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Hospitals

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Let’s Focus on Behavioral and Mental Health in Rural Communities

by Bailey Amber
written by Bailey Amber

If there’s a silver lining to the past two years, the pandemic brought mental health to the forefront.

Studies show that one in five adults will experience a behavioral health disorder yearly. The number is almost certainly higher in rural areas.

Anxiety and depression rates among adults reached 42% during the pandemic, according to data secured by the National Center for Health Statistics in partnership with the U.S. Census Bureau.

About a fifth of the population lives in rural areas. While mental health issues aren’t necessarily higher in rural areas, rural residents receive less frequent mental health treatments and often have more limited access to doctors and counselors who specialize in mental health.

In rural communities, patients often go directly to the emergency room with mental health issues. Unfortunately, these hospitals’ emergency rooms often do not have a safe waiting area for psychiatric patients or patients in crisis.

Sometimes patients can wait hours before a hospital can find the right place. Unfortunately, this scenario diverts one or more nurses away from their primary emergency room or acute care responsibilities because they must stay with that patient one-on-one until the hospital can find somewhere for them.

This scenario often plays out in hospitals and compounds an existing problem.

Rural areas already struggle with an acute shortage of medical personnel and particularly nurses. With patients coming in with urgent, life-threatening medical issues, hospitals need their nurses to focus on those patients.

In the next 12-18 months, healthcare providers — especially rural providers — have an opportunity to lay the foundation that will stem the volume of patients with mental health issues from going to the emergency room. Instead, organizations can see these patients receive the help they need and deserve.

Telemedicine will be more prevalent

Amid the pandemic, rural mental health providers increasingly deployed telehealth to reach more patients. Organizations can use that technology to treat patients, schedule counseling sessions, and hold outpatient and one-on-one sessions.

Telehealth options took off as a “necessary evil” amid the pandemic. In the post-pandemic world, it will be necessary for survival and a bit easier to roll out from a staffing standpoint.

To deliver counseling — whether via telehealth or in-person — healthcare providers must find these qualified counselors out there that can conduct the actual telehealth sessions.

More than that, rural health clinics can relieve hospitals of the need to be the sole provider of mental health counseling for children or adults. These rural health clinics or their outpatient clinics serve as a route to provide health and care by using telehealth, bringing that telehealth into their outpatient offerings.

Furthermore, tapping into larger health systems — specifically, their psychiatric units — for advice and help will enable smaller providers to expand their offerings without increasing staffing and outlaying capital on new services.

While we’re making progress, building those bridges and making those connections takes time.

Growing the connection is paramount

One challenge with telehealth offerings is that not everybody has a computer or a reliable network connection. The good news is that nearly everybody has a smartphone, which has helped patients and providers stay connected.

The federal government has allocated billions of dollars to expand broadband connectivity. Moving forward, some healthcare providers may take a more active role in advocating for the expansion of reliable broadband in rural areas to ensure telemedicine becomes an even more viable option for underserved communities.

As community leaders, healthcare providers and perfectly positioned to advocate for this expansion.

Increased use of analytics will help predict outcomes

Perhaps the most significant trend we’ll see in the next 12-18 months is the increased use of analytics to predict patient outcomes.

Incorporating analytics into enterprise resource planning (ERP) systems allows organizations to monitor and capture data better. That will help organizations gain more insight into where the shortfalls are and what we need to do to improve.

This insight improves strategic planning because organizations can look at those numbers for a more complete picture of what’s happening.

Smaller rural hospitals benefit from ERP systems to help them survive, but since the implementation of ERP systems, I see these hospitals using data more often to capture what’s happening with trends and growth in their marketplace. This technology helps organizations manage their financials and see the bigger picture of what’s happening and what is needed.

For example, I’ve seen this technology specifically benefit diabetic populations in rural areas. Recent trends show that the diabetic population is climbing in rural areas. Now healthcare providers can use technology to help decide whether they need to bring on board diabetic counseling or teach classes with a nutritionist.

Technology can be applied in the same manner to mental health. It helps inform organizations where their shortfalls are and where they can add or enhance services.

More conversation means more clarity.

Ideally, every small town in America would have a psychiatrist. Many rural hospitals are integrating these services into their practices, recognizing the need for psychiatric services. These expansions include adding geriatric psychiatry units to help older populations.

