Archive for the ‘News’ Category

Can Reality Programming Help to Prevent Diabetes? Stay Tuned

March 15th, 2012 by Patricia Donovan

Think “The Real Patients with Diabetes:” a reality series follows six patients with Type 2 diabetes.

While it may not draw the legions of viewers of a “Real Housewives” franchise, UnitedHealth Group hopes this type of programming can impact a more dire reality: the number of individuals who will develop type 2 diabetes.

To pilot the power of television as a diabetes prevention medium, the Minnesota-based payor and Comcast are seeking viewers in the Knoxville, TN area to watch the 16-episode NOT ME &#174 video on demand (VOD) programming. NOT ME uses a reality TV format to follows six adults with prediabetes as they go through the Diabetes Prevention Program.

Each VOD episode will feature a health and wellness coach leading a class of real participants who are working to reach a healthier weight and reduce their risk of developing type 2 diabetes. Between each episode, participants in the UnitedHealth Group study will practice at home the skills they learn from the program.

Participants in the pilot also will be given tracking assignments each week and opportunities to put what they learn into action.

NOT ME is based on the CDC-led National Diabetes Prevention Program, which brings evidence-based lifestyle interventions to communities by working through organizations that adhere to CDC-recognized, evidence-based standards.

Meanwhile, new market research by the Healthcare Intelligence Network indicates that successful diabetes management necessitates a delicate balance of primary care, patient education, case management and medication monitoring.

The 80-some healthcare organizations that responded to the 2011 e-survey report that while the primary care physician is still the primary influencer in diabetes care, case managers and certified diabetes educators (CDEs) increasingly round out the care team.

Also supporting the plan of care are health coaches (live and via telephone) and support groups.

Respondents’ efforts appear to be working: one-fifth of respondents report program ROI of between 2:1 and 3:1.

Since the goal of any diabetes management program is to guide the patient toward successful self-management of the disease, education is paramount. Many respondents reported the presence of case managers and/or nurses who have trained as CDEs. One respondent even offers patients a choice between a pharmacist, a registered dietician or a CDE.

Printed materials were overwhelmingly the most common educational component, reported by 78 percent of respondents. Thirty-five percent offer Web-based education tools.

With all of the challenges facing patients with diabetes, should patients be incentivized for successful self-management of their disease? Three-quarters of survey respondents say yes.

In fact, almost a third of respondents — 30.4 percent — already offer patients and health plan members incentives for compliance with their plans of care.

Baptist, Geisinger and Banner Among Top Performing Health Systems: Thomson Reuters

January 24th, 2012 by Cheryl Miller

Our congratulations to three frequent contributors to HIN for taking top honors in Thomson Reuters’ annual Best Hospitals list: Banner Health, a leader in ER efficiency, Geisinger Health System, on the forefront of comprehensive primary care, and Baptist Health, a model for bundled payments. These three esteemed health organizations, and 12 others, were singled out from more than 300 organizations for having achieved superior clinical outcomes based on eight metrics that gauge clinical quality and efficiency: mortality, medical complications, patient safety, average length of stay, 30-day mortality rate, 30-day readmission rate, adherence to CMS clinical standards of care, and HCAHPS patient survey score. A full list of the 15 winners can be found in this issue.

At the same time CMS issued its annual report on healthcare spending, showing historically low rates of growth for 2009 and 2010, the HHS has determined that Trustmark Life Insurance Company proposed unreasonable health insurance premium increases in five states, hikes that would affect nearly 10,000 residents. HHS is requiring the insurer to immediately rescind the rates and issue refunds to consumers, or publicly explain their refusal to do so. The ACA requires that insurance companies disclose and justify rate increases over 10 percent. States also have the authority to reject unreasonable premium increases since the passage of the law, to date, 37 states have this authority.

Certified Diabetes Educators and case managers are instrumental in diabetes management, according to the results from our 2011 survey on diabetes management strategies. More than three-quarters of healthcare organizations said they were taking a disease-specific approach to improving health outcomes and self-management in patients and health plan members with diabetes. And the majority of respondents said that weight management was the greatest challenge of managing diabetes. More details can be found in this story, and our complimentary downloadable white paper.

