Better patient-centered medical homes cost more:
Running a better patient-centered medical home (PCMH) may have higher operating costs, according to a study in the Journal of the American Medical Association. Researchers from the University of Chicago found that having an overall score that was 10 points higher than the average performance score was associated with a $2.26 higher operating cost per patient per month, which translates to an annual cost of $508,207.
PCMHs scoring 10 points above the mean for patient tracking and for quality improvement both were associated with higher operating cost per physician full-time equivalent (FTE) and per patient per month.
However, better access/communication was associated with a lower operating cost per physician FTE. For instance, the cost of providing telephone-based clinical advice could be offset if it replaces a more costly in-person visit, the researchers wrote.
Researchers said the larger price-tag is fairly small compared with the potential cost savings from avoided hospitalization and emergency department visits, reported MedPage Today. Previous studies have estimated savings of up to $18 per member, per month from patient-centered medical homes, according to the study.
In fact, patient-centered medical homes already are recouping savings and improving care. CareFirst Blue Cross Blue Shield PCMH has saved $40 million in the program's first year, while the first-year results for Horizon Blue Cross Blue Shield of New Jersey's PCMH are a 10 percent decline in the cost of care per member, a 26 percent decline in emergency room visits and a 25 percent decrease in hospital readmissions.
With the trend toward patient-centered medical homes, healthcare organizations can heed the lessons learned shared at the American College of Healthcare Executives' annual congress in March. Laura Etchen, partner at healthcare consulting company The Chartis Group in Chicago, recommended considering National Committee for Quality Assurance accreditation to attract physicians, and John Butterly, executive vice president for medical affairs at Dartmouth-Hitchcock in Lebanon, N.H., advised healthcare leaders to engage physicians and nurses by being honest about implementing the new care model, FierceHealthcare previously reported.
To learn more:
- read the study
- here's the MedPage article
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Monday, June 25, 2012
Thursday, June 21, 2012
National Trends in Emergency Department Occupancy, 2001 to 2008: Effect of Inpatient Admissions Versus Emergency Department Practice Intensity
Unsustainable ED crowding grows twice as fast as visits:
Emergency department crowding is growing twice as fast as visits and will rise to unsustainable proportions, according to Jesse Pines, director of the Center for Healthcare Quality at George Washington University and associate professor of emergency medicine and health policy in Washington, D.C.
ED visits increased 60 percent faster than population growth over an eight-year period. Crowding, or occupancy, as it's called, grew even faster, according to an Annals of Emergency Medicine study published online Tuesday. While ED visits increased by 1.9 percent annually from 2001 to 2008, crowding grew by 3.1 percent.
"Visit volume is going up, which is outpacing population group, and patients are staying longer and longer within the ED getting more intense work-ups and treatments," Pines said in a statement to FierceHealthcare. "Together, the 'occupancy,' which is the number of patients in our nation's emergency care system at one time, is rising at a very rapid, unsustainable rate."
Although advanced imaging often receives much of the blame for delays in the ED, researchers found that it had more to do with practice intensity, that is, blood work and x-rays at triage, that's really bogging down the ED.
Patients are getting more tests, fluids and procedures for a number of reasons, Pines explained. Some providers are practicing defensive medicine, but patients and providers also expect high-technology care, such as requiring CT scans or other advanced test before admitting the patient to the hospital.
"As technology outside the ED improves, such as organ transplantation and cancer care, when patients have complications--and they do--they end up coming in and are sicker and need more ED resources to take care of them," Pines said about the older, sicker population.
Even more, EDs have become rapid diagnostic centers. For example, patients who need X-rays will go to the ED because it's the fastest place to do it, especially when their physicians refer them there, Pines said.
"Lengthy work-ups in the emergency department are not always a bad thing if they prevent a costly hospitalization. The problem is that more and more demands are being placed on emergency departments and the mood in the health policy community is to shrink emergency departments, not grow them," Pines said in a research announcement.
Providers can help patients early in the care process, trimming off wasted time in the waiting room. For instance, hospitals can place a physician at triage or eliminate triage altogether when there are empty rooms.
In addition, facilities can use space better to meet patient demands. When the ED is full, patients can wait in the ED, as opposed to outside of it in the waiting room, for tests to be completed.
And lastly, much of the way that ED crowding should be avoided is pinching it off at the source and preventing ED visits altogether with public health measures so patients don't get sick or allowing patients to get "sick visits" at their doctor's office, Pines noted.
For more information:
- here's the research announcement
- see the study (.pdf)
Related Articles:
ER throughput measures unfair to big hospitals
Psych patients overwhelm hospital ERs
Do patients really need to go to the ER?
Half of EDs overcrowded, leaders report
Hospitals brace for ED overload, enhance primary care
Emergency department crowding is growing twice as fast as visits and will rise to unsustainable proportions, according to Jesse Pines, director of the Center for Healthcare Quality at George Washington University and associate professor of emergency medicine and health policy in Washington, D.C.
ED visits increased 60 percent faster than population growth over an eight-year period. Crowding, or occupancy, as it's called, grew even faster, according to an Annals of Emergency Medicine study published online Tuesday. While ED visits increased by 1.9 percent annually from 2001 to 2008, crowding grew by 3.1 percent.
"Visit volume is going up, which is outpacing population group, and patients are staying longer and longer within the ED getting more intense work-ups and treatments," Pines said in a statement to FierceHealthcare. "Together, the 'occupancy,' which is the number of patients in our nation's emergency care system at one time, is rising at a very rapid, unsustainable rate."
Although advanced imaging often receives much of the blame for delays in the ED, researchers found that it had more to do with practice intensity, that is, blood work and x-rays at triage, that's really bogging down the ED.
