News & Updates

In cooperation with the American Ambulance Associationwe and others have created a running compilation of local and national news stories relating to EMS delivery, powered by EMSIntel.org. Since January 2021, 2,513 news reports have been chronicled, with 44% highlighting the EMS staffing crisis, and 37% highlighting the funding crisis. Combined reports of staffing and/or funding account for 80.7% of the media reports! 163 reports cite EMS system closures/takeovers, or agencies departing communities, and 95% of the news articles reference staffing challenges, funding issues and response times.


Click below for an up to date list of these news stories, with links to the source documents.

Media Log Rolling Totals Protected.xlsx

  • 25 Jan 2018 8:30 AM | AIMHI Admin (Administrator)

    After much speculation, Apple is officially bringing medical records onto the iPhone.
    The company issued an update to its Health app on Wednesday, debuting a new feature that allows users to view their medical records on their phones, according to an announcement.

    To launch the beta version that features a new “health records” section, Apple partnered with 12 hospitals and clinics as well as EHR vendors Cerner and Epic, using Fast Healthcare Interoperability Resources (FHIR) to facilitate the transfer of medical records.

    Patients who receive care at the following healthcare providers will be able to access their records through the iPhone app, including vital signs, procedures, medications and test results. They will also receive updates when new information is added to their record.
    • Johns Hopkins Medicine – Baltimore, Maryland
    • Cedars-Sinai – Los Angeles, California
    • Penn Medicine – Philadelphia, Pennsylvania
    • Geisinger Health System – Danville, Pennsylvania
    • UC San Diego Health – San Diego, California
    • UNC Health Care – Chapel Hill, North Carolina
    • Rush University Medical Center – Chicago, Illinois
    • Dignity Health – Arizona, California and Nevada
    • Ochsner Health System – Jefferson Parish, Louisiana
    • MedStar Health – Washington, D.C., Maryland and Virginia
    • OhioHealth – Columbus, Ohio
    • Cerner Healthe Clinic – Kansas City, Missouri

    “We’ve worked closely with the health community to create an experience everyone has wanted for years—to view medical records easily and securely right on your iPhone,” Jeff Williams, Apple’s COO, said in an announcement. “By empowering customers to see their overall health, we hope to help consumers better understand their health and help them lead healthier lives.” We are proud to collaborate with @Apple to advance interoperability and make personal health care records as convenient as possible for consumers

    Healthcare executives involved in the partnership with Apple lauded the tech giant’s efforts to provide patients with easy access to their medical records.

    “Apple is uniquely positioned to help scale adoption because they have both a secure and trusted platform and have adopted the latest industry open standards at a time when the industry is well positioned to respond,” said Darren Dworkin, chief information officer at Cedars-Sinai.

    Original article can be accessed here.

  • 23 Jan 2018 8:00 AM | AIMHI Admin (Administrator)

    Hospitals are in trouble. Why? Because the conventional wisdom on how to respond to the transition from fee-for-service to value-based payment programs does not seem to be working.

    Consultants insist that consolidation of independent hospitals into regional integrated systems, employing physicians and assuming more financial risk will lead to success. But the results so far are not promising.

    MD Anderson Cancer Center in Houston lost $266 million on operations in 2016, and Partners HealthCare in Boston lost $108 million on operations in the same year, according to an article from the Harvard Business Review. Cleveland Clinic, meanwhile, experienced a 71% decline in operating income for 2016, and Providence St. Joseph Health on the West Coast reported a $512 million drop in operating income and a $252 million operating loss in 2016.

    Seven years ago, I anticipated this development and proposed that hospitals must totally rethink their mission and strategy by becoming Community Hubs of Wellness and Health. The traditional clinical delivery system model—organized around a centralized hospital that provides diagnosis, treatment and disease management—simply no longer makes sense.

    Community Hubs of Wellness and Health would:
    • Support a community’s embrace of the Healthy People 2020 program goals, which provide science-based 10-year national objectives for improving the health of Americans
    • Create links between hospitals and other community groups
    • Become a meeting place that is seamlessly integrated into the community
    • House a trusted repository for advice on how to use new technologies—such as digital devices, AI virtual reality—to attain wellness
    • Connect with diverse communities as the demographics of a community changes.

    A recent New England Journal of Medicine Catalyst article outlines a similar analysis of the challenges facing hospitals in 2018. This article envisions a “smaller, faster, more cost-effective [system] in which healthcare is more accessible, more affordable, more personal and closer to home.”

    The authors describe a decentralized care delivery model that is not centered around the hospital and features:
    • Virtual health and remote monitoring as care migrates away from the hospital
    • Community paramedicine modeled after the Geisinger Health System Mobile Health Team
    • Reimagined emergency departments that provide alternatives to inpatient hospitalization

    Making this transition from a centralized to a decentralized clinical delivery system will be difficult. Indeed, comments from hospital executives at the recent J.P. Morgan Health Care Conference indicate that regardless of their stated goal to keep people healthier and out of the hospital, “the truth is they still want their inpatient beds filled whenever possible,” as Axios reported.

    Geisinger CEO David Feinberg, M.D., however, has been quoted in the Wall Street Journal as stating: “I think my job ultimately is to close every one of our hospitals.”

    When I have shared this quotation with state hospital and medical societies, the pushback has been immediate and ferocious. Feinberg may be overstating his case, but he is on the right track. We must reimagine the clinical delivery system—sooner rather than later.

    Kent Bottles, M.D., is a lecturer at the Thomas Jefferson University School of Population Health and chief medical officer of PYA Analytics.

    Original article can be accessed here.

