Health Care Reform Memo: May 2, 2011 Deloitte Center for Health Solutions publication

The health care reform memos are issued on a weekly basis, highlighting news from the previous week's activities in the administration and implications for the C-suite and various stakeholder groups.

My take 

From Paul Keckley, Executive Director, Deloitte Center for Health Solutions

Friday, Centers for Medicare & Medicaid Services (CMS) released its guidance on the hospital Value-based Purchasing (VBP) program featuring 46 measures that will be used to award bonuses to hospitals based on their overall performance. March 31, it provided its interim final rule for accountable care organizations (ACOs), and in coming weeks, we’ll hear more about specifics of delivery system re-design targeted in the Affordable Care Act (ACA) including medical homes for Medicare and Medicaid enrollees, and clarification of avoidable readmission criteria for hospitals.

The VBP guidance Friday parallels the earlier 429-page CMS rule for ACOs (ACA Section 3022) in many ways:

• Both focus on a shift for providers from payments based on volume to payments based on clinical results: for VBP, 46 measures of patient safety, clinical process improvements, patient safety and patient satisfaction; for ACOs, 65 measures of quality including special attention to five distinct Medicare enrollee populations (i.e. the frail elderly, and others).
• Both focus on collaboration across traditional sectors of the delivery system: VBPs require physician, hospital, long-term, and post-acute care coordination; ACOs require hospital, physician, and long-term care provider alignment with special focus on primary care physicians and allied health professionals.
• Both are dynamic—the bar for each is higher each year: for VBP, 20 additional measures are added in fiscal year (FY) 2014; for ACOs, providers in both the one- and two-sided models will need to navigate Medicare savings thresholds set annually.
• Both build on previous programs tested by the government: for VBP, the predecessor was CMS’ Hospital Inpatient Quality Reporting Program (circa 2004); for ACOs, the CMS’ Physician Group Demonstration Program (circa 2005).
• Both put the providers at financial risk: for the hospital VBP, funding is provided by reductions in base diagnosis-related group (DRG) payments for poor performers starting at one percent in FY 2013 and two percent in 2014; for ACOs, providers participating in either the one- or two-sided models must pay back overspending to Medicare and risk any bonus if quality benchmarks are not hit.

The changes to the delivery system resulting from ACA are profound and immediate. The clock started ticking for participation in savings for avoidable readmissions this year, for ACOs next, for episode-based payments the next and so on. And when the dust settles, the result is likely a fundamental change in how consumers will interact with their doctors and hospitals:

• More relevant information about their performance: safety, outcomes, accessibility, methods for coordinating care, and predictable costs linked to an individual’s personal insurance program.
• More efficiency, consistency, and accuracy in diagnosing and treating medical problems: the powerful combination of electronic health records (EHRs) and personal health records (PHRs) in mobile communication device applications PLUS clinical knowledge management tools linked to genomic mapping PLUS team-based care delivery means customized medicine and paperless transaction management. It means the convergence of what things work in health care (clinical solutions) and what they cost (financial consequence).
• More dependence on information technology and shared decision-making with providers: applications that capture and analyze clinical and administrative data (not either or, but both) providing real-time prompts, alerts, and queries to providers and consumers about pending treatment or decisions and associated financial and clinical risks.

The new normal for the delivery system is not a radical departure from its current state: hospitals, physicians, allied health professionals, long-term care providers, and others are accustomed to transparency and public scrutiny. But ACA does two things that take this to a new level: it links funding to performance, and it requires sectors to share risk together. So perhaps the headline for the general public’s view of the VBP announcement Friday and the ACO declaration March 31 should read “value-based purchasing in healthcare: how to be sure you get the most for what you pay.”

Paul Keckley, Ph.D., Executive Director, Deloitte Center for Health Solutions

ACA implementation update

Update: HHS implements hospital VBP program

Friday, the U.S. Department of Health and Human Services (HHS) launched its hospital VBP program for acute care hospitals paid under the Medicare Inpatient Prospective Payment System (IPPS), as required by ACA Section 3001. Beginning in FY 2013 for discharges on or after October 1, 2012, the program will provide value-based incentive payments to hospitals based on a Total Performance Score. For FY 2013, performance will be based on 17 clinical process and nine patient safety measures. Including in the metrics:

• Clinical process of care measures: focus on processes for treating acute myocardial infarction, heart failure, pneumonia, healthcare acquired infections, and surgical care improvement
• Patient Experience Measures: communication with doctors, nurses; responsiveness of the hospital staff, pain management, communication about medicines, overall rating of the hospital and others.

