Whitney Palmer

Healthcare. Politics. Family.

Accountable Care: Let the Work Begin

Published in the Dec. 12, 2011, Billian’s HealthDATA/Porter Research Hub e-newsletter

By Whitney L.J. Howell

One of the hottest topics in the health sector today is accountable care. The premise seems simple: Providers and clinical settings of all types will closely collaborate and share responsibility for providing patient care. Implementation, however, can be challenging, according to many hospital leaders and industry experts.

The Centers for Medicare & Medicaid Services (CMS) released its final rule on accountable care organizations (ACOs) in October, detailing how its version of an ACO – the Medicare Shared Savings Plan – should be structured. If facilities choose to enroll in this program, they must offer services to at least 5,000 Medicare recipients for at least three years. Providers and clinical settings are also free to design and implement their own collaborative care model that uses a network of physicians and facilities to provide coordinated care.

Past attempts at managed care have failed, and there is still a chance the U.S. Supreme Court could declare ACOs unconstitutional. But that hasn’t stopped some in healthcare from working toward more team-based care. They are advocates of a new form of healthcare – one that ultimately focuses on the health of the patient rather than the bottom line. They are betting that the changes that come with accountable care, repealed or not, will help to usher in and get providers comfortable with this more team-based approach.

“The path forward to accountable care seems brighter and more achievable to many health systems, community providers and small practices,” said Justin Barnes, Vice President of Marketing, Industry, and Government Affairs at Greenway Medical Technologies Inc. “There is flexibility within creating a model for accountable care; and, with the final rule, many care providers are seeing that accountable care is the future of where healthcare is going.”

Barnes was also central to the formation of  the Accountable Care Community of Practice, a group of healthcare information technology providers committed to helping providers and facilities successfully design and implement either a formal ACO business model or less formal accountable care strategy.

Although this care model is getting significant attention, Barnes said, much still needs to shake out before it can be declared a success. In the meantime, many providers are putting the pieces that will support it – healthcare IT, shared-risk plans and provider networks – in place.

Mentors can Make the Difference

However, pivoting from a fee-for-service delivery model to one that prizes teamwork and increased quality at a lower cost isn’t necessarily intuitive. Many hospitals – large, small, urban and rural – need guidance, said Julie Sanderson-Austin, RN, a quality management professional with the American Medical Group Association (AMGA).

“The ACO model and even accountable care are very different animals,” she said. “It’s clear that this isn’t business-as-usual and that the change to healthcare is significant.”

To support facilities moving toward team-based care, the AMGA launched its learning collaboratives program last year. The goal, Sanderson-Austin said, is to help hospitals design ACO models that fit their specific needs by pairing facilities just embarking on accountable care conversations with mentor institutions that are further along in implementation.

Defining and Addressing Challenges

Hospitals just approaching accountable care voice some of the same concerns and encounter similar challenges, Sanderson-Austin said. For many, the biggest problem is integrating their data across care settings to offer patients a complete continuum of care. Having an electronic health record (EHR) connecting the hospital to its outpatient clinics is a good start, but it isn’t enough.

“It’s great to have an EHR that connects to ambulatory sites, but it has to be connected to your other sites, as well,” she said. “Otherwise, how are you going to get data from your nursing homes or home health agencies? If your patients either have to or elect to go to a nursing facility, you need a way to access their information for any possible future care needs.”

The initial capital investment needed to acquire good technology or build fluid health information exchanges can also present substantial problems, especially for smaller facilities, said Erik Johnson, Senior Vice President of consulting firm Avalere Health.

Although physicians are slated to play a vital role in any collaborative model, they can also be a significant sticking point for administrators looking to re-vamp how their facilities provide services. Even hospitals that began looking to a more team-based approach years ago have struggled to bring any changes to fruition.

“Improving engagement between physicians and hospitals continues to be an up-at-night problem for hospital executives,” Johnson said. “It’s difficult to get this kind of alignment.”

The Greenville Hospital System University Medical Center (GHSUMC) encountered this problem when it first considered its own type of ACO roughly a decade ago. According to Chief Medical Officer Angelo Sinopoli, M.D., convincing the doctors was an uphill battle.

“It took 10 years for physicians to embrace the model,” he said. “The concept is foreign because physicians train as individuals and are not accustomed to working in teams.”

However, administrators repeated the facility’s long-term goal and worked to educate the doctors on the benefits of working with other providers. Eventually, Sinopoli said, the physicians became champions of the hospital’s new care model.

Laying the Groundwork

Even though these challenges exist, hospitals can lay the groundwork for accountable care success, said Eric Bieber, M.D., President of the Accountable Care Organization at University Hospitals in Cleveland.

“Creating a collaborative care system that works well requires a high-functioning, multidisciplinary team to work across the organization,” Bieber said. “This team will be responsible for negotiating how the different groups within the hospital come together and divide risk.”