  • 22 Jan 2018 6:49 PM | AIMHI Admin (Administrator)

    The tiny suburb of Hilltop, located just north of Minneapolis, is hosting an experimental mash-up of health care services that’s helping to generate buzz on Wall Street.

    Hilltop is one of more than a dozen locations across the country where pharmacy giant Walgreens has carved out space in its stores for urgent care clinics from MedExpress, a company that Minnetonka-based UnitedHealth Group acquired in 2015.

    The collaboration shows how Walgreens is testing ways of bringing other health care services under its roof, including partnerships that could be part of the pharmacy chain’s future, a Walgreens executive said this month at an investor conference.

    For UnitedHealth Group, the pilot is one example of how the company hopes to shape regional health care markets via its fast growing Optum division for health care services.

    “This is just part of developing an overall higher-performing local health system,” said David Wichmann, chief executive at UnitedHealth Group, after a stock analyst asked about the Walgreens venture during a Tuesday conference call. “This is the future health system that we see delivering considerable value to people.”

    Urgent care centers often consist of a medical office with extended hours of operation, walk-in service and treatment for a variety of current health issues that don’t require a trip to the emergency room.

    Urgent care center sales in the U.S. grew to more than $15 billion in 2017, up 27 from 2011, according to estimates from Kalorama Information, a health care data group in Maryland.

    Operators say urgent care centers offer more convenience for patients while also helping control costs by avoiding unnecessary emergency room trips. Critics question whether urgent care centers simply skim profitable services from other providers, while adding capacity to markets that already have plenty of doctors and hospitals.

    The expansion of the urgent care market has come on the heels of growth in “retail ¬clinics,” a trend launched in the Twin Cities more than 10 years ago. Minneapolis-based MinuteClinic got the ball rolling with small clinics in grocery stores and pharmacies that were staffed with nurse practitioners.

    Ultimately, MinuteClinic was acquired by pharmacy giant CVS, which is based in Rhode Island. Illinois-based Walgreens, meanwhile, also bought into the trend, and currently operates some 400 retail clinics.

    “We see retail clinics and urgent care as complementary and generally serving different patient needs,” said Scott Goldberg, a Walgreens spokesman, via e-mail.

    The urgent care pilot for Walgreens and MedExpress is different because it offers patients a much-wider range of services, in a space that’s about five times the size of a typical retail clinic, said Tom Charland of Merchant Medicine LLC, a Shoreview-based consulting group that follows the market.

    One of the problems with retail clinics, Charland said, is that patient demand has been highly seasonal, with the clinics struggling to attract business outside of cold-and-flu season. Urgent care centers in retail settings might avoid this pitfall, he said, since they are staffed and equipped to handle a broader range of health care problems.

    For MedExpress, a partnership with Walgreens makes sense, Charland said, because big-name retail pharmacies tend to be located in some of the most desirable shopping areas. Walgreens, meanwhile, likely has more square footage than it needs with the growth in online shopping, Charland said, and therefore has room to rent space to the right tenant.

    “It’s a development to watch,” he said.

    Established players in the Twin Cities market are watching, although they sound a bit wary.

    “Ultimately, the consumer will decide if this model is going to be successful, or if they prefer the care coordination provided by a primary care clinic and a relationship with a primary care provider within a system that also provides specialty care,” Wendy Burt, spokeswoman for the Minnesota Hospital Association, said in a statement.

    At the Minnesota Medical Association, the group’s president said that doctors want Minnesotans to have access to affordable and appropriate care. “But convenience also runs the risk of undermining patient-physician relationships and continuity of care, which is particularly critical for patients with chronic or complex conditions,” said Dr. George Schoephoerster in a statement.

    Kevin Ruffe, the chief operating officer at MedExpress, said his company’s health care providers want to help make sure that patients have good continuity in their care. Since opening its first outpost in Minnesota in 2016, MedExpress currently has 11 locations in the state and will open its 12th soon in Rochester. Across the country, MedExpress operates nearly 250 urgent care centers.

    Back in Hilltop, the MedExpress features six examination rooms, an X-ray machine and a procedure room for suturing.
    The urgent care center also offers a half dozen basic tests, from cholesterol to strep throat.

    MedExpress and Walgreens have separate entrances, but there’s also a pass-through door from the clinic to the pharmacy.

    The pilot program — and not Hilltop, in particular — is receiving attention in both retail and health care circles this month after a Walgreens official made comments at the annual ¬JPMorgan Healthcare Conference.

    David Heupel, an analyst in Minneapolis with Thrivent, said the conference is a big deal, and the urgent care-pharmacy pilot is an interesting test. But he added: “In the grand scheme of UnitedHealthcare overall, this is tiny.”

    And like many new ideas in health care, the Walgreens-MedExpress pilot has a familiar feel to some.

    Minneapolis-based Fairview Health Services, for example, has its network of retail pharmacies and has co-located the operations with most of its urgent care centers. A Fairview spokeswoman said by e-mail: “Our first co-located urgent care opened 15+ years ago.”

    Original article can be accessed here.

  • 22 Jan 2018 9:30 AM | AIMHI Admin (Administrator)

    The American College of Emergency Physicians criticized Anthem’s recent moves to incentivize patients with non-emergent symptoms to seek care outside of the emergency department.

    Under Anthem’s policy, which is effective in several states, Anthem will review diagnoses after members’ emergency room visits. If the condition is determined to be non-emergent, Anthem may not cover the ED visit. Exceptions include ED visits for policyholders under age 14, patients with physician referrals to the ED, a lack of urgent care accessibility, and if the visit occurs on a holiday or Sunday when non-emergent facilities may be closed.