In FY 2014, additional measures will be included in scoring including:

• Eleven measures involving clinical processes, for example: 30-day mortality rates for acute myocardial infarction (AMI), heart failure (HF), and pneumonia (PN); hospital-acquired condition (HAC) measures for foreign object retained after surgery, air embolism, blood incompatibility, pressure ulcers stages three and four, falls and trauma, vascular catheter-associated infections, catheter-associated urinary tract infections, and inadequate glycemic control.
• Nine measures involving patient safety used previously in the Agency for Health Care Research and Quality (AHRQ). Inpatient Quality Indicators include accidental punctures, hip fracture mortality rate, post-operative wound dehiscence, and others.

Note: The new VBP program exposes some hospitals to double penalties for HACs: in addition to the VBP HAC quality measures, in FY 2015 hospitals with a high HAC measure will face payment reductions, per ACA section 3008. ACA Section 2702 also prohibits Medicaid payment for services related to HACs. For additional information see Deloitte Center for Health Solutions Issue Brief, “Value-based Purchasing: A strategic overview for health care industry stakeholders.”

Business groups organize to repeal IPAB

Monday, a coalition of business groups sent a letter to Representative Phil Roe (R-TN), supporting his legislation (H.R. 452) to eliminate the Independent Payment Advisory Board (IPAB). Per ACA Sections 3403 and 10320, beginning January 1, 2014, the 15-member board will make recommendations to Congress on how to reduce the rate of growth in Medicare costs without adversely impacting coverage or quality. IPAB's recommendations will take effect unless Congress passes legislation to achieve the same level of spending. The coalition includes:

• American Osteopathic Association
• Healthcare Leadership Council
• International Franchise Association
• National Association for the Self Employed
• National Association of Manufacturers
• National Retail Federation
• U.S. Chamber of Commerce

Dual eligibles update: CMS releases report on dual eligibles pilot program; Part D drug coverage

Last week, CMS released its analysis of Medicare coordinated care demonstration projects for dual-eligibles (i.e. individuals eligible for Medicare and Medicaid). Based on beneficiaries followed from 2002 to 2008, the report concluded savings were negligible, satisfaction increased and quality of care improved.

Note: The Balanced Budget Act of 1997 (BBA) mandated that the Secretary of HHS to implement and evaluate care coordination programs in the Medicare fee-for-service setting to determine whether care coordination improves the quality of care and reduces Medicare expenditures. ACA contains several provisions aimed at improving care for dual eligibles including Section 2601 which establishes five-year Medicaid demonstration projects and Section 2602 which establishes the Federal Coordinated Health Care Office within CMS to improve coordinated care for duals.

Separately, Tuesday, the HHS Office of the Inspector General (OIG) sent a report to CMS finding that 191 of the 200 most commonly used drugs by dual-eligibles are eligible for Part D prescription drug coverage and nine are excluded from coverage. Almost 60 percent of the commonly used drugs are included by all Part D plan formularies. OIG also found variation in the rate at which Part D plan formularies apply utilization management tools for commonly used by dual eligibles.

Note: There are 249 unique Part D formularies used by 3,072 Part D plans operating in 2011.

CBO: repealing state health insurance exchange funding reduces deficit by $14 billion over ten years

Wednesday, the Congressional Budget Office (CBO) released a cost estimate of H.R. 1213, which would repeal mandatory funding to establish state insurance exchanges. According to the brief, enacting the legislation would reduce deficits by almost $13 billion from 2012 to 2016 and by about $14 billion total from 2012 to 2021.

Legislative update

House GOP target cuts to exchanges, school clinics, and public health funding

Two weeks ago, the House passed a bill cutting funding for the prevention and public health fund. This week, GOP leadership announced plans to introduce bills cutting funding in ACA for school-based health centers and state health exchanges.

Note: the CBO estimates state grants for exchanges would reduce the U.S. deficit by about $14 billion from 2012 through 2021. Passage in the Senate is unlikely given its Democratic control.

House Committee to hold hearing on Medicare physician payment system

This week, the House Energy and Commerce Committee will hold a hearing on proposals to change the sustainable growth rate (SGR) which determines Medicare physician payments. The Committee asked 51 medical associations to provide draft legislation to fix physician payments by April 30. The cost of a permanent fix for the SGR is estimated at $300 billion.

