Thomson Reuters names top 10 U.S. health systems

Ten U.S. health systems have been identified by Thomson Reuters as performing at the top when it comes to quality of care, efficiency and patient satisfaction - metrics that are boosted with the use of information technology.

Thomson Reuters released its third annual study Wednesday identifying the 10 top:

1. Advocate Health Care*  ― Oak Brook, IL


2. Cape Cod Healthcare ― Hyannis, MA


3. CareGroup Healthcare System ― Boston, MA


4. Kettering Health Network* ― Dayton, OH


5. Maury Regional Healthcare System ― Columbia, TN


6. Mayo Foundation**  ― Rochester, MN


7. NorthShore University HealthSystem ― Evanston, IL


8. OhioHealth* ― Columbus, OH


9. Partners Healthcare ― Boston, MA


10. Spectrum Health** ― Grand Rapids, MI

*Denotes three-time winner
 **Denotes two-time winner

Compared with their peers, the Thomson Reuters 10 Top Health Systems saved more lives, caused fewer medical complications, made fewer medical errors, followed recommended standards of care more closely, released patients half a day sooner on average, and scored better on patient satisfaction surveys.

"This year, the 10 Top Health Systems set a new standard for high quality of care across all of the communities they serve," said Jean Chenoweth, senior vice president for performance improvement and 100 Top Hospitals programs at Thomson Reuters.

"To produce consistent, strong performance across multiple hospitals, health system leaders must be providing crystal clear goals and communication as well as the means for staff to execute effectively," Chenoweth said. "These systems are positioned to continue performing well as we move further into the era of healthcare reform."

These 10 health systems rose to the top when researchers from the Thomson Reuters 100 Top Hospitals program analyzed the performance of 285 health systems based on eight metrics:

• In-hospital mortality


• Medical complications


• Patient safety


• Average length of stay


• 30-day mortality rate (post-discharge)


• 30-day readmission rate (post discharge)


• Adherence to clinical standards of care (evidence-based core measures published by the Centers for Medicare and Medicaid Services


• Hospital Consumer Assessment of Healthcare Providers and Systems patient survey score (part of a national initiative sponsored by the U.S. Department of Health and Human Services to measure the quality of care in hospitals).

The study evaluated U.S. health systems with two or more short-term, acute care, non-federal hospitals that treat a broad spectrum of patients. Researchers used public data from the Medicare Provider Analysis and Review (MedPAR) dataset and the CMS Hospital Compare datasets.

The Thomson Reuters 100 Top Hospitals program has analyzed and reported on the performance of hospitals since 1993. For more information, visit www.100tophospitals.com.

 

 

5 Strategies to Combat Health Reform Pressures

Health plan executives say their three major challenges are figuring out how to deal with healthcare reform, the health insurance industry's systemic shift from wholesale to retail business and bending the cost curve.

Resolving the challenges will require health plans to shift their focus from group to individual sales, identify and test new behavior predictors and shorten the timeline of product development.

The findings were part of a session about predicting and managing change presented at the annual conference for America's Health Insurance Plans. The session was based on a study developed from interviews with 40 senior healthcare executives by SAS, a Cary, N.C.-based business analytics firm, and Chicago-based Stonegate Advisors, a healthcare research and analytics company.

"Health plans are facing a fundamental change in how they do business," explained Sarah Rittman, a senior industry consultant for SAS. "Accurately predicting market shifts will be imperative for developing go-to-market strategies."

The study, Tackling U.S. Health Plan Challenges with Advanced Analytics, presents these strategies for health plans:

1. Predict market changes in new and creative ways

Today's healthcare market depends on traditional actuarial and underwriting principles to predict risk. But the post-reform market will require health plans to combine third party data – like credit information, social media and purchase data ? with claims data to help understand potential market shifts.

2. Get to know your customers as unique individuals

Reform is expected to bring a flood of individuals into the health insurance market. Member-centric product and service strategies haven't been a focus but now "health plans will need to understand what individuals like and what they want," says Rittman. That includes learning their price and product sensitivity and how they like to communicate and how often. "It will take years for the healthcare industry to figure out how to influence consumers.

