It’s been almost three years since WSHA, Washington State Health Care Authority, Washington State Medical Association and Washington Chapter of the American College of Emergency Physicians took on the challenge of reducing unnecessary trips to the emergency room. We learned a great deal from our colleagues in emergency medicine.
The problem has complex origins, but the results are clear: too many patients were going to the ER to get services that would be better, and more affordably, provided elsewhere. The dependence on the ER was hurting patients and hurting the state’s Medicaid program.
This collaboration has continued from the 2012 legislative session to today. We have seen real gains in this work, saving the state $33.6 million in Medicaid fee-for-service emergency care costs (see here for more impressive data). The best practices that were developed and instituted by the coalition have improved patient care and helped control health care costs in our state.
Medicaid expansion is giving us an opportunity to do this work in a different way. It is not easy or on auto pilot. As hospitals have worked to enroll patients and community members in health insurance, we have also been working to educate the newly enrolled about their primary care and urgent care options so that they can make the choice that is right for them.
As more people move to high-deductible plans, they will be making more of their health care choices. Providers will have to continue to support patients in making decisions about where to best seek care, and this work will continue.
WSHA President and CEO
Rural Nursing Homes Few and Far Between
Public nursing homes in Washington State are falling on hard times. As reported by Northwest Public Radio, there are only six remaining, and the financial hardships of Medicaid reimbursement have proven too much for one. Unable to turn away residents, North Valley Nursing Home, like many others beforehand, is facing rising medical costs, accounting complications, and staffing difficulties.
With state shortfalls in providing adequate Medicaid reimbursements to nursing homes, and with 90% of its residents paying with Medicaid, North Valley is unable to cover the cost of care. The result is a feeling of uncertainty and distress for residents and their families.
North Valley Hospital District previously had an assisted living wing, which also closed due to financial woes, with many of its residents moving into the nursing home. The change brought emotional and physical stress that proved difficult for some residents, and brought home the impact of consolidating community-based care. Without North Valley, the nearest bed available to those who qualify through Medicaid would be over an hour away.
Northwest Public Radio recently covered this story and the ongoing plight if financial shortfalls with Medicaid reimbursement for public nursing homes in Washington State. Read more here. (Lilia Cabello Drain, firstname.lastname@example.org)
Honoring Choices Means Honoring People
The Honoring Choices Pacific Northwest website provides tools, resources and plans freely available to anyone interested in creating end-of-life decisions. Doctors and hospitals will also be gaining familiarity with the site, so as to further the discussions on end-of-life planning and honor patients’ wishes.
While it can be a difficult topic, having the conversation while still able to make tough decisions is important. It is important to understand the options, and make meaningful choices that honor personal values at the end of life.
Honoring Choices was recently highlighted in AARP, which found the website to be an asset in getting such difficult conversations started. The article even featured this encouraging video created to spark discussions that affect end-of-life plans. (Tanya Carroccio, 206/577-1841)
Inside Olympia: Moving Telemedicine Forward
This week telemedicine was a top priority, as the bill WSHA supports was heard in both the House and the Senate. This bill would ensure coverage of medical services received via audio and video technology, telemedicine. (Download the issue brief here.) It would not only bring services to people who have difficulty accessing care, but will produce guidelines for clinics and hospitals interested in the technology.
Discussions from Inside Olympia also centered on meeting work force shortages, health care services provided to inmates and suspects, and transparency concerning heath care quality and cost through the all-payer claims database. The Inside Olympia report discusses WSHA’s impact on health care and the continuous work happening in OIympia to achieve top legislative priorities such as telemedicine.
For one WSHA member’s perspective on workforce shortages, watch Elaine Couture, Regional Chief Executive at Providence Health & Services, talk to State of Reform.
Read Inside Olympia here and subscribe now.