FY 2012 budget proposals

The FY 2012 budget process is in full swing as key agencies and programs announce their recommendation. Among announcements last week:

Inpatient rehab increase 1.5 percent; quality reporting implemented

Last Friday, CMS announced payments to inpatient rehabilitation facilities (IRFs) under the prospective payment system (PPS) would increase by $120 million for FY 2012. The proposed rule also would also implement ACA Section 3004, establishing a new quality reporting program that provides for a two percent reduction in the annual increase factor starting 2014 for failure to report quality data to the HHS Secretary. Reporting would begin in FY 2013.

Note: the rule applies to FY 2012 discharges from 200 freestanding and 1,000 rehabilitation units in acute hospitals. Beginning October 1, 2012, IRFs would be required to submit data on two measures: urinary catheter-associated urinary tract infections and pressure ulcers that are new or have worsened. Failure to report results in a two percent payment reduction starting FY 2014.

Skilled nursing increase 1.5 percent

Thursday, CMS laid out two proposals for skilled nursing facility (SNF) payment in the FY 2012 budget. One option follows the approach laid out by the ACA increasing SNF reimbursement by $530 million (1.5 percent); the other option would cut SNF payments by $3.94 billion to get back money Medicare overpaid SNFs as a result of changing the case-mix index.

Note: The increase is based on a 2.7 percent market basket update less a 1.2 percent reduction for efficiency gains per Section 3401 of ACA.

Hospice increase 2.3 percent

CMS on Thursday proposed a 2012 hospice wage index rule that includes a 2.3 percent payment update (2.8 percent market basket increase less 0.5 percent wage index adjustment), and would implement a quality reporting program included in the ACA. The proposed regulation also tweaks the controversial “face-to-face” encounter mandated by health reform, stating the agency will allow the encounter to be conducted by any physician, rather than only the certifying doctor. The quality metrics include clinical process measures (e.g. pain management) as well as patient experience measures; hospices failing to report performance scores in 2013 will lose two percent of payments from Medicare starting FY 2014.

Inpatient psychiatric hospitals increase 2.7 percent

Medicare payments for inpatient psychiatric facilities (IPFs) will increase an estimated 2.74 percent in 2012, slightly higher than earlier expected, according to the final prospective payment system rule issued by CMS late Thursday. Rural IPFs are estimated to receive an increase in payments greater than three percent (an aggregate 3.8 percent), the final rule states.

The rule includes a 3.2 percent market basket update and finalizes a 0.25 percentage point reduction to the market basket update as required by the health reform law. It also includes an estimated 0.2 percent decrease in estimated IPF outlier payments from the update to the outlier fixed dollar loss threshold amount.

Industry update

AHA proposes refinements to LTACH criteria, objections to IRS Schedule H

Last week, the American Hospital Association (AHA) released its proposal to create facility and patient admissions criteria for long-term acute care hospitals (LTACHs) to replace currently suspended cost-containment policies including the 25 percent rule, short-stay outlier, and budget neutrality adjustment. It would also let expire the current moratorium on LTACH building and expansion, put in place after cost-containment policies were suspended.

Separately, several hospital trade groups including AHA groups filed comments objecting to Internal Revenue Service (IRS) Schedule H standards for federal tax exemption citing several concerns including:

• Redundant and burdensome reporting requirements
• Schedule H revisions go beyond statute requirements
• Some key issues not addressed
• IRS revised Schedule H and Instructions without proper notice and comment period

The groups summarized, “The final Schedule H is burdensome, carelessly redundant, and was developed outside of the normal IRS process for implementing new statutory requirements for tax exemption. By failing to promptly initiate a meaningful notice and comment opportunity in connection with the new 501(r), the IRS has produced a reporting tool that will be more difficult for hospitals and less useful to communities than we hoped or expected.”

CMS seeks comments on seven new medication-related quality measures

CMS contracted with Florida's Medicare Quality Improvement Organization to develop and maintain medication-related quality measures. Seven new medication measures were developed from Medicare claims data based on the Institute of Medicine (IOM) safety and effectiveness domains. Measures were developed for state- and plan-level measurement, but are being evaluated for use in other care settings (e.g. physician offices). Comments on the measures will be accepted until May 11, 2011. Proposed measures are:

Process measures I: adherence measures

• Adherence to antipsychotics for individuals with schizophrenia
• Adherence to mood stabilizers for individuals with bipolar I disorder
• Adherence to antiplatelet treatment after stent implantation

Process measures II: appropriate therapy measures

• Polytherapy with oral antipsychotics
• Avoiding acetaminophen toxicity
• Short-acting opioid formulation for breakthrough pain in individuals with cancer
• Outcome measures
• Bleeding outcomes related to oral anticoagulants

Chicago to develop largest metropolitan health information exchange

Last week, the Metropolitan Chicago Healthcare Council (MCHC) announced plans to develop the MetroChicago health information exchange (HIE). It is expected to be the largest metropolitan HIE in the U.S. serving more than 9.4 million individuals.