3. Do retail like pros

Healthcare needs to learn from other industries – like banking, telecommunications and airlines – that have been through a similar process. "These industries re-invented themselves," explains Marc Pierce, president and founder of Stonegate Advisors. He said that to succeed health plans will need to shorten their product development cycle, add service and loyalty programs, and develop sophisticated pricing strategies.

4. Manage the cost of care

In post healthcare reform managing expenses at a plan member level will be critical to keeping premiums affordable and maintaining the required MLR of 80% to 85%. Plans will need to develop analytics to monitor services, treatment patterns and cost trends to identify medical expense concerns. "Health plans will need to know what customers they can impact and how. They'll need a way to identify those members who are on the edge in terms of willingness to change a behavior and then develop a program that will influence them," says Pierce.

5. Collaborate more effectively with providers

Controlling healthcare will require that health plans work with their providers to develop payer/provider models to see what works based on financial viability and sustainability, including pay for performance, patient centered medical home, an integrated care system and an accountable care organization. Collaboration should include the ability to share clinical, claims and pharmaceutical data to track and analyze outcomes. "This is very valuable information for both the payer and the provider," says Rittman.

This article was originally posted at http://www.healthleadersmedia.com/page-2/TEC-267558/5-Strategies-to-Combat-Health-Reform-Pressures

 

 

No New Health-Law Waivers to Be Given

The Obama administration on Friday said it would stop granting new waivers to the health-care overhaul in September following sharp opposition from Republicans who cited the waivers in their bid to undermine the law.

As of the end of May, the administration had granted 1,433 waivers to a part of the 2010 law that prevents employers and other health-plan providers from capping annual benefit payouts below $750,000 a year. Those entities, and any others that secure a waiver by Sept. 22, will be able to keep their one-year waivers, and apply for extensions through 2013.

But the Department of Health and Human Services said it would stop accepting new applications for the program after Sept. 22. The waivers largely went to low-wage employers who offer "mini-med" plans with limited benefits, including McDonald's Corp. and the Foot Locker Inc. athletic chain.

By cutting off applications, the administration will avoid the bursts of attention each time it granted a new batch. Opponents of the law contended that the administration had shown favoritism in granting the waivers, prompting federal health officials to disclose the names of recipients and the application process for granting them.

Steve Larsen, a Health and Human Services official responsible for insurance oversight, said the department is cutting off new applications because "the vast majority of plans that would need a waiver…are the ones that would have applied and did apply this year." He said waivers were granted to plans covering about 2% of privately insured Americans.

Critics of the health-care overhaul seized on the administration's move as a sign that the law is flawed. "They are shutting it down because it's become clear that the only way to keep what you have and like is to be exempted from the very law they said would lower costs," Sen. Orrin Hatch (R., Utah) and House Ways and Means Committee Chairman Dave Camp (R., Mich.) said in a joint statement.



A Government Accountability Office report this past week found that the administration mostly granted waivers for those who said they would have to raise premiums by more than 10% and cut benefits if they didn't get a waiver. It largely denied applications that projected a premium increase of 6% or less.

The Obama administration described the waivers as a bridge until 2014, when new health-insurance exchanges are expected to largely eliminate such limited-benefit plans and give consumers a chance to shop for better coverage. In the meantime, health plans with waivers must tell consumers their coverage is subject to an annual dollar limit lower than usually allowed under the law, according to new disclosure requirements the administration released Friday.

Beginning in September, that allowable annual limit increases to $1.25 million. For plan years beginning September 2012, it rises to $2 million.

This article was originally posted at http://online.wsj.com/article/SB10001424052702303635604576392200148966610.html

A necessary dose of e-prescribing flexibility

Physicians understand the potential of health information technology to help improve patient care, and doctors are willing to work with the federal government through incentive programs designed to encourage more practices to go paperless. But the government went too far when designing the punitive side of some of these incentives, tying penalties to burdensome, unfair and even unrealistic mandates on many of the practices that are trying to work toward the same goals.

That's why the Centers for Medicare & Medicaid Services made the right move in adjusting its Medicare electronic prescribing incentive program to correct several key shortfalls in the original plan. The program offers a 1% bonus next year to eligible practices that e-prescribe a minimum number of times in 2011, but it also will impose a 1% penalty on those that don't. Under a new proposed rule released in late May, CMS outlined a number of revisions to the details of this plan that members of organized medicine, including the American Medical Association, had insisted were sorely needed.

