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READMISSIONS: Continuity of care in 12 months before hospital admission reduces 30-day readmission rate

This study of over 14,000 Mayo Clinic patients cared for under a patient-centered medical home (PCMH) model looked at the concept of visit entropy, which pertains to the degree of what the authors term “disorganization” of patient care.  What this refers to is whether a patient is seen always by the same primary physician (perfect continuity of care) or whether a patient is seen by different physicians on different visits.

Statistics About These Mayo Clinic PCMH Patients

  • 14,662 patients admitted to hospital (and included in this analysis)
  • 11.6 percent readmitted within 30 days
  • 8 outpatient visits (median patient visits in 12 months before hospital admission) – this excludes any ED visits on the day of admission
  • 5 different clinicians seen (median patient during 12 months before hospital admission)

CONCLUSION

Patients with higher [visit entropy] in the 12 months before hospital admission were more likely to be readmitted or die within 30 days of hospital discharge.

Source: Garrison, G.M., and others. (2017, January-February). Visit entropy associated with hospital readmission rates. Journal of the American Board of Family Medicine, 30(1), 63-70. Click here for free full text: http://www.jabfm.org/content/30/1/63.full.pdf  Posted by AHA Resource Center (312) 422-2050 rc@aha.org

Largest Hospital and Ambulatory Care EHR Vendors

The Office of the National Coordinator for Healthcare Information Technology (ONC) tracks the vendors used by providers that participate in its electronic health record (EHR) incentive program. ONC has released a list of all certified health IT vendors used by providers along with how many hospitals and ambulatory care professionals are using each vendor’s technology.

There were 175 certified health IT vendors supplying technology to 4,474 non-federal acute care participating hospitals as of June 2016. These ten vendors, ranked by the number of hospitals with certified EHR technology, were the largest suppliers:

  1. Cerner Corporation (1,029 hospitals)
  2. MEDITECH (953)
  3. Epic Systems Corporation (869)
  4. Evident (636)
  5. McKesson (462)
  6. MEDHOST (359)
  7. Allscripts  (235)
  8. Sunquest Information Systems (200)
  9. FairWarning Technologies (172)
  10. Iatric Systems (161)

On the ambulatory care side, 632 vendors supplied certified health IT to 337,432 ambulatory primary care physicians, medical and surgical specialists, podiatrists, optometrists, dentists, and chiropractors also participating in the Medicare EHR Incentive Program. These were the top ambulatory care EHR vendors based on the number of participating health care professionals using each vendor’s technology:

  1. Epic Systems Corporation (83,673 professionals)
  2. Allscripts (33,127)
  3. eClinical Works LLC (25,524)
  4. Next Gen Healthcare (19,676)
  5. GE Healthcare (17,704)
  6. Cerner Corporation (15,104)
  7. athenahealth Inc (14,570)
  8. Greenway Health LLC (12,407)
  9. Practice Fusion (8,523)
  10. McKesson (7,347)

Sources:

Hospital EHR vendors: certified health IT vendors and editions reported by hospitals participating in the Medicare EHR Incentive Program. Office of the National Coordinator for Healthcare Information Technology, June 2016. http://dashboard.healthit.gov/quickstats/pages/FIG-Vendors-of-EHRs-to-Participating-Hospitals.php

Health care professional EHR vendors: certified health IT vendors and editions reported by ambulatory health care professionals participating in the Medicare EHR incentive program. Office of the National Coordinator for Healthcare Information Technology, June 2016. http://dashboard.healthit.gov/quickstats/pages/FIG-Vendors-of-EHRs-to-Participating-Professionals.php

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

MEDICAL GROUPS: Top 10 largest in the U.S.

This is a study of large medical group practices, comparing characteristics of academic medical groups (“gown”) with those not linked to medical schools (“town”).  A large part of the study involved developing a list of the 100 largest practices – which included those from about 500 physicians at the bottom of the list of 100 to ten times that many at the top.  An average of about one-quarter of physicians in these large practices were primary care physicians (PCPs).  However, there was a smaller percentage of PCPs in the academic practices than in the community practices.

Top 10 Largest Physician Practices: U.S. 2013

  1. Northern California Permanente Medical Group (the largest with 5,634)
  2. Southern California Permanente Medical Group
  3. Harvard University
  4. Mayo Medical School
  5. Case Western Reserve University
  6. University of Pittsburgh
  7. University of Washington
  8. University of Michigan
  9. Johns Hopkins University
  10. University of Texas, Houston

Source: Welch, W.P., and Bindman, A.B. (2016, July). Town and gown differences among the 100 largest medical groups in the United States. Academic Medicine, 91(7), 1007-1014.  Click here: http://journals.lww.com/academicmedicine/Abstract/2016/07000/Town_and_Gown_Differences_Among_the_100_Largest.32.aspx  Posted by AHA Resource Center (312) 422-2050, rc@aha.org

CANCER CENTERS: 24 infusion chairs on average

Here are some interesting data on cancer center infusion services.  This survey, conducted by the Association of Community Cancer Centers (ACCC) and Lilly Oncology, was responded to primarily by staff in hospital-based outpatient cancer programs.

Number of Infusion Chairs and Beds per Center (average)

  • 24 (2015)
  • 18.5 (2014)

Number of Infusion Encounters per Center per Year (average)

  • 9,561 (2015)
  • 9,133 (2014)

Number of Infusion Patients per Chair per Day (average)

  • 3:1 was reported by 29 percent of respondents in 2015
  • 2:1 was reported by 25 percent of respondents in 2015

Nurse-to-Patient Staffing Ratios in Infusion Service

  • 1:4 was reported by 43 percent of respondents in 2015
  • 1:3 was reported by 20 percent of respondents in 2015

This highlights document can be accessed at no charge – and contains lots of other data on cancer center operations.  The full survey report is available to ACCC members only.

