The Daily Briefing

News for Health Care Executives

Deploy your PCPs where they’ll matter most

March 6, 2012

Hospitals and health systems have sharpened their focus on improving primary care access, with many organizations seeking to add primary care capacity through closer alignment with or employment of primary care physicians. Expanding primary care access strategically—with the goal of maximizing the reach of the limited supply of primary care physicians—requires that organizations consider the impact of local market demographics and practice patterns on primary care utilization.

Create demographic specific cohorts
The rate at which demographic cohorts utilize primary care services varies significantly across age and gender. Unsurprisingly, primary care utilization follows a pattern of strong utilization during childhood, lowest utilization during early adult years, and rapidly increasing utilization late in life.

For example, through age 19, males average a little less than two primary care visits per year. That figure drops by more than half among males ages 20-44, but then climbs back toward two visits per year in the age 55-64 cohort and tops three visits per year beyond age 75. While females’ visits to primary care specialists also drop during early adult years, they drop less severely than males’ visits and climb more rapidly during later adult years.

The type of primary care physician that patients see also varies across age and gender cohorts. While visits to pediatricians comprise nearly three-quarters of primary care visits by children, young adults use general and family medicine physicians for about two-thirds of visits. As adults age, visits shift from general and family medicine physicians to internal medicine physicians. Internal medicine use rates peak among females ages 65 and older, who rely on these physicians for nearly 60% of primary care visits.

Given such variation in utilization, market-specific demographics can significantly impact local market demand for primary care services, and planners should consider the size of age and gender cohorts while assessing primary care capacity and designing the primary care network. Given that demand for primary care will likely outstrip supply in most markets, strategic deployment of primary care resources will be critical to maximizing the potential benefits.

Access the tool
For support in assessing the impact of local market demographics on primary care demand, members of the Marketing and Planning Leadership Council may use the Primary Care Volume Estimator. The tool provides county-specific estimates of primary care utilization and the number of FTE primary care physicians necessary to handle primary care volumes.

Learn more
For additional context on primary care planning, Marketing and Planning Leadership Council members can also access the Council’s recent publication Maximizing Primary Care Access. Not a member of the Marketing and Planning Leadership Council? Learn more on our website.

CMS quality reporting program didn't improve mortality rates

'Jury's still out' on Hospital Compare's quality impact

March 5, 2012

CMS' Hospital Compare website—which began publicly reporting hospital care quality data seven years ago—has had no impact on mortality rates for myocardial infarctions (MIs) or pneumonia, according to a study in Health Affairs.

CMS in 2005 began posting quality ratings for more than 3,000 U.S. hospitals on its Hospital Compare website. The site first included data on adherence to basic clinical care guidelines and expanded to include patient experience scores, readmission rates, mortality rates, and complication rates.

Based on Medicare claims data from 2000 to 2008, Weill Cornell Medical College researchers and colleagues found that hospitals may have reduced 30-day mortality for MIs and pneumonia over the seven-year study period. However, the researchers, who also assessed Hospital Compare site usage, attributed that improvement to ongoing clinical care innovation rather than public reporting.

The researchers also found a modest improvement in heart failure 30-day mortality rates, but could not determine whether the improvement could be attributed to public reporting efforts. In addition, the researchers determined that the Hospital Compare website did not direct patients toward hospitals with better quality ratings.

"The jury's still out on Medicare's effort to improve hospital quality of care by posting death rates and other metrics to a public website," says lead author Andrew Ryan. He recommends further study on the impact of public reporting on care quality (Fleming, Health Affairs release, 3/6; Rau, "Capsules," Kaiser Health News, 3/5; McKinney, Modern Healthcare, 3/5 [subscription required]).

New RNs report greater commitment to employers—but will it last?

Study: Newly licensed nurses had positive view of work environment during recession

March 6, 2012

A recent study in the American Journal of Nursing found that newly licensed RNs reported higher commitment to their employer during the recession, but the authors warn that turnover could increase dramatically as the economy improves.

The study was part of the RN Work Project, a Robert  Wood Johnson Foundation-funded initiative. University of Buffalo and New York University researchers analyzed results from two surveys of newly licensed RNs across 15 states: one from 2006—before the recession—and one from 2009, during the recession.

According to the results, RNs in the 2009 cohort reported a greater intent to stay with their current employers than RNs in the 2006 cohort. However, the findings showed that RNs surveyed in 2009 were more likely to be searching for other jobs, even though they perceived fewer job opportunities than the earlier group.

"This lack of job options might have led newly licensed RNs to feel more organizational commitment," the authors said, noting that many nurses could have been reluctant to leave a secure position.

Although new RNs in 2009 reported having a more positive view of their work environment and better nurse-physician relationships than new RNs in 2006, the study notes that job satisfaction did not significantly improve during the recession.