(Mary Kay Clunies-Ross, 206/216-2894)
New Survey Gives Insight Into Medical Resident Recruitment
Washington Hospital Services Industry Partner Merritt Hawkins just released the results of a national survey of medial residents that provides hospitals and health systems information that is useful for recruiting new physicians. The survey of 1,200 final-year medical residents shows a preference for employment and serious competition for these soon to be available professionals. An infographic provides an overview of the survey findings. WSHA members can receive a complimentary copy of the entire survey report by contacting Corey Johnson at email@example.com or (469) 542-1752.
CMS Rapidly Tying more Medicare Payment to Quality and Value: Secretary Burwell’s Announcement
The federal government today announced a dramatic change in payment from fee-for-service to payment for quality and value. HHS Secretary Burwell set the goals, which state that traditional Medicare payments will be tied to alternative payment models such as ACOs:
- 30 percent by 2016
- 90 percent by 2018
This is very dramatic when you consider that in 2011 Medicare had almost no payments to providers through alternative payment models. Today we are at about 20 percent.
“If we succeed,” Secretary Burwell wrote, “a patient who is admitted to a hospital or referred to a specialist, will be more likely to get the right tests and medications because his or her doctors are coordinating and have the information they need.” For more information see a blog posting from HHS. (Carol Wagner, firstname.lastname@example.org)
Partnership for Patients National Results Include 50,000 Lives Saved, Significant Savings
In December, the Department of Health and Human Services (HHS) released a report showing results from the three-year quality improvement efforts of the Partnership for Patients Initiative. Nationally there have been 50,000 lives saved, 1.3 million fewer patient harms and $12 billion in savings as a result of this innovative program.
All hospitals in the state of Washington and related systems participated in this important work resulting in:
- 23,000 fewer patients experienced harm
- $235 million cost reduction
Examples of results in specific areas include a 27% reduction in readmissions and a 94% reduction in early elective deliveries.
WSHA will support hospitals’ continued efforts to reduce harm and improve the quality of care for patients in our state. Much credit for what we have achieved so far is due to visionary hospital leadership and tireless efforts of hospital staff to get this project underway and achieve results in a short amount of time. Thank you for your extraordinary work!
For more information, please review the press release from HHS and accompanying report on Partnership for Patients results from the Agency for Healthcare Research and Quality or contact Carol Wagner, email@example.com.
Coming Monday: Partners in Quality Leadership Forum
As health care organizations continue to focus priorities on the Triple Aim – better care, better health, lower costs – and a shift toward value-based contracting, some of the top priorities are improving the quality and efficiency of health care delivery and maximizing the relationship with key partners.
Partners in Quality: CEO and CMO Leadership Forum
Monday, February 2, 2015
8:00 a.m. – 4:30 p.m.
SeaTac Marriott Hotel
To register or for more information contact Megan Boucher at firstname.lastname@example.org
Join us at this this intimate, highly interactive conference focused on engaging hospital and clinic CEOs, CMOs and senior physician leaders in the following topics: leveraging partnership roles to sustain continuous improvement; optimizing effective clinically integrated networks; review and implementation of the Call to Action initiative and more. (Tanya Carroccio, email@example.com).
Court Victory May Impact Medicaid DSH Payments
A recent court victory by Seattle Children’s Hospital and Texas Children’s Hospital may significantly impact how Medicaid Disproportionate Share Hospital (DSH) payments are distributed by Washington State and other states. The Washington State Health Care Authority is in the process of analyzing the details of the injunction.
The two hospitals won a preliminary injunction against the Centers for Medicare and Medicaid Services (CMS), preventing the enforcement of a change to definitions used to calculate DSH eligibility and payments. The new definition applied payments from private insurance to services provided to Medicaid enrollees, even if the hospitals did not bill or receive Medicaid payment for the patient. The effect of this was to offset the losses incurred on patients where Medicaid was the payor. The ruling initially may impact the results of a recent audit of the 2011 DSH payment distribution and the DSH payment calculation process for 2015, but could ultimately include the distributions made during 2012-2014. (Andrew Busz, firstname.lastname@example.org)
To find out more about how WSHA is a part of these fiscal challenges, read the rest of the Fiscal Report here and subscribe now.