Archive for January, 2014

Infographic: American Hospitals Are Prepared to Care

January 31st, 2014 by Jackie Lyons

There were 26 million more emergency department (ED) visits in 2011 than in 2000, yet there are 189 fewer EDs, according to a new infographic from the American Hospital Association. Payment gaps in hospitals reached a total of $71 billion for uncompensated care, Medicare and Medicaid patients.

This infographic also details access to care, necessary hospital treatments and staffing areas, levels of emergency readiness and more.

American Hospitals are Prepared to Care

You may also be interested in this related resource: 2014 Healthcare Benchmarks: Reducing Hospital Readmissions. With fewer EDs and more ED visits, it is vital for hospitals to keep readmissions down. This resource documents the latest key initiatives and partnerships to reduce readmissions by patients with these costly conditions and others by more than 100 healthcare organizations.


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Have an infographic you’d like featured on our site? Click here for submission guidelines.

4 Trends for Healthcare Providers in 2014

January 30th, 2014 by Jessica Fornarotto

Dual-track medical homes, e-visits, retooled patient handoffs and more post-acute care are predicted provider trends for 2014, according to Steven Valentine, president of The Camden Group. HIN interviewed Valentine prior to his presentation during an October webinar on Healthcare Trends & Forecasts in 2014: A Strategic Planning Session.

HIN: What is the physician practice going to look like in 2014? How has the primary care team evolved to meet the Triple Aim values inherent in the PCMH and accountable care models?

(Steven Valentine): We should expect to continue to see consolidation amongst the medical groups. The independent practice associations will begin to assimilate together because they need to put more money into their infrastructure. And many of the organizations have underperformed, in all honesty.

The primary care team is still critical. We’ve benefitted by keeping many primary care doctors around because they were negatively hurt with their net worth in the recession in 2008-2010. But it’s slowly coming back and we’re starting to see those physicians thinking about retirement again. The reality is, we’re never going to replace all of these primary care doctors as they wind down their practice. We need to do a better job of getting telehealth going and utilizing e-visits. We’re seeing the health plans starting to pay for those e-visits, as well as having the consumer who uses them use a credit card and pay at that time, just like a visit.

We’re going to have to look at different models. Obviously, the nurse practitioner is getting more involved with the primary care. And yes, they’re still pursuing the Triple Aim. We know that quality scores, satisfaction scores and trying to manage cost per unit is still a critical focus of the triple aim moving forward with population health.

Lastly, with a PCMH in accountable care, while some of the pioneer accountable care organizations (ACOs) reduce themselves out of pioneer into the Medicare Shared Savings Program (MSSP), we still have a number of organizations and it’s growing. The commercial ACOs have been very successful in California.

We fully expect accountable care to continue. We think the PCMH will evolve into two tracks. The first track is a primary care PCMH. The spinoff is a chronic care medical home that has the multidisciplinary team organized around a chronic disease. This is a model developed by CareMore years ago in Southern California and it’s been expanded across the country. As I travel the country, I run into organizations that have set up these chronic care centers around the chronic disease.

HIN: Regarding the Pioneer ACO program, one of the top performers in the CMS pioneer program, Monarch HealthCare, told us that it’s going to be working to engage specialists in care coordination roles in year two and year three. What’s ahead for specialists in terms of quality and performance improvement as well as shouldering perhaps more care coordination duties, especially for Medicare patients?

(Steven Valentine): The specialists are going to be a critical piece to this whole solution. They have been a tremendous asset in the area of bundled payments, where you have the facility fee and physician fee combined into one payment. That works for both the Medicare as well as the commercial side. You’re beginning to see more of the bundled payments within an ACO.

The ACO manages what we call ‘frequency’ — in other words, the number of procedures to be done. Specialists are involved in satisfaction, quality scores, and resource consumption once the decision is made that the procedure needs to be done.

We expect the specialists to be involved with quality and performance. Everybody is putting in incentive programs to help drive higher quality, better performance, and a lower cost.

HIN: Hospitals have tightened the patient discharge process as a means of shoring up care transitions. But what other work needs to be done in terms of collaborations, perhaps with skilled nursing facilities (SNFs), long-term care and home health, for example, to improve patient handoffs and reduce hospital readmissions?

(Steven Valentine): Handoffs have probably been one of the areas where we’ve seen the most disappointment or underperformance within many ACOs. They have not effectively involved the hospitalists and the care/case managers who are typically embedded within the medical group that would oversee the patient throughout the care continuum. Or if it’s a health system, emanate centralized care/case management function where they manage all of the transitions from pre-acute, acute to post-acute. We think this will get better. As the doctors are more at risk, they will get more engaged with the care/case managers to manage these transitions and handoffs.

