HCPro.com - Health Plan Insider

HealthLeaders Media Live from Gundersen Health System: End-of-Life Care Coordination

Strategies to curtail the unnecessary use of the emergency department involve efforts that rely on data, care management, and patient involvement. >>>

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May 1, 2013

Providers Grade Health Plans. Guess Who Still Stinks.

Jacqueline Fellows

An annual survey of hospital leaders' opinions of large health plans shows WellPoint and UnitedHealthcare fighting for last place among their peers—Cigna, Aetna, Coventry, Humana, and the independent Blue Cross Blue Shield plans. >>>

Editor's Picks

IPPS Proposed Rule Adds Readmission Measures, HAC Timeline

CMS's proposed rule for Inpatient Prospective Payment Systems for acute care hospitals includes clarification on which patient stays qualify as legitimate hospitals admissions and exempts certain planned admissions from the readmissions penalty. >>>

Incentives, Motivations Clash Under ACOs

A body cannot serve two masters—except—some contend, in healthcare. The old saying is being put to the test as healthcare organizations join multiple ACOs without standard practice protocols. >>>

Bond Ratings Pressure Smaller Hospitals as NFP Sector Falters

While five of six not-for-profit hospitals that saw their bond rating downgraded in the first quarter of 2013 had less than $500 million in revenues, the outlook is grim across the board. "It's negative for the whole industry," says an executive at Moody's Investor Service. >>>

FDA Probes Docs Over da Vinci Robot Problems

The U.S. Food and Drug Administration is counting on physicians to offer insights into complaints about the da Vinci robot, which is under scrutiny in lawsuits and medical board reviews as never before. >>>

Healthcare M&A Activity Dips

Healthcare merger and acquisition activity was down in both deal volume and deal value in the first quarter of 2013 compared to the last quarter of 2012, says a new report. >>>

IPAB Has to Go, Providers and Advocates Urge

A coalition of healthcare provider groups, drug and device manufacturers, health insurers, and patient advocates have signed a letter to Congress urging repeal of the Independent Payment Advisory Board. >>>

Q&A: Kaiser Permanente's CIO on Predictive Analytics and Other Challenges

Philip Fasano, CIO of Kaiser Permanente, discusses how predictive analytics can prevent sepsis and improve other medical conditions, and explains how he is working to execute on his belief that "every citizen of this country should have the right to have their medical record present when being treated by a physician." >>>

Intelligence Report

Intelligence Report: Reshaping the Cardio Service Line for Population Health and Reform Challenges

76% of healthcare leaders report positive margin from cardio. This report explores how best to evolve cardio service lines to support prevention, expand offerings, and maintain healthy margins. Purchase Today >>>

News Headlines

Opinion: Medicare should pay for patients, not treatments

Bloomberg, May 1, 2013

Healthcare experts propose $1 trillion in savings

The Hill, April 30, 2013

Hospital stocks rally as Medicare tempers budget cut blow

Bloomberg, April 30, 2013

Healthcare spending growth at record low

CNNMoney, April 30, 2013

Obama administration simplifies healthcare form

Boston.com / Associated Press, April 30, 2013

80 million Americans didn't use healthcare services due to cost

WEAR, April 29, 2013

GOP bill hits alleged ObamaCare exemption talks

The Hill, April 29, 2013

Obamacare exemption talk lights up Capitol Hill

Politico, April 26, 2013

Hatch questions Obamacare transition period for MA

The Hill, April 26, 2013

Senator places hold on Obama's Medicare pick

The Washington Post, April 25, 2013

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Multimedia/Events

CT Readies its HIX for Small Business

Wed, 24 Apr 2013 17:31:00 GMT

Health Leaders Media

From HealthLeaders Magazine

Improving Surgical Quality

Strategies to curtail the unnecessary use of the emergency department involve efforts that rely on data, care management, and patient involvement. >>>

Bridging the Physician-Management Chasm

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April 24, 2013

CT Readies its HIX for Small Business

Jacqueline Fellows

The CEO of Connecticut's state-based health insurance exchange says the strategic decision to outsource some of the work stems from his belief that "value rests more in marketing and outreach relations with health plan and product designs than it does with operational issues. >>>

Editor's Picks

Hospitals Crack Down on ED Repeat Users

With renewed urgency, hospitals, healthcare leaders, and insurers are initiating strategies to curtail what is a growing problem: the use of emergency department services by patients who return time and again. >>>

Diagnostic Errors Common, Costly, and Harmful

Wrong site surgeries and medication mishaps get more attention, but diagnostic errors are a larger, deadlier, and costlier problem, for patients and healthcare providers, Johns Hopkins researchers say. >>>

Managing Physicians May Be Impossible

If physicians can't be managed, we're all in for trouble, because healthcare is bankrupting us. Everyone needs to be managed, whether they're the President of the United States or a country doctor. >>>

Q&A: Kaiser Permanente's CIO on Technology's Role in Redefining Healthcare

Philip Fasano, CIO and executive vice president of Kaiser Permanente, discusses the rise of consumerism and what it means to providers, why cloud computing isn't quite ready for the demands of healthcare, and the current state of data security. >>>

Consumer Reports Expands Hospital Ratings List

Almost two-thirds of the nation's 258 teaching hospitals that report enough data to calculate a safety score ranked below average, the director of the Consumer Reports Health Ratings Center says. >>>

How 4 Health Systems Rein in Supply Costs

Collectively, four Ohio-based health systems report that they have saved nearly $700,000 in the roughly four months since launching a purchasing collaborative, including $250,000 on physician preference items. >>>

Outpatient Growth Must Keep Pace with Population

Two out of three health system leaders say their top strategy for fueling financial growth is expansion of outpatient services. The trick is "to grow at the same market share with the [population] growth," says one senior executive. Market share increase is likely to be incremental—but even a small increase means a large raw number. >>>

Intelligence Report

New Intelligence Report: Collaborative Care—Hospitals Balance Risk and Revenue With Physicians and Payers

Download the free Intelligence Report for exclusive insight from top healthcare executives and clinical leaders on their proven strategies for implementing collaborative care models.

