Archive for April, 2014

Infographic: The Quality of Nursing, Patient Care

April 16th, 2014 by Jackie Lyons

Seventy-five percent of Americans 30 years and older are more concerned with the quality of nursing staff in hospitals than with the availability or accessibility of electronic medical records (EMRs), according to a new infographic form API Healthcare.

While confident in nursing abilities, a majority of consumers feel nurses are spread too thin, which is impacting the quality of patient care. This infographic also provides data on the quality of nursing care, impacts of the Affordable Care Act (ACA), consumer concerns and quality of patient care.

Looking for other ways to increase patient satisfaction? You may also be interested in The Patient-Centered Payoff: Driving Practice Growth Through Image, Culture, and Patient Experience, which is filled with easy-to-implement ideas. This 260-page resource describes how the patient-centered movement has changed medical practice and offer insights into the opportunities this new environment provides to practices.

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Predictors of PHO Longevity and Financial Success

April 15th, 2014 by Patricia Donovan

Today, value-based payment models encourage hospitals and physicians to work together and make each more accountable for the other’s actions in a physician-hospital organization (PHO). But what are predictors of PHO longevity and financial success?

Here, Healthcare thought leaders Travis Ansel, MBA, manager of strategic services, Healthcare Strategy Group, and Greg Mertz, MBA, FACMPE, director of consulting operations, Healthcare Strategy Group, debate the question.

Response (Greg Mertz): It’s pretty evident that no one entity is going to be able to meet the needs of the population. If you’ve got a hospital that employs physicians, there’s an excellent chance that the employed physician network isn’t the total answer for caring for the population. They’re going to have to embrace non-employed physicians, other specialties, larger based primary care. Some entity is going to have to be created to make that happen.

But the PHO is an excellent model. Basically, it creates a collaborative entity that can bring in hospitals, employed physicians, non-employed physicians, ancillary providers. The PHO this time is something that is going to be necessary. Value is inevitable. I don’t see any reason that it would not have great longevity.

Response (Travis Ansel): I definitely agree. I think the biggest predictor of long-term success is the culture, but it’s going to be how the governance of the PHO is set up. It’s going to be giving the physicians, both employed and independent, a real voice in the organization and getting their expertise leveraged going forward. That’s going to be the biggest predictor. Beyond that, a willingness to experiment.

We’re in a situation now where organizations can’t really afford to sit on the sidelines for too long with all the different models that CMS and private payors are putting up in order to encourage shared risk between providers and hospitals. A willingness to experiment would be another key to success in my mind because it’s really the only way to learn how to be successful in this new environment, how to get involved in it and not hang on to the current FFS environment until it withers and dies.

Excerpted from Essential Guide to Physician-Hospital Organizations: 7 Key Elements for PHO Success.

Infographic: Does Early Breast Cancer Detection Save Lives?

April 14th, 2014 by Jackie Lyons

An extensive study of mammograms found that they do not decrease breast cancer death rates, and they increase over-diagnosis, according to a new infographic from based on a Canadian study.

Consequences to misdiagnosis include unnecessary radiation, surgery and chemotherapy that come with high costs. The average cost of treating early stages of breast cancer is $22,000, according to the infographic. This infographic also includes the history and statistics of mammograms and early detection.

Learn more about assessing health risks in 2013 Healthcare Benchmarks: Health Risk Assessments. This 60-page resource provides metrics on current and planned HRA initiatives as well as lessons learned and results from successful health assessment programs. It is enhanced with guidance from industry thought leaders on the necessity of HRA and stratification prior to launching a population health management program.

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Infographic: The Growing Industry, Effects of mHealth

April 11th, 2014 by Jackie Lyons

mHealth is currently a $1.3 billion industry that is expected to reach $20 billion by 2018, according to a new infographic from Mobile Future and Infield Health.

This infographic shows savings attributed to remote patient monitoring and medication adherence resulting from mHealth. It also assesses how mobile tools are transforming healthcare as more Americans, including healthcare providers, adopt mobile devices and wireless connectivity, and more.

