Modern Healthcare THE ONLY HEALTHCARE BUSINESS NEWS WEEKLY | JULY 24, 2017 | $5.50 Riding out the storm Even as GOP efforts to repeal the Affordable Care Act hang by a thread, rural providers see no end to attacks on funding that’s critical to their survival. Page 6 Primary-care doc pay rises, but large disparities persist with other specialties / Page 15 Dr. Halee Fischer-Wright says healthcare’s gender gap is closing, but not fast enough / Page 30 PATIENT CARE TRANSFORMATION DENISE M. PETERSON JOHN F. RODIS, M.D., M.B.A. BILL ORRELL PAUL OSBORNE SENIOR VICE PRESIDENT AND REGIONAL CHIEF NURSING OFFICER TRINITY HEALTH – NEW ENGLAND PRESIDENT SAINT FRANCIS HOSPITAL AND MEDICAL CENTER ASSOCIATE DIRECTOR BRG MANAGING DIRECTOR BRG “We partnered with BRG to transform our clinical operations to run at peak efficiency while continuing to maintain and exceed excellent quality outcomes and patient experience. BRG provided expert consulting and world-class data analytics and management tools, allowing for sustainable results. We achieved dramatic cost savings, improved throughput, and decreased our length of stay. We would highly recommend BRG to any organization looking to transform its clinical operations.” Denise M. Peterson Senior Vice President, Regional Chief Nursing Officer • Trinity Health – New England BERKELEY RESEARCH GROUP works with health systems, academic medical centers and community hospitals to deliver measurable bottom-line improvements. Experienced consultants, best-in-class data analytics and a clinical focus make BRG the right team for your performance improvement initiative. Contact us today to see what sets us apart. 877.221.1479 | firstname.lastname@example.org | THINKBRG.COM COST REDUCTION • REVENUE IMPROVEMENT • CLINICAL REDESIGN • STRATEGY News 2 Late News Louisiana vetting Medicaid managed-care contract extensions. 4 The Week Ahead 6 Cover story Rural hospitals on the edge By Steven Ross Johnson Rural hospitals have been struggling with financial challenges for years, leading to layoffs and closures. Now with the uncertain future of Medicaid, executives are even more fearful for their facilities’ survival. Investors wait to see if hospitals held admission volumes in second quarter. 5 Regional News Ascension names Memorial Hermann exec to lead Texas division. Cover photo: Getty Images 8 Policy Features 15 Rising pay for primary-care docs With ACA’s fate unsettled, healthcare groups eye options for killing taxes. By Steven Ross Johnson While demand for primary care is on the upswing, driving increases in pay for physicians providing those services, the industry has a long way to go before there is compensation parity between primary-care docs and specialists. Opinions/Ideas What doomed the GOP’s latest ACA repeal-andreplace proposal? There are plenty of reasons. Read about eight of them. 28 Best Practices By Maria Castellucci Memorial Hermann partners with the community to tackle a root cause of poor health—food insecurity. “It’s never been an asset to be a woman in executive ranks. Sometimes it’s not been a detriment, but it’s never been an asset.” 9 Quality Readmission prevention not harming quality, reports show. 30 Q&A 10 Providers MGMA CEO Dr. Halee Fischer-Wright discusses diversity issues in healthcare management and emerging trends affecting physician practices. Hospitals question decision to redistribute $900 million in 340B funding. 11 Insurers CMS pushing to take closer look at Medicare Advantage networks. By Maria Castellucci The nation’s medical schools are working to add programs that go beyond scientific knowledge and clinical skills, emphasizing the importance of things such as compassion and community health. 34 By the Numbers The largest allopathic and osteopathic medical schools. @ModernHealthcare.com Education and Events Workplace of the Future conference Join top-tier executives from the country’s leading healthcare organizations to discuss best practices and strategies for creating an exceptional workplace. /Workplace Data 29 Data Points Read the latest stats on the impact of the Affordable Care Act, including the number of uninsured, Medicaid enrollment and exchange plan premiums. 20 Adding compassion to the curriculum Awards and Recognition Final weeks to nominate Up & Comers Know some young healthcare leaders already making a difference in the industry? We’re accepting nominations through Aug. 4 for this year’s class of Up & Comers. /UpandComers 25 Guest Expert Amid all the ongoing drama over repealing and replacing the Affordable Care Act, there’s a solution that’s hiding in plain sight. 24 Editorial Diversions 36 Outliers People 32 Newsmakers VA veteran David Waltman joins the federal team at health IT giant Cerner Corp. They might be “magically delicious,” but the cereal maker hasn’t had any luck making them naturally flavored. MODERN HEALTHCARE (ISSN 0160-7480). Vol. 47 No. 30 is published weekly by Crain Communications Inc., (except for combined issues the last week of June and the first week of July; the last two weeks of December), 150 N. Michigan Ave., Chicago, Ill. 60601-7620. Periodicals postage is paid at Chicago, Ill., and additional mailing offices. U.S. subscription price: $169 per year, $258 for two years; foreign subscriptions: $218 per year. Canadian subscriptions: $226 for one year (includes GST). Sales Agreement No. 0293547. GST #136760444. Printed in U.S.A. Title® at U.S. Patent Office. © Entire contents copyright 2017, by Crain Communications Inc. Use of editorial content without permission is strictly prohibited. All rights reserved. POSTMASTER: Send address changes to MODERN HEALTHCARE, Circulation Department, 1155 Gratiot Ave., Detroit, Mich. 48207-2912. July 24, 2017 | Modern Healthcare 1 Briefs Louisiana vetting Medicaid managed-care contract extensions n The Trump administration announced NASHVILLE –Louisiana is expected to decide by September whether it will keep five Medicaid managed-care companies currently overseeing the care of beneficiaries or adjust the group, said Dr. Rebekah Gee, the state’s secretary of health. Speaking on the sidelines of the Modern Healthcare Women Leaders in Healthcare Conference last week, Gee said Louisiana’s year-old Medicaid expansion has allowed 437,000 newly insured to get care that they often previously delayed. The state now has 1.6 million enrolled in Medicaid, resulting in a spike in preventive and early Gee treatment since the expansion, Gee said. During the concluding keynote presentation of the twoday conference, Gee said 110,000 of the newly insured under Medicaid received preventive care in the past year and more than 27,000 received outpatient mental health services. Of the newly insured, another 18,000 received breast cancer screenings and 12,000 underwent colon screening. Louisiana has a three-year Medicaid contract with the potential for a one- or two-year extension, Gee said. The state marked its first year of expansion this month. Current Medicaid managed-care companies include Aetna Better Health of Louisiana, Amerigroup Louisiana, AmeriHealth Caritas of Louisiana, Louisiana Healthcare Connections and UnitedHealthcare of Louisiana. —Dave Barkholz administration would pony up money this month for the so-called cost-sharing reduction payments came one day after President Donald Trump hinted he may let Affordable Care Act insurance exchanges collapse. During a news briefing, White House spokeswoman Sarah Huckabee Sanders said no determination has been made regarding the payments past July. Currently, the federal government is spending $7 billion a year to lower deductibles and co-pays for about 8.4 million customers. CMS considering value-based pay model for behavioral health The Center for Medicare and Medicaid Innovation last week announced that it would like to design a payment or service delivery model to improve healthcare quality and access for Medicare, Medicaid or Children’s Health Insurance Program beneficiaries with behavioral health conditions. The model may address the needs of beneficiaries battling substance use or mental disorders. It could also target Alzheimer’s disease and related dementias. The Innovation Center will solicit ideas at a meeting on Sept. 8 at CMS headquarters in Baltimore. The announcement comes as the agency has dialed back other value-based payment initiatives. CMS officials, however, have reiterated that clinicians who have invested 2 Modern Healthcare | July 24, 2017 millions in implementing pay models or the quality reporting system under MACRA don’t need to worry about the CMS changing course. “We will be continuing this progress towards value-based care under this new administration,” Dr. Kate Goodrich, chief medical officer at the CMS, said at a bundled-pay summit in June. Freezing implementation of various models was new leadership’s attempt to better understand them and their potential benefits, said Christina Ritter, director of the patient-care models group at the CMS. —Virgil Dickson Corrections The July 17 story on hospital systems (“Health systems seeing returns on risk-based reimbursement,” p. 30) incorrectly listed UPMC as having 14 acute-care hospitals in 2015. The organization reported having 18 acutecare hospitals. last week that it would make July payments that help insurers defray costs for offering low-income customers more affordable plans. News that the n Eleven Cleveland Clinic surgeons and a team of specialists performed the hospital’s first total face transplant in May, replacing 100% of the facial tissue for a 21-year-old woman who suffered from a gunshot wound as a teenager, the health system announced. The 31-hour surgery was the clinic’s third face transplant since it became the first U.S. hospital to perform the operation in December 2008. This year’s surgery included transplantation of the scalp, forehead, upper and lower eyelids, eye sockets, nose, upper cheeks, upper jaw and half of lower jaw, upper teeth, lower teeth, partial facial nerves, facial muscles and skin, according to a news release. n NYU Langone Medical Center, which has been expanding in recent years, is the latest health system in the New York City area to outgrow its name. NYU Langone Health will serve as the new umbrella and logo for NYU Langone’s hospitals and outpatient centers. Name changes are also planned at core facilities, including NYU Lutheran Medical Center in Brooklyn, whose moniker will no longer invoke its religious origins. The move follows similar rebranding efforts at Northwell Health and NYC Health & Hospitals, which have sought to create systemwide identities in periods of rapid change. BECAUSE SOMEDAY I’ll look forward to the night shift. Every someday needs a plan. Together, we’ll help you achieve what matters most. ® -XVWDV\RXPDNHDGLσHUHQFHLQWKHOLYHVRIRWKHUVZHFDQKHOS\RX ÷'HYHORSDORQJWHUPLQYHVWLQJVWUDWHJ\ ÷*HWDQGVWD\RQWUDFNWRZDUG\RXUJRDOV ÷/LYHWKHOLIH\RXZDQWWRGD\DQGLQWRUHWLUHPHQW Talk with Fidelity today about retirement, and together we can help you get there. Fidelity.com/retirementready 866.715.6111 Investing involves risk, including risk of loss. The trademarks and/or service marks appearing above are the property of FMR LLC and may be registered. -PKLSP[`)YVRLYHNL:LY]PJLZ33*4LTILY5@:,:07* :HSLT:[YLL[:TP[OÄLSK90 -4933*(SSYPNO[ZYLZLY]LK EDITORS Aurora Aguilar 312-649-5218 Editor email@example.com Matthew Weinstock Managing Editor 312-397-7585 firstname.lastname@example.org Paul Barr 312-649-5418 Features Editor email@example.com Erica Teichert 212-210-0209 News Editor firstname.lastname@example.org David May 312-649-5451 Assistant Managing Editor email@example.com Patricia Fanelli 312-649-5318 Art Director firstname.lastname@example.org Keith Horist 312-649-5467 Production Manager email@example.com Merrill Goozner Editor Emeritus firstname.lastname@example.org DIGITAL Blair Chavis 312-649-5225 Web Producer email@example.com Fan Fei 312-280-3155 Digital Graphics Producer firstname.lastname@example.org SENIOR REPORTER Harris Meyer 312-649-5343 Chicago email@example.com REPORTERS Rachel Z. Arndt 312-649-5314 Chicago firstname.lastname@example.org Dave Barkholz 313-407-9469 Southern Bureau Chief email@example.com Maria Castellucci 312-397-5502 Chicago firstname.lastname@example.org Virgil Dickson 202-434-4552 Washington Bureau Chief email@example.com Steven Ross Johnson Chicago 312-649-5230 firstname.lastname@example.org Investors wait to see if hospitals held admission volumes in Q2 Investors will be watching beginning this week to see if hospitals maintained admission and outpatient volumes during the second quarter. The start of second-quarter earnings releases will see publicly traded hospitals trying to match fairly tough comparable numbers from last year. There was also one less weekday in this year’s second quarter to provide services. “We’ll be looking for them to reiterate (earnings) guidance for the year,” said Brian Tanquilut, senior vice president of healthcare equity research at investment firm Jefferies & Co. Tanquilut Giant HCA kicks off the hospital earnings season on July 25 followed over the next several days by Tenet Healthcare Corp., Community Health Systems, LifePoint Health and Universal Health Services. Tanquilut said hospitals and their physician service vendors such as Envision Healthcare are coming to grips with “a new normal” of slowing admissions growth. Hospitalizations are rising at 1% to 2% annually today vs. 3% to 4% in the years following the Affordable Care Act and related state Medicaid expansions. Growth in the ranks of the newly insured from the ACA have flattened and nearly full national employment means few new people are getting employer-sponsored insurance to juice volumes, Tanquilut said, adding that dynamic also could begin to affect outpatient volumes. Envision recently throttled back guidance for growth in same-store ambulatory surgery volumes from the mid-to-high single digits to the low-to-mid single digits, Tanquilut said. Despite concerns about a repeal of the ACA, investors in hospital stocks have stuck with them given the ability of management to navigate the choppy waters. The Modern Healthcare Hospital Stock Index, encompassing nine major hospital companies, is essentially flat since the U.S. House of Representatives passed its version of ACA replacement on May 4. —Dave Barkholz Alex Kacik 312-280-3149 Chicago email@example.com Mara Lee 202-434-8462 Washington, D.C. firstname.lastname@example.org Shelby Livingston 312-649-5398 Chicago email@example.com RESEARCH Yonatan Gebre 312-649-5471 Research Associate firstname.lastname@example.org How effective have efforts to combat the opioid epidemic over the past year been in your community? COPY DESK Julie A. Johnson 312-649-5236 Copy Desk Chief email@example.com Ineffective: Rate of overdoses and fatalities is rising 76.2% A bi-weekly poll taking the pulse of the Modern Healthcare audience EDITORIAL SUPPORT Valerie Lapointe News Intern 312-280-3173 firstname.lastname@example.org Somewhat effective: Rate of overdoses and fatalities is flat 22.2% CUSTOMER SERVICE 877-812-1581 email@example.com Effective: Rate of overdoses and fatalities has declined 1.6% Modern Healthcare editorial offices at: 150 N. Michigan Ave., Chicago, Ill. 60601-7620; 685 Third Ave., New York, N.Y. 100174036; 104 East Park Drive, Building 300, Brentwood, Tenn. 37027; 1200 G St. NW, Suite 859, Washington, D.C. 20005; 1975 W. El Camino Real, Ste. 304, Mountain View, Calif. 94040Member of Business Publications Audit of Circulation. 