A fast-read monthly summary of the vital news of ACO, Medical Homes and the hospital to consumer continuum.

1. Information Advantage Group’s Healthcare Digest is focused on the emerging delivery
models for the hospital to consumer continuum. In a fast-read format, we
provide only the vital news that is essential to keeping you current on the latest and
most germane trends, ideas, results, technological developments and resources.
Simply click on a category relevant to you below to jump to the news topics, click on the
linked topic title to be taken to the source article. Most sources are publicly available; you
may have to subscribe for others.
Innovation
Trend Drivers HIE ACO
Trends
Physician & Oversight &
Medical Home Consumer
Professional Influence
Innovation Trends:
Just as a he shift of medical costs to consumers is driving changes
in financing the delivery of healthcare, disease specific concierge
services and the development of innovative systems for patient
recruitment, compliance and education is enabling cost-effective
quality care to capture an increasing proportion of the $363
billion healthcare market that is not included in overall
healthcare costs.
The Bond Market Has Pinched Hospitals Options For Securing Debt - Plenty Of Alternatives
Remain.
Three crucial changes have occurred this year that have narrowed the choices that hospitals
have for debt:
• The Build America Bonds program that permitted government hospitals to receive a 35%
reimbursement of their interest costs from the government has expired.
• The annual debt limit on bank-qualified bonds was dropped down to $10M from $30M.
• Bonds issued with a Federal Home Loan Bank credit may no longer be tax-exempt.
So how should hospitals plan? It depends on the financial girth of the hospital itself - a hybrid
of general obligation pledges and revenue pledges is the most likely the course - see article
for ideas. (H&HN Magazine, March, 2011)
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2. $363 Billion Of Healthcare Costs Not Being Counted.
Based on NHEA (Centers for Medicare and Medicaid Services), a
Deloitte analysis estimated that the hidden cost of healthcare in
the U.S. in 2009 was $363 billion and represents expenditures
that fall outside of traditional areas such as doctors, drug
coverage.
prescriptions, hospitals and insurance coverag This amounts to
14.7%
an additional 14.7% of health care spending that was not
previously captured in the National Health Expenditure Accounts
Accounts
data.
data 55% of this is the cost of supervisory care of taking care of a
sick or disabled spouse, family member or friend with the rest for
products, like nutritional supplements, mental health and
substance abuse facilities, alternative medicine, certain
ambulatory and ambulance services and weight-loss centers.
[Source: NHEA (Centers for Medicare and Medicaid Services) and
Deloitte Analysis]
Doc-In-
Focused Factories, Doc-In-A-Box, Hybrid ACOs: Carve Outs -
The Next Big Things?
all-
The next big thing in healthcare won't be large, all-purpose healthcare organizations -- it will
"focused problems,
be "focused factories" – bundles of care for treating very specific or expensive problems
according to Harvard Business School professor and health economist Regina Herzlinger,
PhD. Her observations include:
their
• When consumers start spending $1,000 or more of their own money for healthcare, that
opens up opportunities for retail medicine to be sold directly to consumers -- CVS and
Wal-Mart are offering clinic services now.
• Studies have shown these types of clinics are cheaper and better because they offer a
limited menu of what they do as focused factories than emergency rooms or physicians'
offices.
• Retail medicine is going to grow and will increasingly become the first point of contact for
the self-care which is the critical component of patient participation in chronic disease
management
• In a consumer driven system, patient’s costs will drive the creation of narrow networks for
chronic diseases and disabilities such as back pain because when people have to pay a
greater share for those services, they will pick narrow networks that cost less than the ER.
• These networks could be considered a type of accountable care organization (ACO) which
can encompass a wide variety of things – ACO doesn’t necessarily mean “everything-for-
everybody integrated delivery network.” (MedPageToday, March 30, 2011)
67% Of Those Surveyed Said Watching The Patient-Centered TV (Online) After Discharge
Those Patient-
Made Them More Motivated To Stay On Their Treatment Plan.
If you are viewing digital screens in pharmacies and doctor offices, you are seeing the Digital
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3. Out Of Home (DOOH) market at work. A number of digital out-of-home networks have sprung
up over the last few years targeting one of the more captive and engaged audiences there is -
- patients in healthcare settings. A new study from GfK Research North America for the
Wellness Network, which owns two hospital-based DO networks, showed that TV plays a
major role in passing the time during a hospital stay:
• Patients watched an average of 28 hours during their stays (five days average in 2008 for
the U.S.).
• Six hours were spent watching the Patient Channel, which reaches an average of 20
million hospital patients a year.
