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7 ways physicians can improve health care quality

7 ways physicians can improve health care quality | Healthcare and Technology news | Scoop.it

Patients want to receive health care that is of the highest quality. Physicians want to provide it. But what is “high-quality health care?” On that, few agree.


Ask most Americans and they’re unsure where to find it. They know they want to be kept healthy, have rapid access to personalized care whenever they need it and be charged only what they can afford.

Ask the leaders of the national medical and surgical societies, and they are likely to define quality as having access to the latest — and often the most richly reimbursed — procedures, diagnostic imaging, and genetic testing.

Ask physicians themselves and, well, they’re already overwhelmed by the exponential growth in clinical measures of quality developed for public and private pay-for-performance formulas.


Even so, medicine is coming closer to a definition of high-quality health care — and also to a system for evaluating how physicians and medical groups perform. The Institute of Medicine (IOM), a highly regarded independent organization established by Congress to advise on health care issues — the gold standard on improving our nation’s health – recently released a report: “Vital Signs: Core Metrics for Health and Health Care Progress.”


The IOM panel of experts identified 15 measures, narrowed down from hundreds, with the best potential for improving health, including reducing the overall rate of preventable deaths.The consensus: If the U.S. systematically raises its performance in each of these 15 domains, the quality of life for millions would improve dramatically.


This IOM report is important, even though it received surprisingly scant media attention. It should serve as a starting point and a road map about how clinical practice can most effectively lift the quality of care delivered to patients.

But let me come back to the report itself in a minute.


The quality conundrum


A little context about the issue of quality might help here. At last count, the number of health care quality measures in place was in the thousands. The Joint Commission has 57 just for inpatient care at hospitals. The Healthcare Effectiveness Data and Information Set has about 81. The National Quality Forum currently endorses more than 630. The Centers for Medicare & Medicaid Services has no fewer than about 1,700.


That may explain why keeping track is such a challenge for all parties involved.


Perceptions of quality are of course subjective. According to the Merriam-Webster Dictionary, quality is “how good or bad something is; a characteristic or feature that someone or something has; a high level of value or excellence.” The Oxford Dictionary says quality is “the standard of something as measured against other things of a similar kind; the degree of excellence of something” It cites this example: “The hospital ranks in the top tier in quality of care.”


The upshot here is a paradox: a definition that is itself ill-defined – and as such, leaves plenty of uncertainty and doubt.


7 actions physicians can take


That’s why the IOM report is so valuable and welcome. It cites 15 “vital signs,” but let’s focus on the seven that relate to direct health care delivery and better care for patients.


1. Overweight and obesity. Physicians should help their patients exercise regularly, eat a healthy diet and maintain their weight within a normal range. More than two-thirds of Americans are overweight or obese. Specifically, physicians can make diet and weight management a vital sign and counsel every patient on the options available.


2. Addictive behaviors. Eliminating smoking and alcohol abuse, along with reducing the percentage of people who are overweight, would dramatically lower the incidence of diabetes, lung cancer, and cardiovascular disease. Physicians should engage and educate patients about approaches to take to quit smoking and alcohol abuse, and provide advice and resources toward that end. Today, addiction to nicotine, alcohol, opiates and other psychoactive drugs continues at unacceptably high rates.


3. Preventive services. Physicians should urge patients to take the recommended screening tests and stay current on their vaccinations. Preventive screenings alone could dramatically lower the risk of dying from cancer, heart disease, and strokes.


Combining this with smoking cessation and exercise could help avoid 200,000 heart attacks and strokes in the U.S. each year, and reduce the mortality from cancer by tens of thousands yearly, based on an internal analysis done by The Permanente Medical Group’s Division of Research.


Screen for colon cancer in fewer than 50 percent of patients, rather than in 80 percent to 90 percent, and you double the chances of dying from an invasive adenocarcinoma. Smoke at the national average of 18 percent, rather than at under 10 percent, and you dramatically increase lung cancer, emphysema, and heart attacks.


Preventive services present a valuable opportunity for both improving health and reducing health expenditures.


4. Patient safety. Physicians and nurses can, through rigorous practice, help patients avoid hospital-acquired infections, pressure ulcers, medication errors and wrong-site surgery. Even a decade after the 1999 IOM report, “To Err is Human” — with its estimate that 100,000 patients die each year from medical errors, the equivalent of a jetliner crashing each day — these so called “never events” still occur too frequently.


And when patients develop infections like sepsis, or suffer an adverse drug reaction, they face a higher chance of dying in the hospital, and experiencing problems long after hospital discharge. Avoiding harm has been a core value of the medical profession from the time of Hippocrates, and is “first among equals” when it comes to the principal responsibilities of the health care system. Yet medical errors with adverse outcomes are still far too common.


5. Unintended pregnancy. Physicians should take the opportunity to focus on ensuring the health of an expectant mother in order to increase the chances for a healthy baby and safe delivery, whether a pregnancy is unintended or the result of careful planning.


An estimated 50 percent of pregnancies in the US are unplanned, and occur in women across the spectrum of child-bearing years, and among women in every socioeconomic demographic. Unintended pregnancy results from social, behavioral, cultural, and health factors, including — and perhaps most especially — women’s lack of knowledge about and access to tools for family planning.


Research has demonstrated that medical care soon after conception is critical, and identified ways to reduce the risks of a maternal or fetal complication. Good nutrition, along with avoidance of drugs, alcohol and cigarette smoke, are essential. After birth, comprehensive medical care and early diagnosis of problems can prevent longer-term health problems and future complications.


6. Access to care. Access to health care is one of the most powerful determinants of clinical outcomes. The ability to access care when needed is a vital precondition for a high-quality health system.

Physicians in integrated, multi-specialty practices have advantages in ensuring patients get all the care needed thanks to comprehensive electronic health records. But in today’s fragmented health care system, with close to 15 percent of the population still uninsured, health care still remains beyond the reach of all too many Americans. Policy makers are relentlessly pursuing affordable access.


7. Evidence-based care. Physicians should see to it that patients receive medical care based on the most current scientific evidence for what is appropriate and effective, rather than on an anecdote or an “in my experience” approach. Physicians working in hospitals with electronic health records can do so, deciding about care according to scientifically validated protocols for complex problems like heart attacks, strokes, and hip fractures.


In the not-too-distant past, when physicians lacked many of the current diagnostic tools and access to sophisticated information technology, medical practice was far more art than science.


Even today, variation in how physicians treat patients with the same problem is unwarranted, and leads to system-wide under performance and less-than-optimal clinical outcomes.


Fortunately, medical practice today is far more science than art.


What patients should do


The best quality, then, according to the IOM, is not based on using a robot, providing transplantation or completing genetic sequencing. The reality is that, contrary to what some might assume, these often advertised technologies have minimal impact on mortality.


And quality is not a result of individual technical excellence in performing procedures such as heart surgery, neurosurgery or hip replacement surgery. The variation from surgeon to surgeon is far less than people assume. In fact, many health care experts now perceive overuse of these high-intensity surgical interventions to be a problem that sometimes results in associated complications and minimal improvements in clinical outcomes.


The list, in short, is more practical than exotic or “sexy,” offering the interventions which have the greatest impact on human life.

The IOM committee concluded that leadership “at nearly every level of the health care system” will be required to adopt, implement, refine and maintain these core measures. And among the many stakeholders, physician leadership will be key.


Patients should make health choices based on these 15 vital signs from the IOM. They enable people to distinguish the most important quality measures from all the “noise” about what are the newest and most exotic tools and approaches available. More specifically, patients would be wise to select a personal physician or medical group whose practice philosophy incorporates these approaches — and whose clinical results in each area are superior.


We physicians are obligated to heed the IOM recommendations on behalf of our patients, the better to fulfill health care’s promise of easing suffering and extending lives. This is where American health care should invest its efforts. The IOM is a gift to both physicians and patients. Taking our eyes off what will most impact the health of all would be a mistake our nation can ill afford.

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The Hidden Side of Health Care: How Rural Pennsylvania Is Facing and Overcoming Obstacles

The Hidden Side of Health Care: How Rural Pennsylvania Is Facing and Overcoming Obstacles | Healthcare and Technology news | Scoop.it

Although Pennsylvania is the sixth most populous and ninth most densely populated state in the Union, based on information from the United States Census Bureau from 2010 and 2013, it also is home to a significant amount of rural areas. According to the Pennsylvania Rural Health Association, 48 of the 67 counties in the state are classified as rural, and all but two counties have rural areas. Approximately 27 percent of Pennsylvanians lived in rural counties in 2010, The Center for Rural Pennsylvania reports.


Although rural living offers many advantages, according to the National Rural Health Association (NRHA), rural healthcare in America faces challenges not seen in urban areas. Population loss, poverty and access to healthcare have been problematic in recent years. Here are just a few of the initiatives that have been launched to improve the health needs and overall well-being of rural Pennsylvanians.


Healthcare Issues in Rural Pennsylvania


In general, rural residents in the U.S. are less healthy than those in urban environments. According to Unite for Sight, “rural residents smoke more, exercise less, have less nutritional diets, and are more likely to be obese than suburban residents.” Already against the odds, residents in rural Pennsylvania face several specific problems that jeopardize the state of healthcare in the area.


Population Loss


Between 2000 and 2010, Gary Rotstein of the Pittsburgh Post-Gazettereports, rural Pennsylvania counties grew by 2.2 percent while urban counties grew by 3.9 percent. However, the small increase in rural counties was only due to eastern counties. Western rural counties decreased by 0.9 percent, and by another 0.5 percent from 2010 to 2012.


In some places, the situation is bleak. Rotstein highlights the population loss in Taylor Township, a part of Lawrence County that experienced a 13.6 percent population loss from 2000 to 2010. “Of its 1,052 residents, more than twice as many are over age 65 as under 18,” Rotstein adds. “That ratio is practically unheard of among municipalities and doesn’t bode well for the township’s future.”


For rural areas where population is declining or (slowly) rising, healthcare faces challenges. Economic opportunity is threatened when workers and students pursue a better future. And when healthcare professionals depart, accessibility is undermined. In addition, communities with a disproportionately older population can require more healthcare resources, at the same time as access is dwindling.


Economic Challenges


According to the Rural Assistance Center (RAC), rural Pennsylvania lagged behind urban areas in poverty, unemployment and income for 2013:


14.3 percent poverty rate; 13.6 percent in urban areas

7.9 percent unemployment rate; 7.3 percent in urban areas

$36,099 per-capita income; $46,202 for the state

The Center for Rural Pennsylvania adds that from 2007 to 2011, 39 percent of rural households had incomes below $35,000.


Access to Healthcare


Rural Pennsylvania also has less access to healthcare than is available in urban areas. The Center for Rural Pennsylvania reports that in 2008, rural counties had just one primary care physician for every 1,507 residents, while urban counties had one physician for every 981 residents. In 2009, rural counties had one practicing dentist for every 2,665 residents, while urban areas had one for every 1,845 residents.


Solutions and Initiatives


In response to some of the healthcare challenges facing residents in rural Pennsylvania, the following solutions and initiatives have been developed.


Telehealth


Based on a 2014 research report from The Center for Rural Pennsylvania, telehealth can promote strong health to reduce chronic conditions and diseases, educate the public and healthcare workers, enable senior citizens to remain in their homes and much more. Using videoconferencing, online remote monitoring and diagnostic scans, electronic health records and other tools, telehealth can help providers give high-quality, affordable and accessible healthcare even in remote locations.


The study estimated that telehealth’s universal implementation would result in a 22 percent savings for the first year, increasing to 66 percent for the 20th year. Instead of a healthcare cost of $25,500 per person each year, the cost would be just $8,500; Pennsylvania would save $194 billion in the 20th year of implementation. Not only would the healthcare be less expensive, it would also be higher quality.


Currently, telehealth in rural Pennsylvania is not widely used and quality is poor. However, investing in the infrastructure and getting more healthcare providers on board can help improve the quality and access to this care, giving rural residents the chance to experience affordable, quality healthcare.


Rural Healthcare Funding


Federal programs are available to help rural areas across the country improve healthcare delivery. One example is the Rural Health Care Coordination Network Partnership Program, which supports organizations that are trying to improve the outcomes chronic diseases, specifically chronic heart failure (CHF), chronic obstructive pulmonary disease (COPD) and Type 2 diabetes. It awards up to $200,000 per year for three years to qualified rural health networks.

