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May 22, 2015   Download print version

POH executive testifies before Congress to discuss value that physician ownership brings to healthcare

Hospitals say no to Scott's profit-sharing plan

Are more Americans benefiting from Obamacare than realize it?

Study: 'Underinsured' population has doubled to 31 million

Cyberattack on CareFirst exposes data on 1.1 million customers

Analysis of 4,600 hospitals nationwide helps patients find hospitals for routine procedures and medical conditions

Identifying illness correctly is key to drugs' effectiveness, researcher says

AHIP President and CEO Karen Ignagni to lead EmblemHealth; AHIP EVP Dan Durham appointed Interim CEO

Happy Memorial Day from our entire staff at HPN



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Self Study Series:
June 2015

Control of CRE transmissions and the use of Ethylene Oxide Sterilization

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POH executive testifies before Congress to discuss value that physician ownership brings to healthcare

Representing the physician-owned hospital (POH), was Joe Minissale, President of Methodist McKinney Hospital, a joint venture partnership between area physicians, the non-for-profit Methodist Health System and Nueterra. Methodist McKinney Hospital offers specialized care for Cardiology, ENT, Gastroenterology, General Surgery, Gynecology, Internal Medicine, Neurology, Neurosurgery, Orthopedics, Pain Management, Podiatry and Primary Care, went before the House Ways and Means Subcommittee on Health hearing titled "Improving Competition in Medicare: Removing Moratoria and Expanding Access", Congress to discuss the value POH’s bring to healthcare.

Minissale has spent his career both in private and community healthcare organizations turning around failing hospitals, successfully growing and stabilizing struggling rural hospitals, and opening new hospitals. He will share his experience as a higher quality, lower cost provider in his community and the ban on growth that was enacted as part of the Affordable Care Act. 

The law continues to have a chilling effect on the POH industry by prohibiting any new physician owned hospitals from treating Medicare and Medicaid patients and also in effect prohibiting those POHs that were grandfathered under the law from expanding. The inability of POHs to expand their capacity meet community demand for healthcare services has negatively impacted access to higher quality, lower cost healthcare, particularly Medicare and Medicaid patients.

Physician-owned hospitals account for only approximately 5% of hospitals nationwide, yet consistently outperform general non-profit and corporate-owned hospitals. On April 16, 2015, the Centers for Medicare and Medicaid Services (CMS) released summary star ratings based on patient satisfaction and experience in its HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) Survey for hospitals nationwide. 67% of the participating POHs received a 4- or 5-star rating.

Under the new CMS Value-Based program that rewards or penalizes hospitals based on the quality of care they provide, seven of the top 10 and 43 of the top 100 hospitals in the country are physician owned in FY 2015.

Dr. Blake Curd, M.D, President of the Board for Physician Hospitals of America, addressed the special treatment for major medical centers and large hospital systems with the U.S tax system, stating, "Community hospitals enjoy non-profit status and receive additional state and national funding for serving medically underserved areas while POHs operate in the same medically underserved areas, care for a similar percentage of Medicare and Medicaid patients, yet receive no governmental assistance. Additionally, Physician-owned hospitals pay millions of dollars in local, state, and national taxes per year."

For more information visit

Testimony from the hearing is available on the Ways and Means Committee web page.



Hospitals say no to Scott's profit-sharing plan

Florida hospitals have a response to Gov. Rick Scott’s proposal that lost federal healthcare funding be offset by profit sharing: No way.

On May 8, the governor wrote in a letter that surpluses from profitable hospitals could be used to help keep afloat those that don’t break even as a possible replacement for the federally funded Low-Income Pool, which ends June 30.

But the FHA says its hospitals already fund poor Floridians’ healthcare by way of Medicaid. Pointing to a report commissioned by the state, FHA points out that hospitals contribute roughly $1.3 billion to Medicaid.

“You have suggested that a new tax on hospital operating surpluses might be a way to sustain the existing LIP program,” the letter, signed by the association's board of trustees, says. “Such an arrangement is not a solution to the challenge we face.”

The hospitals support a Medicaid expansion plan put forward by the Florida Senate, which Scott and the House are unwilling to agree to.

