Bridging Business & Healthcare

OIG Recommends Monthly Screenings for Excluded Individuals

Martie Ross — Mon, 13 May 2013 15:45:32 -0500

The Office of Inspector General (“OIG”) has posted updated guidance regarding healthcare providers employing or contracting with individuals who have been excluded from participation in federal healthcare programs. The federal excluded individual rule prohibits a provider from submitting a claim to Medicare for any good or service furnished by or at the direction of such an individual.

A provider that violates the excluded individual rule must refund any payment received on such a claim. Also, the OIG may impose civil money penalties if the provider knew or should have known about the exclusion.

The excluded individual rule has been broadly interpreted to prohibit any direct or indirect involvement by an excluded individual in providing goods or services billed to Medicare. This includes physicians, administration, nursing staff, and support personnel. The rule extends to employees as well as suppliers and independent contractors.

OIG has long taken the position that Medicare providers should screen employees and contractors through federal exclusion databases. Although such screenings are not required by statute or regulation, OIG has made clear that failure to screen is a basis for imposition of civil money penalties.

Among other things, the OIG’s updated guidance addresses (1) how to screen; (2) who to screen; and (3) how often to screen.

(1) How to screen. The OIG directs providers to utilize the List of Excluded Individuals and Entities (“LEIE”). This on-line database, along with detailed instructions for its use, is available at http://exclusions.oig.hhs.gov/.

(2) Who to screen. TheOIG recommends a provider review each job category or contractual relationship to determine whether the item or service being provided is directly or indirectly, in whole or in part, payable by a federal healthcare program. If the answer is yes, the provider should screen all persons that perform under that contract or that are in that job category.

According to the OIG, a provider should determine whether or not to screen contractors, subcontractors, and the employees of contractors using the same analysis that it would for its own employees. For example, OIG recommends screening nurses provided by staffing agencies, physician groups that contract to provide emergency room coverage, and billing or coding contractors.

Alternatively, a provider could choose to rely on screening conducted by the contractor, but OIG recommends that the provider validate such screening. Regardless of whether and by whom screening is performed and the status of the person (e.g., employee, subcontractor, employee of contractor, or volunteer), the provider will be subject to overpayment liability and for any items or services furnished by any excluded person and may be subject to civil money penalties if the provider does not ensure that an appropriate exclusion screening was performed.

(3) When to screen. The OIG directs providers to check the LEIE prior to employing or contracting with persons and periodically check the LEIE to determine the exclusion status of current employees and contractors.

While noting it is up to a provider to decide how often screenings should be performed, the OIG notes that the LEIE is updated monthly, so screening employees and contractors each month best minimizes potential liability for overpayment and civil money penalties.

In support of its position, the OIG cites a January 2009 state Medicaid director letter issued by the Centers for Medicare & Medicaid Services (“CMS”) recommending that states require providers to screen all employees and contractors monthly. Also, in 2011, CMS issued final regulations mandating states to screen all enrolled providers monthly.

The OIG’s new guidance is an important reminder of the emphasis the agency places on providers maintaining effective compliance programs that prevent, detect, and correct compliance problems. PYA can assist you in evaluating and improving the effectiveness of your compliance program, (800) 270-9629.

Martie Ross is a Consulting Principal with PYA.

Have PowerPoint, Will Travel

Martie Ross — Fri, 10 May 2013 15:04:09 -0500

If my calendar is any indication, people are hungry for information about health care reform. Last Wednesday, I participated in the annual meeting of the Kansas County Commission Association, with a one-hour “everything you wanted to know about the Affordable Care Act but were afraid to ask” presentation. You can find the powerpoint I used here.

Later the same day, I was a featured guest during a 30-minute live broadcast of “This Week in Accountable Care” on BlogTalkRadio. During the interactive discussion, we explored the world of accountable care organizations, the Medicare Shared Savings Program, and PYA’s whitepaper “Medicare ACO Roadmap,” a to-the-point resource for ACO formation and navigation. The broadcast may be found on BlogTalkRadio’s sister blog “ACOwatch.”

To round out the week, I presented at the National Rural Health Association’s Annual Meeting in Louisville, Kentucky, on accountable care organizations involving rural providers. You can find the powerpoint for that presentation here. We had a great discussion regarding rural clinically integrated networks, or RCINs, as an alternative to the MSSP ACO.

Martie Ross is a Consulting Principal with PYA.

"This time feels different."

Burl Stamp — Wed, 08 May 2013 09:11:58 -0500

This quote, which is attributable to a health system strategy executive attending last fall’s Executive Dialogue sponsored by the Society for Healthcare Strategy & Market Development (SHSMD), sums up the sentiments of the participants in the unique round-table discussion of major challenges and issues facing our industry. I had the privilege of facilitating the lively dialogue among the strategic planning, marketing/business development, and communication executives attending the event, which included presentations from industry leaders representing the Jefferson School of Population Health, Catholic Health Initiatives, Wells Fargo Bank, and Geisinger Health System. (An Executive Briefing summarizing the major ideas and insights from the Executive Dialogue, which was authored by my PYA colleague Chris Wilson and me, is available from SHSMD.)

Even though debate continues on whether the Affordable Care Act offers the best solutions for reforming our healthcare system, most agree that change must occur. Perhaps more than any specific legislation or mandate coming from Washington, D.C. or a state legislature, it is a new sense of innovation from healthcare providers, payers, technology firms, and major employers that will provide the best solutions for improving outcomes and reducing cost.

So why does “this time feel so different?” This time, it is the market that is demanding higher value in healthcare services, and the organizations that lead with the most promising innovations in cost and quality will be the major winners.

Burl Stamp is a Consulting Principal with PYA

CMS Announces July 31 Deadline for Medicare Shared Savings Program Applications

Martie Ross — Thu, 04 Apr 2013 10:20:29 -0500

On April 2, 2013, the Centers for Medicare and Medicaid Services (“CMS”) released key dates for the 2014 Medicare Shared Savings Program application cycle. Many were expecting the 2014 application deadline to be the same as 2013: the first week in September.

However, CMS has announced a July 31 deadline. An accountable care organization intending to submit an application must file a Notice of Intent by May 31 and obtain a CMS User ID by June 10. Failure to meet these deadlines will disqualify an organization from MSSP participation in 2014. CMS has not yet published the Notice of Intent form or the application packet.
CMS will be hosting a national provider call regarding the 2014 MSSP application process on April 9. A second call is scheduled for April 23.

We know from experience that compiling the information needed to complete the MSSP application is no small feat. Providers interested in participation now need to accelerate their planning efforts. To help organize your efforts, please refer to our MSSP ACO Development Task List.

To discuss how PYA can support your organization in completing these tasks and submitting your MSSP application, please contact David McMillan or Martie Ross.

