News

Happy 4th of July to all

Anne Zieger — Thu, 02 Jul 2009 13:21:32 -0400

Readers:

This is just a brief note to wish you a happy July 4th. We at Fierce will not be publishing tomorrow, July 3rd, but will resume publishing on July 6th. In the mean time, grill those dogs and burgers, get some sun and relax. We'll be there giving you the best of healthcare business news on Monday!

- Anne

SPOTLIGHT: Dem Senators prep reform plan with government-option

Anne Zieger — Thu, 02 Jul 2009 12:48:30 -0400

So, wherefore the public health plan option? Apparently, the Democrats on a pivotal Senate committee have a plan ready to roll that includes a government-run insurance option and a $750-per-worker annual fee on larger companies that don't offer coverage to employees. The Senators behind the plan are estimating its cost at $611.4 billion over 10 years. Article

White House reform director served on boards w/questionable behavior

Anne Zieger — Thu, 02 Jul 2009 12:44:19 -0400

White House health reform director Nancy-Ann DeParle is in a tight spot. A new investigative report has concluded that DeParle earned more than $6 million serving on the boards of major healthcare corporations, some of which have been accused of fraud, mismanagement and regulatory violations during her service there.

While there's no evidence she was aware of or involved in allegedly illegal activities, she served in three cases on board committees overseeing the companies' legal and regulatory compliance. That certainly doesn't look good, regardless of what actually happened, particularly given her rep as a progressive.

One example of the problem was her involvement as director and compliance committee member at DaVita Inc., which has been subject to investigations into its billing and drug-prescribing practices. She also served in a similar role at medical equipment supplier Guidant, whose execs apparently knew of cases in which its devices failed but never disclosed those failures.

To learn more about these issues:
- read this Kaiser Health News piece

Extending Medicare drug payments pays

Anne Zieger — Thu, 02 Jul 2009 12:35:39 -0400

Extending prescription coverage for Medicare enrollees sounds like an expensive boondoggle to some. However, a new study suggests that the extra cost of such coverage was substantially offset on lower spending for patients who didn't have prescription-drug access before.

These findings conclude that while monthly spending, including on both insurer costs and plan co-pays, rose $41 after uninsured participants joined Medicare Part D plans, spending on other forms of medical care by newly-covered folks fell by $33 a month. Authors also believe that increased use of meds improved control of chronic illnesses, a major policy and clinical goal for healthcare system players.

One cautionary note arose, however. The study, which was published in the New England Journal of Medicine and funded by NIH, concluded that the study group with the most generous drug coverage increased spending on both prescription drugs and other medical needs. The study's authors concluded that people with rich coverage might actually overuse drugs.

To learn more about the study:
- read this Kaiser Health News item

Trend: E-prescribing on the rise despite problems

Anne Zieger — Thu, 02 Jul 2009 12:28:33 -0400

In the past, prescribing electronically was confusing to many doctors. Today, however, e-prescribing sounds like a reasonable idea, and its benefits--largely improving prescription accuracy and safety--are well known to most. While the technology continues to be a bit clunky, its use is climbing rapidly. Today, more than 120,000 doctors are using e-prescribing, or more than 20 percent of all office-based prescribers, according to industry sources.

Several things are holding back further growth of this approach, however. First of all, doctors say that the hardware is tricky to use, and security features--such as automatic 30 minute logouts--can be frustrating. Patient prescription histories aren't always robust, either. Among the worst problems, meanwhile, is that federal law still prohibits doctors from prescribing controlled substances online. Sometimes, frustrated doctors stop using the systems they install.

Ultimately, for e-prescribing to become widely popular, it takes money. Fortunately for advocates, the stimulus package and other incentives should drive greater adoption of e-prescribing over the next several years. Also, the merger of two prescribing networks to form vendor Surescripts, which works with about three-quarters of U.S. retail pharmacies, should be helpful as well.

To learn more about this trend:
- read this Kaiser Health News article

Related Articles:
Study: Clinicians bypass most alerts from e-prescribing systems
Group says controlled-substance rules block e-prescribing
E-prescribing: What's holding it back?
MN lawmakers approve e-prescribing measure

Johns Hopkins facility settles false claims allegations

Anne Zieger — Thu, 02 Jul 2009 12:05:56 -0400

Johns Hopkins Bayview Medical Center of Baltimore has agreed to pay $2.75 million to settle false claims charges. The claims asserted that patients suffered from malnutrition and acute respiratory failure to get higher reimbursements for them.

