False start: Systems falling short on outpatient investments
February 24, 2012
Alicia Daugherty, Marketing and Planning Leadership Council
Seeking to secure market share and prepare for population health management, hospitals and health systems are adding primary care practices and other alternative care sites to build out their “medical perimeter.” As the Daily Briefing reported recently, the number of retail clinics grew by 11.2% in 2011, and ambulatory job growth continues to outpace hospital job growth.
These projections are understandably intriguing to hospital and health system leadership, particularly in an era of stagnating or declining volume growth for many inpatient service lines. Unfortunately, many organizations are finding—often through failure of a new business venture—that they are unprepared to succeed in the outpatient arena.
Case study interviews conducted by the Marketing and Planning Leadership Council across the past two months indicate ambulatory planning and management are too often:
Reactive, not proactive: Two small health systems in the East were caught off-guard when competitors—a neighboring health system and a national independent operator—established retail clinics and urgent care centers, respectively, in their primary service areas. Seeking to protect their patient populations, each system agreed to partner with the competitor, despite their concerns about the viability of these new care sites. Several years later, the sites continue to struggle to break even.
Physician-centered, not patient-centered: Many health systems have limited their urgent care, retail, or worksite investments in response to physician resistance, even when survey and market share data indicate that patients are seeking care at competitors’ facilities or the ED. One health system in the East established retail clinics, but severely restricted the scope of services to the point that the clinics’ nurse practitioners are forced to turn away many patients, reducing volumes and jeopardizing return visits.
Hospital-centric, not partner-friendly: An S&P 500 firm attempted to engage two local health systems in establishing a worksite clinic at one of its major facilities in the Northwest. Neither system had developed a unified sales department for its employer-facing offerings, and as a result, neither was able to capitalize on the opportunity. The firm instead partnered with a national worksite clinic operator; the two systems continue to compete for share among the employee base.
Before You Invest
To assist member organizations in developing a proactive, patient-centered ambulatory investment strategy that attracts group purchasers and other partners, the Marketing and Planning Leadership Council’s 2012 national meeting series will offer guidance on key questions including:
- What do we need in our ambulatory network? What do we build? What do we acquire? Where do we partner?
- How are progressive organizations structuring ambulatory planning and management functions? What are the key metrics for the ambulatory performance dashboard?
- How can we promote the full value of our ambulatory offerings to group purchasers?
- What marketing messages and media are most effective for engaging patients in primary care and fostering utilization of alternative care sites?
- How can we position ourselves successfully against new market entrants?
Learn more at the national meeting
The 2012 Marketing and Planning Leadership Council national meetings are open to hospital and health system planning, business development, and marketing executives. Members can review our agenda, Blueprint for Growth, and register for an upcoming session on our website.
Not a member of the Marketing and Planning Leadership Council? Learn more on our website.
U.S. News names RN 'best job' for 2012
Five health care posts make top 10 'best careers' list
March 1, 2012
Registered nurse topped U.S. News and World Report's Best Jobs of 2012 list, which ranks career paths in the United States based on employment projections, salary data, and job satisfaction.
According to U.S. News, nursing offers strong growth in employment and considerable opportunities. Specifically:
- In 2010, the median RN salary in the United States was $64,690.
- The top 10% of RN wage earners—who often worked as personal care nurses or for pharmaceutical or medical device companies—made about $95,130.
- The highest-paid RN positions were in northern California metropolitan areas, including San Jose, Oakland, and San Francisco.
The Bureau of Labor Statistics recently estimated that the RN workforce—which currently includes 2.7 million nurses—will grow by 26% between 2010 and 2020, creating 711,900 new jobs.
According to U.S. News, which also considered job satisfaction data from job review website Glassdoor, the RN position can by physically and emotionally demanding, but "the variety of career options open to nurses today make tailoring your work life to your own desired schedule much easier."
Five health care professions make top 10 careers list
In addition to RN, four health care professions—pharmacist (#3), medical assistant (#4), physical therapist (#8), and occupational therapist (#10)—made U.S. News' top 10 careers list for 2012.
