31 January 2012

Midwest Edition
Calendar
February 22
;/"6<7!=/#/>4<!?4%/@<42#0! "#5!ABC"@<!>%2B!..D:DE! F45G/0<!=$04#/00!H%2$C!2#!;/"6<7) :74@"82E :64@I!;/%/!>2%!F2%/!A#>2%B"<42#

Iowa Blues Aim At Enrollee Waistlines

Cost-Curbing Program Aims to Alter Health Climate
A recent Gallup report found that obesity in the United States declined by a fraction of a percent, from 26.6% to 26.1%, from 2010 to 2011, the rst decline in many years. Thats cold comfort to payers, governments, and employers, who are fronting the lions share of an estimated $270 billion a year in excess healthcare costs related to obesity. Unhappily, the Midwest is one of the fattest regions of the country. Our wide bottoms and spillover bellies put us deep in the lower half of state rankings for body mass index. Is there something in the sausage? Gov. Terry Branstad thinks there might be. Hes trying to make Iowa the healthiest state in the country in ve years, with an eye to boosting not just quality of life but economic viability. Because health behaviors and the environment account for 70% of the factors governing personal health, the concept is to change the environment so that state residents eat less, eat better, walk more, and overall take more personal ownership for their own health and that of their communities. In January, 54 Iowa towns (out of 58 invited) submitted applications to become Blue Zone demonstration sites. A Blue Zone, as described by National Geographic author Dan Buettner, is a region where people live longer because they enjoy healthier lifestyles. For instance, they eat plant-based diets, with little meat; they attend faith services; they walk a lot; they live close to their elderly parents; or they keep in touch with their friends. The key variable, Buettner says, is the environment. People dont like to follow diets or change their health habits in a party of one, but theyll adapt to the prevailing norms in the society around them. If you can optimize the built environment, the social network, building designs, and enhance a sense of purpose and inner self in a community, you will elevate the overall wellbeing of individuals in that community. Branstad enlisted a local grocery chain, HyVee; the Iowa Sports Foundation; Healthways; and the dominant health insurance company, Wellmark, in this quest. Wellmark decided to lend nancial and tactical support to the Blue Zones venture, by
Continued on Next Page

April 27-28
F;D!.7&04@4"#!9/"5/%074C!D@"5/B&E NO2$!D%/!P2<!!$0<!"!?2@<2%!D#&!F2%/Q .7&04@4"#!"0!9/"5/%)!A#>6$/#@/% "#5!:2BB$#4@"<2%ER F4@748"#!;20C4<"6!D002@4"<42#) F4@748"#!S<"</!T#43/%04<&)!9"#04#8E :64@I!;/%/!>2%!F2%/!A#>2%B"<42#

June 11-13
J742!;20C4<"6!D002@4"<42# KL<7!D##$"6!F//<4#8E ;46<2#!:26$B-$0!"<!M"0<2#! :26$B-$0)!J742E :64@I!;/%/!>2%!F2%/!A#>2%B"<42#

A NEW WEBINAR! Thursday, Feb. 24, 2012 Noon CST

Pre-Term Deliveries: Management Strategies

E-Mail [email protected] with the details of your event, or call (877) 248-2360, ext. 3. It will be published in the Calendar section, space permitting.

Please join Larry Boress, President, Midwest Business Group on Health, Peter Weeks, M.D. Chairman, obstetrics department, Edward Hospital, and Harold Miller, President, Future Strategies, LLC, to discuss a movement toward ending deliveries prior to 39 weeks of gestation.

http://www.healthwebsummit.com/pp022412.htm
a HealthcareWebSummit Event
co-sponsored by

PAYERS & PROVIDERS

!"#$"%&!'()!*+(*!,!*+(*!-&!."&/%0!1!.%2345/%0!.$-64074#8)!99:

Payers & Providers

Top Placement... Bottomless Potential

NEWS
Iowa (Continued from Page One)

Page 2

Advertise Here
(877) 248-2360, ext. 2

In Brief
UnitedHealth Profits Rise on Growth in Membership, Margin
UnitedHealth Group, the countrys largest insurer, reported a 21% increase in net income in the fourth quarter on an 8% increase in revenues. Medicare Advantage enrollment went up 9.3%, while Medicaid enrollment rose 1.1%. Total medical enrollment went up a half a percent, to 34.57 million members. Analysts said it was an impressive show of the ability to grow membership in a tough environment. Full year revenues for the Minnetonka, Minn.-based company hit $102 billion, an increase of 8% over the year before. Competitor WellPoint, parent of Blue Cross Blue Shield plans in 14 states, reported a 39% decline in net income. UnitedHealth projected that 2012 revenues will be in the range of $107 billion to $208 billion. But Wall Street was disappointed that guidance wasnt raised, and the entire sector declined when United CEO Steven Helmsley predicted that 2012 would be a more difcult year than 2011.

