Advice and Commentary on the World of Professional Consulting


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by George Chapman, GW Chapman Consulting

Hospital rankings released.   After months of delay due to concerns about the methodology used, CMS released the results of its hospital quality rankings. 4,600 hospitals received from one to five stars based on 64 quality measures like post-surgical infection rates, average waiting time in the emergency department, readmission to the hospital after a heart attack, use of CT and MRIs, complications after hip surgery, etc.  102 hospitals (2%) earned ***** stars. 934 (20%) earned ****stars. 1,770 (38%) earned *** stars. 723 (16%) earned ** stars. 133 (3%) earned * star. 937 hospitals (20%) received no ranking due to insufficient data. NYS had the most one star hospitals with 35 of the 133. 33 were downstate. Faxton-St. Luke in Utica and SUNY Health Science Center in Syracuse were the two upstate hospitals getting a single star. Many  believe the rankings were biased against teaching hospitals which typically treat more trauma, transfers from other hospitals and the more complex cases.  Go to “CMS Hospital Compare” on line to check a hospital’s ranking.

Cancer survivors increasing.   The number of cancer survivors will increase by 11 million over the next two decades according to the National Cancer Institute. Their numbers will increase from the current 15 million to over 26 million.   Almost 75% of the survivors will be over 65 by 2040.  

Text messaging your physician.  CMS is working on guidelines for text messaging. The availability of better and secure text messaging technology caused CMS to  reconsider its ban on text messaging which has been in force since 2011.  Various studies indicate text messaging can accelerate care, boost communications between patients and their providers and streamline patient activity. A recent study of women diagnosed with breast cancer found a much higher level of satisfaction with both treatment plans and their decision making among women who used some means of electronic communication with their physician.

Healthcare to be 20% of GDP. According to Office of the Actuary under CMS, healthcare expenditures will grow 5.8% a year between now and 2025. That is about 1.3% faster than the rest of the economy, which could make healthcare 20% of the GDP by 2025. We spent $3.2 TRILLION last year on healthcare. The Affordable Care Act has been credited with keeping annual increase to “moderate levels” compared to the 8% growth rate in the two decades prior to the ACA. Price inflation accounted for less than 1% of the increase in expenditures. We continue to spend far more, per capita or percentage of  GDP,  than any other country.

Curbing fraud.   Penalties will soon double.  The minimum penalty for EACH false claim submitted to CMS will double from the current $5,500 to nearly $11,000. The maximum penalty per false claim would increase to over $21,000.  There are typically thousands of false claims in a particular case meaning penalties reach into the million and sometimes billions.  Whistleblowers receive a cut of the monies recovered. Many feel the higher penalties may invoke the constitutionality of the fines as a defense. The eight amendment prohibits excessive fines. However, most cases are settled on damages or the government’s actual losses versus penalties.

Trump’s plan.  Republicans have tried to repeal the ACA nearly 50 times. Mr. Trump has vowed to repeal it if elected. According to the non-partisan Center for Health and Economy, Trump’s plan would upend most of the recent reforms under the ACA.  18 million Americans would lose their insurance due to elimination of tax credits and Medicaid expansion.  Premiums would decrease across all plan categories (bronze, silver, platinum) by removing actuarial rating and deductible restrictions and the individual mandate.  Medical productivity would increase 2% due to a shift from employer sponsored plans to individual plans.  More cost sharing would result in a more price conscious consumer.  Provider access would increase 11% based on the assumption that new low benefit, low premium  catastrophic plans would offer a wider network of providers.  The federal deficit would decrease $583 billion over the next decade due to provisions directly related to removing the standard benefit packages under the ACA.

Feds to Increase value of primary care.   In a continuing effort to make primary care more appealing to medical students and to reward those already practicing, Medicare will increase payments for lnternal Medicine, Family Medicine, Ob/GYN, Pediatrics, Geriatrics and mental health by $900 million next year. Most of the increase will come at the expense of specialists. Commercial insurers tend to follow Medicare’s lead on how physicians and hospitals are paid.      

Random health facts.  Lack of exercise causes as many deaths as smoking.  Eating out regularly at restaurants doubles your risk of obesity. Laughing 100 times equals 15  minutes of exercising on a stationary bike. 30% of cancer can be prevented by avoiding tobacco, limiting alcohol and exercising regularly. Averaging less than seven hours of sleep a night reduced your life expectancy. Just one soda a day increases your chances of type 2 diabetes by 22%. 

In April, James McEntire came to talk to us about The Art of Persuasion. He spoke to us about 4 particular things that stood out and garnered some conversation amongst the members.

