iLoveBenefits: Industry News Blog

Birth Defects Account for 5.2% of Hospital Costs

The CDC recently released an analysis of the hospitalization costs associated with birth defects. Here are some key findings from the report:

• Structural or genetic birth defects affect 3% of live births in the U.S.
• 20% of infant deaths in the U.S. are due to birth defects.
• Birth defects accounted for 3% of all hospitalizations.
• 5.2% of total hospital costs are attributable to birth defects.
• Birth defect–associated hospitalizations cost $22.9 billion in 2013.
• Cardiovascular defects accounted for 14% of birth defect hospitalizations.

Source: Centers for Disease Control and Prevention, January 20, 2017

January 30, 2017 | Categories: Cost,healthcare,hospitals,quality | Tags: , , , | Comments (0)

Educating patients and families on palliative vs hospice care is critical

Medicare Spent $11,393 per Hospice Beneficiary in 2014

 

CMS recently released an analysis on hospice spending. Here are some key findings from the report:

 

In 2014, Medicare spent an average of $11,393 per hospice beneficiary.
There were 1.3 million hospice beneficiaries in 2014.
11% had a live discharge from hospice care in 2014.
In 2014, 1 in 3 beneficiaries had more than 60 days of hospice care.
13% had more than 180 days of hospice care in 2014.
South Carolina had the highest spending ($14,778) per hospice beneficiary.

 

 

Source: CMS, October 6, 2016

Innovations to Reduce Non-Urgent Use of Emergency Services

The Agency for Healthcare Research and Quality (AHRQ) announces the August 17 issue of the Health Care Innovations Exchange (https://innovations.ahrq.gov/node/8388).

  • The featured Innovations describe how an ambulance provider redesigned its emergency medical services system to create new care and referral pathways for 911 callers not facing true emergencies; a community paramedic program that significantly reduced unnecessary 911 calls from a local shelter and enhanced access to primary care for shelter residents; and a city EMS program that used a multipronged strategy to reduce unnecessary ambulance transports and ED visits, connecting non-emergent patients to primary care.
  • The featured QualityTools include resources for reducing inappropriate emergency department use and tools to support community paramedicine programs.
  • The featured Perspective, Convening a Learning Community to Reduce Non-Urgent Use of Emergency Services, describes the collaborative work of the Innovations Exchange Emergency Services Learning Community, based on an interview with its champion and expert faculty. https://innovations.ahrq.gov/perspectives/convening-learning-community-reduce-nonurgent-use-emergency-services

Diabetes Spending Reached $16,021 Per Capita in 2014

The Health Cost Institute recently released a study on healthcare spending for diabetes patients. Here are some key findings from the report:

  • Spending on people with diabetes reached $16,021 per capita in 2014, an $897 increase from 2013.
  • Health care spending for people with diabetes rose 6% compared to 3.2% for people without diabetes.
  • The number of ER visits among people with diabetes rose 8.1% annually from 2012-2014.
  • People with diabetes had 7x more filled days of cardiovascular drugs than those without diabetes.
  • Young adults (19-25) with diabetes had 4x more hospital admissions for mental health and substance use.
  • In 2014, insureds with diabetes spent $1,944 out of pocket compared to $752 for those without diabetes.

Source: Health Cost Institute, June 20, 2016

Hospital at Home model gains steam

Hospital at Home model gains steam as Mt. Sinai program cuts costs, readmissions

Monday, June 6, 2016 | By Zack Budryk

Cutting readmissions and reducing medical errors, the nation’s third-leading cause of death, are among the healthcare industry’s top priorities, and the secret to solving both may be stepping up home care, according to Oregon Public Broadcasting.

Nearly two years ago, New York’s Mt. Sinai Hospital premiered the Mobile Acute Care Team (MACT) program. This pilot program aims to deliver hospital-quality home care for patients who are at high risk for readmission. So far, the ongoing pilot has cut costs by nearly 20 percent, according to the article, while also reducing an unspecified percentage of readmissions and delivering high patient satisfaction.

Under the program, Mt. Sinai partners with community institutions such as Visiting Nurse Service of New York to provide home treatment for such conditions as chronic obstructive pulmonary disease (COPD), congestive heart failure, diabetes and urinary tract infections, according to a blog post from the hospital. “This is a real paradigm shift in medicine,” Mt. Sinai’s Linda DeCherrie, M.D., told OPB.  People will often say on first glance, ‘That sounds so great that we should definitely do that,’ but when you really get into it, it’s a totally different way of providing care.”

Medicare’s refusal to cover hospital-at-home services has kept many such programs from getting off the ground, but the Center for Medicaid & Medicaid Services’ Innovation Center awarded the MACT project $9.6 million in 2014 as part of its second round of Health Care Innovation Awards.

Nor is the MACT program the only example of such a program working; an internal analysis of the Humana At Home care management service found it cut hospitalizations among participants 45 percent while boosting survival rates, according toOpen Minds. Those Hospital at Home programs that have demonstrated consistent success have been connected to primary- and palliative care programs as well as disease-management programsFierceHealthcare previously reported.