Learn more about mHealth in 2013 Healthcare Benchmarks: Mobile Health, which delivers a snapshot of mHealth trends, including current and planned mHealth initiatives, types and purpose of mHealth interventions, targeted populations and health conditions, and challenges, impact and results from mHealth efforts. This 50-page resource provides selected metrics on the use of mHealth for medication adherence, health coaching and population health management programs.

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3 Levels of Health Coaches

April 10th, 2014 by Cheryl Miller

While health coaches address the health risk continuum — keeping the healthy healthy without compromising the clinical support needed for high-risk, high utilization individuals, it is necessary to align individuals with the right coaching service at the right time, say Dennis Richling, MD, chief medical and wellness officer, and Kelly Merriman, vice president of service delivery for HealthFitness. Here they explain the three levels of heath coaches needed to address their clients’ wide-ranging needs.

Our approach engages the individual with the right coach for their need. We use three types of professional coaches: there are health coaches, who are lifestyle coaches, individuals with bachelors, masters and doctoral degrees in health-related fields. There are also advanced practice coaches, skilled senior health coaches who have been trained in clinical conditions in chronic disease management. And then there are nurse coaches, who are registered nurses, who also have been trained in behavior change techniques. We take a look at what happens and who fits into which category.

First, there are those people with no chronic disease but who have health risks. They have issues trying to manage their healthy lifestyle and are seeking help. Those individuals go to health coaches.

Next, there are those individuals with chronic diseases but they’re managing their medication appropriately and complying with the preventive and control measures for their chronic disease. But their underlying lifestyle issues remain, and these individuals go to advanced practice coaches.

Lastly, there are individuals who are not following their care plan, their care is not coordinated, they are seeing multiple doctors, and their medication compliance is poor. They do have underlying lifestyle issues, but their biggest problem right now is managing their chronic disease and these individuals go to the nurse coach.

Excerpted from Integrated Health Coaching: Reducing Risk and Empowering Change across the Health Continuum.

Infographic: U.S. Prescription Drug Costs

April 9th, 2014 by Jackie Lyons

American consumers pay 50 to 100 percent more for prescription drugs than any other country, with the average American paying $983 per year, according to a new infographic from Clarity Way.

This infographic outlines the cost of specific prescription drugs in comparison to other countries and the cost of drug research and development. It also identifies the benefits of access to prescription drugs, such as savings, prevention of death and hospital visits and more.

Drug Benefit Trends and Strategies: 2013 includes insight and expert analysis — from the publishers of Drug Benefit News and Specialty Pharmacy News — to help you understand what pharmacy benefit management trends are on the horizon in regards to: market share, formulary structures, PBM contracting, transparency, copays and Rx drug costs and utilization.

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.

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Do You Factor Transitional Care into Medicare Value-Based Reimbursement?

April 8th, 2014 by Patricia Donovan

There is a wealth of assistance available to avoid hospital readmissions penalties.

In the suite of performance-based measurement that currently comprises Medicare reimbursement, a big component of value-based purchasing relates to transitional care, as well to the readmission penalty program, notes Amy Boutwell, MD, MPP, president of Collaborative Healthcare Strategies and a co-founder of the IHI STAAR (State Action on Avoidable Rehospitalizations) Initiative, Dr. Boutwell is also senior physician consultant to the National Coordinating Center for the CMS QIO Care Transitions Theme.

All of these elements factor into your Medicare reimbursement over the next several years. The good news is that along with these penalties and performance-based value purchasing strategies, there is a wealth of technical assistance available to hospitals and community-based teams trying to improve care transitions. There are literally hundreds of millions of dollars in technical assistance that has been funded by CMS and the Administration on Aging to help hospitals and community-based partners such as area Agencies on Aging and others work together to improve care transitions to reduce readmissions.

Many of you are very familiar with the Hospital Engagement Networks. I want to remind you that the Quality Improvement Organizations (QIOs), of which there is one in every state, have been charged through their contracts to help communities. Groupings of hospitals and of post-acute providers in regional geographies help to improve care transitions and care coordination across settings. Take advantage of the wealth of other programs and incentives that are coming out of the federal government in this domain.