Rehabilitation Institute To Build New Hospital in Downtown Chicago

The Rehabilitation Institute of Chicago, one of the countrys most highly regarded rehab hospitals, is getting ready to build a new structure that would raise its current capacity of 182 beds by half, to 272 beds. The new hospital would cost $462 million, according to a notice the institute led with the Illinois certicate of need authority.

Continued on Page 3

making a long-term investment designed to cause, and that means changing the make a lasting and sustainable change to the environment. health and wellbeing of Iowans, said Wellmark is investing $25 million over ve Courtney Greene, spokesman for Wellmark. years in support of Blue Zones. Because its a The Des Moines-based company, the Blue mutual company, it can pursue other Cross and Blue Shield plan for the Hawkeye objectives besides return on the dollar. It State as well as South Dakota, is the dominant already has pushed administrative costs down insurer in the market, with about 2 million to the bare minimum and has achieved a high members. medical-loss ratio of 87% to 90%, Jackson According to a report by the Trust for said. Americas Health, 28.1% of adults in Iowa are Under the Blue Zones program, local obese and 11.2% of children are. The rate of communities will receive expert advice and adult physical inactivity was 24.7%. The tools to engage the citizenry, increase the diabetes rate is participation rate, and 7.4% and the ultimately raise the hypertension rate is well-being ratio. 26.5%. The metric is the The Fat of the Land The governors Gallup-Healthways healthiest state Well-Being Index, a With one exception, Midwestern states program is as much telephone survey that fall into the heavier half of the 50 states, an economic measures in a ranking of obesity rates: development respondents total strategy as a healthwellbeing, including and-wellness such factors as 14. Minnesota program. emotional health, 27. Wisconsin When youre physical health, trying to bring healthy behavior, life 29. Illinois businesses to Iowa, evaluation, work 32. Iowa and you have a environment, and 36. Kansas healthy vibrant access to care. The work force thats not Gallup polling rm 37. Indiana calling in sick, thats interviews 1,000 39. Ohio very productive, Americans every day thats a draw for any to compile the index. 41. Missouri business, Greene Its able to track 41. Michigan said. The state has changes in wellbeing calculated that if over time, as well as The eight worst states Iowans can just compare one locality maintain their to another. were all in the South. current rate of After the obesity through applicants are Source: Robert Wood Johnson Foundation 2018, without evaluated, 10 getting any fatter, communities will be they could save as chosen to get the full much as $1.6 transformational billion in healthcare costs. support package from the Blue Zones project. Wellmark has set a goal of pushing the They will get a comprehensive program to healthcare cost trend down to the level of the change the built environment, such as wider consumer price index by 2014, said Laura sidewalks and paths to encourage walking, as Jackson, executive vice president for strategy well as more stairways in ofce buildings. and policy. Restaurants will get advice on new cooking But there are two primary drivers of methods and smaller portions. medical cost increases: Cost per service, and The town of Albert Lea, Minn., embraced the number and type of services received. the Blue Zone concept in 2009. Life Wellmark believes that the only way to stem expectancy increased 3.2 years, absenteeism the increases in premiums is to get to the root dropped 20% for key employers, and city employees health costs declined 49%.

!"#$"%&!'()!*+(*!,!*+(*!-&!."&/%0!1!.%2345/%0!.$-64074#8)!99:

Payers & Providers

Longer ALOS!*

NEWS

Page 3

Advertise Here
(877) 248-2360, ext. 2
*For our ads, not your hospital

WellPoint To Raise Doctor Payments

Insurer Will Pay for Care Plans, Better Outcomes
WellPoint, the parent company of Blue Cross and Blue Shield plans in 14 states, will begin to compensate physicians for care-management tasks that havent been reimbursed before. Indianapolis-based WellPoint said last week it will boost the rates it pays to primary-care practices and will pay for creating care plans for patients with complex conditions. The insurers move comes almost four months after the committee that advises Medicare on physician payment recommended that the government reimburse doctors for telephone calls, team conferences, patient education, and management of anticoagulation therapy (Payers & Providers, Oct. 18, 2011). WellPoints primary-care doctors will get extra money in three ways: * Regular fees for specic services will go up. * Preparing care plans for complex conditions will be reimbursed. * Achieving quality outcomes and reduced medical costs will earn shared savings. In a statement, WellPoint said the new reimbursement strategy is based on a medical home pilot program that in some cases led to 18% decline in inpatient admissions and a 15% decrease in emergency room visits. Primary-care doctors who maintain or improve quality could earn 30% to 50% more than they earn today through the shared savings model. Those quality improvements must meet quality standards set by the American Diabetes Association, the American Academy of Pediatrics, the National Committee on Quality Assurance, and other groups. The company believes that full implementation of the program could eventually cut overall medical costs by 20% by 2015. It plans to introduce the strategy in the third quarter of this year, and start in markets where the need is greatest, measured by quality data, outcomes, and costs. WellPoint envisions having the program operating across its entire primary care network by December 2014.

