Move the dial from compliance to commitment
March 13, 2012
Shana Owens, HR Investment Center
Significant changes in the health care industry are placing considerable pressure on hospitals and health systems to deliver stronger outcomes at lower costs. Moreover, with changes to payment models now a reality, hospital finances will be directly tied to organizational performance on cost and quality goals.
Hospitals that continue on their current course, failing to react and adjust for these changes, could face double-digit declines in operating margins over the next decade.
Clearly, hospitals’ ability to improve cost and quality performance depends on staff at every level within the organization. Yet, as providers are being held more and more accountable for institutional performance, there is a troubling disconnect between expectations for the organization and frontline staff.
The majority of staff have no real stake in organizational performance and are instead held to standards based on compliance and task completion. In short, staff are still largely operating in an "A for effort" world, while hospitals are increasingly held to an "A for outcomes" standard.
From compliance to commitment
Bridging this disconnect and creating greater individual accountability at the front line is the foundational step to improving organizational performance. Staff must not only excel within their specific roles, but also feel individually responsible for the organization’s performance on key goals.
Health care leaders who have successfully created this culture of frontline accountability point to four key steps.
Equip frontline managers to drive staff accountability
Perhaps counter intuitively, leaders must focus first on the primary vehicles for driving staff accountability—the frontline managers. Instilling staff accountability will be near impossible if frontline managers are not reinforcing the organization’s effort. Hospital leaders must ensure that managers are modeling accountability and provide them appropriate support in effectively communicating goals and performance to their staff.
Establish greater line-of-sight
It is not enough for staff to simply know key priorities. All too often, staff do not clearly see how their discrete actions contribute to organizational goals. To improve line-of-sight and allow staff to more easily see their impact on organizational performance, leadership must distill critical organizational priorities into actionable frontline goals and objectives.
Formalize goals in performance management
Performance management is an obvious lever to drive accountability, but is not always fully leveraged at the frontline level. In addition to assessing staff against behavioral competencies, performance management systems should formally capture key organizational priorities and staff-level objectives related to those goals. This formal pairing further reinforces staff connection to and progression toward organizational goals.
Create non-financial incentives
Well-administered, non-financial incentives have proven just as powerful in motivating staff accountability as formal performance management. Recognition programs and targeted developmental opportunities are impactful ways to reward performance and drive long-term commitment. Likewise, formal opportunities for constructive peer-to-peer feedback help generate “positive peer pressure” among frontline staff to hold one another accountable.
To learn more about how to hardwire frontline accountability, HR Investment Center members may register for this year’s national meeting, Answering the Industry’s Productivity Mandate. Not an HR Investment Center member? Learn more on our website.
HHS releases final rule on Medicaid expansion
March 16, 2012
HHS on Friday released the final rule for the Medicaid expansion mandated by the federal health reform law.
The overhaul expands Medicaid to individuals ages 19 to 64 who have an income up to 133% of the federal poverty level ($14,856 for an individual and $30,656 for a family of four). The changes will become effective in 2014, when the state-based health insurance exchanges begin operating.
HHS first proposed policies governing the expansion in August 2011. Responding to feedback from states and various stakeholders, the agency in the final rules included additional protections for consumers and additional options and flexibilities for states, according to a CMS release.
The final rules also make it easier for eligible residents to enroll in Medicaid and the Children's Health Insurance Program by reducing red tape and coordinating enrollment with insurance exchanges.
"Today, too many uninsured Americans turn to the emergency room for care and can't pay their bills," said CMS Acting Administrator Marilyn Tavenner. "Insuring more Americans will decrease the hidden tax states and consumers with insurance pay to cover the cost of caring for the uninsured" (CMS release, 3/16; Daly, Modern Healthcare, 3/16 [subscription required]).
NYT: Why new patient satisfaction metrics miss the mark
Op-ed urges CMS to ask 'deeper questions' about hospital care
March 16, 2012
Using patient satisfaction scores to assess hospital care quality is "worrisomely off the mark," oncology nurse Theresa Brown writes this week in the New York Times.
Starting in October 2012, CMS will base hospital Medicare reimbursement and incentive payments in part on scores from the Hospital Consumer Assessment of Healthcare Providers and Systems survey.