Download Today >>>

News Headlines

Senate panel backs Obama nominee for Medicare chief

Reuters, April 24, 2013

Racing to spread word about new health plans

The New York Times, April 24, 2013

Slowdown in healthcare spending linked to weaker U.S. economy

California Healthline, April 24, 2013

S&P sees pension funding burden on U.S. nonprofit healthcare

Reuters, April 23, 2013

Should Medicare pay hospitals for leaving patients satisfied?

The Washington Post, April 23, 2013

New healthcare law tax surprise

NBC Bay Area, April 22, 2013

Inside India's 'no-frills' hospitals, where heart surgery costs just $800

Business Insider / Agence France Presse, April 22, 2013

26M will be eligible for 'game changer' ObamaCare subsidies

The Hill, April 19, 2013

NYC to seek new provider for $6 billion healthcare program

Bloomberg, April 19, 2013

Co-author of Obama healthcare law sees 'huge train wreck' in implementation

The Washington Post, April 18, 2013

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Multimedia/Events

Webcast: New Physician Referral Models for Value-Based Care

Date: April 25, 2013, 1:00–2:30 p.m. ET

Join physician referral experts from MGMA-ACMPE and Baptist Health System, San Antonio to learn how to create sustainable and scalable marketing plans for physician referrals that will keep pace with healthcare changes in 2013. Register Today >>>

From HealthLeaders Magazine

Improving Surgical Quality

Strategies to curtail the unnecessary use of the emergency department involve efforts that rely on data, care management, and patient involvement. >>>

Bridging the Physician-Management Chasm

Health Plan’s Secret Sauce is Social Media

Wed, 17 Apr 2013 17:58:00 GMT

Health Leaders Media

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April 17, 2013

Health Plan's Secret Sauce is Social Media

Jacqueline Fellows

Magellan Health Services has found a surprising way to not only engage patients, but to change the behaviors that contribute to their health problems. In the pilot program, Magellan reduced readmission rates and exceeded its engagement goals. >>>

Editor's Picks

AHA: Obama Budget Proposes 'Troubling Reductions'

Healthcare industry groups are expressing concern over proposed cuts to Medicare and limits to charitable deductions, but favor the White House budget's proposed delay in cuts to disproportionate share hospital payments. >>>

Gawande: Hospitals Profit When Surgeries Go Wrong

Medical complications in surgical patients generate profits for hospitals, a study led by Atul Gawande, MD, shows. But the American Hospital Association disputes the report's implications that hospitals aren't incentivized to avoid complications. >>>

Doctor's Double-Billing Illustrates Broken System

A pediatrician's billing policies—and an insurance company's inability to negotiate better terms—perfectly highlight the difficult work in store for those of us who would like to see more value in healthcare. >>>

Radiologists Push Back on Reimbursement Cuts

A 25% multiple procedure payment reduction to Medicare reimbursements for interpretations of advanced diagnostic imaging scans performed on the same patient in the same session is drawing the ire of radiologists. >>>

Engaged Patients Cost Less

Patients' level of engagement is directly linked to their health-related outcomes. It's more than just good medicine—engaged patients with the same chronic illness had lower healthcare costs than their less-engaged counterparts, a study shows. >>>

Evidence Base for Vena Cava Filter Use 'Thin'

Inferior vena cava filters "as they're currently used don't really work as well as physicians think they do," and commonly fail to be removed, causing patient harm, researchers say. >>>

CMS Mulls Use of Specialty Registries for Quality Data

Data contained in voluntary reporting registries, a growing trend in specialty care especially for surgery and other invasive procedures, may one day be folded into Medicare performance measures that assess quality of care. But there are some hurdles to clear first. >>>

LIVE Webcast

Webcast: Develop an Innovative and Integrated Palliative Care Program

Date: Date: April 23, 2013, 1:00–2:30 p.m. ET

Join experts from Sutter Health and Saint Agnes Medical Center and learn new tools and strategies for developing a multidisciplinary palliative care program. Register Today
>>>

News Headlines

Hospitals serving the uninsured face challenge under Obamacare

The Washington Post, April 17, 2013

Dems take on pharma in push for Medicare cuts

The Hill, April 17, 2013

Medicare could save millions by limiting advance payments to insurers

Kaiser Health News, April 17, 2013

Showdown brewing over FL healthcare plans

The Miami Herald, April 17, 2013

St. Joseph strikes deal with Medicare to recoup some of lost billings

The Baltimore Sun, April 16, 2013

Healthcare providers want faster changes in payments

USA Today, April 15, 2013

Opinion: U.S. healthcare system has almost worst of all worlds

CNN World, April 15, 2013

Obamacare supporters want another bill to tackle costs.

The Washington Post, April 12, 2013

Employer health coverage in U.S. on 10-year decline

Bloomberg, April 12, 2013

Obesity causing healthcare costs to rise

News & Observer, April 11, 2013

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Multimedia/Events

HealthLeaders Media Live from Parkview Health: The New Readmissions Plan

Date: April 18, 2013, 12:00-3:00 p.m. ET

Parkview Health of Fort Wayne, IN, has worked its way toward the top of the list of lowest 30-day readmission rates in the nation—and this event will show you how. Parkview leaders share their comprehensive strategy for reducing preventable readmissions through a plan of early action, best practices, and coordinated care. Register Today

Download free case study >>>

From HealthLeaders Magazine

Improving Surgical Quality

Strategies to curtail the unnecessary use of the emergency department involve efforts that rely on data, care management, and patient involvement. >>>

Bridging the Physician-Management Chasm

Disparity Evident in Navigator Grants

Wed, 10 Apr 2013 17:49:00 GMT

Health Leaders Media

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April 10, 2013

Disparity Evident in Navigator Grants

Jacqueline Fellows

CMS funding to help states pay for federally required navigator programs isn't nearly enough to adequately help the number of uninsured Americans who are expected to enroll in the health insurance exchanges this October. >>>

Editor's Picks

Are Retail Clinics Competitors or Potential Partners?