The claims sprung from a complaint by two Bayview employees, who said the hospital told them to review charts and upcode conditions for severity of two secondary diagnoses for certain patients, even if the condition wasn't present or treated. These allegations cover a period between July 1, 2005 and Feb. 28, 2007. The two patients who made the allegations are getting 20 percent of the total settlement, or $550,000.

Maryland hospitals get their reimbursement allocated through the state's Health Services Cost Review Commission, which sets rates for all providers in the state. Maryland is the only state in the country that sets rates for hospitals in the same manner as utilities are regulated in other states.

To learn more about this settlement:
- read this Modern Healthcare article (reg. req.)

CMS increases hospital outpatient payments

Anne Zieger — Thu, 02 Jul 2009 11:59:15 -0400

Starting in 2010, hospital outpatient departments will see a 1.9 percent increase in their Medicare payments under a proposed CMS rule that will change payment structures. The new rule would allow hospitals, for the first time, to bill Medicare for pulmonary and intensive cardiac rehab in outpatient departments.

CMS would also pay rural hospitals for offering kidney disease education in their outpatient departments for Medicare beneficiaries who are in end-stage chronic kidney disease.

Meanwhile, the agency is seeking public comment on additional quality measures for future updates, and is phasing in a new validation requirement to make sure hospitals are accurately reporting measures for chart abstracts.

CMS will pay out a total of $31.5 billion more to more than 4,000 hospitals next year under the outpatient prospective payment system. That's up from an increase from projected payments of $28.7 billion in 2009. Total payments to ASCs are projected to be $3.4 billion in 2010.

To learn more about the update:
- read this Modern Healthcare piece (reg. req.)

SPOTLIGHT: Committee develops government-insurance plan draft

Anne Zieger — Wed, 01 Jul 2009 10:00:29 -0400

Though some healthcare industry players are quite unhappy about it, the "public option"--a government run health plan that would compete with commercial plans--is still in play on the Hill. This week, the Senate Health, Education, Labor and Pensions Committee has been circulating a draft for the plan, which would require an upfront loan from taxpayers, but pay for itself after a few months. Article

Doctors delaying discharge due to lack of home health support

Anne Zieger — Wed, 01 Jul 2009 09:56:51 -0400

A new survey concludes that a lack of home health services may be yet another bottleneck in the struggle to cut down on needless patient days in the hospital. The report notes that just over half of doctors responding to a Massachusetts survey last fall said they'd kept patients in the hospital longer than needed because of inadequate access to home health services.

The report, which was produced by the Massachusetts Medical Society in collaboration with the Home Care Alliance of Massachusetts, concluded that doctors believe such agencies can safely reduce longer lengths of stay and their associated costs, along with emergency department utilization. This may be less the case with specialists, who were far less likely than primary care doctors to recommend patients for home healthcare.

One of the biggest problems in getting timely home care to patients is a lack of physical therapists, according to Patricia Kelleher, executive director of the Alliance. Sometimes, a patient may be ready for discharge on a Monday, but an agency can't get a physical therapist to them until Thursday or Friday. This forces doctors to choose between sending patients home with no therapy, or keeping them for a few extra days.

To learn more about the report:
- read this Health Leaders Media piece

Related Articles:
GAO: Upcoding, abuse common in home health
CMS fights home health fraud

Medical college group backs legislation boosting residencies

Anne Zieger — Wed, 01 Jul 2009 09:28:43 -0400

Health reform means a lot of things to a lot of interested parties. To the Association of American Medical Colleges, it won't be complete without language boosting the number of medical residencies supported by the federal government.

The AAMC is heartily in favor of a bill introduced by Sen. Harry Reid (D-NV), Sen. Bill Nelson (D-FL) and Sen. Charles Schumer (D-NY), which would boost the number of Medicare-supported residency positions by 15 percent, or about 15,000 openings. The new legislation could make it possible to train as many as 4,000 new residents per year until 2015, cutting down somewhat on the expanding doctor shortage.

