Having noticed that "the majority of tests we were ordering…really didn't impact the day-to-day care," a group of neurosurgery residents identified five lab tests that could be eliminated without affecting patient safety. They generated nearly $2 million in savings, including $75,000 in direct costs for their medical center.
Cost and reimbursement pressures, the explosion of boomers in the hospital patient mix, and the movement toward population health are spurring health systems to launch their own health insurance plans.
Physicians in nine large groups have dropped out of Medicare's pioneer accountable care organization initiative after just one year of participation, but health policy officials and doctors leading ACO groups said they are not turning their backs on coordinating care for beneficiaries.
Wednesday July 24 2013
ACOs Alive and Well in Miami
"...Rivera, a Medicare beneficiary, coordinates all of his medical care through his internist, who referred all the specialists, and he now receives the kind of comprehensive treatment that he never experienced before the two heart attacks, including regular preventive screenings, management of his blood pressure and cholesterol levels, and convenient access to his doctors..."
Read the Article in Miami Herald Business
Tuesday July 23, 2013
SGM Comments: Though there is controversy among providers regarding the ACO system of reimbursement (especially among those who agreed to be in the Pioneer version of the plan) most healthcare executives agree that a similar version of care and reimbursement will be the future of healthcare. We need to understand how we, as providers of products/services to these providers, fit into the equation. Certainly, the ability to be on a conversational level with your customers regarding this model will help you to build strategic relationships.
Keys to Success as an ACO
"Recently many journal articles and presentations have discussed how important it is under the Affordable Care Act to "get together" with physicians. However, those doing the espousing are often those whose actual physician integration experience has been in theory only. Most have never built and run a hospital-physician integrated system."
Read the Article on Becker's
Tuesday, July 16, 2013
Five Key Trends in Healthcare for 2013
It has been a fascinating first half of the year in the healthcare industry. The industry continues to evolve, due in part to several key issues impacting healthcare delivery today. Below we present what we believe are the five biggest issues facing hospitals and healthcare systems, surgery centers and physician practices this year.
Read the Article at Becker's
Monday, July 15, 2013
Medicare Physician Fees...Winners and Losers
"Some of the biggest cuts are aimed at independent testing laboratories, which see 26% of their fees slashed, followed by radiation therapy centers, which may lose 13% under CMS's "particularly complicated," proposed changes."
Read the Article on HealthLeaders
Tuesday July 2, 2013
Healthcare Quality Metrics "Abysmal"
"The nation's efforts to measure healthcare quality has improved in recent years, but that isn't saying much considering how much stakeholders are still in the dark, several quality experts told members of the Senate Finance Committee this week."
Read the Article
Friday June 28, 2013
Killer Metric Separates Good Hospitals From Bad
"How can you tell a good hospital from a bad hospital? Aside from anecdotal information about bad coffee and surly nurses, we now have actual data to help make the distinction."
Read the Article in HealthLeaders
Monday June 24, 2013
Geisinger's CEO on Cost, Quality, Data Sharing
Glenn Steele, MD, discusses the need for healthcare organizations to collaborate and learn from each other with shared data that can offer real-time insights as healthcare leaders re-engineer the industry to provide real value.
Read the Article on HealthLeaders
Monday, June 17, 2013
Physician Pay Will Soon Depend on Outcomes
The Centers for Medicare & Medicaid Services is seeking feedback from doctors as it builds a model for reimbursing physicians based on actual outcomes rather than process measures.
Read the Article on HealthLeaders
Wednesday, June 12, 2013
Physicians Merging to Better Compete in an Age of ACOs
"Faced with few ACO options, physicians are increasingly considering merging their practices, which would enable them to reduce expenses and wield more clout in negotiations."
Read the Article in HealthLeaders
Wednesday, June 5, 2013
CMS Unveils Charges for Outpatient Hospital Procedures
"...HCA's Fawcett Memorial Hospital, a 238-bed facility in Port Charlotte, Fla., charged $13,984.79 for a level III ultrasound without contrast, and was reimbursed an average of $536.32. At 135-bed Logan (Utah) Regional Hospital, part of Intermountain Healthcare, the list price for the procedure is $678.24, and it was reimbursed $521.60..."
Read the Article at ModernHealthcare.com
Tuesday, June 4, 2013
Payer and Provider Views on Value-Based Contracting
"Value-based contracts can come in many forms and range from bundled payments to shared savings contracts to accountable care organizations. Payers and providers need to work together to form value-based contracts and be successful in the agreement.