We also know that, while not in 2014 but the trend will start, we’ll see lower acute care utilization, pushing more patients to post-acute care. This means, in any given area, acute care hospitals will begin to convert excess capacity to post-acute care services like skilled nursing, long-term care, palliative care, hospice care, home care and rehab care. You will begin to see a closer proximity. The care managers will be able to work more effectively with the doctors and hospitals to manage the patient through the continuum, smooth out these transitions and have a better patient experience with better satisfaction scores at a lower cost.

Excerpted from: Healthcare Trends & Forecasts in 2014: Performance Expectations for the Healthcare Industry

Targeting Heart Failure Readmissions with Telehealth Monitoring

January 30th, 2014 by Cheryl Miller

To further investigate gaps in care, Central Maine Medical Center expanded a team already focused on outcomes improvement for 30-day readmissions to include providers, nurses, home care and hospice. The resulting intervention incorporated home health visits supplemented with telehealth, explains Susan Horton, DNP, APRN, CHFN, executive director of Central Maine Heart and Vascular Institute. This innovative work also led to other home-based interventions that were not always restricted to individuals identified by Medicare as homebound.

About that time our home care and hospice group approached us. They had the opportunity to write a grant for telehealth monitors. They wanted to know whether Central Maine would support that application so that they could then target these telehealth monitors for our heart failure population.

We supported that grant, and they got it. However, that decision caused us to determine that we needed to be more strategic in our partnership with home care and hospice. From that, we developed a job description and hired a full time equivalent: 20 hours on the medical center payroll, and 20 hours on the home care and hospice payroll.

That’s where the home visit program really took off. We were able to say that whether Patient A meets Medicare criteria for homebound or not, home care would go into the patient’s home as a guest of Central Maine Medical Center. We explained to each patient at the time of discharge that we wanted to evaluate their home situation to make sure they were safe.

This was important because we are looking at all-cause readmissions. If a heart failure patient living in an unsafe situation trips and falls and gets readmitted with a head injury, that’s still going to be a black mark for heart failure readmission. It’s all-cause readmission. We felt that we needed to assess what was going on in the home. Who was there for the patient? What were they doing in terms of support? Could they take their medication? Did they have a scale? Could they read the scale? And we would offer telehealth.

Excerpted from: Guide to Home Visits for the Medically Complex.

Collaboration, Medication Reconciliation, Yoga Key to Successful Population Health Management

January 30th, 2014 by Cheryl Miller


Zumba, yoga, Thank God it’s Free Fruit Friday (TGIFF)?

Maybe not top-of-mind elements of accountable care, but all three are helping healthy employees to stay healthy, and luring others to engage in their own health self-management, the keys to successful population health management (PHM), says Elizabeth Miller, vice president of care management at White Memorial Medical Center, part of Adventist Health, in a recent webinar at the Healthcare Intelligence Network.

In Managing Risk in Population Health Management, Ms. Miller shared the key features of the PHM program at White Memorial, the program’s impact on Adventist’s 27,000 employees and how the program was being rolled out to its patient population.

By incorporating elements of the Triple Aim, and collaborating with all stakeholders, including patients, providers, health plans, employers, hospitals and local community members, a PHM program can achieve optimal outcomes, including minimizing the need for ED visits, lowering costs, maintaining and improving individuals’ health across the continuum of care, and reducing readmissions, Miller says.

Medication reconciliation plays a key part in preventing populations from being admitted or readmitted to the hospital, Miller continues, because it is one of the chief causes for readmission. She cites numerous instances where nurse practitioners go into people’s homes to do medication reconciliation only to find that they are going to two cardiologists simultaneously and taking medications from both of them, not realizing how detrimental it is to their health.

Elements of the PHM program include using robust data sets, risk stratification, and predictive modeling to identify populations, and target high-risk individuals with one or more chronic diseases, including the top five: coronary heart failure (CHF), chronic obstructive pulmonary disease (COPD), asthma, diabetes, HIV. Once eligible populations are targeted and enrollment criteria met, analytics, intervention and program development are established for the top 5 percent, or very high risk, and 10 percent, or high risk, and then wellness programs for the 85 percent, or medium risk.

Ongoing assessments and evaluations of interventions follow, usually by care managers, including periodic reassessments of goals, and measuring outcomes with set metrics.

The goal of any PHM plan is to eventually graduate patients by setting up decision support and self-management tools that will help them do so. Offering employees the right incentives is a key contributor to this. White Memorial was able to engage 95 percent of its employee population in a PHM program by reducing monthly insurance premiums by $50 a month. That percentage grew to 98 percent when the reductions were extended to employees’ spouses,’ Miller says.

Ultimately, says Miller, “we really want to focus on the population and modify the behaviors so that we prevent illness in the future. Right now we have a disproportionate investment in illness after it has already occurred. Once it has occurred, it’s difficult to manage and treat…Our goal is to keep the population as healthy as possible.”

