Friday, August 24, 2012

Hospitals Name Their Least Favorite Insurers

Kaiser Health News recently reported the results of a survey in which ReviveHealth, a hospital public relations firm in Santa Barbara, Calif., asked hospitals to name the most problematic insurance companies.

The article can be found here, and the full report can be viewed here.

NAHAM News wonders what problems or differences, if any, among insurers  you see from a data capture and patient access perspective?

Some companies, such as Cigna, have praised the survey. Spokesman Joe Mondy told Kaiser Health News that they “view data from this and other ‘report cards’ (athenahealth, AMA) as very useful in identifying opportunities to improve and gaug[e] the impact of past improvement initiatives.”

Cigna was No. 1 in overall favorability while Aetna scored best in the dealing with hospitals category.

Other companies blasted the survey. Dr. Allan Korn of the Blue Cross and Blue Shield Association, whose plans ranked worst in hospital payment rates for the second year in a row, wanted to remind readers that “Revive is a PR firm that represents medical providers in payment negotiations with insurers and often creates a contentious public and media atmosphere around these talks…This survey is merely another tactic aimed [at] boosting payments for Revive’s clients without regard to the impact this has on millions of Americans who want and deserve affordable health care.”

Overall, the survey reported that WellPoint, a regional insurer, ranked last in overall favorability and in the “dealing with hospitals” category.

“We believe the Revive survey is inherently flawed and without merit,” said WellPoint spokeswoman Jill Becher. “We have a long history of working with providers to improve the accessibility, affordability and effectiveness of quality health care.”

Rising from the basement in previous surveys was United Healthcare, the country’s biggest private health insurer.  United scored sixth out of seven in the dealing with hospitals category, and fifth out of seven in overall favorability.

FDA Approves Vaccines for the 2012-2013 Flu Season

The FDA this week announced it approval of vaccines for the 2012-2013 influenza season.

This season’s vaccines are based on predictions by the FDA, the World Health Organization (WHO), and the Centers for Disease Control (CDC) for which strains of the flu virus are “likely to cause the most illness during the upcoming flu season.”

Even if the strains that affect our areas don’t match what is predicted, the FDA says that the vaccine still “may reduce the severity of the illness or may help prevent influenza-related complications.”

According to the CDC, between 5 percent and 20 percent of the U.S. population develops influenza each year. This leads to more than 200,000 hospitalizations from related complications. The CDC’s Advisory Committee on Immunization Practices recommends that everyone six months of age and older receive an annual influenza vaccine.

“The best way to prevent influenza is by getting vaccinated each year,” said Karen Midthun, M.D., director of the FDA’s Center for Biologics Evaluation and Research. “It is especially important to get vaccinated this year because two of the three virus strains used in this season’s influenza vaccines differ from the strains included in last year’s vaccines.”

The official press release from the FDA can be found here.

“Superbug” at NIH Serves as Precautionary Tale

In the wake of a “superbug” that hit the National Institute of Health’s (NIH) clinical center last year, NAHAM News is looking at what prevention measures can be learned and passed on to other healthcare facilities.

According to a story published by the New York Times, there are “some 99,000 U.S. deaths attributed to hospital-borne infections annually.” The number of those deaths attributed to antibiotic-resistant ‘superbugs’ has been increasing since the Centers for Disease Control (CDC) detected the bacteria in 2000. “Since then, we’ve seen it spread across the country,” said Alexander Kallen of the CDC, “to 41 states.”

Specifically, Kallen reported that nationwide, “about 6 percent of hospitals are battling outbreaks of the class of superbugs known as carbapenem-resistant bacteria, which includes Klebsiella.”

Here’s the skinny of these bugs - These bacteria usually live harmlessly in the intestinal tract and pose little or no threat to patients with healthy immune systems. But, as happened at NIH, in patients with compromised immune systems, the bacteria can turn dangerous, gaining an enzyme that defeats even the most powerful antibiotics.

Later this year, the CDC is launching a program in 10 cities to watch for hospital-borne outbreaks of super-bugs. CDC staff will review hospital records, Kallen said, and hospital labs will be asked to report any antibiotic-resistant bacteria to the CDC.

When the bug hit the NIH, they built a wall in the ICU and moved the infected patients into a new, six-bed unit. Blood pressure cuffs and other reusable gear were tossed after one use. The hospital hired monitors to ensure doctors and nurses were donning gowns, gloves and masks and scrubbing their hands. Staff members took throat and rectal swabs from every patient in the hospital, tested equipment and plumbing, and even went so far as to rip out plumbing when the bug was found in the sink drain of a patient’s room.

The resources and funding to take these extreme precautions are typically not available, but the CDC still says that hospitals and long term care facilities such as nursing homes must be ever vigilant to slow the spread of these superbugs. Some basic methods of prevention are still effective, including constant hand-scrubbing and isolation of infected patients. Surveillance is also key to identifying effected patients.

