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

 

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

How will health reform affect the physician supply?

A recent Congressional Research Service report looks at the physician supply and how the Affordable Care Act may affect it. The adequacy of the physician supply is examined from three dimensions: its size, composition [primary care vs specialties], and its geographic distribution.

The provisions of the Affordable Care Act that may impact physician demand are also reviewed; these include changes in physician training, compensation, and practice. How these ACA provisions will ultimately affect the physician supply is not yet known because the provisions are temporary or not yet implemented, will not have immediate effects, or rely on discretionary spending.

While the answer to the question about how health reform will affect the physician supply is still murky, the report provides useful background information. It concludes:

“The current and future physician supply may be inadequate. Some experts suggest that there are too few physicians overall, too few primary care physicians specifically, and that physicians are inadequately distributed throughout the United States. The ACA may intensify some of these concerns…[but] it is not yet known whether and how these provisions will affect physician supply.”

Source: Heisler EJ. Physician supply and the Affordable Care Act. Congressional Research Service, Jan. 15, 2013. http://op.bna.com/hl.nsf/id/myon-93zpre/$File/crsdoctor.pdf

Related Sources:

Huang ES and Finegold K. Seven million Americans live in areas where demand for primary care may exceed supply by more than 10 percent. Health Affairs 32(3):1, Mar. 2013. http://content.healthaffairs.org/content/early/2013/02/19/hlthaff.2012.0913.full.pdf+html

Petterson SM and others. Projecting US primary care physician workforce needs: 2010-2025. Annals of Family Medicine 10(6):503, Nov/Dec 2012. http://annfammed.org/content/10/6/503.full.pdf+html

Recent studies and reports on physician shortages in the US. Center for Workforce Studies, Association of American Medical Colleges, Oct. 2012. https://www.aamc.org/download/100598/data/recentworkforcestudies.pdf

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

What’s Caused the Recent Slowdown in Health Spending?

How much of the recent slowdown in health spending has been due to the economic downturn?

How much has been from structural changes in the health system?

Are we in a period of high or low “excess” health spending?

What may happen to health spending if the economy recovers?

A new analysis by researchers at the Kaiser Family Foundation and the Altarum Institute’s Center for Sustainable Health Spending attempts to answer these questions. While the analysis sheds some light on the issues, the researchers indicate it will not settle the debate about reasons for the recent spending slowdown.

A strong link was identified between national health spending and economic business cycles and inflation. About 77% of the decline in health spending was due to changes in the economy, while structural changes in the health system had a more modest impact.  The researchers predict that national health expenditures will increase as the economy continues to recover, but probably not at the earlier double-digit rates. An ongoing focus on health care cost containment will be needed to keep growth rates low for the future.

Source: Assessing the effects of the economy on the recent slowdown in health spending. Snapshots: Health Care Costs, Kaiser Family Foundation, Apr. 2013. http://www.kff.org/insurance/snapshot/chcm042213oth.cfm

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

US: Health insurance marketplace opens October 1, 2013

There are members of my family — perhaps yours as well — who would be interested in an overview of the new Health Insurance Marketplace, a.k.a. exchanges, opening October 1, 2013.  The exchanges will offer a way to buy private insurance coverage that will start beginning January 2014.  There is an article posted online today in JAMA, written by Dr. Howard Koh, who is the Assistant Secretary for Health at the US Department of Health and Human Services and Marilyn Tavenner, who is the Acting Administrator for the Centers for Medicare & Medicaid Services — so it’s authoritative.  They provide information about options for low-income individuals and families, as well.

There is a website, of course, at http://www.healthcare.gov, and it is already populated, so I took a look.  I liked the snappy little video:  What Is the Health Insurance Marketplace? http://www.healthcare.gov/videos/2013/01/health-insurance-marketplace.html (short video)

Source: Koh, H., and Tavenner, M.  Connecting to health insurance coverage.  JAMA, Apr. 15, 2013.  Click here for free full text: http://jama.jamanetwork.com/data/Journals/JAMA/0/jama.2013.3469.pdf  Posted by AHA Resource Center (312) 422-2050, rc@aha.org

How many ACOs are there? 250 and counting

Here’s one just-published answer to the popular question: “How many accountable care organizations (ACOs) are there?”  These authors, with Weill Cornell Medical College in New York, state that there are currently more than 250 ACOs and that the number increased rapidly in 2012.  They anticipate that the number will continue to grow lickety-split not only due to federal government initiatives but because commercial insurers are signing ACO-like contracts with various entities.  The authors go on to discuss the meaning of population health (buzzword alert!) and what ACOs can realistically be expected to take on in that regard.

What do I like about this article?  It’s topical.  There’s a useful quotable number in it.  Even though it is not completely free full text online, the publisher will let you see the first page for free.

Source: Noble, D.J., and Casalino, L.P.  Can accountable care organizations improve population health? Should they try?  JAMA;309(11):1119-1120, Mar. 20, 2013.  Click here for the publisher’s website: http://jama.jamanetwork.com/article.aspx?articleid=1669825  Posted by AHA Resource Center, (312) 422-2050, rc@aha.org

Is readmissions penalty a burden on safety net hospitals?