Although Brown notes that the survey includes many important questions about patient engagement, she writes that "implied in the proposal is a troubling misapprehension of how unpleasant a lot of actual care is." According to Brown, much care provided in hospitals is "invasive, painful, and even dehumanizing."
For example, Brown writes that pleurodesis, a treatment that involves abrading the lung lining to stop fluid from accumulating there, is a painful procedure that hurts the patient in the short term to prevent more serious health problems in the long term.
Similarly, Brown notes that honesty about a patient's prognosis may not generate positive satisfaction scores.
Recent research indicates that efforts to boost patient satisfaction scores may increase mortality rates. According to Brown, the findings suggest that "evaluating hospital care in terms of its ability to offer positive experiences could easily put pressure on the system to do things it can't, at the expense of what it should."
If CMS is going to link reimbursement to satisfaction scores, Brown urges the agency to "ask deeper questions" and "incorporate questions that address the complete and expected hospital experience" (Brown, Times, 3/14).
MedPAC recommends 1% pay bump for hospitals
Panel reiterates support for SGR repeal in annual report
March 16, 2012
The Medicare Payment Advisory Commission (MedPAC) on Thursday in its annual report to Congress recommended increasing certain hospital payments and urged lawmakers to overhaul the sustainable growth-rate (SGR) formula.
The 443-page report presents the group's Medicare payment policy suggestions, which were approved by its commissioners in January. Specifically, MedPAC recommends that Congress increase hospital inpatient and outpatient care payments by 1% in fiscal year (FY) 2013. MedPAC also calls for reducing payments for evaluation and management visits in hospital outpatient departments to the rate of free-standing physicians' offices across three years.
In addition, the report recommends a 0.5% payment increase for ambulatory surgical centers, a 1% payment increase for outpatient dialysis services, and a 0.5% payment increase for hospice services. MedPAC did not recommend increasing payments for skilled-nursing facilities, long-term-care hospitals, or inpatient rehabilitation facilities.
MedPAC reiterates support for SGR repeal
MedPAC in its report continued to urge Congress to repeal the SGR formula and replace it with a 10-year path of statutory fee-schedule updates.
Specifically, the panel recommended freezing current primary care payment levels, and reducing payment levels for all other services by 5.9% annually for three years, followed by a freeze.
MedPAC suggested various ways to fund an SGR repeal in October 2011, such as applying an excise tax to Medigap plans and rebasing skilled-nursing facility payments, which it again included in the March report.
Mark Miller, executive director at MedPAC, said he is unaware of any current legislation that aligns with the group's recommendations. "On the one hand, people are very frustrated with Congress: 'Why don't you act?'" Miller said, referring to the SGR formula. "But as long as the cost of the action is $300 billion, they've got to figure out how they're going to finance it" (MedPAC factsheet, March 2012; Zigmond, Modern Healthcare, 3/15 [subscription required]; Pecquet, "Healthwatch," The Hill, 3/15; McCarthy, National Journal, 3/15 [subscription required]).
Hospitals tap R2D2-like robots to handle 'dirty work'
Robot boom could create a 'bonanza' for software developers
March 16, 2012
Hundreds of R2D2-like "service robots" are taking care of basic transportation tasks at hospitals across the country, and experts expect their ranks to swell over the next few years, the Wall Street Journal reports.
Hospital service robots now are equipped with features found in smartphones or gaming consoles—including advanced sensors, motion detectors, microprocessors, and voice activation—that allow them to navigate chaotic hospital environments.
"My guess is that in five years, there will be 10 times the number of robots deployed in hospitals that there are today," says Donald Jones, a managing director at Draper Triangle Ventures, which supports Aethon, a robotics company that has placed service robots in more than 100 hospitals.
For example, Silicon Valley's El Camino Hospital in 2009 leased 20 Aethon service robots to help carry materials after it moved into a larger facility. "We were looking at having to hire 12 new staff at least, just to carry everything around this larger space," says Ken King, the hospital's chief of administrative services.
Software developers eye health care industry
According to the Journal, interest in hospital service robots could create a "bonanza" for software developers to write new programs and applications for the technology.
