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Friday
Apr192019

Five Sterile Processing Questions for Stephen Cuthbertson, College Medical Center and Jeremy Gibson-Roark, DNV GL Healthcare: Post-Webinar Interview

By Claire Thayer, April 18, 2019

Improvement, Regulatory Compliance & Case Management of College Medical Center in Long Beach California, and Jeremy Gibson-Roark, a lead clinical and certification surveyor with DNV GL Healthcare, participated in a Healthcare Web Summit discussion on sterile processing.

If you missed this informative webinar, Is Your Sterile Processing Department Safe? Risks and Opportunities in Sterile Processing, watch the On-Demand version here. After the webinar, we interviewed Stephen and Jeremy on five key takeaways from the webinar: 

1. What are a few of the opportunities you've identified in sterile processing departments for quality improvement? 

Jeremy Gibson-Roark: 

  • IUSS use
  • Tray Completion – All instruments accounted for and delivered
  • Instrument Quality
  • Instrument/Set Availability
  • Tray Management – Removing and repurposing of trays not being utilized
  • Tray Management – Condensing of trays to reduce volume of processing  

2. How does the certification in sterile processing benefit the patient? 

Jeremy Gibson-Roark: It allows an organization to ensure that a Quality Management System (QMS) is in place in the sterile processing department.  This system should be designed to achieve continual improvement in the department.  The benefit to the patient is the assurance that the organization has dedicated the resources and leadership to the processing of surgical/medical instrumentation. 

3. Why were you interested in obtaining Sterile Processing Program Certification for your hospital? 

Stephen Cuthbertson: We wanted a certification to set us apart from our local area hospitals. After review of the SPPC standards, we felt confident we could achieve the certification. We don’t have the volume for attempting, stroke, VAD, or hip and knee, etc… 

4. What are some of the key steps involved in the certification process? 

Stephen Cuthbertson: I think the biggest key steps are first understanding that the standards speak to and expect to see data, policies, QMS, etc.., specific to the SPD. The document review is extensive and the tour of the various departments affected by SPD are the other big steps. It’s also important to realize that the nonconformities aren’t a bad thing, they assist the organization in improving their patient safety related to SPD. 

5. Is certification only available for Hospital? 

Jeremy Gibson-Roark: This is the only certification available for the Sterile Processing Department in the United States. While individual certification is available through other organizations, DNV GL is the only organization that will certify a hospitals SPD.

Friday
Apr122019

CVS Caremark PBM Releases Its Own Report Card and Gives Itself A’s

by Clive Riddle, April 12, 2019

CVS Health’s Caremark PBM has just released their annual Drug Trend Report, and tells is that they “blunted the impact of drug price inflation achieving a negative -4.2 percent price growth for non-specialty drugs and a 1.7 percent price growth for specialty drugs. Furthermore, 44 percent of CVS Caremark's commercial PBM clients saw their net prescription drug prices decline from 2017 to 2018.”

 

In the 12-page report, CVS Caremark notes that while medical costs have increased by 14% since 2013, their member average cost per 30-day Rx decreased 8.4% during that time, from, $11.96 to $10.95. They also remind us Non specialty brand AWP increased 8.1% last year, and specialty brand AWP increased 7.6% last year, while overall U.S. inflation increased 1.9%.

CVS Caremark reports that specialty drugs account for 1% of their Rxs, but 45% of their pharmacy spend.  They cite specialty drug cost growth as the number one trend to keep on your radar going forward. The rest of the top five trends:

2) Integrated management of specialty drug spend that falls under the medical benefit, given 45% of the specialty spend falls under medical benefits

3) Addressing pharma manufacturer innovations in marketing and product protection to reduce market competition

4) Strategies to improve medication adherence for chronic disease patients

5) Identifying “bad actors” through analytics

Friday
Apr052019

Got $285k for Healthcare Costs in Your Retirement Years?

By Clive Riddle, April 5, 2019

West Health and Gallup this week released a 44-page report: The U.S. Healthcare Cost Crisis, with survey results that addressed “the impact of the high cost of healthcare on personal finances, individual healthcare choices and the level of satisfaction with the U.S. healthcare system.”

