Strategic issues to watch in 2012
January 31, 2012
In the fourth in a series of articles, we explore the strategic issues to watch in 2012.
Fate of the Affordable Care Act
In 2012, the Patient Protection and Affordable Care Act will face its most significant threats since the 2010 midterm elections as both the Supreme Court’s ruling and 2012 elections could derail the law’s implementation. How will the outcomes of elections—both for the Presidency and Congress—affect the future of the health reform law? Will the Supreme Court strike down key provisions of the law? And how would any changes to the reform law impact provider strategy?
Where to learn more: To learn more about the Affordable Care Act, Health Care Advisory Board members can access the Health Care Reform Crosswalk.
Launch of the accountable care market
Hospitals, health systems, and medical groups across the country will have the newfound ability to experiment with accountable payment models in 2012. On the Medicare front, providers have several viable options for entering the accountable care marketplace, including the Bundled Payments for Care Improvement Initiative and the Medicare Shared Savings Program.
At the same time, commercial insurers and self-funded employers are also developing their own accountable payment models. Will providers gravitate toward performance risk or utilization risk? Will the public or private sector emerge as the pacesetter in incentive transformation? How will local market competition evolve as providers experiment with accountable payment models?
- For more guidance on strategic issues, register for the Health Care Advisory Board’s national meeting, Beyond the ACO.
Battle for PCP loyalty in the care management marketplace
Despite ongoing challenges to PCPs’ economics, the fight to secure PCP loyalty will continue across 2012. Stakeholders of all stripes—hospitals, payers, employers, and even some big-box retail stores—have recognized PCPs’ centrality in the emerging care management marketplace. At the same time, new payment programs that reward successful care management may enable independent PCPs to remain in private practice. How will PCPs ultimately pick sides? Can stakeholders succeed in the new care management marketplace without PCP loyalty?
Where to learn more: To learn more about the battle for PCP loyalty, Marketing and Planning Leadership members can read or order Maximizing Primary Care Access. Health Care Advisory Board members can read or order The High-Performance Medical Group for more on emerging trends exacerbating traditional employment drivers.
Durability of scheduled provider rate cuts
Providers face a number of high-profile reimbursement cuts in 2012 and 2013. The Sustainable Growth Rate (SRG) continues to be a perennial concern for independent physicians nationwide—and the many hospitals that increasingly employ physicians. Further, the sequestration process created by the Budget Control Act of 2011 calls for a decade of annual two percent cuts to the Medicare program beginning in 2013. Will Congress continue to pass short-term SGR fixes or allow the scheduled cuts to take effect? Will the sequestration process continue as planned—or will Congress intervene to stave off the rate cuts?
Where to learn more: To learn more about the challenge ahead, Health Care Advisory Board members can read or order Running on Medicare Margins.
The next chapter in health care’s identity crisis
Stakeholders across the health care industry will face an ongoing identity crisis in 2012. Mergers and acquisitions continue to reshape local market dynamics—but the new transactions may increasingly include payers as well as providers. Given the multitude of forces threatening inpatient economics and the challenge of running on Medicare margins, hospitals will continue to question their long-term business model. Will 2012 market the year that health systems begin to identify as population health organizations rather than hospital-centric organizations?
Where to learn more: The Health Care Advisory Board is now accepting registrations for the 2012 CEO national meeting series. Sign up today to secure a seat at your preferred location.
Stay tuned for the next installment of our series where we’ll explore issues in IT. Or catch up by reading our predictions for the 2012 workforce, service lines, and care transformation.
Alaska, California have highest health care pay
Business Journals analysis ranks health care pay by metro area
January 31, 2012
Health care providers enjoy the highest pay in California, while health care support staff fare best in Alaska, according to an analysis by The Business Journals.
For the report, The Business Journals analyzed Bureau of Labor Statistics (BLS) data for full-time employee earnings in 2010. The information was extracted from a database that includes the latest statistics for 790 occupation groups, which are separated into 22 broad sectors.
Overall, the analysis found that the top-paying metropolitan areas in BLS' "Healthcare Practitioners and Technical Occupations" category—which includes physicians, surgeons, and nurses—in 2010 were:
- Napa, Calif. (annual average pay: $107,000);
- San Jose, Calif. (annual average pay: $106,590);
- Oakland, Calif. (annual average pay: $96,980);
- San Francisco-Oakland (annual average pay: $95,320); and
- San Francisco-San Mateo (annual average pay: $93,290).
