—
• Nationwide, Not-for-profit Health System – “NHS” (Economies of Scale):
o Single Payer Health Care (Public Option in the Private Sector);
o Nationwide Non-for-profit Health-Insurance Plan;
o National, Non-profit Healthcare Provider Network;
o Uniform Electronic Health Record System;
o Single Purchasing Group for National Healthcare Provider Network;
o A Nationwide, Health Information Database; and
o Corporate Finance, Capital Markets & Charitable Fundraising.
3 Reasons Why Not-For-Profits Hospitals Are Merging
August 16, 2011 | James Ellis and Aaron Razavi
Suggested Content
WellPoint to acquire CareMore Health Group
HealthGrades lists top 10 cities for emergency medical care
Top 50 cities named for hospital care
CMS awards $9M to 51 Senior Medicare Patrol programs
Related Resources
Floyd Memorial Case Study: Just Being Good was Never Good Enough
Automating and Streamlining Point-of-Service Processes: How the Front Line Meets the Bottom Line
Case Study: Little Company of Mary Hospital Saves 39 Percent by Participating in Group Buys
Lawsuits and Litigation: Best Practices to Ensure Your Wage/Hour Practices Stand Up Under Scrutiny
SETMA: Learn How a Multi-Specialty Group Practice Is Using BI to Transform Healthcare
Facing financial difficulties and an eagerness to grow, nonprofit and smaller hospitals are looking towards merging with larger health systems. Moody’s Investors Service’s new report found that 20% of nonprofit hospitals were losing money. Not only that, the report also found 63% of nonprofit hospitals’ attained 0 to 5% margins.
What is the cause of this attraction to larger hospital systems? Three items come to mind: reimbursement cuts, increased capital and large hospital systems seeing an economic advantage.
1) Lower Reimbursements:
More severe cuts are being made to Medicaid and Medicare and some states are even trying to opt out all together. A judge in Arizona recently upheld the state’s plans to implement harsh cuts to its Medicaid program. Now adults will not be covered which should save the state $190 million. As their main source of reimbursement, nonprofit hospitals need to find new solutions to mitigate this dwindling financial strategy making them seek larger health systems’ assistance.
2) Increased Capital:
When seeking to merge and/or sell themselves to these larger entities, the smaller and nonprofit hospitals can expect some of their capital needs to be met: increasing efficiency, lowering operating costs and making the once financially unstable hospital a lucrative one. Such was the case for Detroit Medical Center (DMC) when they sold themselves to Vanguard Health Systems. In the deal, the floundering medical center received $417 million to reduce its debt and an additional $850 million to revamp their facilities. Through the sell, DMC has the ability to not only keep the facility running by investing in the latest technology, but to enhance patient care and reduce operating margins as well.
3) Eager Health Systems:
While helping the nonprofit systems, there is much to look forward to for the health system looking to acquire. Health reform is a blessing in this case. While reimbursement may be low, health reform will only help the bottom line as indigent care will now have increased value. With increased support service, the acquiring health system will have more centralized and consolidated support services providing considerable cost savings as indicated by the Moody’s Investors Service report. Additionally, outpatient revenues may also be increased as outpatient care clinics may compose part of the smaller health systems portfolio and since patients continue to seek treatment in these preferred locations.
When a nonprofit hospital is considering becoming acquired the advantages are great, but be wary the core mission is not compromised. When for-profits health systems become involved the charity care aspect has a way of being reduced. As the uptick in hospital merges continues, the potential for fledging health systems’ is promising.
James Ellis, CEO, Health Care Realty Development Company, is a nationally recognized successful real estate investor and developer of medical office properties with a comprehensive knowledge of sophisticated real estate transactions, cost effective designs, and efficient property management.
Aaron Razavi is Associate Marketing Director at Health Care Realty Development.
Visit their blog at http://www.hcrealty.com/medicalrealestatedevelopment/
More hospitals need to close, says ex-NHS boss
By Nick Triggle
Health correspondent, BBC News
Lord Crisp was NHS chief executive from 2000 to 2006
UK ‘has too many hospital births’
Hospital services ‘need overhaul’
Hospitals must adapt in shake-up
The closure of more hospitals is needed if the NHS is going to cope in the future, a former NHS boss says.
