Ascension’s CEO Anthony Tersigni announced a series of leadership changes

St. Louis-based Ascension revealed changes to its operational structure and leadership amid the departure of three longtime executives in a Jan. 22 announcement.

The changes include the dissolution of Ascension’s solutions and healthcare divisions. The solutions and healthcare divisions were created in 2012 to improve focus and growth for the system’s subsidiaries.

Officials said the decision to eliminate the divisions stems from the health system’s goal to become a unified organization, One Ascension.

In addition to the organizational changes, Ascension President and CEO Anthony Tersigni announced the departure of three longtime executives, and the creation of a new position.

Patricia A. Maryland, DrPH, will leave the organization after a 15-year tenure. She will continue in her role as CEO of Ascension Healthcare through June 30. After her departure, the position will be eliminated.

Executives John Doyle and David Pryor, MD, will retire at the end of the health system’s fiscal year, June 30.

To support Ascension’s integrated health ministry, Joseph R. Impicciche will assume the newly created role of Ascension president and COO. He will oversee Ascension’s healthcare operations and services and report to Mr. Tersigni.

Mr. Impicciche has served as executive vice president and general counsel since 2004.

Johns Hopkins Reaches Settlement with Registered Nurses Affirming Nurses’ Guaranteed Right to Unionize

Nurses at Johns Hopkins Hospital in Baltimore are hailing as a critical victory a settlement reached with the hospital which reaffirms the nurses’ guaranteed legal right to unionize, said the National Nurses Organizing Committee/National Nurses United (NNOC/NNU) today.  

“This settlement makes clear that nurses have the right to form a union, we have a right to speak with our coworkers about a union, and Johns Hopkins does not have the legal right to target and intimidate nurses who engage in union activity,” said Alex Laslett, RN. “We are organizing at Johns Hopkins because we know a union affords nurses the protection we need to advocate freely for the best care for our patients.”

The settlement resolves unfair labor practices charges filed with the Baltimore-based National Labor Relations Board (NLRB) on behalf of the Johns Hopkins nurses by NNOC/NNU. The NLRB found merit to charges that the hospital broke the law by:

  • The creation of the impression of surveillance and unlawful interrogation in regards to protected union activity,
  • Promulgating and/or enforcing a rule barring off-duty RNs access to break rooms, outside patient care areas, in connection with union activity, and
  • Prohibiting Hopkins RNs from talking about the union at work, while permitting other non-work conversations.

The settlement requires that Johns Hopkins Hospital management post signs throughout the facility affirming the nurses’ right to form a union. The signs declare that Johns Hopkins Hospital will not prohibit nurses from talking about the union, will not create the impression that hospital management is watching out for union activities, will not ask nurses about their union sympathies, and will not discriminatorily enforce its policies on nurses accessing break rooms.

Diverting patients from emergency departments with telemedicine can save more than $1,500 per visit.

Telemedicine visits generate cost savings mainly by diverting patients away from more costly care settings, new research shows.

The primary market opportunity for telemedicine visits is the value proposition that they can both expand access to patients while also reducing costs compared to alternative care settings.

The new study is based on data collected from 650 patients who used the JeffConnect telemedicine platform at Philadelphia-based Jefferson Health.

“In our on-demand telemedicine program, we found the majority of health concerns could be resolved in a single consultation and new utilization was infrequent. Synchronous audio-video telemedicine consults resulted in short-term cost savings by diverting patients from more expensive care settings.”

The cost of a JeffConnect visit was a $49 flat fee.

The bulk of the cost savings from the telemedicine program was generated in diverting patients from emergency departments. Each avoided emergency department visit garnered cost savings ranging from $309 to more than $1,500. Cost savings from other alternate care types was below $114 average savings per visit.

“The net cost savings to the patient or payer per telemedicine visit of $19 to $121 represents a meaningful cost savings when compared with the $49 cost of an on-demand visit. The primary source of the generated savings is from avoidance of the emergency department, as this is by far the most expensive of the alternative care options provided,” the researchers wrote.


About 16% of the JeffConnect patients surveyed said they would have “done nothing” as an alternative to a telemedicine visit—representing potential increased utilization of services. But cost savings outweigh possible higher utilization of services due to telemedicine’s easy access, the researchers found.

