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The Department of Veterans Affairs now has fewer than 100,000 backlogged disability claims--that is, claims older than four months; compare that to a backlog of 611,000 claims in 2013. The gains were achieved in part through use of mandatory overtime for certain employees and migrating from paper to digital health records. Overall, VA has about 362,000 open disability cases to process. Rep. Jeff Miller (R-Fla.), chair of the House Veterans Affairs Committee, expressed skepticism over the numbers, contending that officially reported numbers from the VA "rarely tell the whole story." (iHealthBeat; Associated Press) 
   
 
Through its CareConnect health plan, North Shore LIJ Health System has new means and motivation to rein in expenses and enhance quality, says Alan Murray, CareConnect president and CEO, noting "When you take away sales, marketing, and all the administrative functions, insurance is population health." He acknowledges tension between the payer and provider sides, but says overall, it's been surprisingly easy. "Having conversations with clinicians and people at the forefront of care is always difficult when you are coming in with data and ideas, but it's monumentally different when you are integrated into the system." (HealthLeaders Media)
 

Provider-owned health plans are intended to hasten the transition from fee-for-service to value-based care, but according to a new HealthPocket study, they don't reduce premiums. Among the findings: Bronze and gold provider-owned plans were 13 percent more expensive than the cheapest bronze and gold plans not owned by providers. The cheapest provider-owned silver plans in the 12 counties that HealthPocket examined were 12 percent more expensive overall than the cheapest silver plans not owned by providers. (FierceHealth Payer; survey results) 
 
Innovation & Transformation 
High-tech startups open the door to old-school house calls
Startups are using video technology and old-fashioned house calls to improve access, The Wall Street Journal reports. Some physicians, however, fear these services will interfere with the doctor-patient relationship and further fragment health care delivery. Pager, in New York City, dispatches doctors or nurse practitioners via Uber, for $200. Heal, in Los Angeles, San Francisco and Orange County, promises to "get a doctor to your sofa in under an hour" for $99. RetraceHealth, in Minneapolis, has a nurse practitioner consult via video (for $50) who only comes to homes if hands-on care is necessary (for $150). (Wall Street Journal) 
Gray 

The OrthoCare Program, launched by Bon Secours St. Mary's Hospital and VOX Telehealth, is showing early promise, the organizations say. The web-based program starts 30 days pre-op and extends 60-90 days post-op; it provides educational content, reminders and symptomatic observations tied to a notification system. Ninety-two percent of patients were discharged directly to home, vs. a national average of roughly 30 percent. Length of stay was reduced to 1.6 days (vs. 2.0 for the control group and 3.7 nationally). And 91 percent of patients reported they were very satisfied with their overall care. Ninety-three percent said the program improved their episode-of-care experience. (Healthcare Informatics) 
  
 
Many states and the federal government are looking at granting provider status for pharmacists, Managed Healthcare Executive reports. The American Society of Health-System Pharmacists hopes to make providers eligible for Medicare Part B reimbursement; bipartisan legislation introduced this year aims to do just that. "It is about coverage of services and access to them by Medicare beneficiaries, not about a designation as provider," says Stacie Maass of the American Pharmacists Association. States, however, are more concerned with provider designation--expanding the scope of practice of pharmacists, enabling them to offer services beyond dispensing medication and granting compensation by insurers. (Managed Healthcare Executive) 
 
Consumers & Providers
While medical schools are struggling to persuade future physicians to specialize in general medicine, the number of primary care nurse practitioners is expected to increase 30 percent over this decade, The Seattle Times reports. "All too often the media covers the expected primary-care shortage 'as a physician shortage,' says Louise Kaplan, PhD, ARNP, FNP-BC, FAANP, an associate professor at Saint Martin's University in Lacey, Wash., and a family nurse practitioner. "If it were not for that number of [nurse practitioners] practicing, we would already have a shortage of primary-care providers." (The Seattle Times)

PCPs say quality metrics actually have negative impact on care quality
More than half of primary care physicians surveyed say the growing use of quality metrics to assess provider performance is having a negative impact on quality of care, according to a Commonwealth Fund and Kaiser Family Foundation survey. Amy Mullins, MD, medical director of quality improvement at the American Academy of Family Physicians, isn't surprised. "It often seems [payers] are measuring to measure," not to improve quality, she says, and that clinicians receive little feedback as to how they can improve their quality of care. She adds there's a perception that there is more push to measure the quality than to actually improve it. (HealthLeaders Media) 
 

In an anonymous essay published in the Annals of Internal Medicine last week, a physician shares two graphic, horrifying stories of what happened to women in operating rooms. The journal almost didn't publish the essay, Editor-in-Chief Dr. Christine Laine and her team wrote in an accompanying letter. "It is our hope that the essay will gnaw on the consciences of readers who may recall any instance of their own repugnant behavior. The story is an opportunity to see what this behavior looks like to others and starkly shows that it is anything but funny." (Washington Post; Annals of Internal Medicine) 
   
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New & Noted   
Agencies struggle with data integration: Data integration issues pose challenges to health and human services agencies when confirming health benefit eligibility, according to a survey by MeriTalk; 85 percent of respondents say their agencies faced challenges related to determining and verifying eligibility of beneficiaries. (iHealthBeat; study announcement)
 
Reimagining nursing: With a shortage of primary care physicians and increasing numbers of patients needing care, safety-net clinics are realizing the full potential of the nursing workforce and improving the way they deliver care. That's the upshot of RN Role Reimagined: How Empowering Registered Nurses Can Improve Primary Care, a report from the California Healthcare Foundation authored by Dr. Thomas Bodenheimer and colleagues. (CHCF; report)
 
    
Access better in states with expanded Medicaid: Access to health care has improved significantly under the ACA, but those gains are more pronounced in states that have implemented the law's expansion of Medicaid, according to data published in JAMA. (JAMA)
  
Multi-media 
Retail health and the move toward more ambulatory care are trends that are here to stay, Cardinal Health Chairman and CEO George S. Barrett tells Fortune in this video interview. (Fortune)
  
MarketVoices...quotes worth reading
     
"I don't practice medicine, I practice nursing... and there's a difference in how we practice. Nurses believe the captain of the ship is the patient." -- Robert (Bob) T. Smithing, MSN, ARNP, FAANP, quoted in  The Seattle Times


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Wednesday, August 26, 2015













 










































 


    





 
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