Lord Crisp, who was NHS chief executive in England from 2000 to 2006, said the Blair government should have been tougher when it had the chance.
He said there was now an overcapacity in the hospital sector and said the same mistakes should not be made again.
Overhauling hospitals would free up funds for community services to deal with the ageing population, he added.
In an interview with the BBC News website, Lord Crisp said: “In the late 1990s waiting lists, A&E and standards in cardiac care were the big issues and we dealt with them.
“But the challenge now is dealing with the numbers of older people and those with long-term conditions. They need supporting in the community.
“That means a shift away from hospitals. There will be less need for large hospital outpatient departments and some services and whole hospitals will need to close or be merged with others.”
Key moment
He said he could not put a figure on how many hospitals needed revamping, but added it could affect the whole spectrum of services provided.
Continue reading the main story
How hospitals are changing
Hospitals have always been the visible face of the NHS. There are more than 200 hospital trusts in England, accounting for much of the NHS budget.
However, slowly but surely the way they deliver services is changing. In areas such as stroke, heart care and cancer there is a drive to centralise services in fewer “super” units.
In London, this was done for stroke services last year. Traditionally care was provided from 30 hospitals, but there are now eight specialist centres that see all stroke patients.
This ensures they get the right scans and drugs quickly. It is estimated the move will save 400 extra lives a year.
Meanwhile, a number of hospitals across the country have seen their A&E units closed or downgraded to minior injury units. This has often proved controversial, but has won the backing of doctors in many cases who have argued services can get too stretched in smaller units.
The Royal College of Obstetricians and Gynaecologists has called for a similar consolidation of services for maternity care.
But care is also being moved out of hospitals. Dialysis is increasingly being done in the community, while GPs are taking on more responsibility for things such as minor surgery and diabetes care.
His remarks come as ministers are considering the future of A&E, maternity services and children’s units at three hospitals in north London.
Under the plans drawn up by the local NHS one hospital – Chase Farm – could lose its services.
Local campaigners have been fighting the proposals and a decision is expected in the coming weeks.
It is being seen as a key moment in the government’s policy on hospital changes because, in opposition, the Tories promised to fight against such closures.
Lord Crisp, who has written a book about his time at the helm of the NHS called 24 Hours to Save the NHS which will be published later this month, said he did not know the full details of that case, but added it was important not to dodge difficult decisions.
He admitted the NHS under his stewardship in the Blair years should have scaled back on hospital services.
In particular, he admitted that the scale of hospital building projects probably went to far. More than 100 new hospitals or rebuilds were given the go-ahead.
He said: “By 2005 there was no hospital that was not thinking it was going to grow. We had major problems with very bad facilities, [but] perhaps we could have built smaller or consolidated on fewer sites.
“We missed that opportunity and this government needs to grasp that. We can’t keep services going just because there is a nice building.”
However, he said it was essential that any changes made were done to benefit patients not just to save money and that they should be carried out with proper consultation and engagement.
Lord Crisp’s intervention comes after similar warnings by various experts. The King’s Fund and NHS Confederation have both put the case for scaling back on hospital care in recent months.
Katherine Murphy, of the Patients Association, agreed the government should not be afraid of making difficult decisions.
She said: “What is the point of having brand new hospital buildings if there are not enough funds to treat people in them?”
But she also warned: “We must never forget that by merging services, there will be patients who may struggle to get to them because they are too far away.”
Labour said patients had benefited from the investment and reforms during their time in office.
More on This Story
Related Stories
UK ‘has too many hospital births’ 13 JULY 2011, HEALTH
Hospital services ‘need overhaul’ 03 MARCH 2011, HEALTH
Hospitals must adapt in shake-up 24 FEBRUARY 2011, HEALTH
Department of Health
GOVERNMENT
Appeals court panel dismisses Virginia health reform suits
Lawsuits by the state’s top lawyer and Liberty University are thrown out by appellate judges, who said plaintiffs did not have standing to sue.
