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  • Hospital Impact - Revisiting the key components of the Affordable Care Act
    additional quality metrics to be utilized in future pay for value reimbursement methodologies Increase primary care reimbursement by 2014 to 100 percent Medicare rates to support better ambulatory and preventive care Invest in community health centers to ensure improved access Provide free preventive screening with no deductible or co payment evaluations for Medicare and Medicaid beneficiaries Provide support for improved care of seniors with chronic medical conditions such as diabetes or hypertension Promote preventive health screenings at all ages Add residency and training positions for primary care and mid level practitioner training programs and reduce the number of slots for specialty and sub specialty training programs Invest in the National Health Service Corps and loan repayment programs to expand the number of qualified healthcare personnel Expand patient centered outcomes research Establish Community Living Assistance Services and Support CLASS to enable individuals with chronic disabilities to remain in their homes and communities longer Fill the Medicare Prescription Drug Medicare Part D donut hole to ensure better compliance with evidence based recommendations Maintain funding the for Children s Health Insurance Program CHIP through at least 2015 Establish a regulatory pathway for Federal Drug Administration consideration of bio similar versions of previously licensed biologic products Require greater transparency and oversight of skilled nursing facilities to promote comparative quality and cost data III Payment Cuts We spend approximately 18 4 percent of our gross domestic product GDP on healthcare which is almost double that of any other industrialized nation Part A of the Medicare Trust Fund is due to go bankrupt in 2017 Thus the following cuts are included in the ACA Reduce market basket updates for productivity reimbursement by 112 6 billion over the 10 year period 2010 2019 Reduce Medicare disproportionate share hospital DSH payments by 22 1 billion over 10 years beginning in 2014 Increase Medicare payroll taxes from 2 9 percent to 3 8 percent shared between employer and employee Create Independent Payment Advisory Board to reduce Medicare reimbursement by at least 14 7 billion over the next 10 years Reduce medical and surgical specialty reimbursement by 6 percent a year over the next three years Reduce over payment to Medicare Advantage Plans Medicare Part C by up to 14 percent on average Crack down on fraud abuse and waste by expanding federal support for healthcare recovery auditors RACs Implement a fee on carriers that offer high cost health insurance plans by 2018 to encourage the creation of more cost effective plans Increase user fees for durable medical equipment and medical device companies Increase tax penalties on non qualified distributions of healthcare savings accounts HSAs and capping federal savings account FSA contributions to 2 500 in 2013 Increase penalty for failure to report hospital quality data to 2 percent of annual payment update Increase penalty for hospital acquired conditions to 1 percent of Medicare Medicaid reimbursement by 2015 Increase penalty for failure to meet core patient safety measures and Hospital Consumer Assessment of Healthcare Providers and Systems HCAHPS survey scores

    Original URL path: http://www.hospitalimpact.org/index.php/2012/11/27/revisiting_the_key_components_of_the_aff (2016-02-10)
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  • Hospital Impact - What if? 2 post-election scenarios for healthcare
    Disease Control and Prevention and the Veterans Health Administration spending by 29 percent by 2016 and up to 59 percent by 2022 Challenges for President Romney Increasing the rolls of uninsured and shifting rising Medicare and Medicaid costs to beneficiaries will increase the likelihood of cost shifting for those with insurance or who attempt to pay Paradoxically supporting a policy of self sufficiency for health purchasers will make it increasingly unlikely that individuals will be able to afford healthcare coverage Conversely diluting the high risk pool sicker people tend to purchase healthcare benefits with healthy individuals through universal healthcare coverage for basic and preventive care decreases the healthcare costs per capita and increases the likelihood that an individual will purchase healthcare coverage There is no question Medicare and Medicaid need to be reformed through lower spending and greater accountability for both to be sustainable however the approach of cutting coverage for those in greatest need may backfire on those who can afford to pay Healthcare under President Obama Following the U S Supreme Court decision to largely uphold the ACA in June most of the law will remain intact except for the requirement of states to expand Medicaid coverage for individuals up to 138 percent of the federal poverty level Paradoxically many of the poorest states with the lowest healthcare