Patients are getting more tests, fluids and procedures for a number of reasons, Pines explained. Some providers are practicing defensive medicine, but patients and providers also expect high-technology care, such as requiring CT scans or other advanced test before admitting the patient to the hospital.
"As technology outside the ED improves, such as organ transplantation and cancer care, when patients have complications--and they do--they end up coming in and are sicker and need more ED resources to take care of them," Pines said about the older, sicker population.
Even more, EDs have become rapid diagnostic centers. For example, patients who need X-rays will go to the ED because it's the fastest place to do it, especially when their physicians refer them there, Pines said.
______________________________ "The 'occupancy,' which is the number of patients in our nation's emergency care system at one time, is rising at a very rapid, unsustainable rate." --Jesse Pines, director of the Center for Healthcare Quality at George Washington University ______________________________ |
Providers can help patients early in the care process, trimming off wasted time in the waiting room. For instance, hospitals can place a physician at triage or eliminate triage altogether when there are empty rooms.
In addition, facilities can use space better to meet patient demands. When the ED is full, patients can wait in the ED, as opposed to outside of it in the waiting room, for tests to be completed.
And lastly, much of the way that ED crowding should be avoided is pinching it off at the source and preventing ED visits altogether with public health measures so patients don't get sick or allowing patients to get "sick visits" at their doctor's office, Pines noted.
For more information:
- here's the research announcement
- see the study (.pdf)
Related Articles:
ER throughput measures unfair to big hospitals
Psych patients overwhelm hospital ERs
Do patients really need to go to the ER?
Half of EDs overcrowded, leaders report
Hospitals brace for ED overload, enhance primary care
Tuesday, June 12, 2012
ACO development grows 38% nationally
ACO development grows 38% nationally:
The accountable care organization (ACO) trend still is rising with more than 200 identified ACOs in the nation, according to intelligence business firm Leavitt Partners. Located in 45 states and the District of Columbia, ACOs total 221 partnerships, up from 160 ACOs in 40 states in November 2011, showing a 38 percent increase in only six months, according to a report released Thursday.
Most of the ACOs are coming from the private sector rather than from the government, outnumbering them four to one. Although the Medicare ACO model is an outgrowth of the accountable care movement, it's not a driving force behind it, Leavitt Partners noted.
Of the 221 ACOs, 148 are single provider ACOs (67 percent), 43 are multiple-provider ACOs (19 percent), 17 are insurer ACOs (8 percent) and 13 are insurer-provider ACOs (6 percent).
"The consistent growth in the number and variety of organizations adopting accountable care demonstrates the momentum of the ACO movement," Andrew Croshaw, a partner and managing director of the healthcare practice at Leavitt Partners and one of the study authors, said in a company statement. "Many providers appear to believe the accountable care model is an important component of the future of American healthcare."
Hospitals are taking the lead as the sponsoring organizations, growing from 99 to 118 ACOs as the primary backers. However, in the past eight months, the number of ACOs sponsored by physician groups has nearly doubled from 38 to 70 ACOs. Insurer-sponsored ACOs remain steady.
Although the number of ACOs continues to grow, it's difficult to determine their success.
"As ACOs become firmly established, it is increasingly important to measure the results of different models," the report noted.
For more information:
- see the company announcement
- check out the white paper (.pdf)
Related Articles:
'Commonplace' ACO accreditation could raise costs
ACO competition heats up, varies by region
How fast will ACOs spread?
What are ACO start-up costs?
The accountable care organization (ACO) trend still is rising with more than 200 identified ACOs in the nation, according to intelligence business firm Leavitt Partners. Located in 45 states and the District of Columbia, ACOs total 221 partnerships, up from 160 ACOs in 40 states in November 2011, showing a 38 percent increase in only six months, according to a report released Thursday.
Most of the ACOs are coming from the private sector rather than from the government, outnumbering them four to one. Although the Medicare ACO model is an outgrowth of the accountable care movement, it's not a driving force behind it, Leavitt Partners noted.
Of the 221 ACOs, 148 are single provider ACOs (67 percent), 43 are multiple-provider ACOs (19 percent), 17 are insurer ACOs (8 percent) and 13 are insurer-provider ACOs (6 percent).
"The consistent growth in the number and variety of organizations adopting accountable care demonstrates the momentum of the ACO movement," Andrew Croshaw, a partner and managing director of the healthcare practice at Leavitt Partners and one of the study authors, said in a company statement. "Many providers appear to believe the accountable care model is an important component of the future of American healthcare."
Hospitals are taking the lead as the sponsoring organizations, growing from 99 to 118 ACOs as the primary backers. However, in the past eight months, the number of ACOs sponsored by physician groups has nearly doubled from 38 to 70 ACOs. Insurer-sponsored ACOs remain steady.
Although the number of ACOs continues to grow, it's difficult to determine their success.
"As ACOs become firmly established, it is increasingly important to measure the results of different models," the report noted.
For more information:
- see the company announcement
- check out the white paper (.pdf)
Related Articles:
'Commonplace' ACO accreditation could raise costs
ACO competition heats up, varies by region
How fast will ACOs spread?
What are ACO start-up costs?
Thursday, June 7, 2012
New York RHIOs and HIEs team up to create 'model for the rest of the nation'
New York RHIOs and HIEs team up to create 'model for the rest of the nation':
The New York eHealth Collaborative (NYeC) and the New York State Department of Health announced Wednesday that three regional health information organizations (RHIOs) and three health information exchange (HIE) vendors will participate in the Statewide Health Information Network of New York (SHIN-NY), which officials say will function much like a public utility.
read more
The New York eHealth Collaborative (NYeC) and the New York State Department of Health announced Wednesday that three regional health information organizations (RHIOs) and three health information exchange (HIE) vendors will participate in the Statewide Health Information Network of New York (SHIN-NY), which officials say will function much like a public utility.
read more
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