The survey found “that despite 45% of respondents reporting fears of bankruptcy if a major health event strikes, 1 in 4 skipping a medical treatment due to costs and Americans collectively borrowing an estimated $88 billion to cover healthcare costs in the past year.” The report also tells us that: 

  • When given the choice between a freeze in healthcare costs for the next five years or a 10% increase in household income, 61% of Americans report that their preference is a freeze in costs
  • 76% expect their costs for healthcare will increase even further in the next two years
  • 26% have deferred a treatment
  • 12% borrowed money to pay for healthcare in the past year, including nearly 3 million borrowing $10,000 or more
  • 23% cut back on household spending due to healthcare costs
  • Only 36% of  doctors discuss costs with them in advance of procedures, tests or treatment plans, and 34% discussed costs of prescriptions 

But the concern rightfully is heightened for seniors (age 65+) who have the most immediate and more complex healthcare needs overall, and finite financial resources: 

  • 31% of seniors will be unable to pay for basic healthcare in the next 12 months (41% with annual household income <$60,000)
  • 29% will be unable to pay for medicine in the next 12 months (42% with annual household income <$60,000)
  • 38% said a major health event could lead to bankruptcy 38%  (45% with annual household income <$60,000) 

Fidelity this week released their annual analysis of out of pocket Medicare expenses and funds required for medical expenses with a couple retiring today. 

According to Fidelity, “a 65-year old couple retiring in 2019 can expect to spend $285,000 in health care and medical expenses throughout retirement, compared with $280,000 in 2018. For single retirees, the health care cost estimate is $150,000 for women and $135,000 for men.” Fidelity tells us that “while there’s no surprise that health care costs are a top financial concern in retirement, the past two years combined have seen a slower rise (3.6 percent) than in the previous two (2015-2017), which saw the estimate grow to $275,000 from $245,000 (up a total of 12.2 percent). Even without the same rate of growth, some retirees are still surprised by today’s cost of health care.” 

Fidelity healthcare prescription isn’t surprising – they advocate building savings to cover the expenses, through HSAs:

Friday
Apr052019

Friday Five: Top 5 healthcare business news items from the MCOL Weekend edition

Every business day, MCOL posts feature stories making news on the business of health care. Here are five we think are particularly important for this week: 

Average prices higher for outpatient healthcare, study finds

Commercially insured patients face higher prices for a set of healthcare services performed in outpatient settings compared to those at physician offices, according to a Health Care Cost Institute study.

Becker's Hospital Review

Thursday, April 4, 2019 

Insurers, hospitals, physicians united in stance on ACA lawsuit

Hospitals, physicians and insurer groups are united in wanting to preserve the Affordable Care Act and have defended it in briefs filed with the Fifth Circuit Court of Appeals.

Healthcare Finance News

Wednesday, April 3, 2019 

Fixing Surprise Medical Bill Problem Shouldn’t Fall To Consumers, Panel Told

One point drew clear agreement Tuesday during a House subcommittee hearing: When it comes to the problem of surprise medical bills, the solution must protect patients — not demand that they be great negotiators.

Kaiser Health News

Wednesday, April 3, 2019 

CMS, states face difficult choices on Medicaid expansion, work requirements

The Trump administration and many states face a complex set of policy decisions in the wake of a federal judge’s decision vacating Medicaid work requirement waivers in Kentucky and Arkansas.

Modern Healthcare

Tuesday, April 2, 2019 

Association Health Plan Ruling Puts Some Companies in Limbo

A federal judge's ruling against a type of health insurance plan designed for small business owners has some companies now thinking about what to do next.

Associated Press

Tuesday, April 2, 2019 

These and more weekly news items on the business of healthcare are featured in the MCOL Weekend edition, along with the MCOL Tidbits, and more, for MCOL Premium level members.

