This article appears in the May 2012 issue of HealthLeaders magazine.

It seems like each week brings yet another announcement about some combination of physicians, hospitals, and even health plans that are forming collaborations or partnerships, and calling them accountable care organizations. The ACO moniker carries a lot of weight these days. It signals that providers and payers are committed to coordinating healthcare to achieve the vaunted triple aim of improving the experience of care, improving the health of populations, and reducing per capita costs of care.

It’s estimated that there are 160 commercial ACO or ACO-like organizations at some stage of development right now, according to Leavitt Partners, a Salt Lake City–based health intelligence business. Add to that the 32 Pioneer ACOs named in November 2011 and the 27 Medicare Shared Savings Program ACOs named in April by the Centers for Medicare & Medicaid Services, and still more are expected to be named later this year.

Aside from the healthcare reform legislation, among the factors driving interest in ACOs is industrywide acceptance that the current system is simply unsustainable. “Our transaction-based system doesn’t make sense,” says Hal Teitelbaum, MD, the CEO and managing partner of Crystal Run Healthcare, a 250-physician group in Middletown, N.Y. “We’re not in the business of selling mammograms or colonoscopies. We’re in the business of improving health and outcomes.”

Others are looking to ACOs to help push more of their revenue stream into a value-based model. “Living with a bunch of different payment models is challenging,” explains Chuck Lehn, vice president of managed care for Banner Health, a Phoenix-based system with 23 hospitals in seven states. “We think getting paid for adding value will make it easier for us to have a more rational system.” The system formed Banner Health Network, an ACO that is involved in commercial projects with Aetna and Health Net as well as Medicare’s Pioneer ACO program. BHN includes Banner Health–affiliated physicians, 13 Banner hospitals, and other Banner services in Arizona.

And some players are approaching commercial ACOs from a defensive posture. Andrew Croshaw, a partner at Leavitt Partners, notes that uncertainties remain as to the extent of the ACO movement and when it might mature. To protect their negotiating strength, some hospitals are making acquisitions to expand their care continuum and increase their leverage with payers; Croshaw points out that these services will be useful to have as the ACO movement matures, but in the meantime it positions hospitals to negotiate more strongly with payers.

Whatever the motivation, C-suite executives across the payer and provider sectors of the industry are considering how they should approach this opportunity. Whether your organization is ready to jump on the ACO bandwagon or is still trying to figure out if it’s the right move, here are some of the key questions your leadership team needs to consider.

What do you want to accomplish with an ACO?
The basic tenet of an ACO is to create a delivery model with processes, financial incentives, and technology systems to deliver quality care in a cost-efficient way.

The best way to start, suggests Lehn, is to look for simple ways to add value to something you already do and then move forward from that. There’s been growing concern at Banner Health about the increasing number of Arizona residents who either lack healthcare coverage or lack coverage that provides access to quality care. It’s a bottom-line issue. Banner Health Network has teamed with Aetna, a diversified healthcare benefits company that serves 36.4 million people, to offer a shared-risk product, Aetna Whole Health, which covers coordinated care only at Banner Health’s Arizona facilities. The incentive for employees is reduced cost of care. The ACO will base compensation and rewards on reduced hospital readmissions, expanded access to primary care physicians, and increased use of preventive screenings. The effort builds on the health system’s extensive investment in electronic medical records and health IT.

The partners in the Northwest Metro Alliance, an ACO in Minneapolis, have focused on clinical care process changes and designs to improve quality and reduce costs for 27,000 at-risk members. A review of prescribing patterns helped increase the use of generic drugs and produced a $1 million savings. “We also looked at high-tech imaging to see when it really benefits the patient and where might it be overutilized without clear benefits,” explains Penny Wheeler, MD, chief clinical officer at Allina Health Hospitals and Clinics, which collaborates on the alliance with Bloomington, Minn.–based HealthPartners.

What makes the collaboration unique is that the four-hospital HealthPartners and the 11-hospital Allina are competitors in Minneapolis market.

How should your ACO be organized?
The short answer to the question of ACO organization is: Any way you want it to be. While CMS-deemed Pioneer and MSSP ACOs must follow a prescribed set of organizational requirements and meet specific quality and cost-containment goals, commercial ACOs have more flexibility. Organizers of commercial ACOs are working their way through what they want their ACO to become and how they want to serve their markets. For some commercial ACOs, the triple aim is a loose concept, while others are developing specific strategies to meet those goals.

The National Committee for Quality Assurance is trying to establish some order to the ACO process through a three-tier accreditation program that will verify ACO competence. Crystal Run Healthcare is among the early adopters of the NCQA process. “The NCQA provides external validation … It says we’ll achieve what we say we will,” explains Teitelbaum.