By ALICIA GALLEGOS, amednews staff. Posted Sept. 8, 2011.
A panel of the 4th U.S. Circuit Court of Appeals dismissed two high-profile lawsuits against the Obama administration over the health system reform law, ruling that the legal challenges are invalid.
In a 2-1 opinion issued Sept. 8, the three-judge panel said Virginia Attorney General Kenneth Cuccinelli and Liberty University — who filed separate challenges against the reform law’s constitutionality — did not have standing to sue. The judges did not review the constitutional issues in dispute.
“We recognize that Congress has imposed a potentially ‘harsh regime’ on some taxpayers. However … the question of whether these concerns merit consideration is a matter for Congress to weigh,” the majority panel said in its opinion.
The appeals panel sent both cases back to the trial courts with orders to dismiss for lack of subject matter jurisdiction (pacer.ca4.uscourts.gov/opinion.pdf/102347.P.pdf).
In a statement, Cuccinelli said the state was disappointed with the ruling and planned to appeal.
“Our disappointment not only stems from the fact that the court ruled against us, but also that the court did not even reach the merits on the key question of Virginia’s lawsuit — whether Congress has a power never before recognized in American history: the power to force one citizen to purchase a good or service from another citizen,” he said.
More than a dozen other legal challenges have been filed against the health reform law, most of which have been dismissed by lower courts.
Most recently, the 11th U.S. Circuit Court of Appeals ruled in August that Congress exceeded its authority by requiring all Americans to obtain health insurance or pay a tax penalty under the reform law. That decision conflicts with other rulings finding the individual mandate constitutional, including an appellate decision by the 6th U.S. Circuit Court of Appeals, which said lawmakers had the power to require individuals to obtain health insurance.
Legal experts say the U.S. Supreme Court ultimately will make the final decision on the matter. Cuccinelli in February attempted to bypass the appeals court and go straight to the high court with his state’s lawsuit, but the justices in April declined to review the challenge early.
Copyright 2011 American Medical Association. All rights reserved.
Healthcare Business News
Berwick
Exchanges will move forward—step by step, Berwick says
By Jessica Zigmond
Posted: September 12, 2011 – 12:30 pm ET
CMS Administrator Dr. Donald Berwick told reporters Monday that the CMS has the money necessary to move forward in establishing health insurance exchanges.
“We have every intention of running the exchanges on time and helping states do the same,” Berwick said following his remarks at the America’s Health Insurance Plans conference on Medicare and Medicaid, which runs through Sept. 15. “There will be federal exchanges, of course. Some states will choose that as a better way for them,” he added. We don’t know how many.” When pressed for whether the CMS has the funding required to establish these insurance marketplaces, Berwick said: “Step by step, we have the money we need now to take the next steps.”
Meanwhile, Berwick said the selection process for the Pioneer ACO model—the sister program to the Medicare Shared Savings Program for accountable care organizations—is under way. Berwick said the application process, including even the number of applicants for it, is confidential, and that he suspects the CMS will announce the Pioneer ACOs before the MSSP program begins in January.
In his keynote speech earlier, Berwick emphasized that the cost of healthcare is a “center-stage issue” and one that can be addressed in two ways: either by cutting care, which he noted is “seductively easy,” or by improving care, which he said is not only the better option, but one that is within reach.
There are “direct savings policies” that reduce costs even if there are no changes in provider or patient behavior, such as changes to the level of payment to providers and productivity adjustments that he said are easy to quantify. But those policies are less than ideal and “certainly not the best route to the better healthcare that we all seek,” Berwick said. Instead, the focus should be on the “indirect savings policies,” which are ways to work with stakeholders to reduce the waste in the healthcare system.
Berwick outlined six major types of healthcare waste: failures to coordinate care; failures in the care process (such as delays or producing injuries); over-treatment; excessive administrative costs; problems in healthcare pricing; and fraud and abuse.