This type of programming led to:
• Hospitals receiving high evaluations from patients for the facility and its level of care for
patients,
• Patients ranking it ahead of TV news, support groups, and the Internet as a source of
health information; unsurprisingly, it ranked behind doctors and family and friends, and
patient-
• 67% of those surveyed said watching patient-centric TV or online websites after discharge
motivated
made them more motivated to stay on their treatment plan.
According to Magna Global's latest ad forecast, DOOH will show a 15.2% CAGR for the next
five years and be one of the fastest-growing media around the world. That puts it behind just
two hot media categories - online video (19.6% CAGR) and mobile (19.4% CAGR) for the
same period. This sets expectation for DOOH to grow about three times the rate for the
media business overall (5%-5.5% CAGR). (Media Post, January 11, 2011)
Hospitals Not Using Social Media To Its Fullest.
U.S. hospitals are missing an opportunity to engage patients and brand their communities by
failing to take full advantage of social media outlets, such as Facebook.
According to a study of 120 hospitals by Verasoni Ah Ha Insights completed January 12,
2011, only eight (6%) of hospitals had accrued 10,000 Facebook fans and most were not
using social media to its fullest potential. The most common shortages of efforts included
most hospitals not posting daily, attempting to start discussions, or use the Facebook
calendar feature to promote their events. Only eight hospitals (6 percent) had accrued 10,000
Facebook fans. Observations include, “While the numbers clearly indicate that patients are
on Facebook, it is the job of the hospitals to find them and engage them in a meaningful
way,” said Abe Kasbo, CEO of Verasoni Worldwide and co-author of the study. “And, just
because a hospital is on Facebook does not mean that they are building a meaningful
Facebook experience for both the hospital and the patient.” (Hospitals and Facebook: A Case
Study, Verasoni, February 25, 2011)
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4. Trend Drivers:
Anxiety about healthcare permeates not just the consumer, with their
increasing
increasing concerns about higher cost, but is shared by physicians
who are thinking of leaving. In the face of these pressures, Mark Frisse
of Vanderbuilt offers some sober realities about what it will take to
regulations
transform healthcare…can you do it all with regulations (see first topic
below)?
Too Much Transformation – Can Regulations Do It All ?
In an excellent overview article in Health Affairs by Mark Frisse, the Accenture Professor
of Biomedical Informatics at Vanderbilt University, the challenge facing the new leader at
ONC is to harness the momentum of the HITECH machine as goals, methods and public
perception change. He sees its future being determined by: HITECH’s aggressive timelines
ability to deliver; meaningful innovations; and the seasonal political and
economic environment of Meaningful Use. His observations about realities faced include:
• Transformation: To transform care you need to transform the culture - large enterprises
have such skill and resources, but for many other smaller peers, such methods are not as
abundant.
• Innovation: Again large enterprises have the resources to deploy disruptive innovations
like EHRs, while smaller or less sophisticated providers do not have the knowledge, time,
and resources required for transformation and innovation.
• MU Politics: The debate pivots on two poles - those who think you can push reform
through by regulation verses those who believe that market pull is the best response to
health reform initiatives and a more honest reality.
Finally, entities large and small have a very full plate - HIPAA, ICD-10, Meaningful Use, HIE,
EHR/EMR, are but a few pressing needs. Dr. Frisse urges ONC to shift its focus from how to
spend stimulus dollars to how to help providers complete all of this in a time of growing fiscal
restraint and not try to transform too much merely by regulation. (IAG Blog, March 26, 2011)
Over 9% Of Medicare Budget Attributed To Fraud And Abuse
The Government Accountability Office reports finding about $48 billion of fraud and abuse in
Medicare’s $507 billion 2010 budget due to “pervasive internal control deficiencies in CMS’
management of contracts.” This has increased the risk of improper payments and kept
“Medicare on a path that is fiscally unsustainable over the long term.” The report was
prepared for a Congressional hearing on Medicare and Medicaid fraud. (Healthcare Finance
News, March 3, 2011)
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5. Increases
Per Capita Healthcare Costs Increases 6.29% for 2010
Standard & Poor’s Healthcare Economic Composite Index reports the average per capita
cost of healthcare services covered by commercial insurance (8%) and Medicare (3.4%)
programs increased by 6.29 percent over the year ending in January. This marks the first
ary.
January
time since May 2010 that the combined growth rate has accelerated. (Healthcare Finance
News, March 17, 2011)
Per Capita Healthcare Costs $9,217 In 2009 – 15% Higher Than Government Predictions
According to a new Deloitte survey of over 1000 U.S. adults, per capita healthcare costs
amounted to $9,217 in 2009 - almost 15% higher than official government predictions Elderly
almost predictions.