The bill would also enable residents to train in non-hospital settings like physician offices, community health centers and assorted other ambulatory care settings, which isn't allowed now.

To learn more about the bill:
- read this Modern Healthcare article (reg. req.)

Related Articles:
Federal bill would boost residency training slots
Emergency physician shortage settling in
MA facing substantial physician shortage over next decade

Radiation oncologist accused of mishandling seed implants

Anne Zieger — Wed, 01 Jul 2009 02:18:04 -0400

A radiation oncologist accused of mishandling a large number of radioactive seed implants at the Philadelphia Veterans Affairs hospital has come under additional pressure from Congress. The physician, Dr. Gary Kao, told a Congressional panel yesterday that his patients had received effective prostate cancer treatment, despite the fact that he has been identified as performing almost all of 92 substandard implants.

The Nuclear Regulatory Commission, which reviewed about a quarter of the cases of incorrectly placed seeds, concluded that a number of seeds had migrated to the rectum, bladder or perineum. This ties in with an earlier investigation by The New York Times, which had concluded that the prostate cancer unit at the VA hospital also lacked standard safeguards designed to protect patients.

In addition, the NRC charges that while Dr. Kao and others knew that patients received flawed implants, they never reported those mistakes to regulators as required. The program was finally halted last year, pending an investigation of its problems.

Dr. Kao didn't deny that some seeds had been misplaced, but said that the problems were a known risk of the procedure. But an NRC official disagreed, suggesting cases where large numbers of seeds miss the prostate are extremely unusual.

To learn more about this controversy:
- read this article from The New York Times

RI hospitals adopting surgical safety process

Anne Zieger — Wed, 01 Jul 2009 01:50:38 -0400

Never events have always been a huge concern, but with CMS and other payers refusing to cover never-event surgeries, hospitals have even more reason to eliminate them. Now, Rhode Island hospitals are working together to address the problem.

Beginning today, all of Rhode Island's 14 hospitals have agreed to implement a new surgical-safety protocol designed to prevent wrong-site and wrong-patient surgeries. This makes the state the first to implement a voluntary statewide program addressing these issues, according to the Hospital Association of Rhode Island.

The Rhode Island protocol was developed by a statewide committee including providers and medical professional organizations. It includes a verification protocol similar to the World Health Organization's surgical safety checklist, as well as the Joint Commission's universal protocol checklist.

The protocol also includes a briefing process requiring providers to verify surgical site marking, proper identification of patient and procedure and confirm the use and availability of medication and other required supplies. It also includes a time-out process reviewing and confirming the elements included in the briefing process.

To learn more about the process:
- read this Modern Healthcare article (reg. req.)

Related Articles:
Study: Pre-op briefing can lower surgical errors
Study: Never events a major factor in hospital liability costs

SPOTLIGHT: Health plan association head in spotlight

Anne Zieger — Tue, 30 Jun 2009 15:52:40 -0400

If you've been around a while in healthcare, one can hardly miss Karen Ignani, head of the America's Health Insurance Plans. Of late, she's become even more visible, as health plans are deeply engaged in shaping the outcome of health reform efforts. She and her colleagues are working particularly hard to squeeze out the "public option" insurance proposal, which they fear will push commercial plans out of business. Article

Survey: Use of health savings accounts growing

Anne Zieger — Tue, 30 Jun 2009 15:36:27 -0400

A new survey suggests that health savings accounts are becoming increasingly popular, with the number of accounts and level of assets rising steadily. A new study from Celent reported that the number of HSAs increased 46.1 percent between January 2008 and January 2009, and their asset base grew by 62.6 percent.

Average account balances grew by only 13 percent, to $1,561, but that number was dragged down the 18 percent of accounts with a zero balance and a failure of banks to purge inactive accounts. But future numbers should look different, with a relatively high number accounts being created in January 2009.

Investments as a percent of total assets, meanwhile, fell off 5 percent, due to a mix of recessionary pressures, unemployment and falling investment values.

Another piece of survey data was that debit cards--while attached to almost all HSAs-are only used for 66 percent of funds disbursed. Checks account for 20 percent of volume.

