MResult Healthcare Insights

Excellent posting on GreisGuide to LTACs about the resumed rollout of CMS’s recovery audit contractor (RAC) program plus further details of the RAC program. The post outlines some differences between the RAC demonstration program and how it will work moving forward. The changes tilt a little more favorably towards provider, but preparing for RACs will still require a big dedication in time and resource.

RAC Program Proceeds; Bid Protest Withdrawn by way of GreisGuide to LTACHs.

This week the New York Times carried an article with an in-depth, and at times critical look at long term acute care hospitals. In some ways the article paints unfair comparisons between LTCs and “normal” acute care – for example LTCs have higher complication rates than acute care, but after all they do see sicker patients!

Overall though the article does provide an excellent view into the necessary business drivers behind LTACs as well as some of the unique issues they address.

Long-Term Care Hospitals Face Little Scrutiny by way of NYtimes.com

From Business Week, Steve McKee writes that Social Media Marketing is nothing new, just a digital form of “word of mouth marketing”. I particularly appreciate his likening Twitter to “a giant online cocktail party”, with the attendant rules of engagement.

Social Media Is Nothing New – by way of BusinessWeek.com.

Here’s an interesting interview with Steve Garske – vice president and CIO Children’s Hospital Los Angeles – on Social Media. His hospital has seen a positive return on investment with the social media work they’ve done, particularly in fund raising and recruiting.

Establishing a social media presence enabled one CIO to expand his organization’s reach and realize a healthy ROI, from healthcare-informatics.com.

As a follow up to last week’s post on bundled payments, here is a link to an interesting policy paper from the National Institute for Health Care Reform that discusses the ins and outs of a bundled payment plan based on Episodes of Care. Many issues to address, including

• What should constitute an episode of care?
• Striking the right balance between financial incentives and risks
• Adjusting payments based on case mix and quality
• Strategies for phased implementation

As mentioned before, bundling brings both pros and cons. But if post care facilities are going to be compensated based on pre-defined services tied to specific diagnosis, they’ll need to be sure they have in place systems to ensure that those diagnosis are correct.

Episode-Based Payments: Charting a Course for Health Care Payment Reform

Jason Greis is a health care attorney who writes on industry news and legislation pertaining to LTACHs. He has an interesting take on the question of Acute-Care and Post-Acute Care Payment Bundling and some of the potential unintended consequences this could bring about.

We’re interested from the standpoint of admission criteria. If acute care hospitals are going to be responsible for managing post acute placement then its more critical than ever that the admitting criteria for different post acute care venues be clearly defined, and the lines of communication between acute and post acute care facilities be as open as possible.

Exploring the Potential Benefits and Drawbacks of Acute-Care and Post-Acute Care Payment Bundling by way of GreisGuide to LTACHs

One of the groups our CEO, Yann, is involved with is the Metro-Hartford Alliance Health care Task Force; a group of representing influential area health care providers, payers and health care industry leaders. They’re charged with identifying opportunities for job growth and economic development and as you may expect with such a group there is no shortage of great ideas.

A really interesting idea is to develop a state-wide information exchange for hospitals and physicians to share patient information. This would be similar to a RIO, but geared more towards consumer-friendly presentation of information. Think of it as an “online concierge” for your health. The advantages would be controlled costs, improved care, and better outcomes. The challenges? Who pays for it after the initial funding runs out?

Which underscores just why health care is such a difficult issue to sort out. What’s called for is not better technology or even more efficient ways of doing what we’re doing today. We need to develop new ways of doing business that incent reform.

According to this article from BusinessWeek, insuring millions more Americans will only exacerbate the shortage of Physicians in the US. Congress is moving to eliminate caps on medical residencies placed back in 1997 (to control costs!) But given how long it takes to train new physicians the situation will not be remedied over night. We believe technology will have a role in managing the increased workload, but technology is not a panacea. Concentrate on identifying process improvements first. Then implement technology to enable those improvement.

The Coming U.S. Doctor Shortage (BusinessWeek) »

This story from healthcarelawyerblog.com talks about a Detroit LTAC’s settlement of a suit filed under the False Claims Act – more». The claimants allege that the LTAC submitted claims to the Medicare Program for services which were not medically necessary because they were provided beyond the date when the patient should have been discharged, or because the patient did not meet admission criteria for an LTAC. Under the terms of the settlement the LTAC admits no wrong-doing, but the total payout was over $800,000.

There is fraud out there, to be sure. But it’s equally true that admission criteria are complex and many additional factors can play into deciding whether or not to admit a patient. Going back and justifying an admission that might have happened months ago can be nearly impossible without an underlying set of processes and documentation to govern the admission process. These processes don’t have to be onerous, but they should be based on accepted criteria (our Pre-Admissions Screening Program is based on the NALTH criteria) and they should be automated to the extent that a proper digital “paper trail” exisits for the decision making process.

The White House pushes Healthcare IT as a ‘pillar’ of cost containment  (more » ) At the same time Harvard Researchers describe savings from Healthcare IT as “wishful thinking’ (more » )

Both viewpoints are right in stating that Healthcare IT is just one piece to the puzzle. There’s no doubt that technology can increase worker productivity – other industries have been gaining advantage from this for years. But productivity is basically a measure of volume – how much work can you do in a given amount of time. It is not a measure of whether the work you are doing is delivering sufficient value or is in sufficient alignment with your business goals.

At the end of the day it is good thinking about business process and how you deliver clinical care that will help you manage costs. Technology will just enable the initiatives that come out of that thinking.