Orlando Health Care News

Orlando area hospitals face $7.3 million Medicare penalty

This week there’s an article in the Orlando Business Journal outlining upcoming cuts in Medicare reimbursements for local hospitals. Why the reimbursement cuts? Medicare patients are ending up back in the hospital too soon. Penalties are imposed for patient re admissions within one month of initial discharge, and Central Florida hospitals are particularly hard hit with re admissions for heart attacks, heart failure, and pneumonia. 

Penalties are starting small but will double each year for at least the next three years, which could put hospitals at further financial risk and provide incentives to educate patients and to make sure they are adherent to their recovery regimens after discharge. 

Orlando Health, for example, is getting 0.92 cents of every Medicare dollar due to re-admission penalties, and Florida Hospital’s percentage is even higher. This may not seem like much, but these penalties add up to an estimated $4.47 million for Florida Hospital and $1.8 million for Orlando Health and these numbers are expected to grow. 

How it works: The U.S. Centers for Medicare and Medicaid Services measures how many of each hospital’s patients admitted for heart attacks, heart failure and pneumonia end up back in the hospital within a month of leaving. Data is collected over a given period and plugged into a formula that determines the hospital’s penalty. 

Nationwide 2,211 hospitals face losing $280 million.  Hospitals are penalized even when a patient re admission within 1 month is unrelated to the first visit. 

Orlando Health has been able to drop re admissions by 12 per cent, and expects the penalties to grow smaller in the coming years. They’ve increased the number of medical case managers, who make sure patients are educated, adherent, and learn how to navigate the health care system, increasing patient empowerment and self-sufficiency. This should lead to improved patient outcomes.

(Source: orlandobusinessjournal.com)

This has the potential to be the best volunteer gig ever

Over the years I’ve volunteered for a wide variety of organizations:  The Special Olympics, a school for the blind, Habitat for Humanity, the Alliance Francaise, GLBCC in Orlando, a hospital Trauma Department, the Coalition for the Homeless, and the Orange County Health Department are a few of them. I’ve always had a passion for helping other people and I love to see the tangible benefits of my efforts. 

Due to my recent job I’ve had to pare down (at least for now) my volunteer gigs to just one, but it’s a good one:  I’m currently serving on a Quality Management Committee for the Orange County Health Department’s Infectious Disease Group.  

This group focuses on process and quality improvement - what better opportunity to improve the quality of health care? This month’s meeting focused on an overview of measurement and data in quality improvement, and on sampling patient records, designing a data collection plan, and on collecting data. 

Useful info on quality improvement as it specifically relates to HIV care can be found at http://nationalqualitycenter.org/ . 

I really think this group will be a great opportunity to improve patient outcomes through estimating available resources, making accurate predictions, aiding in strategic planning, evaluating the effectiveness of existing systems, learning from historical patterns, and creating a dialogue among providers (both clinical and non-clinical). 

Outcomes from this committee have the potential to streamline processes and improve patient wait times, reduce costs, and increase client satisfaction. 

I look forward to being an active member of this committee, learning a lot, and being able to have a real part in improving health care in the Orlando area. 

Jon 

Quick facts from “Rise of a Massive Health Sector”

I blogged recently about Christopher Conover’s new book American Health Economy Illustrated, which is proving to be a great read.  It’s full of useful, interesting stats on the American health care system. Here are a few takeaways on the MASSIVE size of our health sector I thought interesting:

-Spending on health care in the U.S. has increased more than 60-fold since 1929. In contrast, the U.S. economy grew only 12-fold over the same period.

-The percentage of GDP devoted to health care has more than quadrupled during the past 80 years to more than one-sixth of the entire economy. Health spending has grown faster than almost all other major components of the economy. 

-Health spending now makes up 25 percent of all federal spending compared with only one-sixth of total spending by state and local governments. 

-Health care now absorbs almost one in three tax dollars- a share that is more than eight times as large as it was in 1929.