Pointing to BHN’s mix of commercial and Medicare projects,  Lehn says he likes the freedom of different models of ACOs. “The free market, with different ideas and different markets, is really healthy for the industry. I hope we don’t end up with monolithic models [of ACOs]. I hope this results in a lot of innovation and creativity.”

Do you need a partner?
Commercial ACOs are being formed by physician practices, hospital collaborations, and health plans. Some providers and payers are in multiple ACOs. Your organization’s decision should take into account the goals of the ACO as well as your technology and human resources capabilities.

Crystal Run Healthcare is a single-participant ACO, which means the physician group is clinically and financially integrated. Teitelbaum says the advantage of the single-participant ACO, which does not include a hospital, is that Crystal Run’s physicians are free from the constraints of partnering with a single hospital. The physicians are free to shop around for facilities that offer the best care at a cost-effective price. “We don’t have to worry about supporting one particular hospital.”

Teitelbaum says most physicians don’t have the scale, capital, infrastructure, or management in place to take this approach. Teitelbaum points out that Crystal Run already has in place a sophisticated IT structure as well as care and utilization management and the quality assurance teams that characterize ACOs. It also has database analysts who work with the  business intelligence team to manage care and costs. In other words, the group isn’t starting from square one.

Teitelbaum leaves open the possibility that, depending on its needs, the physician group may decide to partner with another organization as an ACO or just on a contract-for-services basis. “Just because an entity doesn’t want to be at risk for costs, quality, and outcomes doesn’t mean we can’t work with them. But they won’t be inside the ACO.”

Mountain States Health Alliance, meanwhile, a 13-hospital system based in Johnson City, Tenn., opted for a more extensive structure for its ACO: Mountain States is the umbrella company that includes Mountain States Medical Group and Integrated Solutions Health Network. ISHN is the parent company of Anew Care Collaborative, the ACO, and CrestPoint Health, the third-party administrator that will contract with Anew Care as its payer.

As part of the ACO, Mountain States is partnering with four other physician groups that aren’t part of MSHA. If you decide you need a partner, Wheeler says the most important consideration is a shared vision that drives outcomes. It was that shared vision that helped Allina and HealthPartners, competitors in the Twin Cities market, develop their collaboration in the Northwest Metro Alliance.

Wheeler adds that in considering a partner, you “can’t underestimate the ability to marry claims information with really good clinical data” to develop a full picture of care. In the alliance, HealthPartners is able to provide Allina with data for its 27,000 patients. The ability to track those patients improves care by reducing the variability of practice patterns. “We know what is going on with them. We know when they fill their prescriptions, and we know when they are admitted to a hospital that’s not in our system. When a patient arrives at our hospital or clinic we already have that information in our medical records so we don’t duplicate tests. That’s information that Allina on its own couldn’t know.” 

What financial and human resources will you need?
“There is no way to underestimate the dollars and organizational time it takes,” says Marvin Eichorn, senior vice president and CFO of Mountain States Health Alliance, which began developing its ACO from scratch 18 months ago. He estimates his group’s investment is $5 million, which doesn’t include soft dollars like employee time on the project. He says it could take another $5 million over time to get the ACO where it needs to be. Mountain States contracts for its back-office capabilities to lower costs; Eichorn estimates that the investment could easily triple or quadruple if it had to buy all the information systems, hardware and software, plus hire staff to run the operation.

Lehn at Banner Health says forming an ACO is a costly proposition, but because his organization already had the infrastructure in place, it didn’t view the cost as prohibitive. Wheeler describes a similar situation at Northwest Metro Alliance: Together, Allina and HealthPartners already had many of the components in place when they began their ACO. “Where a lot of people are still talking about implementing the system, we’re talking about optimizing the system,” says Wheeler.

Despite that advantage, Wheeler notes that changing the system and having a significant impact on total cost of care, even with the components in place, requires a lot of hard work, collaboration, and true commitment to the triple aim of healthcare.

Teitelbaum warns that the human and financial cost “isn’t discrete. It’s ongoing.”

According to the April HealthLeaders Media Intelligence Report on ACOs, 54% of healthcare leaders whose organizations are or plan to be part of an ACO estimate that annual infrastructure investment for their ACO will amount to more than 1% of attributed patient costs each year.

Are ACOs Too Good To Be True?
Accountable care organizations certainly aren’t a panacea for poorly run organizations, and even well-oiled ACO machines encounter difficulties.