These types of programs can help overcome the economic disparity that most rural communities faced, compared to urban areas.


The Office of Rural Health Policy (ORHP), part of the Health Resources and Services Administration (HRSA), offers other grant programs and initiatives to help support healthcare in rural areas across the country.


Expanding the Scope of Healthcare Workers


The need for more accessible healthcare is not just an issue in rural areas. According to the HRSA, there is a projected shortage of 20,400 primary care physicians across the U.S. for 2020, if the current system remains unchanged. To counter this trend, the HRSA projects the number of nurse practitioners and physician assistants to increase.


Nurses are expected to play an integral role in meeting the need for increased healthcare practitioners. In 2010, the Institute of Medicineannounced that nurses would need to respond to the changes taking place in the healthcare system, which gives nurses more opportunities to provide quality care. It called for higher education standards, including 80 percent of all nurses to hold bachelor’s degrees. To meet these needs, nursing is growing quickly; the Bureau of Labor Statistics already expects the profession to grow by more 19 percent through 2022, making it one of the fastest growing professions in the country.


In rural Pennsylvania, a higher concentration of educated nurses could help make up for this shortage of physicians and the changes taking place in the healthcare system.

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In Colorado, a Collaboration Around Healthcare Technology

In Colorado, a Collaboration Around Healthcare Technology | Healthcare and Technology news | Scoop.it

Across the country, technology and clinical leaders are figuring out ways to try to promote greater interoperability of healthcare data. For seemingly everyone, it’s been an uphill climb and a steep learning curve. In the U.S., there have been pockets of success; some states are at the forefront of true data exchange, while others aren’t quite as mature.


 In one of these pockets is Colorado, where the Denver-based Colorado Regional Health Information Organization (CORHIO) recently announced that its health information exchange (HIE) has grown in number of users by 111 percent, with the amount of data available in the network having grown by 118 percent in the past year. That marks the third consecutive year of triple-digit growth rates for the organization, which, as of a few months ago, encompasses 5,705 active providers/users, 47 connected hospitals, and with more than 223 million clinical messages having been sent.


To this end, also in Colorado are the Englewood-based Centura Health (with hospitals also spanning across Western Kansas) and the Aurora-based University of Colorado Health (UC Health), two organizations that will be represented at the iHT2 Health IT Summit in Denver on July 21 (the Institute for Health Technology Transformation, iHT2, is a sister organization of Healthcare Informatics under our corporate parent organization, the Vendome Group LLC). At the conference will be a panel on “Strategies to Advance Interoperability,” where Steve Hess, CIO at University of Colorado Health and Dana Moore, senior vice president/CIO and managing director, service center, at Centura Health, among others, will address the most effective models and mechanisms for exchanging data.


In Aurora, University of Colorado Health came together as a unified system about three years ago when all of its IT components collapsed into one core set which included the Verona, Wis.-based Epic Systems as the organization’s core electronic health record (EHR), Hess says, who says the health system’s HIE strategy is multi-faceted. “We do offer hosting Epic for independent community practices that want to use our EHR for their own continuity of care and clinical collaboration needs,” Hess says. “We also use a built-in HIE, Epic’s Care Everywhere, to exchange records, and that works very well for Epic-to-Epic health information exchange. We have exchanged records with systems in all 50 states using that methodology,” Hess says.


UC Health is also a part of CORHIO, and that’s where a lot of statewide collaboration has occurred. “There is exchange of not only demographics, labs and discharge summaries, but also immunization and public health interfaces through the HIE,” Hess says. “We are on a journey of health information exchange, and we’re fairly early on that journey. Exchange is happening but the next generation functionalities of orders and results, exchanging CCDs (continuity of care documents), things like that, are still in the early stages,” he says.  “In the meantime, we collectively look at technology not as a competitive advantage but a way to help patient care, doctors, and nurses across the state and beyond. We know our organizations will compete in terms of quality and service and other things, but we’re trying out best not to compete with technology.”


Meanwhile, at Centura Health, Moore says that the organization initially started its own private HIE in 2005 with a company that is now part of Cerner’s arsenal, but wasn’t even an established vendor at the time. Once CORHIO came around, however, Centura quickly migrated over. “We didn’t want to have a competing product and wanted to promote collaboration within the state. When CORHIO was in its infancy, Steve [Hess] and I were frequently helping them build its model,” Moore says. Then, in 2006, Centura installed the Westwood, Mass.-based MEDITECH EHR across its acute care facilities first, eventually expanding into ambulatory and home care. Now, Centura, which did receive Healthcare Information and Management Systems Society (HIMSS) Stage 7 designation, is in the process of switching over to Epic, Moore notes.


Bringing the Data to the Doctor


For both UC Health and Centura, the key to successful health IT adoption and electronic data exchange is that this time around, the HIE brings data into the physician’s workflow so he or she doesn’t have to leave that workflow to see the data. “Success is always relative, and one of the big issues with HIE in Colorado five or 10 years ago was workflow,” Moore says. “Clinicians had to go out of their workflow and try to find the patient. From a user standpoint, it wasn’t successful. The advancements we made getting HIE in their workflow have proven that we are leaps and bounds from where we were,” he says.


Hess agrees that keeping clinicians in the workflow that they use predominantly is crucial. “With CORHIO’s and Epic’s tools, the idea is to bring the data within the workflow of the doctor rather than make them go out of it. There has been a lot of interface work around that,” he says. As such, UC Health has approximately 800,000 records exchanged electronically each year, Hess says, noting that examples of the data being exchanged include complete patient records, CCD summaries, electronic lab results, and immunization and syndromic surveillance exchange.


Despite successes at both organizations, Hess and Moore understand that there is still a ways to go before true interoperability is achieved. For one, Hess says that not having universal patient identifiers will continue to be a struggle for everyone. “A big part in what all these things require is knowing which patient is which,” he says. “Having to pull our different medical record and encounter numbers and hope/make sure that we’re sending data on the right patient is a struggle that might never be solved in our lifetime.”


Hess adds that if you think about the old way of exchanging records where one facility called another and got a 36-page fax of patient data sent over, oftentimes the person trying to pull the clinically relevant data from that fax wasn’t the doctor. “As a result, sometimes that data would go ignored,” Hess says. “So now our struggle will be separating the noise from the gold. If we get 10 CCDs on 10 different encounters across four different care settings, how do we take all that data and turn it into information for the clinicians? I don’t want to have a bunch of CCDs acting like a stack of a paper on a fax machine,” he says.


 This, Hess says, is the next big hurdle, what he calls “HIE 3.0.” He says, “We need to figure out how to stratify the data and present it in manner that allows clinicians to do the right thing with it. If we’re not careful we can overwhelm them and they could potentially ignore the data like they did with the faxes.”


Moore adds that another pitfall is getting providers on board to the HIE. While he notes that most of the major hospitals in Colorado are on CORHIO, there are still some that are not, and that’s a problem, he says. “Also, we talk about CORHIO and that is great, but we have hospitals that border the state too; we actually have a hospital in Kansas right now,” he says. “It’s great that Epic talks across all 50 states, but getting all of these HIEs to talk to each other has been a big challenge, which is ironic since that’s what they’re designed to do.”

Moving forward, a major part of the solution is collaboration on the part of providers as well as vendors, Moore says. “A lot of the onus is on the providers, as we need to be the ones at table bringing people together and removing roadblocks. Vendors respond to the market, so if we as providers—their ultimate customers—demand collaboration and exchange, then they’ll have to respond,” he says.  He adds that close-minded vendors are also part of the problem. “This vendor needs to exchange information with this one and you try to bring two competitors to the table. That’s not easy,” he says.


As such, according to Hess, a lot of vendors see their technology as a competitive advantage. Organizations that do this, rather than use their service or quality as the advantage, are slow to the collaboration table because they don’t want to level the playing field, Hess says. “But we all need to do things in similar ways, and our service and quality will be what brings doctors and patients to us. We need vendors and providers to say ‘we need to level the technology playing field.’ We really need to push that. When someone who is influential goes off that path and starts to do things differently, we get in trouble,” Hess says.

Moore adds that while nationwide interoperability efforts such as CommonWell have popped up, they might not be in it for the greater good as much as some people think. “I’m not necessarily buying that it’s for the greater good, but rather for a competitive advantage or a response to Epic’s Care Everywhere [product]. It would be great if all the vendors got together to make HIE transparent across all platforms without a third party, as that would make everyone’s life easier. But I don’t see that happening. I see them continuing to compete to try to gain market share,” Moore says.


Nonetheless, Hess warns that complete consolidation on one EHR vendor such as Epic or Cerner wouldn’t good either, as that could stifle innovation. “Some of these vendors are expensive and will never get into the small hospitals, the moms-and-pops,” he says. “We have to come up with better ways to share data. This is a journey; if you look back on HIE five years ago compared with today, people would be amazed with the progress. At the same time, we all wish it would be easier,” he says.


Back in Colorado, Moore notes that the healthcare IT leaders in the state meet quarterly, pick up the phone often, and collaborate to ensure the residents of the state get the absolute best care from a technology standpoint. “We want to make sure that the tools we provide our providers with are the absolute best,” he says. Hess, who has been in the state for six years after living in the Mid-Atlantic region, adds that the penetration of robust, mature adoption of health IT in care setting is pretty deep in Colorado. “Without that deep maturity level the collaboration conversations would be much harder,” Hess says. “The combination of the collaboration that goes on and the health IT adoption is a pretty powerful formula.”

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Many docs come to work sick

Many docs come to work sick | Healthcare and Technology news | Scoop.it

Many doctors, nurses, midwives and physicians assistants come to work sick even through they know it puts patients at risk, a new survey suggests.


Many said they don’t call in sick because they don’t want to let colleagues or patients down by taking a sick day, and they were concerned about finding staff to cover their absence.


At the Children’s Hospital of Philadelphia, Julia E. Szymczak and colleagues analyzed survey responses collected last year from 536 doctors and advanced practice clinicians at their institution.


More than 95 percent believed that working while sick puts patients at risk, but 83 percent still said they had come to work with symptoms like diarrhea, fever and respiratory complaints during the previous year.


About 9 percent had worked while sick at least five times over the previous year. Doctors were more likely than nurses or physicians assistants to work while sick.


Analyzing their comments, the researchers found that many report extreme difficulty finding coverage when they’re sick, and there is a strong cultural norm to come in to work unless extraordinarily ill.

The findings are reported in JAMA Pediatrics. The researchers were not able to respond to a request for comment by press time.


Sick health care workers present a real risk for patients, especially ones who are immunocompromised, like cancer patients or transplant patients, said Dr. Jeffrey R. Starke of the Baylor College of Medicine in Houston, who coauthored a commentary on the new study.


“Most of us have policies restricting visitation by visitors who are ill, we screen them for signs or symptoms,” Starke told Reuters Health by phone. “Yet we don’t do the same thing for ourselves.”


Most hospitals do not have a specific policy restricting ill healthcare workers, and developing and enforcing these policies may help address the issue, he said.


These policies should put the decision about who is well enough to come into work into someone else’s hands, not the doctor’s, Starke said.


Aside from spreading illness in the hospital, sick doctors likely perform worse on the job than healthy ones, he said.

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The Feminization of Health Care

The Feminization of Health Care | Healthcare and Technology news | Scoop.it

Historically, health care providers and health care leaders have been selected for and nurtured traits that are traditionally seen as “masculine” – traits such as heroism, independence, and competition. Yet it is clear that as people live longer with more complex conditions, the more traditionally “feminine” traits of interdependence, empathy, and networking become more important. Even in the most technically challenging health care event, the outcome for the patient is determined by a team.


A successful outcome for surgery on a brain tumor requires the heroic hands of a neurosurgeon, along with the primary care diagnostician, the radiologist, nurses, physical and occupational therapists, oncologists, radiation oncologists, the spouse, children, home health aides, friends, neighbors, and the list goes on. It truly takes a village to create a healing environment around individuals with complex conditions.


A lone hero is a lonely voice. A highly coordinated, synchronized team of participants working in concert with the goals, desires, and wishes of the patient and family create the symphony.


A New Approach to Care


This is what I mean by the feminization of health care – delivering care in more team-based ways characterized by collaboration and the use of social networks. This approach is in sharp contrast to the patriarchal, hierarchical model that is traditionally masculine.


