Wednesday, November 13, 2013

Health Management backs takeover by Community Health

Nov 13 (Reuters) - Health Management Associates Inc said on Wednesday its board backed its proposed takeover by Community Health Systems Inc after a review period spurred by activist investor Glenview Capital.
Health Management said that the board had agreed to the transaction at the price of $10.50 in cash plus 0.06942 share of Community Health common stock, or about $13.44, per Health Management share, plus a contingent value right of up to $1.00 per share.
Those were the terms of the deal when it was announced back in August by a previous board of directors, although a decline in Community Health's share price now puts the deal value at $3.6 billion plus the contingent value right compared with $3.9 billion it was when first announced.
Health Management shares have also traded off since the deal and closed on Tuesday at $12.52.
Glenview Capital, which owns 14.5 percent of Health Management's stock and is its largest shareholder, said that UBS Securities and Lazard Freres & Co had conducted a fairness opinion on the deal for the board.

Shareholders replaced Health Management's board in August with a slate of directors that Glenview had put forth, raising questions about whether the deal would go through or whether the terms would change.

Mobile Health Lets Doctors Practice Like It's 1950

Sixty-three years ago, my grandfather suffered a heart attack. His physician arrived at the house upon receiving a call from the family, quickly made the diagnosis, ensured his stability, and recommended that he relax and enjoy life outside the hustle and bustle of the city for a while.
"Not to worry," relatives recall the physician saying, "I am only a phone call away." The entire visit lasted no more than a handful of minutes and after a few phone calls to check-in over the coming months, he was feeling well enough to return to work.
The doctor charged three dollars and fifty cents.
Clearly our healthcare costs and treatments have changed vastly in the half-century since, but so has our medical culture. House-calls and afterhours communication have given way to physician answering services of questionable utility while barriers to physician consultation have made patients feel disconnected, compelling them to seek care in the emergency department. While some have pointed to the diminishing time spent with patients as the main source of erosion to the physician-patient relationship, family doctors as far back as 1950 saw an average of twenty-six patients per day which averages to about 15 minutes per patient--not too fundamentally different than doctors today.
The main difference, rather, is not face time in the examining room, but the connection (perceived and actual) that exists during the 99% percent of the time the patient and physician spend apart. In recent decades, that connection has too often been lost. My grandfather's doctor truly was a phone call away, a tremendously reassuring fact for himself and my family that no doubt aided in recovery. Unfortunately, despite the similar minutes per visit statistics, today's physician struggles to offer the same promises.
In healthcare, texting and emailing patients isn't allowed because of this liability or that rule, but many of us do so anyway because we know it often leads to better care. Not everyone is so bold and due to advancements within the field of mobile health, not everyone has to be. Nor do physicians have to revert back to working 18 hours per day, 7 days per week to rebuild that sacred connection.
Steve Jobs greatest gift to mankind may be that he brings the practice of medicine (and not its technology) back to the Norman Rockwell era.
My journey in medicine has taken me through institutions where anesthetized surgery was first performed and the life sustaining agent used to save countless premature infants,surfactant, was discovered. However, these and many other world renowned institutions are still pouring billions (yes, billions) of dollars into technology for patients and physicians whose original software code dates back to the 1970's. Not only does this system not allow for seamless communication between physicians, patients, and the entire healthcare team, it doesn't even work on a smartphone.
Yet, mobile health is different. Unlike electronic medical records, insurance exchanges or provider order entry systems, mHealth is fundamentally self-directed. No electronic health record titan or insurance conglomerate can force physician adoption. Rather, like house-calls, physician utilization of mHealth stems from the passion to provide the best possible care in a way that patients desire. The apps and mobile technologies which were once the defining features of success at Kaiser Permanente (at one time considered the Walmart of healthcare) and boutique healthcare groups like OneMedical (who received a $40 million investment from Google) are now widely available to any physician who wants to use them.
As such, the mHealth movement has democratized mobile-based secure healthcare communication allowing every electing doctor to work in teams, message, share photos, and exchange files on HIPAA-secure mobile platforms. So today, the local family doctor doesn't have to raise $40 million of venture capital. He or she can leverage a smartphone to practice medicine like my grandfather's physician, and still elect for a weekend with the family at the lake. They can diagnose, treat, educate, and empathize all through the power of a 4-inch screen and a wireless connection, and so while medicine may never return to $3.50 check-ups, it can once again be about the connection that exists between a patient and a doctor. Only this time, it may be 4G.
This post is part of a series produced by The Huffington Post, the mHealth Alliance and HIMSS Media in conjunction with the mHealth Summit, which will take place in the Washington, DC, area on December 8-11, 2013. The Summit brings together leaders across sectors to advance the use of wireless technology to improve health outcomes, both in the United States and globally. For more information about the mHealth Summit, click here.

