Scope of Services

Hey Hospitalists, Let’s Have a Conversation about “The Conversation”

by Howard Epstein, MD, FHM Last week, the Center for Medicare and Medicaid Services (CMS) - the nation’s largest payer of healthcare services and the 800 pound gorilla in setting medical necessity and coverage policies - announced a proposal to begin paying for goals of care and advance care planning (ACP) discussions between medical providers and patients. Sound familiar? It should. This is the same, seemingly no-brainer proposal that in 2009 was stricken from the eventually approved Patient Protection and Affordable Care Act (PPACA, AKA the ACA, AKA “Obamacare”) in response to the intentional and patently false accusations of government run “death panels” in the hopes of salvaging some measure of bipartisan support. As we all know, the bill eventually passed the following year without a single Republican voting in favor in either the House or Senate – and without funding for ACP sessions! This is not the first attempt…

Be Skeptical When Your Hospital Expresses an Urge to Merge

Old myths die hard, and for years as hospitals continue to join forces in the name of efficiency, the refrain cited most often by individuals who steward their systems has not changed:  “do the deal and everybody wins.” Intuitively, when a facility joins a network or bigger hospital, one would expect administrative and clinical redundancy to lessen.  As a result, a system will pass through found savings to payers and offer higher quality--as the organization sorts the clinical wheat from chaff. This belief has become so ingrained in our collective psyche, from the hospital CEO on down, to decry otherwise would be heretical. (more…)

Hospital Growth: Time Check

  Modern Healthcare has a nice piece out today examining the state of hospital growth and consolidation: Many hospitals across the country are reaching a crossroads. The median age of U.S. hospital buildings is rising, and new construction has dropped sharply, with capital going toward ambulatory-care facilities, physician hiring, information technology and telehealth. Mobile-health apps will become more prevalent over the next few years as hospitals, patients and insurers look for new ways to improve care and reduce costs. The piece emphasizes the travails both rural hospitals and AMCs will face as they sail into reform headwinds. Industry trends also seem to offer a cautionary tale to all hospitals, regardless of size, region, and demographic served: (more…)

Surgical Co-management, The Global Package, and Consciously Uncoupling

There is an upcoming Medicare rule that will go into effect in two phases beginning in 2017 that has a lot of surgeons and hospitalists concerned about the direction of peri-operative care and surgical co-management. [caption id="attachment_11629" align="alignright" width="200"] source:[/caption] Medicare’s proposal apes the words of Gwyneth Paltrow when describing her divorce from now ex-husband Chris Martin of Coldplay, “Consciously Uncoupling.” An awesome euphemism to describe the schism and separation of that annoying celebrity couple. It is also a great term to describe what CMS is moving forward with in relation to the Global Surgical Fee, or “the Global Package.” We hospitalists may know of this system of bundling, but don’t really live in that world today. We have heard plenty about how payment systems of the future will be moving toward bundling, but to see one un-bundling seems at odds with the general trend. In today's world, the…

2013: Did we pay more for inpatient care, or did we use more?

  The Health Care Cost Institute is not just another consulting firm or think tank.  They are a a non-partisan, non-profit clearinghouse for all things health care payment.  They obtain commercial and government data and generate reports on health spending direction. Their 2014 release analyzing 2013 commercial trends (think age 18-64 yo)  came out last week. The report has oodles of data and fun graphics covering many domains--but since we live on the inpatient side, you might also want to  take a look at the hospital end of things.  After all, hospital bottom lines live and die by employer sponsored insurance and the rates they pay (or hospitals accept). The verdict?  Inpatient use down, with care intensity and prices up (average price of a stay equals ~$18K). Have a look (page 7 of the report): (more…)