Read the Article on Becker's Hospital Review
Thursday, May 23, 2013
Three Reasons Why Hospitals May Be Scared of Wal-Mart
SGM Comment: For a few years now, we've been saying that the minit clinic model could become more of a challenger than just a quick way to get a flu shot. In this article the emphasis shifts to the impact of Wal-Mart Clinics (and others) on hospital business. Since Primary Care Physicians are admitting more patients to hospitals now than specialists are, imagine the power of a national organization like Wal-Mart and a provider arrangement with a large integrated system like Kaiser. The next few years could see a major change in the way healthcare is delivered as retail becomes more involved. With Wal-Mart's strong position in the use of database technology, it seems it might be even easier for them to move into the healthcare arena in a big way. Consider Wal-Mart's great potential ability to grow marketshare in healthcare and especially in Medicare.
"...In a video from the Advisory Board,Lisa Bielamowicz, MD, CMO of Health Care Advisory Board, said about a third of provider' patients shop at Wal-Mart on a weekly basis. "It's the cheapest place to buy groceries and ammunition, and it could become your [hospital's] most formidable competitor," Dr. Bielamowicz said in the video..."
Read the Article: Wal-Mart
Tuesday, May 21, 2013
Lower Your Healthcare Cost? There May be an App for That
"In the fee-for-service world, this mattered little, because email consultations were not billable events. In an accountable care world, the physician is incentivized to keep the patient healthy, while at the same time keeping costs low, including minimizing office visits, as well as enhancing patient satisfaction."
Read the Article: Aetna to allow app communications with docs
Monday, May 20, 2013
Primary Care Physicians Generating More Hospital Revenue
"As the primary care physician evolves into this quarterback of the medical home model and if they truly do what they are being designed to do, which is to control the entire flux of that patient, in theory they would dictate what tests happen and what procedures are necessary, what specialist are brought in, what preventative care or home health measures are used," Singleton says."
Read the Article: PCP More Hospital Revenue
Wednesday, May 15, 2013
Transforming the Physician Medical Practice
SGM Comment: If you haven't already done so, and you call on office based physician practices, now is the time to have dialogue with them regarding how they see their practices changing. A local primary care physician said that his four physician practice will stop seeing any patients except those who join their concierge practice and pay a monthly fee. He said that he feels current reimbursement scenarios were forcing physicians to either become employees of IDNs or turn to solutions such as their's. What might all of these mean to you and your strategies with such physicians?
"...Dr. Thomas Bellavia transformed his traditional medical practice in Hasbrouck Heights, N.J., into a so-called medical home where patients are seen by teams of doctors and nurses. He says it has paid off in better, more coordinated care for his patients and healthier income for the nurse practitioners and physicians in his group..."
Read the Article: Doctors Transform Practices
Monday, May 13, 2013
Kill Your Chargemaster: Hospital Procedure Pricing in the News
"...Hospital pricing, as we all know, is complex. But if you're the CEO of Brookwood Hospital in Birmingham, AL, and your hospital is charging $87,065 to treat chronic obstructive pulmonary disease while across town, St. Vincent Hospital is charging $23,245, you have a problem today where you didn't yesterday..."
Read the Article: HealthLeaders
Real Life Lessons and Key Concepts Regarding Clinical Service Lines
The link below is to one of the areas most Service Line Leaders and other Hospital Administrators are focused on to move into the new value-based world. There is great raw material for Strategic Business Calls in it. Have a great week!
"...Physicians form a management LLC and strike a co-management service agreement with the hospital. Typically, co-management agreements focus on a particular service line, such as orthopedics or cardiovascular services. The arrangement is analogous to hospitals "outsourcing the management of a clinical service line to a group of physicians," said Mr. Minkin, and it's also a strategy to engage physicians and give them more control to achieve greater operational cost efficiencies and improved outcomes..."
Read the Article: Co-Management Agreements
Thursday, May 9, 2013
CMS Releases Hospital Pricing Data
"In an unprecedented move Wednesday, the Centers for Medicare & Medicaid Services made public extensive hospital cost data, jolting healthcare providers, payers, and consumers alike."
Read the Article: CMS Hospital Pricing Data
Thursday, May 2, 2013
Michigan Blues Reaches Value-Based Payment Agreement with Trinity Hospital
SGM Comment: Michigan BC/BS developed an agreement last year to develop an ACO with the Trinity Hospital system. Yesterday Michigan BC/BS announces that they are working with Trinity to develop a new model that uses "value-based" reimbursement designed to "reduce premiums while coordinating care."