And don’t forget to take our newest survey: Reducing Hospital Readmissions Benchmark Survey. Describe how your organization is working to reduce hospital readmissions for 2012 by taking HIN’s third annual survey on this subject by January 31, 2012 and receive an e-summary of the results once they are compiled.

Gastric Bypass Surgery – Extreme Makeovers for Obese Teens

January 20th, 2012 by Cheryl Miller

It seems that gastric bypass surgery is way more popular than Justin Bieber.

At a time when most teens should be contemplating their friends’ latest Facebook post, there’s instead a large segment weighing the pros and cons of lap banding versus stomach stapling versus sleeve gastrectomy, the current crop of bariatric surgeries now targeted toward teenagers.

According to a recent New York Times article, 1 to 2 percent of all weight-loss or bariatric operations are on patients under 21, and studies are underway to gauge the outcomes of such surgery on children as young as 12. As stated in the Times:

Allergan®, the maker of the popular Lap-Band, a surgically inserted silicone band that constricts the stomach to make the patient feel full quickly, is seeking permission from the Food and Drug Administration to market it to patients as young as 14, four years younger than is now allowed. Hospitals across the country have opened bariatric centers for adolescents in recent years.

Along with the obesity epidemic in America is an explosion in weight-loss surgery, with about 220,000 operations a year — a sevenfold increase in a decade, costing more than $6 billion a year.

The article follows one obese but otherwise healthy teenager who has adjusted to her weight, but gets stomach banding surgery at her doctor’s advice to prevent future health problems like diabetes. The operation takes about 25 minutes, costs nearly $22,000, and is covered by a state insurance plan for low-income families.

Medicaid in almost every state and many private health plans now cover bariatric surgery, often more readily than diet or exercise plans. In fact, braces cost more than bariatric surgery. Federally funded bariatric surgery is a relatively new phenomenon; Medicare first endorsed paying for bariatric surgery in 2006. And Medicaid approved funding of it in 2004.

Gastric surgery is the latest surgical quick fix for teenagers who should be navigating the convoluted hallways of high school adolescence instead of surgery options. These surgeries constrict the stomach so that even eating a slice of pizza with friends, while not condoned in excess, could cause problems.

This, despite reports that show that U.S. obesity rates decreased last year from 26.6 percent in 2010 to 26.1 percent in 2011, according to a report based on the Gallup-Healthways Well-Being Index. Researchers said the decline was due in part to more Americans saying they were a normal weight in 2011.

This small decrease is significant, says Gallup researchers, because:

The cost of obesity is so high that even this small improvement has the potential to save the American economy a significant amount of money. A December 2010 analysis by the Society of Actuaries estimates that the total cost of obesity to the U.S. economy has climbed as high as $270 billion. Gallup’s own analysis finds that obesity and related chronic health issues cost businesses alone upward of $150 billion annually. But with more than one in four adults still obese, the nation has a long way to go to achieve lasting change.

We recently reported that CMS is now offering free preventive obesity counseling to seniors with a BMI greater than or equal to 30 kg/m2. As the Times reports, Allergan is targeting children at this threshold of obesity as candidates for the Lap-Band surgery.

And that’s a lot of children. According to a recent survey from the National Health and Nutrition Examination, nearly one-fifth of U.S. children and adolescents are obese.

It’s hard not to wonder when preventive education and old-fashioned dieting and exercise were replaced with surgical quick fixes like stomach stapling. Instead of paying for these surgeries, we need to finance education programs for the young so they don’t become one of the three American adults expected to have diabetes by the year 2030.

Low Healthcare Spending Linked to Poor Economy, Low Utilization

January 16th, 2012 by Cheryl Miller

The United States’ spending on healthcare increased by just 3.8 and 3.9 percent in both 2009 and 2010 respectively; these figures represent the lowest rate of increase in the entire 51 year history of the National Health Expenditures (NHE.) Analysts point fingers at the poor economy and low unemployment numbers, causing many Americans to skimp on medical care. A breakdown of the report is included in this issue.

