The Daily Briefing

News for Health Care Executives

Migrate to a system of excellence for cardiovascular care delivery

August 23, 2011

As market focus moves toward coordinated care delivery models, CV programs must mobilize to bridge the divide among providers and across time. David Katz, executive director at The Advisory Board Company, shares insights for mastering the care continuum and developing a regionalized approach to the delivery of care. Watch now.

Register now
Cardiovascular Roundtable members may register now for the 2011-2012 National Meeting Series, Toward Value-Driven Cardiovascular Care. Daily Briefing readers with questions about the Cardiovascular Roundtable may email

Top employers

Modern Healthcare names 'Best Places to Work' list

August 23, 2011

Modern Healthcare has released its 2011 "Best Places to Work in Healthcare" list, which recognizes 100 "outstanding" health care employers, including hospitals, insurers, suppliers, and consulting groups.

The Advisory Board congratulates the member organizations honored as "Best Places to Work in Healthcare." The Advisory Board Company was also named to this year's list.

The list was compiled using information gathered from employers and employees of companies with at least 25 employees as part of a no-cost application process. For the application, employers completed a survey detailing their policies and practices, benefits, and employee demographics. Meanwhile, employees were asked to evaluate their employer in eight areas, including:

  • Leadership and planning;
  • Culture and communications;
  • Role satisfaction;
  • Working environment;
  • Relationship with supervisor;
  • Training and development;
  • Pay and benefits; and
  • Overall satisfaction (Modern Healthcare, 8/22 [subscription required]).

The Advisory Board congratulates member organizations named to this year's list:

  • Baptist Easley Hospital (S.C.)
  • Baptist Health South Florida (Coral Gables, Fla.)
  • Baptist Memorial Hospital - Union City (Tenn.)
  • Black River Memorial Hospital (Black River Falls, Wis.)
  • Blessing Health System (Quincy, Ill.)
  • Centegra Physician Care (McHenry, Ill.)
  • Clark Memorial Hospital (Jeffersonville, Ind.)
  • Corazon (Pittsburgh)
  • Doctors Hospital of Sarasota (Fla.)
  • Grundy County Memorial Hospital (Grundy Center, Iowa)
  • Hancock Regional Hospital (Greenfield, Ind.)
  • HaysMed (Hays, Kansas)
  • Heartland Health (St. Joseph, Mo.)
  • Henry County Hospital (Napoleon, Ohio)
  • Holy Name Medical Center (Teaneck, N.J.)
  • Jacksonville Medical Center (Ala.)
  • Jersey City Medical Center (N.J.)
  • Kessler Rehabilitation Center (Lyndhurst, N.J.)
  • Kootenai Health (Coeur d' Alene, Idaho)
  • Langlade Hospital (Antigo, Wis.)
  • Lovelace Westside Hospital (Albuquerque, N.M.)
  • Lovelace Women's Hospital (Albuquerque, N.M.)
  • Lowell General Hospital (Lowell, Mass.)
  • Mayo Clinic Health System - Chippewa Valley (Eau Claire, Wis.)
  • McLaren Health Plan (Flint, Mich.)
  • Memorial Healthcare System (Hollywood, Fla.)
  • Palmetto Health (Columbia, S.C.)
  • Pikeville Medical Center (Ky.)
  • Poudre Valley Health System (Fort Collins, Colo.)
  • Rex Healthcare (Raleigh, N.C.)
  • Riverside Radiology & Interventional Associates (Columbus, Ohio)
  • Roper St. Francis Healthcare (Charleston, S.C.)
  • Saint Francis Medical Center (Cape Girardeau, Mo.)
  • Self Regional Healthcare (Greenwood, S.C.)
  • Sheltering Arms Physical Rehabilitation Centers (Mechanicsville, Va.)
  • Southern Ohio Medical Center (Portsmouth)
  • St. Elizabeth Hospital (Gonzales, La.)
  • St. Joseph Hospital (Kokomo)
  • St. Luke's Lakeside Hospital (The Woodlands, Texas)
  • Sutter Davis Hospital (Davis, Calif.)
  • Sutter Maternity and Surgery Center (Santa Cruz, Calif.)
  • Sutter Medical Foundation (Sacramento)
  • Texas Health Center for Diagnostics & Surgery (Plano)
  • Texas Health Harris Methodist Hospital Southlake (Texas)
  • Texas Health Presbyterian Hospital Rockwall (Texas)
  • The Advisory Board Company (Washington, D.C.)
  • Union Hospital (Terre Haute, Ind.)
  • Valley Medical Center (Renton, Wash.)
  • VHA (Irving, Texas)
  • Wamego City Hospital (Kan.)
  • Woman's Hospital (Baton Rouge, La.)
  • Yale-New Haven Hospital (New Haven, Conn.)
  • Yankee Alliance (Andover, Mass.)
  • Zynx Health (Los Angeles)