While the expansions are helpful and much-needed, they won’t change the situation overnight. It’s a process that takes a while to develop and hire and train the staff, and organizations still need a medical director and a psychiatrist to oversee it.

Everything won’t be solved with staff, but it certainly will make a good step.

Mental health often isn’t talked about in rural areas. Unfortunately, it still carries a stigma and all the technology in the world won’t change that.

Solving the mental health crisis in rural areas still comes down to people acting — no action is too small.

If there’s one change in the next 12-18 months, let’s hope there’s an increased awareness and openness to talking about mental health, especially in our rural communities.

We’ve already done the hardest part: bringing it to the forefront. Now, we just need to see it over the finish line.

Photo: marekuliasz, Getty Images

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Intermountain Partners with Story Health to Better Manage Heart Failure Patients’ Care Plans

by Bailey Amber
written by Bailey Amber

Intermountain Healthcare recently partnered with a startup named Story Health to help manage patients’ heart failure by increasing access to specialty care. Under the partnership, Intermountain clinicians are working with Story’s health coaches to help patients keep up with their treatment plans while they’re outside the walls of the doctor’s office.

Founded in 2020 and based in Cupertino, Story has raised over $26 million to date, according to Crunchbase. Like many digital health startups, the idea to form the company came from the CEO’s personal experience with the U.S. healthcare system.

Story CEO Tom Stanis’ father suffered a stroke years ago. Though much time has passed since the event, it’s still a struggle to manage his recovery.

“This gap between the intensivist and the coordinating primary care physicians is a place where many of us fall behind. Our specialists are overburdened — unable to manage the constant tweaking and deluge of data being generated from patients at home. Primary care is often out of the loop, not knowing or having the confidence to optimize a complex ongoing recovery process. My father fell into this hole,” Stanis said.

Patients are presenting to clinicians with increasing complexity and incomplete care experiences, he pointed out. This problem is made worse by the fact that clinicians are short on time. Constricted by growing administrative tasks and shortened appointment lengths, clinicians often do not have the time they need to contextualize a patient’s full story (hence the startup’s name) and how that story can directly impact their outcome, Stanis said.

To address this issue, Story’s platform offers two key solutions. 

The first is its electronic health record-integrated AI. This technology allows providers to easily connect disparate data from various sources, such as EHRs, medical devices, remote patient monitoring databases and lab results.

“By leveraging data, we can find patients that need support and then automate a personalized care plan based on clinical guidelines, which can be further customized by the physician. This removes the administrative requirements for clinicians to find those patients that aren’t at optimal or goal therapy and makes it easier to get them back on track with the care plan,” Stanis declared.

Once a personalized care plan is established, Story integrates a human touch element. Through its health coaches (which are real people, not AI bots), Story helps ensure that the care plan is followed and the treatment goal is achieved.

Stanis said that Story’s health coaches are an essential part of the business because they serve as an extension of the clinician to identify and resolve challenges like medication optimization, lab draw coordination, transportation arrangements and prescription assistance. These coaches also respond to patient questions via texts and calls.

Story is currently focused on cardiology and heart failure because only 1% of heart failure patients receive the appropriate medications, Stanis pointed out. 

The startup partnered with Intermountain because the startup is seeking to expand its reach and serve more patients. Stanis declined to comment on whether Story’s services are covered for Intermountain patients or how the partners will measure the success of their collaboration. However, Story said that whitepapers detailing the program’s results will be published later this year.

Photo: kieferpix, Getty Images

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How Much of a Risk Is a Potential Class-action Lawsuit against CommonSpirit?

by Bailey Amber
written by Bailey Amber

CommonSpirit Health, one of the nation’s largest health systems is facing a proposed class-action lawsuit over a ransomware attack it suffered last fall.

How perilous is this for a health system already strained by challenging finances?  At least one lawyer believes that like many lawsuits following a data breach, it will be settled out of court.

“It’s almost axiomatic,” said David Balser, a partner at Atlanta law firm King & Spalding. “If a data breach is announced, litigation is going to follow — whether or not the claims are meritorious.”

That litigation is being brought by Leeroy Perkins, who is one of the 623,774 patients notified by the health system that their data had been breached in a ransomware attack. Perkins filed the complaint December 29 against CommonSpirit, a nonprofit health system with headquarters in Chicago. Perkins has been a patient at Seattle-based Virginia Mason Franciscan Health, one of CommonSpirit’s subsidiaries, since 2003.