4 Modern Healthcare | July 24, 2017 To participate and see other poll results, go to ModernHealthcare.com/TheMeter SOUTH Ascension taps Memorial Hermann executive to head Texas division Ascension Healthcare picked Craig Cordola to replace Jesus Garza as its senior vice president and the ministry market executive of Ascension Texas effective Sept. 1. Ascension Texas includes Providence Healthcare Network Cordola in Waco and Seton Healthcare Family in Austin, the parent of Dell Children’s Medical Center of Central Texas. Cordola “will be instrumental in leading the ongoing integration of Ascension Texas, working to coordinate strategies and approaches and promote alignment with community physicians and other partners,” Patricia Maryland, CEO of MIDWEST Missouri last in line to create prescription drug-monitoring program Missouri became the final state to create a prescription drug-monitoring program last week when Republican Gov. Eric Greitens signed an executive order aimed at combating a scourge that killed more than 900 residents last year. The announcement surprised lawmakers, many of whom were unaware such a program was under consideration. Almost immediately, Democrats questioned whether the order goes far enough, while some Republicans expressed concerns about privacy. Ascension Healthcare, said in a statement. Cordola is currently senior vice president of 19-hospital Memorial Hermann Health System and president of its west region, where he oversees operations of inpatient and outpatient services at the hospitals and ambulatory sites. He is the latest executive to leave Houstonbased Memorial Hermann, which has been going through staffing reductions and changes in leadership over the past several months. Prior to his current role, Cordola was CEO of the Memorial Hermann-Texas Medical Center campus. —Alex Kacik The monitoring program could be operating within a month, said Randall Williams, director of Missouri’s Department of Health and Senior Services. Greitens signed the order following a news conference at Express Scripts, the St. Louis-based online pharmacy benefits manager that will help provide data analytics as part of the effort. For many years, Missouri has been the lone holdout without a statewide program that tracks prescription drug scripts as part of the effort to combat doctor shopping and prescription opioid addiction. State lawmakers have considered drugmonitoring programs repeatedly but legislation has failed, largely because of privacy concerns about keeping medical information in a database. SOUTH Bon Secours posts lower operating income amid outpatient shift Bon Secours Health System saw its operating income dip in the past nine months as it prepares for increasing outpatient business and population health management returns. The 19-hospital Catholic system based in Marriottsville, Md., posted operating income of $58.1 million on revenue of $2.5 billion for the nine months ended May 31, according to Bon Secours’ latest financial disclosure. That compares with operating income of $81.3 million on revenue of $2.4 billion in the same period last year. Strong investment returns more than covered the operating decline. Bon Secours posted an investment gain of $74.6 million during the period compared with an investment loss of $15.3 million in the year-earlier nine months. This year’s gain helped the not-for-profit system achieve a net surplus of $105.1 million compared with $33.8 million in the year-ago period. Outpatient volume across the system rose 2% to 729,793 visits from 716,410 in the year-ago nine months, while hospital discharges fell slightly to 75,722 from 76,058, the system reported. Bon Secours operates in Florida, Kentucky, Maryland, New York, South Carolina and Virginia. —Dave Barkholz —Associated Press July 24, 2017 | Modern Healthcare 5 Rural health No signs of relief: Rural providers on edge over ACA’s uncertain future By Steven Ross Johnson Roger Knak has made some especially tough decisions in the past few years. Knak, CEO of Fairview (Okla.) Regional Medical Center in the northwest part of the state, had to lay off one of the center’s three staff physicians. The rest of the employees haven’t gotten a raise in three years. But the past month has been especially hard. As Senate GOP lawmakers worked toward passing a bill to replace the Affordable Care Act that would have severely cut back Medicaid and tax subsidies to purchase individual health insurance plans, Fairview’s leadership had been preparing for what they feared to be the inevita- future will just perpetuate the inertia ble—a loss of revenue from cuts to fed- over addressing the financial problems most rural hospitals now face. eral healthcare programs. “It seems to be the same uncertainty Consequently, Fairview Regional had started slashing its non-essential without any clear direction,” Knak said. Republican lawmakers are continuservices, which could put its Medicare ing their effort to get a majority of seneligibility at risk. Fairview, a 25-bed critical-access ators to vote “yes” on the Better Care hospital that serves a patient popula- Reconciliation Act, but remained four tion of roughly 9,000, is just one of the votes shy as of deadline. The Senate’s many rural hospitals in Oklahoma and GOP-backed bill would stop Medicaid across the country that has been oper- expansion and cut $700 billion from the program by 2026. ating on slim margins for some time. President Donald Trump on July 19 “I don’t know what the next cut would be without taking a drastic action to met with GOP senators to try and perrevisit us as being licensed as a medi- suade them to pass the bill, but with cal-surgical hospital and changing our seemingly little effect. Sen. Majority Leader Mitch McConnell licensing to some other form,” Knak said. THE TAKEAWAY (R-Ky.) has called for a vote on a repeal-only measure The latest Republican The GOP-backed that the Congressional Budeffort to replace the ACA effort to repeal the get Office estimated would failed to garner enough Affordable Care lead to 32 million losing vote to pass the Senate, Act may be losing health coverage by 2026. leaving Medicaid prosteam for now. Medicaid covers nearly grams as they are, for now. That’s good news one-quarter of non-elderly But rural healthcare for rural hospitals, adults, including 52 million providers such as Fairview but the sector’s Americans in rural areas. remain concerned that problems are far from resolved. Thousands of previously the partisan wrangling uninsured Americans reover the healthcare law’s 6 Modern Healthcare | July 24, 2017 “I don’t know what the next cut would be without taking a drastic action to revisit us as being licensed as a medical-surgical hospital and changing our licensing to some other form.” Roger Knak CEO Fairview Regional Medical Center ceived coverage thanks to the ACA’s Medicaid expansion, which increased eligibility to cover adults earning up to 138% of the federal poverty level in those states that chose to do so. Medicaid expansion was a real boon for rural hospitals in expansion states since rural residents are more likely to be uninsured. But the ACA’s treatment of Medicaid ended up hurting hospitals in non-expansion states. To help pay for the expansion, policymakers settled on Medicare reimbursement cuts as the primary source, said Andy Fosmire, vice president of rural health for the Oklahoma Hospital Association. Oklahoma never expanded Medicaid after the Supreme Court in 2012 ruled the ACA couldn’t require states to do so, yet hospitals there are still caring for uninsured patients while facing related hits to Medicare reimbursement. Bad-debt burden In addition, since 2013 many hospitals have seen Medicare reduce the share of beneficiaries’ unpaid debt it covers for out-of-pocket costs; the rate dropped from 70% to 65%. But the cut was much deeper for critical-access hospitals, which went from having 100% of that debt covered down to 65% . “Though we strongly, strongly supported the objectives of the ACA to get people insured, unfortunately where some of the ACA has failed has been in rural areas,” said Maggie Elehwany, vice president of government affairs and policy for the National Rural Health Association. Ironically, some of the financial problems rural providers have incurred in recent years are a byproduct of having more insured patients since the ACA was passed, with many buying insurance plans through a healthcare marketplace. Many of those patients who visit rural hospitals have low-premium, high-deductible plans. Rural hospitals that receive patients through their emergency department often hold them long enough to stabilize them before transporting them to a larger facility, but are stuck with the cost of the deductible if a patient can’t cover it. “A patient’s insurance finally kicks in once they are at a larger facility, because they already met their deductible with the rural hospital,” Elehwany said. Such scenarios have led to a 50% increase in the bad debt rural hospitals have taken on since implementation of the ACA, according to the NRHA. In Oklahoma, where four rural hospitals have closed since 2010, 53 of the 65 facilities in rural areas operate with a negative margin every month, Fosmire said. Thirty-seven operate with less than 14 days of operating cash on hand. Nationally, 41% of rural hospitals are operating at a loss, according to a 2016 study by the Chartis Center for Rural Health. Since 2010, more than 80 rural hospitals have closed; the majority were in the 19 states that did not expand Med- “A patient’s insurance finally kicks in once they are at a larger facility, because they already met their deductible with the rural hospital.” Maggie Elehwany Vice president of government affairs and policy National Rural Health Association icaid. Another 670 rural providers are at risk of closing, mostly in non-expansion states that Trump won in last year’s presidential election. Medicare cuts Other federal programs were reduced by the ACA as a result of the expected increase in Medicaid coverage, with Medicare disproportionate-share hospital payments being reduced by more than $1.25 billion in 2015 and by another $1.2 billion last year. “I’ve been laying off employees over the last 12 months,” said David Keith, CEO of McAlester (Okla.) Regional Medical Center, a 171-bed rural hospital. McAlester serves a population of about 200,000 in the southeastern part of the state. For some time now, Keith hasn’t been replacing staffers who quit or were fired. Keith estimated he was on pace to lose 50 of his staffers and see a 30% decline in total revenue if the GOP plan were to pass. A recent Commonwealth Fund study projected the Better Care Reconciliation Act could lead to 919,000 fewer healthcare jobs by the year 2026. That could hit rural communities with a double whammy: fewer jobs and the loss of essential services. McAlester is the only local provider with urology and interventional cardiology lines, and it receives referrals from many smaller, critical-access hospitals. Still, Keith is contemplating cutting those lines to make sure it can still provide primary and emergency care. “If we don’t have those tertiary services, those hospitals are going to have to send their patients 3½ hours away to the big urban centers for their specialty services,” Keith said. Rural hospitals also may feel the squeeze from proposed changes to the federal 340B drug discount program, which could cut another lifeline for some hospitals (See related story, p. 10). The ACA allowed more rural and critical-access hospitals to save about $10,000 a month in drug costs as prescription drug spending skyrocketed, according to a 2015 Marshall University study. But the outlook is not good for the 340B program. Critics say it’s mismanaged and prone to fraud and waste. The CMS this month proposed cutting hospital payments for 340B to 22.5% less than the average sales price for drugs instead of the current rate 6% above the average sales price. Though HHS Secretary Dr. Tom Price said the move was part of Trump’s promise to address rising drug prices, the change might not influence drug companies to drop their prices. Instead, it would just hit hospital budgets, said Brad Gibbens, deputy director of the Center for Rural Health at the University of North Dakota School of Medicine and Health Sciences. Marginal risk While only 20% of the population lives in rural areas, rural residents make up more than half of the population of areas that lack basic medical care, according to the U.S. Health Resources and Services Administration. Rural areas make up 58% of all dental-care shortage areas and 53% of all mental health shortage areas across the country. Gibbens estimated that 54% of North Dakota rural hospitals now have positive financial margins since the state’s Medicaid expansion compared with 46% of providers that still have negative balances. He said providers most at risk of closing were those in counties with populations of just a few thousand residents where the only other healthcare provider is hours away. For providers such as Fairview and McAlester, continuing the current system is unsustainable. “We have such short cash reserves on hand that all it’s going to take is one hiccup with reimbursement and we could be (tapping) into an operating line of credit, which is usually the first step toward bankruptcy,” Fairview’s Knak said. l July 24, 2017 | Modern Healthcare 7 Policy With ACA’s fate unsettled, healthcare groups eye options for killing taxes By Harris Meyer How much would repealing ACA taxes on the healthcare industry cost over 10 years? With GOP efforts to gut the Affordable Care Act on the verge of derailing, $144.7 billion from = $1 billion healthcare industry groups seeking repealing the repeal of several taxes are looking to annual fee on hitch a ride on new legislative trains. health insurance $66 billion from Potential vehicles for tax relief are the premiums. delaying until 2026 bipartisan Food and Drug Administrathe so-called Cadillac tax on tion user-fee legislation, which must high-value employer be enacted by the end of September to health plans. delay massive layoffs at the agency; re$28.5 billion from authorization of the Children’s Health repealing the annual fee $19.6 billion from Insurance Program; the 2018 omnibus on sales by repealing the 2.3% manufacturers budget bill; the Medicare extenders excise tax on sales by and importers of package; and broader tax reform legismedical-device branded drugs. manufacturers and lation. “We’ll let it play out for the next importers. couple of days and see what the Senate Source: Congressional Budget Office/Joint Committee on Taxation does,” said Scott Whitaker, CEO of the Advanced Medical Technology Association; his group has fought for years at least some of the ACA’s healthcare has raised the cost of health insurance to eliminate the 2.3% excise tax on de- industry taxes, which provide revenue by more than $100 billion. That tax, susvice sales. That levy takes effect again for the law’s coverage expansions and pended for two years, resumes Jan. 1. The Congressional Budget Office in 2018 after a two-year delay. “But we’ll Medicare benefit enhancements. Dempivot to any moving vehicle. We’re not ocrats have backed repealing the taxes projects that repealing the annual on medical devices, health insurance fee on health insurance premiums going to give up.” Legislation to stabilize the individu- premiums and high-value employer would reduce federal revenue by al health insurance market is seen as a plans, which they say increase costs for $144.7 billion over 10 years, delaying dark horse option, given the deep divide consumers. The device and Cadillac the Cadillac tax on employer plans between Republicans and Democrats plan taxes were delayed as part of a bi- would cost $66 billion and wiping out the medical-device tax would cost over the future of healthcare. Senate Ma- partisan budget deal at the end of 2015. AdvaMed argues that the medi- $19.6 billion. jority Leader Mitch McConnell (R-Ky.) There is less political support for recently said he would negotiate market cal-device tax has contributed to the repairs with Democrats if his ACA repeal loss of 29,000 device industry jobs na- eliminating the annual fee on sales bill died, and senior Democrats have ex- tionally since 2013 and has slowed the by manufacturers and importers of pressed their willingness to work with pace of product innovation. Some are branded drugs, which the CBO estiskeptical of that claim, with a 2014 Con- mated would reduce federal revenue by him if ACA repeal is dropped. “It’s well within reason that one or gressional Research Service study con- $28.5 billion over 10 years. Both Presimore of these taxes could be included cluding the financial impact of the tax dent Donald Trump and congressional Democrats have been sharply critical in a bipartisan tax reform bill a year on device firms would be negligible. America’s Health Insur- of the pharmaceutical industry’s price from now, but it’s a steep ance Plans sent a letter to increases and may feel drugmakers are road,” said Billy Wynne, a THE TAKEAWAY Senate Finance Commit- less deserving