Something to consider...there is nothing in the article that says this is an effort just for medicare/medicaid or ACO patients. You can bet that a Patient Centered Medical Home model will also be part of this if it isn't already. But this comment from the article is especially interesting: "...Trinity's 12 hospitals and doctors will work to eliminate unnecessary and redundant medical tests and office visits...."
What does this mean for you and your team? How connected are you to those influencers who are either already or about to build a similar arrangement with providers in your territory or area of responsibility? And what might this mean if protocols are developed in your key accounts without your having any input whatsoever? But more importantly, what kind of competitive immunity might you build if you and your organization were to get there first and work with such customers on the value that your solutions bring?
Read the Article, and think how you might use this "terrain" information in your calls tomorrow. You may uncover information that could lead to significant competitive advantage for both you and your product/services.
Wednesday, May 1, 2013
Critical Success Factors for Bundled Payment Success
"Three health system leaders shared their experiences working with CMS to test one of four models of payments based on episodes of care at an executive briefing today at the American Hospital Associations annual meeting in Washington, D.C."
Read the Article: Bundled Payment Success
Tuesday, April 30, 2013
Predictive Analytics and Other Challenges
SGM Comment: Think of the potential this has on the use of your current products, services, or solutions?
"There's this concept of real-time healthcare, which is what the industry is moving toward, and predictive health, predictive analytics. [It's] basically looking at patients' current conditions, if they're in a hospital, and predicting they're going to get sepsis, and then treating them before they get sepsis."
Read the Article: Kaiser Permanentes' CIO Q&A
No One May Be Coordinating Care
"Betsy Gabay saw a rotating cast of at least 14 doctors when she was hospitalized at New York Hospital Queens for almost four weeks last year for a flare-up of ulcerative colitis. But the person she credits with saving her life is a spry, persistent 75-year-old with a vested interest -- her mother."
Read the Article: Healthcare's Dirty Little Secret
Monday, April 29, 2013
New Hospital Brands
SGM Comment: Since this is such a hot topic right now (hospital brands, strategic positioning) now might be a good time to reference this article and ask your customers how they feel they are differentiated from other clinical options that are available to patients/payers? The value? If I know their strategy, I have a foundation on which to build my competitive positioning. However, as a strategist, I must say that a new logo does not a strategy make!
"Hospitals and health systems across the country have been getting makeovers this year — several organizations have changed their name, brand and/or logo in the beginning of 2013. The following 10 healthcare name changes and new brands represent just a fraction of the organizations that have reinvented themselves this year."
Read the Article: What's Behind the Rash of New Hospital Brands?
Thursday, April 25, 2013
Diagnostic Lab Stocks in Trouble
"...companies like these are capital-intensive, labor-intensive and require massive infrastructure. And as Medicare cuts its reimbursement rates, diagnostic services companies will suffer along with the rest of the industry."
Read the Article: Diagnostic Lab Stocks
Tuesday, April 23, 2013
Diagnostic Errors Common, Costly, Harmful
"The correct premise is that correct therapy begins with correct diagnosis. Unfortunately the entire medical profession operates under the collective delusion that diagnoses are almost always right," Newman-Tucker says. "There are all kinds of things we track in the hospitals; quality measures of one kind or another. But nobody is tracking whether or not their diagnoses are right. It's either ironic or scary but it's not good."
Read the Article: Diagnostic Errors
Friday, April 19, 2013
Former ACP President: "We Have to be More Efficient"
SGM Comments: When the former President of the American College of Physicians speaks about the need for doctors to be more efficient, what does that mean? Read this article and think what the outcomes of "physician efficiency" might be with regard to your products' usage?
"...We want patients to get the right care at the right time, and no more than necessary. I think there's a shift in thinking on this issue. There's a lot more realization we have to be prudent with resources. We have to get rid of the things that add no value in healthcare. The payers are paying attention to this too. They're saying no when there's no indication for a screening test. I don't recommend some of the tests I used to recommend, also, because science has come along and said, gee, we thought that was more useful than it ended up actually being. The PSA (prostate specific antigen) test for prostate cancer is one example..."
Read the Article: Physician Practice Efficiency
Thursday, April 18, 2013
Tips for Successful PCHM Transformation and Recognition
SGM Comments: Accountable Care Organizations and Patient Centered Medical Home models are proliferating. It is incombent on you as a "Phase III, Strategist" to be conversant on these newer systems in healthcare. You will want to uncover potential ways in which your products, services, and solutions will help as provider of care move more fully into these systems of care.