The health care sector "has become the [nation's] core industry," according to the CEO of outplacement company Challenger, Gray & Christmas, who stressed factors like the aging population and federal expansion of health coverage.
Top health care jobs of 2012
Altogether, U.S. News noted that health care and social services will post 5.6 million new jobs by 2020. According to the magazine, the best health care jobs of 2012 are:
1. Registered nurse;
3. Medical assistant;
4. Physical therapist;
5. Occupational therapist;
6. Clinical laboratory technician;
7. Paramedic; and
8. Massage therapist (Shinkle, U.S. News, 2/27; Graves , U.S. News, 2/27; Graves , U.S. News, 2/27; Nurse.com, 2/28).
Bloomberg: Proposed hospital cuts could exacerbate PCP shortage
Residency shift would undermine federal health reform goals
March 2, 2012
Proposed Medicare funding cuts for graduate medical education (GME) would incent hospitals to focus on specialty residencies and possibly worsen the primary care physician (PCP) shortage, according to a Bloomberg Government study.
President Obama's fiscal year 2013 budget proposed a series of health care cuts—including a $9.7 billion reduction in federal GME funds—as part of his plan to reduce the federal deficit by $4 trillion over the next decade.
The Bloomberg Government study projects that the GME cuts will force many hospitals to adjust their residency mix to prioritize specialties—which generally are more profitable—and less on primary care. That shift would further encourage prospective physicians to pursue specialties, which are generally more lucrative than primary care.
According to the Association of American Medical Colleges (AAMC), the proposal would worsen the nation's PCP shortfall. "You can tell people primary care is great all you want, but unless you show you value it through the payment system, people are always going to go the for the economic incentives," said Atul Grover, AAMC's chief public policy officer.
Bloomberg Government and industry experts say that shift would undermine a top priority of the Affordable Care Act (ACA), which seeks to extend health insurance coverage to an additional 32 million uninsured residents and expand primary care.
Hospital leaders caution that the ACA's existing payment cuts leave them ill-prepared to absorb new reduction in GME. "If a hospital agrees to cuts and then you say, now we want to cut further, they're making it impossible to have the resources to train the doctors," says New York Presbyterian Hospital EVP Herbert Pardes (Frier, Bloomberg, 3/1).
Senate kills amendment to overturn birth control rule
Bill would have allowed benefit denials for moral, religious reasons
March 2, 2012
The Senate on Thursday rejected an amendment that would have allowed employers and health plans to refuse to cover certain health services, including contraception, based on moral or religious objections.
Sen. Roy Blunt (R-Mo.) last month proposed the measure—which was attached to a highway funding bill—before President Obama announced changes to a religious exemption to new federal contraceptive coverage rules.
The White House in February announced that religious-affiliated organizations—including certain hospitals and universities—were no longer required to cover employees' birth control and that insurers must offer no-cost contraception directly to women.
The Senate voted 51-48 to table Blunt's amendment largely along party lines. One Republican—Sen. Olympia Snowe (Maine)—joined the majority of Democrats in voting to table the amendment, after expressing concern that it would allow health plans and employers to deny coverage for a wide range of services.
Meanwhile, three Democrats—Sens. Bob Casey (Pa.), Joe Manchin (W.Va.), and Ben Nelson (Neb.)—voted against tabling it (Aizenman/Helderman, Washington Post, 3/1; Morgan/Ferraro, Reuters, 3/1; McCarthy, National Journal, 3/1 [subscription required]).
Minn. nurses reignite staffing levels debate
Union leaders say hospitals broke promises made after 2010 strike
March 2, 2012
The Minnesota Nurses Association (MNA)—which used "safe staffing" as a rallying cry during a historic 2010 strike—this week urged state lawmakers to pass legislation limiting the number of patients per nurse.
The proposed legislation, called the 2012 Staffing For Patient Safety Act, would require hospitals to have specific staffing plans, and administrators to collaborate with nurses on staffing resources and efforts to increase staffing transparency.