When doctors, nurses, medical assistants, and other valuable team members work in collaborative, interdisciplinary teams organized around a common goal we unleash the power of the group. We get a kind of infectious excitement to innovate and create change. The team-based care that is becoming the norm in the United States operates with outcomes in mind but is supported by a network – and a more balanced management style.


Observation and experience during my more than 20 years as a physician reveal some well-defined patterns and trends. The traditional masculine, top-down hierarchical style of management is certainly employed by some women and, on the other side of the ledger, there are men who possess a team-based leadership approach. Yet in general, it has been my experience that the management styles of men and women as a whole are different.


I have found that organizations with a hierarchical approach feel much more focused on compliance, and on the idea that people do things because they have to (because it’s what they are paid for) rather than because they want to (which connects with their sense of purpose). Despite the fact that a large majority of workers in health care are women, most mainstream health care organizations – like most large corporations – operate with this patriarchal mindset.


Alignment with ACOs


The feminization of health care is well-aligned with the trend toward Accountable Care Organizations and other team-based approaches. Creating an ACO, by definition, requires building an effective inter-professional, interdisciplinary team. And the team must be capable of caring for the patient from the clinic to rehabilitation to home – with all of the actors working together around the individual patient. The “lone-wolf” leadership style is counterproductive in this sort of setting.

When doctors, nurses, medical assistants, and other valuable team members work in collaborative, interdisciplinary teams organized around a common goal we unleash the power of the group.


The feminization trend is particularly evident in middle layers of management where there is rapid growth of a management style that is team-based, collaborative, interdependent, and helps people develop and perform as highly as possible. This has been happening throughout Kaiser Permanente where there are more women in leadership as chiefs of service, as physicians in chief, assistant physicians in chief, and hospital leaders.


In addition, there are active social networks among interregional teams, using network-based learning to accelerate making care better for our members. In this model people come together as peers, organized around a common purpose rather than under a hierarchy.


Glass Ceiling in Health Care


While this trend is pervasive within middle management the news is less encouraging at the top. According to a report by Rock Health, women represent only 21 percent of executives and 21 percent of board members at Fortune 500 health care companies despite making up more than half the health care workforce.


At senior management levels and in board rooms, leaders-as-heroes and leaders who drive results top-down remain highly valued. At these levels there is clearly greater comfort with authoritative rather than collaborative, servant leaders.


I believe that greater balance in leadership and management styles can accelerate capitalizing on the benefits of the feminization of health care. If we are to transform health care in the United States we need to get “unstuck” from our reliance on the traditional models of leadership in our industry.


Hierarchical models have moved us toward greater accountability for results. However, we are not going to manage our way out of our current health care crisis. We need to learn our way out, enabling disruptive thinking from a much larger set of contributors.


We need to evolve our health care leadership both because the traditional hierarchical approach excludes many women and because, quite honestly, the method has not gotten us where we need to be. Adding in the “yin” to complement the “yang,” the feminine to the masculine can bring the benefits of balance, inclusion, and diversity to help transform the industry.


Historically, health care providers and health care leaders have been selected for and nurtured traits that are traditionally seen as “masculine” – traits such as heroism, independence, and competition. Yet it is clear that as people live longer with more complex conditions, the more traditionally “feminine” traits of interdependence, empathy, and networking become more important. Even in the most technically challenging health care event, the outcome for the patient is determined by a team.

A successful outcome for surgery on a brain tumor requires the heroic hands of a neurosurgeon, along with the primary care diagnostician, the radiologist, nurses, physical and occupational therapists, oncologists, radiation oncologists, the spouse, children, home health aides, friends, neighbors, and the list goes on. It truly takes a village to create a healing environment around individuals with complex conditions.

A lone hero is a lonely voice. A highly coordinated, synchronized team of participants working in concert with the goals, desires, and wishes of the patient and family create the symphony.


A New Approach to Care


This is what I mean by the feminization of health care – delivering care in more team-based ways characterized by collaboration and the use of social networks. This approach is in sharp contrast to the patriarchal, hierarchical model that is traditionally masculine.

When doctors, nurses, medical assistants, and other valuable team members work in collaborative, interdisciplinary teams organized around a common goal we unleash the power of the group. We get a kind of infectious excitement to innovate and create change. The team-based care that is becoming the norm in the United States operates with outcomes in mind but is supported by a network – and a more balanced management style.

Observation and experience during my more than 20 years as a physician reveal some well-defined patterns and trends. The traditional masculine, top-down hierarchical style of management is certainly employed by some women and, on the other side of the ledger, there are men who possess a team-based leadership approach. Yet in general, it has been my experience that the management styles of men and women as a whole are different.

I have found that organizations with a hierarchical approach feel much more focused on compliance, and on the idea that people do things because they have to (because it’s what they are paid for) rather than because they want to (which connects with their sense of purpose). Despite the fact that a large majority of workers in health care are women, most mainstream health care organizations – like most large corporations – operate with this patriarchal mindset.

Alignment with ACOs


The feminization of health care is well-aligned with the trend toward Accountable Care Organizations and other team-based approaches. Creating an ACO, by definition, requires building an effective inter-professional, interdisciplinary team. And the team must be capable of caring for the patient from the clinic to rehabilitation to home – with all of the actors working together around the individual patient. The “lone-wolf” leadership style is counterproductive in this sort of setting.

When doctors, nurses, medical assistants, and other valuable team members work in collaborative, interdisciplinary teams organized around a common goal we unleash the power of the group.

The feminization trend is particularly evident in middle layers of management where there is rapid growth of a management style that is team-based, collaborative, interdependent, and helps people develop and perform as highly as possible. This has been happening throughout Kaiser Permanente where there are more women in leadership as chiefs of service, as physicians in chief, assistant physicians in chief, and hospital leaders.

In addition, there are active social networks among interregional teams, using network-based learning to accelerate making care better for our members. In this model people come together as peers, organized around a common purpose rather than under a hierarchy.

Glass Ceiling in Health Care


While this trend is pervasive within middle management the news is less encouraging at the top. According to a report by Rock Health, women represent only 21 percent of executives and 21 percent of board members at Fortune 500 health care companies despite making up more than half the health care workforce.


At senior management levels and in board rooms, leaders-as-heroes and leaders who drive results top-down remain highly valued. At these levels there is clearly greater comfort with authoritative rather than collaborative, servant leaders.

I believe that greater balance in leadership and management styles can accelerate capitalizing on the benefits of the feminization of health care. If we are to transform health care in the United States we need to get “unstuck” from our reliance on the traditional models of leadership in our industry.

Hierarchical models have moved us toward greater accountability for results. However, we are not going to manage our way out of our current health care crisis. We need to learn our way out, enabling disruptive thinking from a much larger set of contributors.

We need to evolve our health care leadership both because the traditional hierarchical approach excludes many women and because, quite honestly, the method has not gotten us where we need to be. Adding in the “yin” to complement the “yang,” the feminine to the masculine can bring the benefits of balance, inclusion, and diversity to help transform the industry.

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US adults step away from the tanning bed

US adults step away from the tanning bed | Healthcare and Technology news | Scoop.it

Slowly but surely, individuals are turning their backs on indoor tanning -- without catching any rays -- according to a new study.

To be clear, the practice is still in full swing with an estimated 7.8 million women and 1.9 million men still flocking to tanning beds despite a decades-old link to increased cancer risk, according to the study.

Yet the rates dipped from 5.5 percent in 2010 to 4.2 percent in 2013, the study concluded.


In the study, which was published online in a research letter by JAMA Dermatology, a team from the Centers for Disease Control and Prevention, Atlanta, worked with data from 59,145 individuals.

The team was able to identify decreases in tanning bed use among those aged between 18 and 29, whose rates dipped from 11.3 percent in 2010 to 8.6 percent in 2013.


In this group, women made up 8.6 percent of indoor tanners in 2010 and 6.5 percent in 2013 while men represented 2.2 percent in 2010 and 1.7 percent in 2013.


Women who use tanning beds saw a 28 percent drop in the oldest age bracket, and college graduates' use of tanning beds dropped 45 percent.


Whereas women in fair or poor health saw a dip of 33 percent, very fit women abandoned tanning bed use by 23 percent.


Their male counterparts, however, flocked to indoor tanning salons, upping their frequency by 177 percent in the 40 to 49 age bracket.

Tanning bed use was 71 percent higher in men age 50 or older, however, cancer survivors discontinued use by 45 percent.


The research team attributes the dip to increased awareness and the classification of indoor tanning beds as carcinogenic as well as a 10 percent excise tax that exists nationwide.


"Physicians can also play a role through behavioral counseling, which is recommended for fair-skinned persons aged 10 to 24 years," write the researchers. "Continued surveillance of indoor tanning will aid program planning and evaluation by measuring the effect of skin cancer prevention policies and monitoring progress."

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Keeping Blood Pressure Low in Those Under 50

Keeping Blood Pressure Low in Those Under 50 | Healthcare and Technology news | Scoop.it

Higher blood pressure in young adulthood increases the risk for coronary heart disease, a new study found.

Researchers followed almost 3,500 men and women for 25 years with periodic physical examinations beginning in 1985, when all were healthy and 18 to 30 years old. They calculated their cumulative exposure to high blood pressure over the years.

The scientists, writing in The Journal of the American College of Cardiology, studied left ventricular dysfunction — damage to the part of the heart that pumps blood to the entire body except the lungs. Left ventricle impairment is a main cause of heart failure. They found the higher the blood pressure, the greater the damage to the left ventricle. In addition, even after adjusting for other risk factors, chronic high blood pressure in young adulthood increased coronary calcium in middle age to a degree similar to that of the initial stages of atherosclerosis.

“This paper highlights that in the first half of adult life, it’s very important to keep blood pressure as low as one can,” said the lead author, Dr. João A.C. Lima, a professor of medicine at Johns Hopkins, adding that “130/80 or 130/70 should be the goal for people under 50.”

Current guidelines advise treatment at 140/90 for people ages 30 to 59.

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Obamacare ruling ends threat to U.S. hospitals, insurers

Obamacare ruling ends threat to U.S. hospitals, insurers | Healthcare and Technology news | Scoop.it

The U.S. hospital and health insurance industries breathed a collective sigh of relief on Thursday after the U.S. Supreme Court upheld subsidies for individuals under President Barack Obama's signature healthcare law.


Shares in hospitals surged, with several hitting all-time highs, on the expectation that patients would be able to continue paying for services. Health insurer stocks also gained. Wall Street analysts called the ruling positive for an industry on the edge of consolidation.


Health economists have estimated $15 billion to $22 billion in healthcare spending was at risk with the decision. About 10 million Americans have insurance through the healthcare law's insurance exchanges and, of those, 6.4 million have subsidies.


The court ruled 6-3 that the 2010 Affordable Care Act (ACA), widely known as Obamacare, did not limit subsidies to states that establish their own online healthcare exchanges. It marked the second time in three years that the high court ruled against a major challenge to the law.


Trinity Health, one of the largest not-for-profit health systems, was holding a board meeting when the ruling hit.


"There was a ‘Yahoo!’ and a big round of applause," Dr. Richard Gilfillan, chief executive of the Livonia, Michigan-based hospital chain said.


Insurers said subsidies were key to bringing in new customers.

"For a lot of the individuals who were depending on these subsidies in order to have coverage, I think it is a major sigh of relief," said J. Mario Molina, chief executive of insurer Molina Healthcare.


Annie Wisecarver, 53, of Shepherdstown, West Virginia, receives a monthly subsidy of about $200 to buy Obamacare insurance.

"I really only purchased insurance for an emergency, like if I fell off a mountain and broke my leg," Wisecarver said. "I can’t see myself spending $300 or $400 a month on insurance just because I might have an accident."


The ruling could remove uncertainty for the insurers who are seeking deals, like Anthem Inc and Aetna Inc, Leerink Partners analyst Ana Gupte said.


Anthem is pursuing an acquisition of Cigna even after being rejected, while sources previously told Reuters that Humana put itself up for sale last month, with Cigna and Aetna making offers. Bloomberg reported on Thursday that an Aetna-Humana deal could be reached as soon as this weekend.


Humana jumped 7.5 percent. Aetna Inc gained 3.6 percent, Anthem Inc 1,1 percent, Cigna Corp 2.6 percent, and UnitedHealth Group Inc rose 2.7 percent.


Among hospitals, shares of Community Health Systems were up 13.3 percent, HCA Holdings rose 8.5 percent and Tenet Healthcare jumped 12.2 percent. HCA, Universal Health Services and LifePoint Health hit lifetime highs.