    ACEP responded to the policy change with a tongue-in-cheek video featuring three patients presenting to the ED with stomach pain. ED physicians then ask the patients which one has “simple diarrhea” or “a leaking abdominal aortic aneurysm‎ — a true, life-threatening emergency?”

    Paul Kivela, MD, president of ACEP, said, “Insurers cannot reasonably expect patients to know the difference” between emergent and non-emergent symptoms. Dr. Kivela argued Anthem’s policy is “unlawful” and the “‘prudent layperson standard’ is federal law and requires health insurance companies to cover emergencies visits based on the patient’s symptoms, not the final diagnoses.”

    Anthem previously said it will cover claims that meet the so-called layperson standard.

    In August, Anthem spokesperson Tony Felts told Becker’s Hospital Review claims submitted for non-emergent care will be reviewed by an Anthem medical director, who will consider the patient’s symptoms when he or she came to the ER and the diagnosis. In Indiana, where Anthem rolled out the policy this month, the insurer will use a list of about 300 codes it considers non-emergent, which the company developed with four board-certified ER physicians.

    Original article can be accessed here.

  • 11 Jan 2018 9:00 AM | AIMHI Admin (Administrator)

    CMS announced a new voluntary bundled payment model on Tuesday, which is the first advanced alternative payment model introduced by the Trump administration.

    Here are six things to know about the bundled payment model.

    1. The new model, called Bundled Payments for Care Improvement Advanced, includes 32 clinical episodes, with 29 in the inpatient setting and three in the outpatient setting. The clinical episodes may change in the future, as CMS may elect to revise them on an annual basis beginning Jan. 1, 2020.
    2. Under the program, provider payments will be based on quality performance during a 90-day episode of care. A clinical episode will begin at the start of an inpatient admission to an acute care hospital, which CMS referred to as the “anchor stay,” or at the beginning of an outpatient procedure, the “anchor procedure.” The clinical episode will end 90 days after the end of the anchor stay or the anchor procedure.
    3. CMS selected seven quality measures for BPCI Advanced. Two of them, the all-cause hospital readmission measure and the advanced care plan measure, will be required for all clinical episodes. The other five measures will only apply to select clinical episodes.
    4. BPCI Advanced will qualify as an advanced APM under the Quality Payment Program, meaning participants will be eligible for bonuses under the Medicare Access and CHIP Reauthorization Act.
    5. The first cohort of providers will start participation in the model Oct. 1, and the performance period will run through Dec. 31, 2023. Providers selected to participate in BPCI Advanced beginning Oct. 1 must be held accountable for at least one clinical episode and may not add or drop clinical episodes until Jan. 1, 2020.
    6. Providers have until March 12 to apply. CMS will provide a second application opportunity for BPCI Advanced in January 2020.

    Additional Info from the CMS Website:
    https://innovation.cms.gov/initiatives/bpci-advanced

    BPCI Advanced
    The Centers for Medicare & Medicaid Services (CMS) Center for Medicare and Medicaid Innovation (Innovation Center) is announcing a new voluntary episode payment model, Bundled Payments for Care Improvement Advanced (BPCI Advanced or the Model) that will test a new iteration of bundled payments for 32 Clinical Episodes and aim to align incentives among participating health care providers for reducing expenditures and improving quality of care for Medicare beneficiaries. BPCI Advanced will qualify as an Advanced Alternative Payment Model (APM) under the Quality Payment Program.

    The first cohort of Participants will start participation in the Model on October 1, 2018, and the Model Period Performance will run through December 31, 2023. CMS will provide a second application opportunity in January 2020.

    Background
    One of the most important goals at CMS is fostering an affordable, accessible healthcare system that puts patients first. A bundled payment methodology involves combining the payments for physician, hospital, and other health care provider services into a single bundled payment amount. This amount is calculated based on the expected costs of all items and services furnished to a beneficiary during an episode of care. Payment models that provide a single bundled payment to health care providers can motivate health care providers to furnish services efficiently, to better coordinate care, and to improve the quality of care. Health care providers receiving a bundled payment may either realize a gain or loss, based on how successfully they manage resources and total costs throughout each episode of care. A bundled payment also creates an incentive for providers and suppliers to coordinate and deliver care more efficiently because a single bundled payment will often cover services furnished by various health care providers in multiple care delivery settings.

    Model Overview
    BPCI-Advanced is defined by following characteristics:
    • Voluntary Model
    • A single retrospective bundled payment and one risk track, with a 90-day Clinical Episode duration
    • 29 Inpatient Clinical Episodes
    • 3 Outpatient Clinical Episodes
    • Qualifies as an Advanced APM
    • Payment is tied to performance on quality measures
    • Preliminary Target Prices provided in advance of the first Performance Period of each Model Year

    Can participate as a Non-Convener Participant:
    • Acute Care Hospitals (ACHs)
    • Physician Group Practices (PGPs)

    Can participate as a Convener Participant:
    • Eligible entities that are Medicare-enrolled providers or suppliers
    • Eligible entities that are not enrolled in Medicare
    • Acute Care Hospitals (ACHs)
    • Physician Group Practices (PGPs)

    A Convener Participant is a type of Participant that brings together multiple downstream entities, referred to as “Episode Initiators (EIs).” A Convener Participant facilitates coordination among its EIs and bears and apportions financial risk under the Model.

    A Non-Convener Participant is a Participant that is in itself an EI and does not bear risk on behalf of multiple downstream Episode Initiators.

