News & Updates

Article by Shawn Shinneman

Hurst-based Cook Children’s Northeast Hospital will close on April 20 and begin a transition to become an ambulatory surgery center, with the new name of Cook Children’s Surgery Center, according to a news release. Here’s how the release from Cook Children’s Health Care System describes the decision:

In late 2017, the Centers for Medicare and Medicaid Services (CMS) issued a memo defining the overnight census requirement to operate as a hospital. Cook Children’s Northeast Hospital, located at 6316 Precinct Line Road in Hurst, Texas, does not meet the census requirement and will no longer be able to operate as a hospital.

The memo referenced—I believe I’ve located it here—contains CMS’ move to redefine what constitutes who can or can’t call themselves a hospital under Medicare and Medicaid. Under the new definition, things like average daily census and average daily stay can be taken into consideration.

The memo casts those merely as pieces to the puzzle, but it appears Cook Children’s leadership has determined it won’t be able to overcome the census requirement. (I’ve reached out to gauge how they made the call, and I’ll update here or post anew if and when I get answers.)

The release says only that the board that oversees the hospital made the decision on the new direction. Cook Children’s says it will “assume ownership and operations of the Urgent Care Clinic, Imaging Center, and Draw station at this location” on April 23.

The surgical center will open on May 1 and run as a joint venture between Cook Children’s, NueHealth, and physician investors.

The transition will result in 150 lost jobs, the release said.

Editors Comment: Welcome news from our friends in Georgia!  – Another example of payers moving toward economic models for EMS that include reimbursement for patient assessment, treatment and navigation to the most appropriate resource!  And, confirmation of something that Health Affairs journal identified several issues back – Medicaid programs are one of the most innovative payers in the country…

EMS Partners,

As you may be aware, in early 2017 the Georgia State Office of Rural Health (SORH) submitted three proposals to the Georgia Medicaid office requesting changes to reimbursement for EMS. The three proposals requested consideration to reimburse EMS for Treat Without Transport, Transport to Alternate Destinations, and Mobile Integrated Healthcare/Community Paramedicine (MIH/CP) programs.

Our office has recently received notification that Georgia Medicaid has approved Treatment Without Transport and Transport to Alternate Destinations, with the intent of submitting the MIH/CP proposal to the Centers for Medicare & Medicaid Services (CMS) for approval.

Assuming no unforeseen barriers, Treat Without Transport will be effective April 01, 2018.

Submission of a claim will require that the response originate through a “9-1-1” call and the patient receives treatment with pharmaceuticals before refusing transport to the hospital.

The intent behind this proposal was to allow EMS to recover some of the cost associated with providing medication to patients who, ultimately, choose not to be transported for continuation of care.

Assuming no unforeseen barriers, Transport To Alternate Destination will be effective July 01, 2018.

Submission of a claim will require that the response originate through a “9-1-1” call, an approved protocol signed by the Medical Director specific to patient evaluation and transport to an alternate facility exists, documentation of patient agreement for transport to an alternate facility is included, and a receiving facility agreement is on file.

The intent behind this proposal was to allow EMS an opportunity to transport properly screened patients who have non-emergent conditions to facilities appropriate for their needs, reduce over-crowding of emergency departments with non-emergent patients, and allow patients to receive medical attention in a less costly setting. This option may also allow counties with no local hospital and/or limited ambulance service coverage to shorten “turn-around times” and keep resources within county borders for longer periods.

All Medicaid claims are subject to review and audit, therefore, proper documentation on the patient care report as well as all required supporting documents must be maintained and provided upon request.

Currently, four states in the US have received approval from CMS for Medicaid reimbursement for MIH/CP programs. Georgia Medicaid is submitting a proposal similarly structured as those receiving previous CMS approval, and anticipate this proposal will also be approved. However, this is still uncertain, and confirmation of this change will be contingent upon CMS ruling. The State Office of Rural Health will keep our EMS partners informed of the progress of this proposal.

