ABL Member News * Healthcare Industry Trends * May 1, 2018

Sumit Mahendru is Managing Director of SAVI Group, Inc., a medical billing, medical records management, and revenue cycle management company. SAVI's medical PMS (Practice Management Solutions) results in higher efficiency, greater productivity, and increased collections. SAVI starts with a customized medical billing system, designed to quickly and accurately gather patient data, increase reimbursement through better medical record coding, and speed up the collection process through a comprehensive, electronic submission and collection process. SAVI also has offices in India for U.S.-based electronic medical records processors and consolidators who require discounted bulk processing for pharmacies, health records, and compliancy audits. Previously, Sumit was Co-Founder of Tahj Entertainment, in Los Angeles, specializing in event management and more. Sumit has joined the Orange County Round Table.

from Adaptive Business Leaders
by Mimi Grant

Even the second-richest man in the world doesn't feel he has enough money to develop a universal flu vaccine with just the resources of the Bill & Melinda Gates Foundation. That's why he's working his network. Just last week, Bill announced that the Gates Foundation put up $6 million, matched by another $6 million from Google co-founder Larry Page, to fuel advances in the vaccine, but that won't be nearly enough. So, when he met last month with President Trump in the Oval Office . . . READ MORE >>>

PreludeDx Announces DCISionRT PREDICT Registry Study

Prelude Corporation (PreludeDx), a leader in molecular diagnostics and personalized medicine for early-stage breast cancer, has announced the official launch of its large registry study, DCISionRT PREDICT. The study will evaluate the impact of DCISionRT, the prognostic and predictive DCIS test, on clinical management of patients with surgically treated ductal carcinoma in situ (DCIS) as compared to traditional clinical and pathologic risk factors. Recent data presented at SABCS 2017 demonstrated that, using tissue and patient outcomes from the landmark SweDCIS randomized trial, DCISionRT predicted radiation therapy benefit in reducing invasive recurrence, a much anticipated first for genomic testing in DCIS. The next step is to assess the impact of the assay in the broad range of clinical practice settings. The study will enroll up to 2,500 patients at 100 sites over the next 12-18 months and will work with top academic and community cancer centers to gather this important data and ensure patients and their breast cancer physicians can have an accurate assessment of recurrence risk and therapeutic benefit before making a treatment decision. (Dan Forche, Orange County)

OneLegacy in Article on "Regifting" Transplanted Kidneys

The recent STAT article - A new way to ease the organ shortage: 'Regifting' kidneys used in previous transplants - includes input from Tom Mone, CEO of OneLegacy, a nonprofit organ procurement organization based in Southern California. The article examines the so-far infrequently used practice of "regifting" kidneys from previous transplant recipients who died with their donated kidneys still healthy. In the article, Tom said he thought the practice would spread if outcomes remain positive: "Large centers ought to be paying attention. There's no reason not to do this, and every organ is one more patient that might not get transplanted otherwise." (Tom Mone, Los Angeles)

Nelson Hardiman to Open New Westwood Village Office

Nelson Hardiman (NH) has announced its upcoming move in August 2018 to a 41,000+-square-foot office at 1100 Glendon in the Westwood area of Los Angeles. The move was sparked by the law firm's rapid growth in recent years to over 44 people, including 25 attorneys, plus will provide larger presentation space for NH's frequent calendar of educational events for the healthcare and life sciences communities, and will serve the expanding needs of several organizations that have grown out of the firm's industry leadership over the past decade. (Harry Nelson, Los Angeles)

King & Spalding's Marcia Augsburger Spotlighted in Biz Journal

Marcia Augsburger, a Healthcare Partner at King & Spalding (K&S), was featured in a recent Sacramento Business Journal article - Attorney Marcia Augsburger gets listened to - in which she says that she has really enjoyed her focus in recent years on developers of telemedicine products. She advises startup firms on the seemingly unending skein of regulations waiting to entangle them.
       Meanwhile, K&S has published CMS Proposes Changes to Inpatient Admission Orders in 2019 IPPS Proposed Rule and upcoming webinars include: > Lessons Learned From Government Scrutiny of Opioids: What Every Company Should Know, May 9, 10-11 a.m. Pacific, and > Convergence of Enforcement and Compliance: What You Need To Know Now, May 23, 10-11 a.m. Pacific.  And, the recent issue of K&S Health Headlines includes: > CMS Releases FY 2019 Medicare IPPS and LTCH PPS Proposed Rule, Proposes Significant Changes to Several Regulatory Requirements; > Part C DSH Decision Challenged in the Supreme Court; and > Save the Date: 11th Annual King & Spalding Medical Device Summit Sept. 6, 2018. (Marcia Augsburger, Sacramento & Travis Jackson, Los Angeles)