CommonSpirit operates 140 hospitals and more than 1,000 care sites across 21 states, according to its website. The health system did not respond to MedCity News‘ request for comment on the lawsuit.

An unauthorized third party obtained access to “certain portions of CommonSpirit’s network” from September 16 to October 3, according to a notice the health system posted about the data breach. During this time, CommonSpirit experienced EHR downtime and suffered appointment cancellations across its network of hospitals.

The exposed patient information included names, addresses, phone numbers, dates of birth, and “a unique ID used only internally by the organization,” according to CommonSpirit’s notice. The health system said it “has no evidence” that any of this personal information was misused as a result of the cybersecurity incident.

The lawsuit claims that the health system “failed to properly implement basic data security practices” and did not “employ reasonable and appropriate measures” to protect against unauthorized access to patient data. The complaint also said that this negligence has left patients vulnerable to identify theft and financial fraud. 

In his complaint, Perkins asked for class-action status. He also demanded damages, restitution, all other forms of equitable monetary relief, and declaratory and injunctive relief.

The vast majority of hospitals’ data breach lawsuits get settled, though, Balser declared. This is because there must be “some concrete harm or injury” to permit the case to go forward into court, he said. 

The mere fact that information was accessed by ransomware attackers doesn’t automatically create a claim for a plaintiff, Balser pointed out. He also said that health systems usually have insurance that will kick in to cover data breach claims.

Last year, Balser represented Capital One for a data breach case. The company faced a lawsuit over a 2019 data breach that exposed the information of more than 100 million customers, and the banking giant ended up issuing a $190 million class-action settlement. Balser said that to his knowledge, that case got further than any other data breach lawsuit. It went all the way through class certification and summary judgment briefing, but the case settled before the court could move on any of those motions. 

“At the end of the day, there is not a data breach case that I’m aware of that has actually gone to trial. Either the defendant gets the case thrown out or it gets resolved,” he said.

Photo: Valerii Evlakhov, Getty Images

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This Year’s 3 Most Expensive Hospital Construction Projects

by Bailey Amber
written by Bailey Amber

Hospitals’ operational margins are shrinking, and some financial analysts have said that 2022 may have been the worst year for hospital finances in decades. And the outlook for next year isn’t rosier — increases in hospitals’ labor and supply expenses are expected to continue to outpace their revenue growth.

Though hospitals’ financial circumstances were dire this year, some expansion projects have managed to move forward. Below is a rundown of the three of the most expensive hospital projects that were pursued in 2022.

$5 billion medical campus in Nevada

In March, the city of North Las Vegas, Nevada sold a 135-acre property for nearly $37 million to Pacific Group, a Salt Lake City-based developer. The developer bought the property to build a multibillion dollar medical campus that includes a hospital and research center, as well as office and retail buildings.

In October, Pacific Group broke ground on the medical campus, called Helios. The developer estimated that construction would cost about $5 billion and take 10 years to complete.

Pacific Group is building Helios to expand healthcare offerings in North Las Vegas. The city’s population exceeded 260,000 people in the 2020 U.S. Census, but North Las Vegas only has 209 hospital beds aside from its Veterans Affairs hospital, which is nearby the construction site. More than 70% of people transported to a hospital by the city’s fire department have to receive care outside the city, officials told the Las Vegas Review-Journal in March.

Helios’ hospital will have more than 600 beds, according to Pacific Group. The developer also said the campus will create more than 10,000 jobs for North Las Vegas once it’s complete, as well as add $3.2 billion to the economy each year.

Pacific Group has not yet found a healthcare partner for Helios.

UCSF’s $4.3 billion hospital

In May, the University of California’s board of regents granted approval to the University of California San Francisco to construct a $4.3 billion hospital at UCSF Helen Diller Medical Center, which is located in San Francisco’s Parnassus Heights neighborhood.

UCSF Health is building the new facility to address its capacity constraints. The health system said the new hospital will increase its overall inpatient bed capacity by 37% — from 499 beds to 682. UCSF also said the new facility will create about 1,400 new jobs.

The new hospital is scheduled to open in 2030, and it will meet California’s new earthquake-resistance standards set to go into effect that year. UCSF Health said it is funding the project through external financing, philanthropy and hospital reserves.

