Health Care Year in Review 2012

By Matthew Weinstock H&HN Senior Editor	December 20, 2012
The Supreme Court. The election. The fiscal cliff. But did you hear about?

As you read this, I am scurrying across the globe with Chicagoan John Cusack (you wouldn't believe how well he dodges flying chunks of molten lava!). We're making our way to China so we can sneak aboard a giant boat and float away to safety.

Yes, John and I are ready for tomorrow ? Dec. 21, 2012 ? and the end of the world as we know it. If you text me, maybe I'll be able to hold the boat for an extra minute. Oh wait, cell towers will be gone. Too bad.

OK, so tomorrow isn't really the end of the world. Not even the Mayans believed that earth was truly imperiled. It's a huge misperception. As rocket scientists at NASA point out, "Just as the calendar you have on your kitchen wall does not cease to exist after Dec. 31, the Mayan calendar does not cease to exist on Dec. 21, 2012. This date is the end of the Mayan long-count period but then ? just as your calendar begins again on January 1 ? another long-count period begins for the Mayan calendar."

One thing that does end tomorrow though is the 2012 edition of H&HN Daily. We'll be taking a holiday break, returning on Jan. 2, 2013, with a fresh set of columns from all of your favorites ? Ian, Emily, John, David, Joe and more ? along with insightful blogs and multimedia pieces from the H&HN staff.

Before closing things out, I wanted to take a quick look back at 2012, and what a year it's been. The Supremes upheld the Affordable Care Act as the law of the land, although they did toss everyone a curveball by allowing states to opt out of Medicaid expansion. President Obama won re-election, further solidifying the ACA's status. Sandwiched between those landmark events, HHS postponed ICD-10 implementation another year, issued stage 2 meaningful use regulations, announced ACOs, and more. We saw major hospital mergers from Michigan to Texas. And as the ball readies to drop in Times Square, we can't help but wonder if we'll be tumbling down the fiscal cliff, or, by some miracle, stepping away from the edge.

But what about those stories that didn't make the headlines? I reached out to some sources and asked for their thoughts on 2012. Besides the mega-events, which issues shaped the Year in Health Care?

Marty Fattig, CEO of Nemaha County Hospital, a critical access hospital in Auburn, Neb., says that an area that continues to be of "tremendous concern" for small and rural hospitals is physician supervision, something that CMS addressed in its Outpatient Prospective Payment System rule by extending until 2014 enforcement of the direct supervision requirement for CAHs.

"For years we have performed outpatient therapeutic procedures, such as IV antibiotic therapy, blood transfusions and chemotherapy with the understanding that general physician supervision was what was required. CMS now says that direct physician supervision is required for us to perform these procedures. General supervision means that a physician must be available if something should go wrong. Direct physician supervision means that the physician must be physically present in the room with the patient when the procedure is being performed. CMS has also stated that direct supervision was required all along so we are all at risk of sanctions should an audit be conducted, since we have been performing these procedures under general supervision for the last several years. Efforts are in place to change this ruling and CMS has agreed to not penalize hospitals for now. We simply cannot function under the direct supervision regulation. There is a shortage of primary care providers in rural areas already and they do not have the time to stay in the patient's room while these procedures are performed. These procedures have been performed under the general supervision guidelines for years with no adverse effects, so we fail to see the need to change now."

Regular H&HN Daily contributor John Glaser, CEO of health services at Siemens Healthcare and former health system CIO, singles out an IOM report that calls for creating a health system that embraces continuous learning. We covered the report's initial release back in September. John believes it could have a lasting impact on the field:

"The Institute of Medicine report 'Best Care at Lower Cost: The Path to Continuously Learning Health Care in America' created significant discussion when it was released this year, but due to its late summer timing, mainstream media coverage had already turned to focus mostly on?the presidential election. This document is important and could become a reference benchmark for years to come. It touched on several topics that are especially important to our work at Siemens Healthcare. Mainly, it stresses that change ? for the better ? is possible and that we now have the tools to make it happen: health care information technology,?connectivity, workflow engineering and team-based care.

In outlining 10 basic recommendations to achieve positive change, the authors specify?three areas that focus on HIT: digital infrastructure, data utility and?clinical decision support. In an August H&HN Daily column, I discussed the?need to move to an electronic health record that eschews a transactional-based approach for one that supports?intelligent decision-making and continuity of care. When paired with powerful business intelligence/analytics tools that can mine data across multiple silos, and from multiple provider settings, this type of intelligent EHR' can play a significant role in bettering population health.?If we are to ever start chipping away at?the?rising cost of health care,?we need to better understand?how we can address people's?health needs?before they require more acute intervention."

Both Fredric D. Leary, M.D., senior medical director at McKesson Health Solutions, and Blair Childs of Premier health care alliance, referenced the increased scrutiny ? and payment penalties ? for readmissions that started in 2012.

Leary notes that "reducing preventable readmissions is tied to the overarching goal of health care reform: quality, affordable health care for all Americans.?While hospitals are on the hook to begin the identification and coordination activities that have proven to reduce readmissions, they will only be successful if they can collaborate more effectively with their medical home providers on the ambulatory side and their SNF networks on the post-acute side. Health care IT can help close the gaps between the health care providers that are part of the patient's care continuum, assist them in proactively focusing on at-risk patients, and support patient education and engagement."

Childs, senior vice president for public affairs at Premier, points out that there are significant concerns with CMS' policy on readmissions. "While well-intended, the Medicare policy that penalizes hospitals with high readmission rates is flawed, based on an imperfect risk-adjustment mechanism that does not capture these socioeconomic factors and, as a result, adversely impacts at-risk communities ? This will result in vast resources being withheld from all affected hospitals, but particularly from those that need them most, namely those that serve populations of at-risk patients."

AHA officials pointed to a few significant events inside the Beltway:

• The departure of influential health care policymakers, including Don Berwick at CMS. Sens. Olympia Snowe, R-Maine, and Kent Conrad, D-N.D., did not seek re-election and will retire at the end of the year. Rep. Pete Stark, D-Calif., lost his re-election bid.
• The AHA's D.C. staff also point to the demise of the Blue Dog Democrats as a key factor in policy debate.
• Along those lines, they say that 2012 saw a major pivot from "making health policy to now making budget policy, which drives health policy."

And let's end on an uplifting note. Jim Hinton, president and CEO of Presbyterian Healthcare Services and the incoming AHA chair-elect, offers this appraisal of 2012:

"The health care field has been consumed by our focus on the Affordable Care Act, the Supreme Court decision and most recently the November elections. What may have lost visibility as a result are the incredible gains we have made in quality. In health systems and hospitals throughout America the rallying cry continues to be the Triple Aim' of quality of care, the overall experience of care, and affordability. While reform-driven policy issues will continue to occupy our attention, the primary mechanism for success will be a laser focus on what is of most value to the people we serve, and it is hopeful that these successes will contribute significantly to health system success. Those who place their trust in us deserve our best."

And on that note, we at H&HN would like to wish you a safe, happy and healthy holiday season and a very happy New Year. We'll see you in 2013!

The opinions expressed by authors do not necessarily reflect the policy of Health Forum Inc. or the American Hospital Association.

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