Kaiser Permanente Releases Results of Decade-Long Initiative

Over the past 10 years, Kaiser Permanente (KP) has used different aspects of its Healthy Eating Active Living (HEAL) initiative to improve health policies, programs, and ultimately health outcomes across 60+ communities, positively impacting the health of 715,000+ people. However, there is still more work to do on obesity prevention, say the KP experts and community health leaders who authored a series of 11 studies that appeared in a recent American Journal of Preventive Medicine supplement. Study highlights and insights include:  > Significant impact is possible when working with youth, especially in schools and on physical activity.  > To improve the health of communities, the impact needs to reach a lot of people with well-chosen, strong strategies.  > Working with municipal leaders to provide tools, resources, and information to adopt policies that advance population health goals is crucial to long-term success. (Walt Meyers, Bay Area)

Gorman Looks at "More Medicaid Managed Care for Less Oversight"

Recent blog posts from Gorman Health Group (GHG) include: Trump Administration to States: We Will Trade More Medicaid Managed Care for Less Oversight, which looks into a proposed rule by CMS that would provide for a reduction of administrative burden with states that have high rates of Medicaid managed care enrollment; and Lack of Staff: Biggest Hurdle to Success, which shares that a recent poll conducted by GHG found that 38% of respondents believed the biggest hurdle to success in their organization was lack of knowledgeable staff or lack of staff. (Dave Sayen, Bay Area)

Global 1 Expands Bundled Payments to 85 Outpatient Centers

Global 1 has expanded its medical bundled payment system to more than 85 outpatient surgery centers with a growing network of 650+ physicians. Global 1 is now the largest commercially insured bundled payments manager in California and among the largest in the nation. Global 1's goal is to use this disruptive payment system to provide transparency, reduce cost, and simplify billing. "Can you imagine if automakers gave you a separate bill for every part of a car that you purchased? And, you didn't know the cost or how many bills would come? That example is what many patients deal with after having surgery," said Scott Leggett, Co-Founder and Principal of Global 1. "We take that basic automotive model and apply it to non-emergent surgeries. We work as a team with surgeons, anesthesiologists, and facilities to provide one out-of-pocket price for the patient that is set prior to the surgery or episode of care." (Scott Leggett, Orange County)

GeBBS Announces Strategic Partnership with BioScrip, Inc.

GeBBS Healthcare Solutions has partnered with Bioscrip, Inc., the largest independent national provider of infusion and home care management solutions. Bioscrip partners with physicians, hospital systems, payors, pharmaceutical manufacturers, and skilled nursing facilities to bring customer-focused pharmacy and related healthcare infusion therapy services into the home or alternate-site setting. GeBBS will provide end-to-end revenue cycle management and strategic outsourcing solutions to help Bioscrip leverage their people, processes and technology to reduce operating and capital costs, recover revenue, improve patient satisfaction, and increase productivity. (Nitin Thakor, Los Angeles)

ElderConsult to Take Part in Geriatric Care Discussion

On the afternoon of May 16, Elizabeth Landsverk MD, of ElderConsult Geriatric Medicine, will participate in Three Geriatricians Discuss Geriatrics, a panel discussion that will examine the issues and challenges of treating geriatric patients, including the most important issues for elders and their families to help live the best lives possible. Taking place in Santa Rosa, this event is primarily for elder care professionals. (Elizabeth Landsverk MD, Bay Area)