Simplified enrollment procedures for Medicaid, Medicare, CHIP programs sought

Last week, a new nonprofit organization Enroll America (EA), was announced by its founders, the Pharmaceutical Research and Manufacturers of America (PhRMA), America’s Health Insurance Plans (AHIP), the AHA, and Kaiser Permanente. EA’s acting Director is Rachel Klein, the deputy director of health policy at the consumer advocacy organization, Families USA. EA seeks to encourage more effective enrollment of eligible Americans in Children’s Health Insurance Program (CHIP) and Medicaid programs, and later in subsidized coverage through health exchanges. The announcement indicated EA will be operational in four to six weeks.

Mystery shopper program for primary care physicians anticipated

Thursday, the HHS Office of the Assistant Secretary for Planning and Evaluation (ASPE) announced plans to collect data about the performance of primary care physicians (PCPs) using a mystery shopper approach. Using two “mystery shopper” visits to 465 practices in nine states, the goal is to assess the timeliness of services from PCPs, and “gain insight into the precise reasons that PCP availability is lacking”. Participating practices will be contacted twice initially: once using a privately insured patient scenario, and once using a publicly insured patient scenario. A standard clinical problem will be presented and thereafter researchers will interview the physicians in each practice to obtain additional data. Practices will be directly contacted a third time to assess their accessibility for new patients to provide a comparison to the mystery shopper methodology.

Food advertising targeting kids focus of new guidelines

Thursday, the White House proposed new restrictions on food advertising targeting kids two to 17 years of age through 20 media channels including broadcast, print, and online. The guidelines restrict marketers from advertising products that do not make a “meaningful contribution” to a healthier diet by limiting sodium content to 210 mg per serving, saturated fat to one gram per serving or 15 percent of calories, and eliminating trans fats in foods. The guidelines, as proposed, will be implemented in 2016 overseen by the U.S. Food and Drug Administration (FDA) , U.S. Department of Agriculture, Federal Trade Commission (FTC), and Centers for Disease Control and Prevention (CDC).

May 10 arguments in Richmond, VA Fourth Circuit Virginia v Sebellius

Monday, the U.S. Supreme Court denied Virginia Attorney General’s petition to immediately hear Virginia’s lawsuit challenging the ACA’s individual mandate. Arguments are scheduled May 10, 2011 for the Fourth Circuit Court of Appeals in Richmond, Virginia; a decision is expected late summer. Arguments before the U.S. Supreme Court are expected in September 2011.

Note: Five federal district courts heard arguments against ACA. The Supreme Court decision last week was pragmatic: it wished the appeals processes in circuit courts to continue before ruling on ACA rather than acting on the Virginia case alone.

HITECH update

New ONC leader sets agenda for HITECH

Tuesday, the Bipartisan Policy Center (BPC) hosted a “Dialogue on Health Information Technology” featuring comments by new Office of the National Coordinator for Health Information Technology (ONC) Coordinator Farzad Mostashari, MD. Highlights of Dr. Mostashari’s comments:

• U.S. is entering an “intense phase of implementation”
• ONC has achieved notable milestones to date including:
  • Technology Regional Extension Centers (RECs): RECs, funded by the Health Information Technology for Economic and Clinical Health Act (HITECH), help providers to quickly adopt meaningful use (MU) of EHRs through training, information, guidance, and technical assistance. There are currently 62 RECs which work with over 100,000 PCPs. RECs received $677 million in funding for the next two years.
  • Community College Consortia Program: consists of community colleges from all 50 states who received funding to rapidly create health information technology (HIT) academic programs or expand existing HIT training programs that can be completed in six months or less.
  • Framework for meaningful use: HHS has provided framework for MU, which has balanced stakeholders competing interests with patient care goals. Stage Two MU measure development is currently in progress.
  • HIEs: Dr. Mostashari is optimistic about HIEs. They require better information system which could lead to better health care financing.
  • National Quality Strategy: Section 3011 of the ACA requires HHS to establish and update annually a national strategy to improve the delivery of health care services, patient health outcomes, and population health.
  • Partnership for Patients—Better Care, Lower Costs: new public-private partnership that brings together hospitals, employers, physicians, nurses, and patient advocates along with state and federal governments to improve hospital safety, reliability, and to reduce cost through two main goals:
    1.   Decrease preventable HACs by 40 percent from 2010 to the end of 2013.
    2.   Decrease hospital readmissions by 20 percent from 2010 to the end of 2013.
• The guiding principles of going forward are:
  • Free market place with limited government action: ONC believes in using a free market place to promote innovation in HIT; however there are times when “minimum government action is necessary” to help promote action in the health market place. Examples include:
    • To help markets be more competitive
    • To reimburse providers for externalities associated with implementing HIT
    • To promote development of HIT standards
  • Transparent, accountable, and responsive HIT system: HIT is successful when the health care system is transparent, accountable, and responsive. Public meetings facilitate discussion on success of current HIT initiatives and ways to improve HIT. On average, ONC has had a public meeting every other day. Federal advisory committees also help ensure implementation of effective HIT policies.
  • Adaptable HIT policies: strategic HIT plans must be adoptable and able to be changed as time progresses.
  • Focusing on the end-goals: constant attention must be placed on what the end goals are (e.g. improved patient safety and care, lower cost of care). Must ask what’s best for patient (e.g. “patient-centered” care).
  • Pragmatic and incremental implementation: implementation must remain pragmatic and incremental.

Privacy and security remain a major focus of ONC consideration. It prefers an incremental approach including tests using encrypted records and standards for data sharing data through smaller HIEs which could be used on a larger scale. It is respectful of commercial vendor capabilities in securing privacy and security as a differentiator and wishes to provide standardization that will be complementary to established industry tools.

Interoperability remains a major challenge. ONC will leverage its “Direct Project” pilots to continue its leadership toward scalable interoperability. The Direct Project has more than 200 participants (e.g. EHR and PHR vendors, medical organizations, systems integrators, integrated delivery networks, federal organizations, state and regional health information organizations, organizations) that provide HIE.

Regarding secondary use of data by third parties, the ONC is keen on applications of derivative data for quality improvement purposes so long as data is de-identified. This could require standards or regulatory activities (e.g. rule, guidance).

Note: Under HITECH, $27 billion is available to hospitals and physicians from Medicare and Medicaid for implementation of certified electronic medical records, with the caveat they implement before payment cuts begin for non-adopters in 2016.

The Bipartisan Policy Center has launched a major effort to accelerate adoption of HIT under the leadership of Julie Barnes, Policy Director, and Janet Marchibroda, Project Director. For more information, go to www.bipartisanpolicy.org.

Consumer electronic consent solution

Wednesday, ONC announced its intent to sponsor a consumer electronic consent pilot as part of advancing HIE. The ability for patients to decide whether they should provide electronic consent in situations that would trigger it is a step that can build trust in sharing their health data and accelerate exchange. A potential vendor would develop and evaluate how to obtain feedback on patient choice in HIEs and create innovative ways to educate consumers about options they have in providing consent in a clinical setting, whether it is automated or determined through a decision process with their primary physician in which the patient is a knowledgeable participant. The potential vendor would partner with healthcare providers that exchange health information. Interested vendors must respond by April 29, according to the announcement.

State watch

• Update: Vermont Senate passed a law (21-8) that will allow the state to establish a single-payer system in 2014, three years earlier than ACA stipulates. Last month, the state’s House of Representatives passed the same bill (92-49).
  Note: per ACA Section 1332, states may apply for a waiver from specified ACA requirements beginning in 2017 so long as they demonstrate that they will cover at least as many residents with coverage that is at least as comprehensive and affordable as prescribed under federal law.
• Massachusetts House of Representatives voted to repeal a law that regulates interactions between doctors and medical device and pharmaceutical manufacturers. The law requires manufacturers to disclose the value, purpose, and recipient of any economic benefit with a value of at least $50, and prohibits the receipt of certain meals, payments, and activities by the doctor.
• Maine lawmakers are considering a repeal of the state's guaranteed issue and community rating provisions for the insurance market. The law prohibits denials for pre-existing medical conditions, guarantees issuance of all products, and it prohibits the use of health status in premium rate setting. Maine implemented its guaranteed issue policy in 1993 and is one of five states with such a requirement.
• Mississippi's insurance department asked the Mississippi Comprehensive Health Insurance Risk Pool Association—the non-profit entity responsible for operating the state's high-risk pool—to consider operating the state’s insurance exchange. A response from the Association is expected by mid-May.

