The Daily Briefing

News for Health Care Executives

Workforce imperatives for 2012

January 17, 2012

As 2011 drew to a close, the Daily Briefing sat down with a group of Advisory Board experts to garner opinions on the most important issues for members to watch in 2012.

In the first in a series of articles, we explore the 2012 health care workforce—with a special focus on nursing and human resources. 

Labor costs: Pressure to curb growth
The coming year is sure to be filled with continuing cost pressures, and pressure to achieve lower labor costs (and higher workforce productivity) will be intense. What’s more, a one-time cut in hospital labor budgets will not be sufficient to enable hospitals and health systems to thrive in the new environment.

Patient care leaders must pursue a new generation of strategies to slow the growth of labor cost, such as:

  • Increasing the ratio of flexible staff to core staff;
  • Targeting drivers of incremental overtime; 
  • Investing in alternatives to sitters; and 
  • Advancing employee wellness.

Inpatient staffing model: Need to innovate
In light of rising patient acuity and nursing salaries (and reimbursement rates not rising commensurate to cost growth), current inpatient staffing models are threatening to become unsustainable.

In the coming year, look for nurse leaders to innovate on the inpatient staffing model, with the goal of finding an approach to inpatient staffing that allows all caregivers to practice “at the top of their license” and assures high-quality, financially sustainable care.

Cross-continuum nursing roles: How to develop them
Due to changing reimbursement models and patient demographics, hospitals and health systems have new imperatives to manage their case mix and provide care in the most appropriate setting. This focus on avoiding unnecessary hospital admissions has catalyzed experimentation with a number of cross-continuum caregiver roles (nearly always filled by nurses) designed to support at-risk patients and populations to manage their own care at home.

In 2012, look for nursing leads to continue to experiment with the scope and responsibilities of these new cross-continuum nursing roles.

M&A activity: Push to redesign organizational structures in response
The environmental pressures in the U.S. health care industry have many observers predicting an upsurge in mergers and acquisitions.

Hospital and health system HR executives involved in consolidation, many of whom are simultaneously expanding across the continuum of care as well as horizontally, are quickly confronting challenging questions about organizational structure—within and beyond the human resources enterprise. In the coming year, look for a resurgence of interest in organizational redesign and productivity, with a focus on which functions should be centralized, decentralized, or outsourced.

    Where to learn more: The HR Investment Center's Perfecting the Business Partner Model publication offers strategies to redesign organizational structures. HR Investment Center members also can register for this year's national meeting.

Physician alignment strategies: How to succeed
The importance of hospital-physician alignment isn’t news to hospital executives. Nor is the shift to employment of physicians. Unfortunately, hospitals relying solely on employment agreements to achieve stronger physician integration have been sorely disappointed.

In the coming year, look for hospitals and health systems to strengthen their alignment and partnership with physicians by pursuing strategies directed toward improving physician engagement.

Hospital leaders’ roles and responsibilities: Time for an update
As hospitals and health systems adapt to new market imperatives, many hospital HR leaders are asking:

How should hospital leaders’ roles, responsibilities, and formal job descriptions change to reflect new organizational priorities? How should performance management and compensation systems be redesigned to ensure leaders are focused on the appropriate priorities? 

  • Understand how to create a highly productive health care organization in 2012. The HR Investment Center's national meeting will review strategies to bend the cost curve and instill accountability. HR Investment Center members can learn more or register now.

Stay tuned for the next installment of our series where we’ll explore service line-specific imperatives for 2012.

Thomson Reuters names '15 Top Health Systems'

Top systems report fewer fatalities, complications

January 17, 2012

Thomson Reuters on Monday released its fourth annual list of top U.S. health systems based on clinical performance, patient satisfaction, and efficiency.

For the list, Thomson Reuters assessed all U.S. health systems with two or more short-term, general, non-federal hospitals. Overall, 321 health systems with a total of 2,194 hospitals were evaluated.

Using data from the Medicare Provider Analysis and Review and from CMS Hospital Compare, the researchers built the list of top hospitals by looking at eight metrics that gauged clinical quality, efficiency, and patient satisfaction. Those metrics included mortality, complications, patient safety, 30-day mortality and readmission rates, average length of stay (LOS), adherence to clinical standards of care, and patient survey data.

For the first time, each health system this year was categorized as large, medium, or small based on total operating expenses. Thomson Reuters identified the top five health systems in each category.