"Transforming primary care practices into patient-centered medical homes and achieving PCMH recognition from the National Committee for Quality Assurance is anything but easy. Many months or even years of work can go into the transition process, and the NCQA application can take more than 300 hours to complete."
Read the Article: 4 Tips
Wednesday, April 10, 2013
The Future for Hospitals and Healthcare Providers
"Hospitals and health systems today are confronted by a number of challenges that could ultimately impact how they deliver care. From reduced reimbursement to increased government scrutiny and anticipated provider shortages, we anticipate the future forecast for these providers will be a cloudy one. Here are six observations on the current climate surrounding hospitals and health systems."
Read the Article: 6 Observations and Concerns
Monday, April 8, 2013
Could the Toyota Playbook Help Improve Cardiac Treatment?
"The management principles used to improve quality and efficiency at Toyota Motor Corp. and other manufacturers also are linked to better delivery of cardiac care and lower death rates from heart attacks, according to research that demonstrates for the first time how well the so-called lean production system functions across a wide swath of U.S. hospitals."
Read the Article: amednews.com
Friday, April 5, 2013
Fee For Service Not Dead Yet?
"Despite growing pressure for hospitals to deliver higher quality, more patient-centered care, the fee-for-service model isn't dead yet--putting CEOs in the tough spot of continuing current fee-for-service reimbursement while simultaneously moving toward payment reform."
Read the Article: CEOs Navigate Transition
Thursday, April 4, 2013
Walgreens Becomes 1st Retail Chain to Diagnose and Treat Chronic Conditions
SGM Comment: Since healthcare providers are looking at how they can be successful through structuring for easier patient access, we can expect this trend to grow and expand. How might this impact your products/solutions, and how does it change the "terrain" for you in your territory and/or area of responsibility? Who will have access to this "new" player in healthcare delivery, and can we simply wait to see what happens?
"It’s not just sore throats and flu shots anymore. Walgreens today became the first retail store chain to expand its health care services to include diagnosing and treating patients for chronic conditions such as asthma, diabetes and high cholesterol."
Read the Article: Walgreens
Wednesday, April 3, 2013
Hospital to End OB Services
SGM Comment: Do you know which Service Lines your Hospital customers are getting out of? Do you know what it means to your business?
"This is not uncommon as hospitals throughout the State of Texas and across the nation, all face significant challenges with decreased reimbursements and rising underinsured/uninsured populations. Hospitals are implementing strategies to mitigate these negative impacts, and at the same time, are making changes which ensure their community strength for the long term."
Read the Article: Ending OB Services
Tuesday, April 2, 2013
Majority of Physicians Unfamiliar with ACOs, PCMHs
"The survey's findings are based off of 613 responses from primary care physicians, surgical specialists, non-surgical specialists and other physicians. Most also believe that…
- Medicaid and Medicare reimbursements may be problematic, prompting many physicians to limit or close their practices to these enrollees.
- Physician-hospital integration is expected to increase.
- Clinical decision support information technologies that reduce unnecessary services and increase clinician adherence to evidence-based practices are of interest to physicians."
Read the Article: Physicians Unfamiliar
Friday, March 29, 2013
"5 Leadership Traits for Accountable Care Leaders"
SGM Comment: How do your products, services, solutions potentially impact the leadership of an organization striving for Accountable Care excellence?
"In a recent post on athenahealth's Leadership Forum, Amy Edmondson, PhD, a faculty member at Harvard Business School, discussed the leadership successes of two individuals closely involved in advancing accountable care models: Richard J. Gilfillan, MD, director of the Center for Medicare and Medicaid Innovation, and Susan Thompson, president and CEO of Iowa-based Trinity Health Systems, which participates in the Medicare Shared Savings Program, along with partner TriMark Physicians Group."
Read the Article: 5 Leadership Traits
Thursday, March 21, 2013
"We Are Your New Doctor"
"...These drugstore chains provide services people once turned to their primary-care physician for, such as wart removals, jellyfish stings, immunizations—and now, physicals. Nurse practitioners perform the actual examinations, while many pharmacists are certified to do immunizations and alter patients’ medication. And if the American Pharmacists Association gets its way, pharmacists will soon have more medical cred..."
Read the Article: 10 Things Your Durgstore Won't Say
Wednesday, March 13, 2013
Diabetes Costs Hit $245B in 2012
"The price tag includes $176 billion in direct medical costs for hospital and emergency care, office visits, and medications. The indirect medical costs were estimated at $69 billion to account for absenteeism, reduced productivity, unemployment caused by diabetes-related disability and lost productivity due to early mortality."
