News & Updates

Payment and care delivery innovation have long held bipartisan political support, the Health Care Transformation Task Force said Tuesday.

The Health Care Transformation Task Force called on the incoming Trump administration in a letter sent Tuesday to continue efforts to replace fee-for-service payment models with value-based care.

The task force, which includes patients, payers, providers and purchasers in its ranks, notes in the letter (PDF) that payment and care delivery innovation have long held bipartisan political support, and asked that President-elect Donald Trump, Vice President-elect Mike Pence and leaders in Congress make it clear to the industry that the support will continue.

“Given the significant industry investment and strong progress to date, we urge the new Administration and Congress to send signals of support and encouragement so this transition can be sustained,” the task force wrote. “This is not the time for policymakers to waiver [sic] or reverse course, which would send a negative message to the industry and chill ongoing transformation efforts.”

The consensus of the task force’s 43 member organizations—which includes six of the 15 largest health systems in the country and big-name payers such as Aetna and Blue Shield of California—is reflected in the letter. As healthcare costs continue to soar, the high expense becomes unsustainable for both businesses in the industry and consumers, they wrote, and the letter offers several key ways the incoming administration can show its commitment to lowering healthcare costs.

The task force’s work is an example of the individual private sector leadership that Trump and Republicans have extolled, they wrote, but despite individual groups working hard to continue transforming care delivery and payment models, progress will be stymied if the Centers for Medicare & Medicaid Services doesn’t also signal that it is on board.

Sustainable value-based payment models are only possible “by aligning private sector and public sector efforts,” according to the letter. Policymakers can remove red tape hindering the private sector to improve this, they wrote, but that alignment is key. In particular, they point to the Center for Medicare & Medicaid Innovation as a source—a public-sector entity that has made great strides in payment and care delivery transformation.

A likely decrease in regulations under Trump and a Republican-controlled Congress may help foster other industry innovation as well.

Original article can be accessed here.

In medical emergencies, patients have few alternatives to calling 911 or rushing to the emergency department for costly care. That’s the status quo, but a growing number of providers, payers and agencies are testing care approaches that help patients in novel and proactive ways.

One of these approaches is mobile, integrated healthcare. Teams made up of a mix of clinicians are available 24/7 to attend to patients’ needs—outside the hospital and in person or by video chat, phone or text message, whether there’s an emergency or not. Evidence suggests this approach can improve patient outcomes and lower costs, although putting it into practice presents considerable challenges.

“There is significant, potentially avoidable cost in most populations, and it can be identified if you choose to look for it,” said Dr. Eric Beck, CEO and president of Evolution Health, a population health management company that managed such a program in Florida. A preliminary study of that program, carried out among members of a Medicare Advantage PPO, was recently published by Beck and other researchers in the Journal of Health Economics and Outcomes Research.

The study showed a 19% decrease in monthly emergency room costs per patient and a 21% decrease in emergency department utilization among the roughly 1,000 patients enrolled in the model, compared to a control group. Patients also appeared to be more engaged and active in managing their health. A larger, forthcoming study will include 60,000 patients.

The program in Florida began with specifying high-risk, high-cost patients for whom interventions would most likely have an impact. The patients in the study represented between 9% and 12% of the entire Medicare Advantage membership and more than half of its costs.

Those patients received planned and unplanned care from physicians, nurses, paramedics, pharmacists, social workers and other providers. A patient with a chronic illness, for instance, would have a care plan that included coaching, appointment follow-ups and medication adherence through home visits and weekly phone calls.

Such regular contact is supposed to help patients manage chronic diseases by ensuring they receive timely preventive care. And if they do have emergencies, they can call the team.

Previous studies have suggested that as many as 27% of all emergency department visits could be handled safely at sites such as urgent-care centers, with annual savings estimated at $4.4 billion. From 2009 to 2010, people over the age of 65 made 19.6 million visits to emergency departments, or 15% of all such visits, despite making up 13% of the overall population.

The National Association of Emergency Medical Technicians has described mobile integrated healthcare and community paramedicine as an innovation with “the potential to transform EMS” into “a value-based mobile healthcare provider that is fully integrated” with healthcare and social services. The association estimated in 2014 that 103 EMS agencies had such programs with more agencies developing them.