Large health systems (more than $1.5 billion in overall operating expenses):

  • Banner Health (Phoenix);
  • CareGroup Healthcare System (Boston);
  • Main Line Health (Bryn Mawr, Pa.);
  • Memorial Hermann Healthcare System (Houston); and
  • St. Vincent Health (Indianapolis).

Medium health systems (between $750 million and $1.5 billion in overall operating expenses):

  • Baystate Health (Springfield, Mass.);
  • Geisinger Health System (Danville, Pa.);
  • HCA Central and West Texas Division (Austin, Texas);
  • Mission Health System (Asheville, N.C.); and
  • Prime Healthcare Services (Ontario, Calif.).

Small health systems (less than $750 million in overall operating expenses):

  • Baptist Health (Montgomery, Ala.);
  • Maury Regional Healthcare System (Columbia, Tenn.);
  • Poudre Valley Health System (Fort Collins, Colo.);
  • Saint Joseph Regional Health System (Mishawaka, Ind.); and
  • Tanner Health System (Carrollton, Ga.).

Thomson Reuters also recognized 49 additional health systems as top performers, representing the remaining top 20% of the systems analyzed.

Top systems outperformed peers across-the-board
Overall, the researchers found that the 15 top systems outperformed their peers across all measures. For example, the winning systems reported nearly 17% fewer deaths than expected, while non-winners reported 4% more than expected. Similarly, complication rates at the 15 top systems were 19% lower than rates at other health systems (Thomson Reuters release, 1/16; Vesely, Modern Healthcare, 1/14 [subscription required]).

The Advisory Board congratulates members named as 'Top Health Systems'

14 of 15 honored organizations are Advisory Board members

January 17, 2012

Thomson Reuters on Monday released its fourth annual list of top U.S. health systems based on clinical performance, patient satisfaction, and efficiency.

For the list, Thomson Reuters assessed all U.S. health systems with two or more short-term, general, non-federal hospitals. Overall, 321 health systems with a total of 2,194 hospitals were evaluated. (To learn more about the methodology, see this article in today's Daily Briefing.)

The Advisory Board congratulates the following members named to Thomson Reuters' annual list of "Top Health Systems." Altogether, 14 of the 15 health systems honored by Thomson Reuters are Advisory Board members:

  • Banner Health (Phoenix)
  • Main Line Health (Bryn Mawr, Pa.)
  • Memorial Hermann Healthcare System (Houston)
  • St. Vincent Health (Indianapolis)
  • Baystate Health (Springfield, Mass.)
  • Geisinger Health System (Danville, Pa.) 
  • HCA Central and West Texas Division (Austin, Texas)
  • Mission Health System (Asheville, N.C.)
  • Prime Healthcare Services (Ontario, Calif.)
  • Baptist Health (Montgomery, Ala.)
  • Maury Regional Healthcare System (Columbia, Tenn.)
  • Poudre Valley Health System (Fort Collins, Colo.)
  • Saint Joseph Regional Health System (Mishawaka, Ind.)
  • Tanner Health System (Carrolton, Ga.)


NCQA: First six providers apply for ACO review

Four health systems, two physician groups seek accreditation

January 17, 2012

The National Committee for Quality Assurance (NCQA) last week announced the six organizations that were the first to apply for its ACO Accreditation program.

The six organizations are:

  • Billings Clinic (Mont.);
  • Children's Hospital of Philadelphia (Pa.);
  • Crystal Run Healthcare (Middletown, N.Y.);
  • Essentia Health (Duluth, Minn.);
  • HealthPartners (Minneapolis, Minn.); and
  • Kelsey-Seybold Clinic (Houston)

As "early adopters" of NCQA's program, which launched in November, the hospitals and physician groups will undergo NCQA accreditation surveys—which measure their ACO capabilities—between March 1 and Dec. 31.

"I applaud these organizations for having the courage to go first and measure themselves against objective, balanced standards of ACO readiness," said NCQA President Margaret O’Kane. "Volunteering for this evaluation is the first step to showing payers and providers how well they can do the things ACOs are expected to do" (NCQA release, 1/12; Evans, Modern Healthcare, 1/12 [subscription required]).

What 'The Obamas' reveals about health reform

Five new details about the White House fight on ACA

January 16, 2012

Dan Diamond, Managing Editor  

They're the most dissected First Couple in a generation.