of a tax break. Democratic lobbyist who Attaching provisions Cutting healthcare taxes would leave tee Chairman Orrin Hatch represents healthcare into repeal ACA taxes (R-Utah) last week urg- less budgetary room for other tax changdustry groups. The current to other legislative ing Congress to repeal the es Republicans may value more, such repeal-and-replace effort vehicles presents health insurance premium as reducing corporate income tax rates, “was definitely their best some political tax and the Cadillac plan tax said Sheila Burke, a strategic adviser at chance to get this done.” and bureaucratic as part of broader tax reform. Baker Donelson and chief of staff to forStill, there is bipartisan challenges. AHIP said the premium tax mer Senate Majority Leader Bob Dole. l support for eliminating 8 Modern Healthcare | July 24, 2017 Quality Focus on readmissions not hurting quality By Alex Kacik Hospitals are not so focused on reducing readmissions that they’re neglecting measures that prevent patient mortality, despite a financial incentive to do so, results of a new study indicate. Hospitals have successfully reduced readmission rates for patients with selected conditions over the past several years. But some worried that the up to 3% penalty Medicare assesses for what it deems to be excessive readmissions would lead hospitals to react by doing things like sending patients who should be admitted home from the emergency department or becoming distracted from other clinical improvement efforts. So far, those concerns are unfounded. A new study published July 18 in JAMA analyzed about 5 million Medicare feefor-service hospitalizations between 2008 and 2014 and found that 30-day readmission rates declined for all conditions studied—heart failure, acute myocardial infarction and pneumonia. While 30-day mortality rates slightly increased for heart failure patients over that time, they dropped for acute myocardial patients and remained steady for those with pneumonia. The data suggest that hospitals that lowered their readmission rates also tended to have small reductions in mortality, wrote Dr. Karen Joynt, an assistant professor of medicine at Washington University School of Medicine, in a JAMA editorial. The results are important because of potential unintended consequences of payment incentives, Joynt wrote. The federal HosTHE TAKEAWAY pital Value-based Purchasing proAs hospitals gram levies lower continue to lower penalties, up to readmission 2% of payments, rates and satisfy new value-based based on mortaliincentives, mortality ty and other mearates have also sures, compared dropped, signaling to 3% of Mediimprovement in care inpatient care quality. payments under the federal Hospital Readmissions Reduction Program. “Under these two programs, the financial consequences per excess readmission far exceed the financial consequences per excess death,” Joynt wrote. Readmission rates for the three conditions studied by the researchers declined from 21.5% to 17.8% between 2007 and 2015, the study found. l AHIMA CONVENTION & EXHIBIT We’re rolling out the red carpet for the health information event of the year! utive Exec INSPIRE INNOVATE LEAD Information Governance ahima.org/convention Revenue Cycle Join us in discussions on innovative solutions to lower costs and increase quality in your organization through: 100+ al ation Educ ions s Se s Edu ca Site tional Visi ts ul Insightf ssion e S l ra e Gen rs e k a e Sp Netw Opp orking ortun ities 100+ Exhibitors Informatics Industry Hot Topics R R FO N ISTE REG VENTIO T 21, CON AUGUS 0! RE $10 BEFOD SAVE AN Innovation 949.17 OCTOBER 7–11, 2017 LOS ANGELES, CA #AHIMACON17 July 24, 2017 | Modern Healthcare 9 Providers Hospitals question decision to redistribute $900 million in 340B funds By Virgil Dickson Hospital officials say that a proposed $900 million reduction in payments through the 340B drug discount program will cut into charity care and may not be redistributed fairly by the CMS as intended. The $900 million cut would be enacted by the CMS through a sharp reduction in the rate paid to hospitals in the program, which aims to reduce operating costs for hospitals that see a disproportionate share of low-income patients. The CMS suggested that hospitals in the federal program be paid 22.5% less than the average sales price for drugs, rather than the current rate of 6% above the average sales price. Under the proposed changes, if a drug costs $84,000, the CMS would pay just over $65,000, instead of the current $89,000. The reduction is intended to be budget-neutral, so the CMS said it would $4 million and uses the money to offer redistribute the savings by increasing patients free medications. Approximately 45% of all acute-care Medicare payments to hospitals by hospitals participate in the 340B pro1.4% next year. “You’re taking funds from hospitals gram. The Medicare Payment Advisory that treat the most fragile populations Commission estimates that 2,140 were and spreading it across all hospitals,” relying on the program in 2014, up from said Karen Fisher, chief public policy 583 in 2005. Spending during that period officer at the Association of American jumped from $2.4 billion to $14 billion, according to federal data. Medical Colleges. One of the ongoing criticisms of Providers now use savings from the 340B program to provide ongoing care the 340B program is that hospitals management for conditions ranging with mostly high-income patients from HIV to diabetes, according to have taken advantage of the proTed Slafsky, CEO of 340B Health, an gram, sometimes turning it into a moneymaking opportuassociation of more than nity. MedPAC wrote in 1,300 340B hospitals. THE TAKEAWAY 2015 that “covered entiFor instance, Monroe The CMS wants to ties can purchase 340B County (Ala.) Hospital, reduce 340B payments drugs for all eligible pauses the $1.1 million it gets by $900 million and tients, including patients from the 340B program to redistribute the funds with Medicare or private fund cancer care for paamong all hospitals, insurance, and genertients with no insurance a proposal that was ate revenue if the reimcoverage. The University slammed by advocates bursements for the drugs of Rochester (N.Y.) Medical for 340B hospitals. from payers exceed the Center saves more than 10 Modern Healthcare | July 24, 2017 GETTY IMAGES One of the ongoing criticisms of the 340B program is that hospitals with mostly high-income patients have taken advantage of the program, sometimes turning it into a moneymaking opportunity. discounted prices they pay for the drugs.” Plus, the Affordable Care Act made new categories of hospitals eligible for 340B discounts, including some children’s hospitals, free-standing cancer hospitals and sole community hospitals. A CMS spokesman said the agency wants feedback on ways to ensure the savings return to hospitals that serve uninsured and underinsured patients. The agency is taking comments through Sept. 11. If finalized, the change would become effective Jan. 1, 2018. l Insurers CMS pushing to take a closer look at Medicare Advantage networks By Virgil Dickson The CMS wants more authority to ensure that Medicare Advantage plans aren’t creating narrow networks that ultimately limit a beneficiary’s access to care. The agency last week proposed that Medicare Advantage plans upload the details of their networks to a central federal database for review if they haven’t undergone an entire review in the previous three years. The request must be approved by the White House’s Office of Management and Budget before it can be implemented. “This (proposal) is essential to appropriate and timely compliance monitoring by CMS,” the agency said in a notice. Currently, the CMS can only evaluate a plan’s network when a so-called triggering event occurs, such as when a plan starts operating under Medicare The Government Advantage, it expands coverage offerAccountability Office has ings to new areas or the CMS receives a found in the past that the complaint that a network is inadequate. CMS needed to do a better But even in those instances, somejob ensuring that there times the agency can only conduct a are adequate networks partial network review. The CMS may following evidence that review a select set of specialty types or counties rather than reviewing the some plans had been entire network with all specialty types narrowing beneficiaries’ and counties. choices for providers. The Government Accountability Office has found in the past that the CMS needed to do a better job ensur- of the CMS’ network adequacy requireing that there are adequate networks ments and instructions on how to upfollowing evidence that some plans load their network information. Those had been narrowing beneficiaries’ letters will be sent to plans that have not had an entire network review in the choices for providers. previous 12 months. Every Medicare AdApproximately 304 Medivantage plan that is due THE TAKEAWAY care Advantage plan confor its three-year entire Currently, the tracts will receive the initial network review will reagency has limits review request, the CMS esceive a letter from the on how frequently timated. agency that will specify it can review plans If the CMS finds network which contracts will be for compliance with deficiencies, the insurer examined, the reason for federal standards. may be subject to enforcethe request, a description GETTY IMAGES ment actions, including civil monetary penalties or an enrollment freeze. The CMS in January revealed that a review found 45.1% of Medicare Advantage plans’ provider directories were inaccurate. For that report, the agency examined the online provider directories of 54 Medicare Advantage plans, which represent approximately one-third of all Advantage plans. The review was conducted between February and August 2016. Combined, the plans have a network of 5,832 providers. The inaccuracies ranged from the provider not being at the location listed, wrong phone numbers and the listing incorrectly noting the provider was accepting new patients. Before submitting the request to the OMB, the CMS is collecting comments on the proposal through Aug. 18. Since 2004, the number of beneficiaries enrolled in private Medicare plans has more than tripled from 5.3 million to 17.6 million in 2016, according to the Kaiser Family Foundation. l July 24, 2017 | Modern Healthcare 11 “Competition is and should be the first choice, but in an area where competition becomes irrational and there are limited choices, there has to be a Plan B. If not this, then what?” Alan Levine CEO Mountain States Health Alliance PHIL GALEWITZ/KAISER HEALTH NEWS Providers Two systems seek state-sanctioned end to their healthcare ‘arms race’ By Phil Galewitz, Kaiser Health News JOHNSON CITY, Tenn.—Looking out a fourth-floor window of his hospital system’s headquarters, Alan Levine can see the Appalachian Mountains that have defined this hardscrabble region for generations. What gets the CEO’s attention, though, is neither the steep hills in the distance nor one of his 14 Mountain States Health Alliance hospitals Delivering Systemness Access resources from the Modern Healthcare Custom Media & Medline partnership at ModernHealthcare.com/Systemness 12 Modern Healthcare | July 24, 2017 just across the parking lot. Rather, it’s mont promise to use money saved from a nearby shopping center where his the merger to offer mental health and main rival—Wellmont Health System, addiction treatment services and attack which owns seven hospitals—runs an public health issues such as obesity and urgent-care and outpatient cancer cen- smoking—areas previously neglected by ter. Mountain States offers the same the systems because they don’t increase hospital admissions and bring in big revservices just up the road. “Money is being wasted,” Levine said, enue. In recent years, hospital mergers noting that duplication of medical services is common throughout the north- and acquisitions have created huge eastern Tennessee and southwestern health systems that have used their Virginia markets where Mountain States near-monopoly status to demand high and Wellmont have been in a health- payments from insurers and patients. care “arms race” for years, each trying Studies by health economists have to outduel the other for the doctors and repeatedly found that consolidation means higher prices. services that will bring in Federal antitrust regpatients and money. THE TAKEAWAY ulators have become inThe two not-for-profit creasingly suspicious and systems now desperately Mountain States have even blocked mergers want to end their fight and Health Alliance deemed anti-competitive. merge their 21 hospitals in and Wellmont But the same calculus a 13-county region that’s Health System may not apply here and in among the sickest and both face daunting other poor regions where a poorest in the country. To ﬁnancial challenges. Executives say preponderance of patients do it they are asking percreating a single are poor or uninsured, ofmission to form what is essystem is the best ficials from both Mountain sentially a state-sanctioned option for their States and Wellmont say. monopoly. In exchange, communities. Since 2014, they’ve spent Mountain States and Well- millions of dollars on legal costs, publicity campaigns and lobbying efforts to traverse an obscure process under state law called a Certificate of Public Advantage, or COPA. Their prize: A cooperative agreement that they say will be good both for their survival and for consumers and employers paying the bills. If Tennessee and Virginia regulators sign off, the Federal Trade Commission could not try to block the merger under U.S. antitrust laws. State regulators would supervise the merged company for at least 10 years to ensure the public gains more than it stands to lose from reduced competition. The states could rule on the matter as soon as this month. “The question that needs to be asked is whether tight state oversight of a monopoly is better than failed competition,” said Robert Berenson, a health policy expert at the Urban Institute. Without their proposed merger, Levine said, both hospital systems would likely have to sell to an out-of-market chain, eliminating local control of the facilities and leading to massive layoffs and the closure of hospitals and services. Opponents such as the Federal Trade Commission and insurance giant Anthem are pressing regulators to reject the merger, arguing that less competition will lead to higher health costs and reduced quality of care. The FTC contends a full merger is unnecessary for the hospitals to accomplish the benefits they say one will bring. The FTC even says the hospitals’ market probably would be no worse off if one chain merged with a company outside the area. The systems are making big promises to sell their deal. They say no hospitals would close for at least five years, although some could be converted to other types of health facilities with fewer services. After the merger, all qualified doctors would have staff privileges at any of the hospitals involved so they could treat patients. No single insurer would pay lower rates than others. The new system would spend at least $160 million over 10 years to improve public health, expand medical research and support graduate medical education for work in rural areas. The FTC maintains the systems’ pledges are unreliable and dismissed them as having “significant short- comings, gaps and ambiguities” in a detailed analysis filed with state regulators in January. Levine said it’s the best deal for the community given the factors that handicap hospitals. They include declining populations and lower Medicare reimbursement rates (due to lower average wages). Another is the cost of caring for uninsured people—neither Virginia nor Tennessee expanded Medicaid under the Affordable Care Act, which would have lowered uninsured rates. “Competition is and should be the Opponents such as the FTC and insurance giant Anthem are pressing regulators to reject the merger, arguing that less competition will lead to higher health costs and reduced quality of care. first choice, but in an area where competition becomes irrational and there are limited choices, there has to be a Plan B. If not this, then what?” he added. The federal antitrust exemption made possible through a COPA dates