Please share this information with your Medical Director and billing staff.

We would like to thank Georgia Medicaid, and specifically Deputy Director Heather Bond, for their effort in reviewing and approving these proposals. This change is a huge step forward for the EMS industry in Georgia.

Article by Paige Minemyer

Hospitals that aim to reduce readmissions among high-risk patients may want to hire lay-health workers, according to a new study.

Researchers at the University of Kentucky piloted such a program at St. Claire Regional Medical Center, a 159-bed rural hospital in Morehead, Ky. Hospitalized adults deemed at-risk for readmission within 30 days were targeted for the intervention, according to the study published in Health Education Research.

The study team measured 30-day readmissions during a four-month baseline period, compared the data to a six-month window after the lay-health workers were deployed and found a 47.7% reduction in the readmission rate for patients who received the intervention.

Lay-health workers assisted these patients with post discharge needs such as appointment scheduling and transportation. They were also able to serve as a resource for patients during their care journey, according to the study. Because they could offer these services—and could be deployed relatively quickly to address patients’ needs—the model shows promise for high-risk patients with complex social concerns, the researchers said.

“We have the potential of impacting one’s overall health if we can assist with those social determinants, such as paying bills or having access to fresh food, much more so that what we do through traditional medicine that occurs in clinics and hospitals,” said the study’s lead researcher, Roberto Cardarelli, D.O., chief of the division of community medicine at UK HealthCare, in an announcement.

One of the major barriers to expanding programs like the lay-health pilot is that payment structures have not quite caught up to the demand for these services, according to Cardarelli.

“Our dilemma is that our healthcare system does not pay for such services,” he said, “and we continue to see marginalized populations keep coming back to hospitals in an acute crisis.”

There has been increasing focus on targeting social determinants to improve health—poor minority patients, for example, face worse health outcomes than others. But while far-reaching work is necessary to address these concerns, it will require a culture shift in healthcare to fully achieve sustained population health success.

Experts have called for improved data gathering and analytics in this area to establish a stronger foundation for initiatives on the social determinants of health. Issues ranging from patient loneliness to lack of internet access are seen as areas for improvement.

https://www.fiercehealthcare.com/hospitals-health-systems/lay-health-workers-readmissions-high-risk-patients-university-kentucky

Patients often face long waits for emergency care, so the Permanente Medical Group set out to improve patient flow in Kaiser Permanente emergency rooms by deploying staff members more efficiently at high-volume times.

ERs are the busiest on nights and weekends—the least desirable shifts for clinicians—so KP took steps to adjust what its ER nurses were doing and added nontraditional ER doctors to these shifts to avoid delays, wrote Robert Pearl, M.D., a clinical professor of plastic surgery at Stanford School of Medicine and former CEO of the Permanente Medical Group, in a column for Forbes.

The triage process is often redundant and results in nurses asking many of the same questions that patients will answer a second time for admitting physicians. KP made doctors the first point of contact in the ER to move nurses more directly into patient care, especially during high-volume, low-staff times of day, which got more clinicians involved in treating patients.

KP emergency rooms also brought nonemergency clinicians to the ER during high-volume times, Pearl wrote. The organization paired board-certified ED doctors with other physicians, such as pediatricians or family medicine practitioners, who would also be able to treat patients with minor illnesses or injuries.

“By staffing appropriately for the acuity of patient problems, doctors can treat and discharge those with less-emergent issues faster,” Pearl wrote.

Other hospitals have looked at re-engineering the triage process to make emergency care more efficient, as patients with nonemergent conditions often face long waits in the ER. A pilot program at a Chicago hospital streamlined the process so that the sickest patients were treated more quickly, reducing wait times by two hours.

The pilot set a goal of patient admission within one hour of arrival in the ER. In addition to cutting down wait times, the updated triage pilot improved communication between clinical teams and fostered more collaboration on care.