The changes, which are set to be finalized this summer, provide a measure of relief to physician practices that were worried about being subject to Medicare e-prescribing penalties even though they are actually early technology adopters.

Because CMS did not align the requirements for its e-prescribing program with those for its separate electronic medical records meaningful use program, some practices had to contemplate installing a stand-alone paperless drug order system -- on top of the EMR they already had -- just to be compliant. Some practices took this duplicative step earlier in the year just to be sure.

With its latest changes, the Medicare agency has confirmed that practices that already have certified EMRs can use those systems to meet the e-prescribing mandate as well. CMS recognized that in most cases, approved EMRs have the same level of functionality when it comes to sending paperless drug orders as the systems called for by the e-prescribing program.

In future reporting years, physicians who use certified EMRs will know for sure that their systems will be acceptable to the government when it comes to e-prescribing.

Better aligning the requirements of the e-prescribing and EMR programs was only one of the revisions that CMS needed to make. Many other physicians were facing Medicare penalties for practice circumstances that truly were out of their hands.

CMS initially only proposed exemptions to the e-prescribing requirements for rural physicians with limited Internet access and those living in areas where pharmacies don't accept paperless medication orders. That left too many other physicians who still would have faced a 1% penalty in 2012 simply because they had limited opportunities to prescribe electronically. Now CMS also will offer exemptions to doctors who don't prescribe enough drugs in the first place, who are barred by law from issuing enough electronic drug orders (such as under prohibitions on e-prescribing of controlled substances), or who prescribe drugs only during patient encounters that don't count under the program (such as many surgeons). Practices also will be able to avoid the penalty if they did not e-prescribe by the June deadline because they were planning instead to adopt and use EMRs in 2011 to qualify for meaningful use bonuses.

When the proposed changes are finalized, physicians not meeting the e-prescribing requirements will have until Oct. 1 to apply for one of these waivers. The agency predicts that more than 200,000 doctors and health professionals might be eligible to claim a hardship. By expanding the exemption list and the deadline to file, CMS is acknowledging that many practices will not meet the minimum this year not because they don't want to, but because they can't.

When it comes to providing needed regulatory relief to doctors, the Obama administration shouldn't stop with the changes it already has proposed. Medicare and Medicaid have a whole host of burdensome, redundant or unnecessary rules for physicians, including certain regulations pertaining to translators, claims audits, documentation and enrollment.

Now that CMS has shown it can be flexible on the e-prescribing requirements, it needs to devote its attention to these rules.

This article was originally posted at http://www.ama-assn.org/amednews/2011/06/13/edsa0613.htm

 

 

HHS Releases NPRM Altering HIPAA Accounting Rule

the Department of Health and Human Services (HHS) released for public review a Notice of Proposed Rulemaking (NPRM) about the accounting provisions of the Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule.  An advance copy of this NPRM is here.  The Federal Register publication of the rule is available here. There will be a 60-day comment period from the time of publication.

This proposed rule implements a statutory provision from the Health Information Technology for Economic and Clinical Health (HITECH) law.  It dramatically alters the current HIPAA accounting rule, with substantially increased burdens for covered entities and business associates.  For example, it requires a much broader set of disclosures to be tracked by covered entities and business associates.  More significantly, it also creates-based on HHS' general authority under HIPAA rather than the HITECH law-a new obligation for covered entities and business associates to track internal "access" to protected health information in a designated record set.

Over the next few weeks, companies in the health care industry-including all covered entities and their business associates-should evaluate these proposals carefully and should determine promptly whether they wish to comment on this proposed rule.

This article was originally posted at http://ping.fm/IybCT

 

Medicare to offer more waivers from e-prescribing penalty

[caption id="" align="alignnone" width="468" caption="New revisions to Medicare e-prescribing incentives are part of a larger administration effort to identify burdensome federal regulations. A review by the White House Office of Management and Budget, led by Director Jack Lew, has uncovered some rules that appear redundant. [Photo by AP / Wide World Photos"]"][/caption]

Physicians who see Medicare patients would have more opportunities to avoid being penalized for failing to prescribe medications electronically by a June 30 deadline under a proposed rule from the Centers for Medicare & Medicaid Services.