to a 1940s U.S. Supreme Court decision and has only been used about a dozen times to allow hospital mergers, mostly decades ago. There’s little scholarly research on their results. But COPAs could be on the upswing. Last summer, the FTC dropped its challenge to a merger of two West Virginia hospitals after the state adopted a COPA law and permitted the deal. Blue Cross and Blue Shield of Tennessee, the state’s largest health insurer, is not opposing the Mountain States-Wellmont combination, a spokesman said. But its counterpart in Virginia, Anthem, hasn’t been persuaded. “Anthem does not believe that there are any commitments that will protect Southwest Virginia and Northeast Tennessee healthcare consumers from the negative impact of a state-sanctioned monopoly,” the company said in a statement. The proposed COPA has strong support among large employers in the region, including Kingsport, Tenn.based Eastman, a chemical company with $9 billion in annual revenue that employs more than 7,000 people locally. “We get local governance, input and control . . . and that’s a lot better situation for us,” said David Golden, a senior vice president at Eastman. Levine said no place better supports the case for a hospital merger than Wise County in southwestern Virginia, a scenic area with 40,000 people where three hospitals all operate below half their capacity. Mountain States and Wellmont each own a hospital in Norton, the county seat with 4,000 residents. Despite few patients, the hospitals still bear hard-to-cut costs for buildings, equipment and adequate staffing levels, Levine said. On a recent weekday morning, Wellmont’s facility, Lonesome Pine Hospital, looked nearly deserted. No volunteers or staffers were visible inside its main entrance and less than a fifth of its 70 acute-care beds were being used. A five-minute drive away, the 129 beds of Mountain States’ Norton Community Hospital are about a quarter filled. Its maternity unit delivers fewer than five babies a week. The hospital offers hyperbaric oxygen therapy—a treatment that pays well under Medicare’s reimbursement rates—to help diabetics heal their wounds. But it has no endocrinologists to help diabetics manage their disease to avoid such complications. Despite a high rate of heart disease in the community, there’s no cardiologist on staff. Whether a state-approved merger will resolve the incongruities—here or in other poor regions—depends how firmly regulators hold hospitals to their pre-merger commitments. If the merger plan is rejected, Mountain States and Wellmont will resume arch-competitive business practices that do not always put community interests first, said Bart Hove, Wellmont’s CEO. “It’s about competing for the dollar in any way you can and extracting a dollar from your competition,” Hove said. “You do what you can to drive patients to your hospital.” l Kaiser Health News, a not-for-profit health newsroom whose stories appear in news outlets nationwide, is an editorially independent part of the Kaiser Family Foundation. July 24, 2017 | Modern Healthcare 13 Executives Gender pay gap still a stark reality for healthcare executives, employees By Dave Barkholz cours Health System, Borgstrom and Nancy told attendees. Schlichting, recently reTo keep breaking the NASHVILLE—Women hospital extired as CEO of Henry glass ceiling, women ecutives can start closing the pay Ford Health System. executives need to engap with their male counterparts Women are still heavter job interviews preby truly negotiating compensation ily underrepresented in pared to state the value rather than accepting fi rst offers, healthcare C-suites and proposition they bring C-suite leaders said last week at the on boards of directors. to organizations and Modern Healthcare Women Leaders And they earn far less be informed about the in Healthcare conference. than their male countergoing industry salaKathy Lancaster, who has been parts, including in the ries for the responsichief financial officer of giant Kaiser nursing profession. bilities they seek, said Permanente for 12 years, told about Women CEOs of hos“You have to Debra Canales, chief 300 conference attendees that she pitals earn 22% less than know what administrative officer passed on the job over work/famitheir male counterparts, you want.” at giant Providence St. ly-life balance issues. a difference that equates Joseph Health, based “I told them (initially) that I didn’t to about $132,000 in anDebra Canales in Renton, Wash. have the bandwidth,” she said. nual income, said Paula Chief administrative “You have to know Song, program director She had three children at home ofﬁcer Providence what you want,” said of the health policy and at the time and the position cenSt. Joseph Health Canales, who previtralized everything from audits and management department ously worked in mancashflow to putting together bond isat the University of North agement at Macy’s, sues for capital needs Carolina at Pepsi and Hewlett-Packard. at the nation’s largChapel Hill. Teri Fontenot, CEO of Woman’s est integrated health Song led a CEO comsystem with revenue pensation study, which is Hospital in Baton Rouge, La., also was today of about $70 bilstill being vetted for publi- uninterested in her post when it was lion. After Lancaster cation, looking at Internal offered to her 21 years ago. The hospisaid she would not Revenue Service filings tal at the time was dealing with physifrom 1,500 not-for-profit cians disgruntled with management, graduate from interim and she didn’t want to walk into a hospitals to get the data. CFO to the permanent position, manageHer research also hornet’s nest. But Fontenot told her recruiters that ment and the board found that male nurses restructured the job to on average earn $5,000 she would take two weeks to talk with more annually than each of the medical staff individually put some responsibili“I told them female nurses, even to see if the issues could be defused. ties with other fi nance (initially) that I After those conversations, Fonexecutives to give Lanthough they make up didn’t have the caster the time she just 5% of the nurse tenot said, she was confident that bandwidth.” physicians were ready for the new needed for family. workforce. Kathy Lancaster That theme of buildBoth the C-suite and administration and she took the job. The lesson is that women execing a lasting career Chief ﬁnancial ofﬁcer pay disparities speak to utives need to ask for echoed throughout Kaiser Permanente biases that what they want and the conference, which persist in THE TAKEAWAY be authentic because was geared around prohospital culthere’s nothing to fear viding women with tools and contures and the need for more Salary negotiations from boards and emmentoring of women exectacts to advance their careers. are one key to ployers when they are utives, Gloria Goins, chief Other speakers included Venclosing gender pay confident in their own tas CEO Debra Cafaro, Yale New diversity and inclusion ofand hiring gaps. skins, Fontenot said. Haven Health System CEO Marna ficer at 19-hospital Bon Se- 14 Modern Healthcare | July 24, 2017 PHYSICIAN COMPENSATION SURVEY GETTY IMAGES Primary care doc pay rises with demand, but the disparity is still large when compared to other specialties THE TAKEAWAY By Steven Ross Johnson ne of the lingering challenges to recruiting more doctors to pursue a career in primary care over the years has been the large wage differential found between those types of physicians and just about every other kind. And while progress is being made in paying primary-care physicians relatively more, in absolute terms the highest pay still goes to the specialists who have traditionally been paid the most, according to the results of Modern Healthcare’s 24th annual Physician Compensation See 5 years’ worth of physician compensation data Survey. The median income for an at ModernHealthcare.com/physiciancomp orthopedic surgeon was the highest O Demand for primary care is on the upswing, leading to a boost in compensation for primary-care physicians. But the industry has a long way to go before there is compensation parity between primary-care doctors and most other physician specialists. July 24, 2017 | Modern Healthcare 15 PHYSICIAN COMPENSATION SURVEY Key: AMGA Cejka Search Compdata Surveys & Consulting ECG Management Consultants1 Jackson Physician Search The Medicus Firm1 Merritt Hawkins2 Medical Group Management Association Pacific Companies1 Pinnacle Health Group1 Sullivan, Cotter & Associates medical groups (M) Sullivan, Cotter & Associates1 physicians (P) GENERAL SURGERY Compensation range: $441,262 to $312,889 Sullivan-M Sullivan-P AMGA Merritt MGMA ECG Pacific Medicus Compdata Jackson Cejka Pinnacle $441,262 $414,609 $413,047 $411,000 $407,519 $404,081 $398,000 $379,000 $375,400 $367,000 $350,455 $312,889 ANESTHESIOLOGY Compensation range: $447,796 to $354,357 MGMA $447,796 Sullivan-M $428,888 (1.95%) (0.10%) AMGA ECG Pacific Sullivan-P Jackson Medicus Merritt Compdata Pinnacle Cejka (0.21%) 9.10% (1.22%) 0.58% NA 3.08% (5.29%) 3.05% 1.70% NA $415,685 $408,444 $406,000 $403,549 $402,000 $401,000 $376,000 $368,700 $354,357 NA HOSPITALIST % change 2015-16 4.01% 3.21% (0.19%) 8.73% (0.52%) 6.37% 3.11% 2.16% 3.50% NA 6.47% (3.70%) Compensation range: $292,687 to $238,000 Sullivan-M MGMA Sullivan-P AMGA Pacific ECG Medicus Merritt Cejka Pinnacle Compdata Jackson $292,687 $285,102 $284,495 $281,500 $272,000 $269,472 $266,000 $264,000 $258,429 $257,348 $244,200 $238,000 ORTHOPEDIC SURGERY PATHOLOGY Compensation range: $621,113 to $465,556 Compensation range: $375,473 to $253,100 Sullivan-M MGMA Sullivan-P AMGA Medicus Merritt Pacific ECG Compdata Jackson Pinnacle Cejka $621,113 $592,019 $591,322 $581,092 $581,000 $579,000 $579,000 $574,910 $534,700 $526,000 $468,772 $465,556 % change 2015-16 % change 2015-16 5.92% 2.66% 5.45% (0.17%) 4.68% 11.13% 2.84% 5.63% 4.70% NA 7.76% 5.41% Sullivan-M AMGA ECG MGMA Sullivan-P Pinnacle Merritt Compdata Cejka Jackson Medicus Pacific $375,473 $373,794 $363,003 $354,814 $343,048 $326,301 $290,000 $253,100 NA NA NA NA CARDIOLOGY (INVASIVE) CARDIOLOGY (NON-INVASIVE) Compensation range: $673,900 to $431,804 Compensation range: $489,459 to $391,624 Compdata $673,900 Sullivan-M $614,714 Sullivan-P $605,844 AMGA MGMA Merritt Pacific ECG Medicus Pinnacle Cejka Jackson % change 2015-16 12.62% 2.85% 2.85% $598,675 2.49% $588,638 3.88% $563,000 3.30% $554,000 2.40% $541,072 8.80% $454,000 (4.62%) $431,804 (14.28%) NA NA NA NA INTENSIVIST % change 2015-16 5.57% 2.28% 7.62% 2.23% 1.12% 5.07% 2.31% 6.02% 24.02% 3.74% 9.21% NA Compensation range: $400,232 to $273,400 Sullivan-M AMGA ECG Pacific Sullivan-P MGMA Merritt Pinnacle Compdata Cejka Jackson Medicus $400,232 $400,000 $399,791 $391,000 $386,420 $381,000 $380,000 $303,771 $273,400 NA NA NA 5.60% 2.79% 7.70% 3.58% 6.54% 54.65% 6.62% (8.06%) NA NA NA NA Compensation range: $259,862 to $183,600 Sullivan-M Sullivan-P ECG AMGA Merritt Medicus MGMA Pacific Compdata Jackson Cejka Pinnacle 2.17% 0.08% 8.40% 6.54% 3.05% (4.31%) 8.57% (4.82%) 1.79% NA NA NA Compensation range: $275,752 to $211,364 Sullivan-M Sullivan-P AMGA Merritt Medicus ECG Compdata MGMA Pacific Jackson Pinnacle Cejka $275,752 $262,640 $259,765 $257,000 $255,000 $252,750 $251,000 $247,954 $246,000 $237,000 $233,034 $211,364 % change 2015-16 4.15% 3.29% 4.08% 8.44% (1.16%) 5.15% 1.13% 0.26% 1.65% NA 3.35% (6.93%) PLASTIC SURGERY % change 2015-16 $259,862 0.67% $244,178 0.00% $242,084 9.90% $241,116 2.49% $240,000 7.14% $229,000 2.69% $228,068 (1.49%) $227,000 1.34% $215,000 (2.80%) $207,670 NA $202,500 (2.41%) $183,600 (13.7%) Note: Figures represent average total annual cash compensation, which includes salary and bonuses. Percentages rounded. 1 Company provided preliminary data. 2Company data tracks average starting salaries for physicians, rather than average incomes. 16 Modern Healthcare | July 24, 2017 $489,459 5.78% $485,945 0.47% $470,610 3.99% $462,550 4.64% $461,000 4.30% $449,607 9.30% $436,000 NA $428,000 (13.18%) $424,000 (12.32%) $391,624 (6.28%) NA NA NA NA INTERNAL MEDICINE % change 2015-16 PEDIATRICS % change 2015-16 Sullivan-M AMGA MGMA Sullivan-P Pacific ECG Jackson Merritt Compdata Pinnacle Cejka Medicus % change 2015-16 Compensation range: $550,840 to $335,117 Sullivan-M AMGA Sullivan-P MGMA ECG Pacific Compdata Merritt Pinnacle Cejka Jackson Medicus $550,840 $528,283 $510,909 $509,561 $493,445 $398,000 $380,900 $350,000 $335,117 NA NA NA % change 2015-16 3.10% 3.58% 0.51% 2.68% 7.80% (1.00%) 14.49% 2.34% 0.03% NA NA NA DERMATOLOGY Compensation Range: $504,746 to $203,396 ECG Sullivan-M Pacific Sullivan-P AMGA Compdata MGMA Merritt Jackson Cejka Pinnacle Medicus % change 2015-16 $504,746 8.90% $503,510 3.11% $469,000 1.52% $467,487 2.87% $457,118 5.20% $437,700 (11.34%) $422,884 (7.55%) $421,000 (5.18%) $403,000 NA $300,000 0.00% $203,396 (35.51%) NA NA NEONATOLOGY Compensation Range: $356,000 to $245,000 Pacific Sullivan-M AMGA Merritt MGMA Compdata Sullivan-P ECG Pinnacle Cejka Jackson Medicus $356,000 $348,763 $337,388 $336,000 $322,758 $315,300 $314,354 $305,478 $245,000 NA NA NA Sullivan-M MGMA AMGA Merritt Pacific ECG Sullivan-P Medicus Jackson Compdata Pinnacle Cejka $272,374 $267,766 $266,540 $263,000 $262,000 $256,636 $252,976 $248,000 $245,250 $239,700 $235,182 $223,400 FAMILY PRACTICE Compensation Range: $372,365 to $279,440 Compensation Range: $264,123 to $210,614 Pinnacle Sullivan-M Merritt AMGA Pacific Sullivan-P Compdata Medicus MGMA Jackson ECG Cejka $372,365 $353,985 $349,000 $348,178 $340,000 $338,058 $337,100 $337,000 $334,065 $323,000 $318,277 $279,440 % change 2015-16 21.35% 2.90% 14.80% (2.00%) 0.89% 6.78% 8.43% 14.24% 7.12% NA 5.33% 6.10% NEUROLOGY % change 2015-16 2.30% 7.77% 10.69% 7.69% (0.17%) 9.29% 4.27% 7.26% 10.73% NA NA NA PSYCHIATRY Compensation Range: $272,374 to $223,400 EMERGENCY MEDICINE % change 2015-16 4.31% 4.78% 4.55% 5.20% 1.16% 4.20% 5.61% 4.20% NA (2.80%) 0.70% 7.66% Compensation Range: $314,500 to $249,786 % change 2015-16 Compdata Sullivan-M MGMA Merritt AMGA ECG Sullivan-P Medicus Pacific Cejka $314,500 $307,584 $305,989 $305,000 $295,211 $291,861 $291,247 $287,000 $286,000 $278,046 7.26% 4.79% 6.99% 7.02% 3.67% 5.77% 5.24% 0.70% 5.54% 12.34% Jackson Pinnacle $268,000 NA $249,786 (13.32%) Sullivan-M Sullivan-P AMGA ECG MGMA Pacific Merritt Medicus Compdata Jackson Cejka Pinnacle $264,123 $255,534 $242,210 $242,000 $234,110 $233,000 $231,000 $229,000 $228,500 $223,250 $210,667 $210,614 0.47% 1.54% 3.44% 2.76% 2.67% 16.36% 3.35% 7.42% (1.34%) (0.47%) NA (7.51%) Compensation Range: $493,900 to $320,265 Sullivan-M Sullivan-P AMGA MGMA ECG Merritt Pacific Compdata Medicus Jackson Pinnacle Cejka ECG Sullivan-M AMGA MGMA Sullivan-P Pacific Medicus Merritt Compdata Jackson Pinnacle Cejka % change 2015-16 $371,803 5.30% $351,222 5.53% $342,700 2.84% $340,691 3.02% $337,050 5.57% $335,000 4.36% $334,000 3.09% $330,400 4.66% $320,000 7.74% $301,333 NA $274,670 (15.75%) $257,667 (1.1%) Compensation Range: $529,244 to $313,628 4.95% 3.16% 0.86% 4.62% 7.46% 0.80% 8.44% (1.22%) (3.23%) NA NA NA $531,696 $527,000 $526,685 $519,124 $505,582 $497,433 $493,194 $492,000 $443,000 $424,800 $419,333 $394,023 ONCOLOGY (INCL. HEMATOLOGY) RADIOLOGY $544,400 $541,123 $525,000 $523,121 $515,999 $502,996 $488,000 $485,000 $350,000 NA NA NA MGMA Pacific Sullivan-M AMGA ECG Cejka Sullivan-P Merritt Medicus Compdata Jackson Pinnacle % change 2015-16 Compensation Range: $371,803 to $257,667 Compensation Range: $544,400 to $350,000 Compdata Sullivan-M AMGA MGMA Sullivan-P ECG Merritt Pacific Pinnacle Cejka Jackson Medicus 6.40% 5.69% 3.20% 4.73% 1.87% 1.75% 2.67% 1.33% 0.93% NA (1.10%) (2.83%) Compensation Range: $531,696 to $394,023 OBSTETRICS/GYNECOLOGY RADIATION ONCOLOGY % change 2015-16 GASTROENTEROLOGY % change 2015-16 Compdata Merritt Sullivan-M MGMA AMGA Pacific ECG Medicus Sullivan-P Cejka Jackson Pinnacle % change 2015-16 $493,900 4.02% $471,000 7.78% $451,890 4.39% $448,000 1.01% $444,766 6.73% $434,000 1.64% $427,344 9.83% $425,000 3.91% $408,923 7.00% $342,500 (10.71%) $336,330 NA $320,265 (18.18%) UROLOGY $529,244 $515,670 $503,225 $489,090 $478,788 $476,000 $470,000 $436,000 $429,600 $386,000 $313,628 NA % change 2015-16 7.41% 0.46% 2.62% 0.61% 1.28% (1.45%) 9.05% (8.21%) 3.47% NA (1.02%) NA Compensation Range: $476,191 to $341,358 Sullivan-M ECG Pacific Merritt AMGA % change 2015-16 $476,191 $469,514 $462,000 $460,000 $453,680 2.87% 8.91% (0.65%) (2.34%) 2.68% Sullivan-P $452,232 2.91% MGMA Medicus Jackson Compdata Pinnacle Cejka (0.97%) 3.03% NA 4.30% (9.73%) NA $447,916 $442,000 $425,000 $390,500 $341,358 NA Source: Modern Healthcare’s 2017 Physician Compensation Survey July 24, 2017 | Modern Healthcare 17 PHYSICIAN COMPENSATION SURVEY After borrowing among 23 medical specialties in 2016 at Primary-care specialties such as in$579,000, yet the median income for a ternal medicine, family medicine, emerheavily to pay for pediatrician was about 40% of that figgency medicine, pediatrics, hospitalist medical school, ure at $228,530. care and obstetrics and gynecology all non-primary care Following orthopedic surgeons on the remained at the bottom end of the physipay list were invasive cardiologists with cian pay scale despite most seeing steady specialties often an annual median income of $575,810, rises in compensation from 2015 to 2016. remain a more radiation oncologists at $515,999, gas“I anticipate that the gap between priattractive choice. troenterologists at $495,300, and radiolmary care and some of the procedural ogists with a median income of $477,390. specialties will continue, but I do see After borrowing heavily to pay for some acceleration of compensation for medical school, medical students often primary care,” Halverson said. find non-primary-care specialties to be a more attractive Indeed, among the medical specialties that saw the choice. “These people come out of training with massive biggest average percentage gains in compensation over loans and debt to pay back, and so there’s still an incentive that period were emergency medicine, which increased to specialize in more lucrative specialties from a compenby 7.9%; neonatology, which increased by 6.9%; and hossation perspective,” said Josh Halverson, a principal with pitalist care, where annual pay rose by an average of 6.1% healthcare consulting firm ECG Management Consultants. from 2015 to 2016. About the survey firms AMGA The Alexandria, Va.