UC Davis’ $3.8 billion tower

In May, the University of California Davis Medical Center started demolishing temporary offices so it could begin construction on a nearly $3.8 billion new tower.

Just like UCSF’s new hospital, UC Davis’ tower is slated to open in 2030. The 14-story tower and five-story pavilion will replace parts of the medical center that don’t meet California’s upcoming earthquake-resistance standards.

The project, which spans a million square feet, will include about 400 single-patient rooms, new operating rooms, an imaging center, a larger pharmacy and more burn care units. Once the expansion project is finished, the medical center will have 675 to 700 inpatient beds.

Photo: Paul Bradbury/Getty Images

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The Battle Between Primary Care and Time: The Doctors are Losing

by Bailey Amber
written by Bailey Amber

The classic battle between time and the best interest of the patient is real in primary care.

The average primary care doctor has between 1200 to 1900 patients, with Kaiser Permanente reporting a mean per-physical panel size of 1,751. This most likely is not accurate nowadays, with some reports saying 2500 to 4000 is the new norm, as stated brilliantly by a LinkedIn comment by Sharon Ng M.D.

I asked my followers to share their thoughts on how they can make the healthcare system better, and they posted some great comments on this Linkedin Thread – 70 comments and counting.

What does this mean?

Basically, primary care doctors do not have much time to do anything but the basics and very little time for preventive care measures.

With basic math you can see the numbers do not add up, 24 hours in a day, proper care takes 26.7 hours.  And unfortunately, we are not robots that can work non-stop or manipulate time with the Infinity Gauntlet or have special powers like Dr. Strange to make up the difference.

PCPs were estimated to require 26.7 h/day, comprising

  • 14.1 h/day for preventive care
  • 7.2 h/day for chronic disease care
  • 2.2 h/day for acute care
  • 3.2 h/day for documentation and inbox management

“There is this sort of disconnect between the care we’ve been trained to give and the constraints of a clinic workday,” said Dr. Justin Porter, assistant professor of Medicine at the University of Chicago and lead author of the paper. “We have an ever-increasing set of guidelines, but clinic slots have not increased proportionately.”

With most doctors spending less than 15 to 20 minutes with their patients per visit, there is not much time for fact-finding, let alone education for the doctor to learn what preventive screening resources are available for their patients, even if that care is reimbursable by Medicare/Medicaid, such as a lung cancer screening.

To many chronic disease screenings to manage

Chronic diseases are a leading cause of morbidity and mortality worldwide, and preventative screenings are the most effective way to reduce the risk of developing a chronic disease. However, many individuals do not take advantage of preventative screening services for chronic diseases, especially in rural areas.

Another study from Duke in 2005 calculated that doctors would need an additional 10.6 hours per workday to manage the top 10 chronic diseases among their patients.

And it has real consequences for the delivery of health care; the researchers said that time pressure helps explain why improvements in outcomes have not kept pace with advances made in the field, the study said.

If you do surveys with patients about what frustrates them about their medical care, you’ll frequently hear, ‘My doctor doesn’t spend time with me’ or ‘My doctor doesn’t follow up,’” said Porter in the UChicago article. “I think a lot of times this is interpreted as a lack of empathy or a lack of willingness to care for a patient. But the reality—for the majority of doctors—is simply a lack of time.

Why is this?

The bottom line is the education of the physician, time, and patient access.  All things can be fixed if given the proper allocation of resources and expertise.

With 59% of all Americans (194 million) suffering from at least one chronic disease, and almost one in three adults having three or more chronic conditions doctors are tasked with doing the impossible. ent lives and cost of care for risk-bearers.

Source: Rand Corporation

The authors suggested “team-based care,” where nurses, physician assistants, counselors, and others help to deliver recommended care, as one solution to the problem of overworked, burned-out primary care docs.

Using team-based care, they estimated that the amount of primary care physician time could decrease to 9.3 hours per day.

Photo: malerapaso, Getty Images

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Telehealth in 2023 – Predicting the Unpredictable

by Bailey Amber
written by Bailey Amber

Making predictions in unpredictable times can be dangerous. As long-held certainties – even ones as basic as person-to-person contact – have proven unreliable, perhaps we can only really trust the trends that bring us the flexibility to deal with the unexpected.

