Real World Health Care Blog

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The Caregiver Act and AARP’s CARE Act Aim to Reduce Readmissions

Hospitals nationwide have gone to great lengths in an effort to reduce readmissions and improve patient quality. However, despite these concerted efforts, hospitals continue to incur fines from Medicare for excessive rates of patient readmissions, which are projected to total more than $428 million. Even worse, readmissions cost patients a collective $17 billion.

Eric Heil, RightCare

Eric Heil, RightCare

However, these numbers and rates are starting to drop thanks to new tools and programs, such as the Delivery System Reform Incentive Payment (DSRIP) Program. We’re also seeing new legislation being introduced in several states aimed at reducing readmissions by ensuring hospitals and their patients communicate better after they are discharged.

The Caregiver Act and AARP’s model state bill, called the Caregiver Advise, Record, Enable (CARE) Act, are examples of legislation currently being discussed in several states. Together, they have the potential to prevent hundreds of thousands of unnecessary hospital readmissions. Oklahoma was the first in the nation to pass legislation back in November 2014 and New Jersey followed suit later the same month.

The new laws would require hospitals to work directly with a patient’s caregiver (usually a family member) to ensure that necessary preparations are in place for the patient to successfully recover at home after being discharged. This process includes providing discharged patients and their caregivers with a clear path to follow for addressing medication, nutrition and living needs in-home.

To achieve this level of customized, high quality care, technology is essential to streamline the care coordination process and support the unique needs of patients. RightCare, a growing medical technology company, has an end-to-end software solution designed to assess patient risk and needs at the time of admission, ensure the most appropriate post-acute care plan is offered, and seamlessly transition patient information to post-acute care providers. RightCare’s software is based on 10 years of academic and clinical research and has helped hospitals nationwide optimize workflow, reduce length of stay times, reduce readmissions and ensure hospitals meet Medicare-mandated standards for preventable readmissions.

We’ve seen time and time again how effective post-care planning with providers, community organizations and technology can significantly decrease readmissions, so it’s encouraging to see these efforts are now supporting caregivers.

Readers: Are you a family caregiver? What are some of the challenges you face, and what tools are you using to help? Let us know in the comments.

Four Ways Data is Transforming Your Health

The increasing availability of data about health care in the U.S. is empowering patients to take charge of their care and quietly revolutionizing how patients are treated. Last month, the Centers for Medicare & Medicaid Services released data on which services were provided by over 880,000 health care providers, how many times each service was provided, and what the providers charged. Yesterday, top health and technology experts for the federal government and the Brookings Institution gathered to discuss how the growing catalogue of public health care data is leading to profound improvements in America’s health care. The event was hosted by Brookings’ Engelberg Center for Health Care Reform in collaboration with 1776 DC’s Challenge Festival.

Jamie Elizabeth Rosen

Jamie Elizabeth Rosen

Here are the top four ways that data transparency is already beginning to transform Americans’ health. The benefits are expected to grow as the data is analyzed, matched with other sources, and organized into user-friendly and accessible formats.

 

1.    Selecting the best doctor

When Farzad Mostashari learned that his mother needed an epidural steroid injection, he wanted to find out which orthopedic surgeon was the best at this specific procedure. So he searched the millions of medical claims recently released by the Centers for Medicare and Medicaid Services (CMS) to discover which providers were the most experienced in this procedure.

An interesting result emerged. “There is one provider who does more than everyone else combined,” said Mostashari, who is a Visiting Fellow at the Brookings Institution, where he is focused on payment reform and delivery system transformation. “He’s probably pretty good.”

As health care data increasingly becomes available, patients will have more information to make the most rational decisions for their health care, said Kavita Patel, a physician and fellow in the Economic Studies program and managing director for clinical transformation and delivery at the Engelberg Center.

Patel asks her patients why they choose to see her. “Nobody’s ever said: ‘I looked up your quality scores and saw that your out-of-pocket costs are less than the average provider in your area,” Patel said of her 12 years in medical practice. “This is one of the first times that everyone in this room can take out a laptop…and look at this data.”

Mostashari added that the data can be used to identify outliers. For instance, he found that while the average orthopedic surgeon performed controversial spinal fusion surgeries on 7 percent of the patients they saw, some did so on 35 percent. This knowledge empowers patients to choose providers that best align with their health care values and preferences.