-based consultancy and professional membership organization, which represents large multispecialty medical groups, surveyed 102,261 physicians and 269 organizations representing 140 positions/specialties. The survey was conducted from January to May 2017. The full report costs $1,000. For more information, call Christopher Gibbs at 703-838-0033, ext. 362. Cejka Search The St. Louis-based physician and executive search ﬁrm surveyed 81 physicians and 56 organizations representing 82 positions/specialties. The survey was conducted from Jan. 1 to Dec. 31, 2016. For more information, call Tiffanie Lee at 314-236-4542. Compdata Surveys & Consulting The Olathe, Kan.-based data services and consulting ﬁrm surveyed 9,580 physicians and 299 organizations representing 100 positions/specialties. The survey was conducted from July to August 2016. The full report costs $699. For more information, call the ﬁrm’s customer service department at 800-300-9570. ECG Management Consultants The Seattle-based healthcare management consulting ﬁrm surveyed 40,000 physicians and 130 organizations representing 150 positions/specialties. The survey was conducted in January 2017 and is based on 2016 data. For more information, call Maria Hayduk at 314-726-2323. Data submitted are preliminary. Jackson Physician Search The Alpharetta, Ga.-based physician stafﬁng ﬁrm surveyed 364 physicians and 200 organizations representing 38 positions/specialties. The survey was conducted from January through April 2017. Data represent permanent placements only. Full survey results are available free of charge. For more information, call Ashley Bowlin at 770-643-5557. The Medicus Firm The Dallas-based physician search ﬁrm surveyed 2,351 physicians and one organization representing 24 positions/ specialties. The survey was conducted in May 2017. Full survey results are available free of charge. For more information, call Steve Marsh at 214-3829925. Data submitted are preliminary. 18 Modern Healthcare | July 24, 2017 Merritt Hawkins The Dallas-based physician search ﬁrm surveyed 3,287 physicians and 1,056 organizations representing 20 positions/specialties. The survey was conducted from April 2016 to March 2017. Its ﬁgures represent starting salaries rather than overall physician compensation. Full survey results are available free of charge. For more information, call Samantha Avila at 800-876-0500. Medical Group Management Association The Englewood, Colo.-based consulting and professional membership organization surveyed 121,709 physicians and 6,644 organizations representing 213 positions/specialties. The survey was conducted January to February 2017. For more information, call the MGMA at 877-275-6462, ext. 1801. Pacific Companies The Aliso Viejo, Calif.-based healthcare stafﬁng ﬁrm surveyed 2,684 physicians and 269 organizations representing 20 positions/specialties. The survey was conducted from December 2016 through March 2017. For more information, call Chris Kahl at 800-741-7629. Data submitted are preliminary. Pinnacle Health Group The Atlanta-based physician recruitment ﬁrm surveyed 114 physicians and 160 organizations representing 51 positions/ specialties. The survey was conducted in June 2017. Full survey results are available free of charge. For more information, call Ashlee Dennis at 800-492-7771. Data submitted are preliminary. Sullivan, Cotter & Associates The national independent consulting ﬁrm submitted results for two surveys this year—one from medical groups and another from a broader sample of physicians and organizations. The medical group survey included over 110,000 providers and 269 organizations representing 177 positions/ specialties. The physician survey included nearly 135,000 physicians and 579 organizations representing 226 positions/ specialties. Both surveys were conducted from Jan. 1 to April 28, 2017. For more information, call 888-739-7039 or email firstname.lastname@example.org. Submitted medical group survey data are published, while the submitted physician survey data are preliminary. president at Merritt Hawkins. “Regardless of how it looks, Experts say the year-over-year increases in compensawe are fairly confident that quality is going to be a major tion have been a direct result of more competition among driver of our healthcare system. The debate now is about hospitals and other providers to hire professionals within by how much.” certain medical specialties. And among the most highly Efforts to tie doctor pay to quality have been underway sought after specialties are those within the primary-care on a wider scale since the CMS last October issued its final field, most of which saw a marked rise in compensation rule for implementing the Medicare Access and CHIP Rethe past year. authorization Act, which included provisions that replaced “The biggest movement that we’ve seen over the past the sustainable growth-rate formula for 18 months in terms of rapidly shiftdetermining how much doctors got paid ing compensation are within primary under Medicare. care,” said Steve Look, executive vice Currently doctors Some see the performance-based president with the healthcare recruitin primary care reimbursement models created under ing firm Medicus. specialties MACRA as already playing a role in Currently doctors in primary-care make up roughly the changes seen in physician pay for specialties make up roughly 48% of the primary-care specialties. It’s a role that entire physician workforce in the U.S., 48% of the they see will only increase in the comaccording to the Kaiser Family Foundaentire physician ing years and be a larger determinant in tion. An additional 8,500 primary-care workforce in the how much physicians get paid, which practitioners would be needed to procould reduce pay for non-primary-care vide care for the more than 65 milU.S., according to specialties. lion Americans currently living in the the Kaiser Family “As MACRA becomes more firmly in more than 6,500 areas where there is Foundation. place, and we begin to see quality paless than one provider for every 3,500 rameters outstrip volume, then we do people. think that compensation will decline Growing demand has also been seen some,” said Dr. C. Michael Valentine, within psychiatry, where salaries rose vice president of the American College of Cardiology by an average of 3.3%. The field was the second-most-reand an interventional cardiologist with Virginia-based cruited physician specialty behind family medicine Centra Medical Group, part of Centra Health. “We don’t from April 2015 through March 2016, according to a 2016 expect it to be a major drop, and we don’t think it will be review of recruiting incentives by Merritt Hawkins. career-changing for anyone. We think this is just a natuPopulation health influence ral progression in the healthcare system.” The greater role primary-care physicians will likely The increase seen in the need for many primary-care play within such a financial model will keep demand specialties in recent years also reflects the move by hoshigh and may induce hospitals to continue or increase inpitals to pay greater attention to population health mancentives to recruit such clinicians. Some of those efforts agement, which leads to more emphasis on quality and have included signing bonuses of $5,000 to $15,000, loan wellness. And as part of the change from volume to value forgiveness and relocation expenses for doctors and their in care delivery comes the increased use of reimbursement entire families. models that rely more on quality metrics. Medicus’ Look said some of the hospitals and health “As we get into this new era of population health and systems that are most successful at attracting physichronic disease management, we look at those physicians can be found in large metropolitan areas where cians that are maybe spending more time to manage that they not only have the advantage of being located in a chronic population,” said Travis Singleton, senior vice large urban environment, but tend to pay above-average starting salaries and higher bonuses than more-rural providers. How we did it Loan forgiveness or assistance could be important to steering more physicians into primary care. At least 79% of Eleven firms participated in Modern Healthcare’s medical school graduates in 2015 had school debt totaling 24th annual Physician Compensation Survey. Seven more than $100,000, with a median debt amount of more of the surveys were conducted completely in 2017, than $180,000, according to the Association of American including two separate surveys by the same firm. Medical Colleges. Two surveys were spread over 2016 and 2017. And Dr. Richards Olds, president of St. Georges University, a three surveys collected data solely in 2016. The medical school based in the West Indies, suggested medsurveys represent a combined 9,900 healthcare ical schools offer more in the way of scholarships for stuorganizations and more than 521,000 physicians. dents who promise to work in primary care in underserved Average compensation figures include only areas upon graduation as one of the best ways to even the salaries and bonuses, not stock options, insurance playing field between large and smaller providers for reand other benefits. cruiting primary-care physicians. l July 24, 2017 | Modern Healthcare 19 Cooper Medical School of Rowan University has a program called Week on the Wards, when students during their first and second years venture into the hospital environment and interact with physicians and patients. Medical schools aim to make curriculums mirror the real world By Maria Castellucci r. John Raymond, CEO of the Medical College of Wisconsin in Milwaukee, thinks there is a 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 pro- D 20 Modern Healthcare | July 24, 2017 ductivity. “These pressures can dehumanize medicine,” he said. Raymond isn’t the only one concerned that the growing burdens doctors face are harming their crucial relationships with patients. Leaders from six other medical schools have joined the Medical College of Wisconsin to form a network aimed at addressing this conundrum well before doctors begin their careers. Through the National Transformation Network, which officially launched in June, the schools will work together to develop a curriculum focused on three components: char- THE TAKEAWAY Medical schools are trying to build out programs that go beyond traditional clinical and scientiﬁc learning, including emphasizing such things as compassion and population health. acter, competence and caring. The network was established with the help of a $37.8 million grant from the Kern Family Foundation, a not-forprofit 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 and Vanderbilt University School of Medicine. 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 education curriculum. He said he Students at Penn and mindset to care for the nation’s vulnerable or sick. College of hears from skeptical professors who State The lack of focus on these qualities during medical school Medicine serve as say change isn’t necessary. But Gon- patient navigators ultimately hinders efforts in the healthcare industry overall zalo argues that it is. When he was beginning their first to provide care that is more patient-centered. “We need to in medical school roughly 15 years year. They work onemake (medical school) feel more real and more directly reon-one with patients ago, less than eight hours of his ed- in various clinical lated to the patient,” Raymond said. ucation was dedicated to working settings to help How exactly the National Transformation Network will with electronic health records and guide them through change curriculums is still being worked out, but there informatics. And, he admitted, he the complex will be a strong emphasis on ensuring students appreciate healthcare system. only truly understood the difference and understand the importance of compassion to patients, between Medicare and Medicaid afRaymond said. This will likely take the form of more oneter nearly 10 years of schooling. “We on-one time with patients and an emphasis on personal are not preparing physicians,” he said. wellness and burnout, which plagues a majority of physiPenn State is one of 32 schools that are part cians today. of the AMA’s Accelerating Change in Medical The transition won’t be without challenges Education Consortium, which launched in since it requires not only a change in curric- A big challenge 2013. The AMA has given about $12.5 million ulum but a change in mindset. “You really in grants to the schools to fund their innovacan’t change students without changing the is that teachers faculty and curriculum and even the culture, are still learning tive approaches to curriculum reform. The participating schools also embrace an which is probably going to be the hardest and adapting to evolving discipline dubbed health systems part,” Raymond said. changes in the science by the AMA. The association recently The network isn’t the only major collabreleased a textbook aimed at helping schools orative aiming to revamp medical edu- industry. that are not part of the consortium adapt the cation. Medical schools across the nation new curriculum, which focuses on aspects are re-evaluating how they prepare future of healthcare delivery not currently addressed in-depth doctors for their careers. Yet the leaders behind this push during traditional medical education. Topics range from readily admit change isn’t easy. Because there is so much population health management, healthcare financing and upheaval in healthcare—whether it’s new payment modreform, to behavioral and social determinants of health. els, increased use of technology, the push to consumerism, The approach is intended to be applied along with the and more—faculty members have a hard time keeping up scientific and clinical competencies already established in with it all and finding the best ways to teach new concepts. medical education, said Dr. Susan Skochelak, group vice At the same time, traditional mentalities on what medical president for medical education at the AMA. She co-aueducation should look like can be tough to break. thored the textbook with Gonzalo and four others. “There is this feeling of, boy you’re