The Daily Briefing

News for Health Care Executives

The Atlantic: Physician, nurse executives in high demand

How MDs, RNs can use clinical perspective to effect system-wide change

April 6, 2012

Federal health reform law implementation has prompted a "major uptick" in demand for physician and nurse executives, who are uniquely equipped to adapt to new care models and quality challenges, an executive search leader writes in The Atlantic.

Drawing on their strong clinical backgrounds, physician and nurse leaders offer a "nuanced perspective" on patient care and physician behavior, which can help organizations bring new delivery models to scale, boost quality and efficiency, and align physicians with hospital leadership, according to a senior VP with staffing firm Witt/Kieffer.

Witt/Kieffer reports that physicians already lead at least 64 U.S. health systems. Meanwhile, requests for physicians and nurses who are prepared to lead health systems, academic medical centers, community hospitals, and managed care organizations are on the rise.

While some physicians and nurses are hired as CEOs, others are placed in new, more specialized executive roles. For example, more hospitals are establishing chief quality officers and chief integration officers to oversee delivery model transformation, staff alignment, and best practice adoption.

"Our only hope in making this new world work is to keep calling out the problems in the present system that every patient…must navigate every day," said physician John Chessare, president and CEO of Greater Baltimore Medical Center.

From physician to executive
According to The Atlantic, physician and nurse executives have varied career paths: some launched their careers in private practices or medical offices, while others began as nursing leaders and worked their way up the hospital chain.

Meanwhile, many nurse and physician executives obtained an MBA or an alternate business degree to hone the skills needed for executive positions, such as pro forma development, business plans, staff productivity, cost containment, and data mining (Mackey-Ross, The Atlantic, 4/5).

Another hospital merger blocked—this time in Illinois

FTC wins preliminary injunction to temporarily halt deal

April 6, 2012

A federal judge has granted a preliminary injunction that will temporarily halt a hospital system merger in Illinois until the Federal Trade Commission (FTC) can resolve antitrust challenges against the deal.

U.S. District Court Judge Frederick Kapala in a 45-page opinion sided with FTC arguments that said a merger between OSF HealthCare, which operates Rockford-based OSF St. Anthony Medical Center, and Rockford Health System would increase health costs in the city. Specifically, FTC said the acquisition would have allowed OSF and Rockford to control more than 64% of the local general hospital care market and 37% of the primary care market.

According to the judge's opinion, the systems under the preliminary injunction are "restrained from acquiring each other's assets or other interests and are directed to return all confidential information received directly or indirectly from one another." OSF and Rockford also were instructed to "maintain the status quo" until all legal proceedings—including appeals—are complete.

"The court's ruling…is a victory for both competition and consumers," FTC said. "If this deal is ultimately allowed to proceed, the result will be less competition and higher health care prices in the Rockford area."

Meanwhile, the hospital systems' executives expressed disappointment in the judge's decision, noting that the deal would allow the organizations to meet federal health reform law goals, increase collaboration, and streamline technology systems. "We maintain that combining two of Rockford's three health care systems…is the best means to promote and ensure healthy competition in the marketplace," they said.

The case now goes to an FTC administrative judge, who is slated to hold an initial hearing on April 17, the Wall Street Journal reports.

Hospital merger challenges heating up
The OSF-Rockford case is one of a handful of hospital merger challenges unfolding across the country. For example, FTC last week ordered Ohio-based ProMedica Health System to dissolve its merger with St. Luke's Hospital, after ruling that the deal was "anticompetitive and likely to substantially lessen competition and increase prices."

In addition, U.S. Solicitor General Donald Verrilli Jr. in February disclosed plans to appeal an 11th U.S. Circuit Court of Appeals decision on behalf of FTC that allowed a merger between Georgia-based Palmyra Park Hospital and the Hospital Authority of Albany-Dougherty County, which owns Phoebe Putney Health System, the city's other hospital (Carlson, Modern Healthcare, 4/5 [subscription required]; Forden, Bloomberg, 4/5; Morath, Wall Street Journal, 4/5; Westphal, Rockford Register Star, 4/5).