Martie Ross is a Consulting Principal with PYA.

No man is an island ... and healthcare organizations shouldn't be either

Burl Stamp — Mon, 25 Mar 2013 14:41:53 -0500

“Is going it alone still an option for your hospital?” was the interesting question posed on the cover of Hospitals and Health Networks magazine in the current March issue. Arguably, what was even more interesting was the emphatic answer: “Yes!”

But looking beyond the provocative headline, the second paragraph of the story actually refutes the categorical answer on the cover:

“… as an independent hospital, keeping up with the current pace of change is a demanding, never-ending task. Increasingly, (CEO Rachel) Gonzales is looking beyond the four walls of the institution and closely collaborating with other regional providers, from a nearby critical access hospital to two larger tertiary centers.”

Today, savvy organizations that understand the limitations of capital, operational expertise and clinical capabilities are looking in unexpected places to enhance market position and competitive advantage. A prime example is the announcement this month of the new strategic alliance between Community Health Systems, the nation’s second-largest for-profit provider system, and the venerable Cleveland Clinic, whose heart program was ranked as the best in the nation for the 18th straight year in the U.S. News and World Report annual survey of top hospitals.

Obviously, the right question to be asking is whether an individual hospital organization should remain independent from the standpoint of governance. The right answer to that question is dependent on many factors, including market position, financial strength, capital needs, and community support. In today’s environment, those hospitals that pursue a strategy of truly going it alone without collaborative relationships with physicians and other providers are increasingly at risk of being outmaneuvered by those who recognize the power of strategic partnerships.

Burl Stamp is a Consulting Principal with PYA

Rethinking Readmissions

Burl Stamp — Wed, 20 Feb 2013 14:25:12 -0500

Despite our industry’s focus on the need to better coordinate care and reduce costs, only slight progress was made in reducing 30-day readmissions between 2008 and 2010 according to a new report from the Robert Wood Johnson Foundation and the Dartmouth Atlas of Health Care. In “The Revolving Door: A Report on U.S. Hospital Readmissions”, researchers also document significant variability from market-to-market in readmission patterns, which cannot be explained by differences in underlying patient population characteristics.

The fact that there are significant discrepancies in practice patterns, utilization, and resultant cost of providing care in markets across the country is not new news. John E. Wennberg, M.D., M.P.H., the founder of the Dartmouth Atlas, pioneered the methodology of determining population-based rates of healthcare utilization. Dr. Wennberg’s small-area analysis methodology was first published in 1973, and it uncovered significant variations in health care usage among different areas and that the higher spending was not correlated with improved outcomes as measured by mortality rates. Over the years, the Dartmouth Atlas’ research has consistently corroborated these findings, and the project continues to release reports detailing the variations in care for Medicare patients.

While the quantitative findings of this study are interesting, in many ways it is the back half of the report that is most enlightening. “Hospital Readmissions from the Inside Out: Stories from Healthcare Patients and Providers” helps to uncover the why behind the disappointing results in readmissions trends nationwide. Conducted by PerryUndem Research & Communication, the patient and provider in-depth interviews studies in this report revealed a number of the root causes of unnecessary readmissions trace to what happens – or doesn’t happen – before patients are discharged from the hospital. Quoting from report, the major reasons patients cited for readmission were:

Patients did not necessarily see readmission as a problem
Many patients felt they were discharged too soon
Many patients did not understand their discharge instructions
Care instructions were too general
Patients and caregivers both wished they had been more assertive (in other words, they wished they had asked more questions)
New diagnoses posed special challenges
Primary care physicians were missing from the picture
Some patients had only limited or no support at home
Some patients were not ready to change behaviors
A few patients had chronic health conditions for years but were not educated about their illnesses
If their doctor was affiliated with the hospital, their outcomes were better

Note that over one-half of the reasons (italicized above) cited by patients relate to ineffective, insufficient communication with patients and their families before they leave the hospital. Despite this finding, there is a tendency to immediately jump to solutions that rely primarily or exclusively on post-discharge intervention.

The temptation to jump to addressing downstream symptoms instead of the root cause of problems reminds me of the great story about the deteriorating granite on the Jefferson Memorial that has been told countless times at healthcare quality improvement seminars over the past couple of decades. The story appears in the Juran Institute’s Quality Minutes Video Collection. In case you haven’t heard the story, following is a brief recap.

The National Parks Service was having difficulty figuring out why the granite on the Jefferson Memorial was crumbling faster than at the other monuments in Washington, D.C. At first glance, the solution to the problem seemed to be removal of the birds that were leaving droppings on the memorial – a process that would be expensive and likely inhumane. But digging deeper into the root cause revealed a simple, economical solution. Here is an abbreviated version of the root cause process that revealed the most effective solution:

Problem: The granite of the Jefferson Memorial is crumbling at an increased rate

Why? Because it is hosed off with corrosive detergent more frequently than other monuments

Why? Because it needs to be cleaned more often

Why? Because it attracts a larger bird population

Why? Because there are large numbers of spiders for the birds to eat

Why? Because there are large numbers of gnats for the spiders to eat

Why? Because gnats are most active at dusk and are attracted to the lights of the Jefferson Memorial

Solution: Turn on the lights after dusk and the number of gnats will decrease … leading to fewer spiders … then fewer birds, and ultimately decreasing the need for frequent washings

Are healthcare provider organizations missing one of the most important, straightforward solutions to reducing readmissions when they short-change efforts to improve patient/family communication? Using Juran’s root cause philosophy of asking, “Why? Why? Why?”, perhaps one of the primary solutions to the complex problem of excessive readmissions is more obvious than we think.

Step-By-Step Recipe for Transitional Care Management

Martie Ross — Thu, 24 Jan 2013 13:41:23 -0500

One of the greatest opportunities for increasing savings and efficiency – and for improving outcomes - is providing appropriate follow-up care for patients discharged from institutional settings. Study after study demonstrates that health systems that have implemented even the most rudimentary transitional care management programs realize impressive results.

For the first time, the 2013 Medicare Physician Fee Schedule includes reimbursement for post-discharge transitional care management services. Specifically, Medicare now pays physicians and other qualified non-physician professionals for post-discharge transitional care management services (TCM services) under two new CPT codes, 99495 and 99496. Based on the 2013 conversion factor, the national payment rates for TCM are $163.99 (for 99495) and $231.36 (for 99496).

The Centers for Medicare & Medicaid Services (“CMS”) anticipate two-thirds of all discharges will be eligible for TCM. Based on these estimates, CMS expects to spend well over $1 billion on TCM services in 2013.