“A substantial shift would be necessary to outpace the savings from diversion. Conversely, this population of patients who would have done nothing may represent improved access and incorporation of patients into the healthcare system that might not have participated previously. This might actually prevent more costly care further down the line.”

Medical schools overhaul curriculum to better prepare future docs!

Dr. John Raymond, CEO of the Medical College of Wisconsin in Milwaukee, thinks there is an critical element sorely missing in the training of aspiring physicians: compassion.​ 

Since there is an assumption that all doctors are inherently compassionate and caring individuals, traditional medical education doesn’t outright address its importance in patient care, he argued.

But recently compassion seems to be getting lost as doctors face more administrative burdens and an increased emphasis on clinical productivity. “These pressures can dehumanize medicine,” he said.

Through the National Transformation Network, which officially launched in June, the schools will work together to develop a curriculum focused on three components: character, competence and caring. The network was established with the help of a $37.8 million grant from the Kern Family Foundation, a not-for-profit that funds educational initiatives. The other participating schools include the Mayo Clinic School of Medicine, Geisel School of Medicine at Dartmouth, UCSF School of Medicine, Vanderbilt University School of Medicine and the University of Wisconsin-Madison School of Medicine and Public Health. 

Raymond quickly acknowledged that clinical competence isn’t lacking in medical education, emphasizing that medical schools do an excellent job of equipping future doctors with the scientific background and clinical skills needed to treat patients. What’s lacking is making sure aspiring doctors have the right intentions and mindset to care for the nation’s vulnerable or sick. 

The lack of focus on these qualities during medical school ultimately hinders efforts in the healthcare industry overall to provide care that is more patient-centered. “We need to make (medical school) feel more real and more directly related to the patient,” Raymond said. 

How exactly the National Transformation Network will change curriculums is still being worked out, but there will be a strong emphasis on ensuring students appreciate and understand the importance of compassion to patients, Raymond said. This will likely take the form of more one-on-one time with patients and an emphasis on personal wellness and burnout, which plagues a majority of physicians today.

At the Kaiser Permanente School of Medicine, slated to open in 2019, students will be asked to come up with solutions to a variety of complex health issues such as low immunization rates or falls in the inpatient setting.

“Part of what we have to do is show medical students how to be leaders of change,” said Dr. Edward Ellison, board member of the school and co-CEO of the Permanente Federation, a Kaiser subsidiary connected to its medical groups.

The students will also benefit from the school’s affiliation with Kaiser Permanente, the not-for-profit health system based in Oakland, Calif., Ellison said. Students are expected to shadow doctors, work in the more than 30 safety-net clinics that are part of the Kaiser system, and visit patients in their homes after discharge. 

Kaiser’s move to open a medical school represents a growing trend in medical education. Health systems are increasingly working with their affiliate medical schools to brainstorm how students should be trained, said Leah Gassett, a principal at ECG Management Consultants with an expertise in medical education. 

“Health systems are recognizing they would like a seat at the table so the graduates are prepared to be effective clinical leaders of their systems,” she said. 

But Ellison said Kaiser’s foremost goal wasn’t to foster a pipeline of future doctors to work at the system—though they expect some students to stay at Kaiser to pursue their residency. Instead, the main driver was a desire to be part of the changes happening in medical education. 

“We want to contribute to the broader evolution of medical education,” he said. “We see this as a way to learn and share outside our system.”

Physician-staffing firm email breach exposes 31,000 patients’ data.

An unauthorized user recently accessed several employee email accounts at physician-staffing firm EmCare, compromising personal information from roughly 31,000 patients.

EmCare said it became aware of the data security incident “recently,” leading to an internal investigation. It has engaged a forensic security firm to determine the scope of the breach, according to a notice the company posted online Saturday. EmCare determined on Feb. 19 that the email accounts in question contained patient data, including some names, dates of birth, clinical information and Social Security numbers.

An EmCare spokesperson said the company is not releasing information regarding when it learned of the breach.

SSM Health’s 2018 net income more than doubles through acquisitions

Early 2018 acquisitions helped SSM Health more than double its revenue over expenses last year. 