    For a list of the 29 Inpatient Clinical Episodes, please see below:
    • Disorders of the liver excluding malignancy, cirrhosis, alcoholic hepatitis *
    *(New episode added to BPCI Advanced)
    • Acute myocardial infarction
    • Back & neck except spinal fusion
    • Cardiac arrhythmia
    • Cardiac defibrillator
    • Cardiac valve
    • Cellulitis
    • Cervical spinal fusion
    • COPD, bronchitis, asthma
    • Combined anterior posterior spinal fusion
    • Congestive heart failure
    • Coronary artery bypass graft
    • Double joint replacement of the lower extremity
    • Fractures of the femur and hip or pelvis
    • Gastrointestinal hemorrhage
    • Gastrointestinal obstruction
    • Hip & femur procedures except major joint
    • Lower extremity/humerus procedure except hip, foot, femur
    • Major bowel procedure
    • Major joint replacement of the lower extremity
    • Major joint replacement of the upper extremity
    • Pacemaker
    • Percutaneous coronary intervention
    • Renal failure
    • Sepsis
    • Simple pneumonia and respiratory infections
    • Spinal fusion (non-cervical)
    • Stroke
    • Urinary tract infection

    For a list of the 3 Outpatient Clinical Episodes, please see below:
    • Percutaneous Coronary Intervention (PCI)
    • Cardiac Defibrillator
    • Back & Neck except Spinal Fusion

    Quality Measures
    CMS has selected seven quality measures for the BPCI Advanced Model. Two of them, All-cause Hospital Readmission Measure and Advance Care Plan, will be required for all Clinical Episodes. The other five quality measures will only apply to select Clinical Episodes.

    • All-cause Hospital Readmission Measure (NQF #1789)
    • Advanced Care Plan (NQF #0326)
    • Perioperative Care: Selection of Prophylactic Antibiotic: First or Second Generation Cephalosporin (NQF #0268)
    • Hospital-Level Risk-Standardized Complication Rate (RSCR) Following Elective Primary Total Hip Arthroplasty (THA) and/or Total Knee Arthroplasty (TKA) (NQF #1550)
    • Hospital 30-Day, All-Cause, Risk-Standardized Mortality Rate (RSMR) Following Coronary Artery Bypass Graft Surgery (NQF #2558)
    • Excess Days in Acute Care after Hospitalization for Acute Myocardial Infarction (NQF #2881)
    • AHRQ Patient Safety Indicators (PSI 90)

    Original article can be accessed here.

  • 3 Jan 2018 12:00 PM | AIMHI Admin (Administrator)

    Talk about a New Year’s hangover. Healthcare—17.9% of the nation’s gross domestic product and still growing—will dominate the news in 2018 as it has for much of the past decade. It’s not shaping up as a good news story. Here’s why:

    1. The opioid epidemic will remain unaddressed. Drug overdose deaths soared to 63,632 in 2016, with two-thirds of those deaths opioid-related. Despite President Donald Trump declaring a national emergency, no money has been earmarked to fight the epidemic. Looming budget deficits from the new tax law mean little or nothing will be done about it in 2018.

    2. Life expectancy will fall for the third straight year. The average life-span fell to 78.6 years in 2016, down from 78.9 two years earlier. While opioid abuse and obesity get most of the blame, income and status inequality (as a famous British civil servant study showed) are also major factors. The new tax law will heighten income and status inequality.

    3. Medicare funding will get hit with new cuts. In the wake of the new tax law, the Balanced Budget Act will trigger “pay-go” rules, which will lead to a major political battle over the shape of seniors’ healthcare. Trump will not stick to his campaign promise to leave Medicare alone. He will side with the most conservative elements of the party and back new cuts.

    4. The ranks of the uninsured will grow. It won’t show up immediately, given the strong performance by the Affordable Care Act insurance exchanges during this year’s shortened sign-up period. But elimination of the individual mandate will lead to sharply higher individual rates for 2019, even if cost-sharing subsidies are renewed, and a rise in the nation’s uninsured rate.

    5. Hospital layoffs and closings will dominatethe news in many parts of the country. Job growth in the sector slowed dramatically in 2017, especially during the second half of the year. The outlook for 2018 is bleak. Admissions and lengths of stay continue to fall as more care moves to outpatient settings. Pressure to keep price increases low remains strong. Margins are narrowing.

    6. Drug price sticker shock will pummel payers, providers and patients. Every new advance in personalized medicine will have the unwanted side effect of six-figure and even seven-figure price tags. The drug industry will point to moderate growth in overall drug spending and justify prices using the life-preserving value of each new product. Imagine what seat belts and air bags would cost if the auto industry insisted on similar financial rewards for the deaths prevented by those safety features.

    7. Digital health and storefront medicine will remain molehills in the broader healthcare landscape. Apple, Amazon, Google and CVS will be revolutionizing the sector, according to their news releases. But changes in how people access and receive care will be small and incremental. Ditto on progress toward interoperable electronic health records.

    8. The growth of value-based reimbursement will slow dramatically. Look for new programs to emphasize go-slow, voluntary approaches.

    9. Republicans will make one last attempt toturn Medicaid into a block-grant program.Their thinking is that the cap on state and local tax deductions will heighten pressure in liberal, high-tax states to curb spending. The more likely outcome will be strengthened grass-roots movements in those states for single-payer systems.

    10. The November midterm elections will result in Democrats regaining control of theHouse of Representatives. While that will put an end to legislative assaults on the Affordable Care Act, reversing the damage already done will be impossible as long as Trump sits in the White House.

  • 2 Jan 2018 11:00 AM | AIMHI Admin (Administrator)

    1. Disruption got real. After years of speculation about who or what would become the “Uber of healthcare,” the tectonic plates of the industry shifted substantially in the past year — and there’s reason to believe this will only continue in 2018. A number of mergers illustrate the blurring line between healthcare and other industries, such as retail and insurance. Consider the combinations of CVS and Aetna or Optum and DaVita and Surgical Care Affiliates. As for what’s to come, Apple and Amazon have both shown interest in expanding their healthcare footprint. In fact, just last month, we reported Amazon was in talks to move into the EHR space.