Walgreens' expansion into treatment of chronic illness could look like competition to hospitals and health systems, or it could be a possible referral source. Many provider executives are eager to partner with retail clinics. >>>

Patient Advocates are Not the Enemy

Healthcare leaders in the nonprofit sector may see themselves as being under attack from proponents of access to care for the poor and underserved, but embracing the adversary can prove to be an effective strategy. >>>

Hospitals Re-Think Neurological Services to Meet Geriatric Needs

With the cost of treating dementia alone expected to double within 30 years, it's no wonder hospitals are ramping up their care planning with specialized clinics in neurological institutes aimed at geriatric patients. But shrinking reimbursements and physician resources are forcing innovative thinking. >>>

Small Budget Cancer-Screening Campaign Pays Off

Months after a Virginia medical center's launch of a campaign targeting employees for mammograms, it's clear the marketing effort was a success. >>>

ONC Responds to HIE Criticism with Grants

Stung by a negative report on health information exchanges, the federal Office of the National Coordinator for Health Information Technology is handing out nearly a half million dollars to spur private efforts in the area. >>>

HIT Errors 'Tip of the Iceberg,' Says ECRI

A report from the ECRI Institute blames humans for 46% of errors in which health information technology malfunctions and either causes or creates a risk of patient harm. >>>

Healthcare Sector Props Up March Jobs Report

Healthcare accounted for a quarter of the new jobs created in March across the United States, according to federal data. The majority of new healthcare jobs came in ambulatory services, followed by hospitals. >>>

LIVE Webcast

Webcast: Develop an Innovative and Integrated Palliative Care Program

News Headlines

Why Republican senators like Obama's Medicare nominee

The Washington Post, April 10, 2013

AG: ME Gov's plan to pay off hospital debt is constitutional

Bangor Daily News, April 10, 2013

How price transparency could end up increasing healthcare costs

The Atlantic, April 9, 2013

Obama administration pushes toward EMR

The Hill, April 9, 2013

Big data could mean big savings in healthcare

GigaOm.com, April 8, 2013

MS hospital group: No Medicaid expansion will leave 200,000 in 'the gap'

Mississippi Business Journal, April 8, 2013

AL won't enforce federal healthcare rules

Tuscaloosanews.com / The Associated Press, April 8, 2013

Walgreens first retail chain to diagnose, treat chronic conditions

Kaiser Health News / USA Today, April 5, 2013

Obama's budget to spare medicaid from deep cuts

NPR / Associated Press, April 5, 2013

Cancer clinics turning away thousands of Medicare patients

The Washington Post, April 4, 2013

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Multimedia/Events

HealthLeaders Media Live from Parkview Health: The New Readmissions Plan

From HealthLeaders Magazine

Isolation gives way to integration as healthcare leaders look to create service lines that work collaboratively >>>

HealthLeaders Media Live From Dean Clinic: Primary Care Redesign

Claims Costs Report Puts Actuaries in Political Hot Seat

Wed, 03 Apr 2013 16:53:00 GMT

Health Leaders Media

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April 3, 2013

Claims Costs Report Puts Actuaries in Political Hot Seat

Jacqueline Fellows

Reaction to a report from the Society of Actuaries has thrust the group into unfamiliar territory: politics. The report bolsters an insurance industry group's claims that premiums will rise under the Patient Protection and Affordable Care Act. >>>

Editor's Picks

Scores Predict Readmission Likelihood

Researchers say they have developed a formula that can identify roughly one-fourth of a hospital's patient population with the highest likelihood of being readmitted within 30 days. >>>

Mortality Rates at CAHs Ratcheting Higher

Researchers comparing 30-day mortality rates of CAHs and non-CAHs in urban and rural settings find that while rates on several key measures were comparable in 2002, CAHs have fallen behind significantly. >>>

Doctor-Hiring Rush is On

The fervor by physicians to become employed stems from the decline in reimbursements. But if a hospital's financial and clinical goals aren't clearly defined, the employment arrangement can be disjointed from the outset. >>>

Phishing a Real Threat to Healthcare, No Fooling

When the Chief Justice of the United States Supreme Court falls prey to credit card fraud, you know that anyone, and any organization, is a potential target for email fraud scams and data theft. >>>

Q&A: Lucian Leape Wants Tougher Patient Safety Regs

The man known as the father of the modern patient safety movement is calling for the creation of a special federal regulatory agency to compel safer hospital practices. >>>

RAC Reform Movement Gains Some Traction

The American Hospital Association's recent win over the Centers for Medicare & Medicaid Services in a court fight over Recovery Audit Contractor penalties opens the door for a bigger strategic push to overhaul the RAC system. >>>

Better Blood Use, Better Outcomes

Limiting blood transfusions to cases where it is really needed can reduce patients' adverse events, cut lengths of stay, drop hospital costs by millions of dollars a year, and even prevent mortality. >>>

Roundtable

HealthLeaders Media Live from Parkview Health: The New Readmissions Plan

News Headlines

How insurers flipped a Medicare pay cut into a pay raise

The Washington Post, April 3, 2013

Opinion: State Medicaid eligibility and care delayed because of cost

The New England Journal of Medicine, April 3, 2013

Insurers await final 2014 Medicare Advantage rates

Bloomberg Businessweek, April 2, 2013

MD's tough hospital spending proposal seen as 'nationally significant'

Kaiser Health News / The Washington Post, April 2, 2013

Analysis: Healthcare, tax cuts issues colliding

SFGate.com / Associated Press, April 1, 2013

Opinion: The Starbucks syndrome in healthcare

Los Angeles Times, April 1, 2013

Hospitals question Medicare rules on readmissions

HealthLeaders Media, April 1, 2013

Health reform's changes stir worries as they take shape in MD

The Baltimore Sun, April 1, 2013

Federal healthcare law could boost some California premiums by 30%

Los Angeles Times, March 29, 2013

The secret Republican plan to repeal Obamacare

The Atlantic, March 29, 2013

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Multimedia/Events

From HealthLeaders Magazine

Isolation gives way to integration as healthcare leaders look to create service lines that work collaboratively >>>

HealthLeaders Media Live From Dean Clinic: Primary Care Redesign

Blue Cross Merger Decision Expected Soon in MT

Wed, 27 Mar 2013 17:54:00 GMT

Health Leaders Media

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March 27, 2013

Blue Cross Merger Decision Expected Soon in MT

Jacqueline Fellows

The long road to approving a deal under which Health Care Service Corporation would purchase Blue Cross and Blue Shield of Montana is due, in part, to a state law which is meant to protect consumers if a nonprofit health plan converts to one that is for-profit. >>>

Editor's Picks

9 in 10 Health Plans Still Tied to FFS Model

A study of data voluntarily submitted by commercial health plans to an independent, non-profit group working on behalf of large healthcare purchasers finds that only 11% of payments to providers are value-oriented. >>>

What is Fair Payment for Outpatient Care?