FHA likens Scott’s profit-sharing idea to an additional tax on hospitals. The governor likes to compare it to something else.

The healthcare funding question will likely come to a head during a June 1-20 special session of the Legislature, when lawmakers are expected to approve a budget and will consider the Senate’s Medicaid plan. Visit Tampa Bay Times for the story.



Are more Americans benefiting from Obamacare than realize it?

One reason the Affordable Care Act gets mixed reviews is the persistent and sharp partisan divide in public opinion on the law. But a less appreciated reason for this is simply that many more people benefit from the ACA than may realize it.

More than half of Americans say the health reform law has had no impact on them or their family, Kaiser Family Foundation Health Tracking Polls have found. As the chart above shows, that’s true of Democrats (60%), independents (54%), and Republicans (55%).

But the ACA benefits more people than say it has affected them and far more than the approximately 23 million more people who have signed up for a marketplace plan or Medicaid as a result of the law.

For example, 49% of Americans say they or a family member have a pre-existing medical condition such as heart disease, diabetes, asthma, or cancer; and a quarter say someone in their family had been denied coverage or had their premium raised because of it. The ACA solves this problem for all these people by eliminating underwriting for pre-existing conditions, giving them peace of mind that they can get coverage if they lose employer-based insurance or the ability to buy health coverage if they are in the non-group market.

The Obama administration released a report last week estimating that 137 million people are eligible for these no-cost prevention and screening services, which are guaranteed for everyone with private insurance except those in grandfathered plans that people had before the law passed in 2010.

The law also eliminated lifetime caps on insurance coverage, something the government estimates affected 105 million people who faced the possibility of using up their insurance if they had a serious illness.

Such ACA-related insurance reforms affect many Americans, and these provisions are popular with the public. But as the Kaiser poll findings show, Americans don’t always connect the benefits with the law. It’s likely that many people just don’t know that the law is responsible for their free flu shot, or contraceptive coverage, or their ability to get coverage if they have a pre-existing condition. These new benefits are provided by insurers or employers without a promotional label reading “brought to you by the ACA.”

To be sure, there are some unpopular features of the ACA that many Americans are not fully aware of, such as the “Cadillac tax” on higher-cost health plans set to take effect in 2018 (and that could lead to some employers scaling back coverage). People are, however, very aware of the law’s most unpopular feature: the individual mandate.

The ACA may never be as popular as Medicare or Social Security, programs in which people enroll and from which they receive common benefits–something that makes these programs almost sacrosanct. But gradually, more people may become aware of the popular benefits the ACA provides beyond expanding coverage for the uninsured. Visit Wall Street Journal for the article.



Study: 'Underinsured' population has doubled to 31 million

One-quarter of people with healthcare coverage are paying so much for deductibles and out-of-pocket expenses that they are considered underinsured, according to a new study.
An estimated 31 million insured people are not adequately protected against high medical costs, a figure that has doubled since 2003, according to the 2014 national health insurance survey by the Commonwealth Fund.

Rising deductibles — even under ObamaCare — are the biggest problem for most people who are considered underinsured, according to the 22-page report.

“The steady growth in the proliferation and size of deductibles threatens to increase underinsurance in the years ahead,” the report warns.

The data is an early warning sign for the Obama administration, which has promised that the millions of people who gained healthcare under the president’s law would have affordable access to healthcare.

The survey found that millions of people are paying into healthcare but are largely unable to reap the benefits. People who purchase the lowest-quality health insurance are also less likely to see a doctor when they are ill or injured because they fear their high out-of-pocket costs.

When people do see a doctor, the costs accumulate quickly. Half of underinsured adults and 41 percent of privately insured adults with deductibles of $1,000 or higher were paying off accumulated medical bills of $4,000 or more, the report found.

The increase in deductibles comes even as the nation’s healthcare costs have flatlined overall, which the Obama administration has taken partial credit for.

The underinsured rate has flattened over the last several years, with the biggest increases in the underinsured population occurring between 2003 and 2010. Visit The Hill for the report.



Cyberattack on CareFirst exposes data on 1.1 million customers

CareFirst BlueCross BlueShield was the victim of a cyberattack that compromised information on about 1.1 million current and former customers, the health insurer that covers residents of DC, Maryland and Virginia announced Wednesday.