 

2.    Reducing costs

The newly-released CMS data enables comparisons of the prices different providers charge for the same services. This data reveals that in some cases providers charge vastly different rates to Medicare for the same services, Mostashari said. The Wall Street Journal provides a consumer-friendly database detailing the types of procedures, number of each, and costs per procedure charged by individual health care providers.

Last year’s release of hospital charges led some hospitals that were charging higher rates to uninsured and underinsured patients than their peers to seek advice from CMS. “Some hospital associations called us and said, ‘We want to change. Help us develop new accounting practices to set prices more fairly for those who are uninsured or underinsured,’” said Jonathan Blum, Principal Deputy Administrator at CMS.

The ability to access and analyze a growing amount of data on procedures performed and their outcomes also helps patients and providers avoid low value services and make decisions about the relative risks and benefits of different procedures. Patel pointed out an ABIM Foundation initiative called Choosing Wisely that equips providers and patients with lists of procedures that should be carefully considered and discussed to ensure that care is supported by evidence, not duplicative, free from harm, and truly necessary.

 

3.    Promoting accountability

When health care providers know that their records will be publically available for scrutiny, they are incentivized to ensure that they won’t be embarrassed by what people find. This can profoundly change which procedures providers choose. For instance, one analysis revealed a wide disparity between the percentage of black versus white patients who were tested for cholesterol levels. “Simply asking providers how often they were doing [cholesterol tests], without any payment incentive,” removed this disparity, said Darshak Sanghavi, the Richard Merkin fellow and a managing director of the Engelberg Center. “This is one example of how simple transparency can improve health care and ultimately save lives.”

 

4.    Expediting spread of best practices

Jonathan Blum, Principal Deputy Administrator at CMS, has seen data transparency expedite the uptake of best practices by health care providers and public health authorities. For example, when analyzing the data on dialysis providers, CMS found that there was an uptick in blood transfusions by certain providers in specific geographic regions. “Our medical team got on the phone and called the dialysis providers and said: ‘Did you know you are doing more blood transfusions than your peers?’” The result? Those providers decreased blood transfusions, improving health outcomes for their patients. The same pattern occurred for nursing home facilities that overused antipsychotic drugs.

“I want to convince folks that you can change policy, you can change procedures, you can make things safer,” Blum said. “Data liberation can help us build [accountable care organizations], help us build better payment policies, help us reduce hospital readmissions. There is tremendous opportunity ahead for us.”

Bryan Sivak, Chief Technology Officer at the Department of Health & Human Services, added that data transparency is affording entrepreneurs from outside the health care sector – such as startups Aidin, Purple Binder, and Oscar – the potential to transform the health care system.

“We’re sitting on the edge of an incredible moment in history,” he said. “Everybody is looking at things in a different way because everybody understands that we have to do things differently.”

“Government data is a public good and a national asset,” said Claudia Williams, Senior Advisor for Health IT and Innovation for the U.S. CTO in the White House. “It’s something we have to release if we can to allow innovation and change.”

How do you make your health care decisions? Have you used any of these new tools?

Categories: General

Live Updates from 15th Annual Patient Assistance & Access Programs

Because this blog is all about increasing access, lowering costs, and improving patient outcomes, we think there’s no better place for us to share ideas that work than to report live from the 15th Annual Patient Assistance & Access Program, in Baltimore, March 5-7.  Check back often as we publish updates from sessions, and follow all of the developments by following #PAP2014.

UPDATE 9:45  Resources for navigators: www.nationaldisabilitynavigator.org; patient advocacy groups such as AIDS Institute are publishing helpful sites.  Also marketplace.comment@cms.hhs.gov is a place you can send questions. This is monitored 24/7 with staff – not interns – but people who really know how to help.  These are triaged and go up to leadership when there are problems or trends.

UPDATE 9:40 Lessons learned:

  1. Partner’s are critical to success of ACA implementation; reach out early, often because plan selection often isn’t a one step process.  Patients need to come back many times before ready to sign up.  Very real “huge” health literacy gaps.
  2. Things to come: we are in closing days of enrollment.  March Madness may be a great opportunity for outreach; then we’ll reach out to those most in need; final week will be “here we are.”  So theme weeks continue.   After window closes Mar 31, you’ll soon start seeing promotion of the new window.