Healthcare is the perfect bellwether. The sector has borne – and continues to bear – the brunt of this volatility. It has been severely limited by emergencies such as the pandemic, just as these events have driven surging demand for its services.

The fact is, telehealth helped the industry get through the pandemic and it continued to step up in 2022, pivoting to address new realities. So, if we look at the trends that were accelerated this year, we can see that telehealth is the common thread, and the driving indicator, of what’s to come in 2023.

Hospitals at home

Even before 2020, the hospital model faced significant challenges. In 2023, spiraling costs alongside tanking recruitment and retention rates will leave some systems in crisis.

If we look at staffing alone, research suggests that the US will need an additional 275,000 nurses this decade, while nearly a quarter of existing staff report they are thinking of leaving the industry due to issues such as burnout. It’s a situation putting a lot of stress on the system with, for example, Massachusetts reporting 19,000 unfilled hospital jobs in 2022. It’s simply unsustainable.

We have an alternative: as telehealth technologies become ever-more sophisticated, we can move the treatment of more patients currently occupying expensive and resource intensive hospital beds to their own homes. We have a precedent: with telehealth stepping up to fill the care vacuum caused by the pandemic – its use skyrocketed between January and April 2020 by 78 times.

The next five to 10 years will see more and more healthcare services move from the hospital to the home.  While relieving pressures on hospitals, it will also see telehealth emerge as a distinct and increasingly valuable part of the healthcare mix.

Tech giant takeovers

Well-executed telehealth combines real-time data, deep consumer insight and the innovative application of technology. Remind you of anything? Telehealth sits squarely in the tech giants’ sweet spot – and it’s a realization that hasn’t gone unnoticed.

Google was one of the first to get off the mark – initially as a health data repository, but soon expanding into data-powered and enhanced healthcare services. The company is now making direct investments in telehealth providers, while Google’s parent, Alphabet, is making billion dollar bets on data driven healthcare that focuses on the needs of individuals rather than generalized services.

Much was made of Amazon’s apparent withdrawal from telehealth as it announced the closure of Amazon Care this year. Subsequent announcements, however, suggest that this was a reappraisal, not a retreat. The company has now acquired One Medical – a telehealth-powered primary care provider – for close to $4 billion. Further, its newly launched Amazon Clinic will act, among other things, as a market place for third-party telehealth providers.

The potential of big tech in telehealth is mouth-watering. Meta’s pioneering exploration of the metaverse, and Microsoft Mesh’s development of ‘mixed reality’ technologies, suggest exciting possibilities around remote virtual healthcare environments and treatments.

With seemingly limitless opportunities to apply new technologies in the telehealth setting, expect to see more tech giant acquisitions through 2023 and beyond.

Behavioral and holistic health

Opportunities to shift more, and more complex, aspects of care into the patient’s home, alongside the attention of the tech giants, point to the most intriguing trend of all.  The use of behavioral insights to build a holistic care environment – one that truly integrates physical, social, and mental health to create wellbeing.

If there’s one thing that big tech nails, it’s behavioral insight. Take a stroll across the internet and we are greeted with content that magically aligns with our needs and interests.

Now, imagine a health system that applies this level of insight to patients and their care. A health system that goes beyond monitoring a patient’s vitals, providing remote diagnostics and assisting with medication management. A health system that embeds real community by recognizing and connecting like-minded patients. A system that turns ‘remote’ and potentially isolating healthcare into a very real and health-enhancing sense of belonging.

This isn’t some soft or intangible benefit. We know that there are clear links between anxiety, loneliness and depression. We know that depression can lead to higher morbidity rates in chronic disease such as cancer. We know that major depressive disorders cost the US an estimated $326 billion in pre-pandemic 2018, affecting around 17.5 million adults. And we know that these two figures surged during the pandemic as 11% of US adults reported symptoms of anxiety and depression in 2019, compared to over 40% in 2021.

Fully integrated telehealth offers us the opportunity to not only better treat depression, but intervene long before its incidence – with far reaching implications in terms of care costs, and human health and wellbeing.

One thing we can be sure of: unpredictability will outlive 2022. It means that 2023 will continue to see ever-more innovative technologies applied to telehealth. The opportunity is to ensure that these technologies are themselves applied in innovative ways – ways that put the patient and their wellbeing at the center of care.