outcomes e g Mississippi have declined to expand their Medicaid coverage thus transferring the cost of indigent care to hospitals physicians and federal state sponsored healthcare facilities and threatening their own tax base The penalty for not purchasing mandatory healthcare coverage for individuals and employers under the ACA is small and not enforceable and so many healthy individuals will continue to not purchase healthcare until the need is there or the penalties become substantial Adding more insured individuals will decrease the number of uninsured to less than 5 percent at a time when physician shortages will climb towards 100 000 and nursing shortages already exceed 350 000 Creating a viable infrastructure to support these new beneficiaries will be essential to ensure they have access to cost effective healthcare services The biggest challenge will be dismantling the fee for service Medicare payment structure that is a hallmark of healthcare as a cottage industry and rewards higher numbers of patient encounters tests and procedures rather than those that meet evidence based medical necessity criteria and other quality standards This reimbursement model does little to reward preventive services reduce the number of medically unnecessary encounters tests procedures or encourage high quality service at lower costs The current pay for value initiatives within the ACA will incentivize up to 12 percent of Medicare reimbursement by 2018 for quality service preventable readmissions hospital acquired conditions and Meaningful Use criteria However many may choose to work around these incentives by increasing their volumes and disregarding incentives they perceive as under someone else s control Finally Medicare reimbursement has not kept pace with inflation and many physicians no longer accept Medicare beneficiaries Medicare actuaries predict 15 percent

    Original URL path: http://www.hospitalimpact.org/index.php/2012/10/24/what_if_2_post_election_scenarios_for_he (2016-02-10)
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  • Hospital Impact
    in readmissions that Dallas based Baylor Health Care System achieved without a smooth transition of care based upon the seamless flow of electronic information Read more Leave a comment Reducing readmissions It s harder than it looks September 12th 2012 by Jonathan H Burroughs A centerpiece of the Center for Medicare Medicaid Services efforts to enhance the value of healthcare is to reduce preventable hospital readmissions The volume and cost of these readmissions is significant According to the Institute for Healthcare Improvement of the 5 000 000 U S hospital readmissions approximately 76 percent are preventable at an annual cost of 25 billion As of 2012 under section 3025 of the Patient Protection and Accountable Care Act hospitals receiving inpatient prospective payment by Medicare are penalized 1 percent for high rates of avoidable readmissions with the three highest diagnosis related groups DRG of congestive heart failure acute myocardial infarction and community acquired pneumonia and this penalty is projected to increase CMS also will publish the rate of avoidable readmissions of these three DRGs for all U S healthcare organizations as a part of its Hospital Compare website This website is of great interest to third party payers who create tiered networks of preferential referrals and modulation of premium costs based upon high performance and low cost thus significantly impacting a healthcare organization s market share Read more Leave a comment More of what health reform doesn t do July 31st 2012 by Jonathan H Burroughs Following up from last week let s resume our list of what the health reform legislation failed to do We already noted it didn t create universal coverage for essential and preventive healthcare services or a rational and humane way to ration healthcare It also failed to reform our reimbursement system What else 4 Reform Medicare With the Patient Protection and Affordable Care Act the solvency of the Medicare trust fund has been extended from 2017 to 2024 through the imposition of a higher Medicare payroll deduction tax Why is Medicare failing Two reasons Read more Leave a comment What the Affordable Care Act doesn t do July 26th 2012 by Jonathan H Burroughs With all of the political noise around the U S Supreme Court s recent decision to uphold most of the Patient Protection and Affordable Care Act ACA with the exception of the states obligation to expand Medicaid coverage we still do not have a healthcare system that compares favorably to other industrialized nations in terms of the outcomes we get for the money we spend Although our healthcare per capita expenditures almost double any other nation we rank between 35th and 40th in such major outcomes as infant and maternal mortality longevity and male female mortality rates What did the ACA fail to do that we will be obligated to do in the near future to have the healthcare system we deserve 1 Create universal coverage for essential and preventive healthcare services When there is little incentive to seek essential and