Wheeler says that while the collaboration between Allina and HealthPartners hasn’t been a problem, the Northwest Metro Alliance has faced other challenges common to coordinated care efforts:

• Lack of timely claims data. The alliance works with adjudicated claims, but there is typically a two- to three-quarter delay in receiving the information. The group keeps its own quality measures but needs timely claims data so it can assess outcomes in terms of cost efficiency and quality improvement. Wheeler says the alliance is working to receive some feeds on commercial claims that are pre-adjudicated, meaning they aren’t completely settled up. CMS has agreed to provide monthly feeds of adjudicated Medicare claims.
• Overwhelmed physicians and medical staff. Wheeler explains that much of the care savings achieved by the alliance involves providing patient care in different ways. That means getting the clinical involvement of the providers who know the patient best. “But they are often loaded up with patient care and improvement initiatives of their own, so we have to try and sync those things up to make sure we aren’t overtaxing them.” She notes that within the Allina system alone, providers are responsible for more than 700 quality measures requirements from regulatory agencies and different commercial payer arrangements.
• Migratory nature of health plan members. Wheeler would like to work with the same patients throughout the collaboration, but the reality is that health plan members come and go, so it’s impossible to develop perfect cost or quality comparisons from year to year.

She says entering into an ACO-like strategy allows providers to really look at and understand all of their clinical practice patterns. It puts a focus on developing efficiencies and improvements around staff, work flow, and clinical performance—all to the benefit of patients.

Still, she cautions that “there’s no quick fix to the total cost of care, so things like collaboration and joint commitment to the mission become even more important and take time.”

About Morgan Hunter HealthSearch
Morgan Hunter HealthSearch (MHHS) provides Executive Search and Interim Leadership solutions for hospitals and health systems throughout the United States.  Our services include executive healthcare recruiting, retained healthcare executive search, healthcare interim management, executive placement for hospitals. 

On a mild, gray day in February, fatigue lined the face of Anthony Parish, a slight, 39-year-old man who has been through a lot. He had a cancerous portion of his lung removed and struggled with postoperative pain. Chemotherapy treatments caused abscesses in his mouth that ruined his teeth and repeatedly sent him to the emergency department for relief, delivered in the form of painkillers and antibiotics.

Despite his health problems, Parish voiced hope on that midwinter morning. His medical team had developed a plan to help alleviate his dental pain. By the end of the month, his infected teeth would be removed and replaced with dentures. He still has intermittent chest pain, but he is learning to cope with it.

Parish is one of about 950 patients identified by Spectrum Health System in Grand Rapids, Mich., as having used their hospital EDs 10 times or more during the previous year. These patients accounted for more than 20,000 total visits and at least $40 million in costs during that period. In November 2011, Spectrum launched the Center for Integrative Medicine, a $1 million multispecialty clinic modeled on a pilot program that slashed ED use by nearly 90%, to help patients like Parish address the source of the problems that keep bringing them back to the ED.

“A lot of doctors, they just say, ‘Take this [drug] and see how it goes.’ They don’t really try to figure out your problems,” Parish says.

That is not the approach he encountered at the center, where Medical Director R. Corey Waller, MD, works with a staff of six to deliver intensive medical and case management interventions to patients over the course of three to six months before transitioning them to primary care physicians in the community or within Spectrum, an integrated health system.

The Spectrum clinic is part of a fledgling movement to devise new methods to help some of the most challenging patients in medicine — those who visit the ED frequently. The reasons why these patients visit the emergency department vary, and there are no easy fixes. But initiatives that seek to address patients’ medical, psychological and social needs are showing promise.

The efforts come as states around the country target emergency department use among Medicaid patients. Democratic Washington Gov. Christine Gregoire suspended a plan that was set to take effect April 1 and would have restricted Medicaid pay to EDs for more than 400 conditions. The American Medical Association was among the physician organizations that objected to the policy.

Meanwhile, starting in October, hospitals face up to 1% in Medicare pay cuts for high readmission rates. That penalty threat is giving hospitals another incentive to do what they can to help patients avoid the ED.

Understanding repeat ED users

There is no standard definition for what constitutes frequent emergency department use, but researchers set four or more annual visits as a cutoff. The 8% of patients who use the emergency department four-plus times a year account for 28% of adult ED visits, according to a July 2006 Annals of Emergency Medicine study.

Compared with patients who use the ED less often, frequent users are much likelier to have poor physical health and live below the poverty threshold, said the study, based on a nationally representative household survey. Frequent ED users are more likely to be uninsured or publicly insured and 70% likelier to have poor mental health. And these patients do not rely solely on the emergency department; they are three times more likely to have made five or more outpatient visits in the last year.

The notion that most frequent ED users are abusing the system is not backed by evidence, says Dr. Weber, professor of clinical emergency medicine at the University of California, San Francisco School of Medicine.

“They’re not necessarily coming to the ED because it’s easier or convenient, or for minor reasons,” she says.

