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By Andis Robeznieks 
Posts tagged Healthcare News Top Stories
Although they face significant obstacles, physician hospital investors will likely succeed in the end because they have a history of doing so, a crowd of these investors was told at the Physician Hospitals of America annual conference in Austin, Texas. The opening keynote speaker, futurist Jim Carroll, first voiced the message, which was later echoed by healthcare consultant Kevin McDonough.
Carroll's general theme was nothing new, and it reminded me of Alvin Toffler's book Future Shock, which I was assigned to read in my high school sociology class more than 30 years ago. But the more he tailored his message, the more Carroll's words resonated. "There is so much opportunity in front of you, it's staggering," Carroll said, adding that—even though the Patient Protection and Affordable Care Act restricted business opportunities for physician-owned hospitals—growth was still possible with a change in mindset and a change in business models. McDonough, a senior manager with Dallas-based consultants VMG Health, and VMG Health manager Sarina Hickey offered some specifics. "Margins have remained remarkably stable" for physician-owned hospitals, Hickey said. She added that doctor owners have been "adept at controlling costs," and, while legal and market challenges are daunting, "survivors will emerge stronger." McDonough noted that the ACA's limits on growth may increase the value of existing physician-owned hospitals because they have been made a "limited commodity."
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Pathologists are integrated thoroughly into patient care at Cooper University Hospital, Camden, N.J., and this is by design—architectural design, that is.
The new $163.7 million Roberts Pavilion at Cooper was one of 105 entries in the 27th annual Modern Healthcare Design Awards contest. It was one of 11 winning designs, and EwingCole architects took home a Citation award for their work. What caught my attention, however, was that the architects said that special care was taken to locate the "clinical and anatomic pathology departments to enhance increased involvement of pathologists in the patient treatment stream, a fundamental shift in the role of pathology." "We love it, it's gorgeous," said Dr. Roland Schwarting, Cooper's pathology department chairman and chief. "What I love about it is it's an integrated design.” Schwarting explained how, typically, pathology departments and hospital laboratories are fragmented into various silos, hindering communication and collaboration. He said that on paper, it would amount to a very confusing "spaghetti diagram," with arrows pointing every which way to connect the various functions. One can still use a spaghetti diagram to illustrate the department's operation at Cooper, but "the noodles are not as long," Schwarting said.
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Physician Hospitals of America says that by supporting the Republican opponent of the junior senator from Montana, it's hoping to send a message to the state's senior senator, Democrat Max Baucus, that "anti-competitive healthcare" will no longer be tolerated.
The PHA, an association for physician-owned hospitals, is backing GOP Congressman Denny Rehberg over Democratic incumbent John Tester in the Senate race and is planning to host a breakfast fundraiser for him in Austin, Texas, on Sept. 22—the morning after it concludes its annual conference. The PHA also hopes to slice away at the Democrats' Senate majority helping to keep Baucus in the Senate Finance Committee chairman's seat. In an e-mailed news release promoting the Rehberg fundraiser, the PHA says Baucus "has time and time again blocked the necessary reform needed to provide relief for physician-owned hospitals." The group has been at odds with Baucus for several years over the senator's opposition to physician-owned hospitals. Since the PHA was unable to get rid of Section 6001 through litigation, the strategy makes sense—but doctors don't always get what they want from politicians they support. Case in point: Jim Bunning, the Hall of Fame baseball pitcher and former GOP senator from Kentucky who was re-elected 51-49 in 2004 thanks in part to the financial support he received from physicians to defeat another physician, surgeon Daniel Mongiardo. Six years later, Bunning was filibustering to allow a 21.2% Medicare physician payment cut called for by the sustainable growth-rate reimbursement formula.
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If the patient-centered medical home supported by per-member, per-month care-management fees becomes the standard primary-care practice model, then Oregon Health & Sciences University in Portland can claim to be its first training ground.