For hospitals and health systems, these programs require considerable amounts of time, resources and energy to build. Having the right financial incentives and revenue models are key. For the growing number of providers moving into bundled payment programs and other CMS demonstration projects that hold them financially accountable for patient outcomes, a mobile, integrated program might prove particularly appealing.

“It’s not for organizations that aren’t strategically interested in making an investment to do that at scale,” Beck said.

Another challenge is preparing personnel and training clinicians.

“How do you bring together a team?” Beck said. “How do you take paramedics and nurses and physicians, and how do you prepare them for virtual, mobile, 24/7 delivery? It’s a new mental model that needs to be familiar to the patient but to the clinician as well.”

Original article can be accessed here.

A visit from a primary care clinician that focuses on following up on treatment plans after a patient’s discharge from a hospital stay lowers the risk of readmission.

A study by Kaiser Permanente found that tailored post-hospital visits lowered readmissions for Medicare Advantage patients. The 20-minute visits are scheduled for patients while they are still in the hospital and focus specifically on follow-up treatment plans, according to the study published in JAMA Internal Medicine. In contrast, regular outpatient visits by a primary care clinician may focus on routine care and not cover specific issues related to the recent hospitalization.

Researchers reviewed the electronic health records of more than 71,000 Medicare Advantage patients discharged from 14 Kaiser Permanente hospitals from 2011 to 2014. The study found patients who had one or more visits within seven days of being discharged home were 12% to 24% less likely to be readmitted to the hospital than those who did not have an outpatient visit from a clinician.

Patients who had a visit tailored to address their post-discharge treatment plans—called a POSH visit—were 28% less likely to experience readmission.

“Although any primary care clinician outpatient visit appeared to reduce readmission risk compared to no outpatient visit, the POSH visit provides the added benefit of the care team being alerted to, and therefore better prepared to address, patients’ post-discharge needs,” Ernest Shen, Ph.D., research scientist biostatistician at the Kaiser Permanente Southern California Department of Research & Evaluation, said in an announcement.

The POSH visits focused on a patient’s immediate post-discharge needs and allowed the clinicians to assess the person’s clinical status, determine if more intensive treatment was needed, follow-up on test results and referrals, review medications and provide patient and family education.

The research is important as one analysis projected more than half of U.S. hospitals would be penalized for excessive 30-day readmission rates this year, with Medicare withholding more than half a billion in payments.

Original article can be accessed here.

Shares in Lewisville-based Adeptus Health took a major hit Wednesday after the nation’s largest operator of freestanding emergency rooms reported an $11.7 million loss in the third quarter.

The loss was attributed to high fixed costs that resulted in continued decline in patient volumes at facilities that are not hospital-affiliated. Adeptus refers to those facilities as non-hospital outpatient departments.

The company also surprised analysts by disclosing it needed to secure $27.5 million in emergency financing from investors.

Adeptus shares fell about 3 percent to $26.87 a share on Tuesday, but tanked on Wednesday. It closed down 68 percent to $8.60 a share.

The company’s low patient volume was coupled by billing and collection issues, and expenses associated with opening three new hospitals, which are planned for the end of the year.

Leadership admitted frustration during a call with analysts after the market closed Tuesday.

“Let me be clear, third quarter results were disappointing and are not acceptable operating results,” chief financial officer Frank Williams told analysts. “While our business is currently underperforming, we have put in place plans … that will allow us to correct this underperformance.”

Analysts were less optimistic, describing it as a “distressed situation” and noting that without emergency financing Adeptus has enough cash to fund just two additional quarters of operations. Volume dips and cost scrutiny could hamper any possibility of aggressive expansion, noted equity analyst Brian Tanquilut said in his report on Wednesday.

Cedrick Dark, an emergency medicine physician at the Baylor College of Medicine in Houston who also works in hospital-affiliated freestanding ERs, said the freestanding model will continue to face challenges, but not just with low volumes.