Maria C. Raven, MD, MPH, agrees.

“People aren’t coming to just hang out,” says Dr. Raven, assistant professor of clinical emergency medicine at UCSF. “They’ve got some real issue that’s bringing them in. They’re scared.”

Coordinating care is critical

Before coming to UCSF, Dr. Raven helped start a pilot program at New York City’s Bellevue Hospital Center that enrolled 19 patients who had a total of 106 ED visits and 64 hospital admissions in the previous year. Of the 19 patients, all men, 18 had substance-abuse problems and 17 were homeless. The hospital hired a care manager to coordinate care inside and outside the hospital.

In-depth interviews at the bedside identify the patients’ housing, transportation and medical needs such as substance-abuse rehabilitation. Instead of discharging patients to the streets, staffers work to find permanent housing and put them up at the YMCA while housing applications get processed. Often, patients are given prepaid cellphones to facilitate planning.

Weekly conference calls with primary care doctors, visiting nurse services, methadone programs, substance abuse programs and others are conducted to make sure everyone is “on the same page,” Dr. Raven says. Overall, ED visits were cut by 10%, and hospitalizations were slashed by nearly 40%, according to results published Oct. 13, 2011, in BMC Health Services Research.

“One of the most problematic things is that the medical side of things is not well-aligned with the mental and behavioral-health services, and things are often very fragmented,” Dr. Raven says. “There’s not really the ability for the medical system to communicate with the welfare system.”

Without help, it is difficult for physicians in the hospital to address the root cause of what is bringing patients back to the ED so often, she adds.

“Often where things break down during the hospital or ED visit is that the medical team working with these patients may not know them or what’s going on with them outside of the hospital,” Dr. Raven says. “There’s pressure to get them out of the hospital, depending on the payment structure. They sort of do what they can to wrap up the individual episode of care neatly and discharge the patient. There’s not someone doing the simple things like postdischarge follow-up with a phone call.”

The program has been expanded to a total of three hospitals that are part of the New York City Health and Hospitals Corp. and is being funded by the state’s Medicaid plan to prevent costly ED and hospital use.

In neighboring New Jersey, a nonprofit effort chronicled in The New Yorker and on TV’s “Frontline” is targeting frequent emergency department users in the city of Camden. In 2007, the physician-led Camden Coalition of Healthcare Providers organized a collaborative of primary care, behavioral health and social service professionals to help these patients avoid the ED. Among the first 36 patients identified for extra help, the total average monthly number of hospital and ED visits dropped from 62 to 37, a 40% cut. Meanwhile, hospital bills were slashed by 56%.

Rerouting frequent ED users

These fledgling quality initiatives are not only critical to improving patients’ lives and controlling health care costs, but to sustaining the morale of emergency physicians. A survey of more than 400 emergency physicians presented at the Society for Academic Emergency Medicine’s June 2011 annual meeting found that about 60% reported having less empathy for patients who use the ED more than 10 times a year, sometimes derisively dubbed “frequent fliers.” Experts fear that hardening of the heart could translate into worse patient care.

And while nearly all the emergency doctors reported experience with frequent ED users, only 30% said they work in a hospital that has a program dedicated to helping these patients avoid the hospital through programs involving case managers and social workers.

Dr. Waller, of the Spectrum Center for Integrative Medicine in Grand Rapids, said he grew so frustrated during his time working in the emergency department that he considered quitting medicine. He never had the time to delve deeply into the complex conditions that were bringing patients back to the ED so often. And most frequent ED users have a constellation of physical and mental illnesses that go beyond the scope of emergency medicine, he says.

“If you’ve been smashed by a truck, or you have a laceration from the top of the chest to the bottom of the toe, that’s perfect for the ER,” says Dr. Waller, who also specializes in addiction and pain medicine. “What it’s not perfect for is someone with a chronic, debilitating mental-health disorder who shows up and is seen by a physician who’s had one lecture on that in their entire training.”

So far, the center has seen about 100 high-volume ED patients, and about a third have been completely stabilized and transferred to a primary care physician. Other patients randomly wait-listed for the clinic’s services act as a control to determine the effectiveness in reducing ED visits. The first visit to the clinic can last as long as four or five hours, with patients seeing a case manager and then a medical social worker before visiting Dr. Waller for a complete work-up.

The vast majority of the center’s patients have chronic pain and mental health problems, and the goal is to find the medical source of the pain and address it directly. Patients sometimes have major undiagnosed conditions such as Crohn’s disease or spinal pathology, or simply have poorly managed chronic conditions. For patients with no discernible source of pain, Dr. Waller works to wean them off opiates by using buprenorphine and similar medications. Meanwhile, patients receive counseling on how to use cognitive-behavioral and other techniques to cope with the aches, pains and stressors of daily life.