The Financial Risks of Transitioning to ICD-10: Key Considerations for Hospitals and Health Systems

The following content is sponsored by VitalWare.
Concerning ICD-10 preparation, the time has come for hospital finance executives to put pen to paper, says Kerry Martin, CEO and founder of healthcare intelligence provider VitalWare. Waiting too long could result in getting caught in "rush hour" as providers leave crucial tasks until the last-minute scramble to catch up before the deadline next year.
"Being an early adopter in the ICD-10 world is the smartest thing they can do," Mr. Martin says of hospitals and health systems.
A key part of preparing for the transition is assessing the potential financial impact and taking steps to prevent a decline in physician and coder productivity, which could lead to revenue loss. The fiscal risk depends on various factors including physician documentation, coder education and DRG Grouper version updates, which will change in the months before ICD-10 goes live Oct. 1, according to Mr. Martin.
The process is definitely "more like a marathon than a sprint," he says. He shared some advice to help healthcare providers make it across the finish line by the implementation deadline.
Look beyond predictive analysis and top DRGsMany companies in the healthcare marketplace promote predictive analysis, which involves "cross-walking" ICD-9 claims to ICD-10, using general equivalence mappings or some other translation tool, to determine whether diagnosis-related group shift will occur or not. But Mr. Martin says this technique isn't the best way to determine financial risk comprehensively.
"To me, the only way they can assess their risk is by pulling charts, coding those charts and grouping those charts natively," he says. "Until a coder looks at a chart and codes it [in ICD-10], they have no idea what their financial risk is. It's not fun and it's not easy, but it's the only way for them to get their arms around that."
VitalWare has natively ten-coded 7,500 inpatient charts from hospitals around the country and can run a hospital's claims against this data to get a good understanding of what lies ahead for the provider's finances, he says. Based on those coded cases, they've discovered the real risk lies outside of the top 20 or 100 high-volume DRGs, according to Mr. Martin. Therefore, it's crucial for hospitals and health systems to look beyond those DRGs when preparing for the transition to ICD-10.
"That's exactly where CMS has said they're going to be financially neutral," he says of the top DRGs. "They've made sure the grouper is solid in those top DRGs."
Focus on physicians: The risk is in the charts Lost coder productivity has emerged as a point of concern for providers as the ICD-10 changeover date looms closer. Based on other countries that have already switched to their own uses of the coding system, some health information management leaders have projected a 20 to 40 percent decrease in coder productivity, which could lead to delayed cash flow and lost revenue.
Mr. Martin says providers must address the coder's productivity in unison with physician productivity.  Why should healthcare executives look to the physician to prevent a drop in productivity?  Because, he says, "it all starts with documentation."  That's what coders code from and, if the right details are not in the chart, then the physician will need to be "queried" for additional information.
"The best thing we can do is educate the physician," he says. "If we focus on physician productivity, the coder productivity loss will be nominal."  
It's only when coders are searching charts for information that doesn't exist that their productivity really suffers, he says.
For hospitals and health systems looking to keep physicians productive, it all comes down to training them to document the right things so coders don't have to use not-otherwise-specified codes or query back to the physician for clarification, he says.
"If [the physician is] interrupted the next day for more information from the previous day that he didn't document, the physician's productivity is going to go down," he says. "We should be focused on how we can keep the physician's productivity such as it is today and not decreased due to additional queries and interruptions by clinical documentation specialists."
He advises providers to pull charts, look at what's in their current documentation and note any deficits. For instance, physicians might not include documentation that may lead to major complications or comorbidity designation in the DRG groupers, resulting in the patient looking less sick on paper and the hospital getting reimbursed less than it should.