A well-designed and well-run TCM program – one that identifies and enrolls eligible patients and provides the required post-discharge services in an efficient manner- can generate significant revenue, especially if commercial payors follow CMS’ lead and pay for these services. Also, the savings from reduced readmission and other costs avoided are significant.

Our new white paper, Transitional Care Management Programs: The Time Is Now, provides a step-by-step explanation of the Medicare billing rules for TCM services. The paper also details how providers can organize TCM programs to take advantage of this new source of revenue.

A Trillion Here, a Trillion There: Now You're Talking Real Money

Martie Ross — Wed, 16 Jan 2013 15:58:10 -0500

We may have swerved to miss the fiscal cliff, but spending cuts will remain front and center for the next several months. A serious plan that purports to reduce entitlement spending without cutting essential services would be likely to garner significant attention, as it would hold the promise of satisfying both sides of the political debate.

In a new report released on January 10, the Commonwealth Fund details a ten-step program to slow national health expenditures by more than $2 trillion over the next decade, all while improving health outcomes.

The Commonwealth Fund worked with Actuarial Research Corporation (ARC) to estimate the ten-year cumulative financial impact of implementing a set of ten policies identified below beginning in 2014. As compared to current estimated growth in health care spending over the next decade, ARC determined these policies could generate significant savings for the federal government ($1.036 trillion), state and local governments ($242 billion), private employers ($189 billion), and individual households ($537 billion).

The ten policies fall into three broad categories:

I. Payment reforms promoting value and accelerating delivery system innovation. ($442 billion in savings between 2013 and 2018; $891 billion between 2019 and 2023)

A. Keep Medicare physician payments at current levels, but adjust relative rates for services identified as overpriced; tie future increases to provider participation in population health management strategies; institute competitive bidding for drugs, equipment, and supplies.

B. Change payment for primary care to reward care management, coordination, and patient centered medical homes.

C. Bundle hospital payments.

D. Adopt payment reforms across markets by requiring private plans participating in health insurance exchanges to incorporate similar payment reforms.

II. Policies creating incentives for consumers to choose high-value care and high-performing care systems based on comparative information about quality and costs. ($41 billion in savings between 2013 and 2018; $148 billion between 2019 and 2023)

A. Offer a new "Medicare Essential" plan with value-based benefit design to encourage beneficiaries to seek care from high-performing care systems.

B. Provide positive incentives for Medicare and Medicaid beneficiaries to seek care from high-value providers.

C. Enhance information on clinical outcomes and patient experiences to inform treatment decisions and choices of providers and care systems.

III. System-wide actions to improve market functioning. ($203 billion in savings between 2013 and 2018; $279 billion between 2019 and 2023)

A. Simplify and unify administrative policies across public and private health plans.

B. Reform medical malpractice policies to provide fair compensation for injury while promoting patient safety and adoption of best practices.

C. Establish national and regional spending targets not to exceed economic growth per capita and adjust policies as appropriate based on progress in meeting targets.

Maybe not every policy championed in the Commonwealth Fund’s report will catch on like wild fire. However, by attaching real dollar amounts to specific policy options, the report makes a compelling case that payment and delivery system reform – rather than across-the-board payment and benefit cuts – is the best starting point for entitlement reform.

Provisions in the Affordable Care Act – everything from the Medicare Shared Savings program to value-based purchasing to bundled payment initiatives – push payment and delivery system reform, but mostly over a three- to five-year window. We anticipate those timelines may accelerate as private insurers, providers, and lawmakers better understand the potential economic impact of these reforms.

Providers will no doubt be carefully following the budget discussions in Washington. But providers should also anticipate and prepare for a more comprehensive move to value-based purchasing in federal health care programs than now on the books.

The Commonwealth Fund report’s estimated savings are based in part on private payers implementing reforms at the same pace as federal health care programs. While private payer initiatives are not likely to be as coordinated with government initiatives as the report recommends, it is reasonable to expect a similar acceleration in the pace of value-based purchasing tactics implemented among providers and private payers. The value-based purchasing “train” has left the station, so they say, and is accelerating down the tracks rapidly.

Avoiding Antitrust Problems In Initial Collaboration Discussions Among Competing Health Care Providers

Martie Ross — Wed, 02 Jan 2013 16:58:19 -0500

Hospitals and physicians keep hearing that new payment and delivery models demand collaboration among independent providers, but how can providers pursue possible opportunities given the restrictions imposed by antitrust laws? Given the harsh penalties for violating these federal and state laws, you may be reluctant to start or join discussions about alignment opportunities.

Providers interested in pursuing these conversations with competitors (i.e., anyone who is not part of the same organization that offers the same or similar goods or services) should follow a basic code of conduct in their preliminary discussions. Once they decide they are interested in exploring opportunities together, the providers should enter into a more formal confidentiality agreement to protect their individual interests as they work through the group process.

The following are six simple principles to include in a "code of conduct" for communicating with competitors about opportunities for collaboration and alignment:

First and foremost, keep in mind that e-mails and electronic files are permanent records. Once you create, send, and/or store an e-mail or electronic document, you are answerable for its content. Assume that any attempt to recall, hide, revise, or delete any electronic record will fail, and such actions could be construed as an attempt to conceal inappropriate behavior. Always think twice before hitting the send or save key.

Second, until the parties enter into a formal confidentiality agreement, do not assume any of your communications are confidential. Instead, assume anything you say or write to one of your competitors can be printed on the front page of the local newspaper or posted on-line.

Third, in dealing with competitors, there are five subjects that should be off limits, regardless of the way in which the parties communicate:

(1) Price fixing: any form of agreement (written, verbal, or inferred from conduct) among competitors that raises, lowers, or stabilizes prices or competitive terms.

(2) Bid rigging: competitors agreeing in advance which person/entity will win a bid.

(3) Market division or customer allocation: an agreement among competitors to assign sales or service territories or customers.

(4) Group boycott/refusals to deal: an agreement among competitors not to do business with targeted individuals or businesses except on agreed-upon terms.

(5) Exclusive member benefits: an agreement among competitors to withhold the benefits of their business association from would-be members who offer a competitive alternative that consumers want. If the agreement is exclusive to members and it is difficult for non-members to compete without access to those benefits, the agreement is a barrier to competition.

Any communication which could be interpreted as an attempt to garner support for such an agreement or as evidence of such an agreement should be avoided. Review all written communications prior to distribution to ensure they cannot be construed as furthering an impermissible purpose.

Fourth, communications should focus on working together to achieve clinical integration, quality improvement, and efficiency. Do not discuss banding together to gain economic clout to negotiate with insurance companies, employers, health systems, or other third parties.

Fifth, do not discuss referrals as leverage to get another provider (physician, hospital, long-term care, etc.) to act in a particular manner.