“Facility fees” designed to help freestanding ERs cover their overhead are a major concern for patients who show up for medical issues that could be handled at urgent care.  “They’re getting emergency room sized bills,” Dark said.

Freestanding ERs must provide access to doctors, lab testing, nurses, radiologists, and other staff all day, every day.

“It’s not cheap to do,” he said. “The facility fee helps pay for all that. Without it, the model’s not going to financially be viable.”

The proliferation of freestanding emergency facilities in the U.S. also has increasingly been met with criticism by health policy researchers.

They worry that locations are cropping up in wealthy communities and may not be regulated by the same standard that has prevented hospitals from dumping people who cannot afford to pay. Patients have also complained about their confusion over whether services are covered by insurance.

Operators of the facilities, on the other hand, call it an industry of demand. They argue the facilities provide a convenient alternative to affluent patients who do not want to wait in crowded hospital emergency rooms.

Adeptus operates more than 90 freestanding emergency rooms in the United States. In Texas, where growth has been the fastest, Adeptus runs First Choice Emergency Room locations in Dallas-Fort Worth, Austin, San Antonio and Houston.

Patients who are willing to pay higher prices provide the greatest revenue per visit given the company’s high fixed cost model, Williams said.

“Our predominantly fixed cost model has a fairly direct impact on our bottom line,” he told analysts.

The biggest impact was in Houston, its largest market. The company reported “a decline of approximately 2,000 mainly lucrative commercial patients quarter over quarter.” Over 15,200 patients were seen in Adeptus ERs in that market in the third quarter, and the majority of the facilities there became affiliated with hospitals in October.

Other markets that experienced drops in volumes were San Antonio, where 2,578 patients were seen in the third quarter, and Austin, which had a patient volume of 2,644. “These are small markets and less significant to the bottom line,” Williams said. “But still an impact in excess of $2 million for the combined markets.”

The third quarter results were a significant change from the previous quarter, when Adeptus saw operating revenue increase 12 percent to $100.2 million, which it attributed to its affiliations with hospitals. Operating revenue in the third quarter was $85.4 million.

On Tuesday, the company again noted positive results from hospital-affiliated outpatient departments. Patient volume rose 39.3 percent at hospital-affiliated emergency departments and dropped 19.1 percent at those that were not.

Adeptus has been seeking partnerships to bolster hospital relationships.

Texas Health Resources

Texas Health Resources, an Arlington-based health system, began rebranding 31 of Adeptus’ North Texas freestanding emergency facilities and one hospital with its logo in September.

ER volumes in the Dallas-Fort Worth market in the third quarter topped 37,000 patients. Chief operating officer Graham Cherrington said the THR affiliation has “already been a positive impetus.”

Adeptus has opened 21 new freestanding ERs and two hospitals this year alone, and has plans to add three more. That would bring its total to 104 ERs, most of which will be hospital-affiliated.

It also plans to open hospitals in Denver, Houston and Colorado Springs by the end of the year.

In light of the disappointing quarter, Adeptus leadership plans to focus on affiliating facilities with hospitals that do not have those relationships. It also plans to address issues with billing and collections, and scale back on expansion.

The company went public in June 2014 at $23.30 a share. Its share price peaked at $115.68 in September 2015.

Original article can be accessed here.

More than 1,600 hospitals will see bonuses from Medicare in 2017 under the Hospital Value-Based Purchasing program, according to federal data released Tuesday. The number earning positive pay adjustments is about 200 fewer than last year.

The program affects some 3,000 hospitals, which are penalized or rewarded based on how well they perform on certain quality measures. A hospital’s performance is assessed in comparison to its peers’ and to its own performance over time.

The results are “somewhat concerning,” said Francois de Brantes, executive director of the Health Care Incentives Improvement Institute. One reason was the fact that fewer hospitals are being rewarded. Another was hospitals’ lack of movement in rankings.

Search the results:

Search by hospital and location to see the bonuses and penalties for 2017 compared with 2016.

The payment increases add up to about $1.8 billion for 2017. To create the pool for the bonuses, the CMS imposed a 2% reduction to base DRG payments for hospitals paid under the Inpatient Prospective Payment System. Medicare redistributes that money to hospitals based on their performance on patient surveys and quality and efficiency measures. They earn two scores—one for achievement and another for improvement.