To learn more: – read the OPB article – here’s the Mt. Sinai blog post – read the CMS announcement – check out the Open Minds post

Related Articles: How to make Hospital at Home programs work How transitional care cuts readmission risk First Medicare-approved transitional care center opens for business Readmission reduction solution: House calls How hospital-community partnerships can boost population health ER overcrowding solution: Community paramedicine

50% in Four Years – The Increase in Surgical Admissions

According to a recent report, the average price of a surgical admission for a child in 2010 was $35,423, but by 2014 it had risen to $53,372 – a more than 50% price increase. Source: “Higher Prices for Children’s Health Care Drove Spending Growth in 2014, While Use of Services Declined,” Health Care Cost Institute Press Release, May 16, 2016, http://www.healthcostinstitute.org/news-and-events/higher-prices-children%E2%80%99s-health-care-drove-spending-growth-2014-while-use-services-d

Superior Customer Experience Correlates to 50% Higher Hospital Margins

Superior Customer Experience Correlates to 50% Higher Hospital Margins

Accenture recently published an analysis on customer satisfaction from the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS). Here are some key findings from the report:

  • Hospitals that deliver “superior” customer experience have 50% higher net margins than average hospitals.
  • The margin increase at urban hospitals is roughly eight times that of rural hospitals.
  • Academic hospitals had a 2.1% margin increase per 10% increase in HCAHPS score in 2013.
  • Margin increase correlated to a 10% consumer experience improvement grew 70% from 2008-2013.
  • Among the top 20% of patient experience performers, revenues grew 10.9% and costs grew 7.8% in 2013.
  • For profit hospitals had a 3.3% margin increase per 10% increase in HCAHPS score in 2013.

Source: Accenture, May 11, 2016

What revenue does a physician generate for their hospital?

According to a recent survey, the average net revenue generated on behalf of an affiliated hospital is as follows:

  • $1,560,688 by a single physician
  •  $2,746,605 by a full-time orthopedic surgeon
  •  $2,448,136 by an invasive cardiologist
  •  $2,445,810 by a neurosurgeon
  •  $2,169,693 by a general surgeon
  •  .$1,493,518 by a family physician
  • $1,830,200 by a general internist

Source: “Survey: Each Physician Generates an Average $1.56 Million a Year Per Hospital,” Merritt Hawkins News Release, April 12, 2016, http://www.merritthawkins.com/uploadedFiles/MerrittHawkins/Pdf/2016%20Merritt%20Hawkins%20-%20Inpatient-Outpatient%20Revenue-%20Press%20Release.pdf

State Board information available to consumers

A newly released report of the Informed Patient Institute, done in conjunction with Consumer Reports,  that evaluates what type of information is available to consumers on medical board websites nationwide. Medical boards are state government agencies established to protect the public from the unprofessional, improper and incompetent practice of medicine. Seeking Doctor Information: A Survey and Ranking of State Medical and Osteopathic Board Websites in 2015 http://www.informedpatientinstitute.org/Seeking%20Doctor%20Information%20Online.pdf

After evaluating 65 state medical and osteopathic board websites, the report concludes that the information you find on these sites varies greatly—and all can be improved to make it easier to access information about doctors.  In some states, a site may be easy to use, but have little information about a doctor.  In others, the information may be comprehensive, but is hard to find.

Sixty-one criteria were used to evaluate the boards including their search capabilities, complaint process, general board information, and what types of information about board disciplinary actions, hospital actions, malpractice, Federal actions and criminal convictions could be found on an individual doctor.  Each website was rated on a scale of 1 to 100.  The results ranged from a low of 6 (for the Mississippi Board) to a high of 84 (for the Medical Board of California).  All of the state medical board websites were rated using the signature Consumer Reports Red and Black circles. The report also includes over 20 recommendations for making medical board websites more consumer-friendly. The report is also available at Consumer Reports’ Safe Patient Project, and is mentioned in the latest version of Consumer Reports magazine cover story on doctors.

Medicaid programs educating beneficiaries

A new AHIP Issue Brief provides background information about the Medicaid program and explains how health plans work with the states to deliver care for Medicaid beneficiaries.

Our issue brief provides an overview of the federal-state Medicaid partnership, who is covered by Medicaid and the benefits they receive, the role of Medicaid health plans, research findings on the value offered by Medicaid health plans, and the key issues health plans face under the Medicaid “mega reg” that CMS is expected to finalize at some point this spring.

The brief also highlights key areas where Medicaid health plans are demonstrating strong leadership:

  • By offering integrated health care delivery systems, Medicaid health plans promote access to coordinated, quality care and prevent overutilization of services that are both unnecessarily costly and potentially harmful for their enrollees, including dual eligibles.
  • By conducting outreach and health education efforts that encourage Medicaid beneficiaries to receive needed preventive care, Medicaid health plans help to reduce unnecessary hospital admissions.

By helping to manage chronic conditions through patient-centric disease management programs, Medicaid health plans are improving health outcomes while also reducing the costs of providing health care to beneficiaries with complex health care needs.

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