The city that never sleeps could be getting just what the doctor ordered: expanded care facilities. Cigna and Weill Cornell Physician Organization have launched Manhattan’s first ACO between a health plan and a physician organization, in order to meet the
IHI’s aims to improve health outcomes, lower total medical costs and increase patient satisfaction. Crucial to the program’s success will be the utilization of RNs, employed by Weill Cornell, who will serve as clinical care coordinators and help patients with chronic
conditions to navigate their healthcare system. They will use patient-specific data provided by Cigna to identify patients being discharged from the hospital who might be at-risk for readmission, as well as patients who may be overdue for important health screenings or who may have skipped a prescription refill.

Job-hunting smokers beware: Geisinger Health Systems has joined the list of healthcare systems that will no longer hire smokers. As of February 1st, job applicants will be screened for nicotine as part of the company’s routine drug test. Cigarettes, smokeless tobacco, even nicotine patches and gum will prevent an otherwise eligible candidate
from being hired; however, applicants will be given a chance to reapply for the job in six months’ time if they take advantage of the company’s smoking cessation resources and can quit smoking in that time. Non-nicotine hiring practices are currently legal in 20 states, including Pennsylvania, where Geisinger is based.

And Google’s Flu Trends Tool is proving to be a successful warning system for hospital EDs. Researchers from John Hopkins noted in a 21 month study that the rise in Internet searches directly correlated to a rise in ER patients with flu-like symptoms; the study was particularly effective when noting the surge in searches for flu symptoms and the
number of children entering the pediatric ER. In the past EDs, hospitals and other healthcare providers have relied on CDC flu case reports provided during flu season, October to May, as a key way to track outbreaks. The Google tool collects and provides data on flu search topics on a daily basis. While the medical and science community has
generally accepted flu search activity as a good indicator of impending sickness, this study, detailed in this issue, is the first of its kind to show the relationship between the data and an increase in ER activity.

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

Study Suggests New Ways to Assess Hospital Quality

January 9th, 2012 by Cheryl Miller

It’s a new year, time to ring out the old, ring in the new, and reassess existing notions that, like some of those old sweaters, just don’t fit anymore.

For example, a new study from the Yale School of Medicine suggests that previously used ways to assess hospital quality might be in question. Until now hospitals, health insurers and patients measured hospital quality on the number of patient deaths during hospitalization. New research reveals that this measure could be misleading given that some hospitals keep their patients for a shorter time due to patient transfers, and that these hospitals are being favored. The study suggests an alternative approach: measuring patient deaths over a period of 30 days of admission, even after they have left the hospital. This finding could have wide implications as quality measures take on more importance in the healthcare industry.

And an international study suggests that the U.S. healthcare system can be modified to decrease readmission rates, showing that up to one third of heart attack readmssions might be preventable. The study of more than 5700 heart patients in the United States, Canada, Australia, New Zealand, and 13 European countries showed that readmissions may be preventable because rates are nearly one-third lower in other countries.

The HHS finalized its core set of Health Care Quality Measures for Medicaid-eligible adults; it comprises six major categories, among them prevention and health promotion, management of acute conditions, and availability of care. Healthcare providers and
insurers can use these measures to track care delivery among adults enrolled in Medicaid, as well as monitor and improve quality. More details can be found in this issue.

And lastly, a new initiative welcomes an old friend: Dr. Janice Pringle, a valued contributor on medication adherence, has been named an Innovation Advisor;
she is one of 73 selected for this initiative from CMS, designed to improve healthcare for patients. She and others will test new models of care delivery, form partnerships with local organizations to drive delivery system reform, and improve their own health systems.

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

War on Prescription Drug Abuse: Michael Jackson’s Doctor Found Guilty of Involuntary Manslaughter

November 9th, 2011 by Cheryl Miller

We recently reported that 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.