    Original URL path: http://www.hospitalimpact.org/index.php?blog=1&s=Jonathan%20Burroughs&page=1&disp=posts&paged=8 (2016-02-10)
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  • Hospital Impact - Patient experience defines quality of care
    keeping the facilities attractive by picking up litter they see in lobbies and hallways More In 2001 when we created our strategic plan and illustrated it as a pyramid we knew the patient should be at the top but we didn t fully understand what this could mean With the plan we embedded a permanent strategic focus on the relentless pursuit of quality and safety In the years following we saw incremental improvements in patient satisfaction scores By 2007 we realized that quality and service were closely connected The following year we introduced mandatory service training for all team members which helped us develop a shared understanding of how to improve the patient experience In 2009 we adopted experience based design an innovative method that helps us better understand patients feelings and concerns This gives us new ways to listen to our patients and their family members as we look for opportunities to further improve service and quality Along the way we held another round of service training for all team members This was followed by training on respect for people because we know how we treat each other affects how we treat our patients Earlier this year we asked our team members to reflect on how they can affect patient experience Managers distributed patient experience cards giving each person in their department a simple visual way to commit to how they will make a difference The card says I make the patient experience better by and asks every team member to fill in the blank describing his or her role in providing the perfect patient experience Patient experience spans the continuum of care from scheduling an appointment to the day of visit to checking information online and receiving follow up phone calls We know how important it is to show empathy while providing care We ve also learned how important it is to align care with our patients personal goals and values What s important to you when you receive medical care Your answer is possibly the same answer your patients would give Have you asked them Gary S Kaplan M D is chairman and CEO of Virginia Mason Health System in Seattle He also is a practicing internal medicine physician at Virginia Mason and current board chair of the Institute for Healthcare Improvement Leave a comment Please enable JavaScript to view the comments powered by Disqus Enter your search terms Submit search form Web www hospitalimpact org Get Hospital Impact in your inbox Healthcare Industry news Final Obama budget takes aim at opioid addiction superbugs Zika outbreak White House seeks 1 8B to respond to virus More hospitals replace nurseries with rooming in with moms Hospitals must train millennial nurse leaders in empathy frontline engagement St Louis hospital creates unit to improve outcomes through innovation 4 ways hospitals can foster family centered care Pediatric ER seeks to limit stressors for autistic patients Nurses hospital groups clash on Massachusetts bill to improve response to violence Superbug linked scopes Feds

    Original URL path: http://www.hospitalimpact.org/index.php/2014/06/04/patient_experience_defines_quality_of_ca (2016-02-10)
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  • Hospital Impact - It's time for a structured systems approach to delivering care
    time unnecessary tests and procedures and inefficient workflow The way most institutions deliver care isn t efficient Additionally there s an alarming lack of transparency around quality and cost This makes being a smart healthcare shopper extremely challenging Moreover the conversation about cost is incomplete unless we address the elephant in the room I am referring to the way some providers charge extraordinary prices for procedures simply because they can A recent report by the Centers for Medicare Medicaid Services disclosed dramatic differences in what hospitals in the same markets charge for the same medical procedures Even in the same city providers located only a few blocks from each other often charge wildly differing amounts for identical procedures This is outrageous Islands of excellence do exist in healthcare and there is much to be proud of Yet for the most part there is too much variability and inconsistent quality By 2030 healthcare will consume another 10 000 of the average family s annual budget at the current rate of cost increases An Institute of Medicine discussion paper published in July for which I had the privilege of being a co author advises a structured evidence based systems approach to managing care delivery would be transformative It would address performance gaps mitigate inevitable human error eliminate waste and variability reduce cost and encourage a culture of continuous improvement Based on our experience at Virginia Mason where we began applying Toyota Production System