News Roundup: May 13, 2013
How hospital CEOs see future: More home monitoring
Published by Sacramento Business Journal
May 9, 2013
Facing a shortage of doctors and other providers as millions more people gain health coverage next year under the Affordable Care Act, local hospital CEOs see promise in patients doing their own monitoring from home — and better use of mid-level providers to the full extent of their license.
Not all patients need to be seen by a doctor, and the health care system is going to have to be a lot more efficient than it is now if new folks with high expectations are going to get the care they need at a competitive cost, speakers said at a health care CEO roundtable Wednesday sponsored by Drexel University Sacramento.
“Some patients have immediate needs. Some need to be touched, but some just have questions that can be answered with secure messaging or a phone conversation with the doctor,” said Ed Glavis, Kaiser Permanente’s Roseville area manager. “A lot of things can be taken care that way.”
Expect more reliance on blood pressure, temperature and weight checks at home with relatively inexpensive devices that may or may not be covered by insurance — but will feed information to a computer that can identify factors that are out of normal range, said Anne Madden Rice, CEO of the UC Davis Medical Center.
“We’re waiting now for a doctor to read it,” she added, “but we could use technology in a way that makes sense.”
Another answer is using people to the full extent of their capabilities, said Janet Wagner, chief administrative officer at Sutter Davis Hospital. “But even with that, we can’t put enough physician assistants and nurse practitioners into circulation.”
Telemedicine's value proposition
Published by Healthcare Finance News
May 7, 2013
Ironically, Andrew Watson's first telemedicine procedure was with a rural patient who was a Mennonite. At first, the patient and physician looked at each other warily.
"He didn't have a TV," said Watson, a colorectal surgeon and vice president at Pittsburgh-based UPMC, with a wry laugh. "And I'd never done this."
But the procedure worked. And it was worth it. "He didn't drive," Watson said. "And I spared him an expensive trip to Pittsburgh."
But that's far from the only value derived from telemedicine. In a session Monday at the American Telemedicine Association's 18th Annual International Meeting & Trade Show titled "The Telemedicine Value Proposition: ROI & Sustainability," Watson laid out the numbers, so far, for UPMC's forays into virtual care since 2009.
He cautioned that his is not a "boil the ocean" tale – it's simply the perspective of a single surgeon at a single medical center based in a single area of the country. But UPMC's experience, he said, offered an example of "how one model can work for telemedicine."
UPMC Bedford Memorial is a 59-bed acute-care community hospital based in tiny Everett, Pa. (population: barely 2,000), about 115 miles from Pittsburgh. Travel time between Bedford and UPMC's main campus takes about two hours, and many patients aren't willing to make the trip.
It's not because they're lazy. There's a financial cost, too. Telemedicine has helped alleviated that burden.
Watson crunched the numbers and found that the past four years or so have seen a total patient benefit of some $25,000.
That's based on multiplying the total of 173 telemedicine encounters so far by a conservative back-of-the-envelope cost of $145 per four-hour round-trip (factoring in gas, tolls, meals and less tangible costs such as lost wages and child care).
"It's right for the patients," said Watson.
It's also proven worthwhile to rural hospitals. He calculated revenues accrued via telemedicine encounters since 2009 for Bedford to be about $32,000, thanks to ancillary services, procedures, admissions, etc.
Deduct the not-insignificant $25,000 capital expense of one Polycom Practitioner Cart, and the facility is left with a profit of some $7,000.
"It's small numbers," Watson admitted. But when one considers that typical critical access hospital margins might hover around 2.5 percent, "this adds up."
Home Care, Hospice Components Add Competitive Edge in ACO Bids
Published by Home Health Care News
May 6, 2013
Post-acute care providers with home care and hospice components will be head and shoulders above the competition among those looking to partner with hospitals as part of an Accountable Care Organization (ACO), said two healthcare lawyers.
“Going it alone will no longer be a viable long-term strategy,” said John Durso, JD, partner at law firm Ungaretti & Harris, at a Life Services Network session last Thursday. “If you’re not part of an ACO, your patient base is probably going to shrivel up, at least on the Medicare side.”
Right now is an ‘exciting’ time to be involved in post acute care organization as there’s increased focus on the relationships between hospitals and other organizations in the care continuum and the synergies that can be created, said Jonathan Brouks, an associate at Ungaretti & Harris’ Healthcare Group.
“Now, [the hospital industry] is starting to think more longitudinally, figuring out, ‘How can we continue to care for these patients after they leave our walls?’” Brouks said during the session.
Penalties for hospitals with 30-day readmissions above a certain threshold for heart attack, heart failure, and pneumonia patients will go up to 3% of total Medicare reimbursements by 2015 under the Affordable Care Act. For some acute care providers, that could translate to a “very large” amount, Durso says.
The push to partner with post-acute providers is becoming more urgent, and skilled nursing facilities are competing to be chosen for ACO participation. Senior care providers with home care service lines will boost their attractiveness to hospitals.
Providers want to be able to tell prospective partner hospitals that they’re able to manage an entire population, including home care, hospice, or care coordination, Durso says.
“If you think about it, where do residents want to stay? For many cases, the biggest competitor is the home,” he says. If a skilled nursing provider has its own home care service, “That’s most likely where [hospitals] are going to go,” he says. “That’s another reason why home care is really, really important.”