U.S. residents accounted for 36% of total health spending ($1.01 trillion) were elderly of
which 83% of the spending came from those with annual household incomes of $100,000 or
less. Estimated for non-covered care totaled to almost $2.83 billion in 2009 including:
• $199 billion for the estimated value of supervisory care provided by friends and relatives;
• $144 billion spent on nursing homes;
• $72 billion spent on home healthcare; and
• $246 billion spent on prescription medications.
(Deloitte, March, 2011)
70% Of Patients Have Anxiety Is Rising Over Medical Bills, And 73% Expect Their
Physicians To Be Accessible Online
An industry survey from Intuit Health showed that patients expect doctors to be online and
rising anxiety over their medical expenses. As Americans are now so accustomed to paying
bills online that they expect that same convenience and connectivity from their doctor’s office.
The survey highlights include more than 50% of respondents stated that "anytime, anywhere"
access is so important that they would consider switching doctors for a practice that does
offer online services. (Healthcare Finance News, March 3, 2011)
services.
Medi/Medi Enrollment May Exceed PCP Capacity By 2019.
health
Growth of at least 16 million in Medicaid enrollment by 2019 under health reform will greatly
outpace growth in the number of primary care physicians (PCPs) willing to treat new
Medicaid patients, according to a study by the Center for Studying Health System Change
(HSC). In the U.S:
• 42% of PCPs in 2008 were accepting all or most new Medicaid patients
• 61% of PCPs were accepting all or most new Medicare patients
• 84% were accepting all or most privately insured patients.
Concerned policymakers worry that primary care capacity may fall short in meeting the
increased demands from new Medicaid patients. It is thought that higher Medicaid
reimbursement rates cause a greater probability of PCPs accepting all or most new Medicaid
patients - the effects are relatively modest, according to the study sponsored by the Robert
Wood Johnson Foundation. (CMIO, March 18, 2011)
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6. 2010 – Running A Practice Has 40% Of Primary Care Physicians Thinking About Leaving
Their Field
Paperwork, reimbursement worries and bureaucracy, running an office and costs to do so are
leading causes for physicians thinking about alternatives to primary care. Yet, face-to-face
time with patients has been the most rewarding part of the job for many, but this has been
eroding steadily.
A late 2010 survey of 3,729 family care physicians found that about 40% had considered
leaving their primary care practices that year…16% said it was the first year they had
considered a career change.
The survey also reported that three out of five physicians enjoy better job satisfaction than
they anticipated on their first day in medical school. (CMIO, March 23, 2011)
NEWLY RELEASED - HELPFUL RESOURCES
The Direct Project
Office of the National Coordinator for Health IT (ONC) has released “The Federal Health IT
Strategic Plan: 2011-2015," an 80-page last published in 2008.
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7. HIE
As the HIE rollout proceeds, the Direct Project gains interest and
the federally funded Alembic open source project gains
momentum. Several new recourses for evaluating your HIE.
The Direct Project Gaining Broad Support
Over 65 IT vendors and integrated delivery systems, have planned support for the Direct
Project, according to the Office of the National Coordinator for Health IT (ONC) in addition to
twenty states having ONC-approved HIE plans that incorporate Direct as part of their health
IT plans. Several key Direct Project specifications are now complete or in late-stage draft,
late-
and reference implementations are compete and production-tested (CMIO, March 22, 2010)
production-tested.
NEWLY RELEASED - HELPFUL RESOURCES
Evaluating
A Framework For Evaluating HIEs
The CHIDS HIE Evaluation Framework for HIEs includes five performance measures
for: business model sustainability and value, organizational structure and decision making,
use of technology, engaging the community; and developed trust in the system. The center
used the framework as it assessed the District of Columbia Regional Health Information
Organization, see the report here.
Alembic Foundation To Shepard The CONNECT Open Source Project – Access To All.
Two leaders of the federally-funded CONNECT initiative to develop open source,
downloadable health information exchange software now head a new foundation created to
take the lead in promoting and expanding use of the technology that was released in April
2009 to the open source community. It was always the government's plan to see a private
sector organization take over management of CONNECT to optimize the availability of the
code to all participants in addition to federal agencies. The Alembic Foundation in Falls
Church, Va., and Vanessa Manchester, COO, served as staff for CONNECT in the Office of
the National Coordinator for Health Information Technology. As one of their first acts, the
foundation has copied the latest version of the software, CONNECT 3.1, private-labeled it as
Aurion 3.1 and released it to the open source market on March 21…Aurion 4.0 is to be
released on May 3. More information on The Alembic Foundation and Aurion is available at
alembicfoundation.org and http://aurionproject.org/.