Source: Association of Community Cancer Centers. (2015). 2015 Trends in Cancer Programs. Click here: accc-cancer.org/surveys/pdf/Trends-in-Cancer-Programs-2015.pdf  Posted by AHA Resource Center (312) 422-2050, rc@aha.org

 

 

 

Health Care Consumerism: Spending on Shoppable Services

A new report from the Health Care Cost Institute suggests that providing consumers with pricing to help them shop for health care may only have a modest impact on reducing overall health expenditures. Less than 7% of health expenditures are paid for by consumers for shoppable services.

Here are some numbers from the HCCI study:

  • About 43% of the $524.2 billion spent in 2011 on health care for the privately insured was considered shoppable.
  • Roughly a quarter of the privately insured population does not have a claim during a given year.
  • Around 15%, or almost $81 billion, was spent out of pocket on health care by privately insured consumers.
  • Of the out-of-pocket spending, $37.7 billion [7%] was spent on shoppable services.
  • Coinsurance and deductibles made up about three quarters of out-of-pocket shoppable spending.
  • Most out-of-pocket shoppable dollars [44%] were for ambulatory doctor services.

While price and quality information is important and should be available to consumers, it may be unrealistic to expect that it will drive major market changes. The HCCI analysis found less price variation for outpatient than for inpatient services, and the more shoppable outpatient services generally are lower-priced to start with. While consumers with serious health conditions or high deductibles could realize significant savings, there may be little value for many consumers to shop when there is minimal price variation.

The report concludes that one should be realistic about the power of consumers to control health care costs. Instead, it recommends efforts be focused directly on providers and payers who are better positioned to put downward pressure on prices.

Sources:

Spending on shoppable services in health care. Health Care Cost Institute, Issue Brief #11, Mar. 2016. http://www.healthcostinstitute.org/files/Shoppable%20Services%20IB%203.2.16.pdf

Frost A and others. Health care consumerism: can the tail wag the dog? Health Affairs Blog, Mar. 2. 2016. http://healthaffairs.org/blog/2016/03/02/health-care-consumerism-can-the-tail-wag-the-dog-2/

Related sources:

White C; Eguchi M. Reference pricing: a small piece of the health care price and quality puzzle. National Institute for Health Care Reform, Research Brief 18, Oct. 2014. http://www.nihcr.org/Reference-Pricing2

Price transparency efforts accelerate: what hospitals and other stakeholders are doing to support consumers. American Hospital Association, Trendwatch, July 2014. http://www.aha.org/research/reports/tw/14july-tw-transparency.pdf

White C and others. Healthcare price transparency: policy approaches and estimated impacts on spending. West Health Policy Center, Policy Analysis, May 2014. http://www.westhealth.org/wp-content/uploads/2015/05/Price-Transparency-Policy-Analysis-FINAL-5-2-14.pdf

Muir MA and others. Clarifying costs: can increased price transparency reduce healthcare spending? William & Mary Policy Review 4: 319-366, 2013. https://www.wm.edu/as/publicpolicy/wm_policy_review/archives/volume-4/volume-4-issue-2/MuirAlessiKing_s13f.pdf

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

Update: Physician Office Adoption Rates of Certified Electronic Health Record Systems

A new data briefing from the National Center for Health Statistics reports on the progress physician offices have made in adopting EHR systems. Here are the latest key findings for 2014:

  • Nationally, nearly three-quarters of office-based physicians now have a certified electronic health record system, but adoption rates vary among states.
  • A third of physician offices with an EHR system were electronically sharing patient health information externally with other providers.

The report also provides data on adoption rates by state and by primary vs non-primary care physicians. Electronic data exchange is analyzed by type of provider the patient record is shared with externally.

Source:  Jamoom EW and others. Adoption of certified electronic health record systems and electronic information sharing in physician offices: United States, 2013 and 2014. NCHS Data Brief [National Center for Health Statistics], no. 236, Jan. 2016. http://www.cdc.gov/nchs/data/databriefs/db236.pdf

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

Unplanned Revisits Following Ambulatory Surgery

The outpatient counterpart for hospital inpatient readmissions is revisits. Even though two-thirds of surgeries  are done on an outpatient revisit, less quality of care data has been available for unplanned revisits following outpatient surgery than for unplanned readmissions after an inpatient operation. Here are some initial benchmarks from one research team that looked at ambulatory surgeries performed in hospital-owned settings that had low surgical risk:

  • All-cause revisits within 30 days of ambulatory surgery: 95 per 1000 operations
  • Most revisits were to emergency departments: 59 per 1000 operations
  • Revisits to inpatient surgery setting: 27 per 1000 operations
  • Two-thirds of the revisits [65 per 1000 operations] were for complications related to the procedure, while the remaining revisits were attributed to unrelated conditions.

The authors indicate more research is needed to determine which of the ambulatory surgery complication revisits may be preventable.

Sources:

Steiner CA and others. Return to acute care following ambulatory surgery. JAMA 314(13):1397-1399, Oct. 6, 2015. http://jama.jamanetwork.com/article.aspx?articleid=2449176

AHRQ study: ambulatory ‘revisits’ occur frequently, often due to complications. AHRQ Electronic Newsletter, no. 497, Dec. 8, 2015, p. 3. http://content.govdelivery.com/accounts/USAHRQ/bulletins/129ba69

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