Bundles begin

CMS announces bundled payment program

August 23, 2011

CMS on Tuesday announced its new Bundled Payments for Care Improvement initiative, which was created by the Affordable Care Act as a way to better align provider payments across an episode of care.

What will the program mean for providers? Click here  to read initial takeaways from Chief Research Officer Chas Roades.

Under the program, the CMS Innovation Center is inviting providers to apply for four broadly defined models of care; three models involve retrospective bundled payments and the fourth would reimburse providers using prospective payment. Applicants would propose the target price and have "great flexibility" in selecting which conditions to bundle, setting up the delivery structure, and determining how to allocate payments among participating providers, the agency notes.

In a conference call, CMS officials said that they expect "hundreds of providers" to join the program, Modern Healthcare reports. Participants would choose to define their model of care based on one of the following four models:

  • Model 1: Only the acute care hospital stay.
  • Model 2: The acute care hospital stay plus associated post-acute care.
  • Model 3: Only the post-acute care services.
  • Model 4: CMS would make a single prospective payment that encompasses all services delivered during an inpatient stay.

Providers interested in Model 1 must submit a letter of intent to CMS by September 22, 2011; the other three models have a deadline of November 4, 2011.

"Hospitals and other providers recognize that they have to accommodate the current (fiscal) environment," according to Nancy Foster, the American Hospital Association's vice president for quality. She says some providers ultimately may receive less money through bundled payments; however, she notes that they may qualify for care coordination rewards and costs will still be covered (CMS release, 8/23; CMS website, accessed 8/23; Daly, Modern Healthcare, 8/23 [subscription required]; Selyukh/Yukhananov, Reuters, 8/23).

On the clock

Hospitals slash door-to-balloon time for MI patients

August 23, 2011

Almost all myocardial infarction (MI) patients now are treated within the recommended 90-minute time frame thanks to nationwide efforts to speed cardiac care, according to a study in Circulation.

For the study, Yale University researchers and colleagues assessed 300,000 patients who received emergency angioplasty between 2005 and 2010 at hospitals that treated Medicare patients.

They found that door-to-balloon (D2B) time—the period from hospital arrival to angioplasty—dropped from a median of 96 minutes in 2005 to 64 minutes in 2010. Moreover, roughly 91% of patients in 2010 received care within 90 minutes, up from only about 44% five years earlier, while about 70% of patients received care within 75 minutes, up from approximately 27% in 2005.

The study attributed the improvements to various nationwide efforts to speed heart treatment after research revealed that most patients did not receive care within the recommended time frame. For example, CMS began publicly reporting the percentage of patients treated within recommended D2B times, while the American College of Cardiology and other organizations launched the D2B Alliance, which urged hospitals to adopt strategies to accelerate care.

According to the study's lead author, the findings "show the profession at one of its finest moments." He notes that "Americans who have heart attacks can now be confident they're going to be treated rapidly in virtually every hospital of the country" (Marchione, AP/Sacramento Bee, 8/22; Kaiser, MedPage Today, 8/22; Hobson, "Health Blog," Wall Street Journal, 8/22).

Punished for partnering?

FTC puts hospital mergers under 'virtual microscope'

August 23, 2011

The Federal Trade Commission's (FTC) challenge of a hospital merger in Toledo, Ohio, could have broad implications for providers nationwide as they move to collaborate in the face of health reform, the New York Times reports.

According to a representative from the health care law firm Epstein Becker Green, health providers increasingly are exploring collaboration, in part because of incentives included in the federal health reform law. Overall, the firm estimates that 50% to 60% of hospitals and physicians are considering ways to "team up," such as mergers, consolidations, or joint ventures. Moreover, a recent study from the Center for Studying Health System Change found that hospitals are hiring more physicians in an effort to increase market share and revenue. 

