More on Merger Mania

There is a flurry of mergers and acquisitions in the health insurance and hospital industry. There are several driving forces creating this activity. The first is the mandate to obtain electronic medical records both by individual providers, and hospital systems. The federal government is incentivizing this activity but also holding a big stick threatening penalties in reimbursements if providers do not adopt EMR and HIT systems.

The second factor is the proposition to form Accountable Care Organizations (ACOs).

The merger mantra is not fueled by healthcare reform, the rationale is market share.

The acquisition of HIT is expensive, either way. However hospital administrators wish to capitalize on size for market share, as well as IT. Other HIT requirements regarding interoperability amongst differing hospitals creates the need for forming regional health information exchanges. Merging two entities into one enables easier legal requirements for exchanging data without the complexities of separate Health Information Exchanges. The incentives offered by the federal government to fund EMR and HIE are inadequate, and do not take into consideration ongoing maintenance expenses. To be sure, reimbursements will continue to decrease just as the water level subsides when the tide goes out.

The health care market place has already seen mergers, such as [Humana-Concentra[,[ Community Health Systems-Tenet Care], [Steward Health Systems-Merrimack Valley-Neshoba Valley], [Peace Health System – Southwest Washington Medical Center][Inova Health Systems – Prince William Health System ]

These mergers and the need for IT mean big business for IT hardware and software vendors.

There have been several mergers and dissolutions amongst EMR vendors. Misys was purchased by All scripts about 24 months ago. That marriage dissolved quickly in June 2009, when Misys dumped Allscripts by merging it with Eclypsys, another EMR software vendor. Mike Laurie read very well the signs of demand for HIT companies in purchasing Misys, and then taking a quick profit by dumping Allscripts when it became evident that the EMR market is highly competitive and not very profitable.

Wise investors in Health IT and software must have knowledge and expertise about much minutiae and realize that HIT software is not something bought off the shelf. The applications are highly specialized in a market that is not user friendly amongst providers.

The number of overall mergers peaked in 2006, and the number of independent hospitals as opposed to hospital systems has decreased during that same time period (see figure)

del.icio.us Tags: mergers,health IT,hospital systems,independent hospitals

What is a Prezi ??

 

I wanted to take a break from all the ‘serious nonsense’ that effects each and every one of us, from doctors to patients.

In today’s blog I am introducing “Prezi”.  Rather than go into a long dissertation about it, just go to prezi.com  I have inserted just a sample in today’s posting. Give it a second or two to load, then click on the play arrow. To proceed, advance by clicking on the arrow again.  Caution, the web site advises that some viewers become disoriented, dizzy and nauseous.  I am usually that way without Prezi.

Enjoy, there will be more coming as I learn how to  use Prezi.

IceRocket Tags: prezi,presentations,health train express

The Lancet Commissions

 

Health professionals for a new century: transforming
education to strengthen health systems in an interdependent world

The Journal Lancet this week features an article whose research has been supported by,  The Bill and Melinda Gates Foundation, The China Medical Board, and The Rockefeller Foundation.

It is an exemplary and exhaustive analysis of world health resources, past, present and future requirements.

As we rush along into the second decade of the 21st Century it seems that health care throughout the world is suffering.  The United States is battling with the concepts of ‘collective health’ delivery which seems to run counter to the republic and it’s constitutional guarantees of freedom of choice.

In Europe we witness the strains about the UK N.H.S. as it becomes introspective about it’s systems shortfall. 

Perhaps neither system will benefit global health, and a more uniform health system will morph from the present near ruins.

The article is an involved read, and not for the weak of heart, mind, or eye.

 

IceRocket Tags: lancet,world health,medical education

Mergers and Acquisitions

 

Mergers and acquisitions are not something most physicians pay any attention to, unless it is one of your daughters getting married.

In the world of finance and industrial companies they are common. Witness the recent bailouts of huge financial institutions where mergers of banks,  and acquisitions of financial organizations took place faster than a roving sperm trying to get to the ova.

The recent passage of the Affordable Patient Care Bill has alerted many insurance companies, hospitals, medical groups and even individual solo practitioners that something huge may be about to take place in health care and the health industry at large.

Accountable Care Organization (ACO) stands for much more than it’s name implies.