A senior finance executive explains how he hopes to help minimize the "natural conflict that exists between the forward-looking technology companies and process innovators and the retroactive-looking team at CMS." >>>

Medical Error Risk Rises Under Shorter Medical Intern Shifts

Researchers found that handoffs, a known risk factor for medical errors, increased 130% to 200% under rules limiting consecutive hourly duty limits for house staff interns. >>>

Less Than 1% of Health Plan Premiums Spent on Quality

The Patient Protection and Affordable Care Act's medical loss ratio rule requires insurers to spend at least 80% or 85% of premiums on medical claims and quality improvement activities, or else pay rebates to consumers. >>>

Lumbar Spine MRIs 'Frequently Inappropriate'

A study of requests for MRI scans of patients' lumbar spines finds that more than half of the medical imaging tests were "substantially" inappropriate or of uncertain value. >>>

Not-for-Profit Hospitals Tighten Oversight as Revenues Fall

While healthcare executives have become more focused on expense management, a Moody's Investors Service analyst expects that not-for-profit hospitals will continue to endure a negative credit outlook for the near future because of challenges to top-line revenues. >>>

IOM: Geographic Value Index Won't Fix Variation

A geographic value index "would reward low-value providers in high-value regions and punish high-value providers in low-value regions," says a report by the Institute of Medicine. >>>

LIVE Webcast

Webcast: New Physician Referral Models for Value-Based Care

News Headlines

Health overhaul to raise claims cost 32 percent

News & Observer / Associated Press, March 27, 2013

Re-engineering healthcare

The New York Times, March 27, 2013

Doctors, non-physicians battle over medical turf

Los Angeles Times, March 27, 2013

MD passed bill to fund health exchanges

The Washington Post / Associated Press, March 26, 2013

Editorial: Report card on healthcare reform

The New York Times, March 25, 2013

Health poll reveals where people go for care

The Bakersfield Californian, March 25, 2013

How amnesty for undocumented immigrants would impact health care

KPBS / CHCF Center for Health Reporting, March 25, 2013

Supreme Court strikes down state Medicaid recovery law

Reuters, March 22, 2013

The face of future healthcare

The New York Times, March 22, 2013

Some states balk at enforcing health law's insurance protections

The Austin American-Statesman, March 21, 2013

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Multimedia/Events

From HealthLeaders Magazine

Isolation gives way to integration as healthcare leaders look to create service lines that work collaboratively >>>

Webcast: Develop an Innovative and Integrated Palliative Care Program

Health Leaders Media

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March 20, 2013

Nonprofit Health Plans Edge For-Profits in Customer Satisfaction

Jacqueline Fellows

While consumers continue to give low satisfaction ratings to health plans in general, they assign higher marks to nonprofit health plans, a J.D. Power and Associates study shows. It ranks health plans by region in seven categories. >>>

Editor's Picks

When States Reject Medicaid Expansion, Providers, Businesses Will Pay

States that reject Medicaid expansion under the Affordable Care Act will subject the hospitals and employers within their borders to a considerable financial hit, separate analyses show. >>>

Proposed Changes to Part B Inpatient Billing Open for Comment

The proposed changes revise the current policy on Part B billing following the denial of a Part A inpatient hospital claim that a Medicare review contractor has deemed to be not reasonable or necessary. >>>

CDI Prevention Protocols Maddeningly Inconsistent

Not only does Clostridium difficile infection kill 14,000 patients a year in the U.S. while racking up costs of roughly $1 billion, but providers are all over the map in their attempts to stop it. >>>

Does Primary Care Need To Be Retooled?

The president of Partners Healthcare and a Harvard University economist contend that primary care in the U.S. needs to be restructured to improve physician business practices and provide more value for patients. >>>

The Cardio Service Line, Rebooted

The tactics for caring for cardiology patients are changing. Care partners, often practicing in the community and not in the hospital, are playing pivotal roles in expanding the patient referral base in new ways. >>>

The Trouble with Nurse Practitioners

At a time when healthcare institutions need and should be hiring more APRNs, turf battles, nurse practitioner shortages, and state laws are stubbornly standing in the way. >>>

News Headlines

Group medical appointments may help ease physician shortage

The Washington Post, March 20, 2013

U.S. drug costs dropped in 2012, but rises loom

The New York Times, March 19, 2013

What hospitals charge the uninsured

The New York Times, March 19, 2013

29 states get 'F' for price transparency laws

Kaiser Health News, March 18, 2013

New HIPAA rules pose challenges for healthcare industry

Reuters, March 18, 2013

Opinion: One form, faster prescriptions, better health care

Detroit Free Press, March 18, 2013

LifePoint's Bill Carpenter wants to keep patients out of hospitals

Nashville Business Journal, March 18, 2013

Opinion: Hospitals' doctor-buying binge likely to end badly

Forbes, March 15, 2013

Hospital admissions continue to decline

The Philadelphia Inquirer, March 15, 2013

Experts debate all-payer setups vs. Medicare for all

Politico, March 15, 2013

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Multimedia/Events

From HealthLeaders Magazine

Isolation gives way to integration as healthcare leaders look to create service lines that work collaboratively >>>