Meanwhile, the lowest-paying metropolitan areas for the sector were:
- Wheeling, W.V.-Ohio (annual average pay: $49,440);
- Johnstown, Pa. (annual average pay: $49,560);
- Pine Bluff, Ark. (annual average pay: $51,290);
- Jefferson City, Mo. (annual average pay: $53,730); and
- Bloomington, Ind. (annual average pay: $53,980).
For BLS' "Healthcare Support Occupations" category—which includes therapists, aides, orderlies, and attendants—the analysis found that the top-paying metropolitan areas were Anchorage, Alaska (annual average pay: $37,330) and Fairbanks, Alaska (annual average pay: $36,470), while the lowest-paying metro areas were Brownsville, Texas (annual average pay: $19,410) and Abilene, Texas (annual average pay: $19,820).
According to The Business Journals, surgeons were the highest-paid health care providers in the analysis, earning an average salary of more than $200,000 in 91 metro areas. Surgeons earned the most in Camden, N.J., where they averaged $248,720 per year, followed by Lexington, Ky. ($248,480), and Greenville, N.C. ($247,840) (Thomas, The Business Journals, 1/30; Thomas, The Business Journals, 1/19).
CBO: Health spending to double across decade
Aging population biggest driver of health spending growth
January 31, 2012
The Congressional Budget Office (CBO) on Tuesday predicted that the cost of government health care programs—including Medicare and Medicaid—will more than double across the next 10 years.
According to CBO's latest economic outlook, federal spending on health care programs will increase to $1.8 trillion by 2022 and account for about 7% of the nation's economy. CBO said the biggest driver of the projected health care spending increase is the aging U.S. population.
CBO estimates that Medicare spending will rise by 90% by 2022, assuming Congress allows a 27% physician pay cut to take effect in March. However, if lawmakers delay the cuts for the next decade and freeze physician pay rates at 2011 levels, CBO says Medicare spending would increase by an additional $316 billion across 10 years.
Overall, CBO predicted that the federal deficit likely will surpass $1 trillion in fiscal year 2012 for the fourth consecutive year and that unemployment would remain above 7% until 2015 (Baker, "Healthwatch," The Hill, 1/31; Peterson/Paletta, Wall Street Journal, 1/31).
Sneak peek: Johns Hopkins unveils $1.1 billion patient towers
New towers include 560 private patient rooms with hotel-like amenities
January 31, 2012
The new $1.1 billion Johns Hopkins Hospital last week opened its doors to the press for the first time, revealing a 1.6 million-square-foot building designed to improve the patient experience.
Nearly 12 years ago, the Johns Hopkins board of trustees decided to replace buildings on its East Baltimore medical campus that had been built in the 1930s and 1950s. To fund the project, the renowned medical center borrowed $400 million, fundraised about $325 million, and obtained about $100 million from the state. Major donors included the United Arab Emirates and New York City Mayor Michael Bloomberg. Construction on two connected 12-story towers began five years ago, next to the current main hospital.
The 355-bed Sheikh Zayed Tower and the 205-bed Charlotte R. Bloomberg Children's Center—named after the founding president of the United Arab Emirates and Bloomberg's mother, respectively—are slated to open on April 29. The towers include 33 ORs and adult and pediatric EDs capable of handling 110,000 visits per year.
Photo slideshow: Baltimore Sun tours the new towers
According to Kenneth Cohen, the clinical director of pediatric oncology, the new towers are designed to improve safety and efficiency, while providing an environment that "make[s] the experience a little less stressful." The 560 patient rooms are private and designed to better control infections and house modern technology. They also include sofas, full bathrooms, Internet access, showers, and on-demand dining to accommodate loved ones. Laundry rooms and kitchenettes also are available near patient rooms.
Johns Hopkins Medicine EVP Ronald Peterson notes that the new hospital does not include a VIP section. Instead, VIP patients seeking additional amenities will be treated at Hopkins' Marburg Pavilion, which offers suites, fine furniture, entertainment centers, and expanded dining menus (Cohn, Baltimore Sun, 1/26; Dance, Baltimore Business Journal, 1/26; CBS Baltimore, 1/26).
