ASCA News Digest (December 30, 2014)

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December 30, 2014





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Certificate of Need: An Outdated Law in Need of Repeal
NCSPIN.com (08/15/2014) Restrepo, Katherine

A recent report indicates that an increasing number of surgeries are being performed in North Carolina's Raleigh/Durham/Chapel Hill area as Baby Boomers age. The rise in demand is leading to more procedures conducted in outpatient settings, such as ambulatory surgery centers. But North Carolina's outdated Certificate of Need (CON) law imposes rigid rules on health care providers seeking to expand or build facilities or offer innovative services, according to this opinion piece. Fifteen states have already scrapped their CON programs. A study by the Mercatus Center suggests that CON programs should require more evidence from regulators before restricting competition in health care markets.
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Deaths by Medical Mistakes Hit Records
Healthcare IT News (07/18/14) McCann, Erin

Preventable medical errors represent the third leading cause of death in the United States, behind heart disease and cancer, claiming the lives of approximately 400,000 people annually. At a July 17 Senate hearing, patient safety officials presented ideas on how to resolve the crisis, such as increasing the number of registered nurses and establishing incentives. Tejal Gandhi of the National Patient Safety Foundation said, "We need better systems to minimize cognitive errors…such as computerized algorithms. Another important issue is missed and delayed diagnoses, she said, so IT systems need to be designed to better manage test results.
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First Observations Around the Affordable Care Act
Athenahealth (07/14/2014) Sung, Iyue; Gray, Josh

Although there were concerns that the Affordable Care Act (ACA) would release a flood of pent-up medical demand, a new Athenahealth report suggests that this is not the case. New-patient visits appear to have declined slightly over 2013, before 9 million people were newly covered under the ACA. This year marks the implementation of the coverage expansion requirements of the ACA, and before the end of 2016, millions of individuals are expected to sign up for insurance through new health-care exchanges. A research team from Athenahealth looked to see if the trend varied by state, but overall there was no great surge in demand for care. Some states have embraced the ACA and built their own health insurance exchanges and expanded Medicaid, while others have pushed against the ACA and done as little as possible. “One important concern about the transition to coverage expansion was that some newly insured patients might seek care for illnesses that had previously been untreated,” the Athenahealth team wrote. "Physicians and other providers would then struggle to provide care to these sicker-than-average patients while continuing to meet the needs of their established patients.” However, test results, diagnoses, and other data from the doctor visits provide little evidence that patients were coming with, for example, untreated diabetes. New patients, in fact, seemed healthier than expected.
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Surgery Prices Surge With Innovation and Consolidation Under Obamacare
NBC News (08/31/14) Briggs, Bill

The Dartmouth Institute's John Birkmeyer estimates that surgery is now a $500 billion industry in the United States, comprising 80 million to 100 million procedures performed annually. Researchers and physicians attribute the rising cost of surgery to hospital consolidations that create medical monopolies as well as innovative yet costly technologies. Data from the Healthcare Bluebook reveals that gall bladder removal has increased 21 percent since 2009, with a "total fair price" of $5,532; the price of a hysterectomy has increased 19 percent, to $11,780; and hip replacement is up 24 percent, to $22,606.
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Is the Hospital of the Future Not a Hospital at All, at Least Not as We Know It?
MSDN HealthBlog (07/07/2014) Crounse, Bill

A new report from Triple Tree examines how changes in reimbursement, alternate care sites, and rising consumer expectations are impacting how and where care is being delivered. The report suggests that, "The hospital of the future may not be a hospital at all," and looks at the practices of outpatient facilities and ambulatory surgery centers. The report provides instances of how some facilities are partnering with hotel chains and home health service companies to provide overnight accommodations and monitoring for patients needing post-surgical or post-procedural care, forecasting likely growth areas to include oncology, urology, otolaryngology, gynecology, and gastroenterology.
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High-Deductible Insurance Plans Put Pressure on Independent Physicians to Collect Bills
Pittsburgh Post-Gazette (11/23/14) Twedt, Steve

The proliferation in low-premium, high-deductible health insurance plans is impacting small physician practices and ambulatory surgical centers. Donna Kell, CEO of Kell Group billing services, notices a trend over the past four years of patients who are unable to pay their deductible at the time they receive care. An annual employer survey by Mercer found that nearly half of larger employers now offer a high-deductible plan. Terry Bohlke, president of the Ambulatory Surgery Center Association, says high-deductible plans are "definitely a two-sided issue" for the group. He says ambulatory surgical centers likely will see more patients as consumers with high-deductible plans pay more attention to costs, but "collecting from individuals is that much more complex and risky than collecting from insurance companies." According to Bohlke, Kell, and others, providers work with patients who are struggling to pay for their care by accepting credit card payments or setting up payment plans.
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HHS Secretary Announces $840 Million Initiative to Improve Patient Care and Lower Costs
HHS News Release (10/23/14)

