Hospital Consolidation: Can It Work This Time?

One of the consequences of the Affordable Care Act (ACA) is that it has sparked a giant wave of hospital consolidation: 100 deals were completed in the sector in 2014 — up 14% from the previous year, according to Wall Street research firm Irving Levin Associates.

What’s particularly notable about the recent spate of M&A is that it’s both “horizontal” and “vertical,” meaning hospitals aren’t just buying other hospitals, they’re picking up physician practices, rehabilitation facilities and other ancillary health care providers. Consider New York’s North Shore-LIJ, for example. Its aggressive M&A plan has turned it into the state’s largest employer, encompassing 18 hospitals, plus rehab centers, a medical research center, home-care services and hospice facilities. And last year it began offering health coverage through its own insurance company, CareConnect.

Wharton’s health care experts predict the trend of hospital consolidation will continue at a fast clip, particularly as health systems set up more and more Accountable Care Organizations (ACOs) in response to the ACA.

Full details: http://knowledge.wharton.upenn.edu/article/hospital-consolidation-can-it-work-this-time/

Key Trends Facing Private Practice Physicians in the New Year Identified

Physicians in private practice have their non-clinical work cut out for them in the year ahead. Results of the ACA changes, the launch of the federal and state health insurance market places, demanding paperwork burdens, and coming changes in coding requirements and health IT are all issues facing the physicians in 2014.

Among the key trends that seen to be bearing down on practicing physicians are:

 –  Rapidly increasing medical consolidation seen across health care systems and insurance companies alike.

–   The difficulty physicians experience while trying to negotiate favorable terms with payers because  the total number of health insurers has been decreasing for some time as a result of industry consolidation.

–   Physicians are continuing to struggle with a growing regulatory paper work burden.

In addition the recent launch of the health insurance exchanges is already driving high levels of confusion among patients, physicians and employers.

Coping with minimal education and support on the new health insurance exchanges from the government, many private practice physicians are unsure of how these new insurance policies will affect their practices. Continue reading

Model of Highly Coordinated Care Begun By Aetna, Baptist Memorial Health Care

Employers and their workers will get access to what is described as highly coordinated care from physicians and facilities in the Baptist Select Health Alliance, under terms of a collaborative care agreement between Aetna and Baptist Memorial Health Care,  Memphis.

Aim of the collaboration is to bring a “new health care model” to Aetna members and introduce Aetna Whole HealthSM, a commercial health care product, officials said.

The Baptist Select Health Alliance is a clinically Continue reading

Physician Turnover Increases; Competition, Pace of Turnover and Retirements Expected to Increasee

Medical groups reported an average turnover rate of 6.8 percent in 2012, according to the 8th annual Physician Retention Survey.

Likewise, there was turnover of 11.5 percent among advanced practice clinicians (APCs), which includes physician assistants and nurse practitioners, found the survey by Cejka Search and the American Medical Group Association (AMGA). Continue reading

Accountable Care Organizations Getting More Scrutiny

A number of independent practice associations (IPAs) and other physician organizations – PHOs, multi-specialty medical groups and hospitals have created new accountable care organizations.

Because we produce the National Directory of Physician Organizations, we naturally are following ACO developments.

ACOs are very much top-of-mind as ACO numbers grow. And with that awareness comes increased attention. Continue reading

Physicians Need To Adapt and Develop A Vision For the Future, IPA-PHO Survey Finds

The resurgence of hospitals buying physician practices, the shortage of primary care physicians, contract and reimbursement models, market consolidation and the pressure to transform primary care practices are among the key issues the leadership of the nation’s physician organizations – PHOs and IPAs are keenly concerned about.

The issues emerged from the results of the IPA -PHO Physician Organization Leadership Survey 2012 by the Managed Care Information Center (MCIC.) Continue reading

Health Systems Seen Needing New Strategies to Reorganize Delivery Models

To succeed in this new post-health reform arena, Health systems should prioritize information technology infrastructure development, information sharing, and timely distribution of information to ensure outstanding patient care, prepare for a patient-centered medical home and bundled payment system, and move toward best practice levels of care coordination, according to Health Strategies & Solutions, a Philadelphia-based consulting firm.