UPDATE 9:25 25 states and DC have indicated they will expand Medicaid.  About 85% of Americans already have minimum essential coverage.

UPDATE: 9:15 Health care law saved $8.9 M in drug costs for Medicare, said Janet Miller, Division of Strategic Partners, Office of Communications, Centers for Medicare and Medicaid Services.  2014 changes: no discrimination due to pre-existing conditions, annual limits on insurance coverage eliminated, small business tax credit increased; more people are eligible for Medicaid in some states.

Essential benefits include at least 10 general categories such as emergency services, hospitalization, maternity and newborn care, prescription drugs, mental health and substance abuse, lab services, preventive and wellness  services and chronic disease management.

Categories: Access to Care

What’s Getting Lost in the Health Care Debate?

Health care has never been more highly politicized than today.

Last year, it was central to the third longest government shutdown in U.S. history. This week, it consumed a large chunk of President Obama’s State of the Union address. Every day, we are inundated by news of health exchange website defects, insurance policy cancellations, coverage that forces people to switch doctors, and a laundry list of other problems attributed to the Affordable Care Act. On the flip side, advocates complain of the problems that make the U.S. rank among the lowest in health system efficiency among advanced economies and hail the health care law as a ray of hope.

Jamie Elizabeth Rosen

Meanwhile, a new study from the U.S. Centers for Disease Control and Prevention (CDC) revealed that one in four American families struggled to pay medical bills in 2012. Pretty dismal.

But there’s something missing from this barrage of coverage. Incredible advances are being made in health care every day, providing Americans with innovative ways to stay healthy, treat illnesses when they arise, and save money on medical problems. Just this month, a new program was launched to help people on Medicare living with multiple sclerosis afford copays for treatment; the FDA for the first time approved a postnatal test that can help parents identify possible causes of their child’s developmental delay or intellectual disability; and a study published in the Lancet showed that it is possible to train children’s immune systems to become less sensitive to peanuts.

At Real World Health Care, we focus on what is working.

That’s why I am proud to take over this week as editor of Real World Health Care. While much of my professional focus has been on health internationally – advocating for the development of vaccines to prevent tuberculosis, policies that save mothers and infants from dying during childbirth, and the formation of emergency medical systems in places where people have nowhere to turn – I am compelled by the notion that more attention must be focused on solutions that are improving U.S. patient care today. By serving as a central clearinghouse for information about improvements to segments of the U.S. health care system, we hope that our readers and those journalists who get ideas from our blog will be inspired to expand innovations that are working in health care today.

Real World Health Care – only entering its 11th month – already has a reputation for covering solutions to enhance nutrition, prevent diseases, reform medical education, improve hospitals, support patients, fund research, increase treatment adherence, and reduce costs. The blog serves as a resource for policy makers, health systems, research universities, non-profit health organizations, leading biopharmaceutical companies, government agencies, and the nation’s leading health journalists among thousands of others interested in practical and well-researched health care success stories.

We need your help to continue to grow our success. Have an idea for a story or a guest blog? Email me at jrosen@WHITECOATstrategies.com. Want to take part in advancing solutions in health care? Sign up for updates and share stories that inspire you via Twitter at https://twitter.com/RWHCblog. Do you believe in our mission to expedite improvements to our health care system? Consider co-sponsoring the blog while gaining visibility for your organization. We are now followed by over 300 health industry leaders each week, and journalists turn to us for story ideas about the good news on what’s working in our health care system. For more information, email dsheon@WHITECOATstrategies.com.

I look forward to continuing to cut through the political vitriol around health care with inspiring stories of what is keeping Americans healthy and saving lives. Thank you for giving meaning to our work by using this blog as a resource for yours.

Categories: General

Striking the Right Balance for Better Patient Outcomes

A recent article in Health Affairs reports that ChenMed – which serves low-to-moderate income elderly patients primarily through the Medicare Advantage program – is achieving better health outcomes for Medicare-eligible seniors, including those living with five or more major and chronic health conditions.  Dozens of Chen and JenCare Neighborhood Medical Centers are helping tens of thousands of seniors live better, longer: 

chris_chen

Dr. Christopher Chen, ChenMed CEO

  • Total hospital days per 1,000 patients at ChenMed in 2011 were 1,058 for the Miami area in comparison with 1,712 total US hospital days per 1,000 patients in the same year (Centers for Medicare and Medicaid Services Office of the Actuary).
  • Just one year prior, according to Dartmouth Atlas of Health Care, the Miami Hospital Referral Region was above the 90th percentile in inpatient hospital days.

