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The Truven Health Blog


The latest healthcare topics from a trusted, proven, and unbiased source.


Access to Pediatric Healthcare Stands to Raise Parental Awareness about Human Papillomavirus (HPV) Vaccines


By Whitney Witt/Thursday, February 27, 2014
Whitney Witt imageA recent article that my colleagues and I published in the journal Sexually Transmitted Diseases, stated that improving access to pediatric check-ups may increase parental awareness of human papillomavirus (HPV) vaccines. The article was based on research that was funded by the Agency for Healthcare Research and Quality (AHRQ). We identified that parents of children who had a well-child checkup in the last 12 months were significantly more likely to have heard of HPV vaccines. These findings highlight the idea that pediatricians and family healthcare providers may serve as an important lifeline for HPV vaccine-related information for parents.

Our findings also have significant implications for child health insurance policy, as this study reports that children’s access to health insurance may be critical in ensuring that parents learn about HPV vaccines in the health care setting. The association between a child's lack of insurance and lower parental awareness may be a result of decreased access to preventive care.

We need to arm parents with important information about these vaccines and the implications for their child’s health, so that they have all the necessary information to make an informed decision about whether or not they want to vaccinate their child. Improving access to preventive pediatric healthcare may offer a critical opportunity to increase parental awareness of the HPV vaccines.

Read more in our press release.

Whitney Witt, PhD, MPH
Director, Behavioral Health and Quality Research



HPV is a sexually transmitted disease that infects about 14 million people aged 15 to 59 years annually in the United States, with approximately seven million HPV infections among individuals aged 15 to 24 years. HPV infections cause genital warts and a variety of cancers, including cervical cancer. Although current guidelines recommend standard administration of HPV vaccines for boys and girls at ages 11 to 12 years, less than 34% of adolescent girls in the U.S. aged 13 to 17 years completed all three doses of HPV vaccines in 2012.

Hospital-Physician Alignment Key to Hospital Success


By Byron C. Scott/Wednesday, February 26, 2014
Byron Scott imageFinally, physicians come to the forefront as the connecting link that will help hospitals address and improve financial targets in the next three years. Physician-hospital alignment tops the list in the latest HealthLeaders Media industry survey, "Forging Healthcare's New Financial Foundation," and it’s noted as the most important area of focus and improvement, followed by cost reduction and care model direction. These three areas are key as we navigate from volume-based care (or fee-for-service) to value-based care. Physicians have significant influence on quality and the process of care improvement, since they are the delivery agents. Many definitions of quality exist, but every physician and hospital is constantly evaluated on quality by organizations such as the Centers for Medicare & Medicaid Services (CMS), in addition to independent rankings such as the Truven Health 100 Top Hospitals® study.

First, it’s crucial to make sure there are enough physicians. Current Truven Health  data shows differences in productivity by age cohort, and findings show that a retiring physician may need to be replaced by more than one new physician to see the same number of patients. Second, it’s essential to have enough physicians in the right structure.

In the organized structure, there needs to be the right performance-based contract and compensation in place to ensure alignment. Part of this structure includes having the physician leadership at every level in the organization. This includes medical directors, department chiefs, and C-suite physician executive leadership. Third, make sure that physician leadership is selected, trained, and resourced to make the leadership decisions for value-based care. Knowing the practice variation amongst the group and the group variation versus benchmarks helps us understand the drivers of each group and practice to implement changes to better support the practice and reduce variation. The key to this is having health analytic tools to extract the data to measure and compare. As Walter Deming once said, “You can’t manage what you can’t measure.”

Byron C. Scott, MD, MBA, FACPE
Medical Director, National Clinical Medical Leader

CMS Bundled Payment Program Re-Opens, But What Should You Include In Those Bundles?


By Michael L. Taylor/Tuesday, February 25, 2014
Michael Taylor imageDid you miss out on enrolling in one of the Centers for Medicare & Medicaid (CMS) Bundled Payment programs? You’re in luck. The CMS recently announced that they are offering another chance for new participants to enroll in its Bundled Payment for Care Improvement (BPCI) program.