"The physician needs to be trained on their specific cases," he says. "You pull a case and you say, 'Hey Dr. Green, let me show you some of the information necessary for ICD-10 coding. If it is missing I will have to come interrupt you to get it.'  This is why training needs to be laser-focused."
Training physicians on their specific case documentation is only part of the equation, however. Mr. Martin says providers should also implement technology that will prompt clinicians on what to record on their charts, "a tool that specifically says to a physician, 'Here's what you need to document when you're dealing with heart failure,'" for instance.
Hospital executives should consider tools and applications that will accomplish this and can be embedded in electronic medical records or installed on devices such as iPads, he says.
Coder approach: Train and auditAlthough they aren't the main focus, long-term coder productivity issues are still a concern when it comes to financial risk, Mr. Martin says.
"The risk could be in the coder’s inability to forget the ICD-9 guidelines and use the ICD-10 guidelines.  It is hard to forget 10, 20, or 30 years of coding expertise overnight.  However this is exactly what we are asking the coders to do he says.
The number one action providers can take to address this issue is to pull charts, have their staff code them natively and have an outside company audit those charts. Ideally, the outside company should have certified ICD-10 trainers on staff who have coded at least 500 charts in the new coding system, he says.
"That exercise allows you to see how long it's going to take coders to actually code charts," he says. "You're definitely alleviating risk."
Pay attention to payers: Get the analytics from the coded cases to managed care teamsOnce providers have cases their coders have completed in accordance with ICD-10, they should prioritize getting that information to their managed care teams, according to Mr. Martin. He says assessing cases for all payers — not just Medicare — is important for negotiating contracts.
"If you don't give that managed care person any of this analytic data, then they're basically negotiating with a blindfold on," he says.
A managed care team with all of the proper ICD-10 financial analytic data about various DRGs and the provider's financial risk, will know what and how to deal with health insurers and possibly be able to work out neutrality clauses, he says.
The grouper factor: Wait and see and testThe current grouper logic that assigns MS-DRGs presents a certain level of risk for hospitals and health systems preparing for ICD-10. Right now, most organizations are using version 30 of the MS-DRG Grouper to group claims in ICD-10, but Mr. Martin says version 31 should be out within the next month or two, Version 32 will probably be in use when ICD-10 goes live.
"We're still dealing with a 'pilot grouper' that isn’t going to be the production grouper for ICD-10," he says.
Depending on adjustments to future versions and potential added calculations and weightings, providers who think they've adequately minimized their risk at this point could be in for an unpleasant surprise next year if they don't consider grouper changes. Subsequently, he says providers shouldn't do just one risk assessment but several, conducting new analyses as the new versions come out.
Providers who aren't dual-coding inside their patient accounting systems and are using another application such as Excel should strongly consider implementing a database system that can regroup quickly, he says.
"If you put it into Excel, it's not going to be easy to put it back through the grouper," he says.
In the end, though, there's only so much providers can do to avoid snafus. "The grouper is the grouper," Mr. Martin says. "We can't do anything about it except wait and see what the next version does."
ConclusionOverall, Mr. Martin says the biggest financial risk for providers is doing nothing.
At this point, providers should have started the process of pulling charts and should carry out a focused dual-coding effort, he says. By January or February, they should have a blueprint for physician training by individual physician or by specialty.
"There's a huge risk in just sitting back and waiting and not doing any of these exercises," he says.

Highmark eyes deal with Blue Cross company in northeast Pa.