For about half of the hospitals in the program, the changes to base DRG payments will be minimal, in the range of 0.5 to -0.5%. The highest performing hospital will receive an increase slightly more than 4%, while the lowest performing hospital’s payment will be cut 1.83%, CMS said.

The number of hospitals whose payments were docked grew from 1,236 in 2016 to 1,343 in 2017, according to a Modern Healthcare analysis of the data. Last year, 59% of hospitals received bonus payments; this year 55% did.

More than half of the 2,879 hospitals in the program both years will see lower payment adjustments in 2017 than in 2016. Payments improved for 1,388 of those hospitals.

About 1,250 hospitals earned bonuses both years and 875 were hit with penalties both years. By comparison, 437 hospitals that earned bonuses last year were docked in 2017, and 315 hospital penalized in the last round will receive bonuses next year.

The Hospital Value-Based Purchasing Program contains inherent design flaws, de Brantes said. As a “tournament-style” program in which hospitals are stacked up against each other, they don’t know how they’ll perform until the very end of the tournament. “It’s not as if you have a specific target,” he said. “You could meet that target, but if everyone meets that target, you’re still in the middle of the pack.”

The Hospital Value-Based Purchasing program went into effect in October 2012. It was established under the Affordable Care Act as one of many initiatives to pay for healthcare on the basis of quality, not quantity.

The Inpatient Prospective Payment System excludes specialty hospitals such as psychiatric institutions, oncology centers and pediatric facilities; hospitals that do not have a minimum number of cases; and hospitals that don’t participate in the Hospital Inpatient Quality Reporting Program.

The CMS also announced several changes to the program for fiscal 2018. The four domains on which hospitals are scored—clinical care; patient- and caregiver-centered experience and care coordination; safety; and efficiency and cost reduction—will be weighted equally. The program previously allotted 30% to clinical care and 20% to safety.

For 2018, the CMS also removed two measures from clinical care and added a care transition dimension.

The results show “how progress on quality can be accelerated when pay-for-performance programs reward both achievement and improvement,” said Nancy Foster, the American Hospital Association’s vice president of quality and patient safety policy. “However, CMS must continue to refine the program to ensure that it effectively drives quality forward for hospitals and the patients they serve,” she added, including ensuring its measures prioritize areas with the greatest impact on patient care.

Original Article can be accessed here.

Fort Worth, TX – October 31, 2016 – For the past two years, 28 stakeholder organizations and 65 program agencies have participated in the development of measures designed to help EMS agencies create and evaluate community paramedic and nurse triage programs.  Countless task force and workgroup meetings, national webinars, discussions at national meetings and national EMS conferences, and over 50 formal recommendations for enhancements were received during the project term. The project development team is today releasing to the internal and external EMS stakeholders the final outcome measures document and a toolkit for EMS stakeholders.  These tools create the first set of standardized measures to evaluate, benchmark and publicly report the outcomes of EMS-Based Mobile Integrated Healthcare (MIH) programs.

“A high level official at CMS recommended that the EMS industry measure and report outcomes consistently across programs in order to demonstrate the safety and efficacy of EMS-Based MIH programs” explained Dan Swayze, Vice President, Center for Emergency Medicine of Western Pennsylvania, Inc., and a member of the measures core team.  “After two years of incredible work by countless experts, we feel confident that the measures in our document provide a good foundation on which to build the evidence base for MIH programs.”

Brenda Staffan, also a core team member and the Director of New Ventures for the Regional Emergency Medical Services Authority in Reno, Nevada explains, “We focused on the measure domains that payers and other stakeholders most often request: Program Integrity, Patient Safety and Quality, Experience of Care, Utilization and Cost of Care, and Balancing.  The measures for the Community Paramedic and 9-1-1 Nurse Triage interventions were developed first because these were the most common interventions being implemented in most MIH programs.”