Not surprisingly, government healthcare reform initiatives will be the biggest driver of M&A activity, according to 65 percent of investors. The Patient Protection and Affordable Care Act's "clear intent ... is to spur provider collaboration," said Robert Berg, an Atlanta, Ga.-based member of EpsteinBeckerGreen. "From hospital acquisitions of physician practices (with physicians then becoming employees of the hospitals), at one extreme, to the formation of large accountable care organizations [ACOs] comprising a wide variety of independent health care providers and provider groups, at the other extreme--and all manner of provider mergers and joint ventures in between--we are likely to see an unprecedented era of collaboration and consolidation among those who provide health care services."

Gone are the barriers between profit-non profit,  secular v. non-secular religious institutions in merger mode,  although some fears remain. 

“As nonprofit hospitals become increasingly attractive to for-profit companies looking to capture more of the hospital market, one question that looms is whether the non-profits will be able to stay true to their mission. Some worry that patients could lose out, according to Kaiser Health News/USA Today.
For example, Detroit Medical Center's (DMC) network of eight hospitals has long served as a safety net for poor patients. But because it's been cash-poor, it has not been able to borrow the money to upgrade technology, let alone keep the facilities operating properly.
After DMC CEO Michael Duggan approached Vanguard, though, the private equity firm offered a way out. It agreed to pay DMC $417 million to reduce its debt and promised to invest another $850 million in DMC's facilities. The deal has yet to be approved by the state attorney general.
Vanguard, which is best known for buying Chrysler--which was later bailed out by the federal government--pledged to keep the system's five acute-care hospitals open, and to continue its commitment to charity care for at least 10 years. But Rev. Skip Wachsmann, a pastor at the Genesis Lutheran Church on the city's east side for 34 years, said he worries about how the sale will affect poor people. He told KHN: "What happens in 10 years and one day?"
"You can probably expect more stories like this, with the uptick in M&A activity. That's because the health overhaul law's eventual extension of coverage to another 32 million people made urban hospitals more attractive acquisition targets. "Health reform gets rid of a big chunk of the uncompensated care problem," Jack Wheeler, a professor of health management and policy at the University of Michigan told KHN.”

One interesting merger is on the plate in Albany, New York.

In the New York deal, three profitable health systems--Albany-based St. Peter's Health Care Services and the two Troy-based systems, Seton Health  and Northeast Health--have formalized plans to merge and form a new nonprofit corporation after 17 months of talks, reports the Albany Business Review. The as-yet-unnamed regional powerhouse will include five hospitals and 12,000 employees. The organization will be secular but operate as an affiliate of St. Peter's parent, Catholic Health East.

In other actions dissolutions and break ups are occurring in many instances as some  organizations prepare to cut possible losses as a result of ACOs.

Case in Point.   Misys separates itself from Allscripts after a very short lived dalliance in the heat of EMR and ‘stimulus funding”. Misys has previously been grounded in banking and business solutions  with a very small arm into EMRs.  The smell of ‘honey’ at the EMR hive apparently is not inviting enough to warrant the risks of ACOs and other ‘stings’ to the health care  industry.

del.icio.us Tags: Mergers,dissolution,misys,allscripts,health train express

The Year in Review 2010–Hospitals

Gary Levin M.D.

   

 

The last half and quarter of 2010 unveiled an explosion of mergers and acquisitions in the hospital industry. This is also occurring in the health insurance sector. 

Hospitals  have reacted to the Affordable Care Act, and the prospects of Accountable Care Organizations (ACO) with a flurry of activity to increase their size for multiple reasons. A major factor is the enormous investment of capital and human resources to obtain and implement HIT as mandated by ONCHIT and HITECH. The magnitude of the investment for HIT can only be well served by a larger organization.  Even large systems feel the threat of being unable to manage this aspect of technology.

In rather typical fashion the government by it’s action to reduce health expenditures and increase cost effectiveness and better outcomes has guaranteed further health care cost increases.

21 Recent Hospital and Health System Transactions

Health reform sparks hospital merger madness

by Anne Law, December 10th, 2010, Friday.

