payers & providers midwest edition -- issue of january 17, 2012

8/3/2019 Payers & Providers Midwest Edition -- Issue of January 17, 2012

1/5

!"#$"%&!'()!*+'*!,!*+'*!-&!."&/%0!1!.%2345/%0!.$-64074#8)!99:

After 10 years of working on improvinghealthcare quality, U.S. hospitals still have away to go, says the Department of Health andHuman Services:

* About one in 20 patients has an infectionrelating to their hospital care.

* One in seven Medicare patients isharmed during their treatment.

* One in ve Medicarepatients is readmitted within30 days, at a cost of $26billion a year.

Like those throughout theMidwest, Wisconsin hospitalsare digging into the qualityrequirements of theAffordable Care Act to makesure they are improving as

fast as they must to hit thedeadlines and meet the goals.

This winter, under theleadership of the WisconsinHospital Association, asmany as 80 hospitals willband together to ghthospital-acquiredconditions (HAC) and reduce unnecessaryreadmissions.

The effort is part of the Partnership forPatients, an initiative of former CMSadministrator Donald M. Berwick, M.D., to

incentivize hospitals to get on the qualitybandwagon. The project is supported with$218 million in grants to organizations aroundthe country, including the American Hospital

Association and numerous state and localafliates, known as Hospital EngagementNetworks. These networks are tasked withdeveloping learning collaboratives for

hospitals that will develop trainingprograms and technicalassistance to bring all hospitalsup to the minimum standard.

The Department of Healthand Human Services estimatesthat if fully implemented, theprogram could save as much as$35 billion across the entirehealthcare system, including $10

billion in savings to Medicare,over three years.

Wisconsin already enjoyshigher-than-averagequality of care.According to healthrankings monitored bythe Agency for

Healthcare Research and Quality, the BadgerState placed seventh among the fty.

The Partnership for Patients aims to reduceinpatient harm by 40% and readmissions by

.%";?62&>/#


2/5

!"#$"%&!'()!*+'*!,!*+'*!-&!."&/%0!1!.%2345/%0!.$-64074#8)!99:

Payers & Providers Page 2

Top Placement...Bottomless Potential

Advertise Here

(877) 248-2360, ext. 2

In Brief

Self-Insurance GroupSues to Overturn NewMichigan Claims Tax

A new Michigan law that assesses a1% tax on healthcare claims paid has

come under attack from the Self-Insurance Institute of America Inc.,which led a lawsuit seeking tooverturn it.

The tax was passed last year tohelp fund Michigans Medicaidprogram (Payers & Providers, July 19,2011). It effectively transfers theburden of raising the states Medicaidmatch from Medicaid HMOs to thebroader insured population.

The bill was strongly opposed bythe Michigan ManufacturersAssociation, which argued that itwould fall disproportionately onmanufacturers and self-insuredcompanies. It went into effect Jan. 1,

and assessments must be paid everyquarter starting in April.The tax is paid by third-party claims

administrators, insurers of fully-insuredplans, and stop-loss insurers for self-funded plans. It is intended to generate$400 million in revenues each year.Formerly, Medicaid HMO plans paid a6% use tax. The federal governmentsignaled that it would no longerapprove such a funding source.

The Self-Insurance Institute said thetax violates ERISA, the federal lawgoverning how pension and benetplans must be administered nation-wide. The institute represents comp-anies that sponsor and administer self-

funded ERISA plans.

Hospital Fountain WasSource of Legionellathat Sickened Eight

A decorative fountain in the lobby of aMilwaukee-area hospital turned out tobe the source of Legionella bacteriathat sickened eight patients in 2010.

Continued on Page 3

NEWS

Wisconsin Quality (Continued from Page One)

20% by the end of 2013. Achieving thisimprovement would save more than 60,000lives and cause 1.8 million fewer patientinjuries. It will concentrate on 10 keyimprovement goals.

We will have change packages for those10 conditions, said Kelly Court, chief qualityofcer for the WHA, who is spearheading theproject. Well scour the literature, talk to

experts, to nd key things to leverageimprovement.