“Our goal in releasing these standardized measures is for agencies, payers, accreditation organizations and other stakeholders to evaluate program results more consistently.  This will help demonstrate not only the value of these programs, but also allow agencies to find opportunities for improvement by comparing their results to other programs across the country”, said Matt Zavadsky, core team member and Chief Strategic Integration Officer for MedStar Mobile Healthcare in Fort Worth, Texas. “We also want to give special thanks to Anne Jensen, Program Manager for the San Diego RAP Team, for developing an accompanying worksheet that programs can use to enter and calculate the impact of their program and that we can use to establish industry benchmarks.”

Commenting on the process of the measures development, Gary Wingrove, Government Relations Specialist for Mayo Clinic Medical Transport in Rochester, Minnesota, and President of the Paramedic Foundation states “This is one of the most collaborative processes I’ve had the pleasure of being a part of.  We’ve had participation from almost every national EMS association, multiple provider agencies, institutes of higher learning, and healthcare quality organizations such as the National Committee on Quality Assurance, (NCQA), the Institute for Healthcare Improvement (IHI), the Agency for Healthcare Research and Quality (AHRQ) and CMS Quality Innovation Networks.  It has been an incredible team effort that will continue as we develop additional outcome measures for interventions such as Ambulance Transport Alternatives and process measures for Community Paramedic and 9-1-1 Nurse Triage programs.”

Speaking on behalf of the project leadership team, Brian LaCroix, President of Allina Health EMS, in St. Paul, Minnesota thanked all the experts who have been, and continue to be, part of this important project for EMS agencies. “The amount of time invested not only by the core team but so many participants in the process has been incredible.  Agencies from every corner of the country and external stakeholders such as Kaiser Permanente, the National Rural Health Association, and even EMS program support partners such as Zoll, Intermedix, ESO Solutions and ImageTrend have been involved in this process.”

The Program Structure, Community Paramedic and 9-1-1 Nurse Triage outcome measure documents, the workbook tool for data entry and the complete listing of the agencies and people involved in the measures project are included with this release.  They are also available on the National Association of Emergency Medical Technician’s MIH-CP Program Toolkit.

Commenting on the next steps in this process, Zavadsky explains, “As we continue to develop additional outcome and process measures, we will also be working with selected associations, national measures organizations, or accrediting bodies, to determine the best options for hosting the measures and/or the data collected through this process, as well as the process for updating the measures as programs continue to evolve.”

From ACA mandates to baby boomers rapidly switching to Medicare, there are a number of factors influencing healthcare costs in the U.S.

Here are 25 things to know about those costs.

The difference between costs, charges and payments
1. Before delving into an analysis of healthcare costs, it is critical to understand the difference between healthcare costs, charges and payments. Hospital charges are essentially their list prices for medical services, which are different from hospitalization costs, or the actual amount of money insurers, patients or the government end up paying hospitals in exchange for services.

2. Hospital input costs are the costs a hospital incurs to provide care to a patient. This includes both variable costs (salaries of clinicians and costs of supplies and medications) and fixed costs (overhead expenses and cost of equipment, land and buildings), according to a report from The Advisory Board Company.

3. The prices on a hospital’s chargemaster bear little relationship to the amount most patients are asked to pay. That’s because commercial insurers negotiate discounts with healthcare providers on behalf of their members, and Medicare and Medicaid set fixed payment rates for hospital services, which are often less than the actual cost of care. Additionally, most hospitals allow low-income patients to receive free care or care for a reduced charge.

4. Hospital list prices aren’t completely irrelevant, however, as they usually serve as a starting point for negotiations with commercial payers.

5. Hospitals may use chargemasters to boost their finances. A study published in the September issue of Health Affairs suggests hospitals were using chargemaster prices to drive up revenue in 2013.

National healthcare spending
6. National healthcare spending grew 5.5 percent in 2015, reaching $3.2 trillion, according to estimates from CMS’ Office of the Actuary published in July.

7. This growth marks an increase from 2014, when rapidly rising drug prices and health insurance expansion under the ACA drove spending upward 5.3 percent.

8. National healthcare spending is expected to grow at an average annual rate of 5.8 percent over the next decade, according to CMS.