Read the full New York Times story here.

Friday, August 17, 2012

States Deal with Medicaid Challenges with Cuts and New Payment Methods

As NAHAM News has reported before, many States are facing Medicaid budget cuts and shortfalls as costs increase. This has spurred different reactions across the nation, as some states look to privatize programs, others have switched their payment methods away from a ‘fee-for-service’ model, and yet others continue to audit existing programs to try to eliminate unnecessary waste.

Kaiser Health News recently summarized how a number of states are handling the issue.

“Facing budget pressures, state officials in Georgia, Minnesota, Kansas and West Virginia are among those making cuts and switching to new payment methods as well as to managed care to cut the cost of the state-federal health care program for the poor and disabled.” The approaches these states are taking mirror much of the debate we can anticipate in the coming months running up to the election. More on this later…

Find the summary (State Officials Seek Medicaid Savings In Cuts, Payment Methods, Managed Care) here:

In Georgia, Georgia Health News reports that state officials say proposed budget cuts to Georgia Medicaid and PeachCare would total $170 million in state funds through the next fiscal year. And with the matching federal funds generated by that state spending, the reductions would have a more than $500 million impact on the two health insurance programs.

In Minnesota, Minnesota Public Radio reports that the state is first in the nation to receive federal approval for a new way of paying for health care in its Medicaid program. Minnesota will pay some hospitals and clinics based on how well their patients do medically and their ability to cut costs. This challenges the current “fee-for-service” approach that some say does nothing to rein in costs.

In Kansas, Kansas Health Institute News reports that the Kansas Medicaid program is scheduled to convert to a privatized system called KanCare. In January, three for-profit, managed-care organizations will take over the federal/state program that pays for health care for low-income children, seniors and people with disabilities.

In West Virginia, the Associated Press has reported that the state is planning an audit of eight state health care agencies and Medicaid with the goal of improving programs with existing or fewer resources.

Readmission Rates Impact Medicare Reimbursements

Under the Affordable Care Act, hospitals with high readmission rates are beginning to see their Medicare reimbursements cut by up to 1%.

See “Denver Health: Low Readmission Rate Not Easy to Emulate,” by Eric Whitney, Colorado Public Radio (August 16, 2012). This story is part of a collaboration that includes Colorado Public Radio, NPR and Kaiser Health News.

Find the article here:

According to the article, Medicare now sets a standard of tracking readmissions within 30 days of discharge. Those with the worst rates can be fined up to 1% of reimbursements, and that rate will increase to 3 percent in 2014. And as Colorado Public Radio reports, Medicare says two out of three hospitals it evaluated failed to meet its new standards for preventing readmissions within 30 days of discharge.

This may be a particular problem with safety net hospitals – calling the penalties unfair, because the low-income patients they serve often lack access to follow-up care and medications after discharge. But Medicare has pointed to Denver Health, saying it should serve as a model for other safety net hospitals.

So take a look at Denver Health, who despite being a safety net hospital, has an enviable low readmission rate. As reported by Colorado Public Radio, Denver Health’s quality chief calls the new policy imprecise and perhaps unfair.

“The Affordable Care Act has put a ton of pressure on hospitals to focus on this, and my fear is that that is being done at the expense of other quality improvement and safety initiatives,” said Dr. Thomas MacKenzie of Denver Health. “It’s important that we have some incentive in place to try to reduce readmissions; I’m not sure that having a penalty for readmission rates is the way to go.”

But Dr. MacKenzie notes that there are a number of aspects at Denver Health that are hard to replicate everywhere.

Denver Health, Colorado’s biggest safety net system, includes a 477-bed hospital and eight community primary care clinics. About a third of its patients are uninsured, another third are on Medicaid. The integrated system and low reimbursement rates create both a financial incentive and an opportunity to provide as much care as possible in the lower cost outpatient settings.

The hospital is often at full capacity – creating an incentive to make sure patients aren’t readmitted unnecessarily.

Denver Health was also an early adopter of electronic medical records. Colorado Public Radio quotes Dr. MacKenzie: “easy sharing of patient information between the hospital and clinics effectively keeps admissions down. It also helps those recently discharged get priority in scheduling follow-up appointments, putting them at the head of what can be long wait lists at community clinics.”

So here’s the policy conundrum, according to someone on the ground: “It’s a bit of a leap to say that one hospital’s readmission rate being different from another reflects a difference in quality and care… Only a proportion of [readmissions] within 30-days are preventable. We think probably a quarter of them are preventable, at most.”

Dr. MacKenzie told Colorado Public Radio that hospitals should only be held responsible for readmissions within three days to a week of discharge. That’s because readmissions after that period could be either more the patient’s responsibility, or medically necessary for reasons beyond the hospital’s control.