    Executive’s takeaway: Executives grew skeptical of the term ‘disruptor’ when it was used as generously as it was circa 2011-2016. But now disruption is actually unfolding at a rapid clip, and executives are paying close attention to who/what poses the greatest threat to their business models.

    2. Hospital-insurer negotiations heated up. Previously, a health system and a commercial insurer occasionally hit a snag in the contract negotiation process, resulting in a dispute palpable enough to consumers that it warranted headlines. These impasses generally lasted a matter of weeks before outside pressure drove the parties to compromise. The nature of these conflicts has since changed. This past year brought regular coverage of strained provider-payer talks. In fact, we now do a weekly compilation of payer-provider disputes and resolutions to stay abreast of these conflicts as they occur and subside. In 2017, we saw lawmakers intervene in payer-provider disputes, a health system executive’s meant-to-be-private email about an insurance company go public, and a children’s hospital go out of network with a commercial insurer — affecting 10,000 kids.

    Executive’s takeaway: Health system executives are growing increasingly vocal with their thoughts about commercial insurers. In the past, executives took great lengths to observe discretion in these relationships. Now the gloves are off — or at least one is. We’re sure we haven’t seen the worst of a payer-provider dispute yet, but the number we see on a weekly basis, and their tone, indicates that disputes are both more frequent and more serious than in years past.

    3. Investments in value-based care, once a somewhat safe bet, became debatable. In a final rule issued in November, CMS officially canceled the hip fracture and cardiac bundled payment programs and rolled back some mandatory requirements in the Comprehensive Care for Joint Replacement Model. This will continue to have a ripple effect on payers, providers and health system strategy. For hospitals and health systems that made significant investments to support excellence under the program, this news is difficult to take — especially since no investment is made lightly amid thin margins. Although CMS says it is still committed to value-based care as a concept, the mandatory nature of the bundles program acted as a pedal-to-the-metal force that made hospitals act. Since commercial payers follow Medicare, the fate of the program will likely influence the adoption of bundles among private insurers, too.

    Executive’s takeaway: Most all executives tell us they want to be on the leading edge, not bleeding edge, of value-based care. Without a “do it or lose it” approach to bundles, the industry lost a major impetus toward value-based care, in which many health systems and physicians would take the plunge together. Providers have never had a clearly paved path for their “journey toward value-based care.” At best, it was a dirt trail. Now it could be compared to a dirt trail covered in snow. This leaves executives questioning the value of their current and future investments in value-based care.

    4. Big systems want bigger. Just when you thought you had a handle on what a “big” health system looked like in the United States, a few major players rewrote (or are attempting to rewrite) the playbook. After more than a year of talks, Catholic Health Initiatives and Dignity Health signed a definitive agreement in December to create a 139-hospital, $28.4 billion health system. Soon after came reports of St. Louis-based Ascension and Renton, Wash.-based Providence St. Joseph discussing a merger, which would result in a 191-hospital, $44.8 billion operation. Although both of these deals trail Oakland, Calif.-based Kaiser Permanente and it’s nearly $65 billion in revenue, they illustrate how the composition of nonprofit American health systems is continuing to change from local and regional entities to corporate national networks. For example, if Ascension and Providence combine, they will outsize the largest for-profit health system today — Nashville, Tenn.-based HCA Healthcare — which includes 177 hospitals in 20 states and Britain.

    Executive’s takeaway: Executives may want to reevaluate the oft-spoken phrase “all healthcare is local” in light of 2017’s M&A activity. Hospitals will continue to serve as economic engines in their respective communities, but the organization of health systems is moving in a direction where they are viewed as ubiquitous brands as opposed to regional hubs for health. For example, San Francisco-based Dignity and Englewood, Colo.-based CHI are basing the corporate headquarters for their new enterprise in Chicago. Ascension and Providence would have footprints in 27 states if they merge.

    5. Many health systems that were new players in the health plan business got out of it. Provider-sponsored health plans always carried a great amount of risk. Of the 37 health plans launched by hospitals and health systems since 2010, only four were found profitable in 2015, according to research published this past year by the Robert Wood Johnson Foundation. As major health insurers reduced their individual coverage options and rolled back from the public exchanges this year, we also saw several health systems decide to scale back or shut down their health plans. New Hyde Park, N.Y.-based Northwell Health shared plans in August to wind down its health insurance business, CareConnect, over the next year. Dayton, Ohio-based Premier Health is selling its health plan to Evolent Health, a Washington, D.C.-based value-based care platform. Louisville, Ky.-based Baptist Health plans to shut down its health plan operation in 2018. Late last year, Dallas-based Tenet Healthcare revealed plans to scale back its insurance business in 2017 after officials attributed lukewarm earnings to its health plan business.

    Executive’s takeaway: When even the big five health insurers — so well-equipped with analytic tools, data, infrastructure, utilization management experience and risk analysis talent — have a difficult time accounting for risk, it is not surprising many green health systems made their move for the door this past year. This is not an opportune time for health systems with little experience managing risk to build or buy a health plan.

