January 31st Health Exec Briefing

Top Stories

CHS executives ink $60M settlement in investor suit
In an amended complaint, investors claimed Franklin, TN-based Community Health Systems executives caused the company to implement an unlawful inpatient admissions policy, which allegedly enabled CHS to artificially inflate reimbursement payments. A Tennessee federal judge approved a $60 million agreement to resolve the breach of fiduciary duty allegations.
(Becker’s Hospital Review, January 19)

Aetna-Humana merger blocked on antitrust grounds
U.S. District Judge John D. Bates ruled against the $37 billion merger between national insurers Aetna and Humana and blocked the merger on antitrust grounds, claiming that it would substantially reduce competition in violation of antitrust laws. Read more about the proposed merger and the sale of commercial insurance on the public exchange in three counties in Florida.
(Modern Healthcare, January 23)

What’s New in Healthcare

Success of Value-based Care Depends on Clinician Data Access
National Coordinator Vindell Washington, MD, MHCM, and Acting Administrator Andy Slavitt outlined a roadmap for the incoming administration to follow. “While the tools are improving, some clinicians remain frustrated by the limited usability of their technology and data,” Washington and Slavitt wrote.
(EHR Intelligence, January 19)

Study: ACA Repeal Could Mean Loss Of 200,000 Jobs In California
Trump’s selection of leading Obamacare critic Dr. Tom Price as the head of the Department of Health and Human Services seems to support that move, to repeal and replace Obamacare and bring affordable and accessible healthcare to every American. The repeal would also mean the loss of $20.5 billion in annual federal funding if Congress ends the expansion of Medi-Cal services.
(Health IT Outcomes, January 19)

US recovered $3.3B in fraudulent healthcare claims in 2016
Medicare payments have dropped by about $1 billion annually since CMS implemented a cap on total outlier payments of no more than 10% of payments an individual provider may receive in a year. The UPenn Health System reached a settlement with the U.S. government for the voluntary disclosure of improper Medicare billings at one of its hospitals.
(Healthcare Dive, January 23)

Healthcare in Washington D.C.

Price contends Obamacare repeal isn’t intended to yank coverage from millions
According to Senator Patty Murray, the nominee to serve as Health and Human Services Secretary, Tom Price’s proposals for repealing Obamacare “would cause millions of people to lose coverage, force many to pay more for their care and leave people with pre-existing conditions vulnerable to insurance companies rejecting them or charging them more. Read more about the changes that are to come in health insurance.
(Health Data Management, January 19)

Minorities, poor and less educated most at risk to lose health coverage under ACA repeal
According to a report from the Congressional Budget Office, approximately 18 million Americans would lose their insurance coverage during the first year if Congress were to eliminate Medicaid expansions and eliminate ACA subsidies. With a larger number of uninsured Americans, hospitals will likely face major financial stress that could lead them to cut jobs and cost them $165.8 billion in federal payments through 2026.
(Healthcare Dive, January 20)

Healthcare Innovations

Artificial Intelligence: Clear and present opportunities emerge for healthcare
According to the Advisory Board, artificial intelligence can be applied today to clinical decision support, length of stay predictions, or scheduling, natural language processing such as virtual assistants, research data mining and analytics, and pattern classification for tasks. Hospital systems holding off on AI might be missing the opportunity to help shape the technological advancements that other industries are developing.
(Healthcare IT News, January 19)

ONC Challenge Aims to Put mHealth App Security in the Patient’s Hands
The Privacy Policy Snapshot Challenge builds on efforts by the ONC to protect patient data accessed by digital health apps and devices. The ONC will award $35,000 in prizes through the challenge, and will announce winners sometime during the middle of this year. Read more about the tools to enforce safeguarding private health data.
(mHealth Intelligence, January 23)

Security & Analytics

More Primary Care Leads to Less End-of-Life Medicare Spending
Using 2010 Medicare claims data, researchers uncovered that greater primary care concentration areas decreased Medicare spending because patients tended to received lower-cost and lower-intensity care. According to hospital referral regions, Medicare spending during the last two years of life went from almost $70K in areas with less primary care providers to $65K in areas with greater levels.
(RevCycle Intelligence, January 19)

Despite looming ACA repeal, key aspects of value charge ahead
Like prospective payments for hospitals, the ACA’s experimentation with accountable care organizations, shared savings and inclusive payment for bundles of services compelled healthcare providers and payers to take on a new vision for care delivery. Ultimately it called for significantly different, substantial investments in information technology to support new approaches.
(Health Data Management, January 23)

HHS Nominee Price Criticizes Meaningful Use Requirements
The benefits of EHR adoption and use to the healthcare industry were discussed during a recent Senate hearing. Representative Tom Price made the remark, “Electronic health records are so important because from an innovative standpoint they allow patients to have their health history with them at all times and allow whatever physicians or other provider access to that.
(EHR Intelligence, January 20)

Prioritizing Data Privacy, Security in the Healthcare C-Suite
Individuals in leadership positions need to keep data privacy and security issues top priorities, especially as healthcare remains a target for cyber criminals. The first area of concern is security and privacy, followed by disasters and downtime, troubled projects, and leadership changes. Read more about the case of security and privacy and how to handle workflow with security.
(Health IT Security, January 23)