To learn more about this survey:
- read this Healthcare Finance News piece

Court upholds Vermont law on prescription data mining

Anne Zieger — Tue, 30 Jun 2009 12:57:42 -0400

In July, a new law will go into effect in Vermont prohibiting the use of a physician's prescribing history without their consent. The law has been challenged vigorously by a handful of pharmaceutical interests, including the powerful Pharmaceutical Research and Manufacturers of America and three data-mining companies, most recently by attempting to stop the law from going into effect.

This week, however, a federal appeals court in New York has refused to block the Vermont law from going into effect, disappointing data mining companies IMS Health, Verispan and Source Healthcare analytics. The court said it wouldn't grant an injunction since the companies involved hadn't shown a substantial likelihood of success on the merits of their case.

The Vermont ruling follows a decision by a Boston appeals court which upheld a similar New Hampshire law limiting the commercial use of prescription info. The New Hampshire measure specifically blocks the commercial use of information containing patient- and prescriber-identifiable data for pharmacy reimbursement, formulary compliance, care management, utilization review, health plans or healthcare research.

To learn more about this decision:
- read this Modern Healthcare piece (reg. req.)

Related Articles:
VT wins battle to bar marketing use of Rx data
Federal appeals court upholds NH data mining ban

Committee makes comparative-effectiveness spending recommendations

Anne Zieger — Tue, 30 Jun 2009 12:33:44 -0400

How do you spend $1.1 billion in comparative-effectiveness research funding? A new report released by an independent advisory committee to HHS may provide some answers. The 73-page report, which was written by the Federal Coordinating Council for Comparative Effectiveness Research, attempts to help HHS's Office of the Secretary set plans to use the $400 million in comparative-effectiveness funding it received earlier this year.

The council has recommended that HHS use its $400 million to fund projects that aren't likely to fall under the purview of the Agency for Healthcare Research and Quality and the National Institutes of Health. The AHRQ has gotten $300 million in comparative-effectiveness funding and NIH received $400 million.

It's also recommending that the Office of the Secretary's first priority should create a data infrastructure, along with distributed electronic data networks and patient registries. Dissemination and translation of its research should be only secondary priorities, the committee suggests, with funding of research a distant third given that other federal agencies are likely to support such research as well.

To learn more about the report:
- read this Modern Healthcare article (reg. req.)

Related Articles:
Comparative effectiveness research becomes battleground
Study: Comparative effectiveness research might improve mental health treatment
Women, minority groups concerned over 'comparative effectiveness'
Legislators, policy experts push for comparative effectiveness research
Comparative effectiveness institute may lead to more pragmatic studies

Moody's leery of uncompensated care backlash

Anne Zieger — Tue, 30 Jun 2009 11:58:16 -0400

Moody's Investor's Service is nervous about what the next few quarters will bring for investor-owned hospitals. In a recent report, it noted that such companies could take a serious hit to their income statements if uninsured patient volume increases or collections decrease.

It's hard to tell whether such charges may occur given the public information it has, Moody's said, but to date, figures like bad-debt expenses, accounts receivable stats and cash flow aren't being bruised by uncompensated care expenses as of yet. However, it's also said that it's not expecting stimulus funds to bolster hospitals much either.

This report follows the same story line as a previous one from March, in which it predicted that for-profits would continue to deteriorate financially through 2009. It cited the swamped economy, fallen patient volumes and expanding bad debt as reasons for concern, predicting that patient volume was likely to remain lowered and bad debt high with the economy in turmoil.

To learn more about Moody's outlook:
- read this Modern Healthcare piece (reg. req.)

Related Articles:
Moody's: Stimulus may not have big healthcare impact
Fitch: Investor-owned hospitals have strong operating earnings
Moody's pans profit outlook for investor-owned hospitals

SPOTLIGHT: Boston cardinal breaks off deal with health insurer

Anne Zieger — Mon, 29 Jun 2009 15:33:27 -0400

In another sign of the tension between Catholic organizations and secular health organizations, a Boston cardinal has ended a joint venture between a diocesan health system and a health insurers. Church officials and outsiders had argued that the Catholic system shouldn't be too closely affiliated with the insurer, Centene Corp., which covers abortions. Article

Global medical tourism market to hit $100B by 2012

Anne Zieger — Mon, 29 Jun 2009 14:40:52 -0400

We all knew medical tourism was growing, but over the next few years, volume should explode say researchers speaking at a conference in Singapore. According to one researcher, the global medical tourism market should climb to a staggering $100 billion by 2012. (This figure is in direct contradiction to a study done last year by McKinsey & Co., which contended that the demand for medical tourism had been understated by those in the business.)