inspired principles more than a decade ago we know a disciplined management methodology results in higher quality improved safety greater efficiency and lower cost With the Virginia Mason Production System we have attacked costs while raising standards for quality and safety Today most medical procedures at Virginia Mason are 20 percent to 60 percent more affordable than they are at other Seattle area hospitals As a nation we spend hundreds of billions of dollars developing new drugs procedures and medical devices The Institute of Medicine report points out we ve spent next to nothing deploying a systematic method to determine the most efficient and cost effective way to deliver all the care people need and only the care they need at the right time in the right place by the right people and in the right way It s time we do so Gary S Kaplan M D FACP FACMPE FACPE is chairman and CEO of Virginia Mason Health System in Seattle He also is a practicing internal medicine physician at Virginia Mason and current board chair of the Institute for Healthcare Improvement Leave a comment Please enable JavaScript to view the comments powered by Disqus Enter your search terms Submit search form Web www hospitalimpact org Get Hospital Impact in your inbox Healthcare Industry news Final Obama budget takes aim at opioid addiction superbugs Zika outbreak White House seeks 1 8B to respond to virus More hospitals replace nurseries with rooming in with moms Hospitals must train millennial nurse leaders in empathy frontline engagement St Louis hospital creates

    Original URL path: http://www.hospitalimpact.org/index.php/2014/01/01/it_s_time_for_a_structured_systems_appro (2016-02-10)
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  • Hospital Impact - Quality care begins with appropriate care
    experience At Virginia Mason we use this equation to emphasize key components that should be considered when evaluating and delivering quality care One part of the quality equation often overlooked by many organizations but which is increasingly important is appropriateness Even if we provide an outstanding outcome and great service there is no quality if the test or medical procedure was not needed in the first place That s why a critical step in achieving quality is to know whether a diagnostic or therapeutic intervention is necessary and if it isn t it should not be done Inappropriate care can significantly harm patients and lead to unnecessary cost During the last 12 years at Virginia Mason we have learned and demonstrated that when waste is eliminated quality improves and cost goes down Recent charge data from the Centers for Medicare Medicaid Services shows Virginia Mason bills Medicare much less for myriad inpatient and outpatient services than nearly every other hospital in our market Also we know that absence of appropriate care means absence of quality care That s why appropriateness is integral to our culture and is deeply embedded in our working definition of quality Gary S Kaplan M D FACP FACMPE FACPE is chairman and CEO of Virginia Mason Health System in Seattle He also is a practicing internal medicine physician at Virginia Mason and current board chair of the Institute for Healthcare Improvement Leave a comment Please enable JavaScript to view the comments powered by Disqus Enter your search terms Submit search form Web www hospitalimpact org Get Hospital Impact in your inbox Healthcare Industry news Final Obama budget takes aim at opioid addiction superbugs Zika outbreak White House seeks 1 8B to respond to virus More hospitals replace nurseries with rooming in with moms Hospitals must train

    Original URL path: http://www.hospitalimpact.org/index.php/2013/07/24/quality_care_begins_with_appropriate_car (2016-02-10)
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  • Hospital Impact - The pathway to higher quality and lower costs is the same
    to provide high quality care with lower resource utilization More An example of how this works at Virginia Mason is something we call being in flow Changing how primary care works in our clinics has increased levels of satisfaction for medical professionals and our patients By reengineering processes we have created flow stations where the physician works in partnership with a medical assistant who breaks down the paperwork phone calls and emails into small lots that can be handled throughout the day in flow rather than in a huge batch at the end of the day Since it takes less time to work small lots immediately after seeing each patient they have reduced not only the burden of work and the work day but costs as well Physicians are freed up to spend more quality time with their patients and medical assistants flourish as crucial members of the care team Flow also has significantly impacted hospital care at Virginia Mason Combining flow with skill task alignment and simply taking the waste out of processes has enabled us to rethink many of the old tapes in hospital care Our nursing teams used the VMPS rapid improvement workshops to redesign the flow of work so they could focus