9. From 2015 to 2025, health spending is projected to grow 1.3 percentage points faster than gross domestic product.

Medicare, Medicaid and CHIP spending
10. Spending for the major government healthcare programs will rise by nearly $55 billion, or about 6 percent, in 2016, and Medicare will account for more than half of that increase, according to budget projections from the Congressional Budget Office.

11. Outlays for the Medicare program are expected to increase by $30 billion, or 6 percent, this year, with growth largely driven by increased spending per person on prescription drugs.

12. Medicaid outlays are expected to increase by $15 billion, or 4 percent, this year. The CBO anticipates Medicaid enrollment will be roughly flat in 2016.

13. The CBO estimates outlays for the Children’s Health Insurance Program will climb $5 billion this year, to $14 billion.

Prescription drug costs
14. Prescription drug spending increased 12.2 percent to $297.7 billion in 2014, faster than the 2.4 percent growth in 2013, according to CMS.

15. Inpatient hospital drug costs increased by an average of 38.7 percent per admission between 2013 and 2015, according to an analysis from the independent research organization NORC at the University of Chicago.

16. According to a Kaiser Family Foundation poll, 82 percent of Americans want the federal government to negotiate with drug companies to get lower prices on medications for Medicare beneficiaries.

17. Seventy-eight percent of Americans support limiting the amount pharmaceutical companies can charge for high-cost drugs for illnesses like hepatitis or cancer, according to the KFF poll.

Out-of-pocket healthcare costs
18. In recent years, patients have become increasingly responsible for a greater share of their healthcare expenditures due to changes in health insurance policies.

19. Out-of-pocket spending on healthcare costs increased 2.1 percent in 2013. Due to expanded coverage through Medicaid and private insurance, out-of-pocket healthcare spending growth slowed to 1.3 percent in 2014, according to CMS.

20. In 2009, annual out-of-pocket spending on hospital care was $25.6 billion, according to the Peterson-Kaiser Health System Tracker. Out-of-pocket spending on hospital care steadily increased over the next three years, reaching $32.7 billion in 2013.

21. Annual out-of-pocket spending on hospital care fell 4.1 percent to $31.4 billion in 2014.

22. Out-of-pocket spending on prescription drugs increased 2.7 percent to $44.7 billion in 2014, according to CMS.

Costs broken down by hospital type
23. The average cost per inpatient day in 2014 at state/local government hospitals was $1,974, according to the latest statistics from Kaiser State Health Facts. That’s up from $1,878 per inpatient day in 2013. These figures are an estimate of expenses incurred in a day of inpatient care and are adjusted higher to include an estimate of the volume of outpatient services, according to Kaiser State Health Facts.

24. The average cost per inpatient day in 2014 was $2,346 at nonprofit hospitals, compared to $2,289 per inpatient day the year prior.

25. The average cost per inpatient day at for-profit hospitals in 2014 was $1,798, up slightly from $1,791 per inpatient day in 2013.

Original Article can be accessed here.

We’re so excited to partner with FirstWatch to bring you our first webinar introducing our rebranding (formerly the Coalition of Advanced Emergency Medical Systems (CAEMS), that highlights high performance EMS systems’ focus to highlight the rapidly transforming role of EMS agencies across the United States and Canada.

This first of its kind webinar introduced over 100 participants to AIMHI and its mission, and explain the concepts of High Performance EMS (HPEMS).

In this webinar you’ll hear from AIMHI members Doug Hooten, MedStar Mobile Healthcare, Kevin Smith, Niagara Emergency Medical Services, and Jonathan Washko, Center for EMS – Skyealth, Northwell Health.

If you missed it, don’t worry, click here to access it.

Texas and its state medical board on Monday withdrew their appeal that questioned whether Teladoc could challenge the state’s controversial telemedicine restrictions.

The Texas Medical Board said its board on Friday voted to withdraw the appeal before the U.S. Court of Appeals for the 5th Circuit. The board had vehemently opposed Teladoc’s suit that alleges the state’s telemedicine rules violate federal antitrust laws, launching an unusual appeal after a lower court refused to dismiss Teladoc’s case.