It was the most scrutinized legislative battle in decades.

Is there anything left to learn about the Obamas and the health reform law?

According to a new book—yes.

'The Obamas' goes inside personal relationships, political alliances
Reported by New York Times White House correspondent Jodi Kantor, "The Obamas" captures the first 30 months of the Obama presidency by focusing on the dynamic between Barack and Michelle.  

The Affordable Care Act runs through Kantor's narrative—the health battle illustrating differences between the president and first lady, and the political price that Barack Obama paid to pass the ACA framing the book's later chapters.

And Kantor's reporting surfaces new insights and reinforces existing theories about the White House approach to health reform. (The White House has publicly challenged some of Kantor's assertions.)

Here are five takeaways about health reform as captured in "The Obamas."

1. The ACA pitted Chief of Staff Rahm Emanuel against Michelle
Based on his service in the Clinton White House, Emanuel argued that only incremental health reforms would succeed and that attempting a major overhaul like President Clinton's failed bill would doom Obama's presidency.

Meanwhile, Michelle had been long wary of her husband's run for the White House, anxious about the impact on her family and skeptical of the nation's political system. To the first lady, the personal sacrifices to achieve Barack's presidency would only be worth legislation on the scale of the ACA.

It was an ideological clash that divided the president's political and life partners. His spouse ultimately won.

2. Michelle was the biggest cheerleader for the ACA
Facing political attacks and drooping poll numbers throughout 2009, White House officials repeatedly urged Barack to change course on health reform. The administration was unprepared for the anti-ACA backlash, Kantor writes, and many felt that the legislative effort was poorly timed.

However, after advisors headed home and their children had gone to bed, the Obamas would sit on the White House balcony and discuss the policy battle. In these conversations, Michelle would remind her husband of health reform's moral imperatives and their shared goal to accomplish lasting change.

This was "Michelle's most profound influence on the Obama presidency," Kantor writes.

3. Barack's pragmatic approach wasn't shared by Michelle 
To pass the ACA, Barack was willing to trade off on high-minded goals—sacrificing his campaign pledge to close the Guatanamo prison or striking a deal with the pharmaceutical industry, for example.

But the president's deals "were diminishing his reputation as a reformer" across 2009 and into 2010, Kantor writes. Like many Democrats who had supported her husband, Michelle was anxious that Barack was becoming "just another politician," especially if the floundering ACA was to run aground. She further worried that the president's advisors had lost the pulse of the nation.

4. Scott Brown's victory both devastated and empowered Michelle
Michelle's fears were realized when Republican Scott Brown unexpectedly won Sen. Ted Kennedy's Senate seat in Massachusetts in January 2010—a staggering political upset that left the White House stunned and Barack's health reform effort on life support.

But the loss was also "grim evidence" for Michelle, who felt validated in her concerns about White House strategy. The first lady had spent months criticizing senior advisors like David Axelrod and Emanuel: the men "were not careful planners who looked out for worst-case scenarios," Kantor writes.

Both Axelrod and Emanuel would be gone from the White House within a year.

5. Emanuel nearly quit before the ACA succeeded
In the wake of Brown's victory, Barack's stalled agenda, and painful midterm elections looming, Emanuel began to leak his own disagreements with the president. One Washington Post column caused particular consternation.

As the stories emerged, Emanuel went to the president in February 2010 and offered to resign. "I'm not accepting it," Barack reportedly told Emanuel. "Your punishment is to stay here and get this bill done," pushing the chief of staff to work "tirelessly" on shorting up support.

The ACA passed a month later.

Panel rejects almost half of proposed CMS quality measures

Measures would be used to assess provider performance

January 17, 2012

A panel convened by the National Quality Forum last week released a report rejecting nearly half of the proposed quality measures CMS is considering to evaluate hospitals and other health care providers.

CMS is considering 368 quality measures proposed by a variety of government bodies, industry stakeholders, and others. The agency asked the Measures Application Partnership (MAP) to analyze the list and suggest which measures most accurately reflect provider performance.

In its 78-page report, MAP supported 40% of the measures on the list, including measures for diabetes care and hepatitis B vaccinations. The group recommended that roughly 15% of the proposed measures be developed further or tested before use in federal rulemaking and advised against adopting the remaining 45%.