While many large health systems saw their profits sink on investment losses last year, the St. Louis-based health system more than doubled that metric. SSM drew $505.2 million in revenue over expenses last year, up from $246 million in 2017. 

That was mostly thanks to nearly $600 million in so-called “inherent contribution” gains in 2018 stemming from acquisitions in Wisconsin. Inherent contributions are reported when the value of acquired assets exceeds the acquired liabilities, according to a 2016 report by BDO.

SSM acquired Agnesian HealthCare in Fond du Lac, Wis., and Monroe (Wis.) Clinic from the Congregation of Sisters of St. Agnes at the beginning of 2018. The deal added four hospitals, four long-term care facilities and multiple outpatient sites to SSM’s portfolio and extended its reach in Wisconsin to northern Illinois. 

SSM has been growing rapidly in recent years, having acquired St. Louis University Hospital from Tenet Healthcare in 2015, and took control of 26 St. Louis-area health clinics in Walgreens stores in 2016.

The health system’s total operating revenue spiked 16.2% year-over-year, from $6.5 billion in 2017 to nearly $7.6 billion in 2018. Expenses rose 15% during that time, to $7.4 billion last year. Net patient service revenue grew 18% year-over-year.

Kris Zimmer, SSM’s chief financial officer, said in a statement that the Wisconsin acquisitions were the primary driver of SSM’s increased patient service revenue last year. Favorable payer and revenue mixes in other parts of the system helped increase that revenue as well. 

The system’s operating income narrowed in the year, however, to $11.2 million, compared with $30.8 million in 2017. Excluding impairment losses primarily on assets at its mid-Missouri locations, SSM’s operating income before nonrecurring items was $124 million in 2018 compared with $40.1 million in 2017. 

SSM certainly wasn’t immune to the stock market volatility that struck most health systems at the end of 2018. It lost nearly $82 million on investments last year, compared with a nearly $243 million gain in the previous year. 

SSM stated that it continues to appeal a CMS determination that it needs to repay the agency for behavioral health services provided at an Oklahoma hospital. SSM had $37.7 million in a reserve fund connected to the dispute last year and $44.5 million in 2017. The health system repaid the agency $10.5 million last year. 

At issue is the fact that the CMS determined it had overpaid SSM for inpatient behavioral health services provided to children and adolescents at the hospital in 2006. An audit determined certain services should have been classified as non-acute residential treatment services, which are less expensive than inpatient care, and the CMS in 2013 determined the facility would need to repay money it provided to the hospital’s adolescent psychiatric program in 2006. Ultimately, SSM said it expects the ruling will be expanded to payments received in 2004 through 2013.

SSM recorded a $107.3 million impairment loss last year mostly related to assets at its mid-Missouri locations. Roughly $6 million was related to assets held for sale in Wisconsin. The system did not record any impairment charges in 2017.

SSM spent $117 million providing charity care last year, down from $121.1 million in 2017. The system also spent $164.5 million last year on community health improvement services, education, research, community building activities and other community benefits, compared with $161.4 million in 2017.

Rush CEO Dr. Larry Goodman to retire

Rush University System for Health CEO Dr. Larry Goodman will retire this summer, the academic health system announced late Wednesday. 

Dr. Ranga Krishnan, current dean of Rush Medical College and senior vice president of Rush University Medical Center, and Dr. Omar Lateef, the chief medical officer for the system and medical center, and senior vice president of medical affairs for the medical center, will split Goodman’s role. Krishnan will become CEO of the Chicago-based system, a three-hospital network anchored by Rush University Medical Center, and Lateef will become CEO of the medical center. 

Goodman has been CEO of Rush University Medical Center since February 2002 and assumed the role of CEO when the system was formed in March 2017. He informed the board about his retirement plans more than a year ago to kick off succession planning, said Goodman, who will turn 69 soon.

“Things are going well at Rush, I am fortunately healthy, I enjoy what I do, and I believe these kinds of transitions take time so I wanted to be purposeful in our succession planning,” Goodman told Modern Healthcare. “Some CEOs can stay too long or get sick and then not perform as well. I have been here my entire career and I care deeply about Rush, so I wanted to make sure I did the correct thing.”