Health giant Highmark Inc. is eyeing opportunities to grow outside of Western Pennsylvania as it prepares for the possibility of losing customers in the region when its contract with rival UPMC expires.
Highmark said on Tuesday that it is talking with Blue Cross of Northeastern Pennsylvania about creating a “stronger affiliation” between two of the state's four nonprofit Blue Cross companies.
Highmark, the state's largest health insurer with about 5 million members, purchased Blue Cross companies in Delaware and West Virginia in recent years, adding about 600,000 members.
If talks between Highmark and the much smaller Blue Cross of Northeastern Pennsylvania lead to a takeover, Highmark would gain about 545,000 members in 13 counties.
With about 60 percent of the health insurance market in Western Pennsylvania, Highmark is the dominant carrier. That could change if UPMC's insurance division and several national companies persuade employers to leave Highmark for health plans that will keep in-network access to UPMC's hospitals and doctors after 2014.
UPMC refused to negotiate a reimbursement contract with Highmark because the insurer bought West Penn Allegheny Health System and converted itself into UPMC's chief competitor for medical services and health insurance. Without a contract, Highmark members will pay more expensive out-of-network rates at UPMC starting Jan. 1, 2015.
Highmark “could be faced with losing market share” if the UPMC contract expires, said Tom Tomczyk, a principal in the practice of Buck Consultants, a Downtown benefits consulting firm. That means growth could come only from outside the region, he said.
“Highmark branched out into other states to expand their business,” he said. “Highmark's ongoing business plan is to continue to grow.”
Highmark tried to merge with another of the state's Blue Cross companies. But in 2009, Highmark and Independence Blue Cross in Philadelphia dropped their proposed merger, citing conditions that state regulators wanted to place on the deal to maintain a competitive insurance market.
The state Insurance Department declined to comment on the talks between Highmark and Blue Cross of Northeastern Pennsylvania. Spokeswoman Melissa Fox said neither company filed documents with the regulator regarding an acquisition or merger.
Mark Pauly, a professor of health care management at the University of Pennsylvania's Wharton School, said it is unlikely that state regulators would object to Highmark's absorbing the Wilkes-Barre-based Blue Cross company because the markets don't overlap.
It's more likely the smaller Blue Cross wants the protection of a larger company as implementation of the Affordable Care Act creates uncertainty for insurers, he said: “They believe there's safety in numbers and safety in size.”
Some insurers worry they'll lose business from individuals with chronic illnesses who previously could buy coverage only from Blue Cross companies. Under the law, dubbed Obamacare, those individuals can buy insurance through a government website where a number of insurers offer plans. Other customers, who may buy insurance for the first time because their illnesses made them costly to cover, might flock to these same insurers and increase the companies' risk.
Health insurers “are going to need money to deal with negative selection and losses,” said James McTiernan, a health care consultant with Triad Gallagher, a Downtown benefits consulting company.
Pennsylvania is unusual among states for having four nonprofit Blue Cross companies. Only five other states have more than one; there are 37 Blue Cross companies across the country. Several companies, most notably Anthem Blue Cross, are building multi-state companies through consolidation.
“There are not going to be a lot of niche players left,” McTiernan said.
Highmark and Blue Cross of Northeastern Pennsylvania have existing partnerships, officials said. Blue Cross of Northeastern Pennsylvania uses Highmark's information technology systems for claims processing, spokesman Aaron Billger said. The companies jointly own First Priority Health, an insurance subsidiary that sells group health plans to companies in northeastern Pennsylvania. They partner on Medicare Advantage plans sold to seniors there.
Highmark views that region “as very important to the community,” William Winkenwerder, Highmark CEO, said in a statement. His counterpart, CEO Denise S. Cesare, said the discussions are meant to “best serve the long-term needs of the residents” in 13 northeastern counties.
Blue Cross of Northeastern Pennsylvania's revenue averaged $750 million per year in 2011 and 2012, the company told the Tribune-Review this year. Highmark's annual revenue in 2012 was $15.2 billion.

Alex Nixon is a Trib Total Media staff writer. Read More:

Keogh review puts GPs at heart of urgent care reform

GPs should work with other NHS services to deliver fast, consistent advice and urgent care outside hospitals around the clock, an NHS England review has said.

