uses HRAs to improve population health by October 15, 2013 and get a FREE executive summary of the compiled results.

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