Read the Article: Diabetes Costs
Monday, March 11, 2013
Specialty ACOs: The Next Step in Accountable Care
"The concept of accountable care organizations — of payors and care providers working together to achieve the triple aim of lowering healthcare costs while improving the quality of care and patient outcomes — has mainly been focused on primary care since the idea was formalized by the Patient Protection and Affordable Care Act in 2010.
Lately, however, the focus of ACOs has shifted slightly from primary care to specific chronic diseases, such as cancer, chronic kidney disease and end stage renal disease."
Read the Article: Specialty ACOs
Tuesday, February 26, 2013
Coordinated Care Could Save Billions in California Alone
"This could be a game changer in the state," said Stephen Shortell, dean of the School of Public Health at UC Berkeley and a coauthor of the report. "These are the CEOs of big insurers, big health systems and large medical groups saying it's time for a change, and these are the people who can get things done."
Read the Article: LA Times
Thursday, February 14, 2013
Service Lines Still Pay Off
"Positioning is the single most important aspect of hospital communications. Hospital leadership must have a clear view of brand position to accurately portray their organizations to the public and differentiate themselves from competitors."
Read the Article: Service Line Campaign at MGUH
Friday, February 8, 2013
The Physician Hospital Organization in 2013
"Hospitals and physicians have a great incentive right now to figure out how they should be working together going forward, and how they need to align legally and what model to use in order to engage those populations..."
Read the Article: The PHO in 2013
Wednesday, February 6, 2013
Providers Becoming Payors?
"A handful of health systems like Geisinger have successfully played the role of both provider and payor for the past 30-plus years, and it is one of the reasons President Barack Obama has heralded Geisinger as an exemplary system of healthcare delivery. As healthcare reform continues to evolve, more hospitals and health systems are exploring the option of starting their own health plans and insurance divisions. But managing care as both provider and payor is no easy task — and taking the wrong steps could be detrimental to an organization."
Read the Article: Providers Becoming Payors
Tuesday, February 5, 2013
ACO Readiness: 6 Chief Determinants
"That fact is, ACOs and HMOs are not one in the same, and many advancements have been made in care delivery over the last two decades. So in reality, since the ACO concept is still relatively new, there's little information based on real-life experiences that outlines how ready a system is to launch one."
Read the Article: ACO Readiness
Hang On for Risk-Bearing Contracts, Rewards
SGM Commentary: There is no doubt that the move towards Accountable Care is the current wave, but from our experience and simply looking at the past to predict the future, this move to Value Based Reimbursement is setting up more of a global capitation model that was predicted in the mid 90's. What might that mean to you and your organization, products, services, and solutions?
"Of all the strategic shifts facing health systems in the coming years, none involves so many underlying fundamentals of the business as the shift away from a fee-for-service model of reimbursement to one based more on risk-bearing contracts and population health models."
Read the Article: HealthLeaders
Monday, February 4, 2013
CMS Releases Sunshine Act Final Rule
Officially called the "National Physician Payment Transparency Program: Open Payments," the final rule will require drug and device manufacturers that receive government reimbursements to collect data on gifts and payments to teaching hospitals and physicians, starting on Aug. 1.
Read the Article: FierceHealthcare
For Outreach to Outsourcing: Are Hospital Outreach Programs Vulnerable to Buyouts?
I believe this article directly addresses the inflection point facing labs and healthcare in general. Have all of your leaders read this before your next meeting and ask themto give you their best estimate as to how it will impact your business. Make them prioritize the impact they see biggest to smallest (2 or 3 separate issues). You’ll get a real gauge on the strategic thinking in the room. The next obvious question is then, “so what do we do about it and when?” Do the same exercise, have them prioritize the top 2 or 3 imperatives they would take and then look at your current plans and see if you address them with urgency. (If you are not already a member of the AACC site, you will need to register for this free access, or email Matt Modleski for the information.)
Read the Article: American Association for Clinical Chemistry
CMS Unveils 4 Bundled Payment Models
"...those networks who figure out how to improve care and be more efficient, "who know how to manage populations and improve quality will deliver a value proposition, and they will be successful, and will be where the business is going. The future is not that far ahead. We think that by 2017, the whole system will be largely reformed."
Read the Article: HealthLeaders
Friday, February 1, 2013
7 Trends in Hospital-Employed Physician Compensation
SGM Comment: If you understand the trends in the way your customers get paid, it's not a bad way to look for areas of strategic advantage in your solutions.