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MAGAZINE | NEWS | TERMS OF SERVICE | PRIVACY POLICY | ADVERTISE

HealthLeaders Media Live from Heartland Health: Performance Improvement Lessons

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March 13, 2013

3 Cost-Cutting Strategies Insurers Can Learn from Employers

Jacqueline Fellows

Only 26% of employers are "very confident" their company will provide health benefits in 10 years and top-performing employers are already taking big steps toward reducing costs. Wise insurers will pay close attention. >>>

Editor's Picks

Hospitals Fight MedPAC Rate Plan

Under one Medicare Payment Advisory Commission proposal, Medicare might pay hospitals the same rate it now pays for services in a physician's office. Several options are on the table, but under all scenarios, federal payments to hospitals would drop dramatically. >>>

Bundled Payments Come to Cancer Care

Bundling is one of the new payment models being scrutinized as a way to get a handle on skyrocketing service line costs. Here’s how it works in oncology programs. >>>

Diabetes Costs Hit $245B in 2012

More than half (62.4%) of the cost of diabetes care is provided by Medicare, Medicaid, and other government payers; 34.4% is paid for by commercial plans; 3.2% is paid for by the uninsured. >>>

HIMSS Review: Technology Priorities and Realities

The 2013 HIMSS conference featured technology solutions to transform existing healthcare providers into ACOs. But is the technology cart leading the horse? Security concerns may be getting bigger, and interoperability remains a distant goal. >>>

Colonoscopy 'Potentially Inappropriate' for 30% of Seniors

Some providers are overusing colonoscopy for screening purposes in older adults, based on age-based screening guidelines. Research shows wide regional variations in the practice. >>>

How One Hospital Zapped Infection Rates

Hospital leaders are continuously examining assumptions, processes, and actions that lead to infection, often with modest results. Here's how one hospital made a dramatic reduction in central line-associated bloodstream infections. >>>

Healthcare Hiring Strong Despite Looming Sequester Cuts

Any healthcare job losses that do come as a result of sequestration will be "disproportionately low" in relation to other industry sectors says, one economist. >>>

LIVE Webcast

Webcast: Recruiting and Retaining Physicians for the Post-Reform Era

Date: March 22, 2013, 1:00-2:30 p.m. ET

Metro Health System and the National Association of Physician Recruiters share benchmark data and best practices to create the "right fit" for your organization when it comes to physician recruiting in the post-reform era. Register Today >>>

News Headlines

MO House endorses healthcare conscience measure

St. Louis Post-Dispatch / Associated Press, March 13, 2013

NC lawmakers: Surgery centers would provide alternative to high hospital bills

News & Observer, March 13, 2013

Uninsured Americans get hit with biggest hospital bills

Businessweek / Bloomberg News, March 12, 2013

Patients balk at considering cost in medical decision-making

The Washington Post, March 12, 2013

Opinion: MD health insurers' 'fail first' policies jeopardize patient health

The Baltimore Sun, March 12, 2013

Alleged misdeeds haunt CA hospital chain poised to buy NJ hospitals

NJ.com, March 11, 2013

Opinion: The high costs of Medicare's low prices

The Washington Post, March 11, 2013

Most large employers to keep health insurance benefit

The Baltimore Sun, March 8, 2013

Battling fraud charges, FL hospital repays millions to Medicare

Orlando Sentinel, March 8, 2013

How AZ reconciled government-run healthcare with its conservative ethos

The Atlantic, March 8, 2013

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Multimedia/Events

Date: March 19, 2013, 12:00-3:00 p.m. ET

Malcolm Baldrige National Quality Award winner Heartland Health reveals how it has built a culture around performance improvement. Learn how to identify new opportunities for collaboration. Find out how to implement best practices for evidence-based population care management. And start delivering a better patient experience. Register Today

Download free case study >>>

From HealthLeaders Magazine

Isolation gives way to integration as healthcare leaders look to create service lines that work collaboratively >>>

As MissionPoint ACO Turns One, Membership Up, Costs Down

Wed, 06 Mar 2013 15:04:00 GMT

HealthLeaders Media Live from Heartland Health: Performance Improvement Lessons

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March 6, 2013

As MissionPoint ACO Turns One, Membership Up, Costs Down

Jacqueline Fellows

The Tennessee accountable care organization has seen "considerable growth" in its first year and has cut medical costs for its original members by 12%. Now it's partnering with a major insurer and may be a case study for other hospitals and health systems. >>>

Editor's Picks

Better Care is the Key to Super-Utilizer Costs

Super-utilizer patients, also known as frequent fliers, create exorbitant costs for hospitals and health systems yet receive care inadequate to their needs. The failure is in project management rather than clinical delivery, says one physician leader. >>>

SGIM Calls for End to Fee-For-Service

Fee-for-service medicine is a financially unsustainable payment model that should be phased out by the end of the decade, a study commissioned by the Society for General Internal Medicine recommends. >>>

Free Marketeer's Healthcare Scheme Would be Chaos

After watching a hospital botch his late father's care, David Goldhill says he's figured out what's wrong with our healthcare system. Now he proposes eliminating all private health plans and Medicare. >>>

Healthcare's Grim Winter Feels Endless

Healthcare organizations are seeking safety in numbers as a long winter of declining revenues continues. Additional Medicare cuts associated with the sequester don't bode well for an early thaw. >>>

Inside an ACO-Like Partnership

Independence Blue Cross and Abington Health have partnered under an accountable care payment model which pays physicians and hospitals "substantial sums" above the standard reimbursement rate when they meet quality and medical cost targets. >>>

EHR a Money-Loser for Most Physicians

Federal meaningful use incentives alone are not adequate to ensure that the vast majority of medical practices don't lose money on electronic health record systems, suggests the author of a study on the cost impact of EHR. >>>