CHIME, HIMSS name Orlando Health official 'CIO of the Year'
Award honors innovation in health IT
January 31, 2012
The College of Healthcare Information Management Executives (CHIME) and the Healthcare Information and Management Systems Society (HIMSS) have given the John E. Gall Jr. CIO of the Year Award to Rick Schooler, vice president and CIO of Florida-based Orlando Health.
The award—named after a 1960s health IT pioneer—recognizes an individual for a lifetime of contributions to health care organizations and "innovation leadership" in the effective use of health IT.
Schooler has spent 21 years working in the health IT field at three organizations:
Central Georgia Health System;
Methodist Hospital of Indiana; and
- Orlando Health.
He also serves on the board of directors for the Central Florida Regional Health Information Organization and the industrial adviser board for Purdue University College of Technology.
In addition, Schooler has served on the CHIME board of trustees, chaired the CHIME Foundation, and participated in the CHIME Advocacy Leadership Team and the HIMSS Public Policy/Advocacy Committee.
"CIOs now enter a time that requires we understand the demands of health care's present reality and future implications and that we demonstrate the ability to lead and provide information solutions of tangible value,” Schooler says. "Building upon the foundation of effective work-flow automation through EMRs and source data capture, the incessant need for information integration, exchange and analytics throughout the continuum of care will only grow."
Schooler will receive the award at HIMSS' annual conference in Las Vegas on Feb. 23 (CHIME release, 1/26; Robeznieks, Modern Healthcare, 1/27 [subscription required]).
Which doctors are opting out of Medicare? OIG still in the dark
CMS, contractors inadequately monitor dropouts
January 31, 2012
CMS and Medicare contractors fail to track which physicians are opting out of the program, making it difficult to determine why they are leaving, according to a recent HHS Office of Inspector General (OIG) report.
According to the report, the number of physicians who opted out of Medicare and chose to be paid directly by beneficiaries increased annually between 2006 and 2010. OIG investigators pointed to reduced reimbursement rates, more administrative burdens, and increased fines and prosecutions for fraud and abuse as potential reasons behind the declines. However, they were unable to corroborate their findings because of a lack of centralized and complete data from CMS.
The report warned that "more physicians may opt out in the near future, given the potential for legislated decreases in Medicare reimbursement for physician services."
The report states that OIG will conduct a more comprehensive study into the issue once CMS is able to provide more complete data (Walker, MedPage Today, 1/27; Ethridge, CQ HealthBeat, 1/27 [subscription required]; Selvam, Modern Healthcare, 1/27 [subscription required]).
WellPoint throws weight behind PCPs, bets on long-term savings
Insurer says investment will curb ED visits, hospital stays
January 31, 2012
WellPoint, the country's second-largest health insurance company, is making a $1 billion investment in primary care, which it hopes will lead to fewer ED visits and hospitalizations.
Building on the success of its patient-centered medical home pilots, WellPoint this summer will increase payments to its network of roughly 100,000 primary care physicians (PCPs) by about 10%, with the possibility of payment increases of up to 50%. The insurer hopes that the move, which will infuse $1 billion or more into primary care, will reduce ED visits and hospitalizations and cut overall medical costs by as much as 20% by 2015.
At the same time, the insurer will share as much as 20% to 30% of the savings achieved and provide PCPs with data and staffing assistance to improve their practices. In exchange, the physicians must meet certain WellPoint requirements, such as providing 24-hour access for patients and monitoring chronic disease care.
"This will fundamentally change our relationship with [PCPs]," says Harlan Levine, WellPoint's EVP for comprehensive health solutions. Primary care currently accounts for about 6% to 8% of the $100 billion in WellPoint claims filed each year, but company officials say the program could increase its primary care spending by one or two percentage points (Weaver/Wilde Mathews, Wall Street Journal, 1/27; AP/Washington Post, 1/27).
AHRQ: C. diff infections level off in 2009
Infection rate steady after a 300% increase in years prior
January 31, 2012
After a 300% increase in hospitalizations involving Clostridium difficile infections from 1993 to 2008, the number of hospital stays related to the infection leveled off between 2008 and 2009, according to a recent Agency for Healthcare Research and Quality (AHRQ) statistical brief.
Using data from the Healthcare Cost and Utilization Project, AHRQ researchers examined U.S. hospital stays involving C. diff in 2009 along with characteristics of those hospitalizations. The researchers found that hospital stays involving C. diff increased from 86,000 in 1993 to 349,000 in 2008, before leveling off at 337,000 stays in 2009.