 

Aetna Acquires Medicity

Community Health Bids for Tenet

PeaceHealth to Merge with Southwest Washington Health System

Newton Memorial Hospital Merger with Atlantic Health System

Mega merger: CHI, Jewish Hospital and U of L in talks to create new regional system

Illinois' Loyola University Health Considers Merger

Shamokin hospital to merge with Geisinger

 

Jewish Hospital and St. Mary’s Health Care

 

This sector of the Year In Review is just part of the 2010 Health Train Year in Review.

del.icio.us Tags: mergers,hospitals,accountable care organization,affordable care act,health train express

It’s That Time of Year

 

Beginning on Halloween the fall and winter season begin with a variety of sequential days off, decorations and fond memories of past year’s events.  We anticipate the holidays each year either in dread, or with excitement and anticipation and/or a little of each.

I am preparing my “The Year in Review” in regard to health care reform, innovation, and scientific breakthroughs.  We all know 2010 was a banner year for health care debate. (And it is far from over)

 

I will include the new category,  “Movers and Shakers” in the Annual Review of Health Train Express. 

                

                                                                            Patients

To Be Announced

Look for this review somewhere between December 26-31 2010.  It all depends on what I get for Chanukah.

 

                     

Menorah

 

Chanukah came earlier this month, however wifey celebrates Christmas, does not believe in early gifts, and locks things down until 4AM on the 25th of December.

This is my small contribution to our ecumenical family.  Actually I have the best of both worlds, I celebrate both events.

A Simple Solution

 

If there is a simple solution to a problem, and  you want to sandbag it, give it to a committee to make the decision, (or the government)

Admittedly HIT and EMR appears to be complex, but the situation may be simplified greatly, and in the end much more cost effective, efficient and would provide a uniform system that would function across multiple enterprises, and clinics.

What brought this to my attention was the surprise delivery of the new Google Chrome Notebook

I had signed up about a week ago for their pilot program (and forgot about it)   Yesterday UPS overnight delivered a strange flat box to me with the big  Google  stamped on the box.

It was my early Chanukah present !   Like a child I ripped it open, and as usual did not bother to read the instructions or even plug it in.  There was enough battery life to boot it up (just by opening the lid). 

The Google CR-48 Notebook

About 20 seconds later I was surfing the web, using Google’s Chrome Browser.

         

Built into it is 3G Verizon cell coverage, and Wi-Fi..  I closed the lid and it shut down.

  

It is a very simple web browser that uses the internet to access all that is in the world. No hard drive, only a minimal flash drive.

So where am I going with this?

I believe one of the main functi0nalities of EMR should be it’s uniform interaction with physicians, portability, and a one time learning curve to use the EMR. Physicians would love one program to use at their office, ASC, and/or multiple hospitals.

Without entering the depths of EMR software, this little very thin client would serve that end  well.  It is an early design and could be duplicated by many other hardware manufacturers well.

Cool, huh ?

Now I know there will be  hundreds and perhaps thousand of ‘experts who will offer why it cannot be done… And I will offer the fact  when there is a will there is  a way.  Especially if you know where you are going and have a do-able end point.  This is unlike where we are and with a vague, expensive  complex goal.

 

del.icio.us Tags: Google,CR48,Notebook,EMR incentive,HIT,Chrome,Wifi,3G

Important News About Health Care Today

 

 

The Institute of Medicine of the National Academies has released several reports at the beginning of December.

• 

  For the Public’s Health: The Role of Measurement in Action and Accountability Released: December 8, 2010

  Despite having the costliest medical care delivery system in the world, Americans are not particularly healthy. While this information is alarming, the bigger problem is that we do not know how to reverse this trend. Our lack of knowledge is due in large part to significant inadequacies in the system for gathering, analyzing, and communicating health information about the population. In this report, the IOM reviews current approaches for measuring the health of individuals and communities and creates a roadmap for future development.

 

The Science of Adolescent Risk-Taking - Workshop Summary Released: December 1, 2010

Adolescence is a time when youth make decisions, both good and bad, that have consequences for the rest of their lives. Some of these decisions put them at risk of lifelong health problems, injury, or death. The IOM held three public workshops between 2008 and 2009 to provide a venue for researchers, health care providers, and community leaders to discuss strategies to improve adolescent health.

Redesigning the Clinical Effectiveness Research Paradigm: Innovation and Practice-Based Approaches - Workshop Summary Released: December 6, 2010

Currently, a substantial gap exists between the knowledge needed and that available for medical care decisions. The IOM Roundtable on Value & Science-Driven Health Care sponsored a meeting to explore the methods, data resources, tools, and techniques that are emerging in the new generation of accelerated clinical research approaches.