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8. ACO
“Tip of The Day” and release of proposed rules reigns king around
the early days of planning for an Accountable Care Organization
(ACO). However, an evaluation of CMS data by VHA differs on
needed margin (see last topic in this category).
10 Key Points in March 31, 2011 Release of Proposed Rules for ACOs
The 10 key points in the proposal are generally described.
1. Projected savings. Overall Net savings may range $510 million to $960 million over the
first three years.
2. Two payment tracks. In the first phase of the program, ACOs will be allowed to choose
between two different tracks to get shared savings
• "one-sided risk" model, an ACO that saves at least 2% of reimbursements would get 50%
of the money above that threshold, but it would have no penalty if it spent more in the first
and second year.
• A second, more risky model would give an ACO 60 percent of the money above the
threshold but also penalize the ACO if it spent more.
3. No start-up funding. The proposal reportedly lacks any start-up funding for ACOs and the
start-
average start-up cost for each participant in the Physician Group Practice Demonstration was
in the seven figures.
4. Beneficiaries can limit data. Mandatory notification to beneficiaries that they are part of the
ACO, they can opt out of sharing data and still get care from the physician or other providers.
5. Reporting quality data. ACOs would report a total of 65 quality measures in five domains -
in the first year they have to only report quality data. Then in years two and three their quality
data will be scored and affect their shared savings payments.
6. A single hospital can become an ACO… they have enough primary care physicians.
ACO….if
7. Specialists cannot create an ACO. "Specialists can't lead in forming the ACO, primary care
physicians or other providers, such as mid-level practitioners most lead.
8. Existing ACOs can join the program. Existing ACOs may qualify as a Medicare ACO as is,
the
if their governance structure includes Medicare beneficiaries.
9. Three levels of antitrust enforcement. The Federal Trade Commission and the Department
of Justice have jointly issued a proposed statement of enforcement policy for ACOs, which
mapped out the following three levels of enforcement.
50% trigger for automatic antitrust review. If providers in the ACO represent more than 50%
of the market, they are subject to automatic review by the Department of Justice and the
FTC. They will receive a 90-day expedited review. If either agency raises a concern, they
could become part of the ACO program.
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9. 10. Beneficiaries on ACO boards. To demonstrate a partnership with Medicare FFS
beneficiaries and meet patient centeredness criteria by including a Medicare beneficiary
serviced by the ACO on the ACO governing body, the proposal would require having a
Medicare beneficiary on the governing board of the ACO. (Becker’s ASC Review, March 31,
2011)
CIGNA Pilot ACOs Early Returns Are Positive
By sharing “gaps in care” data with care coordinators at two pilots and using this information,
to ensure follow-up appointments are scheduled, prescriptions are filled or additional medical
tests are completed, two accountable care pilot projects shows both are achieving slower
growth in healthcare costs and improving quality of care.
• Dartmouth-Hitchcock Medical Center in New Hampshire shows the provider is closing
gaps in care 10 times better when compared to physician practices without coordinated
care.
• Annual average costs per patient have been lowered by $336 at Cigna Medical Group in
Phoenix, Arizona.
(Healthcare Payer News, March 24, 2011)
ACO Success Tips – Health IT Summit, San Francisco
The success of accountable care models will hinge on engaging patient in their everyday
their
lives and not only on the ability of all stakeholders to coordinate care across the continuum.
Panelist's comments at the Health IT Summit recently in San Francisco offered key concerns
in successful building an ACO:
• Identify at-risk patients early. “Get to them early...It could save millions if not billions of
dollars," noted Glenn Keet, president of Axolotl.
• Get the consumer to know your brand. Patients won’t engage if they don’t know who you
are, noted family physician Katherine Schneider, VP of health engagement for Atlanticare.
• Aggressive communication strategies are needed to identify and engage patients and
cultivate mind share by all ACO stakeholders, noted panelist Scott Young, senior medical
director at Kaiser Permanente.
• Pay attention to the needs of the emerging younger generation of patients – they’re going
to expect their care to be delivered differently. Things like providing digital consultations
via email or instant messaging to meet the younger generations preferences and life style,
said David Nace, McKesson's VP and medical director.
(Fierce Health, March 24, 2011)
Five Way For Providers To Realign For ACOs.
Here are five ways the hospital and physician relationship will evolve in the wake and
preparation of ACOs.
1. A revised culture may mean the expiration of traditional bureaucracy and respected
governance and communication.
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10. 2. Physician and hospital are not knife and fork – they are fighting for the same dollar and
leaders need to have "crucial conversations" for ACOs to work.
3. Independent physicians must form new affiliations with hospitals to maintain negotiating
strength with the payors.