Photo: elenabs, Getty Images

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Panel Orders UnitedHealthcare to pay $10.8M for Allegedly Underpaying Physicians

by Bailey Amber
written by Bailey Amber

Lawsuit, sue, gavel, court, money

A three-judge arbitration panel in Tampa, Florida, has ordered UnitedHealthcare to pay $10.8 million to a TeamHealth clinician group for underpayments from 2017 until 2020. 

Based in Knoxville, TeamHealth employs more than 15,000 affiliated healthcare professionals and advanced practice clinicians in a variety of care, including emergency medicine, hospital medicine, critical care, anesthesiology, orthopedic surgery, general surgery, obstetrics, acute behavioral health, post-acute care, post-acute behavioral health and ambulatory care.

“United persists in exploiting vulnerable patients and refuses to adequately pay providers, despite having faced sanctions, jury awards, and settlement payments of some half a billion dollars,” said Dr. Jay Mesrobian, TeamHealth National Medical Director and Chief Clinical Officer in a news release. 

According to the news release, the panel found that UnitedHealthcare (UHC) had paid TeamHealth physicians 30% of what they were owed as “fair payment” for their care.

The lawsuit is one of nine cases throughout the country that TeamHealth has brought against UHC for alleged underpayments. The other eight cases are still ongoing.

Despite the panel’s decision, UHC doesn’t view the panel’s ruling as a total loss. TeamHealth was originally seeking $30 million but the panel only ordered the insurance giant to pay $10.8 million, said a representative who declined to be named.

“The panel appropriately recognized the $30 million-plus TeamHealth was seeking was undeserving and awarded it only a fraction,” the UHC representative said in an email. “It also ruled that TeamHealth’s implied contract and unjust enrichment causes of action had no merit.” 

Further, the representative forwarded a statement that declared that TeamHealth has unrealistic expectations for physician pay. 

“TeamHealth continues to use litigation to distract from the real reason it no longer participates in our network; it expects to be paid double or even triple the median rate we pay other physicians providing the same services. TeamHealth’s actions are driving up the cost of healthcare for everyone,” the statement said. 

The representative pointed out that the panel of judges denied TeamHealth’s implied contract and unjust enrichment causes of action. Also, they rejected TeamHealth’s request for additional prompt pay penalties the day before Thanksgiving, the representative said.

Meanwhile, TeamHealth does not believe the fight is not over.

“This judgment reflects United’s ongoing, extensive wrongdoing that puts their billions of dollars in record profits ahead of patients’ well-being and the U.S. healthcare system. We will continue to fight United until they change course and start fairly compensating providers,” the company said in a news release.

The contentious legal battle between the two companies began with a separate case in which a Las Vegas jury in late 2021 awarded $60 million to TeamHealth. That award included punitive damages on top of millions in compensatory damages for UHC’s underpayments on thousands of claims for emergency treatment.

Photo: photovs, Getty Images

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The Impending Shift in the Delivery of Cardiac Care Creates Opportunities for Physicians and Hospitals

by Bailey Amber
written by Bailey Amber

Charity, care, cost, expense

Large, single-specialty cardiology practices were not uncommon during the 1990s and early 2000s, but that changed over the past decade as hospitals and health systems have purchased cardiology practices, directly employed cardiologists, and entered into professional services agreements (commonly referred to as “PSAs”) with cardiologists. The migration of private practicing cardiologists to hospitals was caused in large part by the significant site-of-service fee differential between the reimbursements to hospital outpatient departments (HOPDs) and the reimbursements for identical services furnished in an independent physician’s office or ambulatory surgery center (ASC).

During the past 10 years, the primary vehicles for physician alignment with hospitals have been employment agreements, whereby the physicians are employees of the “captive” or “friendly” medical practice; or PSAs, whereby hospitals provide administrative services to physician practices, and the practices remain independent. In this model, practices can access some of the advantages of employed physicians – most notably, the hospital’s favorable payer contracts.

According to a recent opinion piece in The Wall Street Journal “Medicare has paid hospital outpatient departments nearly twice as much as it pays independent physicians or ASCs for the same services. Even off-campus facilities, which are hospital-owned but otherwise identical to independent physicians, have until recently enjoyed higher rates.”

