Should your doctor text you? Probably not.

What ethical and professional factors should be weighed in how a physician interacts with patients via internet or by texting are discussed in this detailed position statement prepared for the American College of Physicians and the Federation of State Medical Boards.  By and large, the guidelines can distilled into three words, “Caution, caution, caution!”  Physicians are exhorted repeatedly to comport themselves in a professional manner vis-a-vis the social media platforms.  E-mailing is somewhat less problematic than friending on Facebook or texting.  To interject a little real world context here, I have to say that my dentist’s office emails appointment reminder/RSVPs, and I find this service helpful.  However, this article is primarily about electronic interactions that have the potential to violate confidentiality or provide misleading information.

Source: Farnan, J.M., and others.  Online medical professionalism: patient and public relationships, policy statement from the American College of Physicians and the Federation of State Medical Boards.  Annals of Internal Medicine;158:620-627, 2013.  Click here for full text: http://annals.org/data/Journals/AIM/926759/0000605-201304160-00007.pdf  Posted by AHA Resource Center, 312.422.2003, rc@aha.org

Top 10 issues in health care for 2013: PwC

PricewaterhouseCoopers has identified the top ten issues in health care for 2013 in this white paper.  Here they are (paraphrased a little):

1. How will states implement the Affordable Care Act (ACA)?
2. How to provide care for dual eligibles (patients who qualify for both Medicare and Medicaid)?
3. Will employers continue to offer health insurance?
4. What role will consumers play?
5. How will consumer ratings affect providers?
6. How will providers transform care delivery?
7. Will population health management trend take off?
8. What role will mobile devices play?
9. How will cost-effectiveness play into treatment decisions, such as prescribing new drugs?
10. How will the excise tax affect medical devices?

Source: PricewaterhouseCoopers.  Top Health Industry Issues of 2013: Picking Up the Pace on Health Reform, Jan. 2013.  Click here for full text (you may have to complete a free registration on the site first): http://pwchealth.com/cgi-local/hregister.cgi/reg/pwc-hri-top-health-industry-issues-2013.pdf  Posted by AHA Resource Center (312) 422-2050, rc@aha.org

Freestanding emergency departments: benchmarks

Urgent Care Association of America, a trade group representing urgent care centers, has produced this brief white paper comparing the characteristics of freestanding emergency departments with hospital EDs and with urgent care centers.  Here are some of the observations:

• 35 to 40 patients/day: break even for a freestanding emergency department (FED)
• 3 to 5 percent of FED patients are admitted to a hospital
• 60 to 90 minutes: length of stay in FED
• $350 to $500: net revenue / patient in FED
• 5,000 to 20,000 square feet: FED size

One city that has been called a hotbed for FED development is Houston, which had 35 centers at the time this white paper was written.  A related article indicates that there are a total of 284 FEDs in operation nationally.

Sources: Ayers, A.A.  Emerging Business Models: Freestanding Emergency Rooms.  Urgent Care Association of America, (Feb. 2012?)  Click here for full text: http://www.ucaoa.org/docs/Article_Freestanding.pdf

Ter Maat, S.  Freestanding emergency department growth creates backlash.  American Medical News, Apr. 29, 2013.  Click here for full text: http://www.amednews.com/article/20130429/business/130429966/4/

Posted by AHA Resource Center (312) 422-2050, rc@aha.org

30-day readmission rates for heart and pneumonia patients

This is the fifth year that Modern Healthcare has published a list of large, medium, and small health systems judged to be top performers on clinical and operational performance indicators.  The analysis is done by Truven Health Analytics.

Here are some of the benchmarks derived from this study for 30-day readmission rates (these are MEDIANS):

• 19.55% acute myocardial infarction patients
• 23.55% heart failure patients
• 18.13% pneumonia patients

These rates represent the performance of the top 15 health systems in the U.S.  The article also provides comparative rates for the entire universe of health systems.

Source: Establishing a culture focused on quality.  Modern Healthcare;43(15):28-29, Apr. 15, 2013.  Click here for publisher’s website: http://www.modernhealthcare.com/  Posted by AHA Resource Center (312) 422-2050, rc@aha.org

Operating room utilization benchmark: 75% suggested

If the operating room utilization rate is lower than 75 percent there is room for improvement, according to the authors.  This article discusses how to improve utilization by tightening up block scheduling rules.  One problem involves the commonly-used 4-hour block, which can be inefficient.  Another problem involves allowing surgeons to release blocks on short notice with no penalty.  How to design an efficient block scheduling system is described.

Source: The right strategies can help increase OR utilization.  OR Manager;29(5):21-22, May 2013.  Click here for the publisher’s website: http://www.ormanager.com/

Related information: Dexter, F., and others.  An operating room scheduling strategy to maximize the use of operating room block time: computer simulation of patient scheduling and survey of patients’ preferences for surgical waiting time.  Anesthesia & Analgesia;89:7-20, 1999.  Click here for full text free: http://www.internetgroup.ca/clientnet_new/docs/OR%20Scheduling%20Strategy.pdf

 

What is a specialty ACO? A disease-specific ACO?

Initial development of accountable care organizations (ACOs) was focused on primary care, but interest is now shifting to how to encompass care management for certain types of chronic care patients, such as those with cancer or end-stage renal disease.  In some cases, the ACOs are contracting care management for these patients out to specialty physician groups.  Examples of these specialty ACOs would be the relationship between Banner Health and the Southwest Kidney Institute or between Florida Blue and Moffitt Cancer Center.  A challenge with specialty ACOs is amassing a large enough patient base.  Another challenge is working out the referral relationships and possible turf issues between a primary care ACO and the specialty ACO(s) in a service area.