Baptist Health South Florida adopted a “tele-triage” program to reduce overcrowding and treat patients with non-life-threatening conditions more quickly. Patients meet remote physicians in a video conference, significantly boosting the hospital’s ER capacity.

Parkland Memorial Hospital took a different route to improve ER efficiency: a partnership with Toyota. The car manufacturer identified a number of inefficiencies in how the Dallas-based hospital operated its ER, including an inconsistent discharge protocol for nurses that Parkland has adjusted.

Article can be accessed here.

During his six years at the CMS, Dr. Patrick Conway oversaw the agency’s big push into value-based reimbursement. He was deputy administrator for quality and innovation and headed the Center for Medicare and Medicaid Innovation. Late last year, Conway left the CMS Innovation Center to become CEO of Blue Cross and Blue Shield of North Carolina. While he’s now removed from rulemaking, Conway remains passionate about the idea of linking payment to outcomes. He recently spoke with Modern Healthcare Editor Emeritus Merrill Goozner. The following is an edited transcript.

MH: Let’s turn to another one of the major programs that you had at the Innovation Center ACOs and the Medicare Shared Savings Program. How do you see its future?
Conway: Overall, the Medicare ACO program improved quality and improved patient experience and had modest savings. On the savings, it’s important to note the ACOs that were in the program longer saved more money. Physician-led ACOs, on average, saved more money. And those ACOs at two-sided risk—at partially capitated or capitated-type payments like Next Generation ACO—did the best.

I think those programs will continue in Medicare, but they may be modified in some ways. In the private market, including in North Carolina, private payers are putting ACO contracts in place with independent physicians and large health systems. We have an ACO that just reported $20 million in savings, but more importantly, the patients in that system are getting coordinated care. They have nurses calling them to make sure they get the care they need.

MH: To what extent do you see the private sector becoming the driver of these? Do you think that the momentum is
there for them to keep going and expand it even without a push from government?
Conway: I do. In North Carolina, we’re going to work to move the majority of our payments to providers into a partnership model like ACOs and bundled payments where the provider is accountable for quality and total cost of care and quality goes up and costs go down.

MH: There are so many strands of reporting requirements quality indicators, process indicators, outcomes indicators. What can be done to lessen the regulatory burden on physician offices and on hospitals?
Conway: At one point in my career, I led quality reporting for a large health system, Cincinnati Children’s Hospital Medical Center, and we had over 700 measures we were reporting to various entities. You cannot improve on 700 things. As a general rule of thumb, you want to try to get 30 or fewer quality measures and 10 or fewer is even better, for providers to improve on.

Original article can be accessed here.

NEW YORK — Roughly $1 trillion per year is spent on hospital care, which is about a third of all health care costs in the U.S. But a new program cuts costs by allowing patients to be treated at home.

Dr. David Levine and nurse Kim Tierney of Boston’s Brigham and Women’s Hospital are making a house call, treating Phyllis Petruzzelli for pneumonia in her living room.

Petruzzelli enrolled in an innovative program. Instead of staying in the hospital, patients are sent to their homes for treatment following a visit to the emergency room. There’s one goal: control costs without sacrificing quality. At first, Petruzzelli was skeptical.

“You’re old-school, you’re sick, you go to the hospital, you stay there,” she said. “You don’t have the doctor come to the house anymore.”

There are daily visits and 24-hour access to her medical team. Vital signs are remotely monitored by a skin patch.

A study out Wednesday found home stays had the same levels of safety and quality of care as those in the hospital at about half the cost. Doctors ordered far fewer blood tests and scans.

“By moving people to their home we automatically are able to customize what they need and tailor it to them and that’s part of the place where we see a lot of cost savings,” said Dr. Levine.

Home patients also walk 10 times more than those in the hospital.

“We believe that because patients are moving more at home that they’re going to be able to preserve their strength and end up better off afterward,” said Dr. Levine.