 

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The first was the Law of Reciprocation. The basic principle behind this one is that all of us in business should always look to see what we can do for others before thinking about what they can do for us or how we can work with them. This in turn makes people feel they owe you something, and that can prove to be very beneficial to your business later on. Your motives need to be genuine, without the expectation of people owing you on the back end; thus, it takes a lot of courage and a good heart.

The second followed up on the first, which he called the Saddle of Obligation. In this case, the concept goes deeper because someone might need help or a favor that you help them with that has nothing to do with business whatsoever. What happens is that most people feel obligated to find ways to help you, even if it's just recommending you to other people they might know who can use what you have to offer.

The third flows with the first two, and doesn't fall into a tidy phrase. His recommendation was that when you meet people at networking events, try to figure out how you can help them. This follows up on a principle Zig Ziglar stated which goes "If you want to achieve your goals, help others achieve theirs."

I felt this one personally because I remembered when I was first in consulting I couldn't get anyone to talk to me, even though none of them were in my field of expertise. Afterwards, when I got my bearings, I made it my mission to always help by giving advice when asked by anyone trying to become independent, even if they could potentially be competitors.

The final piece was to work on being an authority or expert in your field. That sounds pretty easy and yet many people don't figure out how to get that done. We all find it hard to talk about ourselves, to the extent that we might minimize just how good we actually are.

In essence, what's our unique proposition; what sets us apart from others who do what we do? As Peggy Klaus said in the book "Brag", we have to learn how to toot our own horn because we can't always rely on others to do it for us.

These are all good principles for anyone who's self employed or works as a consultant.

By John Hunt, General Sales Manager, 92.1 The Wolf, Movin 100.3/96.5, 95.3/103.9 The Dinosaur And Fox Sports 1490AM

In my opinion, the most interesting aspect of this job can be the perception of radio in the market. Not just the general public perception, but the perception of local businesses in regard to radio as an advertising medium or marketing component. Many local businesses have kindly offered us testimonials in regard to their experience and results with radio on radioworksincny.com. However, there are many businesses that have not yet embraced the full potential radio offers their business. And, after reviewing and researching these myths, our staff came to some interesting conclusions…

Millennials Don’t Listen to Radio

FALSE – Radio has the highest reach for Adults 18-34. 92% of this demographic is reached through radio. Smartphones only reach 83% and TV only reaches 75% of this population group. Source: Nielsen Comparable Metrics Report Q4 2015.

Our Conclusion: Radio overall is a great medium to reach Millennials. Now, be sure the message is honest, emotional and engaging so the content is consumed and absorbed by the listener.

People Only Listen to Radio in the Morning

FALSE – Each week in the 10am-3pm daypart, radio reaches 81% of adults age 18 and up. Also, each week in the 3p-7p daypart radio reaches 83% of adults 25-54 and each week in the 7pm-12am daypart radio reaches 60% of adults in this same demo. Source: Nielsen Audio, RADAR 129, June 2016 (Persons 19+, 18-34, 25-54 and 35-64, Monday-Sunday 24-Hour Weekly Cume Estimates, All Radio)

Our Conclusion: Radio has very few time limits. Listeners enjoy their favorite stations when they are out and about or simply want music on in the background at home. Remember, many people work second or even third shifts and enjoy their favorite stations during non-traditional commute times.

Digital Services like Pandora Get Used More Than Radio

FALSE – The initial industry perception was traditional AM/FM Radio receives 55% share of audio time while services like Pandora and Spotify only have 45% of that share of time. The REALITY is AM/FM radio share is NINE TIMES greater than Pandora and SEVENTEEN TIMES larger than Spotify. Furthermore, Pandora only reaches 15% of the total population and Spotify only 5%. Sources: Perception: Advertiser Perceptions, May 2015, 327 advertisers and agencies. Edison Research “Share Of Ear” Q2 2015; daily reach

 

Our Conclusion: The initial perception is interesting because in our opinion, it clarifies radio/audios biggest strength. The medium is extremely personal, yet at the same time perceived to be larger than life. An individual may believe that since “they” only listen to one particular station (or medium), it makes sense that “everyone” does too. Sensible advertisers know how to separate this perception from the reality of their advertising and marketing plan in order to create a profitable advertising investment for their business.

Want to know more?

Let’s discuss your business’ thoughts about radio and lead generation at no obligation.