MAP based its assessments on HHS' National Quality Strategy, which emphasizes population health, high-quality health care, and affordability. The report is available online for public comment through Jan. 20.

Although CMS is not required to adopt MAP's recommendations, they are expected to be influential. According to the report, this is the first time CMS has consulted an outside group about quality measures before formally proposing them (McKinney, Modern Healthcare, 1/12 [subscription required]; Rau, "Capsules," Kaiser Health News, 1/10; Rau, "Capsules," KHN, 1/12). 

Cars that care? Ford plans checkups on the way to work

System would rely on wearable device, spoken descriptions

January 17, 2012

Ford and Microsoft last week announced a partnership to study how individuals can use in-vehicle monitoring technology to manage health and wellness.

According to Ford, the car is an "ideal platform" for health services—it's convenient, private, and many Americans spend an increasing amount of time in their automobiles. There is "a natural role for the automobile in the emerging digital health and wellness field," according to Gary Strumolo, who manages infotainment, interiors, health, and wellness at Ford Research and Innovation. 

The car and computer giants have joined with online mobile health applications developer Healthrageous and BlueMetal Architects, an interactive design and technology firm, to explore system possibilities.

At this week's Digital Health Summit at the International Consumer Electronics Show in Las Vegas, the companies discussed a prototype designed by BlueMetal Architects.

The system uses biometric data collected from a wearable device, as well as spoken descriptions from the user about his or her health routine. It also allows users to upload data from their in-car monitors to Microsoft's HealthVault personal health record platform.

Strumolo says the new technology is "full of transformative potential" but is not meant to function as a medical device or diagnostic tool. He says, "There is a line we'll never cross," adding, "We don't want to have the car able to make predictions" (Healthcare IT News, 1/12; Versel, MobiHealthNews, 1/12; Ford release, 1/11).

California: Where the public option is alive and well

County-run plans to vie for customers under federal overhaul

January 17, 2012

Although the public option died in Congress, it continues to thrive in California, where county-run plans provide coverage for 2.5 million residents, KQED/Kaiser Health News reports.

Residents participating in the government-run plans typically go to public health clinics and county hospitals for care. Some of the county plans also contract with private physicians and renowned research hospitals.

For example, the Alameda Alliance for Health—which covers 200,000 people in the Oakland area—features a network of physicians and hospitals, and administers a managed care plan for Medicaid beneficiaries and additional plans for county workers.

The public plans soon will compete with private insurers on a new level, as the federal health reform law requires states to establish their own health insurance exchanges by 2014. County plan managers say they will stand up to the competition because they offer low-cost services and a robust network of physicians and hospitals.

Ingrid Lamirault, CEO of the Alameda plan, said, "I think when some people get to make a choice, having local offices they can walk into and get help with things and get their questions answered…those kinds of things are important to them."

However, some private insurers in the state are rebuking the public plans. "Certainly, there are some health plans that didn't like the idea of having to compete with these public plans," said Anthony Wright, executive director of the advocacy group Health Access. "Especially ones that, having come out of the Medicaid program, are used to providing care at cheaper rates" (Varney, KQED/KHN, 1/12).

Weekly review

Key articles from Jan. 9-Jan. 13

January 17, 2012

Missed a day of the Daily Briefing? Here's a quick round-up of top stories and research highlights from last week’s issues.

CDC lists 15 leading causes of death (Jan. 12)

A new condition made CDC's most recent top causes of death list, squeezing out one 45-year mainstay.

More hospitals won’t hire smokers. Is it discrimination? (Jan. 9)

More U.S. health systems—focused on creating a culture of wellness—are refusing to hire tobacco users, but some worker advocates argue that the policy is discriminatory.

Preventing presenteeism: State is nation's first to mandate paid sick leave (Jan. 11)

In an effort to reduce employee "presenteeism," Connecticut has become the first state to mandate paid sick days for certain workers. Policy advocates predict that other cities and states will follow suit.

Patient-centered focus reduces infusion nurses’ steps by 76% (Jan. 9)

Learn how administrators at Lakeland Regional Cancer Center’s infusion center turned a simple, one-day patient flow mapping session into tangible changes for patients and staff.

Two dead after shooting in Ga. hospital (Jan. 9)

A 59-year-old Tennessee man is facing felony murder charges after allegedly shooting two visitors in a Georgia hospital waiting room, the Chattanooga Times Free Press reports.