“The Supreme Court decision to uphold the major provisions of the ACA launches a new era in health care in the United States. Development of a robust foundation of primary care services must move to the forefront of strategic priorities for all health care providers,” the firm, with offices in a number of states, says in a white paper.

According to the firm’s white paper “Primary Care In An Era of Healthcare Reform” health care organizations that  Continue reading

SCOTUS Decision From the Payer and Provider Perspective

By Bob Jenkins

All sides of the health industry universe had ‘skin in the game’ riding on the US Supreme Court decision announced today.

“Health-Care Industry Gains Clarity” was the Wall Street Journal headline.

The upshot for the health-care industry: an influx of more than 30 million newly covered people with the means to pay for care. But there is also a cost, with an array of cutbacks to government reimbursement, new fees and taxes, and pressure to move to new payment models that boost efficiency and quality.

The court’s decision may also spark an effort to “get a bit more realistic about what can happen in the time frame” set out by the law, said Vicky Gregg, chief executive of BlueCross  BlueShield of Tennessee. Many states have stalled on implementing key provisions of the federal law, including the creation of the new marketplaces, known as exchanges, where consumers and small businesses will be able to buy health plans. http://online.wsj.com/article/SB10001424052702304441404577479042245939300.html

American College of Cardiology

“As we sort through the ramifications of this decision, it is important to remain focused on patients and overall health care delivery,” commented American College of Cardiology President William Zoghbi, MD, FACC, following the decision. “The goal should be a sustainable health care system that rewards quality and that allows physicians and their patients to determine together what is the most appropriate care. The American College of Cardiology believes a system that measures performance and rewards quality is the best way to improve public health and reduce costs.”

Hill Physicians Medical Group

The U.S. Supreme Court ruling is one that “clears away doubt, ” said Darryl Cardoza, CEO of Hill Physicians Medical Group, believed to be the largest IPA in the U.S.

“Over the last two years, many healthcare organizations have been working to respond to the new environment created by the reform legislation,” said  Cardoza.

“All that work has been done under a cloud of uncertainty about whether the law would be upheld. Today’s court ruling clears away that doubt. Everyone in health insurance and healthcare delivery now shares a common understanding of what’s expected.

It’s gratifying to know that millions more Americans soon will have access to care, and that doctors, hospitals, plans, employers and consumers now can work together to create more affordable care for everyone.”

AHIP

Maintaining the link between market reforms and universal coverage is essential to avoiding significant cost increases and loss of choice for consumers and employers, said America’s Health Insurance Plans’ (AHIP) President and CEO Karen Ignagni.

“As the reform law is implemented, health plans will continue to focus on promoting affordability and peace of mind for their beneficiaries.  The law expands coverage to millions of Americans, a goal health plans have long supported, but major provisions, such as the premium tax, will have the unintended consequences of raising costs and disrupting coverage unless they are addressed.

“Health plans will continue to work with policymakers on both sides of the aisle to make coverage more affordable, give families and employers peace of mind, and promote choice and competition.  Health plans also will continue to lead efforts to reform the payment and delivery system to promote prevention and wellness, help patients and physicians manage chronic disease, and reward quality care.”

Medicaid Health Plan Industry

“We commend the Supreme Court for keeping in place key elements of this historic legislation. MHPA and its member health plans remain committed to a strong partnership with the states and CMS to find a way to cover this population in need,” said Thomas L. Johnson, president and CEO of Medicaid Health Plans of America (MHPA).

The Medicaid health plan industry has been growing and will continue to grow as states continue to see Medicaid health plans as part of the solution to their budget woes, whether or not they participate in the expansion of Medicaid.

“We are pleased that the Medicaid drug rebate equalization policy included in the ACA remains intact. This provision that extended rebates to pharmaceuticals provided to Medicaid managed care enrollees represents a tremendous improvement in the administration of state Medicaid programs. The result will be improved care coordination and quality of care for beneficiaries enrolled in Medicaid health plans.

What the Supreme Court decision means for insurers, hospitals and drugmakers

Major health insurance stocks plummeted right after the ruling but have been edging upwards over the morning. That might reflect the market girding for the individual mandate being overturned (earlier this morning, InTrade had pegged the odds at 79 percent). That didn’t happen though – and that likely has insurance companies breathing a sigh of relief.