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by George Chapman, GW Chapman Consulting

Medicare fraud. We are losing more than $60 billion annually to Medicare fraud. While the Affordable Care Act has greatly expanded resources to prevent and detect fraud among providers, it is still difficult to completely stop it. First, Medicare is huge. It is by far the largest healthcare insurer/payer in the country. It receives over  4.5 million claims daily and pays out over $1 billion to providers daily. Second, Medicare is more “open” (trusting) than commercial insurers. Once an applicant provider meets all the basic requirements, Medicare is obligated to begin processing the claims and paying. Medicare does not physically confirm the existence of all new providers be they a home health agency, medical group, pharmacy or durable medical equipment supplier.  In addition to the cost, fraud makes it more difficult for Medicare to make policy or health decisions because a lot of the claims upon which decisions are made are fake/tainted, distorting claims data. How much damage can just one doctor do? In 2012, Dallas physician Jacques Roy, bilked Medicare for $375 million through a phony home care company. It is still the largest home care fraud case in the history of Medicare.  Most get caught because they get greedy. Roy “enlisted” more than 11,000 beneficiaries to receive home care thru his phony company. This number was, by far, the most enrollees by a single physician in the country. Fraud auditors were immediately suspicious as this came up on their radar. Dr. Roy is serving a life term in prison, but most of the $375 million he stole is gone.

Fee for service being phased out. It has long been argued that fee for service or volume payments to physicians and hospitals has produced the wrong incentives and the highest costs in the world. In a FFS environment, there is no incentive to not provide unnecessary care or to focus on long term outcomes or to coordinate care with other providers. Expert believe the sooner FFS is gone, the better for all.  Recently, 52% of the members of the New England Journal of Medicine Catalyst’s Insights Council agreed that FFS reimbursements must go and it stands in the way of providing value based and outcome oriented care. The switch to value based reimbursement will not only change how physicians practice. Consumers will be increasingly expected to hold up their end of the bargain by eating healthy, exercising and following physician orders.  

Primary care physician salaries up.  Although most specialists still earn more, compensation for primary care physicians is improving. According to a reliable and respected national survey of medical practices, primary care compensation has increased 18% over the past five years. Specialist compensation rose 11% over the same period. This is good news because it should encourage more medical students to pick primary care and alleviate the predicted shortage of primary care providers.  The transition from fee for service to value based care shifts more responsibility, and therefore more money, towards primary care.

Family health insurance premium.  According to the Milliman Medical Index, health insurance for an average household of four, with an employer sponsored plan, costs $25,826. This is more than three time the cost of $8,414 in 2001. Employers still pay most of the premium (57%) but cost shifting to the employee is increasing. The average household is paying about $11,000 or about 43% of the total premium. The “good” news is  annual rates of cost increases have dropped from 10% years ago to 5% in recent years.  

Exchange rates up 8%.  According to the Robert Wood Johnson Foundation, the average premium on the exchanges rose 8.3 %, but there was tremendous disparity across the country. Rates went up almost 42% in Oklahoma, but fell 12% in Indiana.  So, the RJW researchers concluded the national average is a fairly meaningless statistic and more attention should be paid to comparing the characteristics of markets with high rates of increases to those with lower rates of increases. Despite the disparities among markets, many predicted the average rate of increase  would be in the double digits. Insurers like United are pulling out of the exchanges as the enrollment of sicker and more expensive consumers creates “unsustainable” losses. Some states (Alaska, Alabama, Wyoming so far) will have only one insurer on their exchanges next year. Insurer losses would be mitigated or offset by the enrollment of younger and healthier consumers. But the current penalty for not buying insurance is still far cheaper than buying premiums; so, younger and healthier people take their chances by foregoing insurance and paying the penalty.

Opioid overdoses.    44 people die every day from an opioid overdose. The epidemic is very costly to first responders, ambulances and hospital drug treatment facilities because many if not most of the patients lack insurance. The annual cost to treat these patients exceeds $2.3 billion, most of which is absorbed by the aforementioned providers.  Rehab cost between $16,000 and $20,000 per patient. If the patient contracts hepatitis C, typical for intravenous drug users, the cost jumps as much as $94,000 primarily for drugs.  Frustrated with little to no change in medical school curriculums, Harvard medical students have organized their own training sessions on treating opioid addiction. The FDA wants to require training for all physicians who prescribe opioids, but physician groups remain opposed.

Big Pharma “charity”.  You have heard on the ubiquitous drug ads that, “if you are having trouble paying for….. (the particular drug), financial assistance is available”. This seemingly charitable/humanitarian act is done  to deflect much deserved criticism for profit mongering and bankrupting the entire healthcare system and to boost sales. To offset the “charity” or discount, drug manufacturers merely increase the prices of their drugs.           