Finally, as a practical matter, avoid side-bar conversations. At this stage in the process, the goal is to develop trust among the participants needed to engage in productive conversations and negotiations. As soon as someone gets wind of the fact that x and y have been talking (and presumably making decisions for the entire group), it will be difficult to win back that party's trust.

Of course, every situation is unique, and you may require experienced advisors to guide you through more treacherous waters. By agreeing to such a code of conduct, however, you can start your collaboration-focused conversations on the right foot, rather than stumbling out of the gate.

Good answer - but to the wrong question?

Burl Stamp — Tue, 18 Dec 2012 14:18:18 -0500

With the reality of value-based purchasing settling in, over the past several months I’ve had the same conversation with a number of healthcare executives related to H-CAHPS performance. In describing their efforts, they explain, “We’ve set specific goals; we’ve clearly identified standards on checklists for each H-CAHPS dimension; and we’re rounding with purpose more often to monitor compliance, but ….”

“But your scores aren’t changing?” I interrupt.

“Exactly. How did you know?”

Each healthcare organization’s journey to improve the patient experience and resultant H-CAHPS scores is unique, with many factors influencing performance. But a common problem I hear from many frustrated executives revolves around the mistaken hope that applying tried-and-true approaches that are designed to change discreet, tactical procedures – the kind that lend themselves to checklists – also will change aspects of the culture that support improved H-CAHPS results.

Exacerbating the problem is the natural response to disappointing performance when you use checklists. Assuming that better hardwiring and stricter compliance is the answer, managers pressure staff to adhere to the checklist, which usually heightens frustration and discouragement. The downward spiral of employee dissatisfaction makes progress on the patient experience measures in H-CAHPS nearly impossible.

The recent experience of one hospital provides of stark example of how an organization can perform exceptionally well on process measures but struggle mightily on improving the overall patient experience.

Data in the following two graphs is taken from “Why Not the Best?” (www.whynotthebest.org), the not-for-profit Commonwealth Fund’s healthcare improvement portal, which is arguably the most robust, user-friendly place on the web to access and understand CMS provider scores. Graph 1 trends the composite care process scores of “St. Elsewhere,” an anonymous but real hospital’s current results. The institution’s progress in improving care process compliance is remarkable, moving from below the 75th percentile just a couple of years ago to above the benchmark 95^th percentile in the most recent reporting period.

One might expect an institution’s ability to move performance this rapidly on care process measures would translate to superior performance across the board. But the second graph tells a different story. For the past several years, this hospital has struggled well below the threshold 50^th percentile rank on H-CAHPS scores. (Remember that institutions scoring below the median of all hospitals receive no points in value-based purchasing scoring methodology.)

While there are surely many factors contributing to this hospital’s results, the data do demonstrate that achieving success in process does not translate directly to success in patient experience as measured by H-CAHPS.

So what’s really at the heart of this dichotomy? To understand the problem with using a checklist mentality to improve patient experience scores, let’s look at a few of the specific questions from both the Care Process Measures and H-CAHPS sections from value-based purchasing.

For AMI patients, fibronolytic therapy received within 30 minutes of arrival? “Check.”
For pneumonia patients, blood cultures performed in the ED prior to initial antibiotic? “Check.”
For surgical patients, prophylactic antibiotic received within one hour of incision? “Check.”

Process measures are well defined and straightforward. But when you try to apply that same checklist methodology to H-CAHPS questions, compliance plays out in a very different way that doesn’t lend itself to a simple “check, complete, move-on” mentality.

Did we (specifically, nurses and doctors) always explain things in a way that patients could understand? “I gave them the required information. I think they understood.”
Did we always listen carefully to patients? “I tried to listen … most of the time … I think.”
Did we always do everything we could to help with pain? “I told her to push her call light when she needed more pain medication.”

These examples highlight three major differences between H-CAHPS and care process scores that organizations must understand and address to make real, sustainable progress in patient experience improvement.

How, not just what

While process improvement is about doing the right things, patient experience improvement is more about doing things right. How hospitals implement clinical staff hourly rounding programs, for example, provides a great case study. Staff can enter the patient’s room, assess the required four Ps (pain, position, “potty,” and possessions) on the checklist, and then document compliance. But if they haven’t communicated effectively and connected with the patient on a personal level, the positive impact of hourly rounding is questionable.

Every patient, every hour, every encounter

Remember that the performance standard for most H-CAHPS questions is expressed in how often the practice or behavior was experienced by patients, with “Always” being the top-box response that counts in value-based purchasing scoring. Checklists work for discrete, single-incident compliance; consistent behaviors like those measured in H-CAHPS demand changes in organizational culture and peer-to-peer accountability.

Talents, not just tactics

At the heart of a majority of H-CAHPS measures is effective interpersonal communication. Assuming that all staff naturally possess the skills to communicate effectively is naïve, especially when we know that many communication encounters with patients and their families are under stressful, difficult circumstances. Just as we educate staff to ensure clinical competence, investing in staff development to build superior communication competencies supports higher performance in patient experience, patient safety and employee engagement.

Checklists are effective in standardizing performance and ensuring compliance in many care processes. But expecting them to change organizational culture and the overall patient experience is akin to prescribing a great medication when what the patient really needs is surgery.

Smart leadership teams understand the need to build a robust toolbox of diverse approaches to improve all aspects of organizational performance. Equipping staff with both the tactics and the competencies to achieve success is essential in healthcare’s move from volume to value.

Learning - and unlearning - skills essential for success in healthcare's brave new world

Burl Stamp — Wed, 12 Dec 2012 16:16:41 -0500

At an industry or even organizational level, it is easy to conceptually talk about the monumental changes that must occur to be successful in the emerging healthcare world of tomorrow. Concepts of population health, volume-to-value and outcomes management continue to be actively dissected, debated and developed by most healthcare provider organizations.

But from a tactical perspective, all of these new philosophies and approaches are going to require changes well below the organizational level. Ultimately, what individual healthcare professionals know and how they do their work will determine whether or not we collectively achieve aggressive goals in cost reduction and quality improvement.

In an important recent report, the Physician Leadership Forum of the American Hospital Association (AHA) examines the specific competencies that individual physicians must develop to make real progress in three major areas of focus:

Improving the experience of care
Improving the health of populations
Reducing the per capita costs of healthcare

This qualitative study asked leaders serving on AHA’s regional policy boards, governing councils and other committees to consider the six competencies identified by the American Council for Graduate Medical Education (ACGME) and the American Board of Medical Specialties (ABMS) for physicians completing residency training. To that list was added “use of informatics” to recognize the Institute of Medicine’s 2003 competency priorities. Eleven competencies are grouped in the following seven categories:

Medical knowledge
Patient care
Practice-based learning and improvement
Systems-based practice
Professionalism
Interpersonal and communication skills
Use of informatics

Some of the study’s results were not surprising. For instance, when asked about the overall importance of each competency, ratings for all factors were bunched at the top of the five-point scale, with the lowest rated competency – “investigate and evaluate patient care practices; appraise and assimilate scientific evidence” – rated at 4.68. Essentially, respondents agreed that all of these competencies are relevant and important for practicing physicians today.