The Science of Adolescent Risk-Taking - Workshop Summary Released: December 1, 2010

Adolescence is a time when youth make decisions, both good and bad, that have consequences for the rest of their lives. Some of these decisions put them at risk of lifelong health problems, injury, or death. The IOM held three public workshops between 2008 and 2009 to provide a venue for researchers, health care providers, and community leaders to discuss strategies to improve adolescent health.

The Safe Use Initiative and Health Literacy: A Workshop - Workshop Summary Released: December 1, 2010

Every year at least 1.5 million people suffer adverse effects from medication. These problems occur because people misunderstand labels, are unaware of drug interactions, or otherwise use medication improperly. The Food and Drug Administration’s Safe Use Initiative seeks to identify preventable medication risks and develop solutions to them. The IOM held a workshop to discuss the FDA’s Safe Use Initiative and other efforts to improve drug labeling and safety.

del.icio.us Tags: health literacy,institute of medicine,IOM,adolescent risk taking,public health,health train express,accountability

The Beginning of Rationing

 

Governor Brewer’s decision to withhold Liver Transplants for Medicaid recipients in Arizona should serve as a loud warning to the electorate regarding governmental intrusions into health care financing and health care operations.

The decision was ill advised on the basis of multiple factors.  The survival rates differ from one facility to another.

What is the liver transplant survival rate and what information needs to be considered when looking at such numbers? 

For example, the country and facility in which a liver transplant is performed can have rates that are vastly different from the overall number. Also worth considering is the type of transplant (full organ or partial, i.e. liver graft) and the status of the donor (living or deceased).

 

At the Mayo Clinic in Florida

The survival rate for liver transplant in adults (both living and deceased donors) at the Florida location is higher than the national average.

The one-month survival rate there is over 98 percent for recipients; nationally it’s almost 97 percent. The one-year rate is almost 94 percent, beating out the national average of over 88 percent. Finally, the three-year rate comes in at over 82 percent, as opposed to the over 78 percent rate nationally.

In an article published in the journal Transplantation Proceedings, the MELD/PELD system is credited with an ‘excellent’ transplant survival rate in multiple categories. The study followed 4163 adults and pediatric recipients of whole organ and liver graft transplant from deceased donors from February 2002 through December 2003. The conclusion reads, “We conclude that patient and graft survival have remained excellent since implementation of the MELD/PELD system. Although recipients with MELD scores in the highest quartile have reduced survival compared with other quartiles, their 1-year survival rate is acceptable when their extreme risk of dying without a transplant is taken into consideration.”

There are many considerations besides the availability of funding when a decision is made for or against a patient undergoing liver transplantation .   The overall chances for success or failure of a liver transplant are always considered when appraising a waiting list by those responsible for allotting available donor livers.   In the case of individuals these cannot be disclosed publicly due to privacy and/or confidentiality issues regulated by HIPAA.

Some of these considerations include the etiology of liver failure, a malignant  process may not be confined to the liver,  another comorbidity, such as alcohol or other substance dependency, Hepatitis C, heart disease,  socioeconomic living conditions (homelessness) which can impact postoperative care and follow-up, age of the recipient, co-dependency of other family members, children’s ages, and other factors.  Tissue committees usually review all of these factors prior to assigning liver disposition.  Like it or not these are realistic and time proven methods of recipient selection.

Unfortunately Governor Brewer did not publicly, or the media misrepresented the decision making process done prior to the announcement that Medicaid would not fund a liver transplant in t his case..  Has the process been politicized?  The media would like this to be the case for whatever motivates their reporting.

There was also a lack of transparency of the process.  Where was DHS, Medicare and other public agencies? Is this a last minute crisis decision or another failure of incompetent legislative planning.?

There are many alternative solutions, including cutting back public services to a four day week, furloughing some public employees, delaying of funding pension plans, re-allocating funds from other programs.  Delaying Health IT expenditures, and other non essential services of Medicaid.   Why have Health IT and EMR if patients must die to fund it??

According to the Kaiser Family Foundation,  Arizona ranks poorly in regard to Medicaid cost containment.  Arizona as not:  implemented pharmacy cuts, decreased eligibility, implemented co-pays or share of costs.