Read more: Exchanges will move forward—step by step, Berwick says – Healthcare business news and research | Modern Healthcare
Fitbit Privacy or Lack Thereof – Exposing Sexual Activity of Its Users – EMR and HIPAA
I
EMR and HIPAA john@emrandhipaa.com via google.com to me
show details 6:38 AM (17 hours ago)
Fitbit Privacy or Lack Thereof – Exposing Sexual Activity of Its Users – EMR and HIPAA
Posted: 13 Sep 2011 10:44 AM PDT
Well, privacy rears its ugly head in healthcare again. I don’t want to treat a person’s privacy lightly, but I must admit that I kind of had to laugh at the breach I’m about to tell you about. I think you’ll see why.
I first read about this privacy breach on this Techcrunch article (They originally found it on nextWeb). Here’s a quote from the Techcrunch article:
Yikes. Users of fitness and calorie tracker Fitbit may need to be more careful when creating a profile on the site. The sexual activity of many of the users of the company’s tracker and online platform can be found in Google Search results, meaning that these users’ profiles are public and searchable.
I’ve been a big fan of Fitbit and other devices like that which are trying to track a person’s health and fitness. I think there’s a real market for these devices, but this is a pretty ugly misstep for Fitbit. Although, a search for sexual activity and FitBit isn’t returning results any more. Here’s the Fitbit blog post which details the steps they’ve taken to secure their users profiles. Seems like a reasonable and a smart response to the privacy issue.
Before I go any farther, we should be clear that this isn’t a HIPAA violation. The patient put their information online and agreed to have that information out there. We could argue how much they really agreed to have their profile public, but I’m quite sure that Fitbit would be fine in a HIPAA lawsuit. However, that doesn’t mean they’re not taking the hit for poor decisions.
What can future healthcare app and device companies learn from the Privacy issues at Fitbit?
1. Default healthcare profiles to private. Allow the user to opt in to make it public. Some might want it public, but no company should assume it should be public. This isn’t Facebook.
2. Consider more granular privacy controls. I may want part of my profile public, but part private (ie. sexual activity in a fitness application).
3. Be aware of what you allow search engines to index. There’s a whole category of hackers called Google Hackers. They use Google to find sensitive information like the story above. It’s amazing the power of Google hacking.
Some suggestions to e-patients that put their health data online:
1. Be careful about what information you’re putting online.
2. Check out where the information you put online will be available. Is it private? Is it public? Is it partially public? Can search engines see it?
There’s little doubt that more and more healthcare information is going to be put online by patients. We’re going to see more and more privacy issues like the one mentioned above. This incident will do little to deter this trend. However, hopefully it can serve as a learning experience for Fitbit and other healthcare companies that are entering this new world of online health information.
I love your blog, you should add an RSS feed feature so I can get automatic notifications of new blogs. If you set one up please email me! i will bookmark you for now. Again Excellent Blog!
From: “Absolute®Sopftware The absolute best way to track, manage & protect your digital world”
UK Abandons National Health Records System
August 15th, 2011 Author: arieanna
Back in 2007, we wrote how the UK government had £13bn set aside to digitize the medical records of all 50 million patients in Britain by 2010 under a centralized National Health Service (NHS) system, the National Programme for IT. After 9 years and £11bn ($18 billion) spent, the centralized computer system project is being abandoned. Official news is speculated to be delivered next month.
A story earlier this month by the Independent suggests that, instead of a centralized system, local health trusts and hospitals will be allowed to develop or buy their own computer systems to suit their individual needs. To meet the desired goal of centralizing data, a smaller central server will still be put forth.
The project has run into lengthy delays, changing specifications, technical challenges and issues with suppliers. It appears that the “one-size-fits-all” technical plan was beset by too many issues and obstacles to make it practical in both the short- and long-term. A report by the Commons Select Committee on the status of the project was said to be the impetus towards making this decision, where they stated:
“The Department of Health is not going to achieve its original aim of a fully integrated care records system across the NHS. Trying to create a one-size-fits-all system in the NHS was a massive risk and has proven to be unworkable.”
A lot had been said about the potential security pitfalls of a centralized NHS system, though I can also foresee issues in security and accountability continuing to be a problem for all of these disparate systems.
Here we see impact of “issues with suppliers”; too many chiefs; too few Indians; and the overwhelming negative impact the lack of a base or de facto standard can have, even withing a wholly public healthcare delivery system.