But when respondents were asked to rate how often these skills were evident in practice, a different picture emerged: scores were lower overall and the range between the top and bottom factors was significantly wider. “Medical knowledge,” the traditional measure of a physician’s skill and reputation, was rated highest at 4.56, with “provide cost-conscious, effective medical care” rated lowest at 3.35.

The study points out that the gap between the ratings of how important the competency will be in the future and how evident it is in practice today is highest in four important areas:

Provide cost-conscious, effective medical care
Demonstrate skills that result in effective information exchange
Coordinate care with other health care providers
Work effectively with the health care team

Given the nature of medical school training and the importance placed on independent critical thinking skills and decision-making, the fact that the most significant gaps exist in the areas of “systems-based practice” and “interpersonal and communication skills” is predictable. What will make significant change difficult is the fact that physicians must begin to think differently about how they practice – essentially “unlearning” many of the traditional practices and well-entrenched beliefs about the right way to manage care.

Let’s start with the concept of providing “cost-conscious, effective medical care.” For all intents and purposes, what a specific diagnostic test, pharmaceutical, or procedure costs has not factored into physicians’ decision-making regarding the appropriate course of care for an individual patient. In fact, many physicians would argue that considering how much different care options cost raises ethical issues. Further, regulations such as the civil monetary penalties (“CMP”) statute expressly prohibit hospitals from making payments to physicians that may induce them to reduce or limit services under Medicare.

Despite strong tradition and regulation, most forward-thinking healthcare provider organizations – and physicians – would agree that we will make the most progress in reducing per capita healthcare costs with doctors at the table. This assumes, of course, that physicians come to the table with the old idea that “cost shouldn’t matter” left at the door.

Second, effective interpersonal communication, strong teamwork and coordination of care across the team – and with the patient – have not been encouraged nor highly valued historically. But the importance of these skills and practices is reflected in more than just contemporary thinking on ways to best transform today’s healthcare system. In hospital patient experience studies by the country’s leading satisfaction research companies, “how well staff worked together as a team” is consistently one of the most highly correlated factors to patient/families’ overall satisfaction and willingness to recommend an institution to others. Simply, if physicians, nurses, and other care professionals communicate well with one another it significantly improves a patient’s experience and perception of quality.

The first important step in unlearning old ways is to recognize that there are better, more effective approaches to achieving improved results. This important study from the AHA’s Physician Leadership Forum quantifies that recognition among a group of healthcare leaders and hopefully provides further support for individual provider organizations to shed approaches that may have worked in the past but that will limit our ability to make the transformational changes necessary to sustainably reduce cost and improve quality.

CMS Places $1 Billion Bet On Transitional Care Management

Martie Ross — Tue, 27 Nov 2012 16:38:12 -0500

This is the second of our four-part series on the 2013 Medicare Physician Fee Schedule final rule.

For years, the Medicare Physician Fee Schedule final rule has represented the Center for Medicare and Medicaid Services’ (“CMS”) annual attempt to reign in fee-for-service reimbursement by imposing more restrictive billing rules. This year, however, CMS is taking a step in a different direction. Beginning on January 1, 2013, Medicare will pay for transitional care management, to the tune of more than $1 billion.

Last year, in the 2012 Medicare Physician Fee Schedule proposed rule, CMS “initiated a public discussion regarding payments for post-discharge care management services” seeking to improve “a beneficiary’s transition from the hospital to the community setting within the existing statutory structure for physician payment and quality reporting.”

In response, both the American Academy of Family Physicians and the American Medical Association (“AMA”) formed workgroups to consider new options. Both organizations recommended CMS create new codes and pay separately for post-discharge care transition and care coordination activities.

CMS has, for the most part, accepted the AMA’s specific recommendation to create two new transitional care management (“TCM”) codes, 99495 and 99496. Beginning January 1, 2013, CMS will pay physicians and other qualified non-physician professionals for the work needed to successfully transition a patient out of institutional care back into the community setting. The specific requirements for TCM billing are detailed in the chart below.

CMS is investing an astonishing amount of money on the promise of TCM generating upstream savings from a reduction in repeated and prolonged hospitalizations. Based on the 2012 conversion factor, the national average payment rates for TCM would be $142.96 (for 99495) and $231.11 (for 99496). (Absent Congressional action, the 2013 conversion factor will be 25.5% lower due to the sustainable growth rate adjustment)

For 2013, CMS estimates two-thirds of all discharges will be eligible for TCM, representing approximately 6,667,000 claims. Using CMS’ assumption that 75% of those claims will be submitted under 99495, the 2013 TCM price tag will be approximately $1.34 billion (again, based on the 2012 conversion factor). With beneficiaries responsible for the 20% co-payment, CMS expects to pay $1.1 billion for TCM.

CMS estimates TCM will generate a 4% increase in payments to family medicine physicians, 3% each for internal medicine and pediatrics, and 2% each for gerontologists, NPs, and PAs. By contrast, CMS estimates several specialists will see a 1% decline in payments due to increased TCM, including cardiologists, oncologists, OB/GYNs, and urologists.

The following summarizes the requirements for billing TCM services:

Who is eligible to receive TCM services?	Beneficiaries discharged from inpatient acute care hospitals (inpatient, observation, and outpatient partial hospitalization); skilled nursing facilities; and community mental health center partial hospitalization programs.
What is the time period for TCM services?	30-day period beginning on discharge date.
Who is eligible to bill for TCM services?	Physicians, physician assistants, nurse practitioners, clinical nurse specialists, and certified nurse midwives (referred to as “qualified professionals”). Rural health clinics and federally qualified health centers cannot bill for TCM.
Must the beneficiary be an established patient of the qualified professional ?	Previously established relationship is not required.
What are the required elements for TCM services?	(1) Communication with patient or caregiver within two business days of discharge (or two separate, unsuccessful attempts at communication). (2) Face-to-face visit within fourteen days (99495) or seven days (99496)(cannot be performed on day of discharge; not separately billable; may be performed at any appropriate location; elements of visit not specified). (3) Medication reconciliation and management performed no later than date of face-to-face visit. (4) Non-face-to-face care management services (see next section for further explanation). (5) Medical decision making of moderate complexity (99495) or high complexity (99496) (using E/M code definitions).
What non-face-to-face care management services are required?	The following services must be provided unless the qualified professional determines a particular service is not medically indicated or needed: Performed by a qualified professional: obtain and review discharge information; review need for, or follow-up on, pending diagnostic tests and treatments; interact with other providers involved in patient’s care; educate patient, family, guardian, and/or caregiver; arrange for needed community resources. Performed by clinical staff or case manager under direction of qualified professional: communicate with home health agencies and other community services utilized by patient; educate patient and/or family/caretaker regarding self-management, independent living, and activities of daily living; assess and support treatment regimen adherence and medication management; identify available community and health resources; facilitate access to necessary care and services.
When can claims for TCM services be submitted?	No sooner than 30 days following discharge.
Can multiple TCM claims be submitted for the same patient?	CMS will pay for only one TCM claim for the 30-day period following discharge. . The first claim to be filed will be paid. CMS will not pay a second TCM claim in connection with a discharge that occurs within 30 days of the original discharge (i.e., if the patient is readmitted and discharged within the 30-day period.
What are the limits on submitting claims for TCM services?	A qualified professional who reports a global procedure cannot bill for TCM services for the same time period. A qualified professional who bills for TCM services cannot bill for the following services during the 30-day period: Care plan oversight services (99339, 99340, 99374-99380 Prolonged services without direct patient contact (99358, 99359) Anticoagulant management (99363, 99364) Medical team conferences (99366-99368) Education and training (98960-98962, 99071, 99078) Telephone services (98966-98968, 99441-99443) End stage renal disease services (90951 – 90970) Online medical evaluation services (98969, 99444) Preparation of special reports (99080) Analysis of data (99090, 99091) Complex chronic care coordination services (99481X, 99483X) Medication therapy management services (99605-99607)

With CMS set to begin paying for TCM in just over five weeks, now is the time for hospitals and physician groups to develop strategies and processes for delivering these critical services. For example, developing an “extensivist” program to support TCM provides an excellent opportunity for collaboration between a hospital and its medical staff.

PYA professionals are prepared to assist you in moving forward with your TCM program. For more information, please contact Martie Ross, Denise Hall, or Rachel Harris.

No Time To Waste: The Election's Impact on Payment and Delivery System Reform

Martie Ross — Fri, 16 Nov 2012 10:48:09 -0500

The Affordable Care Act (“ACA”) may have become the law of the land on March 23, 2010, but it became the reality of the marketplace on November 6, 2012. Now, the health insurance reform package known as Obamacare will continue on course toward nearly full implementation in 2014.

We often refer to the “two halves” of the ACA. The front half represents government as regulator, imposing changes on the private health insurance market with the goal of making coverage more affordable, available, and adequate. By contrast, the back half represents government as market participant, looking to drive payment and delivery system reform in response to changes in how the Medicare and Medicaid program pays providers.

Today, our healthcare system is designed to maximize the delivery of healthcare services, as more services equal more payment. Tomorrow, providers will be rewarded for maintaining the health of a defined population. By changing the incentives, the government (and private payors, as well) expects providers to reinvent the system to improve efficiencies and the quality of care.

Providers, therefore, must pay careful attention to changes in the Medicare program as they are announced and identify and implement strategies in response to them. As methods of payment change, your methods of business must do the same. Otherwise, your financial future will be compromised.

Last week, the Centers for Medicare & Medicaid Services ("CMS") published its annual Medicare Physician Fee Schedule (“MPFS”) final rule. This 1,362-page regulation (along with its 10 appendices) includes a few elements that fundamentally shift CMS’ historic payment policy philosophy, the impact of which we will see for years to come.

Here are our “Top Ten” critical provisions of the 2013 MPFS, all of which require careful study and near-immediate response:

(1)    New payment for transitional care management
(2)    Calculation of physician value-based payment modifier
(3)    Development and distribution of Physician Feedback Reports
(4)    Changes to Physician Quality Reporting System and Physician Compare website
(5)    Reduced payments to specialists due to misvalued code adjustments
(6)    Expansion of multiple procedure payment reduction
(7)    Additional payment for telehealth services
(8)    Foundation for new payment system for therapies
(9)    New preventive services coverage
(10) Imposition of limits on coverage for durable medical equipment

Of course, the elephant in the room is the sustainable growth rate adjustment (“SGR”). Absent Congressional action by January 1, 2013, the MPFS conversion factor will be reduced by 26.5%. Some measure to forestall this one-quarter cut to Medicare rates likely will be part of whatever compromise is reached to avoid the looming “fiscal cliff” at the end of this year.

As Congressional leaders and the President begin negotiating how to avoid the fiscal cliff, including the so-called “grand bargain” of tax increases and spending cuts, healthcare reimbursement will once again be on the chopping block. Former Republican Senator Dr. Bill Frist recently commented, “I don't think hospitals understand how deep these cuts are going to be in the grand bargain.” He suggested the ultimate grand bargain solution would likely focus on a 2.5-to-1 ratio of spending cuts to tax increases. That sort of philosophy, in the shadow of the looming fiscal cliff, brings into focus the very real possibility of SGR “type” draconian cuts in Medicare reimbursement.

Over the next two weeks, PYA will circulate additional Alerts to provide analysis of the impact of key provisions of the 2013 MPFS, as well as any “SGR fix” that comes into focus. This information will also be available on PYA’s website. The election (and speculation over the future of healthcare reform) is over; now the real work begins. For more information, contact Butch Bullock, David McMillan or Martie Ross at (800) 270-9629.

National ACO Congress: The Impact of Accountable Care on Specialists

Martie Ross — Wed, 31 Oct 2012 12:01:28 -0500

Los Angeles hosted the Third National Accountable Care Organization Congress from October 30 to November 1. More than 1500 individuals participated in this leading forum on ACOs and related delivery system and payment reforms.

Along with Terry Spoleti, president of Glenridge Healthcare Solutions, I presented at the Congress during a session entitled How to Successfully Integrate Specialists into an Accountable Care Organization. A copy of our presentation materials is available here.

We began our presentation with a brief tutorial on accountable care economics, including the “rob Peter to pay Paul” reality, i.e., primary care physicians’ opportunity to enhance their compensation through shared savings programs by reducing costly inpatient admissions and specialists’ services. Next, we discussed how these economics are likely to impact specialists, as primary care providers become more selective in making referrals.

Terry, whose firm specializes in network development and data management for providers and payers, demonstrated how providers and consumers soon will have access to reports regarding specialists’ scores on quality and cost measures. In the very near future, these scorecards will have a significant impact on network and referral decisions, as well as specialists’ reimbursement rates.

Finally, we discussed specialists’ strategies for adapting to the new world of accountable care. Of course, all physicians need to be aware of, and focus on, improving their quality measure scores and their efficiency. For specialists who are currently part of an integrated delivery system, the focus should be on expanding the patient base served by the IDS, particularly by expanding services into new markets.