Spontaneous mutations influence autism risk, researchers find

Studies identify link between disorder and paternal age

April 6, 2012

Three separate teams of researchers have identified several gene mutations that they believe sharply increase the risk of developing autism, according to a trio of studies published in Nature.

Scientists for decades have debated the influence of inherited and environmental factors on autism, and most today believe there is a strong genetic component. However, researchers have struggled to develop a clear understanding of the underlying genetics associated with autism spectrum disorders, which CDC says affect one in 88 children on average.

The three teams of researchers all analyzed genes from blood samples of families in which parents without autism gave birth to a child who developed the disorder. Specifically, the scientists focused on "de novo" mutations, which occur sporadically near or during conception.

"We found that 15% to 20% of sporadic patients could be explained by 'de novo' mutations," said Evan Eichler, professor of genome sciences at the University of Washington, who led one of the studies. Meanwhile, the second study—led by Yale University researchers—found that at least 14% of autism patients had multiple genetic mutations, which NIH says is five times the normal rate.

The third study, conducted by Harvard University researchers, found that nearly half of children in the study had spontaneous mutations, but that the rate was comparable among children with and without autism.

According to HealthDay, the findings do not suggest that the frequency of de novo mutations is significantly higher among autistic children; rather it indicates that the types of mutations are more detrimental in autistic children than their non-autistic siblings.

The studies also found evidence that the risk of de novo mutations increases alongside paternal age. For example, Eichler's team found that the mutations were four times more likely to be inherited from the father, and that the risk was higher for fathers at age 35 than 25. However, they noted that paternal age probably only plays a role in about 10% of cases (Storrs, HealthDay, 4/4; Carey, New York Times, 4/4; Falco, CNN, 4/5).

Health care adds 26,000 jobs in March

After BLS revisions, health care slips from historic pace

April 6, 2012

This story is in progress. Last updated at 9:05 a.m. ET.

Dan Diamond, Managing Editor

Health care hiring is off to a strong start in 2012, if not the historic pace that the Bureau of Labor Statistics had previously suggested.

The health care sector added 26,000 jobs in March, according to today's monthly employment report. That's in line with the sector's monthly average since 2010.

The BLS estimates that the overall U.S. economy added 120,000 jobs last month—which means health care accounted for 22% of new jobs in March. Altogether, the health sector has added more than 102,000 new jobs to the economy so far in 2012.

Going inside the report
The latest BLS estimates map to recent trends: About half of new health care jobs are on the outpatient side.

  • Ambulatory health care employers added 12,100 jobs, with about 7,600 jobs in physician offices.
  • Hospitals added 8,100 jobs.
  • Home health care providers added 3,900 jobs.

The BLS also revised earlier figures from last month's report. The agency now reports that health care only added 75,600 jobs, down from its previous estimate of 92,300 jobs, across January and February 2012.

According to the revised estimates, health care had a very good first quarter, if not a historic one. The sector fell about 6,000 jobs short of the first quarter record (108,100 jobs added in Q1 1991).

U.S. residents skip more doctor visits, Rx drugs in 2011

Studies suggest patients are abandoning 'more is better' attitude

April 6, 2012

U.S. residents visited the physician less and received fewer prescription drugs in 2011, according to a new report.

The report—released by the IMS Institute for Healthcare Informatics—found that physician visits declined by 4.7% from 2010 to 2011. It also found that 1.1% fewer prescription drugs were issued to patients in 2011 than in 2010.

The decrease in prescription drugs was driven in large part by U.S. residents ages 65 and older, whose prescription drug use declined by 3.1% from 2010 to 2011. That decrease in utilization came despite the average prescription drug copayment under Medicare Part D declining from $25.97 in 2010 to $23.31 in 2011.

The decline in copayments—which the report attributes to subsidies under the federal health reform law—resulted in beneficiaries enrolled in Part D spending less out of pocket, from $11.5 billion in 2010 to $9.7 billion in 2011, according to the report.

Other findings
The study also found that young adults ages 19 to 25 were issued 2% more prescription drugs in 2011 than in 2010. The largest increases for the group were for antidepressants and drugs to treat attention deficit hyperactivity disorder. The researchers said the change was caused by the overhaul allowing young adults up to age 26 to remain on their parents' health plans.