LIVE Webcast

Recruiting and Retaining Physicians for the Post-Reform Era

News Headlines

Lax policing of doc, pharmacy conflicts found in Medicare coverage decisions

The New York Times, March 6, 2013

Push for price transparency in healthcare

The Atlanta Journal-Constitution, March 6, 2013

Health regulator issues subpoenas to 4 HealthSouth hospitals

The Baltimore Sun / Reuters, March 6, 2013

Highmark's 'Community Blue' patients rejected by UPMC

Pittsburgh Post-Gazette, March 6, 2013

GAO reports billions in overpayments to private Medicare plans

The Hill, March 5, 2013

Panel recommends overhauling US doc payments

The Hill, March 5, 2013

Obama asks health plans to report rising rates

The New York Times, March 4, 2013

Some states will rate health plans on quality this fall

Kaiser Health News, March 1, 2013

MA Blue Cross to reinstate board fees

The Boston Globe, March 1, 2013

Hospital readmissions for US Medicare patients decline

Bloomberg, March 1, 2013

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Demand for devices such as the iPad and smartphone comes from clinicians and is having a powerful impact on healthcare delivery as the next wave of technology surges, but don't shut down your PCs just yet. >>>

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Insurers Doubt Fed's HIX Readiness

Wed, 27 Feb 2013 18:19:00 GMT

HealthLeaders Media Live from Heartland Health: Performance Improvement Lessons

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February 27, 2013

Insurers Doubt Fed's HIX Readiness

Jacqueline Fellows

Health plans are getting ready to participate in health insurance exchanges. But 70% of healthcare executives say they're concerned over whether the exchanges will be ready to roll by the 2014 deadline. >>>

Editor's Picks

Don't Blame Hospitals for All Diagnostic Errors

Primary care providers are the cause of "at least 50,000 missed diagnostic opportunities" annually, "most resulting in considerable harm," say physicians commenting on new research. >>>

6 States to Receive $250M in Innovation Model Funding

The Department of Health & Human Services innovation grants aim to enable states to test multi-payer payment models and reduce healthcare costs. >>>

Early Elective Delivery Still a Costly Health Risk

Reducing the number of early elective deliveries to target rates could save an estimated $1 billion in healthcare costs annually, says Leapfrog Group president Leah Binder. >>>

CMS Waiver Answers Safety Net's $64M Question

Hospitals whose local governments subsidize treatment of the uninsured, and whose states have declined to create their own insurance exchanges, should look into the Medicaid waiver granted to Cleveland's MetroHealth through a CMS demonstration project. >>>

Weight Loss Surgery Doesn't Cut Health Costs

Bariatric surgery patients have lower costs for medication and physician's office visits up to six years later, but those savings are offset by more hospitalizations and hospital costs, health economists say. >>>

Intubation in ICU Linked to PTSD

In a small study, symptoms commonly associated with post-traumatic stress disorder have been shown to affect more than one-third of patients treated with mechanical ventilation for acute respiratory illness. >>>

LIVE Webcast

Recruiting and Retaining Physicians for the Post-Reform Era

News Headlines

NJ Governor backs Medicaid expansion

The Hill, February 27, 2013

Coordinated healthcare could save CA $110B

Los Angeles Times, February 27, 2013

Highmark: We need contract with UPMC

Tribune-Review, February 27, 2013

3 Hill panels examining changes to Medicare

Kaiser Health News, February 26, 2013

Aetna consolidates health IT assets

InformationWeek, February 26, 2013

Healthcare braces for sequester

The Hill, February 25, 2013

Health insurance premium increases drop since 2009

Newsday, February 25, 2013

Q&A: Marilyn Tavenner, Obama's pick to head Medicare

The Washington Post, February 22, 2013

Govs to hear OR healthcare plan

The Boston Globe / Associated Press, February 22, 2013

Robot docs will even make health insurance less painful

The Atlantic, February 22, 2013

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HealthLeaders Media Live from Heartland Health: Performance Improvement Lessons

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February 20, 2013

Most States Shun Fed HIE Partnerships, But Seek Accommodations

Jacqueline Fellows

As unlikely as it may have seemed in the early planning stages of health insurance exchanges, a federally run exchange is what most states will use. States may change their exchange model at any time, but many will seek accommodations first. >>>

Editor's Picks

Q&A with WellPoint's Next CEO, Joe Swedish

In an interview, outgoing Trinity Health CEO Joe Swedish discusses the challenges he will take on next month when he becomes head of the nation's second-largest health insurance company. >>>

BCBSNC Kicks Off Orthopedic Bundles

New payment models from Blue Cross Blue Shield of North Carolina mean patients receive highly coordinated pre-operative care and one fixed-rate bill for 30-days pre- and 90-days post-surgery for knee replacements. >>>

Robotic Surgery Hikes Hysterectomy Costs

The volume and cost of hysterectomy procedures performed by surgical robots are soaring. But infection rates, intraoperative injuries, reoperations, and transfusions are all essentially the same as for traditional laparoscopy. >>>

'Readmissions Week' Recap

The countdown toward higher federal penalties for hospitals with high readmission rates is on. That explains a heightened push by providers to impress upon patients their responsibilities to take care of themselves after being discharged. >>>

Coding Issues Land Life-Saving Doc Behind Bars

An Illinois physician, convicted of making false statements in connection with surgical codes, is serving a 10-month prison term. The Association of American Physicians and Surgeons says the federal case against him is having a "chilling effect" on doctors nationwide. >>>

Revenue Can't Fix Bad Metrics; Only Strategy Can

A declining macro environment suggests that organizations in financial straits are likely to stay there. Rising revenues won't save them—they may need a strategy revamp. >>>

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Recruiting and Retaining Physicians for the Post-Reform Era

News Headlines

Insurer stocks slip over possible Medicare cuts

San Francisco Chronicle / Associated Press, February 20, 2013

5 ways to improve HIEs

InformationWeek, February 20, 2013

States worry about rate shock during shift to new health law

Los Angeles Times, February 19, 2013

Geography to play larger role in health premiums

The Houston Chronicle / Associated Press, February 19, 2013

GOP senators reintroduce bill to repeal IPAB

The Hill, February 15, 2013

US official touts health insurance markets, lawmakers leery

The Baltimore Sun / Reuters, February 15, 2013

MedPAC chief warns of Medicare payment crisis

The Hill, February 15, 2013

Healthcare workers need to explain insurance overhaul, Sebelius says

Chicago Sun-Times, February 15, 2013

EMRs probed for over-billing

The Center For Public Integrity, February 15, 2013

After 7 years, will Medicare finally have a leader?