The proposed revisions would provide relief to eligible physicians who do not expect to report at least 10 paperless drug orders to CMS by June 30. Medicare will penalize doctors for failing to meet 2011 e-prescribing requirements by reducing payments by 1% in 2012. On May 26, the Medicare agency said it would give doctors a second chance to avoid the penalty after the deadline. It would allow physicians who did not meet the minimum reporting requirements to claim one of several hardship exemptions through a special website by Oct. 1.

The proposed rule also would apply to physician practices that already have adopted certified electronic medical record systems in an effort to earn Medicare or Medicaid meaningful use bonuses. Those practices could use those systems to satisfy the e-prescribing requirements as well. Under the current program, practices that use certified EMRs to send paperless drug orders will satisfy the e-prescribing requirement as long as the system meets four specific functionalities. If the proposed rule is finalized later this year, certified EMRs will be acceptable for e-prescribing in future reporting years even if they don't technically meet the four specific functionalities.

In addition to the expanded hardship exemptions, the revised language on the certified EMRs was a change requested by members of organized medicine, including the American Medical Association. Physicians complained that because the requirements for the e-prescribing incentive program and the EMR meaningful use incentive program were different, some paperless practices were concerned that they would need to buy and use a stand-alone e-prescribing system to avoid the 1% reduction in 2012.

"Eliminating unreasonable penalties and burdensome requirements, and providing physicians with more flexibility through an exemption process, will help ensure more physicians are able to successfully participate in the e-prescribing incentive program," said AMA President Cecil B. Wilson, MD. "The AMA has continually stressed to CMS that these changes were essential and is pleased to see them become a reality in a rule that will be finalized later this summer."

The Medical Group Management Assn. also was pleased with the proposed rule. However, some practices already had taken special steps earlier this year just to avoid the penalty -- actions that now have become unnecessary, said Anders Gilberg, MGMA's vice president of public and private economic affairs.

Some groups used temporary e-prescribing software, independent of their EMRs, and discarded the systems after reporting the minimum 10 e-prescribing encounters per physician. Others, such as some surgery practices, struggled to find ways to prescribe medications during office visits just so they would not be penalized in 2012.

"It's unfortunate it took until almost June for the proposed rule to come out," Gilberg said.

Expanded hardship exemptions

Approximately 109,000 to 209,000 physicians and other health care professionals could be eligible to file for hardship exemptions to the e-prescribing penalty by Oct. 1, CMS said in the proposed rule. The Medicare agency has proposed developing a special website for doctors and others to claim one of several hardships. CMS would approve the claims on a case-by-case basis, said Michael Rapp, MD, director of the CMS Quality Measurement and Health Assessment Group.

The initial rules had provided only two hardship exemption categories -- for physicians who practiced in rural areas with limited high-speed Internet access or for those who worked in areas with a limited number of pharmacies that accept electronic drug orders. CMS had required one of these exemptions to be reported before June 30.

The proposed rule would allow doctors to choose from these two hardships as well as four new exemptions on the website by the October deadline. The site would go live sometime after the rule is finalized in August, Dr. Rapp said.

The expanded list of hardship exemptions would include:

• Physicians who register to participate in the Medicare or Medicaid EMR incentive program, and adopt and use certified EMR technology by the 2011 deadline.


• Physicians who cannot prescribe enough drug orders electronically due to local, state or federal laws, such as those prohibiting paperless orders for narcotics.


• Physicians with limited prescribing activity.


• Physicians with insufficient opportunities to report the e-prescribing measures because the types of patient visits they claim are not eligible under the program.

"There will be an opportunity for physicians to indicate that they feel that they fit, and are requesting to be classified, in one of these hardship categories," Dr. Rapp said. "Then those individuals would be taken off the list to be 'subject to the negative payment adjustment.' "

Those who report that they e-prescribed 10 times before June 30 automatically would not be subject to the 2012 penalty, Dr. Rapp added. Of that subset, those physicians who report 25 e-prescribing encounters by Dec. 31 would receive a 1% bonus in 2012, assuming they do not opt instead for a Medicare bonus for meaningful EMR use in 2011.

More regulatory relief on the way?