The Asian medical tourism market, in particular, should be bolstered by rising quality standards and the growing demand for quality treatment, according to Andrew Keable, divisional director at Informa Life Sciences. After all, patients who undergo treatments in Asia often pay only 10 percent of the cost of similar treatment in the U.S. or United Kingdom, Keable notes.

What's more, countries like Korea, Malaysia, Thailand and India have implemented state-of-the-art medical technologies that should improve care. Combine that with the increasing sophistication of the travel industry, and medical tourism growth has excellent fuel, he says.

To get more information on this trend:
- read this Healthcare Finance News piece

Related Articles:
Study: Medical tourism market smaller than predicted
WellPoint begins paying for medical tourism
Health plans begin to cover medical tourism
Medical tourism or global healthcare?

NQF urges greater leadership from hospital pharmacist

Anne Zieger — Mon, 29 Jun 2009 14:29:29 -0400

This year, when the National Quality Forum updated its manual on safe practices, it made an important change to its medication management chapter. The group is now urging that hospital pharmacists show increased leadership--and face greater accountability.

The NQF argues that pharmacists should have a larger presence on the leadership team at hospitals, as they're best qualified to help guide their institution through the complex ups and downs of medication management. When pharmacists are more deeply involved, it not only helps hospitals offer more efficient care, but it also makes patient care safer.

To help speed greater pharmacist involvement, there are several steps hospitals can take, according to Mary Andrawis, PharmD, MPH, director of clinical guidelines and quality improvement for the American Society of Health System Pharmacists.

These steps include opening the lines of communication between the hospital's executive team and its pharmacists to help lower drug costs and support new services; creating a medication safety committee led by a pharmacist; involving pharmacists in planning investments in medication management technology; and including a pharmacist on the clinical team, which can eliminate delays in care and promote better decision-making.

To learn more about these guidelines:
- read this Health Leaders Media piece

Report: Five medical home recommendations for states

Anne Zieger — Mon, 29 Jun 2009 12:16:03 -0400

The "medical home" concept is all the rage these days, as many health leaders believe that it can cut costs and improve patient management. The question, however, is what model works best, as the idea is still in its infancy. Ever so slowly, health plans, research organizations and physician groups are weighing in.

This week, a state policy group has outlined five strategies states should consider when rolling out medical home programs. The National Academy for State Health Policy is suggesting that states should form partnerships with key players; create a clear definition of what a "medical home" is; align reimbursement with program goals; support physician practices; and measure results.

These recommendations are coming from 10 states with advanced medical home programs already in place, including Colorado, Idaho, Louisiana, Minnesota, New Hampshire, Oklahoma, Oregon, Washington state, North Carolina and Rhode Island. It's not clear how these recommendations will help individual health plans or employer initiatives, but they're at least a start.

To get more information from the report:
- read this Modern Healthcare piece (reg. req.)

Related Articles:
Primary care groups issue medical home guidelines
NY health plans begin medical home effort
UnitedHealth tests medical home model in AZ
Health plans, MD groups plan 'medical home' project

AZ hospital helps Mexican moms have babies with U.S. citizenship

Anne Zieger — Mon, 29 Jun 2009 12:00:08 -0400

When U.S. citizens think about medical tourism, they envision a vacation-like trip offering heavily discounted procedures in lush surroundings. But medical tourism can also involve patients coming into the U.S.--and in the case of expectant moms, can confer benefits which few medical tourist get.

Of late, a growing number of well-to-do Mexican mothers have been coming to the U.S. to have their babies, who automatically get American citizenship since they were born on U.S. soil. One hospital that is capitalizing on this trend is Tucson, AZ-based Tucson Medical Center, which is marketing a "birth package" offering cutting edge technology, cozy settings and the chance for mothers to grant their babies American citizenship.

It's one of 13 packages aimed at Mexican families, including some that advertise resort stays and shopping trips. Along with maternity services, TMC offers varied screenings and services, including mammograms and urology procedures.