Behind the scenes: Taking a Mayo idea to the Mall of America (Jan. 11)

Innovation experts at Rochester, Minn.-based Mayo Clinic are following a four-stage plan to launch a new retail storefront in the Mall of America, according to a new case study profile.

Study ties nurse miscarriages to chemicals used on the job

Findings also highlight increased risk among those who handle X-rays

January 17, 2012

Nurses who are exposed to certain chemicals at work are two times more likely to suffer a miscarriage than colleagues not exposed to the substances, according to a study in the American Journal of Obstetrics and Gynecology.

For the study, National Institute for Occupational Safety and Health (NIOSH) researchers surveyed nearly 7,500 nurses who were pregnant between 1993 and 2002 to determine how often they were exposed to certain chemicals and equipment, such as X-rays, cancer drugs, and disinfectants.

Overall, one in 10 nurses miscarried before 20 weeks, a rate comparable to the miscarriage rate of the general population. However, nurses who handled chemotherapy drugs for more than one hour per day were twice as likely to miscarry.

Nurses who handled sterilizing chemicals for more than one hour per day also were twice as likely to miscarry, but only in their second trimester. Meanwhile, nurses who performed X-rays were about 30% more likely to miscarry than nurses who did not perform X-rays.

According to University of Maryland nursing professor Barbara Sattler, the findings underscore the importance to adhering to NIOSH safety guidelines, which help protect workers from potential occupational hazards (Grens, Reuters, 1/13).

Daily roundup: Jan. 17, 2012

Bite-sized hospital and health industry news

January 17, 2012

  • California: The California Department of Managed Health Care (DMHC) last week ordered Anthem Blue Cross to reimburse hospitals and physicians for outstanding claims dating back to 2007, saying the insurer failed to resolve violations discovered in a state audit. DMHC gave Anthem 30 days to submit a plan of correction and identify claims violations. Claims found to have been wrongly paid would need to be repaid with interest. According to DMHC spokesperson Rodger Butler, Anthem said it would need to review 2.6 million claims to comply with the order. Anthem spokesperson Darrel Ng said DMHC's order was unexpected because Anthem already paid a $500,000 fine associated with the audit in November 2010 (Tayefe Mohajer, AP/San Francisco Chronicle, 1/12; Robertson, Sacramento Business Journal, 1/12).
  • Iowa: State lawmakers last week announced that they are establishing a bipartisan caucus to raise awareness about cancer research and treatment options. According to state Rep. Scott Raecker (R), the caucus is a "bridge-building opportunity between the parties and between the chambers" that will provide a "platform to talk about the issues" (Boshart, Sioux City Journal, 1/11).
  • Missouri: A proposed state rule would require hospitals to report adverse events involving Medicaid patients directly to the Missouri Department of Social Services, which oversees the state’s Medicaid program. Hospitals previously could confidentially report adverse events to the not-for-profit Missouri Center for Patient Safety. Errors that hospitals would be required to report include wrong-site surgery, and certain medication errors and infections (Okeson, Springfield News-Leader, 1/13).
  • Tennessee: St. Jude Children's Research Hospital in Memphis, Tenn., last week announced the launch of its new "Explore" website where it will publish results from a large genome sequencing study. The project aims to sequence entire genomes of normal and cancerous cells of 600 pediatric patients with cancer. According to St. Jude's, the new Explore website will "expand access to high-quality genomic data related to pediatric cancers, accelerate discovery and hypothesis testing, and provide comprehensive visualizations of the data" (St. Jude's release, 1/11; Charlier, Memphis Commercial Appeal, 1/12).

A common complaint understood

January 17, 2012

70% of physicians don’t believe quality data is accurate. Join our webconference on Jan. 20 to learn how to engage physicians in performance improvement.

Premiums would increase by up to 25% without individual mandate, study finds

Insurance premiums would increase by as much as 25% if the federal health reform law is implemented without an individual mandate, according to a recent study from the Robert Wood Johnson Foundation.

The study found that premiums could increase because young, healthy people would be less likely to purchase coverage.

Premiums would increase by about 10% in states with high levels of participation in new health insurance exchanges, and between 20% to 25% in states where fewer individuals use the exchanges, according to the report (Baker, "Healthwatch," The Hill, 1/12).