Covered California Finds Major Declines in New Federal Enrollment

A new Covered California (CoveredCA) analysis finds enrollment in the federally facilitated marketplace (FFM) has dropped 9% over the past two years, driven by a nearly 40% drop in new enrollees, while the number of consumers signing up for coverage through state-based marketplaces has remained steady over that time. The report finds that the dramatic decrease in new enrollees in the federal marketplace, which coincides with decisions to pull back on marketing for federal marketplace states, will likely mean a less-healthy consumer pool and higher premiums to cover the sicker enrollees. Peter Lee, CoveredCA CEO, noted that similar to CoveredCA, the FFM has collected revenue from its health plan assessment - amounting to $1.2 billion in 2018 - that does not require any appropriation and can be used in a variety of ways. CoveredCA allocates one-third of its assessment revenue to marketing and outreach, and if FFM did the same, it would invest $400+ million, which should lower premiums by 2.3% in 2019 and save consumers and taxpayers $1.6 billion. Maintaining this investment over three years would lower premiums by an average of 3.2% and save an estimated $6.6B during that time. (Kathy Keeshen, Sacramento)

Choice in Aging Announces Doc Mac's "Walk of Ages" Fundraiser

Dr. David MacDonald, a big supporter of Choice in Aging, is once again doing a "Walk of Ages" fundraiser in honor of the organization and the people it serves. Previously, in 2016, "Doc Mac" trekked 100+ miles along Hadrian's Wall, raising money and awareness about Choice in Aging before and during his journey. This year, his trek will focus on the Lake District of Northwest England, and for every person that Doc Mac is walking in honor or in memorial of, he will attach a purple ribbon to his backpack. Click here if you would like to donate to Doc Mac's fundraiser. (Debbie Toth, Bay Area)

Ceresti Debuts Tech-Enabled Service to Improve Dementia Care

Ceresti Health recently launched its technology-enabled service for dementia care, which enables adherence to care plans for the 10% of Medicare patients that cannot be directly engaged due to their dementia or cognitive impairment, a patient population that drives 26% of total Medicare costs. Ceresti's service incorporates family caregivers, utilizing a combination of technology and remote health coaching to deliver personalized education, coaching, and support to increase caregivers' knowledge, skills, and confidence. Ceresti has validated and optimized its first-of-its kind service in multiple studies, including in a pilot study with Landmark Health, a home-based medical care organization. (Dirk Soenksen, Orange County)

Alegre Home Care to Participate in Dementia Conference

Alegre Home Care will be exhibiting at the 20th Annual Updates on Dementia Conference, on May 10, in South San Francisco, the largest educational conference focusing exclusively on dementia on the West Coast. Aimed at professionals in the field, the conference will feature renowned researchers and clinicians presenting their research and experience in dementia and aging from a variety of perspectives: social, biological, psychological, and cultural. It will emphasize the practical applications of that research for treatment or for better coping with the symptoms of dementia. (Charles Symes, Bay Area)

CMS Renames "Meaningful Use" to "Promoting Interoperability"

In its latest Inpatient Prospective Payment System and Long-Term Care Hospital Prospective Payment System rule changes announced April 24, CMS renamed its meaningful use program again in an attempt to reflect its emphasis on achieving interoperability. Meaningful use, which CMS changed to "advancing care information" and rolled out under the Medicare Merit-based Incentive Payment System, will now be called "promoting interoperability." To advance data-sharing in healthcare, CMS is requiring that hospitals make patients' EHRs available to them on the day they leave the hospital starting in 2019.
     CMS hopes to make the program more flexible and less burdensome, in part by adding "measures that require the exchange of health information between providers and patients, and incentivize providers to make it easier for patients to obtain their medical records electronically," the announcement states. Specifically, it is replacing six measures with four:  E-prescribing; Health information exchange; Provider-to-provider exchange; and Public health and clinical data exchange.
     Meanwhile, former ONC chief Farzad Mostashari, MD, pointed out in a tweet April 24 that buried deep in the rule change, on page 1,475, that CMS proposed to use hospital conditions of participation to ensure interoperability and patient access. CMS suggested it may consider revising the current CoPs for hospitals to mandate they electronically transfer medically necessary information to another facility upon a patient transfer or discharge, require hospitals to send required discharge information to a community provider via electronic means if possible, and necessitate hospitals make certain information available to patients or a specified third-party application electronically upon request.
     CMS is accepting comments on the proposed rule until June 25. (Click for Full Article: Becker's Hospital Review, 4/25/18)