It can be labor intensive, Miller points out, but the outcomes are worth it. Improved health status leads to improved performance, and projected financial savings of $49 million by 2017.

3 Nurse Navigator Tools to Enhance Care Management

January 29th, 2014 by Jessica Fornarotto

Where does the nurse navigator spend their day? Certainly on transitions of care. Bon Secours Health System nurse navigators use a trio of tools to identify patients’ obstacles to care and connect them to needed resources, explains Robert Fortini, vice president and chief clinical officer of Bon Secours Health System.

One tool that our nurse navigators use that’s built into our EMR is the hospital discharge registry from Laburnum Medical Center, one of our largest family practice sites with about nine physicians. This tool is used to identify which patients the navigators need to work with, and it’s where the navigators begin and end their day. This registry provides a list of all the patients who have been discharged from one of our hospitals in the last 24 hours, and each patient is listed by the physician. The navigators have to reach out to each of these patients and make telephonic touch within 24 to 48 hours of discharge. Medication reconciliation is extremely important at this time and can be very challenging. When a patient goes into a hospital, often their medications get scrambled, and they come out confused and taking the wrong prescriptions. Nurse navigators spend a lot of time on medication reconciliation at this point.

The Navigators also conduct ‘red flag’ rehearsals with this tool, so that the patient knows the signs and symptoms of a worsening condition and what to do for it. We also schedule the patient with a follow-up appointment, either with a specialist who managed the individual in the hospital or with their primary care physician. We try to do it as close to the time of discharge as possible, within five to seven days, or more frequently if the risk of readmission is higher.

Second, nurse navigators also use a documentation tool to help manage the care of heart failure patients. This tool allows the navigator to stage the degree of heart failure using a hyperlink called the ‘Yale tool.’ The Yale tool allows us to establish what stage of heart failure the patient is in: class one, two, three, or four. Then, a set of algorithms is launched based on these stages’ failure; we manage the patient according to those algorithms. For example, if a patient falls into a class four category, we might bring them in that same day, or the next day, for an appointment rather than wait five or seven days because they’re at more risk. We might also make daily phone calls or network in-home health, as well as make sure that the patient has scales for weight management and an assessment of heart failure status. All of those interventions will be driven by the patient’s class of heart failure.

The last tool we use is a workflow for ejection fractions. The patient’s ejection fraction will define specific interventions that the navigator will follow.

Excerpted from: Profiting from Population Health Management: Applying Analytics in Accountable Care.

Infographic: Healthcare Organizations Adjusting to New Healthcare Mandates for Maximum Productivity

January 29th, 2014 by Jackie Lyons

In the evolving healthcare industry, physicians must constantly implement new technology and processes to meet new mandates. Practices that do not update with new electronic medical record (EMR) codes in ICD-10 risk losing money associated with cost of programs and lowered productivity.

Compared to ICD-9, ICD-10 contains 55,000 longer codes for more exact clinical documentation, according to a new infographic from Capson Physicians Insurance. This infographic illustrates the variable effects of ICD-10 and EMR implementations on physician practices.

Adjusting to New Healthcare Mandidates for Maximum Productivity

You may also be interested in this related resource: ICD-10-CM/PCS Implementation Action Plan. With these new implementations, it is important to be informed concerning ICD-10. This 135-page resource goes beyond its comprehensive coverage of ICD-10 CM/PCS to provide you with training tools, as well. It also includes an 81-page customizable document, as well as a customizeable spread sheet log.

Get the latest healthcare infographics delivered to your e-inbox with Eye on Infographics, a bi-weekly, e-newsletter digest of visual healthcare data. Click here to sign up today.

Have an infographic you’d like featured on our site? Click here for submission guidelines.

Bundled Payments and Provider Partners: Who Should Take the Risk?

January 27th, 2014 by Patricia Donovan
bundled payment

Bundled payments are changing the face of healthcare reimbursement.

In the new healthcare realm, where every touch now translates to an expense rather than revenue, providers must determine which entity will take the risk before entering into a bundled payment agreement, advises Jay Sultan, associate vice president and chief product portfolio architect for TriZetto®.

Think about whether it’s physicians or hospitals; do you want to be the one owning the episode, taking the risk, indemnifying other parties, giving orders? Or do you want to be an entity that’s taking orders and treated as a vendor? If you’re a hospital, do you really want your doctors deciding which hospital to use?

This can help when you are vertically integrated, but ownership does not equal alignment. You need to think about which providers you need to use. The model where everybody owns each other is not necessarily the best one. In fact, we’ve seen more often than not provider organizations that are not co-owned getting involved in bundles and being successful.

There are a lot of issues. You need to look into what legal form you should create. Again, a lot of people are making new companies that are taking on the risk. You should also consider things like STARK and Civil Monetary Penalty (CMP), and Racketeer Influenced and Corrupt Organizations Act (RICO). You need someone to help you make sure you’ve done all that correctly.