The methods will involve webinars, one-on-one coaching, and a few in-personmeetings, she added. Hospitals will collecttwo measures for each condition: one processmeasure and one outcome measure. All thisdata will be rolled up to help meet thenational goal, she said.

At ThedaCare in northeast Wisconsin, Weare tracking results all the time, said ScottDecker, vice president of quality. This is whatwe learned from manufacturing.

ThedaCare got the quality improvement

religion a long time ago. It now has 30 full-time personnel to support improvement for itsve hospitals, 22 clinic sites, and 6,200employees. It uses the Toyota techniques fromlean manufacturing to drive out waste andimprove processes. It has already reducedreadmissions by 3% or 4% using leantechniques.

The changes in Medicare reimbursementthat penalize hospitals for unnecessaryreadmissions or medical errors are drivinghospital transformation, Decker said. And now

the Humanas and CIGNAs and Aetnas aregetting into the act.

In the old days, he explained, If you feand broke your hip, and you needed a CTscan to see if you had a head bleed, what we do? We billed the insurance companieNow what they say is, You did it, youreresponsible for it. I cant argue with that. Tbar just keeps raising.

Take, for example, central line associatebloodstream infections, or CLABSI. In early2009 Wisconsin hospitals undertook acollaborative to eliminate these persistent preventable infections, using theComprehensive Unit-Based Safety ProgramCUSP. From September 2008 to Septembe2009, the CLABSI rate dropped from over 2per 1,000 central line days, to less than 1,where it has remained since.

Similar efforts in Michigan succeeded ireducing the median rate of catheter-relateblood stream infections to zero. A nationaeffort, dubbed Stop BSI, also reduced these

infections, but at a slower rate.Given that the Institute of Medicine

Report, To Err is Human, came out in 1998and that the quality movement was alreadygear before that, why has it taken hospitalslong to address these issues? Why haventreadmissions already been reduced?

Many hospitals have already taken upchallenge, Court said. But it is much easiehospitals and systems with plentiful resourctrain staff and hire quality personnel than it for small or rural institutions to do so.


3/5

!"#$"%&!'()!*+'*!,!*+'*!-&!."&/%0!1!.%2345/%0!.$-64074#8)!99:

Page 3Payers & Providers

Longer ALOS!*

Advertise Here

(877) 248-2360, ext. 2

*For our ads, not your hospital

NEWS

In Brief

A study in Infection Control andHospital Epidemiologyoutlined thedetective work by public healthauthorities who sought to uncover thecause of the local outbreak ofLegionnaires disease. The bacteriumcauses fever, chills, headaches,coughing, and severe respiratory

distress. It can be fatal.The eight sickened persons werenot inpatients but visitors to thehospital, or delivery persons whopassed through the lobby, or had anoutpatient visit, or were picking updrugs at the hospital pharmacy.

Each of them had an underlyinghealth condition, such as diabetes,rheumatoid arthritis, or alcoholism,which left their immune systemsvulnerable to the pneumonia-likeillness.

The fountain in the hospital lobby,once identied as a possible source ofthe bacterium, was tested and foundto contain high concentrations of the

Legionella bacterium, which thrives inwarm water.None of the patients died from

their illness.

Trustmark is Accusedof Violating ACA

The Obama administration hasaccused Trustmark Life Insurance Co.,based in Lake Forest, Ill., of raisinghealth insurance rates above andbeyond whats necessary. It told theinsurer to rescind the rate hikes orexplain why it believes they are

justied.

A Trustmark spokeswoman saidthe company disagrees with thefederal ndings, and blamed theincreases on rising medical costs.Under the health reform law, thesecretary of Health and HumanServices may conduct an annualreview of unreasonable increases inpremiums. The department has setincreases of more than 10% as subjectto review. The department saidTrustmark was aiming for increases of13% in ve states: Alabama, Arizona,Pennsylvania, Virginia and Wyoming.Trustmark said it is in compliance withthe law.

The rise in national spending on healthcareslowed in 2010 to 3.9%, after growing by 3.8%in 2009, the lowest rate of increase in the 51-year history of the National Health ExpenditureAccounts, economists at the Centers forMedicare and Medicaid Services Ofce of theActuary found.