The aim is to provide financial incentives to all providers of care — hospitals, doctors, and post-acute care providers — encouraging them to work together. This represents the ongoing CMS trend of developing new payment models that move away from fee-for-service. The agency also hopes that increasing the scope of the program will result in a richer data set that would improve its evaluation of the new payment models.

There are four basic models of bundled payments, although the re-opening is only accepting enrollment in models 2-4; not model 1:
  1. Acute care inpatient stay — similar to traditional Medicare payment model. In this model, all participants agree to accept a discount from the standard payment, but there can be gain sharing if collaboration reduces costs. Physicians are paid on a reduced Medicare level, but under fee-for-service rules, and hospitals are paid under the DRG system.
  2. Inpatient stay plus post-acute care for 30, 60, or 90 days post-discharge. Each bundle is assigned a certain predetermined payment level, and compared to actual costs.
  3. Post-acute care stay. In this model, the bundled payment is for the skilled nursing facility or long-term acute care only, not the inpatient stay.
  4. Acute care stay only. In this model, CMS pays a lump sum to the hospital for all services provided, including physicians.
This payment methodology is similar to capitation in that it shifts varying degrees of the financial risk to the providers of care and incents better oversight of the care. Under this arrangement, providers are incentivized not to provide unnecessary tests or procedures.

What to Include In the Bundles
One of the challenges with bundled payments is deciding what to include in the bundle — there are 48 different chronic conditions that can be included in the bundled methodology! At Truven Health Analytics™, our teams have done considerable work in defining how to construct these bundles. Our researchers have worked on bundles covering coronary artery bypass, heart valve replacement, defibrillator and pacemaker in-plants, and joint replacements, so Truven Health is well-positioned to support this new opportunity. Truven Health has very strong references and demonstrable expertise in this arena, as we have helped several other clients in the application and ongoing measurement for the program. We offer a well established set of services and deliverables that have been successfully delivered to multiple clients.

Re-opening the opportunity for new participants at this time will expand the breadth of these programs. There are currently 61 sites across the country participating, and gathering more data on outcomes will be fundamental to evaluating its success. CMS continues to drive fundamental changes in payment reform, helping to transition away from the waste and excesses driven by fee-for-service. Will you decide to participate?

Michael L. Taylor, MD, FACP
Chief Medical Officer

CMS Bundled Payment Program Re-Opens, But What Should You Include In Those Bundles?


By Michael L. Taylor/Tuesday, February 25, 2014
Michael Taylor imageDid you miss out on enrolling in one of the Centers for Medicare & Medicaid (CMS) Bundled Payment programs? You’re in luck. The CMS recently announced that they are offering another chance for new participants to enroll in its Bundled Payment for Care Improvement (BPCI) program.

The aim is to provide financial incentives to all providers of care — hospitals, doctors, and post-acute care providers — encouraging them to work together. This represents the ongoing CMS trend of developing new payment models that move away from fee-for-service. The agency also hopes that increasing the scope of the program will result in a richer data set that would improve its evaluation of the new payment models.

There are four basic models of bundled payments, although the re-opening is only accepting enrollment in models 2-4; not model 1:
  1. Acute care inpatient stay — similar to traditional Medicare payment model. In this model, all participants agree to accept a discount from the standard payment, but there can be gain sharing if collaboration reduces costs. Physicians are paid on a reduced Medicare level, but under fee-for-service rules, and hospitals are paid under the DRG system.
  2. Inpatient stay plus post-acute care for 30, 60, or 90 days post-discharge. Each bundle is assigned a certain predetermined payment level, and compared to actual costs.
  3. Post-acute care stay. In this model, the bundled payment is for the skilled nursing facility or long-term acute care only, not the inpatient stay.
  4. Acute care stay only. In this model, CMS pays a lump sum to the hospital for all services provided, including physicians.
This payment methodology is similar to capitation in that it shifts varying degrees of the financial risk to the providers of care and incents better oversight of the care. Under this arrangement, providers are incentivized not to provide unnecessary tests or procedures.