“We have no official appointments,” says Dennis Potter, one of the center’s social workers. “We just want to give patients a chance to hang out and talk through what’s going on in their lives. It’s designed to relieve the anxiety or the issues they’re bringing in, and hopefully assist them in learning that every time you’re in distress, it doesn’t mean you have to go to the ED. Every time you have a pain, it doesn’t mean you have to have a pill.”

Patients who use the ED frequently deserve better care than what they typically get, Dr. Waller says.

“These are patients who have been marginalized, verbally beaten in the hospital and called drug addict, dirt bag, drug seeker. Those are terms I’ve heard from my colleagues about these patients, and it made me angry and it’s not right,” he says.

“It’s really fulfilling to do the right thing for a patient, where the last time you saw that patient in the ER they hated you and the next time they hug you and say, ‘Thank you for helping me.’ Doing the right thing is the right thing to do. It’s not just a theory.”

http://www.ama-assn.org/amednews/2012/04/30/prsa0430.htm

About Morgan Hunter HealthSearch
Morgan Hunter HealthSearch (MHHS) provides Executive Search and Interim Leadership solutions for hospitals and health systems throughout the United States.  Our services include executive healthcare recruiting, retained healthcare executive search, healthcare interim management, executive placement for hospitals. 

With nursing shortages on the rise, there are no shortages of opportunities for good nurses. The best way to combat the turnover that might cause? Make sure your nurses are happy in their environment and their positions.

A Life Concierge

For most employees, a work-life balance is an important facet when choosing an organization. At Lucile Packard Children’s Hospital in Palo Alto, Calif. nurses can choose from flexible scheduling and part-time, 8-hour or 12-hour shifts to accommodate different family and lifestyle needs.

At Kaiser Permanente’s Oakland Medical Center, employees have free concierge services on hand to help with daily errands and essentials. Nurses can call in for help with dinner reservations, car repairs, mailings, event planning, dry cleaning, and lawn and garden care.

“If you want to attend a dinner and play in San Francisco after work, the concierge service can make your reservations,” says Kathy Sommese, a clinical nurse supervisor for Permanente.

There are also numerous health-club membership and local attraction discounts, and tuition benefits.

Education

Most employees want to continue to grow in their career. This is why many medical facilities are now offering on-site degree programs, particularly when the facility is in a partnership with a surrounding university.

Many organizations promote further education by offering onsite master’s- and bachelor’s-degree programs for nurses, tuition reimbursement, scholarships and flexible scheduling to support nurses who want to continue their education.

Beyond a Signing Bonus

A signing bonus usually guarantees a two-year run for a nurse at a facility. But what about when those two years are up? Some places are forgoing signing bonuses for professional development programs, proving nurses with a career path that promises growth.

At Yakima Valley Memorial Hospital in Yakima, Wash., nurses are nurtured with a supportive corporate culture and numerous opportunities for upward mobility. “Into the Blue,” a four-day program, to all employees focuses on maximizing the spirit of leadership in every individual.

“The program essentially teaches employees how to better understand one another’s personalities and temperaments and how to foster healthy relationships,” says Jennifer Tate, Yakima’s director of organizational health and wellness. “It shows how to remove self-imposed limits to achieve your goals.”

More than 1,800 employees have gone through the program and have reported tremendous success.

“I’ve heard story after story of how this program has changed our employees’ lives both personally and professionally,” Tate says. “There was one woman who always wanted to learn how to scuba dive and this course motivated her to do so at the age of 60.”

Whether it’s opportunities for free tuition, leadership development or dry cleaning pickup, organizations need to remember that nurses spend a lot of hours in the workplace. The best way to retain these employees is to make them feel appreciated and empowered.

Want

By Jenny Gold and Christian Torres
KHN Staff Writers

Despite uncertainty over how the Supreme Court will rule on the health law, a key provision intended to help transform the delivery of care is moving ahead.

The Obama administration announced Tuesday that 27 health systems have been selected to participate in Medicare’s Shared Savings Program, which offers financial incentives for physicians, hospitals and other health care providers to team up in “accountable care organizations.”

Advocates say ACOs can improve care for Medicare beneficiaries and slow rising costs by changing the incentives that influence how doctors and hospitals operate. Experts cite as models highly touted health systems such as the Mayo Clinic and the Geisinger Health System of Pennsylvania.

Instead of getting paid for each service ACOs reward providers that are able to manage chronic disease and meet certain quality measures, including reducing hospital admissions and emergency room visits. If they improve care while restraining costs, the systems can share in the savings.