    6. Activist shareholders shook up legacy hospital operators. Board room issues within the major for-profit hospital operators are typically opaque, but 2017 brought a rash of investor-prompted activity that resulted in ousted CEOs, overhauled boards of directors, poison pills and new governance rules. Tenet Healthcare underwent significant change in 2017 under intense pressure from its largest shareholder, Glenview Capital Management. When two Tenet board members, both employed by Glenview, resigned over what they described as “irreconcilable differences,” they made it known that Glenview would possibly “evaluate other avenues” to be a constructive owner of Tenet on or after Sept. 1. By Aug. 31, Tenet announced it would replace CEO Trevor Fetter, “refresh” the composition of its board of directors and implement a short-term shareholder rights plan. Mr. Fetter resigned in October, before a successor was named, after 14 years with the system. In August, an investor in Franklin, Tenn.-based Community Health Systems called for the resignation of CEO Wayne Smith, who has led the 127-hospital system since 1997, over what the investor described as missteps in strategy resulting in financial trouble for the system. At this time, Mr. Smith still holds his job, but CHS may be bracing for more investor activity. Chinese billionaire Tianqiao Chen has gradually been ramping up his stock in the hospital operator since 2016. At time of publication, he holds nearly 23 percent of CHS stock. Finally, directors of HCA Healthcare made a change in late 2017 to allow established investors to participate in the board seat nomination process, a move made in response to an activist investor.

    Executive’s takeaway: The fact that two of the largest U.S. for-profit hospital operators faced calls for CEO resignations in 2017 is part of a sweeping trend across industries in which activist investors start campaigns for change by targeting top management. Between January and May 2017, activist shareholders were responsible for ousting CEOs at three high-profile S&P 500 companies — American International Group, CSX and Arconic, according to The Wall Street Journal. Investors were attempting to oust six other CEOs in the same time frame. It’s worth noting that CEOs feel the heat at the launch of campaigns versus as a last resort. The WSJ characterized this trend as “a new level of aggressiveness for a group already known for its bold actions.”

    7. As the average health system C-suite grew, a few systems reduced administrative roles. While the number of practicing physicians in the U.S. grew 150 percent between 1975 and 2010, the number of healthcare administrators increased 3,200 percent in the same period. Yet in 2017, we saw a few major health systems go against the grain and not only lay off administrators, but eliminate their roles completely. In June, Houston-based MD Anderson Cancer Center eliminated executive vice president roles and gave senior vice presidents more focused areas of responsibility. Valley Medical Center, part of Seattle-based UW Medicine, got rid of the COO position in May, and Charleston, S.C.-based Roper St. Francis did the same in August. In December, San Diego-based Scripps Health shared plans to eliminate the CEO position in its four hospitals in favor of a regional CEO model.

    Executive’s takeaway: This past year contained several isolated incidents in which executive or administrative jobs were not immune from the financial pressures mounting on hospitals and health systems. There is reason to believe “right-sizing” (or at least reducing) administrative staffing at health systems will continue throughout 2018. Chris Van Gorder, president and CEO of Scripps Health, recently shared that layoffs at the system will likely include administrative and leadership roles while the system continues to hire caregivers. His reasoning, an excerpt of which follows, is applicable to many health systems today: “Healthcare is changing rapidly with huge growth in ambulatory care and reduced utilization of inpatient hospitals — and given the elimination of the individual mandate under the Affordable Care Act, the uninsured will once again be growing nationally. … We’ve got to shift our organizational structures around to be able to deal with the new world of healthcare delivery, find ways of lowering our costs significantly. If we don’t, we will not be able to compete.”

    8. Healthcare and the government failed to effectively communicate. In 2017, the opportunities for the Trump administration, Congress and healthcare leaders to convene about healthcare legislation and policy came and went. CEOs from the five largest nonprofit health systems in the country took pen to paper, urging President Donald Trump and Congress to meet with them and exchange ideas. In the end, the closest thing we saw to healthcare reform in 2017 were bills — the American Health Care Act, Better Care Reconciliation Act of 2017 (or Skinny Repeal package), the Graham-Cassidy healthcare bill — that received significant opposition from major healthcare stakeholders, which are not historically liberal. Yet even an avalanche of nays from the American Medical Association, American Hospital Association, Federation of American Hospitals, American Psychiatric Association, Association of American Medical Colleges and several other groups did not sway Congress. All but three Republican Senators voted to pass the Skinny Repeal package, illustrating how the partisan nature of our political process is overriding expertise and informed lawmaking.

    Executive’s takeaway: A bipartisan approach is the most effective way when attempting to redesign a $3 trillion industry that influences life-or-death decisions. These efforts also require input from a variety of seasoned healthcare experts who can challenge ideas, anticipate repercussions and identify blind spots. This holds true no matter which party holds control of the White House, Congress or both. Although healthcare stakeholders and government officials did not productively connect in 2017, health system leaders must persist in their attempts to influence public policy and exercise greater creativity in their advocacy efforts. Strategies that worked in the past can no longer be counted on in 2018 and beyond.

    9. Fed up, nurses walked off the job. While nurses’ strikes are not a novel event, there is a reason many demanded wider attention and transcended local business news to become national headlines. The most noteworthy strike of the year took place July 12, when approximately 1,200 nurses at Boston-based Tufts Medical Center began a 24-hour strike — the first nursing strike Boston saw in 31 years. Roughly 120 miles from Boston, approximately 800 nurses at Berkshire Medical Center in Pittsfield, Mass., participated in a one-day strike in October. Across the country in California, nurses organized rallies and protests at more than 20 Kaiser Permanente sites to protest what they called inadequate staffing levels. In September, nurses and other hospital personnel unionized with SEIU walked off their jobs at Riverside University Health System – Medical Center in Moreno Valley, Calif., for three days. The county footed the $1.5 million bill for temporary replacement nurses for those 72 hours. Speaking of a bill, Minneapolis-based Allina Health tallied the costs of two 2016 strikes — one lasting six weeks — called by the Minnesota Nurses Association. The system put the figure in the ballpark of $149 million, which anchored Allina’s operating loss of $30 million for fiscal year 2016.