The board’s proposed rule requires physicians to meet with patients in person before they can treat them remotely, or another provider must be physically present during the first telemedicine appointment to establish a doctor-patient relationship. Lewisville, Texas-based Teladoc maintains that the board violated the law because federal antitrust laws require the board to be supervised by the state in order to create the rules, which the company maintains will affect access to care. According to the board, the restrictions are to ensure quality of care.

But the U.S. Justice Department and the Federal Trade Commission recently took Teladoc’s side in the dispute, telling the 5th Circuit the state rules were anticompetitive and lacked appropriate review. The federal agencies encouraged the appeals court to reject the medical board’s appeal and maintained the underlying rule should be eliminated.

Teladoc’s chief legal officer, Adam Vandervoort, said the Texas Medical Board’s outgoing executive director called the decision to withdraw “purely strategic.” “The Texas Medical Board evidently withdrew its appeal because it didn’t want to suffer a ninth loss to Teladoc in the courts,” he said.

“That raises troubling questions about the (board’s) motives or its competence in both filing, and subsequently retracting, the appeal,” he added. “Teladoc and its amicus parties expended substantial resources on defending the appeal, all of which may have been wasted.”

Although this appeal is over, the medical board said it will continue to fight Teladoc’s challenge in court and claimed it is immune from federal regulation. The case will continue to be litigated in U.S. District Court in Austin, Texas. While most appeals are sparked by the end of a lawsuit, Texas and the medical board took a rare legal step when they asked the 5th Circuit to weigh in on a federal judge’s rejection of its motion to dismiss Teladoc’s case. Such appeals are seldom granted.

“The regulation of medicine is a right reserved for the states, and the board stands behind and will seek future vindication of its state-action immunity for performing the duties assigned it by the Texas Legislature,” said Scott Freshour, interim executive director of the Texas Medical Board.

Texas is experiencing a severe physician shortage, with 35 counties lacking a single practicing physician within their boundaries. Teladoc has said in court filings that telemedicine can help bridge this gap, as it’s often cheaper than traditional doctor or emergency room visits.

Original article can be accessed here.

As physician leaders in North Texas, we have concerning news. Healthcare for the most vulnerable patients in Texas is threatened even more as the likelihood increases that we’ll see less federal funding in the coming years. In 2015, the state of Texas asked the federal government (through the office of the Centers for Medicare/Medicaid, or CMS) for a renewal of a funding model (we know it as the 1115 Waiver) that would have totaled more than $30 billion statewide.

The request was only partially granted. CMS gave Texas 15 months of funding instead of the five years requested; this would reduce our state’s healthcare system funding by more than $20 billion. Time is running out for the state to address some of CMS’ concerns and receive approval for all the funds previously requested, and it does not take a physician to diagnose this as a serious problem. Not making a counteroffer would create a disaster to the already tenuous safety net. And to provide a counteroffer, the physicians of the Dallas County Medical Society, along with community partners, spent the last two years building a model healthcare delivery plan that we believe can solve this very large problem.

We call it the Dallas Choice Plan.

Initiated in 2012, the 1115 Waiver, also called the Texas Healthcare Transformation and Quality Improvement Program, was intended to “redesign healthcare delivery” with an overarching goal to “transform the current delivery of care and payment systems in Texas to a system that is more transparent and accountable.”

While the waiver has incentivized transformation of healthcare delivery in hospitals and healthcare systems that receive CMS funds toward uncompensated care, the waiver has not had a tangible positive impact on the health of the community at large, nor on physicians who provide care for the vulnerable population in our county and state. The Dallas County Medical Society believes the Dallas Choice Plan is a solution that Texas and CMS are looking for, enabling the restoration of the federal government’s funding for the most vulnerable in our county and state.

We are in the process of asking Gov. Greg Abbott, Lt. Gov. Dan Patrick, Speaker Joe Straus, and Texas Health and Human Services Commissioner Charles Smith to look at our plan. We believe it could serve as the next step and the next model of care for communities across Texas after the 1115 Waiver ends next year.