Tuesday’s announcement was the government’s first major health law action since the Supreme Court hearings two weeks ago on challenges to the law and has been highly anticipated by the health care industry. The new ACOs will serve an estimated 375,000 beneficiaries in 18 states.

The Centers for Medicare and Medicaid Services is reviewing another 150 applications from additional ACOs seeking to enter the program in July, suggesting that the Shared Savings Program is moving full-speed ahead.

The program is “off to a very phenomenal start,” said Jonathan Blum, who is a CMS deputy administrator. “We are on track to fundamentally transform the [Medicare] fee-for-service program.”

More ACOs Will Be Approved

Last December, HHS selected 32 organizations to take part in an advanced version of the Medicare program. These “pioneers,” as they’re called, are further along in developing the ACO model, with many already largely functioning as ACOs.

Pioneers began operating Jan. 1, and during their first two years they will assume a greater risk, but with a greater potential reward, than the ACOs announced on Tuesday.

Although some experts expected hospitals to dominate the ACO field, Blum noted that the majority of ACOs announced Tuesday are physician-led organizations. He also said many of the organizations are working with private health insurers to serve patients not in the Medicare program.

Chas Roades, chief research officer at the Advisory Board Company in Washington, D.C., cautioned that as the ACOS take off and “people actually start to deliver care in a different way, it’s messy and complicated. There will be successes and failures, and it may go slower than policy-makers would like it to.”

He says it’s important that CMS create some way for the initial cohort of ACOs to share their data and best practices with one another. “It’s a slow ramp but everyone will be watching very closely to see how these early ACOs succeed,” Rhoades said.

Some ACO leaders say they aren’t worried about the Supreme Court case.

“It’s not changing anything for us,” said Emily Brower, an executive director with Atrius Health, operator of a pioneer ACO in Massachusetts. “This is a model of care we’ve been trying to evolve into since before the pioneer program existed.”

“We’ll continue making investments, and if the law is overturned, we’ll be asking where the return on investment is for us, if not in shared savings,” Brower added. The return on investment “might be in patient growth because our patients become increasingly satisfied with the quality of care we provide.”

Harold Miller, president and CEO of the Network for Regional Healthcare Improvement and executive director of the Center for Healthcare Quality & Payment Reform in Pittsburgh, says ACOs will continue to be the model of the future, even if the Supreme Court strikes down the health care law. The private sector, he says, has been moving in the direction of coordinated care for years.

Miller points out that the Medicare ACO program isn’t “interwoven with the controversial parts of the law,” such as the mandate requiring all Americans to carry health insurance, and should be able to stand on its own. If not, CMS can likely shift the program into a demonstration project without any new legislation.

Blair Childs, senior vice president of public affairs at Premier health care alliance in Charlotte, N.C., adds that ACOs have always been a rare bright spot of bipartisan agreement. Even if the entirety of the ACA is struck down, he argues, Congress is likely to pass additional legislation to continue both the Shared Savings and Pioneer programs.

But Stephen Nuckolls, CEO of Coastal Carolina Health Care in New Bern, N.C., said the organization’s ACO “would not have the incentive” to institute new services without the law and its funding.

Nuckolls nonetheless says he’s confident about the future. “This part of the law is one of those areas that, even if the law is struck down, I think both parties will come together to reinstate it,” he said.

Shane Carter, CEO of Jackson Purchase Medical Associates in Paducah, Ky., is also optimistic. “The positives are enough that regardless of whether or not there’s a formal program, we’ll continue working” toward an ACO, he said. “We’re in it, and we’re going for it.”

Medicare Shared Savings Program ACOs

Name Location Est. Beneficiaries

Accountable Care Coalition of Caldwell County, LLC Lenoir, NC 5,000
Accountable Care Coalition of Coastal Georgia Ormond, FL (Serving beneficiaries in GA and SC) 8,000
Accountable Care Coalition of Eastern North Carolina, LLC New Bern, NC 10,000
Accountable Care Coalition of Greater Athens Georgia Athens, GA 8,500
Accountable Care Coalition of Mount Kisco, LLC Mount Kisco, NY N/A
Accountable Care Coalition of the Mississippi Gulf Coast, LLC Clearwater, FL (Serving beneficiaries in the Mississippi Gulf Coast area) 7,000
Accountable Care Coalition of the North Country, LLC Canton, NY 5,300
Accountable Care Coalition of Southeast Wisconsin, LLC Milwaukee, WI 10,000
Accountable Care Coalition of Texas, Inc. Houston, TX 70,000
AHS ACO, LLC Morristown, NJ (Serving beneficiaries in NJ and PA) 50,000
AppleCare Medical ACO, LLC Buena Park, CA 8,000
Arizona Connected Care, LLC Tucson, AZ 7,500
Chinese Community Accountable Care Organization New York, NY 12,000
CIPA Western New York IPA, doing business as Catholic Medical Partners Buffalo, NY 31,000
Coastal Carolina Quality Care, Inc. New Bern, NC 11,000
Crystal Run Healthcare ACO, LLC Middletown, NY (Serving beneficiaries in NY and PA) 10,000
Florida Physicians Trust, LLC Winter Park, FL 16,500
Hackensack Physician-Hospital Alliance ACO, LLC Hackensack, NJ (Serving beneficiaries in NJ and NY) 11,000
Jackson Purchase Medical Associates, PSC Paducah, KY 6,000
Jordan Community ACO Plymouth, MA 6,000
North Country ACO Littleton, NH (Serving beneficiaries in NH and VT) 6,000
Optimus Healthcare Partners, LLC Summit, NJ 29,000
Physicians of Cape Cod ACO Description of Organization Hyannis, MA 5,000
Premier ACO Physician Network Lakewood, CA 12,500
Primary Partners, LLC Clermont, FL 7,500
RGV ACO Health Providers, LLC Donna, TX 6,000
West Florida ACO, LLC Trinity, FL 10,000