    Executive’s takeaway: Although it is tempting to reduce labor strikes to events fueled by local market forces and politics, hospital and health system executives should pause and consider that striking nurses’ arguments — that they are expected to work demanding jobs with too few staff, resulting in unsafe conditions, high stress and burnout — is a description that applies to many, if not most, U.S. hospitals. Gender dynamics may also wield greater influence on administrator-nurse affairs in the coming year. As the nation comes to terms with troubling events that went unaddressed after women’s claims and voices were not met with the attention they deserved, health system executive teams are wise to change the approach taken in years past and pay closer attention to the female-dominated field of nursing. As one representative with the MNA told The Nation: “[Management is] a male institution thinking they can snub 1,200 women and pretend their opinions about healthcare don’t count.”

    10. The year healthcare became very, extremely, incredibly difficult. Was any component of healthcare ever easy? Those who have spent years in the industry would say no. Yet 2017 was the year in which officials and lawmakers reminded the American public that healthcare is complicated. While true, this narrative functioned as a sound bite to normalize Congressional dysfunction.

    Executive’s takeaway: What’s concerning here is whether this throwaway statement will make its way from Capitol Hill to hospital board rooms, executive offices, clinician lounges and medical school lecture halls and, over time, nurture a climate that fosters and condones inaction. It is unproductive to constantly point out the complicated nature of healthcare and/or bask in this acknowledgement. To do so is not the behavior of an effective leader. It goes without saying that healthcare is complicated. Healthcare is also necessary, expensive, life-saving, honorable, slow, inaccessible, urgent, flawed, and never going away. What are you doing to make it better?

  • 2 Jan 2018 7:00 AM | AIMHI Admin (Administrator)

    San Diego will try something new in its uphill battle to shrink emergency response times in the sprawling and increasingly congested city: roving “peak-hour” fire engines not connected to any station and deployed at busy times in busy areas.

    City officials say they plan to add six peak-hour engines – three in July 2019 and another three in July 2020 – to help meet a goal of having emergency crews arrive at the scene within seven and a half minutes 90% of the time.

    Fire Chief Brian Fennessy said this month that the city is meeting that goal about 79% to 80% of the time, predicting the peak-hour engines could significantly boost that.

    The engines will operate with four-man crews from 9 a.m. to 9 p.m. each day in areas where response times have been weak, or where regular crews are not available because of training.

    City officials say it’s crucial to have peak-hour engines during late afternoon and evening commute hours, when emergency calls are typically at their highest volume.

    To fully staff all six engines, the city plans to hire 48 additional firefighters at a cost of $6.3 million per year. No capital costs are anticipated because the city has several reserve engines it can use.

    Fennessy stressed that peak-hour engines are not a substitute for new fire stations in key geographic locations, which he called the ultimate solution to the city’s response time struggles.

    “I’ve never considered serving any of the fire station gaps with peak-hour engines instead of, rather than in addition to, fire stations,” Fennessy told the City Council this month.

    Peak-hour engines, however, can shrink response times in areas where new fire stations are badly needed, but where construction has been delayed by lack of money or other problems.

    Fennessy said an example is a planned station on the edge of City Heights that outside consultants Citygate called San Diego’s No. 1 response time priority in reports published in 2011 and 2017.

    City officials considered seven potential locations in the area before buying a Fairmount Avenue site in May that has significant environmental hurdles.

    Those issues have prompted city officials to estimate construction of the three-story station won’t begin until fall 2020, frustrating nearby residents and community leaders.

    Councilwoman Georgette Gomez, who represents many of the neighborhoods the station would serve, said it’s baffling that a consultant’s report called for a new station there in 2011 and the city is still three years away from construction.

    Fennessy said land in the area is scarce and some other potential sites wouldn’t have had as great an impact on response times in the area.

    He said, however, that a peak-hour engine would be ideal for the area until the new station opens.

    Other parts of the city likely to be considered for peak-hour engines, based on the 2017 consultant’s report, include Pacific Beach, south University City, Torrey Pines, Rancho Bernardo, Sabre Springs and southeastern San Diego.

    Three areas with weak response times slated to get new fire stations are north University City in 2020, Black Mountain Ranch in 2021 and the UC San Diego campus in 2022.

    Additional new stations include one already under construction in Little Italy and one planned in the Otay Mesa area.

    Peak-hour engines will save the city money compared with quickly filling all of the 12 emergency-response gaps identified by the consultant, Fennessy said.

    The savings go beyond just the cost of building 12 new stations at roughly $15 million per station. Staffing a new station typically adds about $2 million per year to the city’s budget on an ongoing basis.

  • 27 Dec 2017 6:00 AM | AIMHI Admin (Administrator)

    https://www.beckershospitalreview.com/patient-flow/allegheny-health-network-to-shutter-hospice-unit.html

    Pittsburgh-based Allegheny Health Network will close its nine-bed inpatient hospice unit at its West Penn Hospital, which is also in Pittsburgh, Jan. 25, according to the Pittsburgh Post-Gazette.

    Hospital officials attributed the closure to a declining demand for inpatient hospice services and an increasing demand for home hospice care.

    “Patients are getting on hospice sicker than ever and living less long,” Robert Hebert, MD, CMO of Allegheny Health@HomeHospice, told the Pittsburgh Post-Gazette.

    “A large minority of our patients die within a week — almost half of them — and when they go home [after a hospital discharge], people want to stay home. They don’t want to make one more move.”

    After the closure, the hospital will focus on expanding its at-home hospice services. AHN intends to hire a nurse practitioner and establish a care coordination position to ensure patients are properly cared for during at-home visits.