Robotics industry leader iRobot—the maker of the Roomba robotic vacuum cleaner—recently invested in InTouch Health, which makes video-enabled, remote-controlled robotic devices that allow physicians to conduct virtual rounds. More than 400 hospitals currently use InTouch robots or telepresence technology (Hay, Journal, 3/14).
Enforcement of HIPAA 5010 delayed—again
CMS pushes enforcement date back by three months
March 16, 2012
CMS' Office of E-Health Standards and Services on Thursday announced that it will delay by three months the enforcement date for the transition to HIPAA 5010 transaction sets.
HIPAA 5010 standards regulate the transmission of certain health care transactions among hospitals, physician practices, health plans, and claims clearinghouses. Converting to the HIPAA 5010 standards is seen as key to the larger switch from the ICD-9 clinical coding system to the ICD-10 system.
In November 2011, CMS announced it would wait until March 31 to begin enforcing compliance with HIPAA 5010 standards. However, CMS noted that the compliance date would remain Jan. 1.
In the new announcement, CMS said it now will wait until after June 30 to start taking enforcement action against health care entities that fail to comply with the HIPAA 5010 standards (Robeznieks, Modern Healthcare, 3/15 [subscription required]).
CMS adds 23 organizations to care transitions program
Initiative aims to reduce hospital readmissions
March 16, 2012
CMS on Wednesday announced 23 additional participants in its Community-based Care Transitions Program (CCTP), which seeks to coordinate care for Medicare beneficiaries at a high risk for hospital readmission.
Under two-year agreements, CMS will pay the selected organizations to provide support to patients transitioning to their home, a nursing home, or other care setting after a hospital stay.
For example, the groups will help patients stay in contact with their physicians and ensure that they are following prescription medication regimens.
The agreements are expected to support more than 126 local hospitals and 223,000 Medicare beneficiaries in 19 states.
CCTP is part of the Partnership for Patients, which aims to reduce preventable injuries by 40% and cut hospital readmissions by 20% by 2013. The new participants will join seven other community-based organizations that were announced in November 2011, increasing the total number of sites to 30.
The current participants account for roughly half of the program's $500 million budget, which was awarded through the federal health reform law. CMS will continue to accept applications until the program's funding is exhausted (CMS release, 3/14; Evans, Modern Healthcare, 3/14 [subscription required]; AHA News, 3/14).
Do as I do? Healthy physicians more likely to encourage lifestyle changes
CDC: 66% of surveyed physicians urged patients to modify habits
March 16, 2012
Physicians with good health habits are more likely to recommend lifestyle changes to their patients, according to a CDC study presented this week at an American Heart Association (AHA) meeting.
For the study, researchers surveyed 1,000 U.S. physicians about their lifestyles and asked them whether they recommend five national guideline lifestyle modifications to patients with high blood pressure. Those modifications are: eating healthy, limiting sodium consumption, maintaining a healthy weight, limiting alcohol consumption, and exercising.
The study found that about 66% of physicians recommend all five lifestyle changes to patients with high blood pressure. Physicians who exercised at least once per week and did not smoke were roughly twice as likely to recommend the five changes.
In addition, the study found that:
- 4% of surveyed physicians smoked at least once per week;
- About 27% exercised five or more days per week; and
- Nearly 39% consumed the recommended five or more cups of vegetables and fruits per week (AHA release, 3/14; Preidt, HealthDay, 3/14; UPI, 3/15).
Our reads for the weekend
March 16, 2012
The Daily Briefing editorial team highlights several studies and articles that got us talking this week.
Super PACs take aim at the federal health reform law's Independent Payment Advisory Board, USA Today reports. One TV ad claims the board is made up of "unelected, unaccountable bureaucrats." More.
At 8 feet 3 inches, Sultan Kosen held the world record for tallest man—and a tumor in his pituitary gland forced him to keep adding height. The Daily Progress explains how University of Virginia surgeons helped the Turkish man finally stop growing. More.
Do hospitals do enough to protect radioactive materials? A Government Accountability Office expert this week warned the Senate Homeland Security subcommittee of weaknesses in anti-terror rules, the New York Times reports. More.
In China, the biggest challenge to health reform may be public hospitals. The Wall Street Journal explains why. More.