'PEACE OF MIND'


Since the subsidies were introduced last year, they have helped hospitals reduce the losses from covering the cost of uninsured patients.


"It's just a very positive thing because it takes away the overhang on the company and the industry," said Alan Miller, CEO of Universal Health Services, which has hospitals in 37 states.


Bill Carpenter, chief executive of Lifepoint Hospitals, which has 64 hospitals in 20 states, was at an offsite patient safety event and said everybody in the room was excited about the ruling.


"We are just are so pleased that those people who have secured coverage through state exchanges will have the peace of mind to know that their coverage is going to continue," Carpenter said, calling on states to expand Medicaid to more income levels, another goal of the ACA. "In many states, this has been about politics and not policy."


In Florida, one of the biggest remaining issues is expanding Medicaid, said Jim Nathan, president and chief executive of Lee Memorial Health System in Fort Myers, one of Florida's largest public, not-for-profit health systems.


Jason Montrie, president of Land of Lincoln Health, a non-profit CO-OP health insurance company launched in 2013 with the government funding of the Affordable Care Act, said subsidies are vital to most of its more than 50,000 members.


"We're relieved that our court made the right decision here," Montrie said.


Options activity had been sanguine in the days and weeks leading up to the ruling, with many traders betting on a rally in the hospital names after the Supreme Court decision.


The S&P 500 healthcare sector is up 11.3 percent in 2015 so far. The sector accounts for about 15 percent of the S&P 500 index.

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Margarito Cruz's curator insight, December 10, 2015 10:05 PM

The role being discussed in this article is about Cheif Executive. I didnt realize that so many people were under Obama's Obamacare. I agree with these actions because of all the accidents that happen everyday. People who dont have insurance face the same dangers that the people that do have it. It would be nice to know that theres something that will pay for the ones not as wealthy. Obama is the organizer of Obamacare.

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Are We Getting Closer to the Top of the HIE Mountain?

Are We Getting Closer to the Top of the HIE Mountain? | Healthcare and Technology news | Scoop.it

Two weeks ago, I finally completed the long, enduring process of buying my first home in Hoboken, N.J. The journey, from start to finish, took months to complete, the money put into it was substantial, and the paperwork and effort to try to make sure that everything went smoothly (Does it ever when it comes to real estate?) was rigorous, to put it kindly.


One of the strangest parts about this process, from a personal standpoint, is that I won’t be living in the home! Instead, I see it as an investment opportunity that I hope will pay off in the long run. Will it? It’s hard to say as of right now—the real estate market will dictate how it works out for me in the future, and it might be years and years down the road until I know if it was a savvy move or not.


The quick lesson here: sometimes in life, it takes a really long time to see tangible results for the efforts that we have put in. This couldn’t be more accurate when it comes to health information exchanges (HIE). The investment that our country has put into developing and maintaining HIE platforms has been gigantic, in the form of half a billion dollars, yet many naysayers believe that the return on that investment might never come.


To date, it’s been pretty hard to argue with them. Interestingly enough, I actually blogged about this very issue back in December, referencing a study from the Santa Monica, Calif.-based research organization RAND Corporation which found that due to the lack of evaluation on HIEs in the U.S., simply put, it has been too difficult to determine if they have been successful or not.  It’s too early to judge them, the researchers of that report found. “There are likely other health information exchange organizations in the country that are being used, and some may be having an impact. But, if they exist, they haven't been evaluated,” Robert Rudin, lead author of the study and an associate policy researcher at RAND, said at the time.


Recently, I read another review on HIEs, one that had similar conclusions to the RAND study in terms of early evaluation, although this study had a more optimistic outlook. This latest report, “The benefits of health information exchange platforms: Measuring the returns on a half a billion dollar investment,” from Niam Yaraghi, a fellow in the Washington, D.C.-based Brookings Institution’s Center for Technology Innovation, studied the effects of accessing patient information through an HIE platform on the number of the laboratory tests and radiology examinations performed in two emergency departments in Western New York in 2014, via the region’s HIE, HEALTHeLINK. While Yaraghi readily admits that true HIE benefits won’t be realized until more providers join HIE platforms, and subsequently share data, he sees that there is significant potential.


Yaraghi’s analysis looked at two groups of patients in the ED, one group whose care involved querying HEALTHeLINK’s database of clinically relevant information from a patient’s medical history, and the other group whose care did not involve an HIE query. The study revealed that querying the HIE’s database is associated with significant utilization reduction in ED settings. In the first ED setting, querying the database is associated with respectively, a 25 percent and 26 percent reduction in the estimated number of laboratory tests and radiology examinations. In the second ED setting, querying the HIE’s database is associated with a 47 percent reduction in the estimated number of radiology examinations.


In his conclusion, Yaraghi writes, “The efforts by Congress, patient advocacy groups, and most importantly the shift towards value-based payments promise complete interoperability in the near future. After more than a decade of concerted national efforts, we are now on the verge of realizing the returns on our investments on health IT. HIE platforms have the potential to leverage the national investments on interoperability and radically improve the efficiency of healthcare services.”


Comparatively speaking, the aforementioned RAND study found no evidence showing whether or not health information exchanges are on track as a potential solution to the problem of fragmented healthcare. “It is pretty well established that the U.S. healthcare system is highly fragmented,” RAND’s Rubin said. “Lots of studies over the years, including some recent studies, have shown that a typical patient visits doctors in many different practices. Frequently the doctors don't have the patient's previous medical information. There is no sign of that problem getting better, and in fact it may get worse if medicine continues to become more specialized.”


Indeed, as Yaraghi notes, getting providers on board and increasing the volume of data available on the HIE platform will be the key moving forward. “A RHIO (regional health information organization) without data is an expensive yet empty glass of water,” he writes.  “At the beginning, RHIOs could help physicians have a better understanding of the patients’ condition as much as an empty glass could help them quench their thirst.” Undoubtedly, as HIE organizations look to get providers more involved and willing to share data, the providers themselves are looking for more out of the HIEs. A recent report from NORC at the University of Chicago, funded by the Office of the National Coordinator for Health Information Technology (ONC), found that providers highlight the potential for HIE to ease access to actionable data that integrates data from across the care continuum and provides clinicians with information at the point of care to improve care delivery and care coordination.


At the end of the day, it’s all about value, as with most things in life. If the general public values my condo in Hoboken, and I get renters to pay me to live there, I’m almost certainly going to see a return on my investment. Similarly, if physicians across the U.S. see value in HIEs, the federal government will eventually see a return on their investment as well, in the form of lower healthcare costs and better patient outcomes. As Yaraghi writes, “This is the first study in which access to an HIE platform was provided to all of the patients in a treatment group, while the care of the others in the control group did not include querying an HIE platform.” I hope that this research serves a stepping stone for moreresearch in this area—and down the road, a return on our enormous expenditure into health information exchanges.

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The Supreme Court's Surprise Ruling Saves Obamacare

The Supreme Court's Surprise Ruling Saves Obamacare | Healthcare and Technology news | Scoop.it

The Affordable Care Act survived its second major challenge at the U.S. Supreme Court on Thursday. In a 6-to-3 decision, the justices ruled that the Internal Revenue Service can continue to provide health-insurance subsidies to middle-class people living in all states.


At issue in the case, King v. Burwell, was whether the subsidies should go to residents of the roughly three dozen states that use the federal health-insurance exchange, in addition to those who live in states that run their own exchanges.


It’s a highly technical difference, but had the decision gone the other way, Obamacare might have unraveled. Individuals who receive these subsidies make less than $48,000 per year, and many would struggle to afford health-insurance plans without the government’s financial help. Health-policy analysts feared that, without the subsidies in place, healthy people would withdraw from the health-insurance exchanges in large numbers. That, in turn, would cause premiums to skyrocket, making insurance unaffordable to almost anyone who does not receive insurance coverage through their jobs.

The Affordable Care Act gave states the option to either set up their own exchanges or to rely on the federal government’s marketplace through Healthcare.gov. The part of the law that describes the subsidies said they should only apply to people in the exchanges “established by the state.” The plaintiffs in the King case said that clause meant the IRS was offering subsidies to residents of federal-exchange states illegally.

In the opinion of the Court, Chief Justice John Roberts dismissed the idea that the fate of the entire Obamacare law should hinge on such a technicality.

“In petitioners’ view, Congress made the viability of the entire Affordable Care Act turn on the ultimate ancillary provision: a sub sub-sub section of the Tax Code,” he wrote. “We doubt that is what Congress meant to do.”


Many patient advocates cheered the decision. “It means that millions of people with serious health conditions such as cancer will continue to have access to essential treatment and care, and millions of others at risk for disease will be able to afford preventive screenings and tests that could save their lives,” said Chris Hansen, president of the American Cancer Society’s advocacy arm, in a statement.


Justices Antonin Scalia, Clarence Thomas, and Samuel Alito dissented, writing, “Words no longer have meaning if an Exchange that is not established by a State is ‘established by the State.’”


Roberts concludes by saying that the Court is attempting to respect what Congress hoped to accomplish in passing the law: “Congress passed the Affordable Care Act to improve health insurance markets, not to destroy them.”


There are still a few, more minor, legal challenges to Obamacare remaining. But at least for now, the law lives to see another day.

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Jannell Alino's curator insight, August 27, 2015 7:43 PM

Congress passed the Affordable Care Act and the Supreme Court ruled that the IRS will be able to continue to administer health insurance to middle class people to all in the United States. If this did not pull through Obamacare would have left thousands of people without insurance and helpless. Many who are on Obamacare make less than 48K a year and need assistance from the government. If this were to happen a large number of healthy people would withdraw from health insurances causing prices to go up and then no one would be able to afford health insurance! The Affordable Care Act gives states the option to set up their own exchanges or rely on the government. With the passing of this act people suffering from serious illness will be able to care and have access to treatment as well as others who are susceptible to illness. Some conclusions that can be drawn from this article are that by the passing of this act thousands of citizens are still able to have health insurance and do not have to pay with an arm and a leg. Yes this argument is logical because it would be irrational to take away a program that has aided so many Americans in getting the health care they need. This relates because if this act was to fail our health insurance prices would go up and going to get a simple checkup would cost a fortune! I think it is great that the congress passed this act because I would want everyone to be able to have the privilege to seek out help if they were ill. No there is no bias, it is objective to all citizens in the united states. 

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400 million people still lack access to key health care services

400 million people still lack access to key health care services | Healthcare and Technology news | Scoop.it

Some 400 million people worldwide lack access to essential health services, and the cost of healthcare is forcing many into poverty, the World Bank and World Health Organization reported Friday.

A new report by the bank and WHO on tracking universal health care (UHC) coverage said more people than ever around the world, 80 percent, have access to key health services.


Universal health care, the two institutions say, encompasses services that should reach everyone regardless of socioeconomic level: family planning, antenatal care, skilled support when giving birth, child immunization, TB treatment, HIV antiretroviral therapy, improved water sources and improved sanitary facilities.


But hundreds of millions are reached by only a few of those services. In addition, in low and middle-income countries, six percent of the people were at risk of being forced into or pushed further into poverty by health care costs.


"This report is a wakeup call: It shows that we're a long way from achieving universal health coverage," said Tim Evans, senior director of health, nutrition and population at the World Bank.


"We must expand access to health and protect the poorest from health expenses that are causing them severe financial hardship."

For some kinds of services, well over 80 percent of people have access, the report says.


And it said that the impoverishing impact of catastrophic health expenses has diminished over the past decade.

"However, there is still a long way to go on the road to UHC, both in terms of health service and financial protection coverage," the report said.


The new report seeks to define UHC, in terms of measurable essential services, to be able to assess how governments and communities are performing.

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Americans, their physicians should take sleep seriously

Americans, their physicians should take sleep seriously | Healthcare and Technology news | Scoop.it

Getting enough good quality sleep is essential for maintaining health and quality of life, and not getting enough is dangerous to individual health and public safety, according to a new policy statement by the American Thoracic Society (ATS).


The public and their healthcare providers need to be better educated about the importance of sleep, ways to promote good sleep and the consequences of not doing so, the authors write on behalf of ATS, whose members specialize in respiratory and sleep medicine, as well as critical care.


The statement includes a review of the literature on sleep and recommendations for public health education programs, based on the clinical experience of ATS experts like coauthor David Gozal of The University of Chicago.