The Department of Health and Human Services (HHS) announced on Oct. 23 an $840 million initiative to help improve medical care and reduce costs. "The administration is partnering with clinicians to find better ways to deliver care, pay providers and distribute information to improve the quality of care we receive and spend our nation's dollars more wisely," said HHS Secretary Sylvia M. Burwell. "We all have a stake in achieving these goals and delivering for patients, providers and taxpayers alike." The grant program will fund successful applicants who work directly with medical providers to rethink and redesign their practices. Possible strategies include giving doctors better access to patient information, increasing the number of ways patients are able to communicate with the clinicians taking care of them, and improving the coordination of patient care by primary care providers and specialists.
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What to Expect When You Have Surgery
Wall Street Journal (10/12/14) Landro, Laura

Health care facilities are starting to use interactive programs and mobile apps to inform patients about their surgeries and to help protect against possible legal action if things go wrong. For example, the American College of Surgeons offers a video-based tutorial to help ostomy patients manage their condition, and another video guide helps patients prepare for recovery from a lung procedure. The college also sponsors the Strong for Surgery program in Washington State, which focuses on the preoperative period and uses checklists for initial consultations between doctors and patients. A review published in the American Journal of Surgery in 2009 found that many patients lack adequate understanding of the informed-consent process before their decision to have surgery. Patients may consider themselves well-informed when that is not the case, and some patients may be embarrassed to ask questions.
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Getting Beyond Joan Rivers: Bethesda Center Pushes for More Outpatient Surgery
Washington Business Journal (10/10/14) Reed, Tina

Officials at Massachusetts Avenue Surgery Center, located in Bethesda, Md., are asking regulators and insurers to boost the number of surgical procedures performed outside of the traditional hospital setting. The center is working to get insurers to cover an increasing number of outpatient joint surgeries, such as knee and hip replacements, and they plan to lobby the state's general assembly next session to change a law that would enable them to perform surgeries that require overnight stays allowed under Medicare regulations. "Our doctors have the same training, the same certification, the same equipment, the same protocols as any other facility," said Randall Gross, Massachusetts Avenue Surgery Center's executive director. In addition to the center's very low infection rate and its low rate of cases that were transferred to area hospitals, mainly due to pain control, Gross said the cost can be up to 40 percent lower for procedures performed outside the hospital. The center only works with lower-risk patients, said Dr. Louis Levitt, surgical center chairman at Massachusetts Avenue, adding that patients over 55 must receive clearance from specialists, while those with higher body-mass indexes must meet with the anesthesiologist in person.
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Changing Priorities Shift Hospital Focus to Outpatient Strategies
Healthcare Finance News (08/25/14) Zaino, Jennifer

Greater efficiencies and increased consumer demand are among the factors behind a shift from hospitals to outpatient settings. Same-location revenues at ambulatory service centers have been increasing since 2007, according to a 2013 Moody's Investors Service report, while hospitals have seen a 0.22 annual decline in same-facility inpatient surgeries. "Many revenues that used to be generated from an inpatient setting are being diverted to outpatient settings," said Brad Spielman, vice president and senior credit officer at Moody's Investor Services. The shift comes as more consumers look to receive services at the lowest price point, insurers and government payers focus on controlling health care costs, and health care services advance. Steve Kennedy, managing director at Lancaster Pollard, said "there is greater efficiency in being able to treat certain illnesses and complete certain procedures that negate the necessity of having so many inpatient stays as before."
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The Threat of Health Care Market Consolidation
National Review (08/12/14) Salam, Reihan

Chris Pope observes in a new report from the Heritage Foundation that the problem of monopoly pricing power in medical care has actually exacerbated since the implementation of the Affordable Care Act. Regulatory solutions to the problem of hospital consolidation, like more aggressive price controls, will fail, according to Pope, because they address the symptoms of hospital consolidation rather than the root causes. He cites business models, like ambulatory surgical centers, that specialize in certain procedures, that can help drive down costs. Pope highlights the role of Medicare, which reimburses general hospitals at far higher rates than more efficient ambulatory surgical centers and other independent medical providers. He concludes hospitals are effectively rewarded for underperforming and for spending excessively. In his critique of the Affordable Care Act, Pope points out that the government is trusting that hospitals will use revenue from high reimbursement rates to cross-subsidize other desirable services, even though hospitals have generally failed to do so in a coherent or cost-effective way.
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Surgery Prices--Going Public: Hospital and Surgery Center Prices for 5 New Facilities Now on PricingHealthcare.com
PRWeb (06/10/14)

Current prices for a growing number of surgery centers and hospitals across the country can be found at PricingHealthcare.com, which began hosting facility price lists earlier this year and is expanding into a growing number of states. Facilities in five states (California, Georgia, Virginia, Nebraska, and Utah) have added cash-pay prices to Pricing Healthcare's open, direct-pay marketplace.
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