Source: Centers for Medicare and Medicaid Services.

http://www.kaiserhealthnews.org/Stories/2012/April/10/ACO-Medicare-Shared-Savings-Program.aspx

Consider this:

• 96% of healthcare organizations have experienced at least one data breach in the past two years.
• Only 23% of health care organizations use mobile device encryption.
• Nearly half of healthcare organizations do nothing to protect data on mobile devices.

Now consider that the number of physicians using smartphones has escalated rapidly in recent years. Coincidence? Leading experts think not.

Recent reports by Manhattan Research have found more than 81% of physicians use a smartphone, up from 72% in 2010. And according to research released in December by Ponemon Institute, data breaches have risen 32% in the past year.

The report didn’t specify the percentage of breaches from mobile devices, but it did conclude that “Widespread use of mobile devices is putting patient data at risk.”

Mobile devices create a security risk in two ways. Data can reside on the device and can be accessed. And smartphones’ size makes them easier to lose than a laptop. Also, the device can be a way of gaining access to data that reside on electronic medical record systems at the health care organizations. Either way, someone who steals a physician’s smartphone or finds a lost one can gain valuable data if that phone isn’t secured.

Mobile device security is a primary concern throughout the healthcare field.

Analysts say mobile devices are like other new information technology in health care: A technology is introduced, and the rate of adoption outpaces efforts to ensure its security.

Many hospitals are aiming to bridge that gap by improving security so any mobile device a physician uses may access their EMRs safely.

Adjusting to physicians’ mobile use

Many hospitals have struggled initially with meeting the demand of physicians who wanted to use their personal mobile devices—not those given out by hospitals—to access their hospital’s EMR system.

Some organizations are now making it very plain: if their systems can’t be used securely by a certain mobile device, then no access is granted. Early versions of some smartphones aren’t capable of being encrypted and secured properly, so physicians are not being allowed to use them to connect with the hospital’s data centers.

Or, in exchange for hospital system access, physicians’ personal devices can be subjected to the same security processes as any other hospital information technology. So if a phone is reported lost, it will be remotely wiped of its data. Physicians must sign an agreement to that policy before they are granted access.

What physicians can do

Physicians can help by making sure their phones are encrypted. Software is readily available that will encrypt smartphones and mobile devices. Encryption offers a safe harbor under privacy and security regulations under the Health Insurance Portability and Accountability Act for organizations and practices that have a lost device.

Experts also recommend that physician practices set policies on mobile use, with attention paid to security measures, such as antivirus software and password protection.

Any questions? Contact Morgan Hunter HealthSearch, and we’d be happy to share our expertise.

Very interesting article by David Houle and Jonathan Fleece.

For centuries, hospitals have served as a cornerstone to the U.S. health care system. During various touch points in life, Americans connect with a hospital during their most intimate and extraordinary circumstances. Most Americans are born in hospitals. Hospitals provide care after serious injuries and during episodes of severe sickness or disease. Hospitals are predominately where our loved ones go to die. Across the nation, hospitals have become embedded into the sacred fabric of communities.

According to the American Hospital Association, in 2011 approximately 5,754 registered hospitals existed in the U.S., housing 942,000 hospital beds along with 36,915,331 admissions. More than 1 in 10 Americans were admitted to a hospital last year.

Hospitals make a substantial imprint on local economies. In many communities, hospitals represent one of the largest employers and economic drivers. Of the total annual American health care dollars spent, hospitals are responsible for more than $750 billion.