The CareFirst attack occurred in June 2014, according to a Web site set up by the insurer. The company said its cyber-security team thought it had fended off the attack at the time, but a recent review discovered that the attackers had gained access to the usernames that customers created on its Web site as well as their real names, birth dates, e-mail addresses and subscriber identification numbers.

The database the hackers accessed did not contain members' Social Security numbers, medical claims, employment, credit card or financial information, the company said.

"We deeply regret the concern this attack may cause," CareFirst President and CEO Chet Burrell said in a statement. "We are making sure those affected understand the extent of the attack – and what information was and was not affected."

The company said it first learned that data on customers was accessed nearly a month ago, on April 21, during the course of a review of its systems by cybersecurity firm Mandiant. CareFirst said it did not disclose the discovery until now so it could complete its investigation of the incident.

CareFirst is offering affected customers two years of free credit monitoring and identity-theft protection services. The FBI said it is investigating the intrusion.

The bureau "is working with the victim company in order to determine the nature and scope of this incident," an FBI spokesperson said in an e-mailed statement.

Dave Kennedy, the founder of cybersecurity firm TrustedSEC, said consumers can expect more healthcare industry breaches to be disclosed. "There are probably a whole lot of other places that are just now discovering they were breached," he said. Visit the Washington Post for the story.



Analysis of 4,600 hospitals nationwide helps patients find hospitals for routine procedures and medical conditions

U.S. News & World Report unveiled the broadest expansion of its analysis of hospital quality since it began ranking medical centers 25 years ago. The new Best Hospitals for Common Care ratings cover nearly every hospital in the country and evaluate each one in five common surgical procedures and medical conditions that account for millions of hospitalizations a year.

U.S. News developed the new ratings to help patients easily identify hospitals in their communities that excel in treating common conditions. Patients can look up any U.S. hospital at no cost at to see how it rates in three common operations – heart bypass, hip replacement and knee replacement – and two widespread chronic conditions – congestive heart failure and chronic obstructive pulmonary disease, or COPD. A hospital may be rated as "High Performing," "Average" or "Below Average."

Approximately 90 percent of the hospitals rated in each condition or procedure were High Performing or Average. Hospitals were not rated in a procedure or condition if they treated too few patients of that type for U.S. News to conduct a rigorous statistical analysis.

"The choice of hospital can be life-changing even for relatively routine surgery. Hospitals can differ greatly in quality, and excelling in one area doesn't guarantee that a hospital excels in other areas," said Ben Harder, chief of health analysis for U.S. News. "The good news for patients is that the majority of hospitals performed average or better."

U.S. News' analysis of the data also found:

Approximately 10 percent of the hospitals rated in each condition or procedure were High Performing, meaning their quality measures were statistically better than the national average. Another 10 percent were statistically below average.

More than 700 hospitals were rated High Performing in at least one procedure or condition.

More than 700 hospitals were rated Below Average in one or more procedures or conditions. In each surgical procedure, a Below Average rating was associated with a mortality rate approximately twice the national average.

Thirty-four hospitals earned High Performing ratings in all five procedures and conditions. Another six hospitals that do not offer heart bypass surgery earned High Performing ratings in all of the other four categories.

More than 1,700 hospitals treated too few patients to be rated in certain procedures or conditions. Patients treated in these very-low-volume hospitals fared worse than similar patients treated elsewhere. For example, mortality among hip patients undergoing surgery at unrated hospitals was more than 60 percent higher than among patients at all rated hospitals.

To generate the ratings, U.S. News evaluated hospitals across more than 25 quality measures â€“ including mortality, readmissions, infections and patient satisfaction scores – and analyzed more than 5 million patient records, taking into account each patient's health conditions, age, sex, socioeconomic status and other factors affecting risk. Visit PR Newswire for the release.



Identifying illness correctly is key to drugs' effectiveness, researcher says

Incorrect antibiotic use can cause patient harm, reduce the effectiveness of antibiotics and increase healthcare costs, the researchers noted.