The TMC birth package costs $2,300 for a vaginal birth with a two-day stay, and $4,600 for a c-section and a four-day stay. The hospital imposes a $500 surcharge for each additional child.

To learn more about these packages:
- read this Modern Healthcare piece (reg. req.)

Related Articles:
WellPoint begins paying for medical tourism
Medical tourism or global healthcare?
Middlemen take uncertainty out of medical tourism
Patients, employers choose overseas care

SPOTLIGHT: NH can't take malpractice fund surplus

Anne Zieger — Fri, 26 Jun 2009 13:56:51 -0400

So, New Hampshire officials, thought you'd close the gap in your budget by taking the malpractice fund's extra dollars? "Not so fast," a judge has said. Officials wanted to take the $110 million surplus run by the Medical Malpractice Joint Underwriting Association, on the argument that the fund was an agency of state, but the court wasn't buying. Article

Two high-profile Mass. hospitals to improve accessibility

Anne Zieger — Fri, 26 Jun 2009 13:43:51 -0400

Boston's Massachusetts General Hospital and Brigham and Women's Hospital have agreed to spend millions of dollars to address charges that their facilities and staff were unfriendly to the disabled.

The two hospitals, both Harvard-affiliated teaching institutions, have vowed to search their facilities from top to bottom to find any physical barriers or equipment not accessible to disabled patients. Brigham plans to spend $12 million over the next six years, and Mass. General expects the total to mount into unspecified millions. As part of the agreement, the hospitals will involve representatives from the disabled community, who will be directly involved in approving consultants and reviewing blueprints.

Executives expect to invest in items like exam tables, mammography units and X-ray machines which can better accommodate the disabled, as well as buying lifts and scales that can weigh wheelchair-bound patients. Meanwhile, staffers will get training in order to help them understand and address the needs of patients with walking, vision or hearing problems.

To learn more about this agreement:
- read this Boston Globe piece

Trend: Pharmas using more "medical science liasons" in physician outreach

Anne Zieger — Fri, 26 Jun 2009 13:16:36 -0400

If you're a sales rep for a pharmaceutical product, you're barred from discussing any uses of a drug not approved by the FDA. Like most regulations, however, there's a loophole, and drug companies are marching right through.

Increasingly, pharmas are using employees dubbed "medical science liaisons"--usually physicians or pharmacists--to call medical practices. Since the liaisons are considered medical rather than sales staff, they have more leeway than sales reps in discussing the drugs they're touting. While traditional sales reps have to route any info requests to medical or scientific staff, liaisons can have the conversation on the spot, discussing not only the science behind the drugs but also, potentially, unapproved uses.

While still constituting a small portion of the pharma outreach effort, recently the number of liasons used by pharmas has climbed rapidly. This group totaled 1,970 in 2008, up 48 percent from 1,335 in 2003, according to data from 12 major pharma and biotech companies gathered by PharmaForce International. Meanwhile, drugmakers have been cutting back on the traditional sales forces, with the total number of U.S. sales reps falling to 90,000 in 2008, from a peak of about 106,000 in 2006, according to consulting firm ZS Associates.

To find out more about this trend:
- read this Kaiser Health News piece

Related Articles:
Case study: Miami drug reps not registering as lobbyists
MN limits on pharma gifts to doctors slow drug rep visits
DC considers pharma rep licenses, data mining limits
Study: Pharma disclosure laws not working

Study: 40 percent of diabetics in remission after gastric banding

Anne Zieger — Fri, 26 Jun 2009 12:45:04 -0400

As bariatric surgeries have become more common, health plans have waffled as to whether it makes financial sense to pay for them. Now, there's a study suggesting that, yet again, the longer-term benefit may far outweigh the cost.

The study, which was done by researchers at the New York University Medical Center, analyzed 95 diabetic patients who had laparoscopic adjustable gastric banding surgery from January 2002 to January 2004. The patients were aged 21 to 68 and had an average body mass index of 46.

Researchers found that in 40 percent of patients studied, their diabetes went into remission after a bariatric procedure known as gastric banding surgery. Five year follow-up data showed improvements in an additional 43 percent of patients getting gastric banding surgery for morbid obesity. That puts the total improvement/remission rate at 83 percent.