We know the readmission penalties are here to stay and there will be time lines between your good efforts at the pilot level today and your ability to see those numbers move in terms of getting your hospital out of the penalty zone. In my experience, we do need to move quickly from pilot projects to a portfolio of work to help make some traction on readmission performance for hospitals. I always go back to the STate Action on Avoidable Rehospitalizations (STAAR) initiative, which I co-founded. Its how-to guide to reducing hospital readmissions is the broadest stroke guidebook that is out there.

Some toolkits have a very fine level of detail, which is very helpful; the STAAR toolkit contains broad concepts. I hope it is helpful to teams. These days, I’m seeing hospitals take good ideas from everywhere and put them together into one strategy based on their own resources and cross analysis.

Excerpted from 33 Metrics for Care Transition Management.

Infographic: How the ACA Affects Mental Health

April 7th, 2014 by Jackie Lyons

In terms of medical care, missed days of work, chronic health issues and death, depression is estimated to have cost the United States $112 billion in 2013, according to a new infographic from The Affordable Care Act (ACA) mandates mental health coverage for millions of Americans and requires a free depression screening under all health insurance plans.

This infographic provides an overview of depression in America, including prevalence of depression, the average cost of a hospital stay, cost of medication, as well as how the ACA is expected to impact mental healthcare.

Illness Management and Recovery (IMR): Personalized Skills and Strategies for those with Mental Illness helps people with SMI identify personally meaningful goals and work to achieve these goals by addressing smaller, more manageable segments of those goals.

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.

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Infographic: Technology Poised to Change Future of Nursing

April 4th, 2014 by Jackie Lyons

Healthcare reform is not the only change that will affect the nursing profession, evolving technology is likely to alter the future of nursing as well.

Among emerging healthcare technologies is barcode medication administration, which allows medications to be scanned before being administered. This enables nurses to check that the medication is correct, for the right patient and in the right dosage, according to a new infographic from Norwich University Online.

This infographic outlines other technologies that will change the nursing industry in years ahead, as well as how healthcare reform and education will affect the nursing profession.

Looking for other ways to increase medication adherence? You may also be interested in 2013 Healthcare Benchmarks: Improving Medication Adherence. This 56-page resource provides actionable information from more than 100 healthcare organizations on efforts to improve medication adherence and compliance in their populations.

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.

Lessons from the CMS ACE Bundled Payment Project

April 3rd, 2014 by Cheryl Miller

Simply put, payment bundling is one of the few policy alternatives available to the healthcare industry in which patients, providers and payors do better, explains Jay Sultan associate vice president and chief product portfolio architect, Trizetto® Corporation. Here, he explains the model, in light of lessons learned from CMS’ recent Acute Care Episode (ACE).

I worked on the CMS ACE Demonstration as an agent for two of the hospitals participating in it; I helped them set up and design the program. Going through all the different constituents, the payor received a discount, they shifted risk, the hospital was able to decrease cost and increase market share.

In one fairly straightforward instance, a single diagnostic-related group (DRG) in the ACE Demonstration Project covered roughly 38 DRGs related to hips and knees. It was all of the implantable related cardiac DRGs, like valves, stents and AICDs. It also included coronary artery bypass grafting (CABG). On one of the DRGs, , they were able to get a $2,000 case reduction in their internal costs.

The hospitals and the physicians both had their revenues go up through their share of the cost savings by the 25 percent that CMS limited them to. Had CMS not placed a limit on how much revenue the physicians could collect, at least one hospital said they thought that they could have doubled the physicians.

Just to be clear, the physicians doing ACE on average, based on the data that’s been reported so far, are getting paid 125 percent for doing traditional Medicare. They could have gotten 200 percent if CMS had not capped their savings.

Is all of this bad for the patient? It’s led to improved quality measurement, improved patient satisfaction. And in this particular program, the members actually got a rebate; a portion of the savings CMS negotiated was given to the patient for going to the facility doing the bundles. I’ll come back to that point later when we talk about the role of steerage and winners and losers in these new payment methodologies.

Excerpted from Blueprint for Bundled Payments: Strategies for Payors and Providers.