    AHN will still offer inpatient hospice services at its other hospitals across Pittsburgh, according to the report.

  • 20 Dec 2017 7:00 PM | AIMHI Admin (Administrator)

    To say that it has been a tumultuous year for the healthcare industry is an understatement. Federal policy changes and recent transactions involving large insurers, health systems and retailers will affect providers, payers and patients alike.

    While there are many new and emerging trends we need to pay close attention to in 2018, here are what I think are the four most significant issues that will command our attention in the year ahead.

    1. Inconsistent healthcare policy will continue to dominate the headlines
    The federal debacle with so-called healthcare reform this year has been a case study in confusion, inefficiency and lack of focus. Every week seemed to bring a new twist in the direction of healthcare policy, especially in regards to the ACA, with almost no consistency to the legislative thought process. In many ways, the whole focus of ACA repeal and replace efforts was misguided — you can’t take something apart without some ideas for a replacement. The federal government’s lack of direction on healthcare policy has created chaos among all industry players.

    Given the healthcare provisions in the proposed tax bill and potential future action with the ACA, there are serious implications for states across the country. The confusion surrounding Medicaid and other joint federal-state partnerships has discombobulated state budgets, and it is patients who will ultimately face the harshest consequences if states are forced to slash funding for healthcare.

    For the foreseeable future, we’re going to continue to see inconsistency in government policies and funding. This is especially dangerous for hospitals in underserved communities that rely almost exclusively on Medicaid and Medicare funding. Unless they are supported in some way, many of these providers will sink deeper into debt.

    2. In order to keep pace with newly formed organizations and partnerships, hospitals and health systems need to innovate
    The CVS-Aetna deal did not come as a surprise to industry leaders who have been keeping their ears to the ground and have paid attention to recent trends. But nevertheless, this merger is a major shake-up that cannot be ignored. Google, Amazon and IBM Watson are all looking to stake out a piece of the healthcare field, and deals such as Optum’s purchase of DaVita Medical Group underscore the ever-evolving nature of the ways people access and pay for care and services. Providers should not view this movement as a threat that must be stopped. Instead, we should spur innovation on our end. We can’t sit still. That’s why, in Northwell Health’s case, we have been forging new partnerships and pursuing ventures that will enable the organization to compete more effectively in this rapidly changing environment.

    It will be especially intriguing to see what market segments CVS and Aetna pursue after the merger is finalized. Undoubtedly, they will offer prescriptions, preventive care and other primary services to supplement CVS’ “Minute Clinics,” but it remains to be seen what other health services will be provided as part of this new collaboration.

    Regardless of what new competitors enter the healthcare market, the seriously ill, elderly patients with chronic conditions and those who have suffered traumatic injuries will still be relying on hospitals to take care of them. It’s highly unlikely that any of the new players will be providing inpatient care. As we all know, the bulk of healthcare funding is spent on long-term care for people at the end of life. The Amazons and Googles of the world are not targeting that population.

    Recognizing that traditional healthcare providers do need to adapt to this era of consumerism, among my strategies are to continue expanding our ambulatory network, facilitating innovative partnerships, enhancing efforts in prevention, maximizing our use of artificial or augmented intelligence, and improving our already robust telemedicine program.

    In the end, I believe competition is good. Market disruptions give all of us headaches, but they are ultimately beneficial because they force us to do better and be more efficient, productive and creative

    3. Unless we continue to improve the customer experience, customers will go elsewhere for care
    The more competitive the market becomes, the more work we as providers must do to continually improve the patient experience and develop customer loyalty. This can partly be done through improving communication and curating a more retail-focused experience.

    This is unbelievably important, as patients now have more access and choice for their healthcare than ever before. This is not limited to the in-person experience, but also how hospitals and health systems communicate with patients to help them get information and make appointments. Online and mobile platforms are already important for engaging customers, and they will only grow more essential in 2018.

    Online engagement is not only for younger patients. It’s a medium that has become increasingly more effective than print or broadcast advertising for reaching older patients. Equally important is creating an experience that connects families with providers. We deliver more than 40,000 babies every year in our health system. Those are 40,000 families with whom we could be creating life-long bonds. Pursuing initiatives to maintain a connection with mothers and families is essential.

    Over the past five or six years, we’ve seen major changes in the way innovative organizations in all industries treat their customers. For far too long in our industry, there was a pervasive attitude of, “We’re hospitals, or we’re physicians, people will always come because we’re here in the community,” but those days are over. Consumers don’t want to be told when to come or what to do – they want to access care and services on their terms, not ours. We are in the consumer service business, and our patients are educated and knowledgeable. They value easy access, a pleasant experience and quality care, so it’s our job to adapt quickly to meet their needs and expectations.

    4. Strategies about “healthcare” must now encompass behavioral and mental health
    As social stigmas surrounding mental health begin to break down and more people feel comfortable confronting behavioral health issues, it is the responsibility of providers to design their systems in a way that addresses the needs of these individuals. This is especially important at a time when opioid abuse has become one of this nation’s most-challenging public health crises.

    The problem goes beyond drug and alcohol abuse. For instance, studies have shown that younger generations’ increased use of technology, particularly mobile devices, can lead to increased rates of anxiety, depression or loneliness. We as providers must consider these trends and tailor services accordingly, as more and more patients turn to us seeking care for issues that are destroying lives and breaking up families. All of us need to do a better job developing and training staff to meet this demand, especially when it comes to screening those who are trying to hide their addictions to opioids. It entails not only psychiatrists but nurses, social workers, case managers and other clinicians.

    Regardless of the issues we face in this ever-evolving industry, we as providers must not resist change. We must continually adapt — those that don’t will get left behind.

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