In June 2010, MNA—which represents about 20,000 nurses across Minnesota—organized a walkout over nurse staffing levels that involved about 12,000 nurses across 14 Minneapolis-St. Paul-area hospitals. This week, MNA leaders accused hospitals of breaking promises made following the strike to address staffing issues.
According to MNA, Minnesota nurses filed 988 Concern for Safe Staffing reports in the last six months of 2011 over inadequate staffing levels that they said endangered patients. "We've been left with no choice but to take our concerns to the state Legislature," said Linda Hamilton, the group's president.
However, hospital officials say they take the staffing concerns "very, very seriously," but that legislating staffing levels would not address the problem. "Staffing is a very fluid situation in a hospital setting where the needs of patients change over time, the availability of staff changes over time," said Minnesota Hospital Association President and CEO Lawrence Massa. "Our members…go to great efforts to try to match the needs of the patient with the staffing that's available, day by day, shift by shift, hour by hour" (Dunbar, MPR News, 2/28; Lerner, Minneapolis Star Tribune, 2/28; MNA release, 2/28).
New Rx paradigm? FDA to debate expanding OTC meds
Agency has scheduled hearings for March 22 and 23
March 2, 2012
Would making more medications available over the counter improve medication adherence? FDA later this month will convene hearings to debate the question and consider a "new paradigm" for selling Rx drugs.
According to National Journal, research has shown that U.S. residents often fail to take their medications as prescribed and often are dissuaded from doing so by cumbersome prescription and renewal processes. In addition, much of the costs associated with major chronic illnesses in the United States stem from poor condition management, National Journal notes.
Expand the system?
FDA on March 22 and 23 will discuss the merits of a system that broadens access to medications used to treat chronic conditions, including diabetes, migraines, allergies, and high blood pressure and cholesterol.
According to an FDA notice, the "new paradigm" would sell drugs under conditions of safe use, which would vary based on the medication and could require certain products to be available only in predefined health care settings, such as a pharmacy. For example, the system might allow patients to obtain their medication after a quick consult with a pharmacist.
Janet Woodcock, who leads FDA's Center for Drug Evaluation and Research, notes that the flu vaccine provides valuable precedent for a new prescription drug system. Because the vaccine does not require a prescription, millions of U.S. residents obtain it at local pharmacies each year (Fox, National Journal, 2/29 [subscription required]; Fox, National Journal, 2/27 [subscription required]).
Study links trans fats to stroke risk in older women
Researchers found that aspirin could eliminate the increased stroke risk
March 2, 2012
Consuming large amounts of trans fats may increase stroke risk for older women, according to a study in the Annals of Neurology.
For the study, University of North Carolina-Chapel Hill School of Global Public Health researchers analyzed data on the more than 1,000 incident ischemic strokes that occurred among the 87,025 post-menopausal women participating in the Women's Health Initiative Observational Study.
Based on food consumption surveys completed by the participants, the researchers determined that women who ate the most trans fats—which have been linked to an increased risk of heart disease—were 39% more likely to suffer an ischemic stroke than women who consumed the fewest trans fats.
However, they also found that aspirin may hold that increased stroke risk in check. Women who consumed the most trans fats but did not take aspirin were 66% more likely to suffer a stroke than their aspirin-taking counterparts (Phend, MedPage Today, 3/1).
Doing 'competitive yoga': Sport seeks to name a champion
New York Times highlights challenges in making the competition universal
March 2, 2012
The New York Times previewed this weekend's New York Regional and National Yoga Asana Championship, highlighting the challenges of making a sport that focuses on the connection of body and mind into a universal competition.
According to the Times, adult competitors at the United States Yoga Federation's ninth championship must perform seven poses in three minutes, while competitors between the ages of 11 and 17 must perform six poses. A panel of five judges will then judge each competitor across categories like proper alignment, timing, and steadiness. The top six participants—two men, two women, and two youth participants—will then move on to compete in the international yoga championship in Los Angeles this summer.
However, some are confused by the blending of yoga with competition. "Aren't there enough things in our world that feed the competitive mind?" according to one New York yoga teacher, adding that the "great gifts" of yoga can be distorted by making the practice into a contest.