Finally, I’d like to talk about sharing risk among your provider partners. You’re going to have to contract with each other, find a way of sharing gains with each other that everybody can agree to. One traditional model is that the hospital takes all the risk. They indemnify the physicians, and they’re in an upside-only program with the physicians. I think of better models where everybody is at risk and everybody is putting in capital. And if you’re dealing with employed physicians, you need the variable portion of that to be highly aligned with what you’re trying to do in the program.

Excerpted from: Guide to Value-Based Reimbursement: Profiting from Payment Bundling, PHO Shared Savings, and Pay for Performance

Infographic: Physician Use of mHealth Affects Patient Satisfaction, Clinical Outcomes

January 27th, 2014 by Jackie Lyons

In the post-reform healthcare environment, patient experience and satisfaction rank as high priority goals for healthcare organizations, along with improving clinical outcomes and reducing total cost of care. The key to accomplishing these goals is digital health technology, according to a new infographic from Booz & Company.

Physicians are 250 percent more likely to own a tablet than any other consumer, and more than half find it expedites their decision making, according to Booz & Company. This infographic also outlines smartphone adoption, online patient/physician communication, patient use of mobile health (mHealth) technology and more.

M-Health Physician Use of Mobile Technology

 title= You may also be interested in this related resource: 7 Patient-Centered Strategies to Generate Value-Based Reimbursement. With clinical outcomes and cost of care hinging on patient satisfaction, patient-centered strategies are necessary to generate substantial reimbursement. This resource explores these and more of the seven healthcare areas ripest for development in 2014.

Get the latest healthcare infographics delivered to your e-inbox with Eye on Infographics, a bi-weekly, e-newsletter digest of visual healthcare data. Click here to sign up today.

Have an infographic you’d like featured on our site? Click here for submission guidelines.

Adapting 3 NCQA Standards for the Patient-Centered Medical Home

January 24th, 2014 by Cheryl Miller

Coming from a group of innovators who had adopted EHRs early on and were not afraid of data, participants in the Hudson Valley medical home transformation project decided to concentrate on three out of nine NCQA standards: access and communication, inpatient self-management, and performance reporting, explains Paul Kaye, MD, medical director at Taconic IPA.

Let’s move on to the nine standards of NCQA. All of them are available at NCQA’s Web site. We found that we needed to concentrate primarily on the areas of access and communication, inpatient self-management and performance reporting. It’s not to say that the other pieces don’t warrant a challenge, but many of them reflected EHR use and the ability to report on that use rather than a radical transformation of practice.

Initial steps were to require all of our practices to take TransforMED’s medical home IQ self-examination. Then a practice work plan for each practice was created. There was a staff-wide kickoff with each practice. Scheduling that was a challenge for busy private practices, as well as for the community health centers. Regular contact occurred between the coaches with timetables and deliverables that were there for particular elements and standards that had to be met.

Our medical council met once a month. The council included the physician and non-physician leadership of each practice. We highlighted a different standard at each meeting, shared best practices and came to an agreement on the three conditions that one needs to identify for NCQA medical home recognition. There was agreement across the practices that diabetes was an important condition in our area and there was also agreement on adopting practice guidelines, which had already been worked on at the statewide level, so that was a non-controversial area to be able to tackle. We also had two full-day workshops called learning collaboratives, and continue to have these every six months. For these workshops, outside speakers of national prominence came to talk about the medical home and some of the changes that needed to be done.

With all those areas of success, we had no difficulty agreeing on a clinically important condition and on defining a few more to pick from. Agreement on practice guidelines again came easily because of work that had already occurred. Most of the practices found that the standards that required documentation of an EHR functionality, while challenging to document on a piece of paper, were already present and didn’t require much radical change in their practice. These are the low hanging fruit, and showing some of this early on started to build the spirit of cooperation among the providers.

Excerpted from Guide to Physician Performance-Based Reimbursement: Payoffs from Incentives, Data Sharing and Clinical Integration.

Infographic: The Impact of U.S. Healthcare Spending

January 24th, 2014 by Jackie Lyons

Medical bills cause more than 60 percent of bankruptcies in the United States, where healthcare is the most expensive in the world, according to an infographic from CauseWish.

This infographic also identifies reasons why individuals are uninsured, shows average prescription spending per person and hospital spending per discharge, and shows the states with the highest uninsured populations.

Statistics and Trends of Healthcare in the U.S.

Get the latest healthcare infographics delivered to your e-inbox with Eye on Infographics, a bi-weekly, e-newsletter digest of visual healthcare data. Click here to sign up today.

You may also be interested in this related resource: Healthcare Trends & Forecasts in 2014: Performance Expectations for the Healthcare Industry.

Have an infographic you’d like featured on our site? Click here for submission guidelines.