In January, University Hospitals launched its own accountable care model – a self-insurance plan that covers approximately 24,000 people. The facility is still in the process of identifying what works well and what doesn’t, but Bieber said institutions looking to follow in his hospital’s footsteps should bring together representatives from human resources and the legal department, as well as case managers, to discuss best strategies.

Industry management consultants at Kurt Salmon Associates also recommend hospital administrators focus on a few fundamental changes to position their facilities ahead of the curve.

Perhaps the biggest shift for hospitals, according to Kurt Salmon consultants Kate Lovrien and Luke Peterson, will be that pivot from concentrating on what the facility provides to honing in on what the community needs. With the ultimate goal of preventing inpatient admissions, the hospital is no longer the center of healthcare.

“There needs to be a dramatic change in organizational culture from the inside-out thinking of ‘my care, my time, my location’ to the outside-in thinking of ‘right care, right time, right location,'” Lovrien and Peterson wrote in a statement about ACO preparations, adding that this altered view constitutes a vision change for many facilities, and to do it well, administrators must secure buy-in from their board and staff members.

In addition, a facility’s business model must change. Under accountable care, success will no longer be measured in patient volume or the amount of services provided. Instead, efficiency and efficacy will be based on how well facilities control their costs while providing superior quality. Lovrien and Peterson seem to agree with Bieber – outlining how responsibilities will be divided and shared is a critical step. This move will give the hospital a clear organizational model, bolstering the ambulatory care system and streamlining the continuum of care across settings. The result, they said, will be improved quality and cost control.

Physicians must also turn from being the biggest hindrances to accountable care to being the most enthusiastic foot soldiers in the ramp up to the new care model, they said.  With their knowledge of the interplay between clinical activities, healthcare economics, and provider-patient engagement, doctors can strengthen the bonds across care settings.

Lastly, success will also come easier if hospitals tailor any EHR system to quality measures that are unique to the populations they serve.

Whatever strategies hospitals choose to employ, all facilities would be wise to start giving serious thought to what their accountable care model might look like, Bieber said. Waiting for Congress to announce a directive would be a waste of time.

“Regardless of the result of the elections in November 2012, there’s real support on both sides of the aisle for accountable care concepts,” he said. “It would behoove all organizations to begin to think about a system that focuses on maintaining wellness and managing chronic disease.”

To see the article at its original location: http://www.porterresearch.com/Resource_Center/Blog_News/Industry_News/2011/December/Accountable_Carex_Let_the_Work_Begin.html


December 14, 2011 Posted by | Healthcare, Politics | , , , , , , , , , , , , , , , , , , , , , , , , , , , , | Leave a comment

Mobile System Aims to Improve Cardiac Care

Published in the December 2011 Hospitals & Health Networks Magazine

By Whitney L.J. Howell

Hospitals link with paramedics to get real-time information to clinicians

Surviving a heart attack in rural locations always has been an iffy prospect. Long travel distances to the local hospital often thwart timely delivery of crucial clinical interventions or life-saving drugs. Hospital systems from Virginia to California are trying to harness the power of mobile technology to improve care — and, it’s hoped, reduce mortality — for heart attack victims even before they get to the emergency department.

In July, 100-bed Howard Young Medical Center, Woodruff, Wis., and 25-bed critical access Eagle River (Wis.) Memorial Hospital, both part of Ministry Health Care, launched the Lifenet program. The system is designed by Physio-Control which, until earlier this year, was a division of Medtronic. It cost around $35,000 and allows paramedics to instantly send the results of a patient’s 12-lead echocardiogram to emergency physicians awaiting the patient’s arrival. Sentara Healthcare in Norfolk, Va., launched the system in February in partnership with local EMS councils. El Camino Hospital, Mountain View, Calif., deployed it in 2010.

“It cannot be overstated that when it comes to a heart attack, time is muscle,” says Carl Hartman, M.D., medical director of Sentara Heart Hospital.

In large service areas like northern Wisconsin, every second counts. Roderick Brodhead, M.D., emergency services director for Howard Young and Eagle River, says getting timely information to clinicians lets them make quicker and better care decisions.

Cardiovascular disease is the No. 1 killer of Wisconsin’s men and women of all races and ethnicities, totaling 32 percent of the state’s annual deaths, according to a Wisconsin Heart Disease and Stroke Prevention Program 2010 report.

All hospital-associated 911-response vehicles are linked electronically to a bay station in the Howard Young emergency department. Once paramedics transmit a picture of an EKG, emergency physicians decide which treatments to have ready, Brodhead says.

The hospitals want to expand the service so paramedics can carry and administer thrombolytics. However, this is years away, he says, because the hospitals must study what type of training paramedics need to use these clot-busting drugs without any life-threatening complications.