Although hospital executives say increased collaboration can improve quality and cut costs, the FTC Bureau of Competition's director notes that "the arrangement can create highly concentrated markets that may harm consumers through higher prices or lower quality of care." The agency currently is challenging a merger in Ohio between ProMedica Health System in Toledo and St. Luke's Hospital in Maumee. FTC lawyers allege that the merger would increase ProMedica's bargaining leverage, which would force health insurance companies to pay higher rates to the hospitals and increase consumers' premiums. According to federal officials, combining the two hospitals would grow ProMedica's share of the county's inpatient hospital services market from 47% to 58%.

However, ProMedica's president Randy Oostra says the merger would coordinate care and improve quality at St. Luke's by facilitating electronic health record implementation and streamlining care delivery. Under the deal, ProMedica pledged to invest $35 million in St. Luke's, which was losing money. Oostra notes that St. Luke's—which witnesses identified as a low-cost, high-quality provider—charged privately insured patients "substantially below market rates" for services.

FTC says it is reviewing at least 12 cases involving collaboration between competing physician groups or hospitals. For example, the agency also has "serious concerns" about plans for a Spokane, Wash.-based hospital to acquire two cardiologist practices and has challenged a merger between two Georgia hospitals (Pear, Times, 8/21).

Catholic Recessional?

Nuns, priests disappearing from hospital leadership ranks

August 23, 2011

The New York Times this weekend examined the disappearance of nuns and priests from hospital leadership roles, noting that a gradual transition to lay leadership at Catholic health care systems is "now nearly complete."

Health care long has been a key mission of U.S. nuns, who built 12 of the nation's 40 largest health systems since 1727. Catholic hospitals in 2009 accounted for one in six U.S. hospital admissions, according to the Catholic Health Association (CHA).

Meanwhile, CHA statistics show that nuns or priests in 1968 led 770 of the United States' 796 Catholic hospitals. However, religious executives in 2011 lead only eight of the country's 636 Catholic hospitals and eight of the nation's 59 Catholic health systems.

According to the Times, the leadership shift primarily has been caused by a steep decline in religious orders following the women's movement, the sexual revolution, ethnic assimilation, and the Vatican's decision to open the Church to lay leadership. Today, there only are 56,000 nuns—down from 180,000 in 1965—even though the U.S. Roman Catholic population increased by roughly 50% across the last 50 years. Moreover, 91% of nuns in 2009 were aged 60 or older.

The shift has caused concern at many Catholic hospitals over whether a "values-driven approach" will survive as nuns fade from leadership, the Times reports. Catholic health authorities say nun-led hospitals primarily focused on serving low-income patients and provided spiritual reassurance that health takes precedence over profit (Sack, Times, 8/20). 

Paying providers

Harvard professors offer new reimbursement formula

August 23, 2011

A formula that calculates how long a patient spends with each physician office employee and uses equipment during an appointment could more effectively determine reimbursement rates and reduce health care costs, according to an article in the Harvard Business Review.

The proposal—developed by Harvard Business School professors Robert Kaplan and Michael Porter—estimates the hourly rate of each employee by dividing salary, benefits, and the cost of using technology and facilities by the number of hours each employee works. The system also factors in how long patients spend at each portion of their visit.

According to Porter, the current cost-estimate model is based on a "cost-plus system" which has made reimbursement go up. "Since providers misunderstand their costs, they are unable to link cost to process improvements or outcomes, preventing them from making systematic and sustainable cost reductions," Kaplan and Porter write.

The proposed system would require health care providers to determine their interaction with patients, the services offered, and the length of treatment. For example, if a patient spends 18 minutes with a receptionist who costs $45 per hour, 24 minutes with a nurse who costs $65 per hour, and 9 minutes with a physician who costs $300 per hour, the total cost of the visit equals $84.50, Kaplan and Porter estimate (McCarthy, National Journal, 8/21 [subscription required]).

Going viral

Online videos help hospitals boost marketing efforts

August 23, 2011

Marketing strategies that feature online video may be the most effective for hospitals looking to engage patients and create brand awareness, according to a survey of hospital marketing professionals by the digital media marketing firm Acsys Interactive.

According to the survey, 12.9% of respondents said online videos are "extremely effective," and 33.7% said they are "very effective." Meanwhile, more than half of respondents said they expected the amount of resources devoted to online videos to increase across the next few years.

Videos drive patients to providers
Earlier this month, Lawrence & Memorial Hospital in New London, Conn., launched a new website that uses video as a key component. The hospital posted a series of videos that features physicians, nurses, and other staff members introducing some of the hospital's key services. According to the hospital's director of public relations and media services, "It's a lot more effective for some people to see something moving and to hear someone talking rather than to read words on a page or words on a screen."