-Our apparent willingness to increase expenditures on health care even during periods that the real economy is shrinking is suggestive of the relative priority of health care over everything else. 

-Each 1% increase in GDP has been associated with approximately a 1.3% increase in health spending. 

-Even from a world perspective, the American health system is massive, accounting for approximately 40% of an estimated $5.2 trillion in health expenditures across the globe. 

-The U.S. share of world health expenditures is substantially larger than its share of either world population or GDP.

-More than 70% of the world’s population live in nations with health spending per capita below 10% of U.S. levels.

(Source: aei.org)

Health care development blurbs around metro Orlando

It’s definitely an exciting time to blog about health care in metro Orlando.  Development is everywhere:  ORMC’s main campus south of downtown,  Florida Hospital’s main campus north of downtown, and Lake Nona’s Medical City (UCF College of Medicine, Nemours Children’s Hospital, Sanford-Burnham Institute, new VA Hospital) are a few hot spots. 

Thanks to the Orlando Business Journal for keeping me posted weekly on so many health projects that I have to pick and choose a few to highlight here.

ORMC:  The pic above is one of many new projects, this one a 10-story patient tower at ORMC.  The tower will have 190+ beds, dedicated cardiac floors, and a new Trauma ICU. They are also greatly expanding the size of their already large Trauma Department, the only level one trauma center in Central Florida. Sunrail will have a stop on ORMC’s campus. 

Florida Hospital: Florida Hospital continues to develop its Health Village, the 172-acre development slated to be built around Florida Hospital Orlando, just north of downtown. Sunrail will also have a stop on Florida Hospital’s campus. Some of the projects either built or in progress: 3-story Florida Hospital Translational Research Institute, a $29 million, 8-story administrative office building expected to break ground in November, a $25 million, 90,000 square foot building to house more graduate programs, a 5-story workforce housing apartment complex, and a $55 million bioscience building. 

It should be noted that it appears both hospital systems mentioned above are in a building race.  They are both giants, with main campuses that rival a medium university campus is size. Honestly it’s unclear how much this will improve accessibility to care for the average person, but it’s my guilty pleasure to watch all of the development. 

Here is a rendering of Sunrail and Florida Hospital.

(Source: orlandobusinessjournal.com)

American Health Economy Illustrated

Currently I’m reading an excellent book for anyone looking to better understand the problems facing America’s health care system, an easy to follow guide detailing the issues involved in health care reform. 

Author Christopher Conover, a scholar at Duke University’s Center for Health Policy and Inequalities Research, provides the reader with a guide to the health economy and gives the him the ammunition to make intelligent health care decisions and analysis on a level that’s accessible to the average consumer. 

A few statistics pulled from the book:

-The United States spends more on health care but gets worse outcomes than other developed countries;

-Prices for health care are higher in the U.S. than other countries, but after adjusting spending levels for international price differences, most of the inefficiencies in the U.S. system go away. A lot of this is because America compensates health care workers more generously than other countries. 

-The return on medical education in America is not out of line with the return on education in many other professions. 

-Even though Medicare benefits leave a lot to be desired, Medicare is popular amoung enrolees. This is due to to price for the buyer instead of the quality of the product: beneficiaries pay directly only about one-eighth of the total cost of their benefits. 

-80% of Americans that identified themselves as being in poor health already (before health reform) have public insurance, through Medicare for the elderly or Medicaid for the poor and sick. 

-American private insurance is improving. The proportion of out-of-pocket expenses Americans have to pay is falling continuously, and on average is at a level which puts Americans with private health insurance among the lowest in the world. Conover writes, “This is a far cry from the typical view of critics at home and abroad that the American health care system is a Darwinian horror of high bills that people cannot pay.  Notably, this low rate of risk has been achieved by a system with nearly the world’s highest share of private insurance.”

On a personal note, having volunteered in two public health clinics with the Orange County Health Department, volunteered in the Trauma Department of Orlando Regional Medical Center, and having recently begun employment as a Health and Human Services professional for an HIV/AIDS non-profit, I’m fascinated by all of the practical and useful health care statistics and insight provided in this book. 