To learn more about this research:
- read this UPI item

Related Articles:
Costs for bariatric surgery decline
Study: Bariatric surgery repays cost within two to four years
Trend: Patients going to Mexico to get bariatric surgery
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Proposal creates care "warranty" model

Anne Zieger — Fri, 26 Jun 2009 12:18:46 -0400

Offering any kind of guaranteed results for healthcare services isn't just counterintuitive--some doctors might tell you it's just plain crazy. But that isn't stopping healthcare quality advocate Francois de Brantes, who's promoting a new reimbursement model which (believe it or not) comes with a warranty.

In a new paper published in Health Affairs, de Brantes is talking up a new payment method known as Promethus Payment. The model, developed with the support of the Commonwealth Fund and the Robert Wood Johnson Foundation, offers set fees to providers covering all recommended services, treatments and procedures for specific conditions. Those payments are risk-adjusted to account for the needs of older or frailer patients.

The warranty aspect of the deal, meanwhile, requires providers to pay one-half the costs arising from preventable complications. Not only does a warranty cut costs to the health system, it also improves quality and service, de Brantes says. "A warranty means that you are going to think in terms of the customer's experience and perceptions...not in terms of an artificial payment construct or third party payer system," de Brantes told the New York Times.

To find out more about this model:
- read this article in the New York Times

Related Articles:
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Walgreen plans to sell bundled healthcare package to employers
Geisinger offers flat-fee surgery package

Tennessee top spot for transplant candidates

Anne Zieger — Fri, 26 Jun 2009 11:49:26 -0400

When Apple CEO Steve Jobs needed a liver transplant, he registered with transplant units in locations around the country. He hit the jackpot in Tennessee, which had a 229-person waiting list for a liver--dramatically shorter than the 3,474-person list he would have endured in his home state of California.

Increasingly, Tennessee is becoming the transplant destination of choice for out-of-state patients who can afford to hop into their own jet and be there within hours if an organ becomes available. The median wait for liver transplants at Methodist University Hospital, the facility which gave Jobs his surgery, is only four months. Compare that with the University of California at Los Angeles Medical Center, where the wait is 27 months, according to 2007 data.

Not only has the Tennessee organ procurement program consistently been in the top five of 58 U.S. groups for receiving organs, relatively few locals have seemed to need them. In big cities like LA, Philadelphia and New York, conversely, there's relatively few donors for the number of people on the waiting list.

Big shots like Jobs typically register with organ procurement organizations in multiple states, then leap when they have a chance. People with less means, however, can only register with their local organizations, as an out of state organ will do them no good if they can't get to it quickly.

To learn more about this situation:
- read this piece in The Tennessean

Related Articles:
UPMC gets attention for lucrative, questionable liver transplants
Japanese tourists may have received illegal transplants in China

SPOTLIGHT: Ex-CIGNA exec rips health plans

Anne Zieger — Thu, 25 Jun 2009 14:25:53 -0400

Many providers and consumers suggest that health plans aren't just bureaucratic, but also scheming to trip them up. And at least one former CIGNA executive agrees. With relentless pressure always on from Wall Street, health plans are prone to confusing customers and dumping sick beneficiaries, said former senior exec Wendell Potter testified at a health insurance hearing run by the Senate Committee on Commerce. Article

Trend: Arizona providers de-installing electronic medical records

Anne Zieger — Thu, 25 Jun 2009 13:58:45 -0400

Here at FierceHealthcare, we tend to leave the bits and bytes stuff to our sister publication FierceHealthIT. But we thought the following story was important enough that you might want to hear about it yourself.

A new report suggests that while providers in the state of Arizona have had a high adoption rate for electronic medical records, large numbers of them are now "de-installing" the technology, according to a new research report. Providers adopted the technology in large numbers largely thanks to a 2005 executive order by then-Gov. Janet Napolitano requiring all healthcare providers to install EMRs by 2010.

The report, by HealthLeaders-InterStudy, concludes that physician groups in Phoenix are canceling their EMR contracts after running into significant training, cost and functionality concerns. Unsurprisingly, this phenomenon is most common among small groups.

To learn more about this trend:
- read this Healthcare IT News article

Related Article:
Study: EMR failures fairly common