more on patient care Instead of caring for patients throughout a unit nurses now work as a team with a patient care technician PCT in cells groups of rooms located near each other The cell model makes it easier for nurses to monitor patients and quickly attend to their needs Steps walked per day have fallen from 10 000 to around 1 200 We also evaluated nurses duties and reassigned non skilled work such as room setup to other staff increasing the nurse to patient time from 35 percent to more than 90 percent in areas where cells have been implemented Communication between nurses PCTs and rounding physicians also has improved We are achieving the seemingly contradictory outcomes of lower costs and higher quality All of us in healthcare have a moral imperative to make care better faster and more affordable Using the tools of the Virginia Mason Production System we are finding that the pathway to higher quality and lower costs is the same Gary S Kaplan M D FACP FACMPE FACPE is chairman and CEO of Virginia Mason Health System in Seattle He also is a practicing internal medicine physician at Virginia Mason and a founding member of Health CEOs for Health Reform Leave a comment Please enable JavaScript to view the comments powered by Disqus Enter your search terms Submit search form Web www hospitalimpact org Get Hospital Impact in your inbox Healthcare Industry news Final Obama budget takes aim at opioid addiction superbugs Zika outbreak White House seeks 1 8B to respond to virus More hospitals replace nurseries with rooming in with moms Hospitals must train millennial nurse leaders in empathy frontline engagement St Louis hospital creates unit to improve outcomes through innovation 4 ways hospitals can foster family centered

    Original URL path: http://www.hospitalimpact.org/index.php/2013/03/18/title_89 (2016-02-10)
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  • Hospital Impact
    expensive procedures but amazingly Aetna has agreed to pay them more for less expensive procedures Even though the hospital is getting the smaller slice of the pie this seems to be a rare example in which incentives are more aligned And maybe this provides long term benefits that we ve yet to identify better reimbursement for a whole slew of activities e g diabetes education patient education prevention screening that could really make a tangible impact on an entire community Add on top of that these new insurance plans that financially reward healthy living and we could be on our way to a drastically different health culture The risk of death typically won t change our lifestyle but maybe 2 000 will 9 comments Bringing Toyota s Kaizen Operational Philosophy to Our Hospitals March 21st 2006 A few months back many of us read that executives at Virginia Mason Medical Center sent a bunch of executives to Toyota s plant in Japan to study their Kaizen model of continuous improvement Initially I heard that some physicians revolted at the idea of learning from a car manufacterer What can we learn here We deal with people they deal with cars However after spending two weeks there the same physician recanted saying Toyota treats their cars better than we treat our patients From the Washington Post Article Virginia Mason Medical Center reported these results Whether making a car or a healthier patient the approach fundamentally is about eliminating waste from paperwork and inventory to waiting room delays and extraneous surgical tools Four years after he made his first trip to study under Japanese sensei or teacher Chihiro Nakao Virginia Mason chief executive Gary S Kaplan points to measures of success few American hospitals can boast In adopting the Toyota mind set Kaplan said the 350 bed hospital has saved 6 million in planned capital investment freed 13 000 square feet of space cut inventory costs by 360 000 reduced staff walking by 34 miles a day shortened bill collection times slashed infection rates spun off a new business and perhaps most important improved patient satisfaction Read how this hospital applied Kaizen to their ER reducing patient wait time to depart after service by 71 You start getting a sense of what Kaizen is all about it seems very common sense yet few seem to think this way simply because things have always been done a certain way 66 comments Previous Page Enter your search terms Submit search form Web www hospitalimpact org Get Hospital Impact in your inbox Healthcare Industry news Final Obama budget takes aim at opioid addiction superbugs Zika outbreak White House seeks 1 8B to respond to virus More hospitals replace nurseries with rooming in with moms Hospitals must train millennial nurse leaders in empathy frontline engagement St Louis hospital creates unit to improve outcomes through innovation 4 ways hospitals can foster family centered care Pediatric ER seeks to limit stressors for autistic patients Nurses hospital groups clash on

    Original URL path: http://www.hospitalimpact.org/index.php?blog=1&s=gary%20kaplan&page=1&disp=posts&paged=2 (2016-02-10)
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