On another personal note, I’m pleased to announce that I recently accepted a volunteer position on a Quality Management Committee for the Health Department. I’m really excited about this opportunity to improve local health care- the main point of this blog, my volunteer work, and my career is to make health care more accessible in Central Florida. 

(Source: aei.org)

Reducing patient re-admission after discharge: Orlando Health

The OBJ ran an article earlier this year on Orlando Health’s efforts to improve treatment for patients after leaving the hospital, part of an initiative to improve patient recovery rates and minimize repeat client hospitalizations after initial discharge.

They interviewed David Sylvester, vice president of post-acute and transition services at Orlando Health, a local 5-hospital system. His job is “to worry about what happens after you leave” the hospital. 

As you can see from the graphic above, post-acute care can take many forms: at-home nurse treatment, going to a nursing home, a rehabilitation hospital or a long-term care hospital. 

Medicare spending on post-acute care has grown from $26.6 billion in 2001 to $57.2 billion in 2010. In order to improve care and save money, Medicare plans to punish hospitals financially when patients with certain conditions are readmitted to the hospital within 30 days. 

This is why hospitals have a strong need to help released patients with medically complex treatment plans transition back into the community, and this is why hospital systems are hiring people such as David Sylvester to manage this critical process.

What is a major driver for keeping readmissions under control?  Having patients with medications in hand see a physician within 72 hours of initial discharge.  Making sure patients are adherent, compliant with treatment plans, and motivated to get better and maintain their own health is crucial.

On a personal note, addressing the psycho-social needs of clients to make sure they are adherent/educated/know how to navigate the system/learn how to be self-sufficient upon release cannot be understated. As a health and human services worker for an HIV/AIDS service non-profit, my job is to ensure newly diagnosed clients learn how to take care of themselves and have the right attitude about their care. This will benefit the my clients by improving their health and well being, benefit the local health care system by lowering hospital re-admissions, and benefit Medicare and Medicaid by lowering their costs.

(Source: bizjournals.com)

Thoughts on transforming the structure of a health system

The Affordable Care Act and a slow economic recovery are forcing healthcare systems to reevaluate existing efficiency models. Transforming a healthcare system should yield cost and productivity savings, and these savings can be passed on to patients. 

Looking at the efficiency planning process for a target audience of healthcare finance leaders, there are a few core suggestions:

-Align strategic imperatives for the company and physicians;

-Remember the company’s core area of business;

-Define a starting point and create clear objectives; and 

-Develop a strategy that engages front-line employees to change the culture of the organization.

In other words, set clear objectives that align all employees with the strategic values of the company. The most fundamental piece of integration is the shared strategic plan. This will create efficiencies and in turn yield cost savings, reduce queue times, et cetera.

A provision of the Affordable Care Act that paves the way for Accountable Care Organizations (ACO’s) will probably help to make large hospital systems and medical networks more profitable (for info on ACO’s, see my post last week). ACO’s emphasize quality, efficiency, and shared resources: a value-based system rather than a payment-based system. 

Lowered Medicaid payments from the Federal Government are also forcing providers to look at ways to increase revenue without sacrificing quality. Another way to increase efficiency is to integrate support activities and coordinate care with physicians, which should increase quality of care while lowering costs.

How will improved quality benefit patients as well as hospital systems?  Higher quality via increased efficiency and better communication between all employees will translate to reductions in the length of hospital stays.  When better medical care keeps patients out of the hospital or reduces the time spent once admitted, the turnover rate is faster. This frees up more beds. For example, if you can reduce the length of stay by 10 per cent and you have 1,000 beds, you just created the equivalent of 100 beds every day.  Improving throughput has massive benefits. 