Despite a history of strength and stature in America, the hospital institution is in the midst of massive and disruptive change. Such change will be so transformational that by 2020 one in three hospitals will close or reorganize into an entirely different type of health care service provider. Several significant forces and factors are driving this inevitable and historical shift.

First, America must bring down its crippling health care costs. The average American worker costs their employer $12,000 annually for health care benefits and this figure is increasing more than 10 percent every year. U.S. businesses cannot compete in a globally competitive market place at this level of spending. Federal and state budgets are getting crushed by the costs of health care entitlement programs, such as Medicare and Medicaid. Given this cost problem, hospitals are vulnerable as they are generally regarded as the most expensive part of the delivery system for health care in America.

Second, statistically speaking hospitals are just about the most dangerous places to be in the United States. Three times as many people die every year due to medical errors in hospitals as die on our highways — 100,000 deaths compared to 34,000. The Journal of the American Medical Association reports that nearly 100,000 people die annually in hospitals from medical errors. Of this group, 80,000 die from hospital acquired infections, many of which can be prevented. Given the above number of admissions that means that 1 out of every 370 people admitted to a hospital dies due to medical errors. So hospitals are very dangerous places.

It would take about 200 747 airplanes to crash annually to equal 100,000 preventable deaths. Imagine the American outcry if one 747 crashed every day for 200 consecutive days in the U.S. The airlines would stand before the nation and the world in disgrace. Currently in our non-transparent health care delivery system, Americans have no way of knowing which hospitals are the most dangerous. We simply take uninformed chances with our lives at stake.

Third, hospital customer care is abysmal. Recent studies reveal that the average wait time in American hospital emergency rooms is approximately 4 hours. Name one other business where Americans would tolerate this low level of value and service.

Fourth, health care reform will make connectivity, electronic medical records, and transparency commonplace in health care. This means that in several years, and certainly before 2020, any American considering a hospital stay will simply go on-line to compare hospitals relative to infection rates, degrees of surgical success, and many other metrics. Isn’t this what we do in America, comparison shop? Our health is our greatest and most important asset. Would we not want to compare performance relative to any health and medical care the way we compare roofers or carpet installers? Inevitably when we are able to do this, hospitals will be driven by quality, service, and cost — all of which will be necessary to compete.

What hospitals are about to enter is the place Americans, particularly conservative Americans cherish: the open competitive market. We know what happens in this environment. There are winners and losers.

A third of hospitals now in existence in the United States will not cross the 2020 finish line as winners.

David Houle is a futurist, advisor and speaker and Jonathan Fleece is a health care attorney, advisor, and speaker. They are the authors of The New Health Age: The Future of Health Care in America.

Several industries have taken an interest in the iPad since its 2010 unveiling, but healthcare has been one of the quickest to adopt it.

No numbers exist for iPad sales specific to health care, but major institutions such as Stanford University School of Medicine in California hand them out to medical students and other physicians.

What is it about the iPad that makes it so attractive to healthcare professionals?

• ease of use
• size
• portability
• long-lasting battery power
• relatively low cost of adoption

Most doctors spent the early years of their careers using paper charts. If they wanted to go electronic without being tied down to a computer terminal, they had to use laptops—but laptops are too heavy and awkward to use as easily as a paper chart.

Many physicians and nurses feel that the iPad is the next best thing to paper charts, useful technology for a price that doesn’t break the bank.

Earlier tablets were bulky or heavy and too expensive, with many selling for thousands of dollars. These early versions tried to replicate the feeling of using paper charts by allowing physicians to write on the screen, then have their scrawl translated by a desktop computer into permanent records. But the penmanship didn’t always translate correctly, and having the record transferred off the tablet didn’t allow physicians to have fingertip access to records.

One of the biggest criticisms about the iPad—that it’s simply an oversized iPhone—ended up being one of the things doctors liked about it. They feel the iPad brings the same utility and ease of use that attracted so many physicians to the iPhone. The iPad takes all those features to the next level, making it possible, and practical, to adopt it as a clinical tool.

The most popular applications physicians used on the iPhone were drug reference tools and e-prescribing systems. But the iPhone’s usefulness was limited because of its three-inch screen. The iPad screen is larger, which eliminates that limitation.

“The iPad brings you back to the patient’s bedside,” says Steven K. Libutti, MD, a surgeon and oncologist who is director of the Montefiore-Einstein Center for Cancer Care in New York.

About 80 more tablet models are expected to be launched to compete with the iPad, with most of them working much like it—the ease of touching instead of typing, the capability to download applications and the ability to “flip” through pages instead of entering long URLs.

As predicted two decades ago, it looks like the tablet computer has become the technology choice of doctors.

Want to know more about medical technology? Morgan Hunter Healthcare is here to help! Contact us today with any questions about the latest developments in the industry.

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