The economic recession was the largestcontributing factor to the slower growth, butnew health plans that put more nancialresponsibility on patients may also have playeda role.

Because GDP grew at 4.2% in 2010 (3.0%real growth), health spending grew at a lowerrate than the overall economy. Thus, healthcarespending as a share of GDP remained constantfrom 2009 to 2010 at 17.9%.

The slow growth in health spending in2009 and 2010 was inuenced by slowergrowth in the use of healthcare goods andservices as consumers remained cautious abouttheir spending in part because of losses inprivate health insurance coverage, lowermedian household income, and future nancialuncertainty, the actuaries wrote in an article inHealth Affairs.

Per capita spending on healthcare reached$8,402, compared with $4,878 in 2000, $2,854

in 1990, and $1,110 in 1980.The increase in spending attributable to theprovisions of the Affordable Care Act was 0.2%,the actuaries gured out, but they believe it mayhave been closer to 0.1%.

Most of the 2010 provisions, other than afew specic provisions affecting Medicarepayments, had a negliglbe impact on totalspending or shifted the distribution of spendingwithout affecting the overall rate of growth, theactuaries wrote.

Spending on hospitals hit $814.0 billion in2010, up almost 5% from $776.1 billion in2009.

Physician and clinical services took in$515.5 billion, increasing just 2.5% from$502.7 billion the year before. Price growtwas stable, at 2.3%, but growth in use andintensity declined. Many people put off goto the doctor, and the u season was milde2010 than in 2009.

Spending on prescription drugs stayedalmost level, up to $259.1 billion from $25billion in 2009. Analysts said the market enof numerous generics in place of patenteddrugs helped push down the rate of spendigrowth. Among the blockbuster drugs that patent protection in 2010: Flomax, Effexor Lovenox, and Aricept.

Also, fewer new prescription drugs camonline. The number of prescriptions dispenincreased just 1.2%, in part because of thedecline in visits to physician ofces.

The net cost of health insurance wascalculated at $146.0 billion, increasing 8.4from 134.7 billion in 2009. That gure haddeclined, though, by 2.2% in 2009 and 1.4in 2008. The actuaries dene net cost ofhealth insurance as the difference betweenpremiums earned and benets paid for privhealth insurance, including administrativecosts, plan prots, and premium taxes.

Enrollment in private health insuranceplans fell for the third year in a row, by 1.9in 2010.

The rate of spending increase byhouseholds, businesses, and state and locagovernments all rose at rates less than that overal health expenditures. The federalgovernment, whose spending rose 8.6%,picked up the slack.

The causes for the slowdown in healthspending may have their roots in basicchanges in the healthcare economy, said AGupte, an analyst at Sanford Bernstein.

Healthcare Cost Growth Levels OffCMS Calculates Favorable 3.9% Increase for 2010

HEALTHCARES BEST ADVERTISING VALU]

PAYERS & PROVIDERS reaches 5,000 hospital, health plan and noprot executives statewide. There is no better venue for marketin

your organization or conference, or recruiting new staff.

CALL (877) 248-2360, ext. 2OR CLICK HERE
http://payersandproviders.com/advertise.phphttp://payersandproviders.com/advertise.php


4/5

!"#$"%&!'()!*+'*!,!*+'*!-&!."&/%0!1!.%2345/%0!.$-64074#8)!99:

Payers & Providers Page

The Republican House Budget Chairman PaulRyans plan for reforming Medicare has beenthe subject of much rancor and argument, andno wonder: The proposal would change theprogram so fundamentally as to no longer berightfully called Medicare.

Ryans plan would be a continuation ofwhat one academic called The Great Risk Shift:Big corporations havemethodically shifted much ofthe risk of providing benetsfrom the employer toemployees. Ryans plan wouldaccelerate the trend and take it

further by gradually shiftingmuch of the nancial obligationof paying for benets from thegovernment to Medicarebeneciaries. Under Ryansblueprint, the governmentwould be doing just what bigcorporations have been doingfor several years now: off-loading risk.