According to the report, patients aged 85 and older were at the highest risk for C. diff, with the cohort experiencing more than double the rate of hospital stays as other age groups. In addition, the results showed that more than 9% of C. diff hospital stays ended in death—compared with 2% of other stays—and C. diff patients had a longer average length of stay (13 days) than other patients (less than five days).
Common conditions among C. diff patients in 2009 included dehydration and electrolyte disorders, blood infections, and renal failure, the report said (AHRQ release, 1/25; AHRQ statistical brief, January 2012).
'Marriage killer'? Nagging can be as toxic as bad finances
WSJ: Experts say communication gaps can sink a relationship
January 31, 2012
Experts say nagging can doom a relationship almost as quickly as infidelity or bad finances, the Wall Street Journal reports.
According to Scott Wetzler, a psychologist at Montefiore Medical Center, certain personality types may be more prone to nagging. For example, extremely organized or anxious people may find it difficult not to give their partner reminders.
The communication breakdown potentially may lead to divorce when couples begin to fight about nagging rather than the cause of the nagging, says Center for Marital and Family Studies Co-Director Howard Markman. Although all couples nag, Markman notes that successful couples find ways to reduce it.
To reduce nagging, experts suggest that couples:
- Recognize and admit to the nagging cycle;
- Look at situations from the other person's point of view;
- Learn to properly explain, express, and respond to requests;
- Manage expectations; and
- Establish timeframes for requests (Bernstein, Journal, 1/25).
Daily roundup: Jan. 31, 2012
Bite-sized hospital and health industry news
January 31, 2012
Alaska: Hospitals statewide have launched various construction projects to accommodate the health care needs of the state's growing population. For example, Providence Health and Services is investing $150 million to renovate and expand Anchorage facilities, create private rooms, and modernize ORs (AP/Anchorage Daily News, 1/29).
Arizona: Banner Health, Dignity Health, and Abrazo Health Care on Thursday announced that they are leaving the Arizona Hospital and Healthcare Association. The three organizations, the largest members of the association, say they can more efficiently address areas of "mutual concern" outside of the association (Selvam, Modern Healthcare, 1/27 [subscription required]).
Iowa: Des Moines-based Mercy Medical Center plans to restructure its management by partnering physician leaders with administrative team members to manage seven service lines. According to Mercy President and CEO David Vellinga, the change will formalize physicians' "leadership roles by clearly defining them and engaging them to lead clinical changes and operational improvements" (Lee, Modern Healthcare, 1/27 [subscription required]).
Maine, New Hampshire, and Vermont: The Dartmouth Atlas Project last week announced its plans to study variations in pediatric health care across Maine, New Hampshire, and Vermont. Researchers plan to use the data from the three states to create the Dartmouth Atlas of Children's Health Care in Northern New England, which will assess utilization rates and spending (CQ HealthBeat, 1/27 [subscription required]).
Redesigning cancer care to succeed under payment reform
January 31, 2012
Join the Oncology Roundtable for a complimentary webconference exploring ten strategies across three core workflows to deliver more efficient and patient centered care. More.
Report reveals lagging U.S. cancer screening rates, ethnic disparities
The rate of U.S. residents receiving screenings for colon, breast, and cervical cancers falls below national targets, with Asians and Hispanics lagging even further behind, according to new CDC statistics.
According to the agency's latest Morbidity and Mortality Weekly Report:
- 72.4% of women ages 50 to 74 followed breast cancer screening recommendations, below the 81% target set by Healthy People 2020;
- 83% of women were screened for cervical cancer, below the 93% target; and
- 58.6% of U.S. residents were screened for colorectal cancer, compared with the 70.5% target.
The report also found that Asians and Hispanics were less likely to have received recommended screenings than those in other groups. The report found that:
- 64.1% of Asians were screened for breast cancer, 75.4% for cervical cancer, and 46.9% for colorectal cancer; and
- 78.7% of Hispanics were screened for cervical cancer and 46.5% for colorectal cancer, compared with rates of 83.8% and 59.9% among non-Hispanics, respectively (Reinberg, HealthDay/USA Today, 1/27; Brown, "Booster Shots," Los Angeles Times, 1/27).