Despite a lot of “noise” in the public and among professionals on sleep-related issues, there are few definitive sources that succinctly summarize the evidence so that a medical professional can discuss the topic with their patients, Gozal told Reuters Health by email.

“The purpose of this document was not to challenge the existing scientific evidence, merely create and make accessible a succinct summary of the scientific evidence regarding the importance of sleep to health,” he said.


For adults, less than six hours of sleep per night or more than nine to 10 hours per night may be linked to negative health outcomes, so the sweet spot is somewhere in between, according to the statement published in the American Journal of Respiratory and Critical Care Medicine.


But sleep requirements change with age, and differ by individual. Teens require more sleep and operate with a delayed “body clock,” so school start times for teenagers should also be shifted to later in the morning, the authors suggest.


“Later school start times, particularly high school, have shown substantial beneficial effects on absenteeism, aggressive behaviors and bullying, and even on academic performance,” Gozal said. “However, the cost-benefits need to be weighed as far as the implications for the rest of the family, work, commute, etc. such as to generate a compromise in which the school will start as late as possible under the local circumstances.”


Younger children have unique needs as well, and specific age-based sleep recommendations should be developed for them, according to the statement.


The authors also recommend that all drivers, including teens learning to drive, receive education about how to recognize the symptoms and consequences of drowsy driving, and encourage public education about the impact of working hours and shift work on sleep duration and quality and its association with workplace injuries.


Sleep disorders like obstructive sleep apnea are common, costly and cause major life disruptions, but often go undiagnosed and untreated, they note.


Physicians need to stress the importance of good quality sleep to their patients. And they should be taught that cognitive behavioral therapy is an effective treatment for insomnia, rather than trying hypnotics and sedatives first, the statement authors emphasize.


“If you awake on your own, feeling well, in a good mood, with positive energy and a favorable outlook to the day ahead, then it is very likely that your sleep was sufficient and good quality,” Gozal said.

Promotion of healthy sleep needs to start early in life, at home, in daycare and in schools, and needs to happen often across all media, Gozal said.


“I think that public awareness is there. The problem is in the execution,” said Willis H. Tsai of the University of Calgary in Canada. “It’s like eating at a fast food restaurant. You know it isn’t really good for you, but you end up doing it anyways.”


Employers can be proactive about protecting employee sleep, but it requires government regulation, Tsai, who was not an author of the new statement, told Reuters Health by email.


“At all ages and across all cultures and professions, the public needs to acquire the deep understanding that similar to other healthy behaviors, sleep is not a tradable commodity but rather is a life sustaining physiological function that needs to be as respected and revered as your bank account,” Gozal said.

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Lyfe Media's curator insight, June 16, 2015 4:53 PM

It was the reason your mother sent you to bed earlier than you wanted and the reason you can't keep your eyes open the first few hours at work... Sleep is important. Doctors have been preaching the importance of a good night's rest for decades, but recent studies have linked too little (or too much) sleep to health issues. But really, who's surprised?

Dani Parsley's curator insight, September 9, 2015 1:36 PM

Getting enough sleep is a good health benefit. It will put you in  a better mood, decrease bullying, and also make you a more cautious driver.

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Where are the most expensive hospitals?

Where are the most expensive hospitals? | Healthcare and Technology news | Scoop.it

Talk about sticker shock: Some U.S. hospitals charge patients more than 10 times the rates paid by Medicare.

Of the 50 U.S. hospitals with the highest charges, 49 are for-profit institutions, 20 operate in Florida, and half are owned by a single chain, according to a study published in the journal Health Affairs Monday.

That doesn't mean all or even most patients end up paying those charges. Private insurers are able to negotiate the sticker price down significantly. Patients paying out of pocket can often negotiate discounts or get charity care if they are low-income.

The average U.S. hospital charges a somewhat less staggering sum: 3.4 times the rates paid by Medicare, the federal health care plan for the elderly and disabled which pays fixed rates for procedures.

But for uninsured patients asked to pay full charges, insured patients who end up at an out-of-network hospital and patients whose treatment is covered by casualty or workers compensation insurance, these charges can matter a lot.

"Hopefully this is a wake-up call for people to recognize there's a problem," said Gerard Anderson, a professor of health policy at Johns Hopkins Bloomberg School of Public Health, and one of the authors of the study, which analyzed 2012 Medicare cost reports.

    "There is no justification for these outrageous rates but no one tells hospitals they can't charge them," Anderson said. "For the most part, there is no regulation of hospital rates and there are no market forces that force hospitals to lower their rates. They charge these prices simply because they can."

    Even after full expansion of coverage under the Affordable Care Act, 30 million Americans will remain uninsured and may face particularly high charges, the study said. The law requires nonprofit hospitals to offer reduced-cost or charity care to eligible patients, but the provision does not apply to for-profit hospitals.

    "Hospitals' high markups, therefore, subject many vulnerable patients to exceptionally high medical bills, which often leads to personal bankruptcy or the avoidance of needed medical services," the study said.

    Of the 50 highest chargers, half are owned by Community Health Systems, a for-profit chain with 199 hospitals. The company made $18 billion in profits in 2014 — 45 percent more than in 2013. The researchers looked at charges at nearly 4,500 Medicare-certified hospitals nationwide.


    Florida most likely had the most high-charging hospitals because it has an exceptionally high proportion of for-profit hospitals, consumer advocates said. North Okaloosa Medical Center, a CHA hospital in the Florida panhandle, had the highest charges of all: 12.6 times Medicare's rate.

    In a written statement, CHA spokesperson Tomi Galin said CHA provided more than $3.3 billion in charity care, discounts and other uncompensated care for patients in 2014, as well as "millions of dollars in taxes that help fund critically important services in every community where we operate."

    The charges examined by the study, Galin said, "are not relevant measures of what consumers, insurers or the government pay for services."

    Chip Kahn, president and CEO of the Federation of American Hospitals, a trade group representing for-profit hospitals, also argued that the charges examined by the study were not a fair assessment of hospital prices. If the study had instead examined the actual payments by patients, they would have found that hospitals on the list charge just 1.3 times what Medicare pays, compared to a national average of 1.2, he said.

    A hospital's charges can matter even for patients with private insurance, said Ge Bai, a co-author on the study and a professor at Washington and Lee University. Hospitals use those charges as leverage during negotiations with insurers, and starting from a higher price point can drive up even discounted prices.

    "Except for patients with government insurance, few consumers are immune from negative financial impacts caused by hospitals' high markups," Bai said.

    "We as consumers are paying for this when hospitals charge 10 times what they should," added Anderson. "What other industry can you think of that marks up the price of their product by 1,000 percent and remains in business?"

    The highest charging hospitals were in 13 states, mostly in the South. Besides Florida, the states included Alabama, Arkansas, Arizona, California, Kentucky, New Jersey, Oklahoma, Pennsylvania, South Carolina, Tennessee, Texas, and Virginia.

    The markups charged by the 50 hospitals on the list varied dramatically by procedure. Anesthesiology had the highest charges: an average of 112 times more than Medicare rates. The markup for nursery services, on the other hand, was three times the Medicare rate.

    The authors recommended that state and federal lawmakers enact policies to limit these charges. In Maryland and West Virginia, for example, state agencies set the rates that hospitals are allowed to charge for services. Requiring hospitals to disclose their charges for individual procedures could also help patients shop for the lowest-cost option, they said.

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    What Does IBM’s Acquisition of Merge Healthcare Say About the Healthcare IT Market?

    What Does IBM’s Acquisition of Merge Healthcare Say About the Healthcare IT Market? | Healthcare and Technology news | Scoop.it

    As if everyone’s heads in healthcare IT weren’t already spinning like that of Linda Blair in 1973’s “The Exorcist,” here comes yet another acquisition in healthcare IT, this time the Armonk, N.Y.-based IBM announcing on Thursday its acquisition of the Chicago-based Merge Healthcare.


    All mergers and acquisitions are interesting, but this one offers particular facets worth pondering. First of all, of course, its timing, less than four months after that giant company had just swallowed up the Dallas-based Phytel and the Cleveland-based Explorys back in April, a move announced during the HIMSS Conference.


    That double acquisition is one of the reasons that we editors at Healthcare Informatics made IBM one of our “Most Interesting Vendors” this year, as its trajectory has encapsulated some of the mergers and acquisitions that have taken place in order to give some vendors a particular edge as competition intensifies in the healthcare IT world. As Senior Editor Rajiv Leventhal wrote regarding IBM’s analytics push, “Enter the Watson Health Cloud, which IBM will sell to doctors, hospitals, insurers and patients. That offering will be the centerpiece of a new dedicated, Boston-area business unit, IBM Watson Health, which now includes both Explorys and Phytel.” Leventhal quoted Anil Jain, M.D., chief medical officer (CMO) for Explorys, as saying that “[IBM] is complimenting much of what we do around traditional analytics using machine learning algorithms with some of the cognitive computing and the Watson analytics that Watson Health group will be leveraging. We became the content that will fuel some of the next generation analytics that Watson has become famous for.”


    In a blog published today on AuntMinnie.com, staff writer Erik Ridley wrote this: “For IBM's new Watson Health unit, the deal gives the company access to Merge's image management and analysis software and its installed base of more than 7,500 U.S. institutions, clinical research institutes, and pharmaceutical companies. IBM is adding Merge to other recent acquisitions, such as population health firm Phytel and cloud-based healthcare intelligence company Explorys.”

    Ridley went on to note that “IBM plans to offer Watson Health Cloud to analyze and cross-reference images against lab results, electronic health records (EHRs), genomic tests, clinical studies, and other health-related sources. In aggregate, these represent 315 billion data points and 90 million unique records, according to the company. This could provide Merge's installed base with a useful consolidated, patient-centric view of current and historical images, EHRs, data from wearable devices, and other related medical data.”


    So far, so good. I think that IBM is gaining clear advantage in acquiring Merge Healthcare at this time., as it brings imaging informatics into the fold and potentially will integrate elements of imaging informatics with its already-advancing work in analytics. Indeed, Joe Marion, a Wisconsin-based consultant who blogs regularly for Healthcare Informatics and who is one of the most knowledgeable observers of the imaging informatics sector around, sees clearly the advantages to this pairing. As Joe wrote Thursday in a blog on this site, “Today, IBM is a different company than it was thirty years ago, as is the healthcare industry.  Much of the “big iron” emphasis is gone, and the company has much more of a services focus these days.  Cloud computing was never a factor in the past, and today, coupled with Watson, it offers much more potential for delivery of storage and analytics solutions.”


    Joe further noted that, “In the age of past efforts, there were much larger barriers between Information Technology (IT) and clinical departments.  That is why IBM chose to partner with GE to address RIS-PACS [radiology information system/picture archiving and communications system (issues)] previously, as the two complemented one another in terms of hospital administration emphasis.  Today, there is much more IT emphasis on clinical systems and their integration across the enterprise.  And,” he added, “the healthcare environment today is radically different than in the age of past efforts, given increased regulation and greater provider consolidation.  An IBM-Merge combination should have much broader appeal to integrated delivery networks (IDN’s) who might benefit from greater interoperability and better business analytics.”


    I agree completely with Joe’s perspective on this. Now, what about Merge Healthcare itself? I’ve been following Merge very closely as a company for several years now. Merge has some very talented senior executives, and solutions that are respected and appreciated by providers. The challenge for the company’s senior management has been facing is the shifting landscape of the imaging informatics market right now. PACS solutions have become almost totally commoditized; I’m sure there are PACS systems that are at last marginally better than others, but, given the accelerating demands facing patient care organizations, the need to move quickly into accountable care- and population health-based arrangements, and clinicians’ demands for always-available computing, even significant solution quality differentiation is simply no longer enough (and let’s not even talk about how commoditized RIS solutions have become).


    So, clearly, for senior executives at Merge, a respected company that has been going through some major management changes and has been treading water in a rapidly shifting imaging informatics vendor landscape, this deal makes a lot of sense, too.


    The challenge now will be to make this pairing work for current Merge Healthcare customers and for IBM customers—and customers of the former Phytel and Explorys, too. We all know about the trajectories of healthcare IT vendors that have grown too rapidly through acquisition and that have ended up becoming a jumble of unintegrated parts.

    IBM’s moves so far seem thoughtful and precisely judged. Only time will tell how everything turns out ultimately—and clearly, that will depend on execution. Skillful execution is to healthcare IT what location is to real estate—a fundamental element of success. And this trajectory for IBM is a fascinating one. So stay tuned—because this is going to be an interesting path ahead.