The Washington Post, February 14, 2013

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Aetna, Memorial Hermann ACO: A Year in the Making

Wed, 13 Feb 2013 16:34:00 GMT

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February 13, 2013

Aetna, Memorial Hermann ACO: A Year in the Making

Jacqueline Fellows

A complex deal between the health insurer and one of the largest independent physician networks in Texas to build an accountable care organization required an "unprecedented" level of transparency. >>>

Editor's Picks

DOJ, HHS Announce $4.2B in Medicare Fraud Recoveries

Enhanced enrollment requirements, expanded recovery efforts for overpayments, increased data sharing among government agencies, and greater oversight of private insurance abuses are credited for the improved rates of recovery. >>>

IBM's Watson Heads for Clinics, Spurring Debate

Reports of Watson's projected diagnostic prowess have fed fevered speculation that artificial intelligence is at long last about to make doctors obsolete. But IBM insists that's not Watson's role. >>>

Dartmouth Readmissions Report Shows Scant Progress

Slow progress in reducing rates of 30-day hospital readmissions is partly explained "by the way healthcare systems have invested and the way they've built themselves over the years," says one of the study's principal investigators. >>>

AMA Issues 5 Patient Safety Guidelines

The American Medical Association's five guidelines outline physician responsibilities during care transitions for patients recently discharged from the hospital. >>>

CBO Analysis Renews Calls for SGR Repeal

A Congressional Budget Office analysis released this week lops $107 billion from the cost of eliminating the Sustainable Growth Rate funding formula and may fuel support for a House bill to put an end to the mandate. >>>

Unlocking Value-Based Care's Upside

Data analytics—both clinical and actuarial—and hyper-focused care management in the form of "commando RNs" are two keys to readying healthcare organizations for value-based care, says the new CEO of xG Health Solutions. >>>

How to Stop Unhappy Nurses From Leaving

The key to improving nurse recruitment and retention appears to lie in extending nurses' access to advanced degrees and specialty certifications, a study suggests. >>>

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News Headlines

WellPoint names Swedish from Trinity Health as new CEO

Bloomberg, February 13, 2013

Dispute develops over discount drug program

The New York Times, February 13, 2013

Graph: The slowdown in US healthcare spending

The Atlantic, February 13, 2013

Price for a new hip? Many hospitals are stumped

The New York Times, February 12, 2013

Rule on 'essential benefits' sent to White House for final review

The Hill, February 12, 2013

Lower premiums at stake in NC Blue Cross lawsuit

Winston-Salem Journal / McClatchy-Tribune, February 11, 2013

Feds' 'e-health' initiative reaches out to patients

Politico, February 11, 2013

Comparison shopping coming to Highmark

Pittsburgh Post-Gazette, February 11, 2013

Medicaid expansion divides GOP governors

Los Angeles Times, February 8, 2013

Obama renominates Tavenner to lead CMS

The Hill, February 8, 2013

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Date: February 14, 2013, 1:00-2:30 p.m. ET

Ardent Health Services, Monroe Clinic, and The Baird Group drill down on tools and strategies they've used to create a sustainable patient experience model based on accountability and service excellence. Learn what your team should be doing to accomplish these goals and help your organization boost its bottom line.

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February 6, 2013

Is Your Bundled Care Plan Market-Ready?

Jacqueline Fellows

Three out of four consumers surveyed say they find bundled care plans "appealing." The promise of transparency is tantalizing, but consumers are clear-eyed and armed with a list of essential benefits. >>>

Editor's Picks

CMS Unveils 4 Bundled Payment Models

Payment models introduced by the Centers for Medicare & Medicaid Services are intended to drive efficiency in the care of Medicare patients by bundling episodes of care and may vary with each hospital's negotiated contract. >>>

Hang On for Risk-Bearing Contracts, Rewards

The shift away from fee-for-service reimbursement models toward risk-bearing contracts is described by one healthcare finance leader as "the most unpredictable opportunity I've ever seen." >>>

Individual Mandate More Like Suggested Donation

The IRS has already said it will not enforce penalties for not obtaining health insurance, but according to an exception-filled set of rules proposed by the White House, there wouldn't be much to enforce even if the agency were willing. >>>

Physicians' Persistent 'Overuse' of Care Continues

Researchers examining ambulatory care data find continued overuse of non-beneficial, potentially harmful care. >>>

M&A Roundup: Prime, Tenet, BIDMC Announce Deals

Prime Healthcare Services has announced two separate acquisitions of financially troubled hospitals in New Jersey and Kansas. Tenet signed a joint venture with John Muir Health in California. >>>

'Sunshine Act' Gets Guarded Reaction

Professional associations and lobbying groups have so far avoided bashing the final rule, which details how financial relationships between drug and device manufacturers and healthcare providers must be disclosed to the federal government. >>>

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News Headlines

Obama's health-insurance expansion eroding, CBO projects

Bloomberg, February 6, 2013

Cerner, McKesson cooperating for HIE, interoperability's sake?

TechTarget, February 6, 2013

Insurers press docs to file more claims electronically

The Hill, February 6, 2013

Judge raises more questions about WakeMed Medicare settlement

The News & Observer, February 6, 2013

US proposes scrapping some obsolete Medicare regulations

The Baltimore Sun / Reuters, February 5, 2013

Healthcare spending in America, in 2 graphs

NPR, February 5, 2013

Health insurers highlight excessive out-of-network charges

Los Angeles Times, February 4, 2013

Tick, tock: Administration misses some health law deadlines

Kaiser Health News, February 1, 2013

Aetna profit slips as insurer settles reimbursement lawsuit

Bloomberg, February 1, 2013

How to cut $9.4T from Medicare, in 150 easy steps

The Washington Post, January 31, 2013

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Delaware Determined to Make Partnership Exchange Work

Wed, 30 Jan 2013 18:14:00 GMT

HealthLeaders Media Live from Heartland Health: Cost Containment Lessons

Multimedia/Events

Date: March 19, 2013, 12:00-3:00 p.m. ET

Heartland Health leaders reveal how to achieve significant, sustainable cost savings by identifying value in best practices and the patient experience. Learn how the team identified areas of waste and cost savings that have consistently added millions of dollars annually to the bottom line.