Under Medicare’s Hospital Readmissions Reduction Program (HRRP), which began Oct. 1, 2012, hospitals with readmission rates for certain target conditions that are deemed excessive will lose a percentage of their Medicare reimbursement.  A surprisingly high two-thirds of eligible hospitals will be penalized this year, to the tune of  $280 million total.  These authors note that safety net hospitals and large teaching hospitals are more likely to be penalized, jeopardizing their ability to care for the neediest patients.  Steps that might be taken to adjust the formula so as not to unduly penalize these hospitals are discussed:

1. Adjust for socioeconomic status
2. Weight according to when the readmission occurs — within a few days or at the end of 4 weeks
3. Factor in the hospital mortality rate

Source: Joynt, K.E., and Jha, A.K.  A path forward on Medicare readmissions.  The New England Journal of Medicine, Mar. 6, 2011.  Click here for full text: http://www.nejm.org/doi/pdf/10.1056/NEJMp1300122 

For further study: Glass, D., Lisk, C., and Stensland, J.  Refining the Hospital Readmissions Reduction Program.  Washington, DC: Medicare Payment Assessment Commission, Sept. 7, 2012.  Click here for full text: http://www.medpac.gov/transcripts/readmissions%20Sept%2012%20presentation.pdf   Posted by AHA Resource Center, (312) 422-2050, rc@aha.org

 

FUTURE TRENDS: What is the hospital changing into?

Two traditionally hospital-focused provider organizations that are experimenting with new nontraditional models are profiled in this brief article.  The first is Montefiore Medical Center (Bronx, NY), which has a wholly owned subsidiary named CMO-The Care Management Company.  CMO was established in the late ’90s and was a principal reason that Montefiore was chosen to as a Pioneer Accountable Care Organization by the Centers for Medicare & Medicaid Services.  It provides Montefiore with a platform to assume financial risk for patients and put population health into practice.  The second organization is Texas Health Resources, which has entered into a contract with Healthways, for disease management services. 

Why do I like this article?  It’s topical!  It’s free full text!  Two nice brief case studies.

Source: Betbeze, P.  Embracing nontraditional models.  Health Leaders;16(1):30, 32, 34, 36, Jan./Feb. 2013.  Click here for full text: http://www.healthleadersmedia.com/print/MAG-289193/Embracing-Nontraditional-Models  Posted by AHA Resource Center, (312) 422-2050, rc@aha.org

SEQUESTRATION: It’s here. What impact will it have?

Sequestration, which went into effect Mar. 1, 2013, is expected to cut the federal deficit by $1.2 trillion over the next 10 years.  These automatic cuts impact federal funding of both military and domestic spending.  According to The New York Times, the cuts are widespread, but might not be immediately apparent to the average Joe.  For instance, despite cautions that air travelers might want to factor in extra time at the airport, security lines have not immediately gotten longer due to furloughed TSA officials. 

What about the impact on hospitals?   Here’s an analysis from one state.  The North Carolina Hospital Association has calculated the expected impact of the cuts in Medicare reimbursement, which will decrease by 2 percent beginning April 1.  The decrease in Medicare reimbursement is expected to total $1.3 billion over 10 years.  However, there are other budget cuts that hospitals in North Carolina will face — nearly $8 billion over the next decade.

Sources:  CNN explains: sequestration.  CNN, Feb. 19, 2013.  Click here for full text: http://www.cnn.com/2013/02/06/politics/cnn-explains-sequestration 

Sequestration: when will you feel the pain?  Fox News, Mar. 1, 2013.  Click here for full text:  http://www.foxnews.com/politics/2013/03/01/sequestration-when-will-feel-pain/print 

Shear, M.D.  Across-the-board cuts take effect, but their impact is not immediately felt.  The New York Times, Mar. 2, 2003.  Click here for full text: http://www.nytimes.com/2013/03/03/us/politics/Spending-Cuts-Imposed-US-Starts-to-Trim-Its-Budget.html?_r=0&pagewanted=print

Thomas, J.  Sequestration cuts could cost NC hospitals $1.3B.  Charlotte Business Journal, Mar. 1, 2013.  Click here for full text: http://www.bizjournals.com/charlotte/news/2013/03/01/sequestration-cuts-expected-to-cost-nc.html?s=print  Posted by AHA Resource Center, (312) 422-2003, rc@aha.org

Top Health Policy Think Tanks – 2012 Update

The 2012 list of top global and domestic public think tanks is out, updating last year’s rankings. The report indicates there are now 6603 think tanks worldwide, with 1823 of them in the U.S. The Brookings Institution was again named the top think tank worldwide.

The top-ranked health policy think tanks based in the U.S. were:

1. Bloomberg School of Public Health Research Centers at Johns Hopkins
2. Brookings Institution
3. RAND Corporation
4. American Enterprise Institute
5. Center for Strategic and International Studies
6. Council on Foreign Relations Global Health Program
7. Kaiser Permanente Institute for Health Policy
8. Center for Studying Health System Change
9. Department of Health Policy and Management at Harvard
10. National Bureau for Economic Research
11. Urban Institute
12. Cato Institute
13. Center for American Progress
14. Peterson Institute for International Economics

Among the many other lists included in the report are these:

• Top 55 think tanks in the U.S.
• Top 30 health policy think tanks [global]
• Top 80 domestic economic think tanks
• Top social policy think tanks
• Think tanks with the most innovative policy ideas/proposals
• Best new think tanks
• Thinks tanks with outstanding policy-oriented research programs
• Think tanks with the most significant impact on public policy
• Best university affiliated think tanks
• Best for-profit think tanks
• Best policy study/report produced by a think tank

The report also discusses trends and issues related to think tanks.

Source: McGann JG. 2012 Global Go To Think Tanks Report and and Policy Advice. Thank Tanks and Civil Societies Program, University of Pennsylvania, Jan. 28, 2013. http://www.gotothinktank.com/wp-content/uploads/2013/01/2012-Global-Go-To-Think-Tank-Report.pdf

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