This is similar to thephasing out of traditionalpension plans and thesubstitution of 401(k) plans.

In the early part of my fathers career,401(k)s had not yet been invented. Soon afterhe was hired as a shift worker at a Tennesseeglass factory, he was enrolled in his employerspension plan. When he retired more than 25years later, he began receiving a predeterminedpension benet every month.

By contrast, when I went to work forCIGNA in 1993, pensions were an endangeredspecies. CIGNA still offered one, but thecompany changed the structure soon after Iwas hired, which meant that I would get lesseach month upon retirement than colleagueswho had joined the company a few years

earlier.Aetna also had a nancial services division

back then. So two of the biggest healthinsurance rms in the country, Aetna andCIGNA, played key roles in the early years ofthe great risk shift by ushering in the era of401(k)s and bringing the pension era to an end.Employers began phasing out pensions in the1990s as rapidly as they began jettisoningindemnity health insurance plans in favor ofHMOs and other managed care plans.

Transitioning from pensions to 401(k)s

meant that employers would have much moremoney available to reward shareholders becathey would be paying less in revenues over timto retired employees. The winners consequenthave been the wealthy individuals and instituwho own todays corporations, while the losehave been the ones who work for them.

Instead of being dened benets plans lipensions, 401(k)s are referredas dened contribution plaThat means that workers enrin such plans no longer get acertain amount of money evmonth when they retire as m

father did, but instead will gewhatever is in their 401(k)balances, most of which theycontributed themselves.

Highly compensatedemployees, including CEOs, pleased with the shift becausthey have the means to sockaway more money in their401(k)s than the rank and le

And the money they sock ais tax-deferred, so 401(k)s hbecome a favorite tax sheltfor the well-to-do.

Ryans Medicare scheme would replicate w401(k)s have done to the rank and le. Thevouchers the government would providebeneciaries are the equivalent of a denedcontribution. And the vouchers invariably wobecome less valuable over time as the cost ofinsurance increased. The wealthy among uswouldnt be nearly as disadvantaged as low- amiddle-income earners who would have to dideeper into their own pockets to buy health ccoverage from private insurers. And undoubtethey would nd that the only plans they couldafford would be those with high deductibles.If backers of Ryans plan would drop the word

Medicare and name it something with a bunof numbers and a letter or two in parenthesis,would be far more honest than calling itMedicare. At least the proponents of the greatshift didnt have the audacity to call 401(k)spensions. Theyre entirely different creations.

OPINION

Great Risk Shift Comes to MedicareRyan Plan Would No Longer Be Worthy of the Nam

Wendell Potter, a former public relations

executive with CIGNA, is author of Deadly

Spin and a blogger at WendellPotter.com.

;26$C42#!40!DEE!"!&/"%!

FD'GE!4#!-$6H!$>!C2!'+!0$-0B%4-/%0I@!=C!40!5/643/%/5!-&!/J"&/%0"#5>%2345/%0@B2"&/%0"#5>%2345/%0@B2%2345/%0

]54C2%4"6!Z2"%5X4664"

`200!A@!Y62CC/#)!U@K@^6/4#!Y62CC/#!1!L%/#B7

:74B"82

U4B7"/6!9@!U466/#02#.%/045/#C

W/"6C7!a$"64C&!A53402%0!99:W4876"#5!."%H)!=66@

.$-6407/%

`2#!Y74#H%2345/%0@B26/"0/!B"66!FP((I*GPJ*QR+@

By Wendell Potter


5/5

MARKETPLACE/EMPLOYMENTPayers & Providers Page 5

It costs up to $27,000 to fill a healthcare job*

will do it for a lot less.

Employment listings begin at just $1.65 a word

Call (877) 248-2360, ext. 2Or e-mail: [email protected]

Or visit: www.payersandproviders.com

*New England Journal of Medicine, 2004.

SEEKING A NEW POSITION?

CAN HELP.

We publish advertisements for those seekingnew career

opportunities for just $1.25 a word.

If you prefer discretion, well handle allresponses to your ad.

Call (877) 248-2360, ext. 2, or [email protected].

payers & providers midwest edition -- issue of january 17, 2012

Documents