Medicare Will Require Hospitals to Post Prices Online

Medicare will also require hospitals to post their standard prices online so they are more readily available to patients, officials have announced. CMS head Seema Verma said the new requirement for online prices reflects the Trump administration's ongoing efforts to encourage patients to become better-educated decision makers in their own care. Hospitals are required to disclose prices publicly, but the latest change would put that information online in machine-readable format that can be easily processed by computers. (Click for Full Article: New York Times, 4/24/18)

OIG: 31% of Telehealth Claims Didn't Qualify

CMS paid about $3.7 million on telehealth claims that did not meet Medicare requirements, according to a report from the Office of the Inspector General. The OIG reviewed 191,118 distant-site telehealth claims from 2014 and 2015 totaling $13.8 million in payments. In a random sample of 100 claims, 31 claims should have failed to qualify for Medicare reimbursement. Of the 31 disallowed claims, 24 were because the patient received services at non-rural sites. Other claims showed the use of inappropriate means of communication, services outside the U.S., and billing for non-covered services. The OIG recommends that CMS implement post-payment review of claims to identify errors, as well as training providers on Medicare telehealth requirements. (Click for Full Report: oig.hhs.gov/oas/reports)

"Give Paramedics Power to Make Better Choices on Behalf of Vulnerable People"

If a person is intoxicated or suffering from a mental health crisis, a crowded hospital ER may not be the right place to get treatment. Yet homeless people are often taken there when they may just need a place to sober up or be seen by a mental health professional. That's because, in California, paramedics don't have the option to take homeless people, or anyone else, to a sobering center or a behavioral health facility. Under state law, paramedics (unlike police or sheriff's deputies in L.A. County) summoned through 911 calls are legally obligated to take an individual needing treatment to a hospital emergency room. (Click for Full Article: Los Angeles Times, 4/24/18)

California Online Community College Would Offer Medical Coding Program

The first program under Gov. Jerry Brown's proposed all-online community college would provide workers with an entry point into the growing healthcare field. The California Community Colleges Chancellor's Office is developing a four- to eight-month certificate program to train medical and healthcare coders in a partnership with the Service Employees International Union - United Healthcare West Joint Employer Education Fund. Unionized healthcare coders, who assign alphanumeric codes to medical procedures and services for billing purposes, earn about $30 per hour to start. Proponents of the program anticipate annual openings for 1,600 medical coding positions across the state. (Click for Full Article: Sacramento Bee, 4/27/18)

"All Healthcare is Local" to be Replaced With "All Healthcare is Social"

In a recent Forbes article - All Health Care Is Social: The Increasing Significance Of Social Interaction And Health - Sachin H. Jain, MD, President and CEO of CareMore Health System, writes that a growing number of healthcare organizations, particularly those focused on senior care, have recognized the importance of social interaction to health. In addition to medical appointments, diagnostic tests and studies, and medical prescriptions, these organizations prescribe and deliver social interaction with other seniors. Some interactions, such as education classes, have a health issue at their center, but just as often do not. Social interaction is seen as a medicine in itself - and is often a key engagement tool, getting patients further engaged in their health, and is an integral part of the clinical delivery model. Some healthcare organizations have identified generating greater social connection as a clinical goal. At Cerritos, CA-based CareMore Health, the lack of social connection or loneliness has been deemed a "treatable disease" and patients can enroll in a "Togetherness Program." Every CareMore patient undergoes a Healthy Start screening during which they are asked about their level of social connection to others. Patients who are identified as suffering from social isolation or loneliness are connected with a "Togetherness Connector" who makes a weekly phone call to check up on the patient. (Click for Full Article: Forbes, 4/30/18)

Million-Dollar Cancer Treatment: Who Will Pay?