4. Hospitals and physicians can strengthen ties through a variety of models other than full
acquisition.
5. Shifting from fee-for-service to a culture focused on quality and outcomes will offer
physicians new opportunities for leadership.
(Becker’s Hospital Review, March 28, 2011)
New Models Of Integration For California ACOs.
California's
California's prohibition on the corporate practice of medicine, which prevents hospitals from
employing physicians, has providers increasingly implementing the medical foundation
model.
model This is a legal arrangement in which a tax-exempt organization contracts with
physician groups to create a non-profit foundation, allowing physicians and hospitals to work
together on practice management and other elements of integrated care.
Steve Geidt, CEO of Saddleback Memorial Medical Center in Laguna Hills and San
Clemente, California says that in California, "The biggest challenge now is many physicians
want to be employed; they want the stability that a health system might provide them instead
of going into private practice." He went on to point out that Geisinger Health, Mayo Clinic,
Kaiser Permanente in Oakland and Virginia Mason as examples of successful physician
integration and ACO-like models – these enterprises are health systems, not hospital
systems. Large multispecialty medical groups like these are more integrated than a network
of independent medical groups and often in a better position to manage the health of a
defined populations. However, not every market has a Geisinger or a Mayo Clinic in it.
Strong physician leadership is a key ingredient and one of the biggest challenges they will
biggest
face when integrating physicians to form an ACOs is adapting to change. Courage to trust
each other is another essential element for physician integration. Building trust requires
consistent attention. "The evolution towards the healthcare delivery system of the future is
one that will be littered with anxiety and challenges and a need for vision and
communication," says Mr. Geidt. (Becker Hospital Review, March 21, 2011)
ACOs Could Take More Time And Higher Margin To Break Even.
Authors Trent T. Haywood, MD, JD, and Keith C. Kosel, PhD, MBA, from the VHA network
reviewed the previous government demonstration ACO data anticipating the government
model would have produced promising results that warranted its rapid expansion - their
analysis of the results from the demonstration suggests otherwise. The CMS report showed
five-
that with a five-year time horizon and a mean investment of $737 per PGP provider, the
authors
required margin to break even is 13 percent. Using the same data, the VHA authors
concluded differently and found that an ACO making the mean initial investment of $1.7
three-
million will require the unlikely margin of 20 percent for the three-year period envisioned by
CMS. (CMIO, March 24, 2011)
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11. NEWLY RELEASED - HELPFUL RESOURCES
Accountable Anesthesia Organization to download a free copy of "The Role of Anesthesia in
Accountable
Accountable Care Organizations And Beyond: IT Strategies For 21st Century Healthcare – an
introduction to trends models and architecture for the next generation of care delivery.
There
ACOs How To Get There By H&HN
The ACO Learning Network Is Infused With Knowledge From The ACO Pilots, Which
Comprise A Wide-Range Of Provider-Types Implementing Shared Savings Around The
Wide- Provider-
Country.
Country.
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12. MEDICAL HOME
Strong attention to organization dynamics are essential for the 3-5
year journey of building a medical home practice. House calls,
more nurse Practioners, patient involvement are vital.
3-
AAFP Study: Organizational Learning And 3-5 Year Commitment Is The Road To An Medical
Home
In June 2006, the American Academy of Family Physicians selected 36 mostly small
independent practices from 337 to launch the first large-scale demonstration of the patient-
centered medical home. Practices in this group were randomized into two groups: “facilitated
intervention” and “self-directed.” The authors were members of an independent evaluation
team for the project. These practices that were included in the national demonstration project
made efforts and attempted to implement as were charged with trying to implement as many
model components as possible over the two-year life of the project,
To become medical homes, practices must see themselves as organizations that apply the
four pillars of primary care to the needs and preferences of patients in their communities,
rather than as organizations that process patients for the convenience of physicians. The four
pillars of teams, information, access and healthy living.
patient-
Overall conclusion: Physicians making the transition from conventional practices to patient-
centered medical homes will need to master organizational learning and develop an
awareness that they may need a three to five year commitment Many good lessons included
commitment.
in the article. (CMIO, March 24, 2011)
Matching Fund For State Who Offer Medical Home Care Programs.
According to a March 18, 2011 report by the Health Resources and Services Administration
(HRSA):
57% of children in the United States have access to a medical home, and that children
without a medical home are:
• Nearly four times more likely to have unmet health care needs,
• Three times more likely to have unmet dental care needs and,
• Less likely to have had a preventive health care visit in the past year.
The federal government will match up to 90% of state funds for two years when they offer to
provide medical home models options for Medicaid enrollees with chronic conditions.