Comparing Rush to other institutions, it would be hard to find another university, flagship hospital and medical system led by a single leader, said Susan Crown, chairman of the system and medical center boards. 

“We have grown substantially in all three areas,” she said. “Given our aspirations, it is important for each entity to have strong leadership and focus.” 

Rush has pushed several initiatives during Goodman’s tenure, two of which include boosting community outreach and revamping CMS’ hospital star ratings program. 

Rush spearheaded the West Side United program, a coalition of health systems, public institutions, residents and community groups formed in 2017. The group aims to address some of the root causes that have led to a 16-year discrepancy in life expectancy for some West Side residents from those in Chicago’s Loop. 

The academic health system has led dozens of informal “listening sessions” throughout the West Side to hear what residents need and learn how to appropriately intervene. Rush and West Side United are trying to spark a recovery through job training, local hiring and purchasing, small business funding and housing development. In the West Side and beyond, Rush looks to expand mental health services—particularly for military veterans— reduce gun violence and increase access to healthy food, among other initiatives.

Rush’s quality experts have been vocal about their criticism of the CMS’ star ratings. The agency’s statistical model unevenly weighted the eight measures in the safety-of-care group, which has skewed star ratings since they were first released in 2016, Rush argues. Quality experts contend that the latent variable modeling used in the calculations isn’t appropriate for measuring clinical outcomes and they are working with the CMS to adjust the formula. 

An infrastructure is in place to continue these efforts after his retirement, Goodman said. 

“It goes all the way up to the board,” he said.

Modern Healthcare’s sister publication, Crain’s Chicago Business, recently reported that Rush is exploring a merger with Swedish Covenant Health, which operates a one-hospital community health network in Chicago that includes a 150-member physician group and a managed care organization.

Rush nixed a merger with Chicago-based Little Company of Mary Hospital & Health Care Centers last year but has steadily grown its ambulatory network. More outpatient expansion is planned, executives said.

“We want to figure out how to get closer to the home and how to get new services in place outside of the traditional avenues of more clinics and more surgery centers,” said Krishnan, adding that Rush will look to build its own facilities as well as partner with both typical and atypical healthcare companies.

The academic health system is repaying more than $21 million to the federal government for alleged overpayment for inpatient and outpatient rehabilitation claims. 

Rush reported $94 million in operating income on revenue of $2.43 billion in 2018, up from $69.5 million in operating income on revenue of $2.27 billion in 2017, according to Modern Healthcare’s financial database. It had a 3.9% operating margin in 2018, up from 3.1% the year prior. 

Through the first half of its fiscal 2019, which started July 1, the academic health system posted a 1.9% operating margin and an adjusted $1.5 million operating loss related to early retirement payouts for certain employees. That compared to $47.2 million of adjusted operating income through the first six months of fiscal 2018.

Beth Israel Deaconess and Lahey Health complete merger

Beth Israel Deaconess Medical Center and Lahey Health officially combined to form Beth Israel Lahey Health, the second-largest health system in Massachusetts, the organizations announced Friday. 

In November, Massachusetts’ attorney general approved the deal with conditions including a seven-year price cap; participation in MassHealth, the state’s combined Medicaid and Children’s Health Insurance Program; and $71.6 million in investments supporting healthcare services for low-income and underserved communities in Massachusetts.

The price cap guarantees Beth Israel Lahey Health’s price increases will remain below the state’s annual healthcare cost growth benchmark of 3.1% for seven years. That will prevent more than $1 billion of the potential cost increases over a seven-year span projected by the Massachusetts Health Policy Commission, according to Attorney General Maura Healey.

Healey’s assurance of discontinuance does offer some flexibility amid “significant change in market conditions,” including significant swings in the consumer price index or new laws that significantly raise the cost of care. 

The Massachusetts Health Policy Commission, which has produced critical reports of the merger citing a potential to increase healthcare costs by up to $251 million per year, said it commends the conditions the attorney general placed on the deal that would help mitigate its concerns. They will have a real impact on access to treatment for mental health and substance-use disorders for patients across eastern Massachusetts, the commission said.