As the economy improves, the researchers predict that RNs who were delaying job changes once again will consider new positions, which could drive up hospital staff turnover. They urge hospitals to "take this opportunity to continue to improve RNs' working conditions and wages, and to implement programs that will increase retention" ( News, 3/5; AHA News, 3/5; Robert Wood Johnson Foundation release, 3/5).

Physicians who use EHRs order more tests, study finds

Findings suggest e-access may not curb health costs

March 6, 2012

Physicians who use electronic health records (EHRs) are up to 70% more likely to order an imaging test than other doctors, raising questions about whether the technology will actually reduce medical costs, according to a study in Health Affairs.

The study, conducted by the Cambridge Health Alliance, analyzed data from the 2008 National Ambulatory Medical Care Survey on 28,741 patient visits to 1,187 office-based physicians.

Researchers found that physicians with electronic access to patients' previous imaging results were 40% more likely to order tests than those using paper records. Physicians with EHRs ordered tests on 18% of visits, compared with 12.9% for physicians who used paper records. The study also found physicians with EHR access were 70% more likely to order more advanced and costly imaging—such as MRI tests and CT scans—than those with paper records.

Although the study did not explore why physicians who use EHRs may tend to order more tests, the researchers said the technology could make ordering tests easier. Danny McCormick, lead author of the study, said, "As with many other things, if you make things easier to do, people will do them more often."

Study raises questions about cost savings
The study comes as the federal government plans to provide up to $27 billion in incentives through the meaningful use program to encourage health care providers to transition to EHRs, in the hope that the technology will help rein in health care spending.

Proponents of EHRs have said that they help reduce unnecessary and duplicative testing by providing physicians with better and more up-to-date information when treating patients. However, McCormick said the research "raises real concerns about whether health information technology is going to be the answer to reducing costs."

Experts criticize methodology
Many health policy experts were critical of the study's methods, noting that the survey data predate the meaningful use incentive program and standards that launched last year. Michael Furukawa, a health economist in the Office of the National Coordinator for Health IT, said the focus of the study was limited. "The proper use of advanced health IT functions, we believe, will reduce costs in the long run," he said (Lohr, New York Times, 3/5; Gold, "Capsules," Kaiser Health News, 3/5; McKinney, Modern Healthcare, 3/5 [subscription required]; Sun, Washington Post, 3/5).

When less is more: Hospitals aim to keep patients out

Experts: Calif. hospitals likely will direct patients to clinics, physician's offices

March 6, 2012

Preparing for a wave of reforms and payment changes, California hospital leaders are shaking up their financial models: they're seeking fewer patients, not more volumes, the Los Angeles Times reports.

Medicare and Medicaid—which account for more than 50% of California hospitals' gross revenue—are adopting new provisions intended to better reimburse hospitals for patient outcomes. Hospitals also are being increasingly penalized for preventable readmissions and hospital-acquired infections.

Less care could be good care—but also less revenue
Incenting hospitals to deliver better treatment is overdue, according to Anthony Wright, executive director of the Health Access advocacy group. "We were inadvertently subsidizing bad care," he added.

However, a new payment structure requires hospital leaders to change their goals, according to Michael Rembis, president and CEO of Hollywood Presbyterian Medical Center. Hospital leaders must shift their mindset "from how many patients we have in the beds to how many patients we are keeping healthy and out of the hospital," he said.

"Everyone is scrambling on the hospital side to prepare for fewer patients," says Hospital Association of Southern California EVP Jim Lott, who notes that the new reimbursement model will "change the paradigm." According to the California Hospital Association, hospitals that fail to anticipate the change may be forced to eliminate services or shut down.

Keeping patients out
Seeking to keep patients out of the hospital, experts say hospitals likely will encourage more patients to seek treatment in clinics and physicians' offices. Meanwhile, patients who are admitted to the hospital may experience shorter stays. 

Despite efforts to keep patients out of the hospital, one health care consultant told the Times that hospitals may not reduce patient volumes because aging baby boomers may require more hospital stays in the coming years. "No matter how much we think we can decrease hospital admissions, we are still going to need the beds," he added (Gorman, Los Angeles Times, 3/5).

Where health care is going
The Health Care Advisory Board has created a graphical look at how trends in pricing, cost, payer mix, and case mix will impact operating margins—and what hospitals must do to respond. Click to view the Health Care Advisory Board infographic in full size. Members can log in to download a PDF or order a poster in hard copy.

The New Performance Standard

A $9 doctor's visit? Report charts how U.S. cost of care compares

U.S. residents paid more for 22 of 23 medical services surveyed

March 6, 2012

A report released Friday by the International Federation of Health Plans (IFHB) captures just how much more U.S. residents pay for certain health services than residents of other nations.