Sir Bruce Keogh: urgent care reform plan
Sir Bruce Keogh: urgent care reform plan
The bureaucratic burden on GP practices must be cut to boost access to primary care and reduce pressure on A&E, the review by NHS England medical director Sir Bruce Keogh argues.
RCGP chairwoman Professor Clare Gerada welcomed the report for highlighting GPs' vital role in urgent care without blaming the profession for existing problems.
Transforming urgent and emergency care services in England calls for a dramatic rise in the proportion of urgent care delivered closer to home.
But it warns that ‘many people are struggling to navigate and access a confusing and inconsistent array of urgent care services provided outside of hospital, so they default to A&E’.
Sir Bruce says A&E is a ‘trusted brand’, with an average wait of just 50 minutes for treatment and most patients treated within four hours.
But in a letter to health secretary Jeremy Hunt and NHS England chairman Sir Malcolm Grant, he warns: ‘The opportunities for bringing about a shift from hospital to home are enormous.
‘We know that 40% of patients attending A&E are discharged requiring no treatment at all; there were over 1m avoidable hospital admissions last year; and up to 50% of 999 calls requiring an ambulance to be dispatched could be managed at the scene.’
Sir Bruce argues that ‘starting from scratch, nobody would design the current array of alternatives and their configuration’, warning that the complicated NHS system itself is driving up demand by ‘sending people around various services, confused about who to call and where to go’.
The review calls for a series of changes to improve urgent and emergency care including:
  • A ‘significantly enhanced’ NHS 111 with access to patient records, offering advice from a range of clinicians, appointment booking or call back by GPs and others, or a transfer to 999 services if necessary.
  • Faster and consistent same day, every day access to primary care and community services for people with urgent care needs.
  • Improved 999 services to handle more cases ‘at scene’, with support from GP advice.
  • Two levels of hospital-based emergency centre, with standard centres and a tier of ‘major emergency centres’ with consistent levels of senior clinical staffing and more specialist capability.
  • The ‘array’ of confusing terms for services should be reduced by co-locating community-based urgent care services in facilities uniformly referred to as ‘urgent care centres’.
Professor Gerada said: 'We are pleased that this report recognises the vital role of general practice and other community primary care services in providing care to patients with urgent needs. It is encouraging to see a report that sets out landmark changes in the way NHS emergency and urgent care will look in the future but that doesn't blame GPs.
'It explicitly recognises the sustained pressure and multiple demands on general practice in recent years, and the need to "create headroom" to transform the way we work so that we can continue to provide safe care for our patients. For the recommendations in this report to become a reality, that "headroom" has to include greater government funding and resources, including more GPs.'
GPC deputy chairman Dr Richard Vautrey said: ‘We would agree that the current system is too complicated and fragmented.'
Proposals to overhaul NHS 111 show the GPC is 'being listened to’, he added. ‘There is a need for more clinicians involved in dealing with calls so that patients are not only directed to the right service, but are given appropriate advice and if possible treatment through that one contact,’ he said. ‘The NHS 111 call service needs to be integrated with the see and treat elements of the urgent care service.’
Dr Vautrey said GPs already provide 24/7 services through daytime work and out-of-hours care. But he warned: ‘Both services are running hot in terms of coping with high demand and workload pressures.
‘We need a commitment from NHS England to reverse the fall in the proportion of funding spent on general practice so that both practices and out-of-hours organisations can start to take on additional staff to meet these growing demands. Expecting the current number of GPs to work harder and longer will simply lead to more GP burnout.’

Private company offers Alaskans health insurance option

ANCHORAGE - The troubled website has kept many people from signing up for health insurance. 
Now, a private company is working to get people covered outside the federal marketplace.

Enroll Alaska is taking steps to sign Alaskans up for health insurance.  Problems with forced them to suspend operations last month, but they're back and have ditched the federal website. 
Instead, Enroll Alaska is helping people who don't qualify for federal subsidies sign up for plans not offered in the marketplace. 
"And what's important is that if an individual comes [to] us and they don't think they qualify for a subsidy, and we'll help make that determination for them, and if they do qualify for a subsidy, we'll wait and enroll them when is functioning, when the marketplace is working," said Enroll Alaska COO Tyann Boling.
Enroll Alaska estimates that about 25,000 uninsured Alaskans won't qualify for help paying insurance. That means they can enroll in an insurance plan without losing out on government subsidies.