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    Does the Affordable Care Act Guarantee Healthcare as a Right?

    Does the Affordable Care Act Guarantee Healthcare as a Right? | Healthcare and Technology news | Scoop.it

    In his recent celebratory remarks after the Supreme Court (SCOTUS) upheld the legality of subsidies/tax credits under the Affordable Care Act (ACA), President Obama had this to say: "Five years ago, after nearly a century of talk, decades of trying, a year of bipartisan debate -- we finally declared that in America, healthcare is not a privilege for a few, but a right for all." (1)


    It would be good if this were true, but it is not. Healthcare as a right has been debated over many years, but is still not in place for all Americans as this country remains an outlier among advanced industrial countries around the world. Instead, despite the ACA, we continue to have a patchwork of ever-changing programs assuring access to health care for some people some of the time.


    Let's look at what we do have in this respect. In the 1960s, Congress established a broad right to health care under statutory law by enacting Medicare, Medicaid, and the Children's Health Insurance Program (CHIP) for the elderly, disabled, people living in poverty, and children. In the 1980s it passed the Emergency Medical Treatment and Active Labor Act (EMTALA) requiring all Medicare-funded hospitals with emergency departments to provide appropriate emergency and labor care. More recently, Congress passed the Mental Health Parity and Addiction Equity Act (MHPAEA) in 2013, which assures a right to equal access to care for patients with medical and mental health problems. SCOTUS has established a right to health care for prisoners and has protected some limited rights for women's reproductive care (2), but has never interpreted the Constitution as guaranteeing a right to health care for all Americans. In fact, the words "health," "health care," "medical care," and "medicine" do not appear in the Constitution. (3) 


    It is disingenuous to claim that health care is a right in the U. S. when we consider these inconvenient facts:


    • 35 million uninsured, plus another similar number underinsured.
    • The first question asked of us in seeking care is "what is your insurance?"
    • 21 states have opted out of Medicaid expansion under the ACA.
    • Medicaid eligibility and coverage varies widely from one state to
    • another, in many cases falling far short of necessary care.
    • As the costs of insurance and health care continue to rise and shift
    • more to patients, a growing part of the population cannot afford either and forgo seeking care.
    • More than 40 million Americans now have an account in collection for medical debt. (4)


    This situation stands in sharp contrast to elsewhere in advanced societies. Healthcare has been recognized as a right since 1948 when the General Assembly of the United Nations adopted a Universal Declaration of Human Rights including access to health care. (5) The right to health care was also later adopted by the World Health Organization (WHO) in its Declaration on the Rights of Patients. (6) As a result, most of Western Europe, Scandinavia, the United Kingdom, Canada, Taiwan, and many other countries have one or another form of national health insurance assuring access to care for their populations. Here we spend twice as much and still have no universal access to health care.


    Can we ever see this country coming around to universal access to health care based on medical need, not ability to pay? The record shows that we never can, or will, as long as we permit corporate stakeholders in our medical-industrial complex to call the shots, and as long as they succeed in perpetuating our exploitive for-profit system. There is a fix -- single-payer national health insurance, as embodied in H. R. 676, Expanded and Improved Medicare for All.

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    How New Jersey Public Policy Fails Primary-Care Physicians

    How New Jersey Public Policy Fails Primary-Care Physicians | Healthcare and Technology news | Scoop.it

    We live in a very exciting time in the healthcare industry. Regardless of how you feel or think about decisions that are made on the government level, healthcare is in a period of controlled chaos right now.


    With the potential merger of Anthem and Cigna and Aetna and Humana, or Assurant closing its doors on its health insurance business, things are about to get really interesting for medical practices. Arming yourself with as much information as possible is key to not just surviving financially, but thriving in this new environment.

    Let's take Assurant, for example. They've decided that doing business in the healthcare arena and competing against the dominant healthcare insurance companies was far more expensive than expected. What does this mean for your practice? If you have patients that use Assurant as their medical insurance, it's a great idea to step in and take control of those accounts, now. Create a waiver for Assurant patients that explains what is going on, what to expect from their plan, and how they can still see you with a new insurance plan. The waiver should also state that in the event Assurant does not pay the medical claim, patients will be responsible for the allowed amount, and they will have to pay out of pocket if it is a PPO Plan. If the plan is an HMO, and Assurant does not pay, the practice is not allowed to place a PR (patient responsibility) to the patient and will lose that money.


    Aetna and Assurant have similar fee schedules, so suggest to your patients to look into individual Aetna plans, to ensure that you will retain those patients and not lose revenue if you are contracted with Aetna. You will also need to really follow up with those claims and make sure that Assurant is paying you. I have seen them use a delaying tactic of denying a claim with the code CO95 (plan procedures not followed), which basically means they are sending your claim to a different claim address than what was provided to you at the time of benefit verification.  


    As far as the pending mergers, I really love it when this happens. I'm particularly fond of the companies that have been courting each other lately. With the possible Aetna/Humana merger, Aetna will be able to add a lot more patients to their network. It will position them as a real player and earn them much needed respect within the market. I still have some overall issues with both Aetna and Humana, but merging them together should ease some of those issues.


    The Anthem/Cigna cat-and-mouse game going on is particularly interesting. Cigna claims they're worth more than $184/share, and said no to Anthem's last purchase attempt. But Anthem is not giving up. Cigna used to be a premium plan until they teamed up with American Specialty Health. They have basically cut reimbursements to providers in half (if you signed up under their new network, otherwise you are seeing Cigna patients out of network), and implemented a time-consuming authorization process that eats away at whatever profit your practice may have left over from the reimbursement cuts. They implemented this over the course of the last year, or so. Working with Anthem is pretty cut and dried: What you see is what you get, with no hidden agendas. Anthem requires few to no pre-authorizations, allowing you to see your patient and maybe make a few bucks.


    Just taking a few moments and reading up on what is going on in the healthcare industry today is really key to insuring your practice is not caught off guard. Always be learning, always be aware. There are multiple newsletters you can sign up for that will drop a daily or weekly e-mail into your inbox that will help you keep up.

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    PA’s Health Information Exchange Awards $674K to Hospitals

    PA’s Health Information Exchange Awards $674K to Hospitals | Healthcare and Technology news | Scoop.it

    The institution of a health information exchange (HIE) is imperative for the healthcare industry, as it allows for effective data sharing among multiple medical facilities located on opposite sides of the country and coordinates care throughout patient-centered medical homes, accountable care organizations (ACOs), and other healthcare settings.


    The Penssylvania e-Health Partnership Authority is one such health information exchange institution, which has recently awarded onboarding grants of more than $674,000.00 to connect multiple hospitals and other healthcare providers including ambulatory care practices to its Pennsylvania Patient & Provider Network (P3N), according to a company press release.


    Approximately $67,000 of the awards come from state funding while about $607,000 comes from federal funds. The program’s funding comes from the Centers for Medicare & Medicaid Services (CMS) and is being awarded with the assistance of the Pennsylvania Department of Human Services.
    By integrating provider networks to health information organizations (HIOs), the P3N creates a strong system for electronic health information exchange. The release states that $355,000 is being awarded to the HealthShare Exchange of Southeastern Pennsylvania.


    “The benefits of eHIE to patients and providers are significant,” Alix Goss, Executive Director of the Authority, stated in the press release. “This grant program is critical to helping providers connect to HIOs, and HIOs connect to the P3N.”


    “As more HIOs join the P3N along with their connected providers, more patients will experience better coordination of their care, faster access to their clinical results, and reduced redundancy of medical tests,” Goss continued. “The bottom line for patients, providers, and the healthcare system will be improved patient safety and healthcare quality.”


    These onboarding grants are helpful in terms of supporting sustainability among private-sector HIOs and assisting in increasing its membership. Additionally, the program brings about a stronger emphasis on the participation in electronic health information exchange, supporting healthcare reforms, and offering high-quality healthcare services.


    The performance period for this grant ends on September 30, 2015 and is part of the Medicaid EHR Incentive Program. The onboarding grant funding itself is covered mostly by CMS while the Authority covers 10 percent of it.


    Spreading health information exchange platforms throughout the nation is vital in the industry’s efforts to reduce medical errors, support population health management, improve care coordination, and offer better quality care.


    While health information exchange remains vital to improving medical care services, there are certain regions throughout the United States that have not embraced the use of HIE platforms. Rhode Island is one example. Go Local Prov reports that as many as eight out of ten physicians in Rhode Island are not using the state’s health information exchange. Rhode Island Medical Society Government Relations Director Steven DeToy explained some of the reasons for the low numbers of health information exchange adoption.


    "First, not every physician has a computer that they use for EHRs," DeToy told the news source. "Second, some of those who do, have a system that isn't CurrentCare compatible as of right now, but hopefully will be. There have been some proprietary issues. Certain EHRs don't allow physicians to prescribe electronically.”

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    Health insurer Centene adds muscle with $6.3 billion Health Net deal

    Health insurer Centene adds muscle with $6.3 billion Health Net deal | Healthcare and Technology news | Scoop.it

    U.S. health insurer Centene Corp will buy smaller rival Health Net Inc for $6.3 billion, underscoring the healthcare industry's rush to bulk up to negotiate better prices with suppliers and hospitals, and attract new customers.


    Health Net's shares touched a record high of $76.67 on Thursday, but stayed shy of Centene's offer of $78.57, which is at a 21 percent premium. Centene shares were down 3 percent at $78.42.


    The deal comes a week after the U.S. Supreme Court upheld subsidies for individuals under President Barack Obama's signature healthcare law, keeping a large chunk of patients intact under the Medicare and Medicaid programs.


    Insurers have said subsidies are key to bringing in new customers and the ruling has removed uncertainty for insurers looking for acquisitions. It could also spur more deal making in the health insurance sector, which has already seen a blitz of merger activity this year.


    Aetna Inc, the third largest insurer is looking to buy smaller rival Humana Inc. No. 2 Anthem Inc has offered to buy Cigna Corp to create the largest insurer in the country, toppling UnitedHealth Group Inc . Media reports have also said UnitedHealth could be eyeing Cigna and Aetna.


    Health insurers are not alone in trying to beef up.


    Drugmakers, retailers and pharmacy benefit managers have contributed to the wave of healthcare acquisitions since 2014, pushing deal-making in the industry to record levels.


    Also, an expected increase in federal interest rates, which will make borrowing costly, is expected to push companies to close deals over the next few months.


    UnitedHealth could bid for either Health Net or Centene, or even the combined company, Leerink & Co analyst Anagha Gupte said. Gupte said she now expects other smaller insurers such as WellCare Health Plans Inc and Molina Healthcare Inc to merge.


    Centene's buyout of Health Net will catapult it to the top of the government insurance heap, ahead of bigger rivals who dominate the private insurance market.


    The combined company will serve more than 10 million members across the country, but will still be small in terms of total membership. Market leader UnitedHealth, for example, has nearly 46 million members.


    Centene, which will also assume $500 million in Health Net debt, said the deal is expected to boost adjusted profit by more than 20 percent in the first year.

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    Aetna to buy Humana for $37 billion in largest insurance deal

    Aetna to buy Humana for $37 billion in largest insurance deal | Healthcare and Technology news | Scoop.it

     Health insurer Aetna Inc on Friday said it would buy smaller rival Humana Inc for about $37 billion in cash and stock, in the largest ever deal in the insurance industry.


    The combination will push Aetna close to Anthem Inc's No.2 insurer spot by membership, and would nearly triple Aetna's Medicare Advantage business.


    The deal will face antitrust scrutiny but if it goes through it would dwarf the previous largest insurance deal announced just this week, where Swiss property and casualty giant ACE Ltd announced it was buying Chubb Corp for $28 billion. It would also dwarf Anthem Inc's purchase of WellPoint in 2004 for $16.6 billion.


    Analysts have said that M&A activity in the healthcare sector had been waiting for last week's Supreme Court ruling on Obamacare, which upheld key subsidies that underpin the reform and thus gave more certainty to healthcare insurers.


    The bigger the insurer, the more power it has negotiating prices and improving its doctor networks.


    Anthem has offered to buy Cigna Corp to create the largest insurer in the country, toppling UnitedHealth Group Inc .


    Media reports have also said UnitedHealth could be eyeing Cigna and Aetna. On Thursday, Centene Corp said it would buy smaller rival Health Net Inc for $6.3 billion.