National Committee for Quality Assurance (NCQA) is the leading provider of recognition
programs with its Physician Practice Connections (PPC) recognition program. As of the end
of 2010, almost 7,700 clinicians at more than 1,500 sites across the United States had
received the organization's PPC-PCMH recognition. (Advance March 25, 2011)
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13. Tops
Patient Engagement, Diabetes, Medication Compliance, Strategic Content Are Tops On
PCMH List Of Needs And Goals.
A March patient-centered medical home (PCMH) survey by Promidian, a management
consulting firm, of 181 stakeholders, including physicians, medical directors, nurses, and
administrators and executives from medical group practices, health plans, pharmaceutical
companies, and employer groups found:
• Patient engagement in care, access to care, and a team approach to care are viewed as
PCMH,
the top three most important goals of a successful PCMH
• Diabetes, cardiovascular disease, asthma, obesity, and stroke top the list of priority
disease states to be attended to,
• Medication compliance is viewed as extremely important to the success of a PCMH,
• Most are highly interested in receiving strategic information products that target
maintaining accreditation (e.g., programs, tools and training).
(The Street, March 29, 2011)
Are
Artisanal Healthcare – House Calls? Docs Are Doing More Of Them.
Thanks in part to the Independence at Home provision of the Patient Protection and
Affordable Care Act, more physicians are venturing out to make house calls. It is estimated
practitioners
there are approximately 4,000 physicians, nurse practitioners and other medical
professionals nationwide who either specialize in in-home care or at least make it a part of
in-
their practice. As reported, the vast majority of patients are seniors on Medicare or low-
income Medicaid patients.
The American Academy of Home Care Physicians sums it up, "house calls are more likely to
prevent unnecessary and far more costly [emergency room] visits and hospitalizations. At
$1,500 per ER visit, the cost of 10 house calls is offset by one ER visit prevented." (Get
Healthy, March 20, 2011)
Institute of Medicine - More Nurses could take on more of the primary care load.
practitioners
California is one of 23 states that allow nurse practitioners to provide selected primary care
without physician supervision. Six California regions have a shortage of primary care doctors
and as their health systems take steps to develop medical home models of care, nurse
practitioners are expected to play a greater role in leading teams and providing primary care
services. Last fall, an Institute of Medicine report called for an expansion in the scope of
service that nurse practitioners can deliver. The report found that health systems that
increased nurses' responsibilities generally provided "safe, high-quality primary care." (Fierce
Practice, March 30, 2011)
Communication Perceptions Differ Between PCP And Specialists.
Primary care and specialist physicians see things differently when they consider how their
colleagues communicate about patient referrals and consultations according to HSC
communicate
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14. research titled, "Referral and Consultation Communication Between Primary Care and
Specialist Physicians: Finding Common Ground" and funded by the Robert Wood Johnson
Foundation and published in the Archives of Internal Medicine. The results found:
• 69% of PCPs reported regularly – "always" or "most of the time" – sending a patient's
history and the reason for the referral to the specialist, but only 35% of specialists said
they regularly receive such information
• 80% of specialists said they regularly send consultation results to the referring PCPs, but
only 62% PCPs said they received such information
What improves communication, the study pointed out factors that can improve
communication between specialists and PCPS.
• Having adequate time to spend with patients was the most important factor to both groups
of providers,
• Practice supports for care management that included feedback reports on quality of care
for patients with chronic conditions and nurse monitoring of these patients.
• The use of health information technology (HIT) produced higher reports of receiving and
sending communications by specialists but not by PCPs.
Research compiled by MGMA, the Urban Institute and the American College of Physicians in
2009 indicates that with each NCQA certification level, the median cost for personnel and
information technology, per full-time-equivalent physician, progressively increases. The
research, funded by RWJF shows that costs per certification level add up to:
Level 1 -- $145,000 for support staff, $5,000 for IT (no EHR)
Level 2 -- $153,000 for support staff, $8,000 for IT
Level 3 -- $165,000 for support staff, $11,000 for IT
In most PCMH demonstrations, these costs were offset by management fees paid to the
practice for enrolled patients. (MGMA Blog, March 28, 2011)
No Major Increase In Onsite Medical Home Accreditations Seen
• Currently, only the Accreditation Association for Ambulatory Health Care requires an on-
site surveyor visit in its medical home certification program and has certified more than 60
practices as medical homes. w up some time before the third anniversary of its last
survey.
• The Joint Commission is field-testing its "primary-care home" accreditation program,
which is set to launch in July, 2011.
• The Patient Centered Health Care Home program at URAC, formerly the "Utilization
Review Accreditation Commission," is seen more of as an educational offering through a
self-assessment tool kit. In the future, some level of on-site audits by practices seeking
certification.