(Source: hfma.org)

The new federal health care model, ACOs, and Florida business

Last month, the U.S. Centers for Medicare and Medicaid Services approved two new accountable care organizations, or ACOs, in Central Florida. This brings the total to three approved organizations, responsible for coordinating the care of 13,500 Central Florida Medicare patients. Three additional local ACOs are also in the works. 

By definition, an ACO is an organization formed between health care providers- usually primary care and specialty doctors- who no longer will accept a simple fee from the government for the services they render. Instead of the simple fee from the government, they accept a bundled payment.  If they keep the patients healthier and save money, they get to keep some of that cash. 

There are arguments that ACOs are the HMOs of the 1990s, simply re-named. If they function properly, they should save the government money, lower the cost of health care, and ultimately save businesses money on health insurance premiums. 

The Federal Government, as the nation’s largest health insurer, is shifting its focus to quality not quantity. As does Medicare, so does commercial health insurance. As an example, this means every doctor and hospital that touches a patient during a procedure would no longer bill the government. It also means, for example, if an initial surgery is screwed up, then the hospital must eat the cost of the second surgery. 

Most analysts agree that ACOs will either prove or disprove themselves over the next few years. If ACOs keep patients healthy and out of the hospital, the financial net loser in this scenario is the hospital.  Even if forming an ACO increases a hospital’s market share, the net result, even with the money the government pays it, would be a reduction in revenue. 

(Source: orlandobusinessjournal.com)

Orange County Health Department improvement initiatives

One of the main reasons for this blog is to highlight improvements in the local healthcare system and to suggest options for increasing accessibility to health care in Central Florida. 

The Orange County Health Department has received 7 different awards for its work to improve services and save money. Four of these were Florida Davis Awards, which are awarded to state departments for process and efficiency improvements.

Three of the Davis Awards recognized the following:

1) The Health Department’s Woman Infants and Children (WIC) and I.T. programs won a Davis Productivity Award for a client flow system that helped speed up clinic flow with a new software system called Q-Flow. The system helped WIC see clients in 30 minutes less each day while servicing the same number of clients with 5 less staff members. In addition to financial benefits, the new process resulted in 10% less wait time for clients. 

2) The Immunizations team won a Davis Productivity Award for improvements that sped up processes, reduced waste, and improved services. The data processing project reduced the number of duplicate client records in state databases, improved vaccine accountability, and increased revenue. 

3) The Health Department’s I.T. and Community Health programs won a Davis Productivity Award as the first county health department to start a mobile website in Florida, www.orchd.mobi. An estimated 5 HIV infections were avoided by education and early treatment through the mobile site, saving more than $90,000 annually in treatment costs. 

It is great to see public health initiatives at work to reduce patient wait times, improve access to health information, and improve the accuracy of patient records. 

(Source: newsroom.doh.state.fl.us)

Latino health needs and HIV

Central Florida and the Orlando area have a pronounced need for health services tailored to their burgeoning Latino population. A recent study by the U.S. Department of Health and Human Services, Health Resources and Services Administration (HRSA) HIV/AIDS Bureau (HAN) details a study of 10 HIV services providers treating mainly Latino clients.  The result is an outline of effective approaches to addressing barriers to care experienced by Latinos in America.

Although Latinos represent 14% of the U.S. population, they account for 17% of all diagnosed HIV cases and nearly 1 in 4 Ryan White Program clients (the Ryan White Program provides HIV care to low-income and no-income individuals). 

Latinos have been disproportionately affected, but why? A few factors are cultural and linguistic competence, availability of translation services, acceptability by the Latino community, and policies limiting undocumented clients to services (undocumented clients have limited eligibility for publicly funded programs). 

Some strategies to address these obstacles that have engaged this population in care and encouraged Latinos to stay in treatment:

-marketing campaigns to change social norms;

-partnerships with community organizations to address stigma issues;

-medical case management to increase care coordination; and

-bilingual and bicultural staffing. 

Implementation of these best practices has produced short-run outcomes such as improved access to care, enhanced quality of life, and increased engagement of clients in their health care program. 

(Source: hrsa.gov)