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January 30, 2013

Delaware Determined to Make Partnership Exchange Work

Jacqueline Fellows

In an interview, the top official at the Delaware Department of Health and Social Services discusses the benefits and challenges of implementing a health insurance exchange with the federal government as a partner. >>>

Editor's Picks

CEOs Get a Medicare Compliance Checklist

Hospital and health system senior leaders can ensure their organizations' compliance programs are functioning as intended by following six guidelines. >>>

M-health, Mobile Apps from the Payer Perspective

UnitedHealthcare's chief of medical affairs, Reed Tuckson discusses the power of technology to create informed and healthy healthcare consumers. >>>

Who Pays Hospital Costs for Patients in Police Custody?

Medicare has paid millions of dollars it should not have for incarcerated patients. Now it's cracking down. Hospitals without sound financial policies governing these patients could be stuck with no payment and no recourse. >>>

Physician Groups Blast IPAB, Rally Behind Repeal Effort

Critics of the Independent Payment Advisory Board, which makes recommendations on Medicare spending, describe it as an "unelected, unaccountable body." A bipartisan bill to repeal the board has been introduced in the House. >>>

Managed Care Contracts Need Scrutiny

Physician practices must pay extra attention to managed care contract negotiations as the healthcare industry implements reform. Contract terms may have more bite than in the past. >>>

M&A Forecast: 1 in 5 Hospitals to Realign Over Next Decade

Revenue is expected to plunge 25% and the incremental changes that hospitals and health systems are implementing are not likely to be enough to maintain independence for a large percentage of them. >>>

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News Headlines

4 in 10 Hospitalists Report Unsafe Patient Workloads

HealthLeaders Media, January 30, 2013

Medicaid expansion may save FL money

The Miami Herald, January 30, 2013

Aetna, Texas Health Resources establish ACO

The Dallas Morning News, January 30, 2013

Opinion: Congress can't cut Medicare hospital outpatient payments

US News & World Report, January 29, 2013

Obama law pits insurance giants against MD co-op

Bloomberg, January 29, 2013

Retiring Medicare actuary reflects on why he almost quit

Kaiser Health News / PoliticoPro, January 29, 2013

So you want to start a health insurance plan

The Washington Post, January 29, 2013

Immigration reform could add millions under Obama health law

The Hill, January 28, 2013

Medicare paid $120M in illegal care

The Miami Herald / Associated Press, January 25, 2013

WellPoint expects states to expand Medicaid

The Baltimore Sun / Reuters, January 24, 2013

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From HealthLeaders Magazine

20 People Who Make Healthcare Better—2012

They are nurses and physicians. They are researchers and executives. They are providers and payers. They are watchdogs and innovators. And they are patients. They are this year's HealthLeaders 20 honorees, selected for their efforts to make healthcare better. Their stories are sometimes tinged with struggles or challenges, but always, ultimately, with success. >>>

Anesthesia and Operating Room Efficiency

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HHS Turns Health Insurance Exchanges Into Marketplaces

Wed, 23 Jan 2013 16:26:00 GMT

HealthLeaders Live: Cost Containment Lessons from Heartland Health

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January 23, 2013

HHS Turns Health Insurance Exchanges Into Marketplaces

Jacqueline Fellows

The Department of Health and Human Services is now calling health insurance exchanges "marketplaces." Will the name change make a difference in the public's perception of how healthcare coverage can be attained? >>>

Editor's Picks

HIPAA Final Rule Raises Fines for Non-Compliance

The so-called "mega" privacy rule is not enforceable until September, but hospital and health system executives should begin reviewing current policies now to identify changes necessary for compliance, observers say. >>>

HHS Announces $1.5B in State Insurance Exchange Grants

Nearly all of the six Level One grants are going to states that have decided to partner with the federal government to run their health insurance exchanges. All five states awarded Level Two grants are setting up state-based exchanges. >>>

Will Payers Lead Digital Health?

Payers such as UnitedHealthcare are enabling connections among patients, providers, and employers. Insurers embrace data and the better healthcare decisions that will come of improved data flows. >>>

Is Concierge Medicine Finally Ready for Takeoff?

A fear of major reimbursement cuts and other factors are building toward a "crescendo" of physician interest in direct pay medicine, suggests a report conducted for The Physicians Foundation. >>>

Medical Error 'Second Victims' Get Some Help, Finally

Patients are the obvious first victims of medical mistakes, but doctors, nurses, and other clinicians are often the second victims, who must grapple with the emotional distress of errors and bad outcomes. >>>

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Boost Patient Satisfaction Scores Through an Accountability Model

News Headlines

Obamacare a tempting target for cuts

Politico, January 23, 2013

Insurers prod docs, hospitals to stop elective early deliveries

The Washington Post / Kaiser Health News, January 23, 2013

Ex-Senator to run insurer watchdog group, NAIC

Bloomberg, January 23, 2013

President defends Medicare, Medicaid in inaugural address

The Hill, January 22, 2013

Obama officials ditch 'exchanges' in rebranding of healthcare reform law

The Hill, January 22, 2013

New data threaten deal with Highmark

Pittsburgh Post-Gazette, January 22, 2013

Insurers may prove choosy with overhaul exchanges

Milwaukee Journal Sentinel / Associated Press, January 18, 2013

CA health insurance exchange gets $674M fed grant

Los Angeles Times, January 18, 2013

KY Medical Center agrees to $883K settlement over false claims charges

Nashville Business Journal, January 18, 2013

UnitedHealth, Mayo pool info to drop cost of care

Star Tribune, January 17, 2013

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Why Medicare Advantage Star Ratings Matter

Wed, 16 Jan 2013 16:47:00 GMT