    ANTITRUST ISSUES


    Antitrust authorities, who were aggressive in their review of the failed deal between Comcast and Time Warner Cable , are expected to scrutinize how the combination of insurers will affect competition for each line of insurance: Medicare, Medicaid for the poor, individual insurance, commercial insurance for small and large businesses and the large employer business.


    Aetna and Humana are in nine of the same states in Medicare Advantage. Combined, they would have market share of 88 percent in Kansas, 80 percent in West Virginia, 58 percent in Iowa and 51 percent in Missouri.


    Wall Street analysts and some antitrust experts have said they expect the combination will be approved, although regulators may ask for some divestitures.


    Others have said it is unclear that this group of regulators will stick to the usual review playbook for such a large deal and may add other restrictions.


    The Justice Department, which reviews insurance mergers, will scrutinize deals city-by-city to see if the combination would have a monopoly in any metropolitan area, said Andre Barlow, a veteran of the department who is now at Washington law firm Doyle, Barlow and Mazard PLLC.


    Aetna said the combined company is projected to have over 33 million medical members, based on memberships as of March 31. Operating revenue is expected to be about $115 billion this year, with approximately 56 percent from government-sponsored programs including Medicare and Medicaid.


    Last week, the U.S. Supreme Court upheld subsidies for individuals under President Barack Obama's signature healthcare law, keeping a large chunk of patients intact under the Medicare and Medicaid programs.


    Insurers have said subsidies are key to bringing in new customers and the ruling has removed uncertainty for insurers looking for acquisitions. It could also spur more deal making in the health insurance sector, which has already seen a blitz of merger activity this year.


    U.S. Senate Majority Leader Mitch McConnell, of Kentucky, praised Humana's presence in his home state but also noted the role of the healthcare law in the merger.


    "This morning's announcement, as I predicted during the debate five years ago, is the inevitable result of Obamacare’s push toward consolidation as doctors, hospitals, and insurers merge in response to an ever-growing government," the Republican said in a statement.


    The deal includes a $1 billion break-up fee payable by Aetna to Humana, should the deal fail because of antitrust concerns, an Aetna spokeswoman confirmed. The fee was first reported by the Wall Street Journal.


    CASH AND SHARES


    Hartford, Conn.-based Aetna said it would pay Humana shareholders $125 in cash and 0.8375 Aetna shares for each share held. The offer of about $230 per share is a 23 percent premium to Humana's closing price on Thursday.


    Following the deal, Aetna shareholders would own about 74 percent of the combined company with Humana shareholders owning the rest. Aetna Chief Executive Mark Bertolini will serve as chairman and CEO of the combined company.


    The deal is expected to close in the second half of 2016 and add to operating earnings per share from 2017.


    Humana's sale has been anticipated since May when it was first reported that Cigna Corp and Aetna were interested, and multiple sources confirmed to Reuters that the company was entertaining offers.


    Humana, based in Louisville, Kentucky, has been under pressure for more than a year from investors, which include activist fund Glenview Capital Management, to produce higher returns.


    Last year Humana hired a CFO from investment bank Goldman Sachs and went through a strategic review that included asset sales. But it missed several quarters of earnings targets and struggled with profits in its individual business, disappointing Wall Street.


    Aetna said it has received commitments from Citi and UBS Investment Bank to finance the deal.


    Citi and Lazard are financial advisers for Aetna and Davis Polk & Wardwell LLP is its legal adviser. Goldman Sachs is the financial adviser to Humana, while Fried, Frank, Harris, Shriver & Jacobson LLP is its legal adviser.

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    Under Healthcare Reform, Where Do Practicing Physicians Go From Here?

    Under Healthcare Reform, Where Do Practicing Physicians Go From Here? | Healthcare and Technology news | Scoop.it

    It’s a fascinating time these days in healthcare, on so many levels. And discussions in the past week—mine and others’—have only underscored that fact.


    First, there was my breakfast and interview with Scott Weingarten, M.D., the senior vice president and chief clinical transformation officer at Cedars-Sinai Health System in Los Angeles. Reconnecting with Scott Weingarten reminded me once again of what a vortex we’ve been flying into and through, lately in our industry. Southern California is one of the more advanced managed care markets in the U.S., and yet even there, change has proven to be challenging for physicians. And if anyone is in a position to know just how challenging all this is, it is Dr. Weingarten. As he told me a week-and-a-half ago, when asked what the key to helping physicians move forward to optimize care is, “It’s a combination of things. I think physicians want to do the right thing. They went to med school to help patients; they’re trained in the scientific method. And they need to know that what they’re doing is scientifically valid. If you can’t convince physicians that something is the right thing to do for patients, they’re not going to do it.”


    Weingarten, who practiced for years as an internist before he went into administration at Cedars, then co-founded Zynx Health (which provides evidence-based guidelines), and then came back to Cedars two-and-a-half years ago,  told me this: “ I used to be a practicing physician; and if someone couldn’t convince me something was right for my patients, I wouldn’t do it, either. So they need to understand that all of this is good for their patients; and they need to understand all the changes taking place at the national and local level; and also to understand how change will help them better take care of their patients.”


    Weingarten believes that the MACRA (Medicare Access and CHIP Reauthorization Act of 2015) law that eliminated the SGR (sustainable growth rate) problems under Medicare, and which mandates either participation in the new Merit-based Incentive Payment Program, or MIPS, or participation in alternative payment models, which push practicing physicians forward quickly, once they figure out their options. “We provide them with those resources to help them, because it’s very hard for physicians in small practices,” he noted, of his organization’s clinical transformation and performance improvement work at Cedars-Sinai, because “with MIPS—in 2019, physicians will either need to participate in alternative payment models, or in MIPS. Beginning 2019, they’ll get a 5-percent annual bonus for participating, whereas there could be up to a 9-percent downside under MIPS in Medicare reimbursement over time, and that could be very difficult for the physicians.” And of course, “A lot of physicians are trying to figure out what alternative payment models mean for them,” he noted, “so we try to explain to them what’s going on and what it means.”


    Not every physician is practicing in an integrated health system like that of Cedars-Sinai, where senior executives are working assiduously towards clinical transformation—and even have a senior vice president for clinical transformation, in Scott Weingarten. Joseph Valenti, M.D., an obstetrician-gynecologist who practices at the Denton, Texas-based Caring for Women practice, recently told HCI Associate Editor Rajiv Leventhal, that physicians like himself are becoming stressed by some aspects of healthcare reform. Asked why he believes that some doctors are wary of joining accountable care organizations, Dr. Valenti said, “I think that a lot of physicians are not completely convinced that the data is out there to demonstrate that they could potentially develop the savings necessary, and prevent hospital admissions and readmissions. Much of the healthcare spending that is extreme right now is in hospitals, not clinician offices,” he said, “so the concern is, can you keep this person out of the hospital? Also in terms of Medicare ACOs, you’re going to be assigned 5,000 patients at least, and they could be the sickest patients out there, so there is no guarantee that you can make them well enough and be assured that they don’t need to come back to the hospital. So maybe you can’t demonstrate shared savings. And the ACO stats prove this; one-third of them are working, one-third are breaking even; and one-third are leaving the program. “


    Meanwhile, electronic health records and other clinical information systems are fascinating in this context, because they are absolutely essential to moving forward on value-based care delivery and payment and clinical transformation, but the implementation of an EHR/EMR itself is really, as everyone says, “table stakes”—that go-live is only the first step in a very long process for physician practices. “As Dr. Valenti expressed it to Rajiv, “This is the story with EMRs—no one has compelled them to simply ‘come up to snuff.’ The concern is that I will put my whole future in the hands of this IT system, and maybe it will work but maybe it won’t. The cost of this for us was over a quarter of a million dollars, and we’re not as satisfied as we should be given the cost. We can’t believe the number of bugs and glitches with it,” he said. “There are eight providers in our group, and we do like the ability to access our EMR from anywhere when a patient calls middle of night. I wouldn’t go back to paper, even though I know a lot of doctors actually would—many have been jaded by EMRs that were not well supported and cost them a ton of money and time. I call these things unfunded mandates—things we must do but no one is funding anyone to do them.”


    All these issues were definitely on the minds of the CMIOs and other medical informaticists gathered in Ojai, California last week for the annual AMDIS Physician-Computer Connection Symposium. There are so many “to-do’s” when it comes to optimizing the use of clinical information systems in order to really accomplish the clinical transformation that will be required to fundamentally reengineer the U.S. healthcare system in the coming years. As Doug Fridsma, M.D., Ph.D., of AMIA (the American Medical Informatics Association) noted in his AMDIS address, physician documentation processes need to be seriously revamped; regulations need to be made more focused in their approach; there needs to be greater transparency around EHR functions; and clinical IS innovation among vendors must be encouraged.


    Referring to his association’s recently published “EHR 2020” report, Fridsma said of himself and his association with regard to the policy recommendations made in the report, “We said, if you’re going to focus regulation and increase transparency and encourage attempts to simplify documentation, make sure to keep your patient at the center, as the North Star.”


    I think that that comment will be very important going forward, particularly with regard to helping physicians in practice to do the very difficult work of transforming patient care to improve outcomes around both care quality and cost.


    Certainly, Scott Weingarten and his colleagues at Cedars-Sinai know that. Their challenge is to figure out how to optimally leverage IT tools to support physicians in creating their own clinical transformations while also contributing to broader processes of transformation across their integrated health system. And they’re learning as they go, in terms of ACO and population health development.


    So here’s the thing: Scott Weingarten, Joseph Valenti, and Doug Fridsma are all very, very smart doctors. They’re all trying to do what they can in their organizations to move their organizations forward, and in some way, to move the physician community, and U.S. healthcare, forward.


    And all this change-making is inherently, and inevitably, messy. Because for U.S. healthcare to successfully move into its next phases of evolution, we will need for federal policy mandates, private health insurer initiatives, hospital, medical group, and health system efforts, and individual physicians’ delivery process changes, all to move forward, in some broadly coordinated way. And yet, the reality never matches the theory—thus Dr. Valenti’s legitimate complaints about some of the challenges facing practicing physicians. In particular, he is quite right that demanding accountability from physicians for outcomes that are partly actually the responsibility of patients, is problematic.

    Yet it is still in everyone’s interest for individual physicians in practice, whether solo (though few are left in true solo practice anymore) or in organized groups, to feel themselves to be a part of change, and to be “self-change agents,” as it were. And good medical practice governance, and good IT governance, will be essential to any such advances.


    So how physicians move forward under healthcare reform (public and private alike) is a question that concerns all of us in healthcare. But only time will tell as to exactly how it all plays out. So stay tuned, because the kinds of discussions that I and my fellow editors at HCI have been having in the past couple of weeks speak to some of the deeper issues facing our entire industry. Personally, I can’t wait to see exactly how everything plays out. It certainly will be a fascinating next couple of years!

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    Mobile has put patients in the driver's seat. Here's how.

    Mobile has put patients in the driver's seat. Here's how. | Healthcare and Technology news | Scoop.it

    Many people used to believe that Facebook was an extremely defensible business and that it would be almost impossible for another social network to compete.

    It has grown to an enormous scale with massive troves of data and more than 1.5 billion monthly users. The thinking around their defensibility was that because all of your friends and photos and updates are already stored on Facebook, it would be tedious and unnecessary to switch to another social network. Everything you need is there. Why go somewhere else?

    Facebook did have quite a bit of defensibility back when the predominant access point to the service was the desktop web. Moving your data to a new social network was painful and impractical. But now that the main access point to social is our mobile phone (more than half of Facebook’s traffic comes through mobile) things have changed dramatically.

    We now carry around all of the key elements of a social network on our cell phones. Our phones carry our location, our photos, and our address book and allow us to message anyone at no cost from anywhere in the world. With the click of the touchscreen, we can view and connect with all of our friends on a new social network and instantly recreate our social graph. We can take a photo and instantly send it to a multiple social networks. We can easily join different social networks with different groups of friends focused around different needs. The friction of leaving Facebook and joining a new network has disappeared. This wasn’t possible with the desktop web, or it was at least much more difficult.


    As a result of the increasing use of mobile, we’ve seen lots of new social networks emerge. (There are now dozens of social networking apps with 1 million+ downloads in Apple’s App store, including Kik, WhatsApp, Tumblr, Google+, Instagram, Snapchat and many others.)