impeding on my terThe textbook can help medical schools that want to reritory,” said Dr. Jed Gonzalo, associate dean for health vamp curriculum but don’t know how or where to start, systems education at Penn State College of Medicine, reSkochelak said. A big challenge is that teachers are still garding how some faculty react to reforms in medical edlearning and adapting to changes in the industry. This ucation. Gonzalo has been working with the American learning curve can make it hard to know the best ways to Medical Association to drive more innovation in medical July 24, 2017 | Modern Healthcare 21 The Cooper Sprouts’ Community Garden, run by students at Cooper Medical School of Rowan University and Camden, N.J., residents, offers fresh produce at no cost. Students are required to complete 40 hours of community volunteering per year. teach students new skills, she said. The Brody School of Medicine at East Carolina University, one of the schools in the AMA consortium, used its $1 million, five-year grant to prepare its faculty for curriculum changes before they were adopted. In 2013, the school implemented an education program for faculty called the Teachers of Quality Academy. The faculty participated in group and online courses that addressed quality improvement strategies, population health, interprofessional team work and leadership. “We recognize that healthcare is changing and we need all of our faculty to understand the basics of health system science to lead change,” said Dr. Luan Lawson, assistant dean of curriculum, assessment and clinical academic affairs at Brody. The movement doesn’t stop with large, multi-school collaborations. Medical schools new to the scene have also adopted innovative curriculum. These schools have the advantages of a fresh perspective and the opportunity to learn from their more established peers. These efforts by East Carolina, Penn State and the Medical College of Wisconsin are no longer unique. “There is no school that hasn’t change their curriculum substantially,” said Alison Whelan, chief medical education officer of the Association of American Medical Colleges, which represents all 147 accredited U.S. medical schools. Take the Cooper Medical School of Rowan University in Camden, N.J., for example. The school, which opened in the summer of 2012, researched and reached out to the most forward-thinking medical schools across the country to establish a curriculum they hope will prepare its students for the future of patient care, said Dr. Annette Reboli, interim dean of the school. During their first two years at Cooper, students only have about six hours of lectures a week. The rest of their time is spent in small groups where they work together to solve a fictitious patient case meant to mimic a real-life scenario. 22 Modern Healthcare | July 24, 2017 The students not only work together to determine the diagnosis and best treatment for the patient, but social determinants of health are also addressed. A case might feature an uninsured diabetic patient with poor access to transportation. “The students learn how to navigate the healthcare system,” Reboli said. Teamwork is embedded throughout the curriculum. As part of the ambulatory clerkship program, medical students work with the pharmaceutical, nursing and social work students to run a clinic that’s within Cooper University Health Care, the health system affiliate of the school. Reboli said the Cooper Medical faculty felt it was important for medical students to be exposed early on to different healthcare professionals and their roles because that’s where the industry is headed. Doctors increasingly find themselves working in teams with nurses, pharmacists and others to achieve coordinated care, yet that experience is sorely missing in traditional medical education. The school also emphasizes the importance of population health by requiring each student to complete 40 hours of community service a year. This can take many forms, Reboli said. For example, one student coached a soccer team while another helped teach English as a second language. The experiences allow students to understand their patients and the community of Camden better, Reboli said. At the Kaiser Permanente Medical School, 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.” l Behavioral Health: The Key to Successful Population Health Management Healthcare leaders assess the behavioral health crisis and discuss how better visibility of patient behavior equals better clinical outcomes, loyalty and efficiency. Networking Breakfast | Panel Discussion | Q&A Friday, August 25, 2017 7:30 AM — 9:30 AM Marriott Vanderbilt Nashville PANELISTS: Joey A. Jacobs Chairman & CEO Acadia Healthcare Inc. Dr. Stephen Loyd Assistant Commissioner, Tennessee Department of Mental Health and Substance Abuse Services, Division of Substance Abuse Services Jameson K. Norton CEO, Vanderbilt Psychiatric Hospital (VPH) and Clinics MODERATOR: Dr. Lynn Simon President, Clinical Services & Chief Quality Officer Community Health Systems Merrill Goozner Editor Emeritus Modern Healthcare #MHBRIEFING REGISTRATION NOW OPEN Reserve Your Seat Today. Single Tickets and Company Tables of 10 Available. ModernHealthcare.com/NashvilleBriefing Supporting Sponsor: Eight reasons why the GOP healthcare bill ultimately failed MERRILL GOOZNER Editor Emeritus A sked about his Bay of Pigs fiasco, President John F. Kennedy responded, “Victory has 100 fathers and defeat is an orphan.” The opposite is true for the latest iteration of the GOP healthcare bill, which would have eliminated insurance coverage for more than 20 million people. Here are the eight major reasons why the effort to replace Obamacare has so far come up empty: 1. According to a Pew Research poll conducted earlier this year, 60% of Americans, including 52% of Republicans earning below $30,000 a year, believe the government is responsible for ensuring all Americans have health insurance. Just 38% say it is not the government’s responsibility. 2. The GOP leadership pursued an ideologically driven agenda to dramatically cut back Medicaid, not just eliminate its expansion. The program now covers 74 million Americans and is vital to rural and small town America-the heart of the GOP base. For at least one Republican moderate, and no doubt several more before a vote took place, that was simply unacceptable. 3. The GOP claims that their plan offered an affordable alternative for people without employer-based coverage simply wasn’t credible. It raised rates on older workers and the “skinny” plans enabled by the Cruz amendment wouldn’t provide meaningful coverage. 4. Moderates and conservatives in the GOP couldn’t unite on a conservative alternative to Obamacare because Obamacare is the conservative alternative to single-payer health insurance, the long-time goal of many 24 Modern Healthcare | July 24, 2017 Democrats. It relied on subsidized private insurance to achieve universal coverage and used Medicaid as it was originally intended-as a backstop for the working poor who cannot afford even minimal out-of-pocket costs. 5. The plan’s architects ignored how it would harm the healthcare delivery system. Both the House and Senate bills would have led to more emergency room care, more uncompensated care, and more cost-shifting to employer-based plans. Passage would have undermined all efforts at controlling healthcare costs other than stinting on care. 6. Every segment of the healthcare industry other than the drug and device sectors were highly vocal opponents of the bill. When considering legislation that affects 18% of the U.S. economy, it’s never wise to ignore the concerns of the organizations and the 15 million workers who make up the sector. 7. Believing their own lies about how the Affordable Care Act was crafted, the GOP House and Senate leadership pounded out legislative drafts in secret without the normal legislative give-andtake that would identify flaws and hammer out compromises. The Republicans didn’t need Democratic votes. But they badly needed Democratic ideas. 8. The bills as drafted represented a fundamental shift in GOP philosophy going back more than half a century. The GOP, prior to the tea party arriving on the scene, had always backed expanding health coverage, not cutting it back. President Donald Trump will go down in history as the first sitting U.S. president to propose a major cutback in health insurance coverage. But the campaign to repeal Obamacare didn’t end with the defection of two more GOP senators; the current Senate and House leaders have too much political capital invested in getting something passed that they can call “repeal and replace.” But it’s now clear they will never craft something that can please both their conservative and moderate members. That means they’ll need Democratic votes to get something passed. They have several cudgels to line up those votes. Obamacare backers recognize there are flaws in the insurance exchanges. There will be votes later this year to raise the debt ceiling, reauthorize the Children’s Health Insurance Program and pass a budget, without which the government will shut down. Each vote will present the party that controls the White House and Congress with an opportunity to craft major changes to the nation’s healthcare financing and delivery systems. This drama is far from over. l Amid ongoing drama over healthcare reform, there’s another solution hiding in plain sight By Dr. Claudia Fegan N ow that the Senate GOP’s Better Care Reconciliation Act has crashed and burned, and efforts to repeal the Affordable Care Act appear to have stalled, it’s time to consider another plan: improved Medicare for all. The American public has demonstrated they want real solutions, not empty promises. Voters are demanding change in both town halls and the halls of Congress. The same day the Congressional Budget Office released its initial analysis of the BCRA, the Annals of Internal Medicine published a study called “The Relationship of Health Insurance and Mortality: Is Lack of Insurance Deadly?” Based on the study’s findings, the answer is yes. A review of several other studies shows that each year, for every 769 Americans without health insurance, one will die. Repealing the ACA would mean 32 million Americans losing insurance, according to the CBO, resulting in 42,000 unnecessary deaths. Combined with the 28 million who are currently uninsured, we would see a staggering 78,000 Americans dying prematurely because they are uninsured. That’s more than will die of influenza and pneumonia (57,000) or kidney disease (50,000) each year. Lack of access to healthcare is our nation’s eighth-leading killer, a crisis our leaders can no longer ignore. During the 2016 campaign, Donald Trump promised voters healthcare reform that would provide more coverage, better benefits and lower costs. None of the proposed GOP bills achieves these goals, and they are widely unpopular among both Democrats and Republicans. Of course the ACA also has come up short in delivering lower costs. And despite the major increases in coverage, about 9% of Americans are still uninsured. So the question remains: Have our Dr. Claudia Fegan is national coordinator and past president of Physicians for a National Health Program. She’s also chief medical officer for the Cook County Health and Hospital System in Chicago. elected officials simply run out of ideas? Thankfully, not all of them. Rep. John Conyers (D-Mich.) has introduced a bill called the Expanded and Improved Medicare for All Act, a single-payer plan that would provide immediate, comprehensive coverage to all Americans. The bill has gained 115 co-sponsors, with a majority of House Democrats signing on. How does it compare to President Trump’s healthcare promises? l More coverage. Like enrollment in Medicare at age 65, all Americans would automatically join a national health plan, regardless of age, employment, income or marital status. Medical decisions will be made by patients and providers rather than insurance companies. l Better benefits. Medicare for all will cover all medically necessary services, including dental, vision and long-term care. Patients can visit the doctors and hospitals of their choice. l Lower costs. By eliminating insurance middlemen and their exorbitant executive salaries, advertising and profits, Medicare for all would yield about $500 billion annually in administrative savings. The program would be funded by payroll taxes that will be fully offset by the virtual elimination of premiums and out-of-pocket expenses for patients. Medical bankruptcy would be a thing of the past. Will it work? Medicare for all isn’t a new or fringe idea. Single-payer systems work in industrialized countries worldwide, and most spend about half of what we do on healthcare, with better results. Hiding in plain sight is a single-payer system called Medicare, which is universally popular among patients and physicians, providing care to the oldest and sickest Americans with only about 3% in administrative costs. Polls show strong support for a single-payer program, and healthcare providers agree. Last month the Chicago Medical Society asked more than a thousand members to rate competing healthcare plans. Doctors preferred a single-payer plan 2-to-1 over the ACA and 3-to-1 over the GOP House bill, the American Health Care Act. Nearly 90% agreed that healthcare is a human right that should be available to all individuals, similar to police and fire protection. We became doctors to help others heal and thrive. Instead, we spend hours each day on insurance paperwork and billing, hours that could be—and should be—spent on patient care. Medicare for all is a system designed to serve the needs of patients, not the profit motives of insurance companies. l Interested in submitting a Guest Expert op-ed? View guidelines at modernhealthcare.com/op-ed. Send drafts to Assistant Managing Editor David May at email@example.com. July 24, 2017 | Modern Healthcare 25 Bottom line in reform debate: We need to address costs Bill or no bill. Repeal or replace. As a nation, we must address the cost crisis gripping our system. As a policy, the Affordable Care Act reformed insurance coverage. It extended coverage to people with pre-existing conditions and young adults under 26. Mental health and substance abuse received more funding. And Medicaid was expanded in several states to cover more people in need. But none of this made healthcare affordable. In fact, lawmakers expected that expanded coverage would equal increased cost. They even tried to solve for it by introducing tax penalties and insurance reimbursements. The Senate bill missed the mark, as well. It was just too hard to stomach 22 million Americans losing health plan coverage. Yet, the problem remains: How do we lower costs? Today, the average person with an exchange plan pays almost $4,000 in deductible fees. Families can be on the hook for over $12,000. However, in any given year, more than 80% of non-chronically ill individuals spend less than the average deductible for a silver plan (with an average of about $4,000) on the exchanges. That means for most Americans, healthcare is paid for with cash out of pocket. This gives us an incredible opportunity to introduce market dynamics that let people shop for high-quality, low-cost care—and lower costs for all through the economic principle of price elasticity. We’ve seen that when patients control the marginal dollars, healthcare marketplaces emerge. For instance, the cost of conventional Lasik surgery decreased 25% from 1999 to 2011. And consumers can save significantly when they shop for routine medical services. Through claims data, we’ve verified that when members shop for CT scans, they save an average of $507; an average $586 on MRIs; and an average of $1,250 for colonoscopies. These savings add up. With 80 million CTs performed in the U.S., there’s the potential to save $40.6 billion on that service alone. Consumers can’t afford to overpay for care. Cash rewards, price comparisons, options to shop via the web and with powerful phone support can breed market competition that moves volume, saves money for consumers and lowers prices overall. Heyward Donigan President and CEO Vitals Lyndhurst, N.J. Why force Americans to buy coverage they just don’t want? Regarding the July 17 