These types of regulations could become the new normal for hospital merger and pricing policy in the U.S., policy experts said. 

Between the Massachusetts Health Policy Commission and strong attorney general, Massachusetts has been fairly far out in front in terms of healthcare policy, said Zack Cooper, associate professor of health policy and economics at Yale University.

“What they are signaling with this settlement is that they will allow these sort of entities, conditional upon enforcing price regulation,” he said. “This is the de facto price and spending cap may become the norm in the next decade or so. Frankly, we face a choice of using a public option to put pressure on providers and insurers or simply regulate directly.” 

The industry is moving toward these types of monopolies that require price regulation, Cooper said. The challenge will be whether to regulate prices over the entire systems or only the overlapping sites. With the latter, the evidence shows that systems tend to shift the price increases to other sites in the system, he said.

“Capping prices for the entire system is a notable outcome of this ruling,” Cooper said. 

The merger includes Beth Israel in Boston and Lahey in Burlington, as well as Boston’s New England Baptist Hospital, Mount Auburn Hospital in Cambridge and Anna Jaques Hospital in Newburyport. 

Beth Israel Lahey Health operates a total of 10 hospitals as well as three affiliate hospitals in Cambridge Health Alliance, Lawrence General Hospital and Metrowest Medical Center. 

Its network includes four academic and teaching hospitals with affiliations with Harvard Medical School and Tufts University School of Medicine, eight community hospitals, specialty hospitals for orthopedics and behavioral health, and ambulatory and urgent care centers. It has a population health enterprise and a centralized network of administrative and operational services, executives said. 

“Through local and system partnerships, as well as the enthusiasm and talent of all our employees and providers, we will invest in and strengthen community-based care, informed by innovation and discovery,” Dr. Kevin Tabb, president and CEO of Beth Israel Lahey Health, said in prepared remarks.

The combined entity would have around $6 billion of revenue, more than 4,000 physicians and 35,000 employees.

Beth Israel and Lahey executives argued that their combination is necessary to heal a dysfunctional Massachusetts healthcare market that continues to overuse hospitals and academic medical centers. It’s the only way to check Partners, they said. Executives said they plan to expand the state’s now-limited behavioral health service network, helping divert patients from costly emergency departments. They pledged to use their combined purchasing power and expertise to lower costs, which they say will outpace any potential price increases.

Lahey Health narrowed its operating loss in 2018, but its expenses related to salaries and wages and supplies continued to rise. It reported a $29.6 million operating loss on revenue of $2.15 billion in 2018, compared to a $65.6 million operating loss on $2.03 billion in revenue in 2017.

CareGroup, which is the corporate parent of Beth Israel Deaconess, New England Baptist Hospital and Mount Auburn Hospital, reported $38.7 million of operating income on revenue of $3.53 billion in 2018, a significant increase from a $3.1 million operating loss on $3.33 billion of revenue in 2017.

Will blockchain save the healthcare system?

Blockchain 101

Blockchain is a log of activity that is time-stamped, tamper-proof and shared across a network of computers.

Originally dreamed up in 2009 by an unknown person or group—it’s not known for sure which—called Satoshi Nakamoto as a means to move the digital currency bitcoin, its uses have since been broadened to exchange other types of digital assets, such as data, in private, permissioned networks suitable for businesses.

Each transaction that goes into the log of activity is enclosed in a block and linked together in chronological order to form a chain, giving it the name blockchain.

Blockchain is gaining traction as a tool that could help solve some of the healthcare industry’s age-old problems that have resulted in wasteful spending and higher costs for providers, insurers and patients. Once-reluctant competitors are joining forces to find out just what the technology can do and in the process are developing new transparent business models. 

A senior distinguished engineer at the healthcare services company Optum, had been experimenting with how to solve healthcare industry problems with that emerging, exciting, little understood technology called blockchain. He had heard rumors that health insurer Humana, like Optum, had been testing blockchain’s applications.

So during lunch at the Distributed Health conference in September 2017, Jacobs and Humana Lead Enterprise Architect Kyle Culver described their projects in careful terms (there was no nondisclosure agreement in place) and learned that both companies were attempting to use blockchain to improve the accuracy of healthcare provider directories—a perennial, costly issue for the insurance industry. Their experiments had revealed that blockchain works best when multiple partners are involved.