    This increased use of mobile has reduced the friction of launching a new social network to near zero and, as a result, has shifted ownership of data away from the network and back to the individual. Trying to own the data and lock-in the consumer is no longer a viable strategy.

    Facebook is well aware of this and has adjusted by rapidly buying up many of these new networks. We’ll likely see more acquisitions like these in the months to come.


    Over the last several years, large health care provider organizations and health care software vendors have been employing a similar strategy to that of Facebook. Health systems have been growing by buying up ambulatory, community-based sites and employing doctors to build out giant systems that can offer clinical services across the entire continuum of caregiving the patient no reason to go anywhere else. In parallel, providers and software vendors have been creating a single patient record (including blood tests, physician notes, imaging and other data) that flows across the entire provider organization and can be easily shared with providers across the system. This avoids all of the classic frustration associated with having to fax your x-rays from one provider to another. Everything exists on the web in one single record. Providers then roll out a patient-facing portal that lays across the patient record where the patient can access all of their data (mostly through the desktop Web).


    The strategy is simple. Providers are telling the patient to 1) stay with us because we do everything, and you don’t need to go anywhere else; and, 2) you can’t go anywhere else because we have all of your data.


    But as we saw with Facebook, now that a consumer’s primary entry point to the web is their mobile phone, this strategy has some flaws.

    Not only do our phones enable messaging and carry our location and address book and photos, they can also carry data on our movement, our sleep, our heart-rate, the prescriptions we’re taking, our body temperature and, with the use of implanted devices, much, much more. This real-time data that we carry on our phones is arguably more valuable than the data stored in our clinician’s patient record that only gets refreshed while we’re sitting in the examination room.

    Increasingly, providers will own some patient data but the patient will own more data and better data.


    Like Facebook, health care providers are trying lock in their customer by owning the data. But the increasing use of mobile has changed the game. Just like social network users can effortlessly syndicate their own data out to multiple social networks, a patient will be able to syndicate their real-time clinically relevant data out to multiple providers, regardless of which system they’re associated with.

    Mobile has put patients in the driver’s seat.


    Meanwhile, with the emergence of home care and telehealth and urgent care clinics and apps and implants that manage more serious and chronic conditions, in many ways health care has actually become more fragmented. The traditional providers may be consolidating, but new players are creating new channels for care and causing more fragmentation across the industry. Where and when and how care is delivered is being completely reshaped.


    But unlike Facebook, large health care providers can’t buy their way out of this conundrum. First, because they don’t have enough cash (most are non-profits with microscopic profit margins) and second because health care is local. Health systems are no longer just competing with the hospital across the street; they’re competing with web services that are available to the global market.


    As a result, large provider organizations are going to have to consider new ways of providing value and will have to select which segments of patients they want to serve.


    In short, they can’t own the patient because they can’t own the data.

    The idea of locking the patient into one network of providers was always a bit flimsy. But the strategy was somewhat understandable. A lot of this was driven by the trend towards value-based payments and the convenience of ‘owning’ a patient under that model.


    But the lessons of Facebook are clear. Locking up the data is not a path to success.


    Social networks and health care providers must focus on what they do best and focus on serving the consumer they want to serve and abandon their attempts to win by owning data that isn’t theirs to own.

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    Cases of Wish-Bone ranch dressing recalled

    Cases of Wish-Bone ranch dressing recalled | Healthcare and Technology news | Scoop.it

    The makers of Wish-Bone Ranch Salad dressing are recalling thousands of bottles of the popular product because they contain blue cheese dressing instead.

    Because blue cheese dressing contains eggs, those accidentally-filled products could be dangerous for anyone with an egg allergy.

    New Jersey-based Pinnacle Foods Group said blue cheese dressing was accidentally filled into 8,678 cases of 24-ounce bottles labeled as Wish-Bone Ranch Salad Dressing.

    "Those people who have allergies or severe sensitivity to eggs run the risk of serious or life-threatening allergic reaction if they consume this product," Pinnacle said. But it is still safe to eat for people who are not allergic to eggs.

    Egg allergies strike mostly children and usually lead to skin rashes, nasal congestion or vomiting,according to the Mayo Clinic, but there is little danger of life-threatening anaphylaxis.

    The bottles of dressing affected were filled on April 23, 2015, by a contract company, Pinnacle said. Consumers can identify them by their "best by" date of "Feb 17 16," and may return them for a full refund.

      Pinnacle said it notified the Food and Drug Administration about the issue, and has advised distributors and retailers of the product to remove affected bottles from their assortments.

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      The Security Risks of Medical Devices

      The Security Risks of Medical Devices | Healthcare and Technology news | Scoop.it
      There are a large number of potential attack vectors on any network. Medical devices on a healthcare network is certainly one of them. While medical devices represent a potential threat, it is important to keep in mind that the threat level posed by any given medical device should be determined by a Security Risk Assessment (SRA) and dealt with appropriately.

      So let’s assume the worst case and discuss the issues associated with medical devices. First off, it must be recognized that any device connected to a network represents a potential incursion point. Medical devices are regulated by the FDA, and that agency realized the security implications of medical devices as far back as November 2009, when it issued this advisory. In it, the FDA emphasized the following points:

      Medical device manufacturers and user facilities should work together to ensure that cybersecurity threats are addressed in a timely manner.
      The agency typically does not need to review or approve medical device software changes made for cybersecurity reasons.
      All software changes that address cybersecurity threats should be validated before installation to ensure they do not affect the safety and effectiveness of the medical devices.


      Software patches and updates are essential to the continued safe and effective performance of medical devices.


      Many device manufacturers are way behind on cybersecurity issues. As an example, many devices are still running on Windows XP today, even though we are one year past the XP support deadline. They are often loathe to update their software for a new operating system. In other situations device manufacturers use the XP support issue as a way to force a client to purchase a new device at a very high price. All healthcare facilities would be well advised to review any purchase and support contracts for medical devices and make sure that things such as Windows upgrades do not force unwanted or unnecessary changes down the road. While there are options to remediate risks around obsolete operating systems, they are unnecessary and costly. Manufacturers should be supporting their products in a commercially reasonable manner.

      Why would anyone be interested in hacking into a medical device? Of course there are those that would argue that anything that can be hacked will be hacked, “just because”. While it is possible that hacking could also occur to disrupt the operations of the device, the more likely reason is that getting onto a medical device represents a backdoor into a network with a treasure trove of PHI that can be sold for high prices on the black market. Medical devices are often accessible outside of normal network logon requirements. That is because manufacturers maintain separate, backdoor access for maintenance reasons.


      Hackers armed with knowledge of default passwords and other default logon information can have great success targeting a medical device. For example, this article details examples of a blood gas analyzer, a PACS system and an X-Ray system that were hacked. Many times healthcare IT departments are unaware or unable to remediate backdoor access to these systems. These are perhaps more “valuable” as a hack because they are hard to detect and can go unnoticed for a long period of time. As a reminder, the Target data breach last year was initiated because the access that a third party had to the retailer’s network was compromised. A complete SRA should inventory all network connected medical devices and analyze the access/credentials that a device has, and any associated security threat. The best defense is a good offense – make sure that networked devices have proper security built in and implemented. Then your devices will no longer be “the weak link in the chain”.

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      Oculus Rift Virtual Reality Headset Used to Fight Phobias

      Oculus Rift Virtual Reality Headset Used to Fight Phobias | Healthcare and Technology news | Scoop.it
      While the Oculus Rift, a virtual reality immersion device, is slated for release only early next year, researchers are already trying to implement practical uses for it. At Santa Clara University a couple engineering and computer science students are working on using the Rift to fight phobias, initially focusing on a fear of heights and flying. With a background in video games, the pair teamed up with the chair of the university’s psychology department to study how phobias are treated and how to create a virtual reality experience that will progressively address patient fears.

      The investigators came up with a system that pairs a Rift headset with a touchscreen tablet. The patient wears the Rift, while a therapist uses the tablet to guide the experience and tailor it to the patient’s unique needs. In their heights simulation, for example, the treatment starts with the patient virtually standing on top of a building. Initially it is not very tall, but the therapist can slowly increase the building’s height while watching the emotional response of the patient. By increasing the height without terrifying the patient, the therapy can gently nudge acrophobics to get used to being on tall objects and hopefully eventually lose their fear.

      While the heights in the virtual world may frighten patients, the team noted that because wearers of the device know they can take it off at any time, they seem to more accepting of trying out the system. Of course an important step will be to actually test the system with real patients to see whether it is truly effective at allaying fears once and for all.
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      Lyfe Media's curator insight, June 17, 2015 10:01 AM

      The Oculus Rift virtual headset is going to create a world of opportunity for doctors, therapists, and counselors alike. Dealing with patients and their fears can be one of the most difficult topics to approach, especially since a lot of our fears are irrational or impossible. It's exciting to see the world of technology colliding with modern medicine in such an innovative, helpful way.

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      Hospital group says Illinois could lease Healthcare.gov

      Hospital group says Illinois could lease Healthcare.gov | Healthcare and Technology news | Scoop.it

      A hospital group in cash-strapped Illinois says the state might be able to set up a health insurance exchange at a lower cost by "leasing" the federal government's technology, an option that could appeal to as many as 34 states where subsides could be jeopardized by an unfavorable U.S. Supreme Court decision.


      In a memo written for Gov. Bruce Rauner and state lawmakers and released to The Associated Press, the Illinois Hospital Association says it anticipates the federal government "will be developing a leasing fee" for states to use HealthCare.gov as the backbone for their own insurance exchanges. It also lists an alternate possibility of renting an exchange system from another state that has its own, such as Connecticut or Kentucky.


      President Barack Obama has said there is no backup plan if the Supreme Court strips federal subsidies from the law in Illinois and the 33 other states that haven't created their own exchanges. The administration didn't respond Monday to the AP's requests for comment on the possibility of leasing HealthCare.gov.


      "We do believe that the administration is quietly discussing a healthcare.gov lease option with the states and that it will roll out more specific guidelines in the event that the Supreme Court strikes down the subsidies," said Caroline Pearson, who follows the health law for the market analysis firm Avalere Health.


      The four-page Illinois memo is the clearest plan yet for how the state could create a state-based exchange quickly should the justices rule that only people living in states with their own exchanges can get federal financial help.


      "We as an association are ready to work with the legislative leaders and certainly the administration," said Illinois Hospital Association President and CEO Maryjane Wurth. "We hope we have the governor's support to figure this out."

      Rauner, a Republican who took office in January, hasn't discussed what his approach would be if the Supreme Court rules against subsidies. "The governor's office will take appropriate action depending on how the Supreme Court rules," said Rauner spokeswoman Catherine Kelly.


      The Supreme Court ruling is expected later this month, and the subsidies could end later in the summer unless Congress acts. Leading congressional Republicans are promising to help consumers who lose subsidies, but it's unclear Congress could pass any fix that Obama would sign.


      The partisan fight over Obama's health law stalled a state exchange in Illinois. Former Illinois Gov. Pat Quinn, a Democrat, had supported a state-run insurance exchange but was never able to get enough legislative support.


      At issue in the Supreme Court case are four words in the law. The challengers argue it provides subsidies only to people who get their insurance through an exchange "established by the state." The 34 states that have not established their own marketplaces instead rely on the federal HealthCare.gov system.


      If the court strikes down subsidies in Illinois and the other states, more than 230,000 Illinois residents would lose the tax credits that help them pay for coverage. In Illinois, the average monthly subsidy is $211. On average, consumers would see their premiums increase by 169 percent if the tax credits were no longer available, according to the nonpartisan Kaiser Family Foundation.

      Many Illinois residents would no longer be able to afford insurance. Rates would rise for other individuals, Wurth said. Hospitals would see fewer patients with good-paying insurance and would provide more charity care at a financial loss.


      While no one knows how the Supreme Court will rule, state lawmakers might need to react quickly to keep the subsidies available. Democrats in Springfield are warring with Rauner over a budget that falls $3 billion to $4 billion short on revenue.


      Illinois may be in a better position than some states because it's already running some aspects of its insurance exchange in partnership with the federal government.


      To have its own insurance exchange, Illinois would have to pass legislation to set up a way to pay for it, an annual cost that's been estimated at $50 million to $90 million. A 3.5 percent assessment on the group accident and health insurance industry in Illinois could generate $55 million, the hospital association memo says.


      The memo explores the possibility of Rauner using an executive order to set up the current Get Covered Illinois team as the exchange governance. But it warns such an order "would likely be open to legal challenges."

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