The big fear on the part of health insurance companies was that the individual mandate would get overturned, and people would only buy health insurance when they needed it. That would cause premiums to rise and enrollment to shrink.

Stocks of major hospital companies spiked after the Supreme Court decision, and with good reason: For decades they have been the ones who have covered the costs of providing health care to the uninsured. A federal law requires emergency rooms to provide stabilizing care to anyone whose life or bodily function may be threatened. It’s hospitals that often get stuck with that bill.

The Affordable Care Act will change that by expanding health insurance to about 30 million more Americans and making insurance companies responsible for paying their bills.

Pharmaceutical companies may be one of the industries least impacted by today’s news. About 4 percent of the industry’s revenue over the next eight years depends on the Affordable Care Act, according to the Bloomberg Government report.

Source Washing Post Wonk Blog http://www.washingtonpost.com/blogs/ezra-klein/wp/2012/06/28/what-the-supreme-court-decision-means-for-insurers-hospitals-and-drugmakers/

From US News
The Unintended Consequences of the Supreme Court’s Decision

The Supreme Court settled one matter when it upheld the Patient Protection and Affordable Care Act: President Barack Obama’s landmark health reform law is constitutional and will go into effect as originally planned.  But a wide range of unintended consequences could ripple outward from the court’s historic decision.

  • Economic issues take a back seat
  • Consumers end up even more confused
  • Americans trust government even less

http://www.usnews.com/news/blogs/rick-newman/2012/06/28/the-unintended-consequences-of-the-supreme-courts-healthcare-ruling?google_editors_picks=true

Stocks of hospital companies rose sharply, and insurance companies fell immediately after the decision was announced that Americans must carry health insurance or pay a penalty.   http://www.gazette.com/articles/high-140946-ruling-care.html#ixzz1z7EGSLFi

Bob Jenkins is CEO of the Managed Care Information Center

Almost Half of U.S. Physicians Are on Medical Staffs of the Nation’s Healthcare Systems Hospitals

Some 439,269 physicians are members of the medical staffs of the nation’s largest hospital organizations, Managed Care Information Center research has found.

The figure represents 46 percent of the 954,000 U.S. physicians which the AMA cites as the number of doctors in the country.

Among the physicians almost 260 thousand are primary care physicians and 179,568 are specialists, found the review of the National Directory of Health Systems, Hospitals and Their Affiliates database.

The National Directory of Health Systems, Hospitals and Their Affiliates Database is researched, compiled and produced by the Managed Care Information Center.

The database focus is on the largest hospital operators in the country – the health systems.

The database provides key contact information, names, addresses and other details on the more than 750 major health systems in the United States, the almost 3500 health systems hospitals and more than 12,000 hospital system affiliated provider organizations.

We find the health system affiliates are continuing to grow in numbers.

The system affiliations includes: hospitals, medical centers, community care centers, hospices, nursing homes, ambulatory care centers, clinics, surgical centers, imaging centers, wellness and health promotion programs, and other providers of healthcare.

We believe that the list of affiliates provides sound information for sizing a market area and the health systems impact in a market area.

Information on The National Directory of Health Systems, Hospitals and Their Affiliates is found at: www.healthresourcesonline.com/managed_care/17idse.htm

 

 

 

New Physician Organization Leadership Survey Seeks Insight – Opinion

The Managed Care Information Center periodically conducts our Physician Organization Leadership Survey to identify the issues, challenges and opportunities today for physician organizations.

We are seeking survey responses from those engaged in the management and administration of or who are members of such physician organizations as IPAs, PHOs and MSOs.

For your participation in this brief survey, we will send you free an executive summary of the analyzed results.

What are the ‘looming’ challenges? Any opportunities? What is the most pressing concern from your perspective?

The survey only takes a few moments. You do not have to identify yourself if you choose.

As you know, survey results are reported in the Managed Care Information Center reports, in our Managed Care Weekly Watch, as well as the MCIC Blog, Facebook and Twitter and are posted at our website.

To participate in this survey, go click on this link now: http://bit.ly/JhFn9o

If you are connected with executives of members of PHOs, IPA or MSOs, please let them know about this survey.