There has been a major push for site-neutral cardiac testing payments in order to migrate more services to outpatient settings. This shift could reportedly reduce Medicare spending by more than $150 billion in the next decade and reduce beneficiary spending on premiums and cost-sharing by more than $90 billion during that time. It is remarkable that such dramatic savings may be achieved without reducing the breadth of services or otherwise compromising the quality of care. As an increasing number of Baby Boomers retire and enroll in Medicare, the corresponding economic burden on the Medicare Trust Funds necessitates these kinds of value-based cost-saving measures.

This shifting of services to outpatient settings will likely cause hospitals to unwind their contractual relationships with cardiologists, sending the physicians back into private practice. Indeed, we have observed this process beginning with some of our clients already. Unwinds present several challenges, including but not limited to the fact that the cardiologists transitioning back to private practice no longer have their own Tax Identification Numbers (TINs) and payer contracts. In light of these logistical challenges and as a longer-term survival strategy, we are likely to see a reconstitution of large cardiology practices, this time with the potential for private equity participation.

Until recently, there were few private equity opportunities for cardiology practices, but that could change relatively quickly. In the Wall Street Journal’s opinion piece, authors Neil M. Gheewala and Bobby Jindal noted: “Cardiac care is on the cusp of a major transformation, but hospitals need not be left behind.” Astute hospital administrators will have already anticipated the migration of cardiologists away from hospital inpatient care and started to prepare for a different type of alignment with cardiologists. We anticipate significant opportunities for single-specialty and/or multi-specialty roll-ups in which an investor, such as a private equity firm, purchases multiple medical practices and combines them into a larger practice.  We also expect that Management Services Organizations (commonly referred to as “MSOs”) will continue to be utilized to achieve economies of scale in the furnishing of administrative services to practices.

Experienced health care attorneys who have represented both private practitioners and institutional providers throughout dynamic changes in the healthcare landscape can lead this transformation, working with various stakeholders to develop and implement mutually beneficial alignment models, while ensuring compliance with applicable laws and regulations.

Photo: eakrin rasadonyindee, Getty Images

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Report: Cancer deaths are down but pancreatic cancer is growing, racial disparities persist

by Bailey Amber
written by Bailey Amber

Cancer death rates are coming down for adults and children, and the declines are steepest in some of the most commonly diagnosed types of cancers. However, pancreatic cancer stands out as one of the few cancer types whose incidence and death rates are on the rise.

The findings come from the Annual Report to the Nation on the Status of Cancer, a document compiled by the National Cancer Institute, the Centers for Disease Control and Prevention, the American Cancer Society, and the North American Association of Central Cancer Registries. Those entities have collaborated on the annual report since 1998. The most recent data for this year’s report are from 2019; the findings are based data from before the COVID-19 pandemic. The report was published in the journal Cancer.

Let’s start with the declines. From 2015 to 2019, cancer death rates in men decreased by 2.3% per year, according to the report. In women, death rates decreased by 1.9% per year. The recent reductions observed in cancer deaths was driven by declines in lung cancer mortality, the report said. Lung cancer and melanoma together saw the declines in both men and women.

Declines in lung cancer incidence and deaths were attributed to continuous declines in smoking as well as better treatments, specifically advances in targeted therapies and immunotherapies for non-small cell lung cancer (NSCLC). AstraZeneca’s Iressa became the first targeted therapy approved for NSCLC in 2003 leading the way for other targeted therapies to pass regulatory muster, followed by the class of cancer immunotherapies called checkpoint inhibitors.

Non-treatment variables that may contribute to the declines in lung cancer deaths include improved access to care following the expansion of Medicaid to a broader group of low-income adults starting in 2014, the report said. Another factor is the increase in screening, which in turn leads to earlier diagnosis. Despite this progress, the report notes that lung cancer remains the most common cause of cancer death across racial and ethnic groups and the more than 30 million adults who smoke cigarettes.

In adolescents and young adults, defined as ages 15 to 39, the report states cancer incidence rates increased by less than 1% per year from 2014 to 2018. The most common type of cancer in this age group was female breast cancer; next was thyroid cancer.

In some cancers, the death rates are climbing. In men, the report shows an increase in death rates for cancers of the pancreas, brain, and bones and joints. In women, death rates are increasing for cancers of the pancreas and uterus. Pancreatic cancer accounts for just 3% of new cancer diagnoses. Despite the rareness of this type of cancer, it leads to 8% of cancer deaths, making it the fourth-leading cause of cancer deaths for males and females, the report said.

