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Legal & Regulatory

California AG launches antitrust investigation

California's attorney general is investigating whether increased consolidation among hospitals and physician groups will result in "supracompetitive" prices, according to an alert from Sheppard Mullin Richter & Hampton. There's nationwide antitrust scrutiny of such rapid consolidation, but specific guidance is lacking. "Only time will tell if the new federal mandate for integration and coordination among different groups of providers will pave the way for more specific, concrete guidance from the various antitrust enforcement agencies as to how to legally structure hospital, physician group consolidations," the alert says. (JDSupra) 

 

 

HHS, Justice warn providers about fraud

Health and Human Services Secretary Kathleen Sebelius and Attorney General Eric Holder, responding to reports of providers "cloning" medical records and "upcoding," promise to crack down on providers who misuse electronic records to bill for unprovided services. In a letter to hospitals, they announced a plan to increase audits, medical reviews and comparative billing to identify such practices, Modern Healthcare reports. (Modern Healthcare; letter) 

 

 

Don't blindly sign ACO contracts

Don't be so quick to sign all that ACO paperwork, Jeffrey L. Cohen, Esq., warns doctors in a recent ACO Watch post. "Regardless of a doctor's view of ACOs, no document ought to be signed unless all the questions raised by them are addressed, very clearly and in writing." Too often, he says, physicians sign documents that don't adequately address such issues as credentialing criteria, disciplinary procedures, financial provisions, or how the financial upside or downside can affect compensation. (ACO Watch)

    

Industry News 

Investigation: Hospitals hike cancer drug prices

Large nonprofit hospitals in North Carolina are dramatically inflating prices on chemotherapy drugs as they corner more of the market on cancer care, according to an investigation by the Charlotte Observer and The News & Observer of Raleigh. The newspapers found hospitals routinely mark up prices on cancer drugs by two to 10 times over cost. Some are far higher. Among the drivers: Hospitals are buying the practices of independent oncologists, then charge more--sometimes considerably more--for the same chemotherapy drugs in the same office. (Charlotte Observer)

 

ACOs on shaky foundation, warns editor

"The very foundation upon which ACOs are built could be shaky, making software tools only so effective," writes Paul Cerrato, editor of Information Week Healthcare. Health IT is essential for quality measurement, but he warns "if genuine accountability is your goal, technology gets you only halfway there." Cerrato also notes that not only has recent research from the Physician Group Practice Demonstration been disappointing, but some of the practices may have been gaming the system by "overcoding." (Information Week Healthcare)  

   

   

In a recent interview with FierceHealthIT, Jennifer Bordenick, CEO of eHealth Initiative, said she hopes that as the "techie generation" comes of age, patients will demand data sharing and utilization in ways that positively influence their health. She added that eHI/College of Healthcare Informatics Management Executives survey results "tell us a lot about what little we know." Hospital CIOs say the most important use of data is analyzing clinician utilization and patient outcomes, but the most common use is financial management, the survey found. (FierceHealthIT)


Provider Connections  

Survey: Doctors dubious about ACOs  

Physicians are pessimistic, according to a survey by the non-profit The Physicians Foundation. They are especially dubious about the current payment and technology changes. For example, 62 percent were uncertain ACOs would fulfill their intended goals and nearly 50 percent worried EMRs might compromise patient privacy. Healthcare Informatics poses the question of what this attitude might mean for patient access, worrying such dissatisfaction could catalyze a shift out of the profession. (Healthcare Informatics)



EHR training most sought-after skill

EHR training is the most sought-after skill in the health care market, regardless of the type of opening, according to a report by Wanted Analytics. Indeed, many physicians consider inadequate EHR training as standing in the way of successful EHR implementation. "So it's not surprising that healthcare organizations would want to hire staff who already possess this skill set," notes FierceEMR. (FierceEMR)

 

 

IOM wants team-based, value-oriented approaches

An Institute of Medicine report finds unnecessary services, fraud and excessive administrative costs accounted for about 30 percent of total health spending in 2009. The authors calls on physicians and other health professionals to become part of a learning system that uses new clinical support tools and payment models linking performance to patient outcomes, as well as a team approach to care management, American Medical News reports. The report also calls on payers to adopt outcome- and value-oriented payment models, contracting policies and benefit design to reward and support high-quality, team-based patient-focused care. (American Medical News; IOM report)

 

Innovators
NCQA to announce accredited ACOs by year end

HealthLeaders Media recently offered an overview of the National Committee for Quality Assurance's ACO accreditation review program. Measures include those related to processes of care for specific conditions, medication management and care coordination--and they must be demonstrated throughout the ACO network--physician's office, hospital, hospice, etc. NCQA's Sarah Thomas promises by the end of the year "the public will know the names of several organizations that have passed our tough review." (HealthLeaders Media)

 

  

Blues moving ahead quickly on ACOs

Several Blue Cross and Blue Shield plans have announced ACO partnerships with providers in recent weeks, AIS Report on Blue Cross and Blue Shield Plans reports. It's part of a steep, 18-month growth curve, according to the report. Among the most active of the plans is Blue Shield of California, which has eight ACO deals reaching 135,000 people in California, the report says. (Becker's Hospital Review; AIS Report on Blue Cross and Blue Shield Plans--subscription required)

 

 

Access to health information associated with fewer colon cancer deaths

According to research published in The Milbank Quarterly, states that promote adoption of innovative health care practices and provide greater access to public health information, can reduce the number of colon cancer deaths. Such deaths decreased substantially in states with higher rates of information diffusion (a measure of a state's willingness to adopt public health campaigns and promote practice innovation). States with lower rates of information diffusion had slower declines in colon cancer deaths during the study period. (Health Behavior News Service) 



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"Sully" calls for better safety practices in medicine

Stanford Medical School interviewed Captain Chesley Sullenberger to ask what he thinks health care could learn from the airline industry. He said the annual 200,000 medical/health care-related preventable deaths in America is equal to 20 jet crashes a week and recommended moving "from a blame-based system to a learning-based system." In considering action steps to address this problem, he noted the need to build political will and public awareness. (Stanford "1:2:1" podcast; Inside Stanford Medicine)

MarketVoices...quotes worth reading   

  

"Neither patients nor the nation are well served when administrative manipulations masquerade as changes in care. What is needed is better care, not better coding." -- former CMS chief Donald M. Berwick, MD, quoted in Information Week Healthcare

   
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NCQA Update

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Thursday, Oct. 4, 2012

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