Quotable

“Improving the way we deliver care is the right way to make our health care system sustainable over the long run. The alternative would limit services and shift onerous burdens to the people who need it the most.”

 – Don Berwick, CMS Administrator, “The Right way to Reform Medicare” Wall Street Journal Editorial April 29, 2011.

“And we have today a 21st-century operating room and a 19th-century administrative room. Health IT is the best way to bring that administrative room to the 21st century.”

 – Senator Tom Daschle (D-ND) Co-Leader, Bipartisan Policy Center (BPC) Health Project, April 26, 2011, “A Dialogue on Health”.

Fact file

• Current Medicaid enrollees in managed care plans: 35 million. (Source: CMS)
• U.S. economic growth slows to 1.8 percent in first quarter, down from 3.1 percent in fourth quarter 2010. (Source: U.S. Department of Commerce)
• Total government benefits ($2.3 trillion in 2010) from Medicare, Medicaid, CHIP, Social Security, food stamps, and unemployment benefits total 18.3 percent of personal income in the US—highest since 1929; income from wages at 50.5 percent—lowest in same period. Between 1998 and 2000, government benefits averaged 12.5 percent of income. Per capita government benefits were $3686 in 1990, $4763 in 2000, and $7427 in 2010. (Source: Bureau of Economic Analysis)
• Demand for vendor-furnished information systems and services by the U.S. government will increase from $85.8 billion in 2010 to $111.6 billion by 2015—a compound annual growth rate (CAGR) of 5.4 percent. (Source: INPUT’s Federal Information Technology Market, 2010 to 2015)
• Average state pension fund had 75 percent of assets to cover long term benefits, down from 78 percent in 2009 and 84 percent in 2008. New York is the only state fully funded (101 percent in 2009, 94 percent in 2010); Illinois is lowest at 51 percent. Nineteen states passed legislation to reduce pension obligations. States contributed 64 percent of total $115 billion funds recommended and 36 percent of $47 billion required for retiree worker health benefits by actuaries. (Source: Pew analysis of 16 states’ pension funds)
• Compensation for medical directors varied widely by specialty for medical management oversight activities requiring four to six hours per week. Examples: lowest internists and pediatricians at $7,500, general surgeons at $27,000, highest $50,000 plus for emergency medicine physicians. (Source: Medical Group Management Association’s “Medical Directorship and On-Call Compensation Survey: 2011 Report Based on 2010 Data.”)
• Consumer-directed health plan enrollment increased 22 percent in 2010 from 23 million in 2009 to 28 million in 2010, or 11 percent of total commercial coverage. Preferred provider organization (PPO) enrollment remained unchanged at 69 percent since 2008. (Source: American Association of Preferred Provider Organizations)
• Of 36 of national coverage determinations issued by Medicare since 2007, 20 (55 percent) mention comparative effectiveness research as either the impetus for the decision or as a factor in the coverage determination. (Source: Avalere Health Analysis)
• In FY 2009, states faced a $1.26 trillion shortfall in public employee pensions and other retirement benefits, up 26 percent from $1 trillion in FY 2008. Pension funding shortfalls accounted for $660 billion and unfunded retiree health care costs accounted for $604 billion. (Source: Pew Center on the States)
• As a result of provisions in the ACA, 39 million individuals will gain coverage, and seven to 12 million fewer if the individual mandate is removed, according to new analysis from Princeton economists. (Source: National Bureau of Economic Research)
• Decreased nurse overtime staffing is linked to 44 percent reduction in readmission rates. (Source: Health Services Research)
• Seventy percent of heart surgery patients fully adhered to their statin prescription for a year compared to 79 percent of the medication-only patients. (Source: American Journal of Cardiology March 18, 2011 study of 13,000 adults hospitalized for heart attack/severe chest pain)
  

National health reform: What now? National health reform is here. The health reform bills (HR3590 and HR4872) are now law and will trigger sweeping changes and disruptions – some rather quickly and some over many years. The industry is asking, “What now?” At Deloitte, we continue to explore and debate the key questions facing the industry, and we look forward to helping our clients find and implement the right answers for their organizations. To learn more, visit www.deloitte.com/us/healthreform/whatnow today.

Subscribe to the Health Care Reform Memo

Health Care Reform Memo —The weekly Health Care Reform Memo is available for subscription. Please visit www.deloitte.com/us/healthmemos/subscribe. 

• Step 1, confirm your sector(s) of interest. 
• Step 2, select the Health Care Reform Memo as one of your subscriptions.

Stay Connected

    E-mail |      RSS ( What is RSS?) |     Twitter