"Antibiotic therapies are used for approximately 56 percent of inpatients in U.S. hospitals, but are found to be inappropriate in nearly half of these cases, and many of these failures are connected with inaccurate diagnoses," study author Dr. Greg Filice said in a news release from the Society for Healthcare Epidemiology of America.

Filice, an internist with the Minneapolis Veterans Affairs Health Care System, and his colleagues analyzed 500 inpatient cases at the Minneapolis VA Medical Center. They found that inappropriate use of antibiotics occurred with 95 percent of patients who received an incorrect or indeterminate diagnosis, or those with an identified symptom but no diagnosis.

By comparison, incorrect use of antibiotics occurred in 38 percent of patients who received a correct diagnosis.

Overall, only 58 percent of patients received a correct diagnosis, researchers found. The most common misdiagnoses were pneumonia, cystitis, urinary tract infections, kidney infections and urosepsis (when an infection starts in the urinary tract and spreads to the bloodstream).

The study was published online in Infection Control & Hospital Epidemiology, the journal of the Society for Healthcare Epidemiology of America.

The findings suggest that programs overseeing antibiotic use in hospitals would be more effective if designed to help providers make accurate initial diagnoses and to know when antibiotics can be safely withheld, Filice said.

The researchers said relying on intuition rather than proper analysis contributed to incorrect diagnoses and inappropriate use of antibiotics at hospitals. Other contributing factors on the part of staff: fatigue, sleep deprivation, mental overload, dealing with patients with a previous diagnosis from another healthcare provider, lack of clinical experience, and lack of experience with drug side effects.

"Diagnostic accuracy is integral to the safe use of antibiotics. In order to improve the use of antibiotics in health care, we must consider this challenge and look for tools and strategies that help clinicians decrease unnecessary and potentially harmful antibiotic use" Filice said. (HealthDay) Visit NIH for the study.



AHIP President and CEO Karen Ignagni to lead EmblemHealth; AHIP EVP Dan Durham appointed Interim CEO

America's Health Insurance Plans' (AHIP) Board Chairman Mark B. Ganz, CEO and President of Cambia Health Solutions, released the following statement:

“Today (May 21) the Board of Directors accepted the resignation of Karen Ignagni as president and chief executive officer of AHIP. The board is grateful for Karen’s twenty-two years of service to the association and industry. As the voice of our industry, she has worked tirelessly on our behalf with acumen that is unmatched. As the Board Chair of AHIP, I have had the honor and pleasure of working with Karen and witnessed her incredible skill.  

On behalf of the board, we not only want to thank Karen for her service but offer our congratulations as she begins her next chapter. We are pleased to continue our work with Karen as she joins an AHIP member company, EmblemHealth, as President and CEO. 

As the health insurance industry’s top representative in Washington, Karen has successfully navigated intense challenges from the Patient’s Bill of Rights to the Affordable Care Act. With tenacity, intellect and deep policy knowledge, she ensured our industry has a seat at all tables. Perhaps her greatest contributions have been highlighting the value and innovations of this industry.

The Board of Directors will immediately launch a national search for her successor. While we conduct our search, the board has appointed Dan Durham, Executive Vice President for Strategic Initiatives, as interim CEO.

Dan has over thirty years of leadership experience with major policy and regulatory issues, primarily in the health care field. Prior to his current role, Dan served as Executive Vice President for Policy and Regulatory Affairs at AHIP and led healthcare reform implementation efforts and policy activities. Before joining AHIP, he was Vice President for Policy at the Pharmaceutical Research and Manufacturers of America where he played a leadership role during healthcare reform and implementation of the Medicare prescription drug program. Dan has also served in high-level policy positions in the federal government at the U.S. Department of Health and Human Services, the Social Security Administration, and the Office of Management and Budget. He also held key policy positions at AARP and the California Legislative Analyst’s Office.

Dan and the senior team of the association have the full confidence of the board as they continue to drive the industry’s priorities forward.”

Visit AHIP for the announcement.



Happy Memorial Day from our entire staff at HPN

Healthcare Purchasing News wishes you and your families and friends a wonderful and healthy Memorial Day weekend. The HPN Daily Update will be back on Tuesday, May 26.