What could adult medicine learn from pediatrics? Writing in the New York Times this week, Perri Klass outlines potential lessons. More.
The number of hospitalists in the United States jumped 172% between 2003 and 2010. Writing in The Atlantic this week, the University of Oklahoma's John Henning Schumann explains why young doctors are choosing hospitals over primary care. More.
U.S. doctors are feeling the squeeze and struggling to make ends meet, the Wall Street Journal writes. Why the pressure? More.
About 45% of health care organizations—including Children's Hospital Boston—now offer “artful healing.” The New York Times explains the trend. More.
Reuters goes behind the scenes and explains how the multistate lawsuit filed against the federal health reform law—a lawsuit which will be argued before the Supreme Court this month—came to be. More.
Dr. Chris Schlanger explains why your physicians are the key to your success
March 16, 2012
Combat the economic forces putting downward pressure on health care margins through strong physician network management.
Daily roundup: March 16, 2012
Bite-sized hospital and health industry news
March 16, 2012
Connecticut: Aetna and the Connecticut State Medical Society Independent Practice Association (CSMS-IPA) have announced a collaborative care program in four Connecticut counties. Under the program, Aetna-employed nurses will serve as case managers for Aetna's Medicare Advantage members and liaise directly with more than 500 CSMS-IPA physicians. The organizations also will collaborate to promote adherence to best practices and treatment plans (Anderson, Healthcare Finance News, 3/14).
New Hampshire: The New Hampshire House of Representatives has passed a bill that would repeal the state's certificate-of-need law for health care facilities, services, and equipment. The state's Department of Health and Human Services in a fiscal note said the bill would reduce state revenue and expenditures, increase local expenditures, and cause "uncontrolled spending" and "higher health care costs for all payers" (Lee, Modern Healthcare, 3/14 [subscription required]).
Pennsylvania: A Philadelphia Inquirer analysis of 14 Philadelphia-area hospitals and health systems found a 5.7% increase in aggregate patient revenue at nine Pennsylvania hospitals and systems, despite a 1.4% decline in inpatient admissions. Meanwhile, five New Jersey hospitals and systems reported a 4.4% increase in patient revenue and a 2.5% increase in inpatient admissions (Brubaker, Inquirer, 3/13).
Tennessee: HHS' Office for Civil Rights this week announced that Blue Cross Blue Shield of Tennessee has agreed to pay $1.5 million to federal regulators and follow a corrective action plan as a result of a health data breach that occurred in October 2009. The enforcement action is the first stemming from the HITECH Act's breach notification rule. The breach notification rule requires certain organizations to report health data breaches that affect more than 500 individuals. (Goedert, Health Data Management, 3/13; Cadet, CMIO, 3/13).
New guidelines call for less frequent cervical cancer screenings
The U.S. Preventive Services Task Force (USPSTF) on Wednesday issued new guidelines recommending Pap tests for women ages 21 through 65 every three years to screen for cervical cancer.
The guidelines' language on the three-year interval is more decisive than in the last version, which was issued in 2003 and was more open to annual screenings as an option. Although Pap tests have long been a part of annual gynecological exams for many women, medical groups in recent years have begun urging less frequent screenings.
The USPSTF guidelines, published in the Annals of Internal Medicine, mostly align with guidelines released on Wednesday by the American Cancer Society, the American Society for Colposcopy and Cervical Pathology, and the American Society for Clinical Pathology that also call for increasing the window between screenings.
USPSTF said that a Pap test with an HPV test every five years also is a safe option for women ages 30 through 65. For that age group, the medical groups' guidelines favored the five-year interval using both tests, rather than Pap tests alone at three-year intervals, although they said either is acceptable.
Although some physicians already use co-testing, it was not formally recommended until now. Both USPSTF and the medical groups noted that the presence of HPV in women ages 30 through 65 could signal a persistent infection that would raise cancer risk, which is why co-testing is valuable for that group. Both guidelines also advise against screenings for women younger than age 21 and older than age 65 (Parker-Pope, "Well," New York Times, 3/14; Pittman, Reuters, 3/14; Roan, Los Angeles Times, 3/14; Burton, Wall Street Journal, 3/14).