To read this article in its original location: http://hhnmag.com/hhnmag_app/jsp/articledisplay.jsp?dcrpath=HHNMAG/Article/data/12DEC2011/1211HHN_Inbox_technology&domain=HHNMAG

December 14, 2011 Posted by | Healthcare | , , , , , , , , , , , , , , , , , , , | Leave a comment

Survey: Residents Hold the Cards in Job Search

Published in the December 2011 Hospitals & Health Networks Magazine

By Whitney L.J. Howell

With doc shortage looming, final-year medical students are in high demand

In today’s physician job hunt, it’s a buyer’s market. More than ever, hospitals need qualified doctors, and potential hires, particularly residents, are calling the shots.

Physicians in the younger generation differ significantly from their predecessors in what they want in a job. Location, lifestyle and work-life balance are bigger priorities now than they were 30 years ago, but the shift has become more pronounced in the last decade.

Since 2001, the number of residents interested in hospital-based employment has spiked from 3 to 32 percent, according to the Merritt Hawkins 2011 Final-Year Medical Resident Survey.

“It’s about economic security. Residents like the safety of hospital salaries, and they appreciate someone else covering malpractice insurance,” says Kurt Mosley, Merritt Hawkins vice president of strategic alliances.

As employees, physicians don’t have direct responsibilities for practice management, including many of the regulatory burdens that pose significant financial constraints. Some residents also choose specialties with little on-call time, such as radiology, ophthalmology and dermatology, Mosley says.

Regardless of specialty, the survey demonstrates that health care is already feeling a crunch from a physician shortage that’s expected to hit 160,000 by 2025. Looming vacancies have employers recruiting aggressively — more than half of survey respondents said they’d received more than 100 recruitment contacts during their training.

Most employers recruit via email, says Katie Imborek, M.D., an assistant professor at the University of Iowa who finished her family medicine residency in April. Others are more aggressive.

“Not a day went by that we didn’t receive emails about jobs,” she says. “Some recruiters were more persistent — they wanted to meet with us in smaller groups. Others asked to take us to dinner one-on-one.”

A growing number of hospitals and practice groups have Twitter feeds and LinkedIn groups as ways to court residents.

“Like most places, our biggest need is primary care,” says Kevin Robinson, Southwestern Vermont Health Care communications director. “At the core, we need physicians to serve the entire community and increase access.”

But it’s more than the steady salary and low on-call time pulling residents away from private practice toward hospitals. Many institutions offer loan repayment assistance, says Joanne Conroy, chief health care officer for the Association of American Medical Colleges.

“For residents who graduate with an average of $180,000 in debt, these programs are like music to their ears,” Conroy says.

Hiring a Doc? Maybe It’s Time to Tweet

The rise of social media has forced job recruiters to rethink how they attract the best and the brightest. LinkedIn, Facebook and even Twitter are becoming integral parts of recruitment strategies at many hospitals.

A 2010 New England Journal of Medicine study found more than 40 percent of physicians would job-hunt through social media. The number of employers following suit is small, but the ranks are growing.

“Social media strategies won’t replace traditional efforts, but as add-ons they can enhance recruitment,” says Chris Boyer, digital marketing and communications director for Inova Health System in Fairfax, Va. “The key is that you have social media users among your doctors, your medical staff and your nurses.”

According to experts at Georgia-based physician recruitment firm Jackson & Coker, including social media in recruiting efforts can produce a multipronged, cost-effective strategy. But they caution that each job posting be identical across platforms, and employers must take steps to eliminate any possibility for discrimination.

Inova launched its social media recruiting with a LinkedIn group that posts all jobs, and it can broaden or target searches as necessary. When recruiting specialists, however, Inova contacts individuals directly to discuss potential employment, Boyer says. To reach Twitter users, Inova will go live in December with its own Twitter feed of all open positions. Boyer recommends hospitals create RSS feeds internally for Twitter and route each job to their human resource departments. Inova also has dedicated social networking for residents. Through the free service SocialGo, residents can access resources during training, and the site transitions to help them find employment.

There are other successful online methods. In 2007, Southwestern Vermont Health Care created a microsite dedicated to finding physicians. “We had 22 openings for a staff of 140,” says Kevin Robinson, communications director. “Within two months of going live, we had more than 100 applicants. We filled nearly all vacancies by fiscal year-end.”

SVHC used direct mailing and contextual advertising to announce its microsite. With final-year residents as targets, Robinson says, the site lists all open jobs, offers available housing information, details popular leisure spots and restaurants, and includes information about activities.

“We included information about things residents said were important to them,” Robinson adds. “And it’s working. Doctors come to us because they find the quality colleagues, lifestyle, and work-life balance here.”

To read the article at its original location: http://hhnmag.com/hhnmag_app/jsp/articledisplay.jsp?dcrpath=HHNMAG/Article/data/12DEC2011/1211HHN_Inbox_physicians&domain=HHNMAG

December 14, 2011 Posted by | Healthcare | , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , | Leave a comment


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