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Modern Healthcare July 24 2017

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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
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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),
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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.
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-PKLSP[`)YVRLYHNL:LY]PJLZ33*4LTILY5@:,:07* :HSLT:[YLL[:TP[OÄLSK90 -4933*(SSYPNO[ZYLZLY]LK EDITORS
Aurora Aguilar
312-649-5218
Editor
aaguilar@modernhealthcare.com
Matthew Weinstock Managing Editor
312-397-7585
mweinstock@modernhealthcare.com
Paul Barr
312-649-5418
Features Editor
pbarr@modernhealthcare.com
Erica Teichert
212-210-0209
News Editor
eteichert@modernhealthcare.com
David May
312-649-5451
Assistant Managing Editor
dmay@modernhealthcare.com
Patricia Fanelli
312-649-5318
Art Director
pfanelli@modernhealthcare.com
Keith Horist
312-649-5467
Production Manager
khorist@modernhealthcare.com
Merrill Goozner
Editor Emeritus
mgoozner@modernhealthcare.com
DIGITAL
Blair Chavis
312-649-5225
Web Producer
bchavis@modernhealthcare.com
Fan Fei
312-280-3155
Digital Graphics Producer
ffei@modernhealthcare.com
SENIOR REPORTER
Harris Meyer
312-649-5343
Chicago
hmeyer@modernhealthcare.com
REPORTERS
Rachel Z. Arndt
312-649-5314
Chicago
rarndt@modernhealthcare.com
Dave Barkholz
313-407-9469
Southern Bureau Chief
dbarkholz@modernhealthcare.com
Maria Castellucci
312-397-5502
Chicago
mcastellucci@modernhealthcare.com
Virgil Dickson
202-434-4552
Washington Bureau Chief
vdickson@modernhealthcare.com
Steven Ross Johnson Chicago
312-649-5230
sjohnson@modernhealthcare.com
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
akacik@modernhealthcare.com
Mara Lee
202-434-8462
Washington, D.C.
maralee@modernhealthcare.com
Shelby Livingston
312-649-5398
Chicago
slivingston@modernhealthcare.com
RESEARCH
Yonatan Gebre
312-649-5471
Research Associate
ygebre@modernhealthcare.com
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
jajohnson@modernhealthcare.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
vlapointe@modernhealthcare.com
Somewhat effective: Rate of overdoses and fatalities is flat
22.2%
CUSTOMER SERVICE
877-812-1581
customerservice@modernhealthcare.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
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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
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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
surveys360@sullivancotter.com.
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.
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CEO, Vanderbilt
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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 dmay@modernhealthcare.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.
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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
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THE MOVE
Inform the healthcare industry.
Submit now at
ModernHealthcare.com/PeopleMoves
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C-Suite to C-Suite networking, learning and
conversation on the evolving business structures,
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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 khorist@modernhealthcare.com.
FOR MORE charts, lists, rankings and surveys, please visit modernhealthcare.com/data.
34 Modern Healthcare | July 24, 2017
300
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jobs.ModernHealthcare.com
To place your ad contact Kelly Rademacher l 312.649.5452 l krademacher@modernhealthcare.com
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Direct enquiries to
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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
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