It looks like those home patients do better after discharge. New data shows fewer readmissions to the hospital at 30 days. There may be other benefits beyond the cost savings — better sleep, and a lower chance of catching something from a hospital patient just a curtain away

Free-standing emergency rooms began to pop up in Texas eight years ago, but now economists say the business model grew too fast and may not always be the lower-cost option for patients.

These standalone facilities are licensed by the state to provide 24-hour emergency services to patients and exploded in The Lone Star State after the passage of a law in 2009 that allowed the establishment of ERs independent of hospitals.

Texas had only a handful of free-standing ERs in 2000. Now there are more than 200 across the state.

And they have been a windfall for the state, which has earned $3.1 million in revenue just by issuing two-year licenses, according to the Dallas Morning News. But the cost of care, while still lower than a traditional hospital emergency room, has also increased, the publication reports. The mean cost of a visit at a free-standing ER was $2,199 in 2015, the article notes, compared to $2,259 at a hospital ER.

Research also finds that the facilities tend to open in more affluent, populated areas, and not where they may help the most, in rural communities.

Another problem: State licensing laws vary. For example, a rural community in Missouri wanted to explore the model, but then learned the state currently doesn’t allow free-standing facilities, St Louis Public Radio reports. Further complicating the issue, it’s against federal law for independent free-standing emergency centers, not affiliated with a hospital, to accept Medicaid or Medicare. That means patients must pay out of pocket or find another facility affiliated with a hospital.

This became an issue in Aransas County, Texas, last year when the only hospital in the area had to shut down due to damage from Hurricane Harvey, KRISTV reports. Code 3 Emergency Room in Rockport was inundated with patients for a month after the storm. And in some cases, physicians weren’t paid for the care they provided. If a patient’s life is at risk, even if the patient is on Medicare or Medicaid, Texas law requires Code 3 ER physicians to provide care, according to the media outlet.

“We take care of them, we stabilize them, we call a helicopter. They get paid for it, but we don’t, for doing all the care up to it including calling the helicopter,” Justin Hensley, M.D., medical director of Code 3 Emergency Room, told the publication, adding that physicians are working with members of Congress to try to get disaster funds to treat patients with Medicaid and Medicare.

Hospital systems in other parts of the country, however, are committed to opening new free-standing facilities. For example, Florida Hospital plans to open two standalone ERs, each with 24 beds, in Orlando and Oviedo this year, Orlando Business Journal reports. And in Arizona, a new $8.5 million facility will open next week to provide care to Marana-area residents, the second such facility to pen in the Tuscon area, according to Tucson.com. Both facilities are owned and operated by Northwest Healthcare, which is part of Community Health Systems, so don’t have the same concerns as independent standalone ERs.

“They are controversial in some of the other communities because those free-standing EDs are independent. They are not affiliated with a healthcare system, they don’t have contracts with insurance companies and so patients go there and the get gouged for these big bills,” Kevin Stockton, regional president and market CEO of Northwest Healthcare, told Tuscon. com.“We’re still in network. Patients coming to our ED, whether they are in a hospital or a free-standing one, it’s the same financial implications.”

Original article can be accessed here.

Amazon, Berkshire Hathaway and JPMorgan Chase & Co. are launching a new company aimed at cutting healthcare costs for their U.S. employees.

Here are six things to know about the partnership.

1. In addition to reducing healthcare costs, the companies are aiming to improve employee satisfaction through the new venture. Amazon, Berkshire Hathaway and JPMorgan are hoping the sheer size of each company and their complementary areas of expertise will help them tackle these issues.

2. “Our people want transparency, knowledge and control when it comes to managing their healthcare,” said Jamie Dimon, chairman and CEO of JPMorgan. “The three of our companies have extraordinary resources, and our goal is to create solutions that benefit our U.S. employees, their families and, potentially, all Americans.”