The emergence of genetics-based medicines is pushing the cost of treating certain diseases to new levels, forcing hospitals and health insurers to reckon with how to cover total costs per patient approaching a million dollars. The therapies deliver new genes or genetically altered cells to tackle some of the hardest-to-treat diseases, including in children. They come at a high price: Novartis AG listed its newly approved cell therapy for cancer at $475,000, while Gilead Sciences Inc. priced its rival drug at $373,000. But the price of the drugs is just the beginning, hospitals and insurers say. Administering these therapies can add hundreds of thousands of dollars to the tab, including lengthy hospital stays and use of other services and medicines. (Click for Full Article: Wall Street Journal, 4/26/18)

A Royal Baby is Cheaper to Deliver than Average US Baby

Kate Middleton, the Duchess of Cambridge, gave birth to a baby boy, Louis, April 23, and delivering the new prince likely cost less than the average U.S. delivery, according to The Economist. The Duchess gave birth at the Lindo Wing, a private, upscale maternity ward in London often used by royals. In 2015, the maternity ward charged $8,900 for a non-caesarean delivery and a 24-hour stay in a deluxe patient room, according to data from London-based St. Mary's Hospital. In contrast, the average fee for the same delivery in the U.S. was $10,808 in 2015, according to The International Federation of Health Plans. When accounting for pre- and postnatal care, this figure jumps to about $30,000. Although insurance will cover most of this cost, parents are still left with an average bill of about $3,000, according to Truven Health Analytics data cited by The Economist. (Click for Full Article: Becker's Hospital CFO Report, 4/24/18)

Family Caregivers Finally Get a Break - and Extra Coaching

In California, Dignity Health Systems is partnering with the nonprofit Santa Barbara Foundation to provide caregiver coaches to help caregivers transition their patients to home care. At any given time, 1,000 caregivers are being coached. Across the country, community groups, hospitals, government agencies, and nonprofits are doing more to support at least some of the estimated 42 million people who are the primary caregivers of adults and children who have disabilities, are recovering from surgeries and illnesses, or are coping with Alzheimer's and other chronic diseases. (Click for Full Article: California Healthline, 4/30/18)

How a Stationary Bike + Google Street View Helps Seniors with Dementia

Residents at an Oshawa, Ontario, Canada retirement home are among the first people in that country to try an innovative therapy for Alzheimer's and dementia - called the BikeAround. The device combines a stationary bicycle, a dome-shaped projector, and Google Street View technology. Users sit on the bike and are able to pedal through video of meaningful destinations - a childhood home, a vacation destination, the spot they were married projected onto the screen in front of them. The experience helps recall memories, inspire conversation, and improve mood, according to researchers. (Click for Full Article: cbc.ca/news, 4/19/18)

Bare-Bones Health Policies: Cheaper than ACA Plans - and Riskier

Sales are growing for a type of bare-bones health policy that offers a cheaper alternative to traditional insurance but leaves buyers risking big bills if they have major medical needs. Known as fixed indemnity plans, the products offer limited help, typically paying set amounts toward the cost of doctor visits, hospital days or other services. They generally carry restrictions on people with pre-existing conditions, and they aren't considered true health insurance under the Affordable Care Act. But insurance agents say individuals are increasingly purchasing the plans as a substitute for ACA coverage, which has become far more costly for many people who don't get federal subsidies.
     Isaiah Alicea, a 29-year-old refrigeration technician in San Antonio, last year bought a product called "Core Health Insurance," mostly because of the low price of around $200 a month. The plan pays $70 each for up to 10 doctor visits if he is sick, and up to $500 a day for a hospital stay, up to 31 days, along with payments toward certain other services. The product doesn't pay toward hospital care related to pre-existing conditions for the first 12 months it's in effect. (Click for Full Article: Wall Street Journal, 4/18/18)

MDs' Undergrad Education Another Reason We Spend 18% of GDP on Healthcare

One contributing factor to the high U.S. spend on healthcare is the high cost, in time and money, of becoming a physician. A recent paper for the Mercatus Center argues that the amount of time it takes to become a doctor in the U.S.- four years in college before med school (another four years) and then residencies, almost always at least a decade - constrains the supply, driving up prices. Physician incomes in the U.S. well exceed those in Europe; American generalists earn twice as much as Dutch ones (although most emerge from med school in debt - a median of $195,000 in 2017). Europeans can begin studying medicine immediately after high school - usually with a five- or six-year course. The U.S. has a much smaller proportion of medical doctors graduating each year: 7.5 per 100,000 residents, compared with 11.3 in Germany, 12.8 in Britain, 9 in France, and 14.6 in the Netherlands. Only Canada, which has undergraduate requirements and high physician costs comparable to America's, comes close, with 7.8 per 100,000. (Click for Full Article: Wall Street Journal, 4/23/18)

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