The English National Health Service will not align with a single electronic health record system until the USA Single Payer Option “Not-for-profit Health Service” health information database is available and allows for the modeling of “global” health information into a single, uniform and standardized database.
i.e., at least one billion users on at least two billion devices by the year 2020, including both the English NHS (National Health Service) and the American NHS (Nationwide, Not-for-profit Health Service).
Conyers: Obamacare Is ‘Platform’ for Creating Single-Payer System
By Nicholas Ballasy
March 14, 2011
(CNSNews.com) – Rep. John Conyers (D-Mich.), the ranking member of the House Judiciary Committee, told CNSNews.com today that the health-care law that President Barack Obama signed last March is a “platform” for building a single-payer health care system in the United States.
During a newsmakers program at the National Press Club on Monday, Conyers said that after discussing the issue with Rep. Dennis Kucinich (D.-Ohio) he voted for the health-care law because he saw it as a necessary “platform” for building toward a single-payer health-care system in the United States.
Speaking with CNSNews.com after the event at the National Press Club, Conyers said, “What we’re trying to do is insure everybody, right? We’re trying to insure more people, not less and so it’s my feeling that the rising costs that are going on will not be solved by getting rid of people’s health insurance–that throws them into emergency rooms and charity and other things. That’s why HR 676 is our ultimate solution–is that everybody’s insured from birth on and that’s what we’re still fighting for.”
CNSNews.com then asked Conyers, “Do you see a single-payer health care system ultimately in the United States?”
“Of course,” he said. “Universal health care–well, every industrial country on the planet already has a universal system of health care.”
Rep. John Conyers (D-Mich.) (CNSNews.com/Penny Starr)
When asked if he thinks President Obama’s health-care law will lead to a single-payer health-care system in the U.S., Conyers said: “Well it’s a platform. I don’t think they flow smoothly but without that, if we didn’t have this then health care, universal health care would be an even more difficult legislative objective,” he said.
Health Insurance Costs Soar In Obamacare’s First Year
Insurers reap profits as average family’s premium exceeds cost of a new car.
By Will Oremus | Posted Tuesday, Sep. 27, 2011, at 3:43 PM EDT
Unemployment is high and wages stagnant, but that hasn’t stopped health insurance companies from hiking premiums by 9 percent this year, a new survey shows.
The poll by the nonprofit Kaiser Family Foundation found that the average family insurance plan purchased through an employer now costs over $15,000 per year. That’s more than double the average price 10 years ago, the New York Times calculates. And Kaiser Family Foundation president Drew Altman points out it’s more than the cost of a new Chevy Aveo or Ford Fiesta.
Premiums soared in the decade’s first half, but had grown more moderately in recent years.
The causes of this year’s spike are debatable, but Obamacare is sure to take some of the blame. The Times says some analysts believe insurance companies are getting their price hikes in now before a provision kicks in next year requiring them to justify any double-digit increase. And some of the rise in costs is likely coming from requirements already in effect, such as mammogram screenings and other preventive services.
The White House moved quickly to offer its own explanation: Insurers raised their prices in anticipation of higher costs, but ended up pocketing some of the money in profits. “Wall Street analysts’ review of results from the first quarter of 2011 found that 13 of the top 14 health insurers exceeded their earnings expectations, with profits that were over 45 percent higher than estimated,” the administration noted in a blog post.
If that’s true, next year’s price hikes could be more moderate. But meanwhile, employers are feeling the squeeze, with many citing the high cost of coverage as a deterrent to hiring. And increasingly, they’re passing the costs on to workers in the form of higher out-of-pocket costs, the Washington Post reports. Half of all workers at small firms now pay annual deductibles of $1,000 or more.
In a blog post earlier this month, the Post pointed out that health care cost increases wiped out nearly all of the average middle-class family’s wage growth from 1999 to 2009.
The news isn’t all bad, The New Republic’s Jonathan Cohn argues. The Affordable Care Act has improved coverage for many young adults, with some 2.3 million taking advantage of a provision that allows them to enroll in their parents’ plans up to age 26.