Why is ChenMed so successful?

Dr. Christopher Chen, CEO of the organization, says its patient care model integrates cutting-edge medical expertise in a way that empowers physicians to ensure patients receive personalized attention and optimal care.

“People always ask, ‘What is your secret?’ There really is no secret,” he says. “It comes down to having the right incentives, the right physician and staff culture, and the right philosophy of care. My goal at the end of the day is to be cost-effective through improvement of outcomes by changing the philosophy of care. We care about results.”

The group practice’s popularity also attests to its effective one-stop-shop approach to patient-centered care through multi-specialty services. Smaller physician panel sizes of 350-450 patients spur intensive health coaching and preventive care, and prescriptions are given to patients during their visits at all Chenand JenCare Neighborhood Medical Centers.

This aspect of ChenMed’s model makes the biggest difference in boosting medication adherence, followed by strong one-on-one doctor-patient relationships that help to change habits for the better. Receiving meds within 3-5 minutes of ordering drugs not only means patients don’t have to wait for the treatment they need, but that they receive their medications while having face-to-face interactions with their primary care doctors.

“In our model we aren’t looking for high-income patients,” Dr. Chen says. “People ask, ‘Are you saying that patients like you because you give more attention to them and provide more access to doctors than those who pay for concierge service?’ I would say yes.”

ChenMed continuously employs top specialists from a variety of fields to conveniently provide fully integrated medical services to patients.  It effectively combines services like acupuncture into its portfolio of care, and improves outcomes and patient experience with customized end-to-end technologies enhancing its daily operations. For example, all the medical assistants and staff are equipped with iPads and can offer physician support tailored to each patient. This fuels collaboration, enabling doctors to work side by side with patients and providing a significant convenience to all parties as a result.

Primary care physicians at Chen and JenCare Neighborhood Medical Centers also meet three times a week, engaging in thoughtful ongoing discussions that generate numerous enhancements to care and delivery for better outcomes.

“We discuss whether a hospitalization could be improved through better outpatient care. We ask, ‘What can we do to improve patient outcomes while the patient is in the hospital?’ We innovate to improve outcomes and can achieve great things for patients because of our small panel sizes. These meetings have saved many lives and continue to do so,” explains Dr. Chen.

When interviewing prospective doctors to work at ChenMed, they are asked whether they like spending time with patients and whether they love the complexity of medicine. If they say no to either of those questions, then this group is probably not the best place for them, Dr. Chen says, underscoring that:

“We want you to practice medicine the way you thought you would when you graduated from medical school. It’s not about how many patients you see, how many procedures you do, or how much you bill. You should want to be a doctor to make people feel better.” 

ChenMed, through its Primary Management Resources subsidiary, also provides behind-the-scenes consulting services to enhance medical practice operations nationwide.  Physicians interested in end-to-end solutions that streamline operations while enhancing patient health outcomes and the patient experience should contact ChenMed at (305) 628-6117 or go to ChenMed.com.

More Patients Choosing Hospice “Comfort Care” Option

In today’s health care environment, so much attention is paid to preventing and eradicating disease to improve health outcomes. But for patients facing terminal illness or life-limiting conditions, accessing quality care can be a frightening and lonely challenge.

Linda Barlow

Linda Barlow

That’s where hospice comes in as an option for more and more people. A unique philosophy of care, hospice enhances quality of life for many patients and strengthens the health system’s quality of care by saving critical resources.

Supporting those who choose comfort care with pain and symptom management rather than curative care, it is designed to neither hasten nor postpone death. Hospice is provided in the patient’s home, hospital, extended care facility or residential care homes. Individual insurance plans vary in terms of coverage guidelines.

According to the National Hospice and Palliative Care Organization (NHPCO), an estimated 1.65 million patients received services from hospice in 2011.

“It is important for patients to understand that hospice is as much a part of the health care system as the birthing process,” says Barbara J. Westland, RN, BSN, Director/Administrator, BJC Hospice. “We are there to bring you into the world and we will be there to support you in your journey through hospice until the end.”