"As more physicians become hospital and health system employees, it has become paramount to tackle the sometimes difficult process of benchmarking physician pay. In 2010, the MGMA-ACMPE reported the 25 highest-paid specialties among hospital-employed physicians included orthopedic surgeons, spine surgeons, neurosurgeons, cardiovascular surgeons and specialty pediatric surgeons, among others. The salaries of those 25 high-paid specialties ranged from a low of $465,543 for dermatologists to a high of $714,088 for orthopedic spine surgeons."
Read the Article: Physician Compensation Trends
CMS Launches Bundled Payment Program
"CMS hopes the bundled payments will encourage hospitals, physicians, post-acute facilities and other providers to work together across settings and specialties to improve outcomes, such as reducing readmissions and duplicative care, while lowering costs."
Read the Article: CMS Bundled Payments
Cost of Medication Non-Adherence in US Healthcare
Since the days of Hippocrates, medication non-adherence has been a significant healthcare problem. Recent research suggests that the total economic cost of non-adherence is $290 billion per year in the United States, rivaling the burden of cardiovascular disease. New quality measures have been established and implemented by CMS offering health plans unprecedented financial bonuses (through the ACO models) from improving medication adherence at a population level. Moreover, the cost effectiveness of efforts to improve adherence have never been greater given recent reductions in the average cost of many common chronic disease drug therapies due to the expiration of patent protection for many blockbuster drugs.
From another perspective, preventable hospital readmissions are a threat to patient safety, a burden to numerous stakeholders, occur far too often, and contribute to rising health care costs. Nationally, preventable readmissions cost an estimated $25 billion per year. Hospitals, attending physicians and other providers have been focusing on reducing preventable readmissions, as they seek to improve quality and improve outcomes, and due to Medicare policy and payment changes in this regard. Health plans, employers, care management organizations and other stakeholders also have a significant vested interest in managing readmissions for all applicable patient populations.
Despite recent momentum addressing medication adherence, major progress on improving adherence nationally is lacking because of the difficulty of identifying the specific patients who could most benefit from care management support to address common causes of non-adherence. Readmissions management also is challenged by the ability to predict those most as risk for readmission.
What do your products/services/solutions provide that might have an impact on adherence?
Read the Article: Medication Adherence
Tuesday, January 29, 2013
Sun Tzu, Clayton Christensen, W. Chan Kim, Renee Mauborgne, Michael Porter...What might they tell Apple?
SGM Commentary: In most of our workshops, it is hard to get through a day without referring to "disruptive technology," "Blue Ocean Strategy," "Deciding what not to do," "Switching Costs." We have also referred to Apple as an organization that has made it through, though sometimes not without many stumbles, several strategic inflection points. And when Steve Jobs' health started to deteriorate, we also mentioned that the thing that had us concerned (as Strategists) was whether or not Steven Jobs himself might be the strategy that Apple owned. This article picks up on the question regarding Apple's ability to make it through what might be its most difficult infection point yet.
Read the Article: Apple Versus the Strategy Professors
Monday, January 28, 2013
Who Causes Half of Healthcare Costs?
"Since I’ve written about quality of life vs. quality of death before, let’s focus on what conditions are driving the costs so high and what, if anything, can be done about it."
Read the Article: Forbes
1 in 5 Hospitals to Realign Over Next Decade
SGM Commentary: Much is in the news these days regarding mergers, acquisitions, affiliations, purchasing of physician practices, Bundling, formation of ACOs and PCMHs. The reality is that there is no proven approach to making these adjustments, and this is especially true when healthcare is in the midst of a Strategic Inflection Point. However, we do know that something must be changed since the path we've taken in US healthcare thus far is unsustainable financially. Be prepared and have strategic business discussions with your key customers so that you can be proactive as the model for the future of healthcare builds.
According to the article linked below: "The bottom line is that hospitals... standing alone... can't deliver quality of care that is appropriate and sufficient."
This article speaks about the Hospital Realignment we can expect over the next decade. Consider how all of this might impact your strategies.
Read the Article: HealthLeaders
Friday, January 25, 2013
The Hybrid Concierge Medical Practice Model
"...Graf opted for the middle ground. He is among a growing number of physicians who are dipping into concierge while maintaining a full-time practice, in a scenario that is aptly named "hybrid concierge." A hybrid model allows doctors to merge traditional and concierge programs. This gives them the option to care for patients who rely on Medicare or other government or private insurance programs."