Instead of debating how to reform our local healthcare system, the Dallas Choice Plan proposes a pragmatic and creative solution to address the “access gap” that still impacts about 30 percent of our citizens. Thousands of patients in the gap today are in working families with children. Lack of affordable healthcare for parents and children affects each family’s security and wellbeing, and affects us all through the impact on our businesses, schools, hospitals, and neighborhoods.

Before we share the basics of the Dallas Choice Plan, let’s look at why we need a new model. Dallas is a great city, with great communities and great people. However, Dallas has its blemishes. Although our healthcare industry exists under a free-market economy, today’s crushing, competitive environment among Dallas’ large hospital systems diverts attention from effective planning and execution of community-based health delivery solutions for vulnerable populations.

As hospital systems continue to use profits and federal funds for competitive advantage, they minimize investments in prevention and before-hospital healthcare, placing at risk those vulnerable patients who could benefit from such services. Hospitals clearly hold the largest share of resources and carry the greatest influence toward supporting community-wide solutions. Yet currently, none of the federal funds go toward covering costs for healthcare provided by independent private physicians; this seriously limits non-hospital access to physician services for vulnerable patients.

Here are two simple examples of the unfortunate outcomes of the competitive landscape among our Dallas hospitals. While no patient prefers waiting in a crowded emergency room to treat an issue that could be managed in a doctor’s office, the waiver funds rarely are used to address this concern. Further, no one wants a second or third MRI test simply because our hospitals do not want to share information among themselves.

As Matt Goodman wrote in D Healthcare Daily on Sept. 8, 2016, the federal government has provided more than $3 billion directly to hospitals in North Texas over the last five years through 1115 Waiver funding. Instead of using these funds to transform the system, we argue that we have seen what could be described as a “medical arms race” in hospital facility construction. This surge of hospital construction has targeted the more affluent (and insured) areas of North Dallas, not the needier areas in southern and western Dallas County. This is contrary to the purpose for which we believe these funds were earmarked—to address the unmet needs of thousands of people without health insurance or unable to pay for health care themselves.

The 1115 Waiver Community Needs Assessment Task Force in 2012 listed “Primary and Specialty Care Capacity” as the region’s top community healthcare priorities, stating that “demand exceeds available medical physicians in these areas, thus limiting healthcare access.” Because 1115 Waiver funds flowed entirely into Dallas hospitals, we believe these funds have not been used to their full potential to help solve the decades-long problem of unequal access to primary and specialty physician health care for vulnerable people in Dallas.

As an alternative, the heart of the Dallas Choice Plan is a true Community-based Accountable Care Organization (ACO). A Community ACO is a new term for a healthcare organization that includes physicians, hospitals, and other health providers to care for a population of people. The organization is transparent with regard to performance of its provider network in relation to costs and quality. All health providers in a Community ACO must meet quality and efficiency standards within budget. This is just what the doctors are ordering for Dallas’ solution to this vexing access problem.

The Dallas Choice Plan would rely on Parkland Health and Hospital System’s support and leadership to anchor the Community ACO. Just as the community strongly supported building Parkland’s state-of-the-art hospital facility, we see a great opportunity for Parkland to be supported in this new role. Physicians in North Texas have a strong connection to Parkland, as most of us either trained or worked at this great institution during our careers. This trusted community health system could be the foundation that recruits private hospitals and independent physicians, along with community clinics and a host of other community-based health providers, thereby further strengthening Dallas’ healthcare safety net.

The Dallas Choice Plan is transparent, accountable, and transformative in its emphasis on real and meaningful access to care. It was designed by many of our long-time partners in the Dallas community who care deeply about vulnerable patients. We long ago reached out to Dr. Fred Cerise, CEO of Parkland Health and Hospital System, and his team; they agree with many of our ideas and have expressed an interest in working with us on this. Certainly, much work needs to be done, but let’s be sure to create a model that supports everyone who is serving this patient population. Let’s not waste one more dollar on competing hospital systems.

We propose to test this model in Dallas County, and if successful, believe it could be effective in other areas of Texas. But to even test the model, we need state leaders and CMS to agree to try.

As leaders of the Dallas County Medical Society for the past three decades, we believe our state, our county and our patients need a viable alternative now.

Original Article can be accessed here.