“Overdoses involving prescription painkillers are at epidemic levels and now kill more Americans than heroin and cocaine combined,” said CDC Director Thomas Frieden, M.D., M.P.H. in an agency press release.

Ironically, news of Michael Jackson’s former physician, Conrad Murray, being found guilty of involuntary manslaughter in Jackson’s 2009 death, broke the same week as this news story.

Testimony indicated that propofol, in conjunction with other drugs in the singer’s system, had played the key role in Jackson’s death on June 25, 2009; the Los Angeles County coroner’s office ruled that his death was caused by “acute propofol intoxication.”

According to the Drug Enforcement Administration (DEA,) propofol, a short acting intravenous anesthetic, is a prescription drug for use in human and veterinary medicine. It is to be used in hospital settings by trained anesthetists for the induction, maintenance of general anesthesia, and sedation of ventilated adults receiving intensive care, for up to 72 hours. In fact, propofol has been used in palliative care to sedate terminally ill patients suffering from severe agitation.

Prosecutors at Jackson’s trial said that Murray was guilty of criminal negligence by administering the propofol, and by not having the proper monitoring equipment, among other things. Defense attorneys argued that Jackson gave himself the fatal dose when Murray left the room.

Chances are Murray’s role in Jackson’s death will be debated for quite some time. But regardless, the ruling was a statement to physicians to stop fueling their patients’ reliance on killer prescription drugs, said Steve Cooley, the Los Angeles County district attorney, after the verdict was announced.

At the very least, the ruling re-cast light on this growing problem in the country. As cited by 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, according to the National Survey on Drug Use and Health. Based on the data from the Drug Enforcement Administration, sales of these drugs to pharmacies and health care providers have increased by more than 300 percent since 1999.

Non-medical use of prescription painkillers costs health insurers up to $72.5 billion annually in direct health care costs.

Steps have been taken to address this problem. In April, the administration released an action plan designed to counter the prescription drug abuse epidemic. Titled “Epidemic: Responding to America’s Prescription Drug Abuse Crisis,” the plan includes the following:

  • Support for the expansion of state–based prescription drug monitoring programs,
  • More convenient and environmentally responsible disposal methods to remove unused medications from the home,
  • Education for patients and healthcare providers,
  • Support for law enforcement efforts that reduce the prevalence of “pill mills” and doctor shopping.
  • Already, 48 states have implemented state–based monitoring programs designed to reduce “doctor shopping” while protecting patient privacy, and the Department of Justice has conducted a series of takedowns of rogue pain clinics operating as “pill mills.”

    But until the problem is completely eliminated, hopefully this trial and its verdict will put a face on the more than 40 people who are dying everyday from prescription drug overdoses; 40 plus people that didn’t make the news because they didn’t have the fame or notoriety of Michael Jackson.

    Just the unfortunate commonality of searching for a drug to mute their pain, and then being unable to live without it.

    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.

    60 Percent Increase in ED visits for Sports Injuries Among Youths

    October 17th, 2011 by Cheryl Miller

    There’s been a 60 percent increase in ED visits for sports injuries over the last 10 years. Experts attribute the increase to the public’s growing awareness of the risks of suspected traumatic brain injuries (TBI), CDC officials said. Research indicates that young athletes with a TBI experience longer recovery times and are at greater risk of serious outcomes than adults. The injuries, the majority of which occurred from bicycling, football, playground activities, basketball, and soccer, may appear mild but lead to significant lifelong impairment.

    But the prevalence of avoidable emergency department use still continues, an issue we tackle in our second annual survey, Reducing Avoidable ER Visits in 2011. What are you doing to staunch the flow and expense of avoidable emergency department use? We are seeking input on organizations’ efforts in this area, and if you respond by October 31 you will receive a free executive summary of the results.

    In other news, one third of people 65 years and older are undergoing surgeries in their last year of life, with 1 in 10 having surgery in their last week of life. Researchers from the Harvard School of Public Research, where the study was conducted, say the surgeries vary substantially with age and region, and express uncertainty as to the necessity of many of the surgeries. More details in this issue.