editorial (“This is a disaster,” p. 24), Americans do not want to be forced to pay for medical coverage they don’t want/need. Many people are very willing to live their lives and have only catastrophic health insurance in case of . . . a catastrophe. If the government could be trusted to use our tax dollars wisely, then maybe they could use tax dollars to help those who want care but don’t have the funds. Oh wait, could they utilize a government-run healthcare system like the VA? Daphne O’Brien Indianapolis 26 Modern Healthcare | July 24, 2017 Remembering a healthcare IT game-changer A healthcare game-changer and warrior is no longer with us. Neal Patterson, co-founder and longtime CEO of Cerner Corp., was an icon and mentor in the industry and will always be remembered. I have been in the challenging arena of healthcare information technology for almost 2½ decades. I call it challenging because of the constant changes that have forced all of us to adapt and constantly re-invent ourselves. I faced some of these challenges as an ally to Neal and some on the other side as a competitor. We won some battles and lost others, but the challenge is what made it fun, and Neal’s brilliance pushed us to think harder to stay in the game. The most important thing is that we were always driven by our shared mission and passion to do the right thing for our customers and the healthcare industry. Ultimately, the customers and the industry always won. As we get older and wiser, we are all confronted by our own mortality and realize that we are at an inflection point, where the only way to transform healthcare is by leveraging our past experiences and joining forces with other game-changers to make a difference. Today we should carry Neal’s torch and together execute on our shared vision. My friend, we thank you for making us better and joining your mission and vision. We will not disappoint you! Alan Portela Chairman and CEO AirStrip San Antonio Letters welcome Write us with your comments. To send us a letter electronically, go to modernhealthcare.com/letters; by fax, 312-280-3183. REGISTRATION NOW OPEN What works? Why? How? THE NEW AGE OF HEALTHCARE MARKETING. Spend one day learning from the most creative and strategic minds in marketing and discover the best —and next — practices being used to break through the clutter in an increasingly crowded and data driven world of marketing. November 7, Chicago, IL REGISTER TODAY: ModernHealthcare.com/MarketingConference Co-located with the Healthcare Marketing IMPACT Awards Memorial Hermann targets food insecurity, asks if patients are hungry By Maria Castellucci Food insecurity is a problem in Harris County, Texas. About 18% of adults and 26% of children in the county have difficulty accessing food. Research on food insecurity indicates that lack of nutritious foods can lead to other health problems, worsen existing diseases and increase costs. A 2015 study published in Health Affairs found that food-insecure children were twice as likely to report fair or poor health and 1.4 times more likely to have asthma compared to children who weren’t food insecure. Older adults who were food insecure also had more difficulty with daily living than those who weren’t food insecure. A different study found malnutrition increases healthcare spending by about $15.5 billion per year. Determined to tackle the issue, Memorial Hermann, a 16-hospital health system based in Harris County’s Houston, began to ask its patients in October 2015 about their access to food with the goal of getting them healthier by eating better. The program started in the emergency department in select Memorial Hermann hospitals staffed with patient navigators. The navigators primarily see patients in the ED who are uninsured or on Medicaid to help them find a permanent medical home and help prevent readmissions, according to Carol Paret, Memorial Hermann’s senior vice president and chief community health officer. As part of the program, navigators ask each patient if at any time within the past 12 months they were worried food might run out and if they had difficulty gaining access to nutritious food. If patients say they are lacking access to nutritious food, the navigator ex- 28 Modern Healthcare | July 24, 2017 STRATEGIES Train patient navigators, physicians and nurses to ask all patients if they suffer from food insecurity Partner with local food banks to offer resources to patients in the community Encourage physicians to consider food insecurity when establishing patient-care plans plains the options available in the community to get food. Memorial Hermann has partnerships with several food banks in the Houston area so the navigators are able to give patients details about the programs. The navigators are even trained by staff at the food banks on the appropriate questions to ask patients in order to determine if they suffer from food insecurity. The program has since expanded to Memorial Hermann’s community health centers and to all of its inpatient settings. It is also no longer limited to just uninsured or Medicaid patients, but any inpatient. The effort has been such a success among doctors and patients, Memorial Hermann plans to roll it out to all ED patients by August. Physicians have found the program to be “eye-opening,” Paret said. Doc- tors were shocked to find out some patients were food insecure. “You can’t always look at someone and be able to tell their situation,” she said. “It points out that medical care can’t be done in isolation.” It has also caused doctors to view their most difficult patients differently, Paret said. Patients who don’t take their prescriptions or follow care plans are often viewed as noncompliant by doctors. But the program opens doctors up to the issues in their patients’ lives that might be preventing them from following a care plan, such as loss of employment. The program has led to changes in patients’ care plans. For example, some patients will admit they can’t afford food because the drugs they’ve been prescribed are so expensive. This has led doctors to seek alternative treatments or cheaper generics for patients. Memorial Hermann also has begun to partner with Houston-area food banks on other initiatives. For example, navigators from the system visit the food banks and offer free consultations with patients to set them up with primary-care doctors or other affordable health resources in the area. “We really want to deal with the social determinants of health that are driving so much of the healthcare spend,” Paret said. The work done by Memorial Hermann has inspired other area providers to also try to tackle the issue. Memorial Hermann has been working with other hospitals to adopt the program. The hope is the hospitals will be able to share data so they can better understand the social issues that affect the well-being of Houston-area residents. “We can begin to paint a picture of Houston and what we can do to close care gaps,” Paret said. l The ACA lives, for now After another round of setbacks, congressional Republicans must regroup and assess their options for repealing, replacing or keeping the Affordable Care Act. They’ll need to weigh a number of policy—and political—decisions. Regardless of what happens next, reducing the size and impact of the ACA will be a daunting challenge. In fiscal 2010, 16.3% of Americans— 50.3 million people— were enrolled in Medicaid Medicaid grew from 7% of federal outlays in fiscal 2007 to 9.5% in fiscal 2015 —Medicare Payment Advisory Commission, CMS —Kaiser Family Foundation, CMS 17.5% 9% Uninsured rate in 2009 17 20 22 MILLION 16 COMPARED TO —Centers for Disease Control and Prevention 20 or 4% of Americans, got coverage in the nongroup market in 2013 Uninsured rate in 2016 14 20 13 MILLION As of April 2017, 22.8% of Americans— 74 million people— were enrolled in Medicaid or 7%, in 2015 —Kaiser Family Foundation 43% 50% Average silver plan premiums on ACA exchanges rose from $9,468 in 2014 to $9,636 in 2015 and $13,080 in 2017 of Americans had a favorable opinion of the ACA in July 2015 —Politifact 50% of Americans had a favorable opinion of the ACA in July 2017 of Americans prefer the ACA vs. 24% who prefer the GOP plan to replace it —Kaiser Family Foundation —Washington Post/ABC News poll, July 17 July 24, 2017 | Modern Healthcare 29 “It’s never been an asset to be a woman in executive ranks. Sometimes it’s not been a detriment, but it’s never been an asset.” ‘A woman has to put in twice as much effort as a man’ Dr. Halee Fischer-Wright has been a chief medical officer at a large health system, owned her own medical practice and worked as a consultant. Now, as CEO of the Medical Group Management Association, she leads the nation’s largest association for medical practice administrators and executives. Fischer-Wright started her career as men still largely dominated clinical and leadership roles. Healthcare is doing better, she said, when it comes to closing the gender gap, but it’s not where it needs to be. She spoke with Modern Healthcare reporter Rachel Z. Arndt about the role of women in leadership and how medical practices can transform patient care. The following is an edited transcript. Modern Healthcare: Are things better or worse or both for women in healthcare now as opposed to when you first were starting out? Dr. Halee Fischer-Wright: Definitely better, but not where we want it to be, and I think we would almost universally all agree with that. I started in healthcare over 20 years ago as a general pediatrician. Women were nurses and men were physicians, so I was probably the second generation, but my medical school class was 50/50. That generational differential had taken root, but it hadn’t played out as far as practice goes. If you looked at the percentages that were out in practice, it was still male over female. That led to a lot of challenges in regards to navigating committees in the hospital. I remember going to my first committee meetings during my residency and them saying, “Well, you know, we need to wait until the doctor is here to start the meeting.” “I am the doctor,” I said. “Oh, sorry.” You kind of expected that, but what you don’t know when that happens is how it erodes at your authority and it makes it hard for you to be effective in your role. You don’t recognize from a cultural perspective how much extra effort you have to put in to get things accomplished; a woman has to put in twice as much effort as a man. There were definitely times when I was thoughtful and intentional 30 Modern Healthcare | July 24, 2017 of how I can work so hard so they don’t see me as a woman but they see me as a colleague, and that is a sense of being intentional that I’ve always had. It’s never been an asset to be a woman in executive ranks. Sometimes it’s not been a detriment, but it’s never been an asset. I was in a salary negotiation for a very high-level position prior to this one. I had the market data—MGMA market data, may I add—on what that position should pay. They offered me 30% less than 50th percentile, and I said, “I know it; I did my homework.” They said, “Well, your husband is a physician, so you’re not the primary breadwinner.” I was told this at a job interview. And I responded, “If that’s your logic behind it, I probably shouldn’t take the job. This is not going to work out well for either one of us.” As I’ve gotten further in my career, and as women have gotten into those roles, they’re conscious about it, and they drive organizations and they set behaviors and they role-model the kind of behavior that we should see. That’s why I view my role as really a role model not just for women but also from a diversity standpoint. All of our organizations will thrive and do better with a diverse employee talent base. MH: So, looking more broadly at the organizational culture, what shifts do you see happening now, whether it’s with consumers or providers? Fischer-Wright: Healthcare is lagging behind, and we have such great role models in other industries on how to do things better that we have not necessarily availed ourselves. We all embraced the Six Sigma methodology. We were all on board with that, and that went really well. That was process improvement. But as far as organizational transformation, we haven’t seen a lot of that in healthcare. You brought up consumerism. There’s an intersection of things going on. We have to decrease costs; we need to increase service, and those things are absolutely in conflict. I tend to look at Silicon Valley for innovators because they specifically look for disruptive innovation. That’s what we need in healthcare. We’ve been focused on incremental improvements for the past 20 years. Incremental improvements are not going to get us to where we need to be. We need actual innovation. Get out of the mindset of Six Sigma. I think we’ve Six Sigma’d to the point where we just don’t even know where to go any longer. Where is the leadership? You can look at other industries, the tech industry, for example, where their mindset is what can we do to disrupt ourselves. MH: What role do you think technology will play in healthcare? Fischer-Wright: Technology has, and will continue to have, a profound influence in healthcare. I think we see people in Silicon Valley advocating for the day where we don’t have doctor visits. I don’t think that’s what patients want. If you ask five patients what’s the most important part of healthcare, 4 out of 5 will say it’s their actual relationship with their physicians; 1 out of 5 will say it’s the knowledge. People really need that connection to a human being. The role of technology is not to eradicate the human connection but to find ways to make that human connection stronger, better, and to focus on wellness as opposed to sick care. We’ve not used technology in that way. By and large, we’ve used technology for billing purposes, for data collection. We’ve never really looked critically at technology as a methodology to make what we do more effective. MH: Within physician practices, what models of care do you find particularly promising? Fischer-Wright: I’m writing a book called Back to Balance right now—it will be out on Sept. 12—and we found lots of examples of practices getting it right, different sizes, different places across the country. Iora Health is a very atypical model. It’s backed by venture capital, and they do not accept traditional payment. They basically work with insurers or with Medicare to do per-memberper-month fees, and they deliver comprehensive care around that. They’re using internal clinical metrics like high blood pressure, hypertension, hospital admissions, diabetes care and looking at a long-term perspective of, if we keep this patient engaged for many years, how do we see those health parameters change? And they are also really tackling the social determinants of health. There’s a model around women’s health that we saw in Portland, Ore., where they did something amazingly revolutionary: They asked their patients what they wanted, and they built a practice around that. And they have actually—it’s kind of funny—been around for 20 years. What’s really revolutionary about it is every time they hit a major stumbling block or had a question, they’d discuss it, and it is a big practice—100, maybe 200 doctors. Then someone would say, “Wait, maybe we should go back to the patients.” MH: You mentioned social determinants of health. How do you think the industry needs to adapt to allow for actually tending to those things? Fischer-Wright: The shift from fee-for-service to value-based care will make that basically mandatory, because as the health industry gets held responsible for outcomes, we know how profoundly those social determinants of health really affect our outcomes. And so we’ll have to meaningfully engage in those social determinants because there are not sustainable models without addressing those issues. MH: Drawing on both your clinical experience and your administrative organizational experience, what do you think those two sides can learn from each other? Fischer-Wright: I’m so glad you asked. One of the things I always talk about is that we speak different languages, and so I always ask the question, “Do you speak art or do you speak business?” Healthcare has to be in balance. The art, science and business need to work together. You cannot have one outside of the other. We have seen in the past 10 years where the art of medicine is kind of starting to phase out to everyone’s dissatisfaction. Everybody is dissatisfied. The insurers are dissatisfied with the results they’re seeing. The patients are dissatisfied. The providers are dissatisfied. But you can’t just get rid of business either because it’s a $3.4 trillion economy. If you take out healthcare, the U.S. is the fifth-largest economy in the world; it’s a chunk of change. The question becomes: How can we communicate between those two parameters to really drive the kinds of outcomes that we are looking for? Healthcare executives can serve as translators. I think providers, if they really understand that things have to be in balance, can also learn how to translate that, and then it becomes collaborative as opposed to adversarial. I do think right now healthcare is set up, almost unintentionally, to be adversarial. l “There’s a model around women’s health that we saw in Portland, Ore., where they did something really amazingly revolutionary: They asked their patients what they wanted, and they built a practice around that.” July 24, 2017 | Modern Healthcare 31 VA veteran joining Cerner’s federal team Who: David Waltman New role: Waltman will work on government strategy, engineering and compliance as the vice president for federal strategy and technology for IT giant Cerner Corp. Background: Most recently, Waltman was chief strategy officer for IT developer AbleVets. He also served two stints at the Veterans Affairs Department. During his first, he worked on interoperability between IT systems at the VA and the Defense Department; during his second, he oversaw development of the enterprise Health Management Platform, a collection of services for improving care. Modernizing the EHR: During his most recent years at the VA, Waltman was involved with the department’s homegrown EHR, known as VistA, and worked to modernize the decadesold system. In June, the VA announced it would replace VistA with a Cerner EHR system. 