Just two months later, Optum, Humana and three others—MultiPlan, Quest Diagnostics and Optum’s corporate sibling UnitedHealthcare—had solidified an agreement to form the Synaptic Health Alliance, which in June 2018 piloted the use of blockchain to fix errors in provider directories and lower the cost of keeping that information up to date by sharing the data and workload. Aetna and health system Ascension have since joined the group. With “multiple people looking at the same information, the quality of that information should go up and operational costs for the provider and the payers should go down because there’s less-frequent contact being done between those two stakeholders. And because the quality goes up there should be a better experience for the patient,” Jacobs said.

It’s early, but the companies have already found they are able to locate inaccurate information faster than they would on their own while also protecting information from cyberattacks. The goal is to scale the tool to a national level. But fixing provider directories is an initial foray. “We have a general agreement that, boy, if we can get this to work, this is just the first area of focus,” Jacobs said.

They anticipate that blockchain will be the key that unlocks barriers to healthcare data-sharing and ultimately enables an industrywide shift to value-based care.

“When we talk about healthcare today, we talk about the silos a lot—the silos of data and the barrier for exchanging information,” Humana’s Culver explained. “The hope is that blockchain allows us to connect those silos and … enable new capabilities (so that) access to information no longer is where we compete, but we compete much more on the value-added service and the trust and transparency of the companies that are providing those things.” 

In the simplest terms, blockchain is a shared record of transactions. It enables participants in a group to securely share data with each other without a middleman and keep track of what was exchanged and when. Instead of that record being located on a single, hackable computer, it is maintained across multiple computers, which makes the information extremely difficult to tamper with or delete. That tamper-proof characteristic, along with a process that ensures any information put into the blockchain is valid, enables trust between the group participants.

So in the case of the blockchain-enabled provider directory, if one insurance company in the alliance calls a doctor’s office to verify an address and updates that information in the record, all members of the alliance would see the change. That means less work for the rest of the insurers and the doctor’s office.

Unnecessary ED visits from chronically ill patients cost $8.3 billion

About 30% of emergency department visits among patients with common chronic conditions are potentially unnecessary, leading to $8.3 billion in additional costs for the industry, according to a new analysis.

The report, released Thursday by Premier, found that six common chronic conditions accounted for 60% of 24 million ED visits in 2017; out of that 60%, about a third of those visits—or 4.3 million—were likely preventable and could be treated in a less expensive outpatient setting.

The frequency of unnecessary ED visits from the chronically ill is unsurprising given the fee-for-service payment environment the majority of providers remain in, said Joe Damore, senior vice president of population health consulting at Premier. On average, only 10% of providers’ payment models are tied to value-based models, he said, so providers don’t have an incentive to effectively manage patients to prevent disease progression and promote wellness.

Premier’s findings are in line with other research on patients with chronic diseases, finding they are more likely to use the ED and get admitted to hospitals because they experience poor care coordination. 

“Value-based care is managing a chronically ill patient in a coordinated way, and the traditional payment model hasn’t rewarded that. It’s episodic,” Damore said. 

The six chronic conditions used in the analysis are asthma, chronic obstructive pulmonary disease, diabetes, heart failure, hypertension and behavioral health conditions, such as mental health or substance abuse issues. They were selected because they are often cited in the academic literature as the most common and costly conditions in the healthcare system, Premier said. 

The data from the 24 million ED visits at 747 hospitals comes from Premier’s database, which has information on 45% of U.S. patient discharges, according to Premier. To get the results, Premier identified hospitals with the lowest quartile visit rate, or those that had the lowest ED admission rates by condition, and calculated how many visits at the remaining hospitals could be prevented if all hospitals achieved those rates for the six chronic conditions. 

And then to arrive at the $8.3 billion in costs, Premier used the average cost for an ED visit estimated by the Health Care Cost Institute, which is $1,917. 

Damore said that although the industry is “mostly fee-for-service at this time,” he expects an eventual transition to value. “More and more providers are convinced that the future is going to be value-based payment,” he said.