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TeamHealth to buy hospitalist giant IPC

September 2015

Published in the September 2015 issue of Today’s Hospitalist

TeamHealth to buy hospitalist giant IPC

TEAMHEALTH LAST MONTH announced that it had agreed to purchase IPC Healthcare Inc. in an all-cash transaction worth $1.6 billion.

In a press release, TeamHealth, which has big emergency medicine and hospitalist divisions, pointed to IPC’s strength in post-acute care. Acquiring IPC’s services in 2,000 post-acute facilities in 28 states, the press release pointed out, represented “a substantial growth opportunity.”

The move will also allow TeamHealth to capitalize on bundled payments and other value-based payment mechanisms across ED, hospitalist and post-acute services. Some TeamHealth and IPC groups already participate in Medicare’s bundled payments for care improvement initiative.

The deal is expected to be finalized in the fourth quarter of this year and would bring the number of health care professionals within TeamHealth to 15,000.

Because of the “strong operational overlap,” the press release explained, “TeamHealth expects to realize at least $60 million of combined cost and identified revenue synergies to be achieved within three years.”

Patient in observation? 
Get ready to explain why

A NEW FEDERAL LAW will require hospitals to tell Medicare patients who are being treated in the hospital under observation status that they have not actually been admitted to the hospital. Hospitals will also have to explain to patients how being in observation will affect their insurance coverage for the visit.

Under the NOTICE Act, which was signed into law last month, Medicare patients in observation who have been in the hospital for more than 24 hours will have to be told that they are considered outpatients within 36 hours of the time that they began receiving services.

Hospitals will have to notify patients verbally and in writing, and patients (or their representatives) will have to sign the written notification to acknowledge that it’s been received. Hospital staff presenting the written notification will be able to sign for patients if patients refuse.

While the law takes effect next summer, hospitals will have one year from the implementation date to comply.

Study uncovers surprising facts
 about frequent fliers

WHILE THE CONVENTIONAL WISDOM holds that frequent fliers use a disproportionate share of health care resources, a new study finds that many of these patients usually stop visiting the hospital within a year.

The study, which was published in the August issue of Health Affairs, found that after a 12-month period, only 28% of the patients studied could still be considered frequent fliers. After two years, that was the case for only 14%.

The study was done at Denver Health Medical Center. Researchers looked at patients who had been hospitalized more than three times over
12 months or those with mental illness hospitalized at least twice in 12 months.

While physicians think of frequent fliers as individuals with multiple morbidities, the research found that fewer than half of the frequent fliers studied (42%) had multiple chronic conditions. Forty-one percent frequently used the hospital because of significant mental health issues, while other high-use patients made repeat visits because of trauma, terminal cancer, orthopedic surgery or emergency dialysis.

Steroids help reduce pneumonia complications

A NEW STUDY FINDS that inpatient systemic corticosteroid therapy for patients with community-acquired pneumonia (CAP) may reduce complications and speed overall recovery.

The research, which was published in the Aug. 11 Annals of Internal Medicine, found that patients given steroids were less likely to experience acute respiratory distress syndrome or need to be ventilated. Study subjects were also discharged one day earlier.

The study, however, also found that steroids were associated with an increased risk of hyperglycemia that needed treatment but produced no long-term effects.

The meta-analysis examined more than 2,000 patients in 13 trials. Several of those trials also found that CAP patients who received steroids achieved clinical stability more than one day sooner compared to patients not given steroids. The authors recommend that physicians seriously consider prescribing steroids, particularly to patients with severe CAP.

Medicare: lower costs, mortality 
and hospitalizations

FIFTEEN YEARS OF DATA from the Centers for Medicare and Medicaid Services (CMS) indicate that Medicare patients are benefiting from better outcomes and significant reductions in all-cause mortality, all-cause hospitalizations and costs.

Researchers looked at 1999-2013 data for more than 68 million patients enrolled in both fee-for-service Medicare and Medicare Advantage plans. They found that all-cause mortality rates fell from 5.3% to 4.45%, while hospitalizations dropped from 35,274 per 100,000 person-years to 26,930.

Per capita inpatient costs for fee-for-service Medicare beneficiaries fell from $3,290 to $2,801, while the number of hospitalizations for fee-for-service Medicare patients in their last six months of life decreased from 131 to 103 per 100 deaths. Gains were consistent across ages, genders and racial groups.

In addition, inflation-adjusted inpatient costs per death fell from more than $15,300 in 1999 to less than $13,400 in 2013. Results were published in the July 28 issue of the Journal of the American Medical Association.

How much does MOC cost?

INTERNISTS CAN EACH EXPECT to commit an average of more than $23,000 over 10 years for recertification. That’s according to a new study that calculates the costs of the MOC process based on ABIM fees and the market value of doctors’ time in MOC-related activities.

The estimated 10-year costs for individual physicians ranged from $16,725 for general internists to $40,495 for hematologists/oncologists, with 90% of those costs related to physician time. Researchers estimated that the cumulative cost for all internists entering MOC in 2015 is $5.7 billion over the next 10 years. The authors explained that $5.1 billion of those costs is for physician time (32.7 million physician-hours) and $561 million is related to testing.

Results were published in the July 28 issue of Annals of Internal Medicine. The authors recommend that MOC reform focus on decreasing how much time the MOC process takes and on “increasing integration with existing continuing education activities.”