In addition, the report found that ED visits increased by 7.4% from 2010 to 2011. The study authors attributed the increase in ED visits to the loss of insurance coverage because of long-term unemployment.

Patients shifting toward less utilization?
The U.S. public might be shifting its views on whether more utilization of health care services leads to better care, after believing so for decades, the New York Times' "Well" reports.

Recent studies indicate that U.S. residents are abandoning the "more is better" attitude on health care. The Cochrane Collaboration in March released a review of more than 20,000 patients using "decision aids," which explain potential benefits, harms, and uncertainties. The studies found that patients using the tools more often declined procedures like surgery and cancer screening, and opted for more conservative interventions.

Michael Barry, president of the Informed Medical Decisions Foundation, said, "People are more receptive to conversations about medical interventions having both pros and cons." Barry said that patients traditionally thought "newer and more aggressive interventions" were better, but now, "[w]hen patients are fully informed, they tend to be more conservative."

Barry noted that several books on the dangers of unnecessary treatment and media coverage on the topic could be driving the change in attitude. He added that news coverage on fines paid by drugmakers, the overuse of radiation, medical device recalls, and increasing numbers of deaths linked to prescription drugs all could have an effect on the trend. "Even once-sacred interventions," such as cancer screening, are more scrutinized as researchers realize potential risks and the tests' limited benefits, according to the Times.

The medical community increasingly is acknowledging that many tests and procedures are unnecessary, the Times reports. Health care providers and experts this month in Boston will hold the first major medical conference to focus on the risks of unnecessary care (Thomas, New York Times, 4/4; Newman, "Well," New York Times, 4/4).

NEJM: Analysis tallies cost of medical malpractice claims

Study finds lawsuits cost tens of thousands and vary across specialties

April 6, 2012

Defense costs associated with resolving medical malpractice claims can cost tens of thousands of dollars and vary considerably across physician specialties, according to a letter published in NEJM.

For the analysis, Massachusetts General Hospital researchers analyzed defense costs associated with 26,853 malpractice claims closed between 1995 and 2005 among 40,916 physicians covered by a nationwide professional liability insurer. Defense costs included expert witnesses, lawyers' fees, research costs, and overhead costs like filing fees.

The analysis showed that the average malpractice claim cost about $23,000. However, cases that resulted in indemnity payments cost about $45,000, compared with roughly $17,000 for other cases. According to letter coauthor Anupam Jena, claims that lead to payment typically cost more because closing takes longer—sometimes two years or more.

Costs vary by specialty
In addition, the results showed that costs varied substantially by specialty, with paid claims averaging $83,056 in cardiology and $78,890 in oncology, compared with $24,007 in dermatology and $23,780 in ophthalmology. Claims that involved no patient payments were lower on average but still varied widely, according to the analysis.

"Although the costs of dispute resolution are higher for claims that result in indemnity payments, there is still a meaningful cost of resolving claims that never result in payment," the researchers wrote. "Lowering the costs of dispute resolution could lead to considerable savings for physicians and insurers."

For example, Jena noted that a disclosure, apology, and compensation program at the University of Michigan Health System helped the organization reduce the number of malpractice lawsuits, in addition to reducing costs and the time it takes to resolve claims (Marcus, HealthDay, 4/4; Fiore, MedPage Today, 4/4).

Editor's picks

Our reads for the weekend

April 6, 2012

The Daily Briefing editorial team highlights several studies and articles that got us talking this week.

The Association of Healthcare Journalists this week announced its 2011 awards for Excellence in Health Care Journalism. Winners include Bloomberg News's David Armstrong, Modern Healthcare's Joe Carlson, and the staff of the Milwaukee Journal Sentinel. Check out their award-winning reports.

The Huffington Post offers a sneak peek of the artwork that will brighten up Johns Hopkins University's new patient towers when they open at the end of the month. Altogether, the facilities will feature 500 works by more than 70 artists. More.  

After making revisions, an expert panel deems once controversial avian flu research safe to publish. More

Politics v. science: The New York Times this week explored "internal clashes" between the White House and FDA, highlighting struggles over issues including sunscreen regulation, over-the-counter sales of Plan B, and regulation of a drug to prevent premature births. More.