One such strategy is the development of a service line franchise. Often referred to as “outreach programs” in the past, the service line franchise enhances the relationship between providers and gives smaller communities the opportunity to participate in a continuum of care for a specific disease state or chronic condition. Local providers have access to, and training on, care protocols to manage patients closer to home, with strong referral relationships to a tertiary care provider for more specialized care.

For independent practitioners, we discussed the opportunity for “clouding,” i.e., clinically integrating with other specialists in the community (the “cloud”) while maintaining economic independence. Among other benefits, clouding provides an opportunity for branding, and identifying a specialist with a network of high-quality, cost-effective providers. When structured and executed appropriately with respect to state and federal regulatory issues, clouding also presents an opportunity for joint contract negotiations with payers.

All of the presenters at the ACO Congress offered keen insights into emerging models of care delivery. The level of energy among the attendees reinforces our belief that change is here, and now is the time for providers to make their own destiny.

And So It Begins...

Martie Ross — Thu, 18 Oct 2012 10:59:18 -0500

Happy New Year!

October 1 marked the beginning of the 2013 Federal Fiscal Year. As with each new federal fiscal year, the new Medicare hospital inpatient prospective payment system (IPPS) final rule took effect today. As with most years, payment rates to general acute care hospitals will increase, this year by 2.8 percent. The 2.8 percent is a net update after the typical market basket update, improvements in productivity, a statutory adjustment factor, and adjustments for hospital documentation and coding changes.

But there’s also something very new and different about the IPPS final rule this year. Starting this Monday, Medicarenow adjusts hospital payments based on how well the hospital has performed previously on a set of standard clinical quality measures and on surveys of patients’ experience. Hospitals that have done well receive higher Medicare payments, while poor performers have seen their payments cut. Also, Medicare now shaves up to one percent from payments to hospitals with high readmission rates.

These are two small steps forward on the long journey of payment and delivery system reform. A study published in Health Affairs last month estimates that Medicare payments to more than two-thirds of hospitals will be affected by just a fraction of one percent.

While they may have limited financial impact today, the new VBP payment adjustment and readmission penalty make it difficult to deny the fact change is coming. Over time, we can expect tried-and-true strategies to maximize fee-for-service reimbursement to begin unraveling, as they are inconsistent with the principles underlying value-based purchasing. Leaders face the challenge of living in two worlds: maintaining current fee-for-service reimbursement to build the foundation for quality and efficiency essential to new payment models.

October 1 also marked a major milestone for PYA, as the firm officially opened its new Kansas City office. Chris Wilson, Jonas Varnum and I are thrilled to join the most creative and innovative health care consulting firm in the country. And, we look forward to the addition of our colleague and good friend Jeff Ellis in January. ContinuingPYA’s reach into the Midwest, the KC office also adds a new public policy service line for the firm.

Drawing on decades of experience in healthcare transactional and regulatory work, we will help providers translate evolving public policy issues and challenges into informed strategic direction. We also will serve as a backbone organization for the facilitation of public policy initiatives for providers and public entities. Finally, our public policy service line will deliver practical and accessible education and analysis on the forces impacting healthcare for the public, employers, providers, governmental agencies, and others.

October 1 marks more than the beginning of a new federal fiscal year: it marks the beginning of the biggest change in health care since the introduction of DRG-based reimbursement. Payment and delivery system reform holds the promise of aligning providers, payers, and patients in a manner than improves overall population health while containing costs. Like the healthcare industry we serve, PYA consistently evolves and responds to the needs of providers and patients. The addition of our new Kansas City office, our new colleagues, and public policy service line are part of the next exciting chapter in our firm’s story. Now, more than ever, PYA is ready to support your strategic visioning for the future.

Nurses must play central role on the frontline of reform

Burl Stamp — Mon, 09 Jul 2012 10:15:57 -0500

In an introspective conversation last week, a close friend who is a hospital CEO shared a story that reflects the real struggles most healthcare leaders experience today as they balance the significant – and often competing – demands of reducing cost, increasing quality and improving patient experience. As he was leaving the hospital on a Sunday evening after several hours of catching up on paperwork and emails, he ran into a nurse walking out at the end of her 12-hour shift. “Hi, how are you?” he asked as they walked toward the employee parking lot.

She started to reply with the expected, “Just fine.” But instead she paused. Perhaps it was because it was the weekend or the fact that the CEO was wearing a polo shirt instead of his typical suit and tie. Whatever the reason, she felt safe opening up.

“You know, I’m tired,” she admitted in a frank but respectful way. “Working shifts with a six- or seven-patient assignment seems to be happening way too often. It’s just really hard to take care of the patients and families in the way I know they deserve to be cared for.”

He couldn’t disagree with her heartfelt concerns. Sincerely, he listened and reverently replied, “I understand.”

For healthcare organizations to stand any chance of truly transforming the way that care is managed,realizing aggressive goals for lower cost, increasing quality, and improving patient experiences, candid conversations like the one between this nurse and CEO must happen more often. In many ways, the quality of our engagement with frontline nurses and how we incorporate their critical input into the difficult work of redesigning care will determine how successful, and sustainable, our change efforts will be.

In countless ways, nurses indisputably have earned the right to play a leading role in care redesign efforts at all levels. While we are sometimes reluctant to admit it, the fact is that the lion’s share of the burden of many of the necessary – but difficult – changes we are making today fall squarely on the shoulders of frontline nurses. These include, but certainly are not limited to, reductions in labor costs that affect staffing ratios, the introduction of complex electronic medical records, and increasing requirements from regulatory agencies. In addition to these challenges, research confirms that interactions with bedside nurses are among the greatest influences on a patient’s positive perception of their overall experience during a hospital stay.

The good news? The ranks of nurses are filled with compassionate, talented, dedicated individuals who were called to the profession because of their deep commitment to caring for individuals at some of the most vulnerable times in their lives. Is it any surprise that in Gallup’s annual poll of the most trusted professions in the country nursing again came out on top? The profession has held that top spot for 12 out of the past 13 years, displaced only once in 2001 by firefighters in the wake of the 9-11 tragedy.

Our patients trust their nurses to provide exceptional care. Similarly, healthcare organizations that seek meaningful change in the value and quality of care must trust their wisdom, insights, and commitment to finding solutions that will best meet the needs of our institutions and the patients we serve.

Hope for the Future of Healthcare

Burl Stamp — Mon, 02 Jul 2012 09:24:39 -0500

I have profound hope in the future of the American healthcare system. And it has nothing to do with the Supreme Court’s decision that found most of the provisions of the Affordable Care Act constitutional.