32 Modern Healthcare | July 24, 2017 From Director to CFO PEOPLE ON THE MOVE Inform the healthcare industry. Submit now at ModernHealthcare.com/PeopleMoves The Roadmap to a Transformed Healthcare System C-Suite to C-Suite networking, learning and conversation on the evolving business structures, shifting roles and emerging responsibilities of C-Suite executives in healthcare. An exclusive, invitation-only event. Limited seats available. Closing Keynote: Bernard J. Tyson Conﬁrmed Speakers Include: • • • • • • • • PRE-REGISTRATION OPEN* *Registrations will be reviewed for qualifying criteria Sponsored by: • • • • • • • • • • Bernard J. Tyson, Chairman and CEO, Kaiser Permanente Ben Breier, CEO, Kindred Healthcare Ruth Brinkley, Former CEO, KentuckyOne Health Bechara Choucair, Chief Community Health Ofﬁ cer, Kaiser Permanente Sean Connaughton, President & CEO, Virginia Hospital and Healthcare Association Lloyd Dean, President and CEO, Dignity Health Peter Fine, President & CEO, Banner Health Niyum Gandhi, Executive Vice President and Chief Population Health Ofﬁ cer, Mount Sinai Health System Mark Ganz, CEO, Cambia Health Solutions, Inc. Marc Harrison, President & CEO, Intermountain Healthcare Charles Kahn III (Chip), President & CEO, Federation of American Hospitals Farzad Mostashari, CEO, Aledade Margaret Sabin, President & CEO, Penrose-St. Francis Health Services, President, Centura Health South State Operating Group Ernie Sadau, President & CEO, Christus Health Bruce Siegel, CEO, America’s Essential Hospitals Joseph Swedish, Chairman, President & CEO, Anthem Inc. Michael Ugwueke, President & CEO, Methodist Le Bonheur Healthcare Kate Walsh, President & CEO, Boston Medical Center Largest allopathic medical schools Ranked by total active enrollment for the 2016-17 school year RANK/INSTITUTION LOCATION TOTAL APPLICATIONS TOTAL ACTIVE ENROLLMENT1 TOTAL GRADUATES2 1 Indiana University School of Medicine Indianapolis 7,315 1,404 327 2 University of Illinois College of Medicine Chicago 7,931 1,321 301 3 Wayne State University School of Medicine Detroit 4,770 1,214 269 4 Sidney Kimmel Medical College at Thomas Jefferson University Philadelphia 10,726 1,064 249 5 Drexel University College of Medicine Philadelphia 14,366 1,044 255 6 University of Washington School of Medicine Seattle 8,777 1,020 235 7 McGovern Medical School at the University of Texas Health Science Center at Houston Houston 5,262 977 230 8 University of Texas Southwestern Medical Center Southwestern Medical School Dallas 5,083 938 227 9 University of Texas Medical Branch School of Medicine Galveston 4,992 928 223 Augusta 2,986 913 211 10 Medical College of Georgia at Augusta University 1 Total active enrollment includes students listed as actively enrolled in medical school as of Oct. 31, 2016. Total active enrollment does not include students who had inactive, graduated, dismissed, withdrawn, deceased, never enrolled, completed fifth pathway, did not complete fifth pathway, or degree revoked statuses. 2 Total graduates representing the class of 2017, which is academic year 2016-17. Source: Association of American Medical Colleges Largest osteopathic medical schools Ranked by total active enrollment for the 2016-17 school year LOCATION TOTAL APPLICATIONS TOTAL ACTIVE ENROLLMENT TOTAL GRADUATES1 1 Lake Erie College of Osteopathic Medicine Erie, Pa. 9,183 1,497 353 2 New York Institute of Technology College of Osteopathic Medicine Glen Head 6,697 1,354 298 3 Michigan State University College of Osteopathic Medicine East Lansing 5,389 1,313 4 Western University of Health Sciences College of Osteopathic Medicine of the Pacific Pomona, Calif. 6,941 1,301 311 5 Philadelphia College of Osteopathic Medicine Philadelphia 9,804 1,084 254 6 Kansas City University of Medicine and Biosciences College of Osteopathic Medicine Kansas City, Mo. 5,618 1,056 245 7 Nova Southeastern University College of Osteopathic Medicine Fort Lauderdale, Fla. 7,363 1,009 226 8 Arizona College of Osteopathic Medicine of Midwestern University Glendale 5,907 1,000 244 9 Touro College of Osteopathic Medicine New York 6,389 962 125 Cumberland Gap, Tenn. 5,019 949 171 RANK/INSTITUTION 10 Lincoln Memorial University DeBusk College of Osteopathic Medicine 1 Total graduates representing the class of 2016, which is academic year 2015-16. Source: American Association of Colleges of Osteopathic Medicine For more about the data used to compile these lists, contact the Association of American Medical Colleges, 202-828-0400 or aamc.org; and the American Association of Colleges of Osteopathic Medicine, 301-968-4100 or aacom.org. Information in this chart subsequently may be revised at the discretion of the editor. For more information on our research, contact Keith Horist at 312-649-5467 or firstname.lastname@example.org. FOR MORE charts, lists, rankings and surveys, please visit modernhealthcare.com/data. 34 Modern Healthcare | July 24, 2017 300 classiﬁed marketplace jobs.ModernHealthcare.com To place your ad contact Kelly Rademacher l 312.649.5452 l email@example.com EXECUTIVE RECRUITMENT REQUEST FOR QUALIFICATIONS /M\\PMZQOP\KIVLQLI\M[\WNQTTaW]ZWXMV XW[Q\QWV[_Q\P5WLMZV0MIT\PKIZM+TI[[QNQML[ The Kimble County Hospital District seeks a team of qualified applicants to lease, operate and/or manage the Kimble County Critical Access Hospital and Rural Health Clinic located in Junction, Texas. The Request for Qualifications (RFQ) is available on the Hospital District website at http:// new.kimblecountyhospitaldistrict.org/ Direct enquiries to Allison, Bass & Magee, LLP, 402 West 12th Street, Austin, TX 78701. Completed responses must be received by 5:30 p.m., September 1, 2017. Late responses will not be accepted. Target Candidates with Modern Healthcare Classiﬁeds! ct: Kelly Rademacher @ 312.649.5452 firstname.lastname@example.org PUBLISHER Fawn Lopez ADVERTISING Ilana Klein AUDIENCE DEVELOPMENT AND MARKETING Vice President/ Publisher 312-649-5491 email@example.com National Advertising 312-649-5311 firstname.lastname@example.org Sales Director Jennifer McCullough Project Manager 312-649-5353 email@example.com David Baker Southwest 615-371-6618 firstname.lastname@example.org Cheryl DeSimone Northeast 212-210-0193 email@example.com Cheryl Gordon West 312-649-5367 firstname.lastname@example.org Bill Klingler Midwest 312-649-5463 email@example.com Brian Lonergan Business Development 312-649-5379 firstname.lastname@example.org Kelly Rademacher Business Development 312-649-5452 email@example.com Tara Sullivan Southeast 212-210-0192 firstname.lastname@example.org MARKETING Anthony Roach Elizabeth Davis Gianna Rizzi AUDIENCE DEVELOPMENT Mariah Craddick Audience Engagement and Development Manager Lauren Melesio Reprint sales EDUCATION AND EVENTS Jodi Sniegocki Education and Events Director Steve Eck Event Content Strategist Adam Rubenfire Custom Content Strategist Samantha Dillon Senior Event Specialist CUSTOMER SERVICE 877-812-1581 email@example.com To place an advertisement: Call 312-649-5350 or send a fax to 312-397-5510 To place a classified advertisement: Call 312-649-5452 or send a fax to 312-397-5510 PRODUCTION Michael Kanalas Production Manager 312-280-3108 firstname.lastname@example.org WHO WE ARE AND HOW TO REACH US - Modern Healthcare is the only weekly business news magazine for hospital and healthcare executives. You can learn more about the publication and view our daily news updates on our website at ModernHealthcare.com. Modern Healthcare welcomes letters to the editor. They may be sent by mail to Modern Healthcare, 150 N. Michigan Ave., Chicago IL 60601-7620; e-mail, email@example.com or fax, 312-280-3183. All letters to the editor must be signed with job titles and telephone numbers. Marketing Manager 312-649-5455 firstname.lastname@example.org Graphic Designer 312-649-5335 email@example.com Sales Marketing Coordinator 312-280-3163 firstname.lastname@example.org 312-649-5382 email@example.com 212-210-0707 firstname.lastname@example.org 312-649-5459 email@example.com 312-649-5346 firstname.lastname@example.org 312-649-5229 email@example.com 312-649-5340 firstname.lastname@example.org SUBSCRIPTION 877-812-1581 www.modernhealthcare/subscriptions Subscription fax 847-291-4816 CRAIN COMMUNICATIONS BOARD OF DIRECTORS Keith E. Crain Chairman Mary Kay Crain Treasurer KC Crain President and Chief Operating Officer *** Bob Recchia Chief Financial Officer Chris Crain Senior Executive Vice President *** Anthony DiPonio Chief Information Officer *** G.D. Crain Jr. Founder (1885-1973) *** Mrs. G.D. Crain Jr. Chairman (1911-1996) July 24, 2017 | Modern Healthcare 35 The flexible skin patch developed by Wang’s team converts sweat into energy that can power a radio and possibly wearable sensors. Sweat could fuel next generation of wearable sensors he next big biofuel source could be the most locally sourced yet—it’ll come from your own skin. A research team out of the University of California at San Diego led by Joseph Wang has created a sweatpowered radio that was able to run for two days on perspiration. Researchers used a soft, flexible skin patch just a few centimeters across that contains enzymes that replace the precious metals traditionally used in batteries. The technology could potentially be used in wearable activity or health trackers, researchers say. The patch produces enough current to power a light-emitting diode or a Bluetooth radio. Getting enough power from a biofuel cell to make it a viable fuel source has long proved elusive, but this latest innovation can extract 10 times more power than previous versions. “We’re now getting really impressive power T levels,” Wang told New Scientist. “If you were out for a run, you would be able to power a mobile device.” Wang and his colleagues used the lactate found in sweat to power the cells. The amount of lactate or lactic acid found in sweat is also related to how efficiently a person’s muscles are functioning. “The most exciting application is wearable sensors that can monitor health conditions,” Mirella Di Lorenzo at the University of Bath in England told New Scientist. “Then sweat could generate enough power for a Bluetooth connection so that the results could be read straight from a smartphone.” Another potential application is glucose monitoring, which would allow diabetics to ditch needles or blood samples, since levels of glucose in sweat are related to its concentration in the blood. l Magical? Maybe. But still artificially flavored eneral Mills hit a snag when it wanted to give Lucky Charms a healthier makeover. The breakfast cereal powerhouse tried for two long years, but couldn’t figure out how to manufacture the “magically delicious” cereal without artificial colors and flavors. Maintaining the vibrancy of the colors in Lucky Charms’ little marshmallows while not profoundly altering their flavor has stumped food scientists. G “It’s still our biggest challenge,” Lucky Charms spokesman Mike Siemienas told the Washington Post. “We’ll let you know once we’ve found a solution.” General Mills had six to seven people working full time on the project for two years, but they couldn’t crack the code to make the colorful chewy marshmallows “all natural.” So efforts have stalled. Each marshmallow “brings a different challenge to the table for us,” Kate GETTY IMAGES 36 Modern Healthcare | July 24, 2017 Gallagher, a cereal recipe developer at General Mills, told Quartz. The effort was part of a companywide push to phase out artificial colors and flavors. “People eat with their eyes,” said Jim Murphy, a General Mills division president, in a YouTube video when the effort launched in 2015. “And so food has to look appealing, and bright colors give it an appealing look. People don’t want (artificial) colors with numbers in their food anymore.” With cereal sales on the decline in recent years, General Mills had pinned some hopes on attracting more sales by putting a health-conscious spin on its traditional breakfast brands. For now, Lucky Charms can claim to be on top of one trend: It’s glutenfree, except for the chocolate version. And in the spirit of embracing what it can’t change, Lucky Charms’ latest promotion offers 10,000 winners a box full of only the little artificially flavored marshmallows. l 86 million Americans Maybe even you, have prediabetes. person-ABOUT-TOFACT-CHECK-THIS-FACT. Text KNOW to 97779 Message & Data Rates May Apply. Reply STOP to opt out. No purchase necessary. Terms and Privacy: adcouncil.org/About-Us/Privacy-Policy Earning the Distinction of Board Certification in Healthcare Management Gives You an Edge With Executive Search Firms Adkisson Search Consultants JohnGSelf Partners, Inc. Aegis Group Search Consultants, LLC Kirby Bates Associates Alder Bowman Search Consultants Korn/Ferry International Anderson & Associates, Inc. Management Pathways B.E. Smith Management Recruiters of Berkeley Healthcare executives who have become Billingsly Associates, LLC Merrit Hawkins The Buffkin Group MillicanSolutions, LLC Carrington & Carrington, LTD Morgan Hunter HealthSearch to their boards, staff and the public that Cejka Executive Search, Inc. MSA Executive Search they have the knowledge, skills and CES Partners, Ltd. Nutter Group Daudlin De Beaupre and Company P•A•R• Associates Inc. leading today’s healthcare organizations. Desir Group Executive Search Phillips DiPisa & Associates That is why when we interview candidates DHR International Quick Leonard Kieffer International Diversified Search Salveson Stetson Group in healthcare management have an Exceptional Leadership, LLC Spencer Stuart advantage. Learn more about becoming ExecuConnections Southerland Partners Executive Dimensions, LLC The Synergy Organization FaithSearch Partners, Inc. Tyler & Company Faubion Associates Waverly Partners, LLC Furst Group Wheless Partners Executive Search Grant Cooper & Associates Whittaker Group, LLC Heidrick & Struggles Witt/Kieffer Heinrich, Casey & Associates Zurick Davis board certified in healthcare management as Fellows of the American College of Healthcare Executives (FACHE®) demonstrate commitment to ongoing professional development to meet the challenges of for an executive search, those who have earned the distinction of board certification board certified in healthcare management at ache.org/FACHE.