From 2001 to 2018, the incidence of pancreatic cancer increased by 1% per year in men and women; death rates increased by 0.2% per year, according to the report. Two of the most common subtypes of pancreatic cancer are neuroendocrine tumors and adenocarcinomas. Both types increased in men and women from 2001 to 2018.

Despite those increases, the analysis also found survival improvements according to subtype. In pancreatic neuroendocrine tumors the report found that one-year survival increased from 65.9% in 2001 to 84.2% in 2017. For those diagnosed with pancreatic adenocarcinomas, one-year survival rose from 24% to 36.7% in the same time span. Survival also increased at the five-year mark. These survival improvements may be due to improvements in therapy. However, no improvement was seen for other types of pancreatic tumors, which were mostly diagnosed in older adults.

Racial disparities persist for some types of cancer. While the incidence rates for bladder cancer declined in Whites, Blacks, Asian/Pacific Islanders, and Hispanics, the report found rates increased in American Indian and Alaska Native people. The incidence of uterine cancer was similar in Black and White women, but the death rates from this type of cancer are nearly twice as high in Black women. For breast cancer, the death rate for Blacks is 40% higher than it is for Whites.

“The highest breast cancer death rates seen among Black females are partially caused by the significant barriers to providing access to timely, high-quality medical care, which require addressing multiple dimensions of disparity across the continuum of cancer care,” the report said.

Photo: nopparit, Getty Images 

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Self Care

Investing in social services will improve population health, execs from Kaiser & Mass General Brigham say

by Bailey Amber
written by Bailey Amber

Health maintenance is in some ways overmedicalized in the U.S., executives from major health systems said Thursday at Reuters’ Total Health conference in Chicago. 

The panelists agreed that treatments and procedures aren’t the only ways to support patients’ health and said that providers would be wise to place more emphasis on integrating social services into their care models.

“We fail at delivering some of the most basic care compared to other countries in the world — we are on the bottom of almost every indicator of health,” said Dr. Lindsay Jubelt, chief population health officer at Mass General Brigham. “And a lot of that is because we’ve over-invested in our healthcare systems and under-invested in our communities.”

As the healthcare industry begins to focus more on addressing social determinants of health, Dr. Jubelt urged health systems to spend more time advocating for funds to be sent to community partners and social programs, such as those focusing on healthy food distribution or improving air quality.

She pointed out that investments in social services have been proven to positively impact health outcomes.

“Countries that spend more on social services than healthcare have better health outcomes,” Dr. Jubelt said. “And then it’s true within the United States — states that spend more on social services than healthcare have better outcomes. We need to think about how we can solve that problem by being healthcare institutions and being advocates — the dollars going to the right place can really help our communities.”

Dr. Andrew Bindman, Kaiser Permanente’s chief medical officer, concurred. He encouraged health systems to not only make investments in social programs, but also integrate them into care delivery.

For example, Kaiser Permanente created a tool called Thrive Local, a platform that lets patients know what community resources are available to them. Physicians can also pull up the tool during appointments, just as they would with a prescription, and connect patients to resources in their neighborhood.

“It’s key not only to have these investments, but to make them integrated with how we’re delivering care so that we’re then in a position to be able to also see the value that has returned in terms of health outcomes,” Dr. Bindman said. “These could be differences like reducing cardiac events, cancer events and so forth — events we know are highly related to social causes.”

The U.S. healthcare needs to create payment models that allow providers to test different kinds of interventions and then measure health outcomes, Dr. Bindman declared. Once there is data within the EHR that validates the impact that social interventions have, he said there will be “very good reasons to believe” that community investments return critical value.

“We need a payment model that gives us the flexibility to ask ‘Is it better for us to think about providing an additional CT scan, or would it be better to invest in providing stable food for this patient with diabetes so that they can control their sugar more effectively and reduce the risk of getting a disease or needing an amputation down the line?’” Dr. Bindman said.

Community investments that focus on addressing social determinants of health is something Kaiser Permante is leaning “heavily” into, according to Dr. Bindman. Another example of a related program at the health system is its recent $50 million pledge to battle food and nutrition insecurity.

Photo: MedCity News

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