Because hospice focuses on care rather than cure, patient outcomes are measured in more qualitative ways, focusing on issues like pain relief within 48 hours of admission, avoiding unwanted hospitalizations and avoiding unwanted cardiopulmonary resuscitation (CPR). And according to NHPCO, family caregivers who had the support of hospice report less instances of serious depression in the six months following the death of their loved one.

In addition to serving the physical, emotional, spiritual and practical needs of patients and their families, hospice also saves money. In fact, research published in the March issue of Health Affairs found that hospice enrollment saves money for Medicare – from $2,561 to $6,430 per patient, depending on the length of care – and improves the quality of care across a number of different lengths-of-stay.

“If 1,000 additional beneficiaries enrolled in hospice 15 to 30 days prior to death, Medicare could save more than $6.4 million,” notes the study’s authors. “In addition, reductions in the use of hospital services at the end of life contribute to these savings and potentially improve quality of care and patients’ quality of life.”

J. Donald Schumacher, NHPCO president and CEO, points to a study on the benefits of hospice from a cost and quality of care perspective:

“Hospice can reduce the number of intensive care visits, hospital readmissions and other services, which not only saves health care system dollars, but also contributes to a higher quality of life,” he says.

“With the aging population, we expect to see the hospice population growing,” Westland says, noting that between 2000-2007, the number ofhospice patients nearly doubled and the number of providers grew by 45 percent. “Hospice offers a choice for the final journey that is selected by some, but not right for everyone.”

Despite evidence that hospice provides many benefits some critics question whether the implications of market competition and commercialization driving this form of care are ethically consistent with the delivery of health services. In an article that appeared in the Journal of Law, Medicine and Ethics during the summer of 2011, the authors argue that hospice care should be considered with great caution:

“The conflicting interests inherent in the incentive structures of for-profit health care endeavors demand careful scrutiny,” they say. “This is particularly important in the end-of-life hospice context.”

What do you think? Share your experiences and thoughts with us.

Making Costly – and Deadly – Medical Errors and Unnecessary Hospital Visits Something Only Grandparents Can Remember

“She died from a breakdown in the system. She died from a breakdown in communications.”

These heartbreaking words, from patient safety advocate Sorrel King about the loss of her young daughter Josie King, are words that no one should ever have to say or hear.

Her 10-year commitment to end hospital errors led to a $1 billion war on errors, funded through the Affordable Care Act.  The resulting Partnership for Patients program has already signed up more than 8,000 partners – including organizations and individual medical care providers – in a shared effort to save thousands of lives, prevent millions of injuries and take important steps toward a more dependable and affordable health care system.  According to the Centers for Medicare and Medicaid Services (CMS), the participants include:

  • Hospitals and national organizations representing physicians, nurses and other frontline health care and social services providers committed to improving their care processes and systems, and enhancing communication and coordination to reduce complication for patients.
  • Patient and consumer organizations committed to raising public awareness and developing information, tools and resources to help patients and families effectively engage with their providers and avoid preventable complications.
  • Employers and States committed to providing the incentives and support that will enable clinicians and hospitals to deliver high-quality health care to their patients, with minimal burdens.

In the April 2011 announcement launching the program, Health and Human Services Secretary Kathleen Sebelius shared two goals of the Partnership for Patients:

  1. To reduce preventable injuries in hospitals by 40 percent by the end of 2013, preventing 1.8 million injuries and saving 60,000 lives.
  2. To cut hospital readmissions by 20 percent, saving 1.6 million patient complications that force them to return to the hospital.  Achieving this goal by the end of this year would mean more than 1.6 million patients will recover from illness without suffering a preventable complication requiring re-hospitalization within 30 days of discharge.

{For a video of Ms. King explaining her work and Secretary Sebelius announcing the Partnership for Patients program, please click here.}

According to CMS, a recent study by the Office of the Inspector General (OIG) (PDF) found that 13.5% of hospitalized Medicare beneficiaries experience adverse events resulting in prolonged hospital stay, permanent harm, life-sustaining intervention, or death. Almost half of those events are considered preventable.

A recent article in the Journal of the American Medical Association showed that specific community-wide quality improvement activities are proven to reduce hospital readmissions.

Do you want to find providers and hospitals near you who have signed the pledge? It’s as easy as clicking here.

Do you want to learn more about the specifics of what actions will be taken to reduce accidents and re-admittance, and the studies conducted to determine the solutions?  Check out Altarum Institute’s blog post on the topic.