Rather, I’ve seen the future of our troubled system through the wisdom, dedication and enthusiasm of Elisabeth Askin and Nathan Moore, two aspiring physicians at Washington University School of Medicine who have just completed an important new book that should be required reading for anyone who will depend on our healthcare system at some point in their lives. In other words, this is a book for everyone.

“The Health Care Handbook: A Clear and Concise Guide to the American Health Care System,” which is currently available as an ebook and will soon be in print, was inspired by Elisabeth and Nathan’s keen interest in learning more about the economic, organizational and societal challenges inherent in providing healthcare services to American citizens. Given medical school’s daunting, jam-packed clinical coursework and patient care rotations, these issues get scant attention in the traditional curriculum. So it took a handful of students with similar interests to launch a health economics and policy special interest group to provide a forum to explore important questions prompted largely by public debate around health reform.

As the group came together, they quickly discovered that contemporary, comprehensive information on exactly how our complicated healthcare system works – or sometimes doesn’t work – was tough to come by. Elisabeth and Nathan approached Dr. William Peck, the group’s adviser and the Director of the Center for Health Policy at Washington University, with the idea of writing a book to fill this void. As the past dean of the School of Medicine, Dr. Peck is intimately aware of the rigors facing medical school students. His initial reaction to the idea of writing a book while a medical school student was a respectful version of, “Are you serious!?”

Fortuitously, Elisabeth was approaching the summer following her first year, one of the few times that medical school students have several unscheduled weeks before they graduate. She applied for and received a small grant available to first-year students from the National Institutes of Health to help fund initial research and writing time for the book. With Nathan supporting the effort as primary researcher, Elisabeth completed the majority of the first draft during the ten-week break last summer.

The extraordinary commitment and discipline required to author a book – especially in the middle of medical school – must surely be inspired by more than simply a passing interest in health policy. When asked why they were so driven to complete this important project, Nathan and Elisabeth explained their desire to play a role in helping to improve healthcare in the future by advancing knowledge about how care in the U.S. is actually provided and paid for in today’s fragmented system. Their goal of producing a resource that both professional and lay audiences could read and understand has been achieved in “The Health Care Handbook.”

Further, Elisabeth and Nathan hope that this initial edition of the handbook will become an enduring legacy in the tradition of the “Washington Manual of Medical Therapeutics,” which was first published in 1942 and has become the best-selling medical textbook in the world. The manual remains current because it is updated every few years by residents in the School of Medicine, and Nathan and Elisabeth hope that future students with an interest in health policy and economics will similarly update the Handbook to provide current information on health system questions and issues.

Whether you believe that the Affordable Care Act will help make things better or create new problems, experts on all sides of the health reform debate have to admit that there are vast misconceptions and gaps in understanding about the true nature of the issues we face and how to solve them. If Nathan and Elisabeth’s new book plays even a small role in lessening this gap of understanding, they have made a significant contribution to addressing one of the greatest challenges facing our generation.

Stable performance? Then you're losing ground in Value-Based Purchasing

Burl Stamp — Fri, 22 Jun 2012 12:02:20 -0500

“Even if you’re on the right track, you’ll get run over if you just sit there.” – Will Rogers

Though the witty philosopher-of-the-people Will Rogers spoke these words decades ago, the advice could easily have been meant for healthcare providers today. By design, the Centers for Medicare & Medicaid Services will reward approximately half of the hospitals in the country with higher Medicare reimbursement under the Value-Based Purchasing (VBP) payment methodology, with the other half seeing DRG rates decline because of lower relative performance on care process measures and H-CAHPS.

While the calculation of a hospital’s VBP score is rather complicated, two straight-forward facts are easy to understand and important to heed. First, an institution’s absolute score is somewhat meaningless until it is compared to how other hospitals in the country performed. VBP reimbursement is based on the relative value a hospital delivers compared to other providers.

And second (tipping our hat, as it were, to Will Rogers), if recent trends hold, hospitals that maintain consistent performance will be “run over.” The overall trajectory in both care process and H-CAHPS scores is upward, leaving institutions that are not improving at an increasing disadvantage. This point was emphasized by Jan Gnida, the Director of CAHPS for Professional Research Consultants, at the group’s annual “Excellence in Healthcare” conference earlier this month. The slide below from Jan’s presentation makes this point graphically for several key H-CAHPS component measures.

Steadiness may be a laudable virtue in some aspects of life, but for success in Value-Based Purchasing, institutions must consistently improve performance just to stay even with the pack. Organizations that have developed a culture of continuous improvement will be best-positioned to effectively deal with VBP – and the other challenges that will likely confront healthcare providers over the next several years.

Making the grade under the spotlight of transparency

Burl Stamp — Tue, 12 Jun 2012 15:36:45 -0500

Although it might not make the popular “What’s trending now?” lists, healthcare followers on Twitter have seen a common theme emerge over the last several days. “Our hospital received an ‘A’ in patient safety” has been proclaimed by numerous institutions that performed well on The Leapfrog Group’s Hospital Safety Score website report card released last week. The news has gradually spread to other media outlets, including my local morning news program, which included among its opening stories, “Some St. Louis hospitals are safer than others ….”

While the “A” students happily bask in their public recognition, some “C” players are quick to point out that flaws persist in the data collection and research methodology. Even though most healthcare institutions might agree that the science of measuring patient safety is far from perfect, the reality is that structural flaws are generally applied consistently across providers. Cries from “C” players that “our hospital is different” are tougher to defend when you can find examples of “A” players among all types of institutions; from large, urban, academic medical centers to small, rural, community-based hospitals.

Hospitals, physicians and health systems that accept the reality that transparency is here to stay will be best positioned to effectively compete under increasing payer scrutiny and escalating consumerism. Building a culture focused on continuous improvement and delivering higher value is the only way individual providers will survive – and thrive – in the healthcare fishbowl of cost and quality scrutiny.

Strong leaders - and cultures - start with self-awareness

Burl Stamp — Thu, 24 May 2012 12:57:04 -0500

During a session on great leadership at the Becker’s Hospital Review Annual Meeting in Chicago last Friday, four prominent healthcare executives talked about the characteristics of contemporary leaders and how they contribute to a multidisciplinary, team-based culture that is essential for success.

Especially notable were insights from Pamela Stoyanoff, executive vice president and COO of Dallas-based Methodist Health System. When asked about her biggest mistakes as a healthcare leader, she humbly admitted that she found out from others that she interrupted them while talking, and her listening skills needed honing.

The powerful takeaway -- As healthcare leaders, all of us need to be as self-aware as Ms. Stoyanoff about the ways our interpersonal communication skills and practices affect the culture in our organizations.

Illuminating this important point, President Woodrow Wilson once said: “The ear of the leader must ring with the voices of the people.”