Currently, yoga competitions take place in 15 countries, according to five-time national yoga champion and USA Yoga Founder Rajashree Choudhury. Given the competitive sport's judging inconsistencies, Choudhury currently is working to establish a universal handbook for the competitions. She hopes to one day see the sport at the Olympics. To be considered for the international games, the sport must be practiced widely by men and women across 75 countries and receive approval for the International Olympic Committee (Beck, Times, 3/1).
Daily roundup: March 2, 2012
Bite-sized hospital and health industry news
March 2, 2012
District of Columbia and Maryland: Kaiser Permanente on Wednesday announced plans to build new facilities by 2013 near Baltimore and Washington, D.C., in an effort to double the number of Kaiser patients in the mid-Atlantic region over the next 10 years. Many of the facilities will provide 24-hour urgent care services (AP/Washington Post, 3/1; Walker, Baltimore Sun, 2/29).
Massachusetts: In a formal dedication ceremony this week, Baystate Health unveiled its 640,000-square-foot, $296 million MassMutual Wing, created through its Hospital of the Future project. Located on the Baystate Medical Center campus, the facility—which features a healing garden on the roof—will house the Davis Family Heart & Vascular Center. It also will house a 70,000-square-foot ED, which is scheduled to open as early as November (Kinney, The Republican, 2/28).
Virginia: Gov. Bob McDonnell (R) has signed into law a bill that will require radiologists to include information about breast density in letters sent to patients following a mammogram. State lawmakers passed the bill—which will take effect on July 1—because mammograms miss 40% of cancers in dense breast tissue (Kumar, "Virginia Politics," Washington Post, 2/29).
Wisconsin: The Monroe Clinic's new hospital is slated to open to patients on March 24. The $83 million, 225,000-square-foot facility features an expanded ED and family birth and women's center, updated cardiology and imaging services, and all-private patient rooms (Lethlean, Freeport Journal-Standard, 2/29).
Our reads for the weekend
March 2, 2012
The Daily Briefing editorial team highlights several studies and articles that got us talking this week.
In Westwood, Mass., a fire captain with a 21-year-old autistic son teaches emergency first responders how to identify and best help people with autism. More.
Because of their time spent in space, astronauts are especially prone to fainting and dizziness. ABC News explains what space travelers have taught physicians about the two conditions. More.
New research shows that Medicare pays 14% less than private insurers for knee replacements, despite insuring a more susceptible beneficiary pool. Kaiser Health News has the story. More.
Working with health care economist Austin Frakt, the Briefing's Managing Editor Dan Diamond discovered a Twitter glitch that affected millions of users. More.
Leap year bundles of joy? The Tennessean explains why moms-to-be this year requested Feb. 29 delivery date. More.
Eye in the sky: The Minneapolis Star Tribune explains how technology allows a Minneapolis-based intensive care specialist to monitor patients in Des Moines. More.
How do surgeons see pregnancy? The New York Times's Pauline Chen weighs in on what it means to be pregnant during your residency. More.
The Wall Street Journal this week examined how Roman Catholic employers have been getting past state contraceptive coverage mandates—and how the federal mandate will change that. More.
How would you fix the U.S. health system? In Bloomberg Businessweek, five industry leaders offered their thoughts. More.
Protect future margins by partnering with the right physicians
March 2, 2012
Decelerated price growth and deteriorating case mix continue to threaten profitable hospital margins, but targeting alignment with high-influence PCP and specialists will guard against economic pressures.
Survey: Health costs a top concern for affluent
For the third consecutive year, a large majority of high-income U.S. residents considered rising health care costs their main financial concern, according to a new survey by Merrill Lynch Global Wealth Management.
The survey, conducted by Braun Research, polled 1,000 adults nationwide with more than $250,000 in investable assets.
It found that more than 75% of respondents considered health care costs their biggest financial problem, even though two-thirds of the respondents have not calculated their expected health care costs after retirement (Carrns, New York Times, 2/27).