• The National Committee for Quality Assurance (NCQA) has recognized some 1,800
practices as medical homes since 2008. 5% of recognized medical home are audited,
mostly as "desk audits," a few visits are made with no plans to significantly increase
inspections.
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15. See recently released medical-home principals list of guidelines. (Modern Physician, March
17, 2011)
NEWLY RELEASED - HELPFUL RESOURCES
"Better to Best: Value-Driving Elements of the Patient Centered Medical Home" (PDF), a
Value
alue-
collaborative 48 page effort by the Patient-Centered Primary Care Collaborative and
sponsored by the Commonwealth Fund and the Dartmouth Institute for Health Policy and
Clinical Practice. Includes five consensus statements—each accompanied with a set of
recommendations—that participants in the Sept. 8, 2010, meeting said could build on medical-
home demonstration project findings and synchronize innovations to create a more
sustainable healthcare system.
To become a PCMH, practices must be certified by one of three organizations:
National Committee for Quality Assurance (NCQA) – which recognizes three PCMH levels
Accreditation Association for Ambulatory Health Care
The Joint Commission Primary Care Home Standards To Be Released July 2011
Other:
Patient-
AAFM Patient-Centered Medical Home Checklist
A PCMH Standards And Guidelines
HRSA Initiative For FGHS To Gain PCMH Recognition
HRSCMH Initiative Program Assistance Letter (Pal)
Intro To NCQA PCMH Recognition Program (Teleconference & Text)
NCQA 2011 Standards And Guidelines For PCMH Recognition
Medical
PCCDC “Patient Centered Medical Home: A How To Manual”
Safety Net Medical Home Initiative
Remote
The Connected Patient: Charting the Vital Signs of Remote Health Monitoring
The American College of Physicians Tool - Medical Home Builder
Institute of Medicine - The Future of Nursing: Leading Change, Advancing Health
Patient Centered Primary Care Collaborative – An excellent listing of free publications
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16. PHYSICIAN & PROFESSIONALS
Phone
Physicians Trying To Charge For Phone Calls Just Like Attorneys
Complete Children's Care in Lincoln, Neb., has told patients that a $20 "telephone care"
charge will apply to calls over five minutes that aren’t part of the appointment process or
follow up on a previous weeks visit. Two arguments for and against prevail:
• Attorneys have long charged their clients for phone calls without any argument.
• Telephone calls are already built in to the fee schedules for other physician services, such
as office visits, and therefore not separately billable for most government and commercial
insurers.
(Fierce Practice, March 13, 2011)
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17. CONSUMER
Consumers will increasingly demand online services, devices and
media choices to match the way they want to get their
healthcare. Social media is not high on the list as a way to get
healthcare
Physicians Need To Be Online To Allay Patients Concerns And To Be Paid Better.
A new survey from Intuit Health found two major trends when it comes to Americans and their
healthcare: they expect their healthcare providers to be easily accessible online and they are
:
concerned about their medical bills. Part of this is that we are rapidly getting more
accustomed to paying our bills online and are expecting the same convenience with all parts
of or lives including our healthcare and the people who provide it. The study found:
• 20% of Americans feel they cannot easily connect with their doctor’s office to ask
questions, make appointments or obtain lab results.
• 73% of Americans would use a secure online communication solution to make it easier to
get lab results, make appointments, pay medical bills and communicate with their doctor’s
office, the poll finds.
• 81% would schedule their own appointment via a secure Web service and fill out
medical/registration forms online prior to their appointment.
• 78% of respondents would use a secure online method to access their medical
histories and share information with their doctor.
• 59% of Gen Y respondents said they would switch doctors for one with better online
access compared with only 29% of Baby Boomers.
• Almost 50% of patients would consider switching to a physician that offered online
services such as those.
• 70% are somewhat or very concerned about managing their health care bills and costs, no
change from last year,
• 41% of consumers do not have confidence that the billed amount is correct.
• 20% are unsure whether to pay their doctor or the insurance company. Gen Y
respondents were most unsure whom to pay – 28% as compared to 8% of Baby
Boomers.
• 57% have had at least one medical bill go to a collection agency. Women are twice as
likely as men to let a medical bill go past due.
• 45% of patients wait more than a month to pay their doctor bill, and when they pay, half
still send a paper check in the mail.
• 66% think their healthcare will cost more in the future; only 59% of Gen Y and GenX
thought the same
• 62% saw a rise in their healthcare cost in 2010; only 59% of Gen Y and GenX thought
the same
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18. Clearly, the trend is that patients want some measure of control, convenience and better
communication with their doctor. (Intuit, March 2, 2011)
Healthcare
Patient Not Fond Of Social Media For Healthcare But Love Online Service Options.