    ACO regulations have entered the final stage of the review process. The CMS sent the final Medicare Shared Savings Program regulations to the Office of Management and Budget for review on October 5th , one of the last steps in the approval process. No word yet on when the final rule will be published; we will keep you posted.

    Mount Sinai Research: $6.7 Billion Spent on Unnecessary Treatment in One Year

    October 10th, 2011 by Cheryl Miller

    Are physicians prescribing unnecessary medications or performing unnecessary tests?

    That is the $6.7 billion dollar question this week, given the results of a recent study from Mount Sinai Research. The answer? Well, according
    to this data, 86 percent of the excess spending is attributed to the prescription of brand-name rather than generic statin medications for the treatment of high cholesterol. Other reported areas of excess spending included the over-prescription of antibiotics for sore throats in children ($116 million in costs) unnecessary bone density scans ordered for younger women ($527 million in costs) and needless CT scans, MRIs, and x-rays for people with back pain ($175 million) We list more details in this week’s issue of Healthcare Business Weekly Update.

    Also contributing to excess healthcare costs — $17 billion annually — are hospital readmissions, which persist, especially among the elderly. According to a new Dartmouth Atlas Project Report, roughly one in six Medicare patients end up back in the hospital within 30 days of being discharged for a medical condition. Given the upcoming financial penalties from CMS for excessive readmissions, hospitals need to address this problem.

    One place to start could be by maintaining contact with the patient upon discharge: the Dartmouth study also found that more than half of Medicare patients discharged home do not see their primary care physician within two weeks of leaving the hospital.

    And here’s one possible solution: embedded case managers. They were crucial to CDPHP’s clinical transformation, helping chronically ill patients to better manage their diseases and helping to reduce
    hospitalizations and costs and improve quality of life.

    Another possible strategy? The new medication adherence tool being introduced by Merck. Targeting the high percentage of Americans that fail to take their medications as directed, Merck is hoping its online Web site will help consumers stay on course with treatment and have more informed discussions with their physicians about the medications they have been prescribed.

    Meditation Reduces Stress, Healthcare Costs

    September 19th, 2011 by Cheryl Miller

    Open wide and say…

    Ommm?

    That’s what doctors might be saying to their patients given the results of a new Canadian study that shows the health benefits of Transcendental Meditation (TM.) The study, which used people who consistently incurred the highest healthcare costs, found that the group that practiced the age-old technique for five years decreased their healthcare costs by nearly one third, or 28 percent, while the non-practicing group showed no significant decrease in healthcare payments. Chronic stress is the number one factor contributing to high medical expenses, and TM is known to play a significant part in reducing stress.

    It turns out meditation could be just what the doctor ordered for the 81 million Americans who were uninsured or underinsured in 2010, a number that has increased by 80 percent since 2003. Despite having insurance, these people suffer from financial stress due to higher than usual premiums and limited access. And lower income families aren’t the only victims; in 2010, one out of six middle class families earning between $40,000 and $60,000 a year were underinsured. The PPACA could provide relief, according to the study, not only for the underinsured, but for the uninsured.

    Illustrating the impact that diabetes is having on not only the U.S. healthcare system, but on a global scale, the International Diabetes Foundation (IDF) released the following findings: 366 million people are suffering from diabetes worldwide; 4.6 million people died from the disease in 2011; and healthcare spending on diabetes reached $ 465 billion. The IDF delivered the grim news a week ahead of the UN Summit on Non-Communicable Diseases (NCDs), which will be the second of its kind to focus on a global disease issue. It will target the four most prominent NCDs: cancers, cardiovascular diseases, chronic respiratory diseases and diabetes, and aim toward agreeing on a global strategy to address them. The first UN Summit related to health was the HIV/AIDS meeting in 2001, which led to the creation of the Global Fund to fight AIDS, tuberculosis and malaria.

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