Sometimes, too much happiness makes us feel gullible, selfish, and less successful. The Washington Post explains. More.

Is Medicare built to allow fraud? CNBC's Sabrina Korber this week outlined weaknesses in the program. For example, Korber writes, "The sheer size of ICD-9 makes it a minefield for some providers and suppliers submitting claims for payment and a potential goldmine for others." More.

Can helmet technology help football tackle head injuries? Reuters this week looked at the equipment's design. More.

Childbirth is now about two hours longer than it was in the 1960s, according to a study from the National Institute of Child Health and Human Development. More

Are there accountable care models that succeed in a fee-for-service world?

April 6, 2012

Join us for a complimentary webconference on April 30 to hear Southwind Senior Vice President Laurie Sprung, PhD, and Southwind Executive Vice President and CMO Dennis Weaver, MD, discuss case study examples of their work in building robust physician networks of independent and employed physicians, and the platform those networks create for successfully deploying multiple value-based care programs. More.


Daily roundup: April 6, 2012

Bite-sized hospital and health industry news

April 6, 2012

  • Alabama: Twenty-seven hospitals across the state are participating in Alabama's Putting Power into Healthcare Initiative, the first statewide effort to encourage and monitor handwashing across multiple hospitals. Participating facilities will use Proventix's nGage system, which uses active communication screens and radio-frequency badges to monitor handwashing (Miliard, Healthcare IT News, 4/4).
  • Illinois: Five hospitals have withdrawn their applications for tax-exempt status, according to an Illinois Department of Revenue spokesperson. Illinois Hospital Association spokesperson Danny Chun said the hospitals may be waiting for state lawmakers to pass legislation clarifying charity requirements for tax exemptions. "It's not a surprise, given the risk of denial that might be involved in having an application reviewed now when a potential legislative solution with clear standards is close at hand," Chun said. According to AP/Bloomberg/Businessweek, county governments now will have to decide whether to assess taxes on the hospitals' properties (Johnson, AP/Bloomberg/Businessweek, 4/5).

                          A deeper look: Illinois resumes tax-exempt status reviews

  • Massachusetts: Steward Health Care System has entered into an asset purchase agreement to acquire New England Sinai Hospital in Stoughton, Mass. The organizations announced this week that the 212-bed hospital began seeking a clinical and business partner last year (Lee, Modern Healthcare, 4/4 [subscription required]).
  • Utah: The Utah Department of Health (UDOH) this week announced a data breach involving about 24,000 Medicaid claims that was caused by Internet hackers. According to the Deseret News, health care provider data on such servers could include names, national provider identifiers, addresses, tax identification numbers, and procedure codes for billing purposes. UDOH spokesperson Tom Hudachko said the affected server has been shut down. State officials are investigating why the server did not have appropriate security (Lee, Salt Lake City Deseret News, 4/4; Nelson, Reuters, 4/4; Henetz, Salt Lake Tribune, 4/4).

FDA says more fake Avastin leaked into U.S. market

FDA officials say they have discovered a new batch of a counterfeit version of the cancer drug Avastin circulating in the U.S., fewer than two months after the agency and the drug's manufacturer warned that an unapproved imitation of the drug had entered the U.S. via Europe.

In February, Roche also warned that the imitation version did not contain Avastin's active ingredient. The company initially did not disclose the fake drug's country of origin. FDA also announced that it was investigating the issue and had sent letters to 19 medical practices across the country that might have purchased the fake drug.

The newly discovered batch of the fake drug bears Roche's name and are labeled as Altuzan, the brand name of the unapproved version of Avastin sold in Turkey. FDA this week said it has confirmed that U.S. health care practices have purchased the fakes, but the agency did not identify the practices.

According to the AP/Sacramento Bee, the U.S. practices bought the fake drugs from U.K.-based drug supplier Richards Pharma. Of the 120 packs that Richards Pharma had obtained from Turkey, 38 were sold to practices in the U.S. A spokesperson for Britain's drug regulatory agency said it also is investigating the case and assisting FDA in its probe into the problem (Hirschler, Reuters, 4/5; Rockoff/Weaver, Wall Street Journal, 4/3; Perrone, AP/Sacramento Bee, 4/4).