Read the Article: HealthLeaders
Wednesday, January 23, 2013
11 Most Pressing Issues for Hospital CEOs
"The American College of Healthcare Executives asked CEOs to rank the following issues that confronted their organizations in 2012 in order of concern, with the lowest numbers reflecting the highest concerns. Rankings are based on responses from 472 CEOs from community hospitals, i.e. non-federal, non-specialty and short-term facilities."
Read the Article: Becker's Hospital Review
Tuesday, January 22, 2013
Four Healthcare Businesses That Will Benefit from Obama's 2nd Term
"Here are four key segments of the health care industry poised to take advantage of new benefits under the Affordable Care Act as well as rules and regulations that will bundle payments to medical care providers, rewarding those who provide higher quality medical treatment and lower costs health services."
Read the Article: Forbes
Monday, January 21, 2013
Is It Strategy or Execution? You Mean We Have a Choice? No, not really...
"...But any seasoned strategist knows that strategy is not just sloganeering. It is the series of choices you make on where to play and how to win to maximize long-term value. Execution is producing results in the context of those choices. Therefore, you cannot have good execution without having good strategy."
Read the Article: Strategy and Business
Physician goups, Michigan System Form ACO
"Eight Michigan physician groups have partnered with the University of Michigan Health System to form an accountable care organization. The ACO, known as Physician Organization of Michigan ACO, or POM ACO, was one of 106 new ACO contracts announced by the CMS on Jan. 10, as part of the agency's Medicare Shared Savings Program."
Read the Article: Modern Physician
Thursday, January 17, 2013
Power of Pharmacists In Reducing Readmissions
"Many institutions are trying their best to come up with methods to meet the requirements, and pharmacists are an integral part of the solution," Robert Lee Page II, a physical medicine clinical specialist in the Division of Cardiology at the University of Colorado School of Pharmacy and Medicine."
Read the Article: St. Louis Business Journal
United Healthcare and Mayo Combine Researching Medical Treatments
"UnitedHealth and Mayo Clinic have agreed under a new partnership to combine their data for more than 110 million patients to help research methods to improve healthcare while lowering costs.
Read the Article: FierceHealth Payer
Friday, January 11, 2013
Staying on Top: Business Strategy
"Many are brought down by making a strategic error, of which there are six common varieties. There is the Do-It-All strategy, shorthand for failing to make real choices about priorities. The Don Quixote strategy unwisely attacks the company’s strongest competitor first. The Waterloo strategy pursues war on too many fronts at once. The Something-For-Everyone tries to capture every sort of customer at once, rather than prioritising. The Programme-Of-The-Month eschews distinctiveness for whatever strategy is currently fashionable in an industry. The Dreams-That-Never-Come-True strategy never translates ambitious mission statements into clear choices about which markets to compete in and how to win in them."
Read the Article: The Economist
Thursday, January 10, 2013
HHS Unveils 106 New ACOs
"If the ACOs meet the 33 quality measures of care coordination, patient safety and preventative health, they could realize savings of up to $940 million over four years, HHS said."
Read the Article: 106 New ACOs
Wednesday, January 9, 2013
No Time for Strategy?
"Without making an effort to 'do strategy,' though, a company runs the risk of its numerous daily choices having no coherence to them, of being contradictory across divisions and levels, and of amounting to very little of meaning. It doesn't have to be so. But it continues to be so because these leaders don't believe there is a better way."
Read the Article: HBR Blog
Tuesday, January 8, 2012
Can a Sub Specialty Physician be part of more than one ACO?
Patient assignment and physician exclusivity to an ACO are based on “primary care services” provided to a Medicare beneficiary under a Medicare billing number linked to the federal taxpayer identification number, or TIN, of an ACO participant.
Read the Article: American Medical News
Monday, January 7, 2013
Top 10 Quality Issues for 2013
"Section 2008 of the Patient Protection and Affordable Care Act says that payments for the care of Medicare patients discharged as of Oct. 1, 2014, will be reduced based on each hospital's track record of causing or failing to prevent hospital-acquired conditions (HACs) to their patients."
Read the Article: HealthLeaders
Piecework: Medicine's Money Problem
"Doctors have been paid on a piecework basis since at least the Code of Hammurabi; in Babylon during the eighteenth century B.C., a surgeon got ten shekels for any lifesaving operation he performed (only two shekels if the patient was a slave)."
Read the Article: The New Yorker Magazine
Is Fee for Service Heatlhcare Dead?