When the CMS announced the names of the 500 participants in its four-year Comprehensive Primary Care Initiative, the list included three OHSU primary-care clinics where residents are trained. The CPCI begins with Medicare providing a $20 per-member, per-month care-management fee, with that sliding back to about $15 after the second year, when practices will be eligible to collect money from shared savings. Some private payers and state Medicaid programs are also participating in the CPCI, and—with Medicare, Medicaid and private payers combined—the program's goal is to have at least 60% of the participating practices' patient base covered by per-member, per-month fees. The intent is to have the practices use that money to invest in the staff and information technology necessary for care-coordination services that should help lower hospitalizations, eliminate duplicate testing and avoid other inefficiencies that drive up healthcare costs. Patrick Gordon, program director for the Colorado Beacon Consortium and director of government programs for consortium member Rocky Mountain Health Plans of Grand Junction, Colo., says the program has the potential to "fundamentally change the economics of primary care."
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With the recent passing of Jerry Nelson, the voice of Sesame Street's Count von Count, I'm compelled to note that the 2012 edition of Modern Healthcare's 100 Most Influential People in Healthcare list had 18 first-timers, eight 11-timers, 78 men, 22 women and 25 doctors (20 men and five women).
No doctor is on the "perennial" list of eight people who made the list all 11 years of its existence. In order of their appearance on this year's list, here are the names of the 25 physicians, followed by their titles and the number of times they've appeared on the Most Influential list: No. 3, Dr. John Kitzhaber, governor of Oregon, (1); No. 17, Dr. John Noseworthy, president and CEO, Mayo Clinic, (2); No. 20, Dr. Regina Benjamin, U.S. Surgeon General, (3); No. 21, Dr. Delos "Toby" Cosgrove, (6); No. 26, Dr. Atul Gawande, professor, Harvard Medical School, (1); No. 29, Dr. Gary Gottlieb, president and CEO, Partners HealthCare System, (6); No. 32, Dr. Carolyn Clancy, director of HHS Agency for Healthcare Research and Quality, (10); No. 34, Dr. Farzad Mostashari, national coordinator for health information technology, (2); No. 41, Dr. Gary Kaplan, chairman and CEO, Virginia Mason Medical Center, (4); Dr. Susan Turney, president and CEO, MGMA-ACMPE, (1); No. 46, Dr. Thomas Frieden, director, Centers for Disease Control and Prevention, (3); No. 50, Dr. Risa Lavizzo-Mourey, president and CEO, Robert Wood Johnson Foundation, (7); No. 51, Dr. Mark Chassin, president of the Joint Commission, (5); No. 53, Dr. Glenn Steele Jr., president and CEO, Geisinger Health System, (4); No. 58, Dr. Margaret Hamburg, Commissioner, Food and Drug Administration, (3): No. 60, Dr. Francis Collins, director, National Institutes of Health, (3); No. 63, Dr. Harvey Fineberg, president, Institute of Medicine, (4); No. 64, Dr. Eric Topol, chief academic officer, Scripps Health, (2); No. 68, Dr. Bruce Siegel, president and CEO, National Association of Public Hospitals and Health Systems, (2); No. 75, Dr. Ralph de la Torre, chairman and CEO, Steward Health Care System, (1); No. 80, Dr. Georges Benjamin, executive director, American Public Health Association, (6); No. 85, Dr. James Madara, executive vice president and CEO, American Medical Association, (1); No. 88, Dr. Richard Gilfillan, acting director, CMS Center for Medicare and Medicaid Innovation, (2); No. 94, Dr. Darrell Kirch, president and CEO, Association of American Medical Colleges, (5); and No. 97, Dr. Charles Sorenson, president and CEO, Intermountain Healthcare, (2). Congratulations one and all. Was there an influential physician you thought should have been on the 2012 list? Let me know at arobeznieks@modernhealthcare.com. Follow Andis Robeznieks on Twitter: @MHARobeznieks.
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The 500 medical practices participating in the CMS Comprehensive Primary Care Initiative are going to be under a lot of pressure, as it is now up to them to prove that the patient-centered medical-home model works clinically and economically.