Friday
Mar292019

Five Questions for Change Healthcare's Chris Simpkins and Dr. Andrei Gonzales

By Claire Thayer, March 29, 2019

Recently, Change Healthcare’s Chris Simpkins, Vice President Value Based Analytics and Dr. Andrei Gonzales, Assistant Vice President, VBR Product Management, participated in a Healthcare Web Summit webinar and shared some of the many ways in which episode analytics can be used by Managed Medicaid plans to drive improved care quality and lower total costs of care. 

If you missed this informative webinar presentation, “Creating Value Based Payment Success in Managed Medicaid Through Analytics,” we invite you to view a PDF version of the presentation! To do so, go to: www.healthwebsummit.com/changehealthcare031419.pdf.

After the webinar, we interviewed Mr. Simpkins and Dr. Gonzales on five key takeaways from the discussion:

1. Tell us more about Change Healthcare's recommendation to starting a Value-Based Payment Program with an upside only financial incentive and then gradually move toward an upside / downside program at a later stage?

Chris Simpkins: A value-based payment program should be approached as a crawl walk run process.  Historically, payers and providers have been on opposite sides of the negotiation table.  For one side to win… the other side needs to lose.  Value based payment programs are a shared success & responsibility program. Payers and Providers will win or lose together.  This new collaborative relationship needs time to grow and develop trust. 

Health plans need time to be more comfortable sharing data with providers about what happens outside their offices.  Providers need time to be more comfortable understanding the new financial models (i.e the the rewards & risks of these programs).  Upside only programs allow payers and providers the time they need to focus on their collaborative relationship and the structure of the program without the fear of harsh downside penalties.  As the relationship grows and provider gets more comfortable with how to succeed, downside risk can be introduced.

2. Your discussion illuminated opportunities to leverage episodes in a Medicaid population, and in particular, pregnancy management. How is a Pregnancy Program similar to procedural bundles (i.e., Total Joint Replacement)?

Chris Simpkins: Pregnancy is like a procedural bundle because a large portion of the services within the episode are predictable and clearly related to the underlying trigger event.  Each episode includes prenatal visits, ultrasounds and delivery costs.  This consistency in services allows payers and providers greater accuracy in setting budgets for performance tracking and shared savings programs.  This consistency also allows you to conduct peer to peer comparisons which helps identify variations in care that can lead to higher costs and lower quality.

3. What are some of the key findings from your recent payer survey as to drivers leading Value Based Care program care adoptions? 

Dr. Gonzales: Based on our most recent research we identified four key factors driving payer interest in value-based care programs.

1)      Medical Cost Savings – Payers identified an average medical costs savings of 5.6% from the their VBC Strategies

2)      Care Quality Improvements – 77% of payers responded felt their VBC programs were either improving care quality

3)      Improved Patient and Provider Engagement – More than 64% of respondents noted that their VBC efforts were improving key stakeholder engagement

4. In your experience, what are the top 3 provider engagement challenges in episode of care management?

Dr. Gonzales: Payers continue to struggle to secure provider support for their episode of care programs.   The top three provider engagement challenges identified include:

1)      Gaining agreement on contracted budgets and risk/gain sharing

2)      Gaining agreement on episode of care performance metrics and reports

3)      Engaging providers to consider participating in an episode of care contract 

5. Can you tell us briefly about ways in which population differences between Medicare, Commercial and Medicaid require different approaches with Episodes of Care?

Chris Simpkins: These three populations have very different healthcare needs and access the healthcare system in different ways.  The Medicare population is older and accesses the healthcare system for procedural (i.e. Joint Replacement) and Acute (Stroke, AMI).  55% of Medicare dollars are spent treating these conditions.  The Medicaid population is younger, lower socioeconmic and more female.  This produces higher medical spend for Maternity care, Chronic diseases such as Ashtma, ADHD, Diabetes.  Very little is spent on procedural episodes.  These chronic diseases are not as well suited for an episode program with a fixed budget for treating a single condition.  Total Cost of Care models centered around a PCP that focus on comorbid conditions are better suited for treating these types of conditions.  The Commercial population blends the two, there are procedurals in the older portions of the population (e.g. 55-64), maternity costs for young working families and also Chronic diseases that are prevalent in all populations.

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