Health care policy experts on both the left and the right agree that ending the fee-for-service payment system will be necessary to control health care costs. The New England Journal of Medicine recently published back-to-back articles with how the two approaches would bend the health care cost curve.
Read the Article: What is the ideal payment system for healthcare delivery
Friday, January 4, 2013
Costly Care for Diabetes
"Fiona Clement, PhD, of the University of Calgary in Canada, and colleagues wanted to see if blood sugar control and kidney problems could affect the costs of caring for people with diabetes."
Read the Article: Daily Rx
Tuesday, January 1, 2013
Want to be a Warrior-Diplomat?: "Dining Like a Diplomat" and "Introduction to Sun Tzu" are the pre reqs
Team leaders with the Army's Green Berets and the Navy's SEALs do more than oversee action against enemies, and they must have the skills to know not only how to win on the battlefield but what fork to use for which course at a fancy dinner. Part of that training comes from courses based on competitive strategy, but also on how to manage yourself in a culture that may be very different from where you come. At SGM, we would call this a deep knowledge of the "Terrain."
Read the Article: Tampa Bay Online
Could Patient Error Reports Make Pathologist Responsible for Other Provider Mistakes?
"...what happens when a patient is misdiagnosed because a patient’s physician reads a medical laboratory test report incorrectly? Or what happens when clinicians at a hospital rely on point of care testing (POCT) but fail to confirm the POCT results against those from tests run in the hospital’s core clinical lab..."
Read the Article: Dark Daily
Friday, December 28, 2012
Primary Care doctors may no longer be needed
"As a primary care doctor, my days are busy. Seeing patient after patient, I try to provide the most patient-centric, evidence based care that I can. But if I read anything about healthcare reform, it will tell me that 80-85% of the patients I see can be seen by a nurse practitioner or a physician’s assistant."
Read the Article: Doug Olson, MD
13 Top Healthcare Buzzwords for 2013
"It's that time of year, again,when any self-respecting healthcare provider looks to bone up on the latest terms in the lexicon."
Read the Article: HealthLeaders
Wednesday, December 26, 2012
Building Clinical Integration, the New Wave?
Driving clinical integration, accountable care, and meeting the needs of the healthcare delivery system of today and tomorrow is part of what Scott & White's Physician lead delivery model is all about according to this article in HealthLeaders. What will be of importance to any of us who view ourselves as "Phase III" is how we will fit into the mix....
Read the Article: Building Clinical Integration
Friday, December 21, 2012
Medicare Discloses Hospitals' Bonuses, Penalties Based on Quality
"New York-Presbyterian in Manhattan and Massachusetts General Hospital in Boston, both dominant hospitals in their cities, will have their payments reduced. Other leading names in the hospital industry, including the Cleveland Clinic and Intermountain Medical Center in Utah, will receive bonuses, although not the largest in their regions."
Read the Article: Kaiser Health News
Wednesday, December 19, 2012
Health system streamlines diabetes care to reduce readmission rate
Pam Shannon, a nurse and vice president of population management at TriHealth, said that everyone was surprised at the analysis of the readmission rates of people living with diabetes. “With each condition — pneumonia, AMI, heart failure — people with diabetes were more likely to be readmitted to the hospital than people who don’t have it,” she said.
TriHealth’s chief medical officer gave Shannon a challenge: Reduce the percentage of readmit for those individuals with diabetes and the three targeted conditions.
Read the Article: MedCityNews
Thursday, December 13, 2012
Growing financial instability seen for not-for-profit hospitals
"Fitch believes that the next level of cost reduction within the industry will need to be realized from a change in the care delivery operating model through integrating clinical operations, implementing standardized protocols, coordinating care and managing population healthcare, which will be more difficult to accomplish," according to the report.
Read the Article: In Modern Healthcare Magazine
Monday, December 10, 2012
Don Berwick reflects on Healthcare Reform...
"DB: There was one case where a dentist was charging for root canals in little kids. Kids don't need root canals. He said he was doing a lot but he actually wasn't doing any. Well, when the fraud unit got to him, he started doing root canals on children."
Read the Article: HealthLeaders
Friday, December 7, 2012
Bundled Pricing in the Hospital
"Given looming deficits in Medicare and broad resistance to continuing private insurance premium increases, payors must find new payment models that lower utilization and improve costs. Bundled pricing represents a more market-based approach than accountable care organizations, and comes with less regulatory overhead. From that perspective, it's just a matter of time before payors demand bundled prices."
Read the Article: Hospital Review