What to Include In the Bundles
One of the challenges with bundled payments is deciding what to include in the bundle — there are 48 different chronic conditions that can be included in the bundled methodology! At Truven Health Analytics™, our teams have done considerable work in defining how to construct these bundles. Our researchers have worked on bundles covering coronary artery bypass, heart valve replacement, defibrillator and pacemaker in-plants, and joint replacements, so Truven Health is well-positioned to support this new opportunity. Truven Health has very strong references and demonstrable expertise in this arena, as we have helped several other clients in the application and ongoing measurement for the program. We offer a well established set of services and deliverables that have been successfully delivered to multiple clients.

Re-opening the opportunity for new participants at this time will expand the breadth of these programs. There are currently 61 sites across the country participating, and gathering more data on outcomes will be fundamental to evaluating its success. CMS continues to drive fundamental changes in payment reform, helping to transition away from the waste and excesses driven by fee-for-service. Will you decide to participate?

Michael L. Taylor, MD, FACP
Chief Medical Officer

Three Reasons Why Doctors are Choosing Employment Over Independence


By Michael L. Taylor/Wednesday, February 19, 2014
Mike Taylor imageA recent commentary notes the shifting of doctors from self-employment to being employed by a heath system. Fully 60% of pediatricians and family medicine physicians are now employed, with 50% of surgeons employed. The number is expected to rise to nearly 75% over the next several years. What is driving that trend? There are at least three compelling answers: debt level, work-life balance, and the hospital’s need to develop market share and control referral patterns.

A recent report states the average medical school student graduates with a debt of nearly $280,000. In 1978, the average debt was $13,000. The student may also have debt obligations from college. Newly trained physicians with that staggering level of debt often don’t want to incur more debt by starting a private practice. The average annual salary of a family medicine provider is $224,000, but for newly trained physicians in private practice, initial revenues are much lower, and it may take several years to get to the average level. Add a home and car mortgage, as well as other personal expenses, and it becomes clear why it’s becoming impossible to absorb the start up costs of a medical practice, which often run as high as $100,000 for a solo practice. By working for a hospital or health system, physicians can avoid all the office costs and the professional liability insurance, while knowing they have a guaranteed salary.

I believe a strong second reason physicians are choosing employment rather than independent practice relates to the difference in lifestyle and work life balance. Most newly trained physicians were born after 1980, and the prospect of managing an outpatient practice and hospitalized patients 24/7 is just not appealing for many of these younger physicians. Working as an employee in a healthcare system that provides a guaranteed salary, utilizes hospitalists, and covers all practice-related expenses is too compelling to turn down. Young physicians also find having personal time off from work very important.

A third reason is the changing market itself. As the country moves away from a fee-for-service payment model to a value-based system, hospitals are moving into risk contracting or capitated payments. The best strategy for hospitals and health systems is to exert more control over the markets in which they serve. By employing physicians, hospitals can transfer office-based services into their own outpatient labs and radiology suites. Hospitals with employed physicians can more effectively direct patient admission choices. As Accountable Care Organizations (ACOs) mature, they will assume financial responsibility across the entire care continuum, from outpatient services to admissions, rehabilitation and long-term care. ACOs will drive the need for more efficient care with less wasteful spending. Hospitals can drive that efficiency with smart IT investments, treatment guidelines and care coordination. This can be done without employing physicians, but it’s more efficient to employ physicians and have them be a part of the process. To fully support care, a newer trend is for hospitals to employ specialists in addition to primary care physicians.

One potential advantage of employing physicians is the opportunity to reduce the variation in medical care that is rampant in the U.S. today. Reducing variation should improve the quality of care and reduce costs by avoiding wasteful and unneeded treatments that may be costing the U.S. up to 30% of the total medical spend. Aligning physicians and hospitals to the triple aim – better care for individuals, better care for the population, and slowing medical inflation is best accomplished in an organized approach – and individually owned practices are less likely to deliver on that promise.

Michael L. Taylor, MD, FACP
Chief Medical Officer

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