Source: Punke, H.  Specialty ACOs: the next step in accountable care.  Becker’s Hospital Review;2013(5):26-27, May 2013.  Click here for article: http://www.beckershospitalreview.com/hospital-physician-relationships/specialty-acos-the-next-step-in-accountable-care.html  Posted by AHA Resource Center (312) 422.2050, rc@aha.org

Other related information: Florida Blue launches oncology ACO.  HealthLeaders Media, May 14, 2012.  http://www.healthleadersmedia.com/page-2/LED-280059/Florida-Blue-Launches-Oncology-ACO

Centers for Medicare & Medicaid Services.  Details for: comprehensive ESRD care model.  Fact Sheets, Feb. 4, 2013.  http://www.cms.gov/apps/media/press/factsheet.asp?Counter=4529

 

How do we provide hospital services in rural areas?

How does a society provide hospital care for people located in remote, sparsely-populated areas?  What role does government play in providing financial support to keep the doors open for small rural hospitals?  These are questions of long-standing concern to policy makers.  An approach has been the creation of special reimbursement categories for these hospitals under the Medicare program — such as the critical access hospital (CAH) designation, among others.  In this issue of The Journal of Rural Health, there are 3 articles looking at the financial performance and quality issues related to critical access hospitals.

Critical access hospitals are small facilities (less than 25 beds), located in rural areas, and have a short inpatient length of stay.  Because they are often the only hospital in the area, they receive Medicare reimbursement that is intended to be more supportive than the prospective payment system that is used to determine Medicare reimbursement for most hospitals.  Holmes et al. studied the financial condition of rural hospitals over the period 2004 to 2010 and concluded that if the Medicare CAH program were to be abolished, the percentage of critical access hospitals with negative total margins would jump up from the current 28 percent to 44 percent, which would likely lead to a wave of hospital closures.

Gautam, et al.  analyzed the performance of critical access hospitals in Missouri and found that CAHs were less efficient than other types of rural hospitals.  However, the researchers conclude that there are benefits based on the contribution to the local economy and the critical access hospitals’ role as the only health facility in the area that may outweigh any savings that might be derived from withdrawing their special cost-based reimbursement.

Finally, Casey, et al. took a look at existing quality measures to see which might be appropriate for reporting by critical access hospitals (not currently required to provide data to the Hospital Compare database).

Source:  Holmes, G.M., Pink, G.H., and Friedman, S.A.  The financial performance of rural hospitals and implications for elimination of the critical access hospital program; and, Gautam, S., and others.  Measuring the performance of critical access hospitals in Missouri using data envelopment analysis; and, Casey, M.M., and others.  Rural relevant quality measures for critical access hospitals.  The Journal of Rural Health;29(2):140-171, Spring 2013.  Click here for access to the publisher’s website: http://onlinelibrary.wiley.com/doi/10.1111/jrh.2013.29.issue-2/issuetoc  Posted by AHA Resource Center (312) 422-2050, rc@aha.org

Hospitals must assess and address community health needs

Under the Affordable Care Act (ACA), tax-exempt hospitals are required to 1.) conduct community health needs assessments every 3 tax years; and, 2.) develop an implementation plan to meet those needs.  This brief article discusses some of the questions received by staff at the Catholic Health Association about the implementation plan requirements, such as what the due date is, posting on the hospital’s website, whether multi-hospital organizations need to have separate plans for each hospital, how detailed the plans need to be, and what resources are available to help hospitals develop plans.

Sources: Spugnardi, I.  Implementation strategies to address community health needs.  Health Progress;94(3):79-81, May-June 2013.  http://www.chausa.org/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=11875

Of related interest:

US Internal Revenue Service.  Notice and Request for Comments Regarding the Community Health Needs Assessment Requirements for Tax-Exempt Hospitals, [2011].   http://www.irs.gov/pub/irs-drop/n-11-52.pdf

CHA Community Benefit webpage  http://www.chausa.org/communitybenefit/

American Hospital Association Tax-Exempt Status webpage http://www.aha.org/advocacy-issues/taxexempt/index.shtml

Posted by AHA Resource Center (312) 422-2050, rc@aha.org

CORPORATE CULTURE: Guide for organizational ethics

“Over time, an organization may lose its soul.”  That grabs your attention.  This article presents and describes an organizational ethics guide developed by Catholic Health East to help avoid that kind of erosion of mission and values.  The guide is short and consists of the following three categories of questions that can be applied to value-based decision-making:

1. Significant organizational decisions
2. How does ethical review of policy work?
3. Considering organizational culture and behavior

How several hospitals in the CHE system have formalized this process through the establishment of board-management committees is also discussed briefly.

Source: Sanders, A.  Sustaining a commitment to mission and core values.  Health Progress;94(3):72-77, May-June 2013.  Click here for publisher’s website: http://www.chausa.org/HP/  Posted by AHA Resource Center (312) 422-2050, rc@aha.org

2012 prescription spending: $2262 per Medicare patient

 In 2012, this was the breakdown of overall prescription drug spending by patient’s type of coverage:

• $2262.32 Medicare (notice that this is about 2.5 times commercial patients)
• $  846.85 Commercial
• $  450.58 Medicaid

These figures are “per member per year” and based on Express Scripts’ database.  This is a free report available full text on the web.  It includes an interesting recap of key events affecting pharmaceutical utilization and expenditures from 1993 (the first year that this report was published) to the present.  In 2012, for instance, the “patent cliff” occurred, in which patents expired on a large number of prescription drugs.  This will have a beneficial effect on health care costs, since these previously patent-protected drugs will be challenged by lower priced generics.

Source: Express Scripts.  2012 Drug Trend Report, Mar. 2013.  Click here for full text: http://drugtrendreport.com/docs/ExpressScripts_DTR_0320.pdf Posted by AHA Resource Center (312) 422-2050, rc@aha.org