Hopefully the AMA, and the Arizona State Medical Society have lodged their protest and guidance to alter this policy immediately.

del.icio.us Tags: Arizona,Organ Transplantation,Arizona Medicaid,Governor Brewer,Health Train Express

A Disruption in the Continuum

 

Like Captain Picard I sense a disruption in the continuum. Although we have been travelling at warp 9 through the celestial span, our sensors detect a sub-space discontinuity that is causing the warp engine to overheat.  The plasma container is failing, and we can no longer maintain life support on the holohealth deck.  Health 2.0 and blogging is in grave danger. At the rate of decay of medical ethics, we may also not be able to maintain life forces as we knew it.  The discontinuity in the sub space spectrum is causing a severe disruption in our broadband speed.  We may have to resort to dial-up photon propulsion.

The Federation may no longer provide reimbursement to the outer limits of federation space.  The Romulans have promised global health care to the Federation fleet, as well as the uninsured Klingons.

 

Klingon Insignia

 

A Romulan  (in good health)

Vulcan has  made an offer through their spokesman, Spock to form an ACO(Accountable Care Organization) to provide health care to the entire galactic space. 

They are building outlying clinics for rural areas of the space-timcontinuum. These distant outposts will be eligible for federated grants to underserved, under populated federation space stations.

 

A Klingon in bad health without Federation  ACO

 

Spock ACO delivers preventive health measures as an added value to ACO.

 

The unknown expenditures for the Borg

 

may be offset by the first lady’ charm and budgeting at home.

Non disclosure and waiver of liability.

The events, pictures and portrayals  in this posting are intended as humor, without disrespect, or harmful innuendo, except that Barak Obama has an uncanny resemblance to Spock. 

We need to see his real birth certificate.

del.icio.us Tags: spock,star trek,obama,klingon,vulcan,romulan,health train express

Liberating the NHS UK

 

Equity & Excellence: Liberating the NHS

As we steam along toward centralizing health care with the Obama care Bill, we need to take a look at the corrective actions which the NHS in the UK are attempting to improve freedom of choice and patient involvement in their own care.  This has taken several decades to become important enough to take action.

Unfortunately Don Berwick, the present head of CMS totally ignores this feature of the NHS.  The NHS system has not been  self correcting due to it’s massive bureaucracy and inertial guidance system. This is typical of government.  The only way to  control this seems to be having congress not fund mandates.

del.icio.us Tags: Obamacare,Donald Berwick,UK,National Health Service,NHS,CMS

WORLD’S AIDS DAY

 

Today is AID’s day.  Let’s not forget how much progress has been made, and how we can treat those who have not yet received life saving drugs.

Please go to http://www.worldaidsday.org/  and give someone a new hope for life.

del.icio.us Tags: AIDS DAY,GIVE,CHARITIY,HEALTH TRAIN EXPRESS

Privacy Matters

Sometimes consumer watchdog and whistleblowers do a good thing (actually they do it a lot).

Several Consumer Advocacy Groups have filed an action before the Federal Trade Commission: “Request for Investigation, Public Disclosure, Injunction, and Other Relief” against none other than:

Google, Microsoft, Quality Health, WebMD, Yahoo, AOL, Health Central, Health line, Everyday Health, and Other web companies, including a litany of consumer oriented marketing scams.

All physicians should be pleased that someone has done this for our patients and the medical profession.

The motion requests that the Food and Drug Administration investigate these sites

The plea includes as one portion of its plea the following,

Physicians, nurses and other health professionals are also the target of powerful digital marketing practices that have a direct effect on the health and financial costs born by consumers. The growth of online “e-detailing,” “e-samples,” and other digital ad practices designed to influence health professionals to order specific pharmaceuticals and treatments raises new concerns over the role of online advertising in the healthcare arena. Data collected via e-detailing and related methods also pose privacy concerns.

 

The FDA held two days of hearings in November 2009 on the role of the Internet and marketing for regulated drugs.6 Pharmaceutical marketers purposely painted a sanitized, storybook image of social media and digital marketing. Missing were data and information related to the powerful capabilities of interactive marketing to promote relationships with specific brands, including the ability to foster what has been called consumer “micro-persuasion.” “Direct-to-Consumer Digital Marketing” of pharmaceutical and health-related products requires the FTC to develop safeguards for sensitive-data-related advertising practices, and also ensure that interactive ad techniques are truthful and non-misleading.

The pdf file is well worth the read.  This action required a good bit of research to develop a credible request for an injunction

 

del.icio.us Tags: HIPAA,privacy,fda,ftc,consumers