A senior strategist for Acsys says incorporating online video into a marketing plan requires a relatively low investment of time and money. He notes that a recent Google study found that "irrespective of the quality of the video, it's about the trust in the physician and the hospital" highlighted in the video. The study found that 60% of individuals who viewed a video from a credible source made direct contact with the physician or hospital that was featured.

For hospitals that already have an online presence, adding video can help make a website more interactive and increase the length of an average user's visit, according to Acsys' senior vice president of strategy and innovation. He added, "In terms of taking a first step, a series of well-produced and syndicated videos living on a simple YouTube channel and integrated with website platforms can have a lot of legs, create viral activity, and produce strong results without any ongoing baggage" (Lewis Dolan, American Medical News, 8/22).

CMS expands DME bidding program

Agency plans expansion to eight categories

August 23, 2011

CMS plans to expand its competitive-bidding program for durable medical equipment to include eight new categories, Modern Healthcare reports.

The categories include:

  • Continuous positive airway pressure and respiratory assist devices;
  • Enteral nutrients and equipment;
  • Hospital beds;
  • Negative pressure wound therapy pumps;
  • Oxygen equipment and supplies;
  • Support services, such as certain mattresses and overlays;
  • Walkers; and
  • Wheelchairs.

Congress in 2003 required CMS to establish the Durable Medical Equipment, Prosthetics, Orthotics, and Supplies competitive bidding program. The first round of the program was limited to nine metropolitan areas. CMS officials said the first round saved roughly $130 million in its first six months.

In its second phase, the program will expand to 91 additional metropolitan areas, including Houston, Los Angeles, and New York City. Officials expect new prices to take effect in July 2013. According to CMS, the second round likely will save $28 billion over 10 years, and about one-third of the savings will go to beneficiaries. CMS Administrator Donald Berwick said that Medicare has paid significantly more than the private sector for equipment in recent years and that the agency is seeking more equitable rates.

Critics say the design of the bidding process is flawed because companies can submit low bids to win but are not required to follow through and accept Medicare contracts, National Journal reports. However, CMS deputy administratort Jonathan Blum said officials intend to screen bids by third-party contractors more thoroughly to ensure their credibility (Lee, Modern Healthcare, 8/19 [subscription required]; Baker, "Healthwatch," The Hill, 8/19; McCarthy, National Journal, 8/19 [subscription required]).

Love and your waistline

Men gain weight with divorce, women with marriage

August 23, 2011

Although both marriage and divorce seem to cause weight gain, each marital occasion affects women and men differently, according to a study presented this week at the American Sociological Association's annual meeting. 

For the study, researchers from The Ohio State University analyzed data for 10,071 people who filled out surveys about their weight and marital status between 1986 and 2008. The participants then were grouped based on how much their body mass index fluctuated in the two years after a marital transition.

The researchers found that both men and women gained some weight after getting married, but that women tended to put on more weight than men in the first two years of marriage. However, while both men and women put on some weight after a divorce, recently divorced men tended to put on more weight than women (Stein, "Booster Shots," Los Angeles Times, 8/22; Park, "Healthland," Time, 8/22).

Could you be losing $29 million annually from a single service line?

August 23, 2011

With better visibility into referral patterns, hospitals are finding significant opportunity in both primary and previously untapped service lines. A recent analysis of national markets indicated that hospitals can be leaking on average $29 million in lost referrals annually from a single service line. By understanding where the hospital’s services fit into the landscape of referral relationships, hospital leaders gain a critical advantage in building a value-based care organization.

Many hospital leaders assume they know who are the high-yield physicians for key service lines. However, physician network analytics reveal a much clearer picture of who are the most active physicians in a given market, providing critical intelligence as organizations consider physician alignment and acquisition strategies to drive growth. The Market Advantage Initiative maps the inpatient and outpatient referrals of any given market to provide organizations with a novel approach to capturing market share. Join the webconference to learn how to: 

  • Ensure referral patterns are staying within network and target employed PCPs and specialists who are “leaking referrals;” 
  • Maximize growth potential in secondary and tertiary markets by identifying the most active PCPs in defined networks (e.g., cardiovascular, oncology); and
  • Curb outmigration by identifying physicians in the market who are currently referring cases to out-of-area specialists.