In Brief
The hospitals existing building, nestled in the campus of the Northwestern Memorial Hospital and medical school, is a 20-story modernist box that opened in 1974. It was considered the rst facility to be designed exclusively for comprehensive rehabilitation care. The hospital will move a few blocks away but will still be near the lakefront in Chicagos downtown Streeterville neighborhood. The design for the new structure, by the HDR and Gensler architecture rms, is intended to incorporate research into patient care. It is expected to open in 2016.

Truman Hospital in Kansas City Recruiting Healthy Grocery Store

Truman Medical Center, in Kansas City, Mo., is trying to bring a grocery store to its neighborhood as part of an effort to improve the health of innercity residents. The store would carry fresh fruits and vegetables. Truman, the tax-supported hospital for uninsured and indigent residents of Jackson County, expects the food store to open some time in the next 16 months. John Bluford III, Trumans CEO, recently said he would like to replace the fast food court at the hospital with more healthy choices. While my ofce is about a minute away from a purveyor of cheeseburgers and fries, it is quite a distance from the closest fresh produce case, Bluford wrote in a blog post. In other words, a classic example of an urban core food desert that fosters obesity and chronic health conditions. He said more than half of the hospitals patient base has a chronic condition, such as overweight or diabetes, which may be related to poor nutrition or dietary habits. The hospital has been sponsoring a produce market on its campus for the past two years. We see it as our duty to move beyond the walls of the hospital and take the ght to the community we directly serve, Bluford said.

AMA Wants Feds to Stop ICD-10

Says Implementation Too Expensive, Complicated
The American Medical Association has asked the federal government to halt implementation of the ICD-10 coding regimen and replace it with something more workable. The transition from ICD-9 to ICD-10 expands the number of possible diagnostic and procedure codes from 13,000 to 68,000, a massive administrative and nancial undertaking for physicians, requiring education, software coder training, and testing with payers, the AMA said in its request. The protest came in the form of a two-page letter from AMA Executive Vice President James L. Madara, M.D., to John A. Boehner, Speaker of the House of Representatives and a Republican. The AMA estimated the cost of implementation at $83,290 to $2.7 million, according to the size of the medical practice, with no possibility of nancial assistance from the government, which is requiring the upgrade through the HIPAA law. The transition to ICD-10 is supposed to happen Oct. 1, 2013. The AMA points out, though, that physicians are laboring under a multitude of government mandates that must be carried out over the next few years that cost a lot of money and time but dont necessarily bring higher revenues or benets to direct patient care. They include the e-prescribing program, demonstrating meaningful use of an electronic health record, and the Physician Quality Reporting System. Doctors are expected to make these huge investments in IT capability at the same time that their payments from Medicare decline under the sustainable growth rate formula (SGR). The struggle to keep up with the various health IT use and reporting requirements leaves little time for physicians to get engaged in the practice redesign and payment and delivery reforms envisioned in the Affordable Care Act, Madara said. The AMA also objects to the imposition of penalties for failure to meet the timetables under the law. The association is asking for an appropriate replacement for ICD-9 but didnt specify what that might look like.

!"#$"%&!'()!*+(*!,!*+(*!-&!."&/%0!1!.%2345/%0!.$-64074#8)!99:

Payers & Providers

OPINION

Page 4

;26$</!*)!=00$/!>
."&/%0!1!.%2345/%0!40! ?$-6407/5!/3/%&!@$/05"&!-&! ."&/%0!1!.%2345/%0!.$-64074#8)! 99:A!B#!"##$"6!4#54345$"6! 0$-0C%4?D42#!40!EFF!"!&/"%! GE(>F!4#!-$6H!$?!D2!(+! 0$-0C%4-/%0IA!=D!40!5/643/%/5!-&! /J<"46!"0!"!.KL!"DD"C7</#D)! 2%!"0!"#!/6/CD%2#4C!#/M06/DD/%A
B66!"53/%D404#8)!0$-0C%4-/%!"#5! /54D2%4"6!4#N$4%4/0O
GPQQI!*>PJ*'R+ 4#S2T?"&/%0"#5?%2345/%0AC2<