Despite the buzz and adoption, another study showed that Americans are not embracing
social media as a way to communicate with their providers, according to a national Capstrat-
Public Policy Polling survey which found:
• 85% would not use social media or instant messaging channels for medical
communication if their doctors offered it.
• 11% said they would take advantage of social media such as Twitter or Facebook to
communicate with their doctor,
• 20 percent said they would use chat or instant message,
• Only 21% of Millennials (18 to 29 years old), an age group that seems ripe for
electronic health communication, would use an online forum for healthcare.
Traditional online was much more palatable to respondents:
• 52% were favorable toward conferring with their doctor via e-mail,
• 56% online appointment setting, 50% online access to their medical records,
• 48% online bill payment.
Nurse staffed help lines was the preferred form of communication across all demographic
and ages:
• 72% said they would take advantage of a nurse help line if it was offered by their doctor,
• 55% would be interested in online advice from nurses.
(Health IT News, March 24, 2011)
Fitness Device Vendors Are Interfacing With Each Other To Unify Data
Some of the leading fitness device and application companies are working together to open
up their APIs and share their own data with each othe This amalgam is bringing together
other.
much of the same data that Google Health has promised to host. Wellness services
including Zeo, RunKeeper, FitBit, WiThings and Digifit are all sharing data now…we can
expect more of this in this sector. (Run Keeper, March 30, 2011)
Interactive Monitors Increases Patient Satisfaction With Education Materials
A study of patient’s use of interactive television monitors located in their rooms in six different
healthcare systems saw overall increase in patient satisfaction of 10% and a 42% increase in
satisfaction with educational materials The monitors allowed patients to communicate with
materials.
staff and access information about their care from their beds to:
• Access and review post-discharge instructions before they leave,
• Ask clinicians questions
• Check meal menus
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19. • Access educational materials about their conditions, and
• Request assistance and
• Caregivers to respond.
(Jackson, Sara. Use of Interactive Technology Boosts Patient Satisfaction, Fierce
Healthcare, March 9, 2011)
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20. OVERSIGHT & INFLUENCE
fraud;
Home Health coming under fire for medical fraud; telemedicine gaining
some traction and trying for new regulations…again.
REGULATORY
Crackdown On Home Health Fraud.
Effective April 1, 2011, Medicare beneficiaries, receiving home health services will have to
see a doctor 90 days before or 30 days after starting home health services for home health
agencies to get reimbursed. Services can be prescribed up to 60 days at a time and there are
no deductibles.
This crackdown is the result of Medicare home health costs have doubled to $19 billion in
2009, since 2002 and an increase in Medicare fraud during the same period. (Kaiser
Healthcare News, March 24, 2011)
Telemedicine Bill For Home Health Introduced
Sen. John Thune (R-S.D.) introduced a bill (S 501) that would create pilot programs through
incentive payments to home health agencies that use telehealth technology to improve health
outcomes for Medicare beneficiaries and reduce spending. This is essentially the same bill
introduced in 2005, 2007 and 2009 and targets rural and underserved areas with greater
access to care and allow seniors to stay in their homes longer. None of the previous bills
made it past the Senate Finance Committee..
According to American Telemedicine Association, the lack of Medicare reimbursement is the
biggest barrier to telemedicine adoption. "It's less than $3 million a year. It only does
videoconferencing for 21% of the Medicare beneficiaries. Things like remote monitoring
essentially aren't covered by Medicare at all, " according to Gary Capistrant, senior director of
public policy at the American Telemedicine Association.
According to the Bureau of Labor Statistics, nursing homes cost about $662 a day, as
compared to a one-day stay at a hospital costing about $6,200, accounted for more than 20%
of Medicare payments in 2009 — a total of about $28 billion, according to the Centers for
Medicare & Medicaid Services. Home care is a cheaper alternative to other forms of care as
it costs an average of $135 per visit. (iHealthbeat, March 17, 2011)
Credentialing
New Speedier Telemedicine Credentialing On Its Way
CMS has sent to the Office of Management and Budget a final rule to streamline
credentialing for healthcare providers of telemedicine services. This is one of the last steps
services
before a rule is officially published in the Federal Register. (Health Data Management, March
24, 2011)
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21. If you’ve read this far then we have been successful in giving you some value. Please
reciprocate and let me know your thoughts or if you don’t see something that you would like
to, then just drop a line to - jim@iag.co – thank you.
Jim Bloedau
Managing Partner
Information Advantage Group
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