This webconference is open to all hospital and health system executives. For more information, please contact   
Advisory Board members at non-hospital organizations, please contact

Please note that a valid hospital email address is required to process your registration.

Already a Market Advantage member? Contact your Dedicated Advisor or email to access member webconferences and other resources.

Register now.

Daily roundup: August 23, 2011

Bite-sized hospital and health industry news

August 23, 2011

  • Missouri: The employee turnover rate at Kansas City-area hospitals reached 17.6% in 2010, up from only 13.1% in 2009, according to a survey released last week by the Missouri Hospital Association. Overall, Missouri hospital employee turnover rate was 14.1% in 2010, down from 14.6% in 2009. Meanwhile, the survey found that statewide vacancy rate was 4.3% in 2010, up from 2.9% in 2009 (Twiddy, Kansas City Business Journal, 8/19).  


  • North Carolina: Duke LifePoint Healthcare—a joint venture between Duke University Health System and LifePoint Hospitals—has signed a definitive agreement to acquire Person Memorial Hospital in Roxboro, Modern Healthcare reports. Under the agreement, Duke LifePoint pledged to invest $15 million in the 110-bed hospital over the next decade. The deal, which is subject to approval from the state attorney general, is expected to close in the next 60 to 90 days (Galloro, Modern Healthcare, 8/19 [subscription required]; Nashville Business Journal, 8/19).  


  • North Dakota: Sioux Falls, S.D.-based Sanford Health last week unveiled plans for a new $360 million medical center in Fargo, the Fargo Inforum reports. The 11-floor Sanford Fargo Medical Center will be shaped like an "X" and feature four wings that house each of the facility's four centers of excellence: children's care, heart care, orthopedics, and women's care. The 371-bed hospital will include 30 ORs, 40 ED and trauma care rooms, and 300 clinical examination rooms. According to a Sanford board member, the new medical center may be "the largest project of its kind in North Dakota" (Springer, Inforum, 8/20; Robeznieks, Modern Healthcare, 8/21 [subscription required]).


  • Ohio: An error in Ohio's new electronic billing system has delayed payment to thousands of health care providers and pharmacies that serve Medicaid beneficiaries, the Columbus Dispatch reports. On Aug. 2, Ohio converted to its new $115 million Medicaid IT System, also called MITS. After the conversion, the computer system mistakenly removed some beneficiaries from the program and deemed other health care providers ineligible to provide services. According to Benjamin Johnson, a spokesperson for the Ohio Department of Job and Family Services, less than 1% of the 90,000 Medicaid providers in the state have been denied requests for payment. He added that most health care providers who have been denied reimbursement will receive payment on Thursday (Candisky, Columbus Dispatch, 8/20).


  • Oregon: The AP/Medford Mail Tribune last week profiled two harpists trained in music-thanatology who play for Rogue Valley Medical Center patients nearing the end of their lives. As part of the center's push to improve palliative care options, the two musicians step into patient rooms and ask for permission to play. They draw from spiritual music, lullabies, Gregorian chants, and old Irish songs. After each visit, the musicians fill out medical observation charts to help the hospital collect data on palliative care. According to the center's clinical manager of medical oncology and palliative care, the staff has "seen such positive results" that "[w]e now have nurses and even doctors who are recommending the musicians to patients" (Conrad, AP/Medford Mail Tribune, 8/20).

Despite guidelines, physicians test frequently for cervical cancer

Many physicians recommend women receive the human papillomavirus (HPV) and Pap test for cervical cancer screening on an annual basis, despite guidelines that call for screenings every three years, according to a CDC study in the American Journal of Obstetrics & Gynecology.
For the study, researchers examined 2006 data from the National Ambulatory Medical Care Survey and the National Hospital Ambulatory Medical Care Survey, which garnered responses from 376 private-practice physicians and 216 physicians at hospital outpatient centers. The report found that about 51% of physicians ordered co-testing and only 14% recommended re-screening every three years for women with normal results.

According to MedPage Today, the American Cancer Society in 2002 and the American College of Obstetricians and Gynecologists in 2003 recommended co-testing for women age 30 and older. When the results are normal on both tests, women can wait three years before their next screening, the guidelines say.

The researchers wrote that the findings "suggest a need for continued surveillance and data collection on adherence to cervical screening guidelines, and perhaps an open dialogue on provider, patient, and systems preferences for prevention and management of cervical cancer and abnormalities" (Fiore, MedPage Today, 8/18).