3. The companies said the project, which is in the early planning stage, will initially focus on technology solutions.

4. “The healthcare system is complex, and we enter into this challenge open-eyed about the degree of difficulty,” said Jeff Bezos, Amazon founder and CEO. “Hard as it might be, reducing healthcare’s burden on the economy while improving outcomes for employees and their families would be worth the effort. Success is going to require talented experts, a beginner’s mind, and a long-term orientation.”

5. The new venture will be jointly spearheaded by Todd Combs, an investment officer of Berkshire Hathaway; Marvelle Sullivan Berchtold, a managing director of JPMorgan Chase; and Beth Galetti, a senior vice president at Amazon.

6. “The ballooning costs of healthcare act as a hungry tapeworm on the American economy,” said Berkshire Hathaway Chairman and CEO Warren Buffett. “Our group does not come to this problem with answers. But we also do not accept it as inevitable. Rather, we share the belief that putting our collective resources behind the country’s best talent can, in time, check the rise in health costs while concurrently enhancing patient satisfaction and outcomes.”

Original article accessed here.

LONDON — The Taliban has claimed responsibility for an attack in Kabul Saturday. More than 100 people were killed and twice as many were injured when an attacker drove an ambulance packed with explosives into the heart of the city.

It’s not hard to buy a used ambulance. CBS News posed as buyers and found one on eBay. But according to security experts like Chris Phillips, the resale of emergency vehicles is handing terrorists a lethal weapon.

“The terrorist threat is wider, it’s more diverse,” said Phillips. “One of those attacks will almost certainly be a vehicle bomb.”

It’s a threat that British security services flagged a decade ago when they were being used in Iraq. They’re called Trojan vehicles, seemingly ordinary ambulances that are instead packed with explosives.

“You’re not going to know that the ambulance coming towards you is a real one or a fake one,” Phillips said.

He also said the fear is that tactic will be imported here as terror attacks by Islamic militants grow.

“There needs to be some kind of legislation to stop the use of these vehicles or we’re going to have a major problem with this.”

We found plenty of examples on eBay. A police car with original equipment in the truck, an ambulance with full emergency markings — most run for just a few thousand dollars.

“Anyone can turn up, they can pay cash for the vehicles and within hours those vehicles can be in the hands of a terrorist cell,” said Lord Carlile of Berriew, who led calls to outlaw the resale of emergency vehicles.

But there are still no clear regulations governing the resale of ambulances. Lord Carlile pointed out last year’s Ariana Grande concert where 60 ambulances raced to the scene, is exactly the scenario where a Trojan vehicle could exploit the chaos.

“That is the sort of place where the risk of one of these vehicles entering the cordoned off zone in the minutes immediately after the explosion takes place is a very high risk,” he said.

We contacted the home office, Britain’s counter-terrorism authority repeatedly, and we were told they’re looking into it. EBay said fully operational emergency vehicles are not allowed on their website, and they’re reviewing the ads we pointed out.

CLEVELAND, Ohio (KTRK) — In shocking body camera video out of Cleveland, police say Cleveland EMS refused to help them transport a man who was shot 16 times to the hospital.

Cleveland police said they were forced to cross the border into Euclid to help a bleeding man, so they asked their EMS to crossover the border to help as well.

“They got EMS coming but they’re coming from South Euclid. Can we see if one of our guys can come over here a little faster?” police asked.

According to police, Cleveland EMS refused to help transport the man to the hospital saying it wasn’t in their jurisdiction.

“Our EMS won’t come. Their EMS is coming from South Euclid. That’s why I asked if they would come over here. They won’t come because it’s in your city. Even though it’s our victim they won’t come,” police said.

Cleveland officers were left to scrabble to figure out what to do with the man who was shot and pleading with them for help.

“Notify Euclid we’re coming in with a male with gunshot wounds. It’s taking too long for EMS to get here,” officers said.

The Cleveland officers lifted the man off the ground and placed him inside of a police cruiser.

The police raced from the scene and rushed the man to the nearest emergency room.

Police say they have no word on the injured man’s condition.

The City of Cleveland is investigating the incident.

Original article can be accessed here.