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Care Delivery

 

The goal of accountable care organizations (ACOs), according to CMS, is to better coordinate care for chronically ill patients, avoiding unnecessary services and preventing errors. For ACOs in the Medicare Shared Savings Program (MSSP), however, those weren’t the reasons they saved money, according to a study published in the Dec. 2017 issue of Health Affairs.

The offerings on the Affordable Care Act’s health insurance exchanges for 2018 are dominated by narrow network plans, with higher deductibles for silver- and gold-level plans, according to an analysis from Avalere.

Between 2006 and 2014, the number of emergency department (ED) visits paid for by Medicaid rose from 26.5 million to 44.1 million, making the program the most frequent payer in the ED over private insurance.

Fifteen new states will participate in the Medicare Advantage (MA) Value-Based Insurance Design (VBID) model for 2019, allowing insurers in a total of 25 states to enter the program aimed at encouraging enrollees to focus on services that are of the highest clinical value to their specific chronic conditions.

Several groups representing nurses have accused the American Medical Association of igniting a “turf war” and “hampering access to care” by adopting a resolution to oppose efforts to allow non-physician practitioners to practice independently without the supervision of a licensed physician.

 

Recent Headlines

ACO success limited by high turnover among physicians, patients

The effectiveness of accountable care organizations (ACOs) may be limited by two factors, according to a new study published in Health Affairs: low numbers of enrollees attributed to participating physicians and the constant “churn” of the patient population caused by substantial physician turnover.

Michigan ER doc charged with performing genital mutilation on 7-year-olds

An emergency physician from Michigan has been arrested on charges she performed genital mutilation procedures on multiple girls between the ages of 6 and 8, which prosecutors say could be the first criminal case involving the practice since it was outlawed in the U.S. in 1996.

What U.S. hospitals can learn from a value-based strategy in the Netherlands

While healthcare costs continued to rise at other facilities, one Netherlands hospital was able to lower costs by 8 percent in a single year while improving quality. The credit goes to a value-based care strategy focusing on everything from closer coordination on cardiovascular patients to keeping more experienced physicians in the emergency department. 

ACHE 2017: Embracing value-based care essential to attracting big purchasers like Boeing, Walgreens

Large corporations want healthy workers and lower healthcare costs. If hospitals and medical groups are going to win the right to provide care to those employees and their families, innovative approaches to care, having the right infrastructure in place and taking a lot of meetings are a must. 

AMA: 90% of physicians satisfied with career choice

Despite changes in the healthcare field and multiple surveys finding an increase in physician burnout, almost all doctors say they’re satisfied with their choice to become physicians, according to a new survey from the American Medical Association (AMA). 

AAMC: Physician shortage could surpass 100,000 by 2030

The Association of American Medical Colleges (AAMC) said the nation’s physician shortage isn’t going to get any better, projecting a shortage of between 40,800 and 104,900 doctors by 2030 in a report conducted by global information company IHS Markit.

First-year residents will once again be able to work 24-hour shifts

The Accreditation Council for Graduate Medical Education (ACGME) has revised its limits on how long first-year residents can work in a single shift, increasing it from 16 to 24 hours, matching the maximum for residents at all levels.

How delivery system innovations can succeed: ‘Do fewer projects, but do them better’

The need for changing healthcare delivery is clear, according to David Bates, MD, MSc, chief of the general internal medicine division at Brigham and Women’s Hospital in Boston. Allowing those changes to succeed in the world of value-based care, however, may require organizations to devote more of its own resources to delivery system reforms. 

HIMSS 2017: Prior authorization flaws require collaborative response

A multi-stakeholder conversation about the burden of prior authorization requirements offered a consensus that something has to change with these policies, but the parties could not offer a silver bullet on how the process can improve.

Telehealth increases utilization instead of replacing office visits

Using direct-to-consumer telehealth, where a patient was direct access to a physician on the phone or through videoconferencing, may be a tool to increase access to care. According to a study published in the March 2017 issue of Health Affairs, it also increases utilization and spending. 

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