Let's face it: Government-sponsored pilot programs and demonstration projects come and go. Most produce some headlines at their launch, then they generate a few research papers a year or three after their completion, and then they're forgotten. But hopes are higher for the CPCI, which was described as "very well-conceived, well-designed and, so far, a well-executed program" by Patrick Gordon, program director for the Colorado Beacon Consortium and director of government programs for consortium member Rocky Mountain Health Plans based in Grand Junction, Colo., an area contending for the country's coordinated-care crown. The key to the four-year effort is that around 60% of the patient bases for participating practices will be covered by plans providing per member, per month management fees. In the case of Medicare, it will be $20, with the fees for Medicaid and other participating private payers yet to be determined. According to Gordon, it could "fundamentally change the economics of primary care" if the care coordination results in fewer hospitalizations and lower global costs to the country's healthcare bill.
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According to two influential GOP lawmakers, doctors will not have their Medicare pay cut by around 30% in January as called for by the sustainable growth-rate reimbursement formula. However, the lawmakers differ on when the much-hated SGR will be repealed for good.
Both Rep. Paul Ryan of Wisconsin, the party's presumptive vice presidential candidate, who finished No. 24 on Modern Healthcare's 2012 Most Influential People in Healthcare list, and Sen. Chuck Grassley of Iowa, No. 56 on the list, seemed certain that another temporary fix will be approved by Congress and signed by President Barack Obama before the scheduled pay cut kicks in. "No one is going to go home to their state to tell doctors we're cutting their pay 30%," Grassley said during an interview with Modern Healthcare for the Most Influential list.
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Like the medical research paper whose chief finding is that more research is needed, the Liaison Committee on Medical Education put Puerto Rico's San Juan Bautista School of Medicine on probation so its problems could be studied. And, after studying them, the LCME decided to keep the school on probation.
And, while on probation, it maintains its accreditation. Why it remains on probation remains under wraps, so it's sort of a double-secret probation. "We're not allowed to release any information," Dan Hunt, LCME secretary, told me. "Accreditation is not guaranteed," he added. "Accreditation can be revoked."
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Though they're at the low end of the physician pay scale, pediatricians are often found in leading activist or management roles in the healthcare system.
I was reminded of this when, at an event in Washington this week highlighting the Healthier Hospitals Initiative, Dr. Jeffrey Thompson, Gundersen Lutheran Health System's CEO, told an anecdote about how his organization was saving $1 million annually in energy costs after a $2 million investment in 2008. He then punctuated his remarks by noting how that math was easy to understand "even for us pediatricians." I didn't know Dr. Thompson's specialty before, but I wasn't surprised to learn that the leader of an innovative, high-performing organization was a pediatrician. After all, former CMS Administrator Dr. Donald Berwick and patient-safety pioneer Lucian Leape have pediatric backgrounds. So does Dr. William Jessee, currently senior vice president and senior adviser with Integrated Healthcare Strategies and the former president and CEO of the Medical Group Management Association. Jessee has appeared on Modern Healthcare/Modern Physician's 50 Most Influential Physician Executives list six times.
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Although most public pronouncements from healthcare organizations these days sound like they're prepared from the same we're-all-in-this-together template, the latest scope-of-practice court fight showed that all sides still seem ready to drop the gloves at any moment.
A Colorado state appellate court affirmed a decision from the state's former governor permitting certified registered nurse anesthetists to administer anesthesia without a physician's supervision in the state's critical-access and rural hospitals. Doctors then squared off against nurses and hospitals, and national organizations representing all sides joined in. The court acknowledged it was ruling narrowly on the issues of whether the governor had the authority to make his decision and whether the decision was consistent with state law. It said yes to both, but its opinion (PDF) also included this note: "Our role is limited to determining whether Colorado law permits CRNAs to administer anesthesia without physician supervision. We may not pass on the wisdom of the decision to allow CRNAs to do so."
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When pay raises are small, some can take solace if their compensation rose above the rate of inflation, but that rate—as measured by the consumer price index—is a moving target, so using it as a historical measure may be of limited value. But that won't stop me from trying to do so.
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