In its surveys of providers in nine developed countries, IFHB found that U.S. residents paid the most for 22 of the 23 services and products included in the survey. For example, a hospital stay cost only $1,825 in Spain and $5,004 in Germany, compared to $15,734 in the U.S.

In addition, the survey found that a routine doctor's office visit cost:

  • $9 in Argentina;
  • $11 in Spain;
  • $16 in India;
  • $23 in France;
  • $30 in Canada;
  • $40 in Germany;
  • $45 in Chile;
  • $64 in Switzerland; and
  • $89 in the U.S.

Similarly, the survey found that the total cost of giving birth in the U.S. average $9,280 per birth, compared to just $1,291 in Argentina and $1,967 in Spain. Meanwhile, the prescription drug Nexium averaged $193 in the U.S., compared to $69 in Switzerland.

Only one procedure of the 23 included in the survey was less expensive in the U.S. than in another country. Cataract surgery in Switzerland averages $5,310, compared to just $3,748 in the U.S.

Overall, the study found that health spending as a percentage of GDP was 17.4% in the U.S., compared to 9.5% in Spain and 11.8% in France.

According to National Journal, the findings support health care experts' assertions that soaring U.S. health costs are caused in large part by prices charged by physicians, hospitals and drug and device manufacturers (Fox, National Journal, 3/4; Klein, Washington Post, 3/2).

Disney shutters anti-obesity exhibit

Attraction criticized for shaming overweight children

March 6, 2012

Walt Disney World quickly shuttered a new exhibit—featuring svelte heroes like "Will Power" and "Callie Stenics" battling overweight villains like "Lead Bottom"—after facing criticism for its portrayal of the obesity crisis.

The interactive "Habit Heroes" exhibit was intended to reinforce healthy diets, as children fought "The Snacker" and other evil-doers meant to represent negative behavior.

However, an Ottawa surgeon's Feb. 23 blog post, with accompanying photos, trigged public outcry. According to surgeon Yoni Freedhoff, the exhibit suggests that "Disney is being the schoolyard bully that's been making fun of [overweight children] for years at home."

A board member for the National Association to Advance Fat Acceptance warned that the exhibit only reinforced "depression, despair, bullying, disorder eating, and other unhealthy practices" for children. A petition launched by NAAFA garnered more than 300 signatures before Disney decided to shut down the exhibit within 48 hours.

Disney spokesperson Kathleen Prihoda says the exhibit was still in the "soft-open period" to collect feedback. She notes that the organization contacted individuals who wrote letters expressing concerns with the exhibit and will rework the attraction to convey "a positive message about healthy lifestyles in a fun way" (Hubbard, Los Angeles Times, 3/2; Liston, Reuters, 3/2).

Daily roundup: March 6, 2012

Bite-sized hospital and health industry news

March 6, 2012

  • Florida: Hospitals and nursing homes are expected to lose about $350 million in funds as legislators try to reach a budget deal before the end of the legislative session on Friday. The budget likely will entail a 5.6% reduction in Medicaid hospital rates and a 1.25% reduction in nursing home rates (Kennedy, Palm Beach Post, 3/4).
  • Nebraska: Lawmakers last week passed a bill that would make assaulting health care professionals a Class 3A felony, punishable with up to five years in prison and up to $10,000 in fines. The bill also requires that all EDs and clinics post a sign warning that assaulting an employee is a felony (Hammel/Stoddard, Omaha World-Herald, 3/2).
  • Maine: The state's Supreme Judicial Court on Tuesday upheld state regulators' authority to limit health plans' profits, in a case involving Anthem Health Plans of Maine, a unit of WellPoint (Appleby, "Capsules," Kaiser Health News, 2/28).
  • Ohio: The Cleveland Clinic is expanding its electronic health record system to include diagnostic test images, such as X-rays and laboratory tissue samples. According to Louis Lannum, the Clinic's director of enterprise imaging, the project's goal is "No image left behind" (Kleinerman, Cleveland Plain Dealer, 3/5).

Physician alignment in the era of accountable care

March 6, 2012

Join a complimentary webconference on Mar. 13 to hear Southwind experts discuss their experience building CI programs in over 40 markets. More.


Prescription drug spending triples since 2001

A Government Accountability Office report released on Thursday found that U.S. prescription drug spending has more than tripled since 2001.

U.S. prescription drug spending totaled $307 billion in 2010 and accounted for 12% of U.S. health care costs, according to the GAO. That cost growth slowed in the early 2000s as more major generic drugs—which cost on average 75% less than their brand name equivalent—reached the market. By 2010, generic drugs were used in place of brand name drugs 93% of the time.

However, the report found that studies on cost savings from generic drugs produced "mixed results regarding the effect of using these generics, in that some found they raised health care costs, while others found they led to cost savings" (Walker, MedPage Today, 3/2).