The softening of the e-prescribing requirements is part of the Obama administration's initiative to provide regulatory relief across the federal government. Dept. of Health and Human Services officials are considering revising several of its regulations over the next two years. CMS also will identify and address conflicting requirements between the Medicare and Medicaid programs.

An initial review of the rules has determined that some regulations appear to be redundant and unhelpful, said Jack Lew, director of the White House Office of Management and Budget.

"It will be asked if some of these actually benefit patients or are they a matter of bureaucratic, anachronistic rules," Lew said.

The Medicare agency already has gathered input on revising potentially burdensome rules identified by the AMA and other members of organized medicine. They include:

• Requirements to provide translators for Medicare and Medicaid patients with hearing impairments or limited English proficiency.


• Misaligned incentive programs, such as EMR meaningful use and the physician quality reporting system.


• Overlapping claims reviews by auditors, such as Medicare administrative contractors and recovery audit contractors.


• Various Medicare documentation requirements.


• The prohibition on the use of Medicare consultation codes.


• Burdensome Medicare enrollment requirements.

This article was originally posted at http://www.ama-assn.org/amednews/2011/06/06/gvl10606.htm

 

CMS to align e-Rx incentive with EHR program

The Centers for Medicare and Medicaid Services (CMS) plans to modify its electronic prescribing incentives schedule to better align with its electronic health record incentive program so physicians can both avoid e-prescribing penalties and also participate in CMS’ EHR Incentive Program.

E-prescribing is  a requirement for meaningful use of electronic health records (EHRs) to qualify for incentives.

CMS released the proposed rule on May 27 and it will be published in the June 1 Federal Register. The public will be able to comment for 60 days.

In 2009, CMS started the E-prescribing (eRx) Incentive Program. To qualify for eRx incentives this year, providers must e-prescribe 10 orders between Jan. 1 and June 30, 2011.

Medicare providers cannot earn an incentive under both incentive programs for the same year. However, providers will be subject to an e-prescribing payment adjustment if they do not meet the requirements under the eRx Incentive Program, regardless of whether the eligible provider participates in and earns an incentive under EHR incentive program.

[Q&A: PwC's Bruce Henderson on why the proposed ACO regs are so "onerous and grinding."]

“Stakeholders claim that the requirements under both programs are administratively confusing, cumbersome, and unnecessarily duplicative,” the proposed rule said.

The proposed rule will expand the exemptions and the time to report them so providers can avoid the payment penalties. Exemptions will include putting off deploying an e-prescribing system because they are participating in the EHR incentive program. The rule would also revise the description of qualified e-prescribing systems to include certified EHR technology under meaningful use.

Among the requirements, e-prescribing systems must be able to generate and transmit prescriptions and active medication list; check for drug-drug interactions; and check whether drugs are in a health plan’s formulary or preferred drug list.

The American Medical Association welcomed the flexibility of the proposed rule and the elimination of unreasonable penalties. “Physicians who are working to adopt e-prescribing and other health IT should not be unfairly penalized for practice patterns that do not fit neatly within the current, limited exemption process,” said Dr. Cecil Wilson, AMA president, in a statement..

In February, the Government Accountability Office had said that CMS should reconcile the inconsistencies between the two programs.

The EHR program provides incentives from 2011 to 2016 and introduces penalties beginning in 2015, while the e-prescribing program provides incentives from 2009 to 2013 and provides for penalties from 2012 to 2014, when the program ends. Both programs require providers to adopt and use technology that can perform similar electronic prescribing-related activities.

[Related: VA, DOD test joint EHR interface in Hawaii. See also: HHS proposed rule on disclosure highlights access reports.]

The EHR program requires providers to adopt and use EHR systems that are certified to meet criteria which include electronic prescribing-related capabilities, while the e-prescribing program does not have a certification requirement.]

According to the e-prescribing program, a physician or group practice in 2011 can qualify for an incentive equal to 1 percent of its total estimated Medicare Part B physician fee schedule allowed charges for covered professional services.

In 2012, a payment adjustment will begin for those who do not e-prescribe and increase each year through 2014. Specifically, those physicians will receive 99 percent of the fee in 2012, 98.5 percent in 2013 and 98 percent in 2014.

This article was originally posted at http://ping.fm/kzxqb