Protect your identity.  Hackers want to steal your personal information and your identity. Your mobile phone, laptop and router are all access points for thieves. The best way to reduce your risk of being hacked is to frequently change your passwords. The main reason why we don’t do this nearly enough is that we all have several (too many) passwords. Experts remind us that the hassle of changing our passwords pales in comparison to the disruption of life and financial loss if we are hacked.    

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by George Chapman, GW Chapman Consulting

Drug spending continues to soar. Total spending on drugs was $425 billion last year up a staggering 12% from 2014. According to the AARP’s Public Policy Institute report, the average retail cost of a year’s supply of typically used prescription drugs by seniors is over $11,000. The average annual cost for specialty drugs, like those treating cancer and hepatitis, was $53,384 three years ago.  Overall Medicare spending was up only 1% last year to put the 12% drug increase into perspective. Drugs now account for 25% of overall spending. (Thirty years ago, drugs accounted for less than 5% of all healthcare costs.) Currently, hospitals account for about 32% and physicians account for about 20% of overall spending. The balance of expenses goes towards skilled nursing facilities, substance abuse and addiction, mental health, durable medical equipment and implants, chiropractic, podiatry, nutrition, etc. Congress establishes Medicare payments to physicians and hospitals but cannot set drug prices.  

Reduce your exposure. Seven typical household items rank as most hazardous to your health if not used or maintained properly. They are : step ladders (falls), dryers (fires)  lawn mowers (injuries), bed rails (injuries dues to poor installation), humidifiers (mold), blenders (lacerations, scalding), toasters (fires).

Insurance mergers.   The pending mergers of insurance giants Aetna-Humana and Aetna-Cigna are undergoing increased scrutiny by the Department of Justice and are facing uphill battles. The DOJ is wary of all “super mergers” that may hurt consumers through less competition on service and price. Hospital mergers are in the same boat. This increased scrutiny by the DJ has been happening despite the Obama administration being relatively passive when it comes to blocking mergers.

ObamaCare premium subsidies.  The House Ways and Means committee is questioning the Administration’s method of funding premium subsidies for the indigent who are purchasing insurance through ACA exchanges. Anyone with income between 133% and 400% of federal poverty guidelines qualifies for the subsidy. (Those under 133% qualify for Medicaid.) Subsidies are expected to total $170 billion over the next ten years. Without tax payer support, insurers on the exchange could face the prospect of having to cover the subsidies themselves.

Calculating premiums.  Determining competitive/fairly priced premiums for new enrollees with uncertain health statuses has been a challenge for commercial carriers. United Health has already announced it is pulling out of most state exchanges next year. As more data becomes available each year, insurers will have more experience which allows them to better assess risk and determine premiums. The fear however is that if premiums are too high, it might drive away the relatively healthy. The only way to combat that potential exodus of the “healthy” is to make penalties for not participating much higher than they are now.

Medical errors.    According to researchers at Johns Hopkins University School of Medicine, medical errors in hospitals and other healthcare facilities are the third leading cause of death in the US, claiming over 250,000 lives annually. (700 a day)  Head researcher Dr. Martin Makary summarized: “It boils down to people dying from the care they receive rather than the disease or injury for which they are seeking care.” Only hospital acquired infections have shown improvement over the years.  Many experts believe healthcare has too much tolerance for variability in practice versus other industries. Lack of standardization makes it harder to identify and fix problems.

Oneonta physician creates center for transgender patients. Family physician Carolyn Wolf-Gould offers hormone therapy, counseling, and coordination with other physicians for patients seeking surgery.  Dr. Wolf-Gould said transgender patients come from as far away as six hours due to short supply of providers offering services.

Opioid addiction. The unfortunate death of pop superstar Prince Nelson has brought more attention to the opioid painkillers addiction epidemic in the US. Someone dies from an opioid overdose every 20 minutes. Many addiction experts question the rationale of turning to the pharmaceutical industry for more drugs to combat addiction to drugs. Treatment for the underlying psychological symptoms that can lead to substance abuse should be also be part of a provider’s arsenal. The FDA is considering making it mandatory (currently voluntary) for physicians who prescribe opioids to undergo safety training courses paid for by opioid manufacturers.

Short term policy.    It is a cheaper alternative to policies offered on the exchanges. It is meant to fill gaps in coverage, but for only a few months. However, short term policies do not meet minimum ACA requirements for coverage and benefits, so buyers will face significant tax penalties.    

   

Thought for the month.  “Discussion is an exchange of knowledge. An argument is an exchange of ignorance”. Attributed to American journalist and humorist Robert Quillen.