The Adventure of EHR Implementation

CMS Demands Slow Down Daily Practice Rhythms
The electronic health record: Let me give you a here today, but I have to input this information. progress report. A 15-minute visit stretched to 20 or more as I In October 2011, my ofce practice took struggled to ll in all the elds. I started to get the plunge. No more old-fashioned charting. behind. I began to feel like an opera singer with a Keyboards and iridescent screens have cold: I could perform, but sub optimally. It made replaced pen and bulky paper. Piece of cake? me irritable. I would almost explode if I was Hardly. knocked out of the system for some reason or the The rst challenge was to minimize the screen froze, pushing me off schedule. I came to disruption to our practice. I know physicians dread the patient Id known and liked for twentywho curtailed the number of patients they saw ve years with the ten-active-problems list. How for weeks until they felt do you record everything? comfortable with the new People have suggested hiring system. That was not a someone to scan in the viable option for me. I scores of pages of notes but, belong to a threehonestly, I wouldnt nd that physician private practice helpful since most of my that has relatively shallow notes are not all that pockets. We cant afford interesting or even important. to reduce our workload. When I get a new patients We therefore chose a records, what most interests system that segued nicely me are recent labs or with our style of practice. radiology reports, And we began slowly, consultations from using the computer for specialists, and patients with simple immunization history. problems only. What is most stressful is At rst, it was fun. that my workload has Patients got a kick out of escalated, not diminished, it. They were most and I dont see that changing. impressed that I could For example, lets go back to send their prescriptions the prescription process. By Ross A. Slotten, M.D. electronically to their Overall, the system saves pharmacy. Eventually, however, we had to stop living in two different worlds. It was all or nothing. New patients were a breeze. Although it took some time to understand how to navigate between elds (chief complaint, past medical history, social history, etc.), I was able to obtain a history the same way that I always had. Only the way to record that information had changed. More difcult were the long-standing patients. When was your last diphtheria-tetanus shot? Oops, I guess I never gave you one! Oh, yes, you had your gallbladder removed six years ago. Lets put that down in the surgical history section. I know youre 80, but can you tell me again what your mother died of, because Medicare insists thats meaningful data? My medical assistant forgot to note that you, Mr. So-and-So, are a non-Hispanic Caucasian who speaks English as a rst language. This has no bearing on why youre everyone time, except the doctor. I used to sign off on a request, hand it back to my assistant, who then either called in the prescription or faxed it to the pharmacy. Not any more! The mail-order pharmacies, in particular, are not on board. They continue to fax rell requests. Unless I re-enter the medication myself, there will not be a permanent record of the script in the patients e-chart. Moreover, Medicare rewards me with a bonus for e-prescribing, something that doesnt concern the mail order pharmacies. I could go on. My current relationship with the electronic record is like dating someone that is good for me, smart and connected but not particularly attractive. Maybe in another year Ill be in love.

U"464#8!"55%/00O
P(P!VA!W266&M225!X"&)!Y$4D/!Z Z$%-"#H)!:B!F([+[

X/-04D/
MMMA?"&/%0"#5?%2345/%0AC2<

L"C/-22H
MMMAS"C/-22HAC2<\?"&/%0?%2345/%0

@M4DD/%
MMMADM4DD/%AC2<\?"&/%0?%2345/%0

]54D2%4"6!Z2"%5
X4664"<!UA!KM&/% W/"6D7C"%/!YD%"D/840D ^"#0"0!:4D&)!U2A !"&!X"%5/# Y/#42%!;4C/!.%/045/#D @7/!:"<5/#!_%2$? `200!BA!Y62DD/#)!UAKA ^6/4#!Y62DD/#!1!L%/#C7 :74C"82 U4C7"/6!9A!U466/#02# .%/045/#D W/"6D7!a$"64D&!B53402%0!99: W4876"#5!."%H)!=66A

?$-6407/%T?"&/%0"#5?%2345/%0AC2<

`2#!Y74#H<"#

.$-6407/% ]54D2%

5<22%/T?"&/%0"#5?%2345/%0AC2< =S!&2$!52!#2D!%/C/43/!&2$%!400$/!2S! ."&/%0!1!.%2345/%0!-&!(!.AUA!2#! @$/05"&)!?6/"0/!C"66!GPQQI*>PJ*'R+A

K$#C"#!U22%/

Ross A. Slotten, M.D., is a family practitioner in Chicago. He is a member of the Payers & Providers editorial board.

!"#$"%&!'()!*+(*!,!*+(*!-&!."&/%0!1!.%2345/%0!.$-64074#8)!99:

Payers & Providers

MARKETPLACE/EMPLOYMENT

Page 5

It costs up to $27,000 to fill a healthcare job*

will do it for a lot less.

Employment listings begin at just $1.65 a word Call (877) 248-2360, ext. 2 Or e-mail: [email protected] Or visit: www.payersandproviders.com
*New England Journal of Medicine, 2004.

SEEKING A NEW POSITION?

CAN HELP.
We publish advertisements for those seeking new career opportunities for just $1.25 a word. If you prefer discretion, well handle all responses to your ad. Call (877) 248-2360, ext. 2, or e-mail [email protected].

!"#$"%&!'()!*+(*!,!*+(*!-&!."&/%0!1!.%2345/%0!.$-64074#8)!99: