How Wal-Mart May Have Just Changed the Game on Health Care…A pretty neat read…

Once again, the most important health care story of the week didn’t come up in the prime time presidential debates.

And no — “Road to Reform” isn’t referring to the oft-overlooked Medicaid program, but more news from the private sector: Wal-Mart’s decision to directly contract with six leading hospitals, which could be a real game changer.

The company announced last Thursday that it will become the first retailer to offer a national program that covers certain heart, spine and transplant procedures for its employees. Essentially, when the 1.1 million employees and dependents enrolled in the company’s health plan need those procedures, Wal-Mart will steer them to six “centers of excellence” around the nation, including Cleveland Clinic and Mayo Clinic, at no additional cost to them.

It could be a major step toward other firms directly contracting with hospitals of their choice, potentially reshaping referral patterns.

While the Thursday afternoon news was somewhat buried by other news coverage — namely, the debate between Vice President Biden and House Budget Committee Chair Paul Ryan later that evening — several health care experts took note.

“This could change medicine,”

Inside the Plan: How the Partners Came Together

The new plan will take effect in January 2013, with Wal-Mart also pledging to cover the cost of travel, lodging and food for the patient and one caregiver.

Beyond Cleveland Clinic and Mayo Clinic, the six “centers of excellence” include:

Geisinger Medical Center in Danville, Pa.;
Mercy Hospital Springfield in Springfield, Mo.;
Scott & White Memorial Hospital in Temple, Texas; and
Virginia Mason Medical Center in Seattle.

Wal-Mart selected its hospital partners after a “nationwide search,” spokesperson Randy Hargrove told California Healthline. The company was seeking a range of hospitals that were geographically diverse and offered an established, accredited program for evidence-based care in these procedures.

Meanwhile, participating providers who were approached by Wal-Mart said they were swayed by the company’s stated health care strategy. “We reviewed Wal-Mart’s philosophy articulating a commitment to providing their employees with access to high quality medical care and found it to be in alignment with our own goals,” Glen Couchman, chief medical officer for Scott & White, said in a statement to California Healthline. “We’re looking forward to the opportunity to deliver that care.”

While Wal-Mart hasn’t released planned savings from the partnership, it expects the program to reduce health costs through bundled payment agreements with the participating hospitals.

According to Michael McMillan, Cleveland Clinic’s executive director of market and network services, the arrangement is a “triple win” for the company.

“It’s a boost in quality, it’s an improvement in value and it’s no cost out-of-pocket for employees, so we think it is a great opportunity,” McMillan told Reuters.

Wal-Mart leaders hope employees “have greater peace of mind knowing they’re getting the best quality of care,” according to Wal-Mart’s Hargrove. “They are going to save money … [with care] covered at 100% and no out-of-pocket expenses.”

Looking Ahead: How it Would Change the Game

In some ways, “the Wal-Mart announcement wasn’t overly surprising,” the Advisory Board Company’s Rob Lazerow told California Healthline. (The Advisory Board Company publishes California Healthline on behalf of the California HealthCare Foundation.)

A handful of other big employers, like Pepsi and Lowe’s, already have entered into their own bundled payment deals. In that context, Wal-Mart’s move makes sense, especially given the company’s history of innovation, Lazerow said.

But the announcement is eye-catching because of its scale, both in terms of possible patients and number of partners.

Wal-Mart is among the largest employers in the country, second only to the U.S. government; its 1.1 million employees and dependents represent about 1% of all U.S. residents who get health coverage from their employers.

And contrast Wal-Mart against those earlier announcements like Lowe’s and Pepsi, which partner with only one hospital, Lazerow said. While Wal-Mart’s move to offer employees access to a range of facilities across the country could increase employee satisfaction, it also makes the program more complex to develop and operate.

What’s at Stake: How Participants Might Be at Risk

It’s not hyperbole to say that Wal-Mart’s transformed health care before. In 1996, the company partnered with Mayo Clinic for a similar program on transplant surgeries; it’s been a pioneer in the Medicare prescription drug market; and its support for national health reform helped fuel the push for the Affordable Care Act.

At the same time, Wal-Mart’s made missteps. Its aggressive retail clinic strategy hasn’t quite worked out, for example. And one real risk for Wal-Mart is that its employees push back on having to travel to one of the six participating hospitals for care.

Participating providers face risks, too, Lazerow noted. For example, “the volume of patients treated under the agreement [might be] lower than they would expect or hope.” And there’s significant cost in developing a bundled payment program and modeling out the impact.

According to Hargrove, the company can’t forecast volumes for each individual hospital because it will be dependent on individual factors like Wal-Mart associate usage. However, Scott & White said that Wal-Mart shared projections that an “estimated 400-500 potential cases” per year will be referred to the hospital through the partnership.

Meanwhile, Hargrove said the company’s plan “is to expand to include more procedures and providers, [and] evolve over time,” he told California Healthline, although Wal-Mart is excited about its initial cohort of high-performing centers.

So where would Hargrove — a Wal-Mart employee, after all — go if he needed a heart or spine procedure?

“They all have excellent track records,” Hargrove demurred. “If I was to travel and get one of these procedures, I’d be [confident] at any of these facilities.”

As always, i enjoy bringing everyone my interest in my future and am always interested in hearing your thoughts!!

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Some officials say ‘the transition to ICD-10 will be one of the most significant changes the physician practice community has ever undertaken.’

Last week, Erin McCann from wrote a very current and informed article about the upcoming changes in the physicians coding system, this is important that the medical profession gets this right because it will directly affect us, the general public. Here is what she wrote:

Medical practices nationwide have expressed worry regarding the impact of an ICD-10 (International Classification of Diseases) switchover, according to a recent survey finding 96 percent of respondents concerned about the transition to the updated coding system.

The Nuesoft Technologies sanctioned survey, “Attitudes Toward the Transition to ICD-10 and ANSI-5010,” also showed that 73 percent of respondents anticipate ICD-10 significantly affecting their practice, whether it be financially or operationally. With HHS issuing a final rule that establishes Oct. 1, 2014 as the ICD-10 compliance deadline, physicians and medical personnel are girding themselves for what many officials perceive to be a complex labyrinth of documentation.

This diagnosis code is slated to replace ICD-9 and expand the number of diagnosis and procedural codes from 17,000 to some 155,000. “It’s not the number,” said Barry Blumenfeld, MD, CIO of Maine Medical Center in Portland, Maine. The complex addition of coding, he added, “makes things very complicated for physicians choosing codes and will require a lot of training and a lot of insight into how these codes are different.”

Some officials say the transition to ICD-10 will be one of the most significant changes the physician practice community has ever undertaken. The more detailed level of specificity required by ICD-10 will impact areas of practice management processes, including documentation, billing, workflow and quality reporting.

In addition, many practice software systems will need to be upgraded, and physicians and responsible staff will need extensive training to successfully make the transition. “Most physicians are dreading the change to ICD-10 because the number of codes and level of specificity will increase exponentially,” said Barbara Dunn, president of MedRecovery Solutions, Inc., a large billing firm that works with practices throughout the country to optimize operations through appropriate coding and billing.

Julie Nobles, president of Premiere Medical Billing, echoed Dunn’s concern. “Most physicians I have spoken with are worried about the rollout of ICD-10 because they are not certain the increased costs and staff hours justify the change to a new and larger set of diagnostic codes.”

Yet, for some physicians, the impending transition is being taken in stride. According to Robert Goldman, MD, the founding physician of Georgia Hormones, with the proper training, the transition to ICD-10 will be doable.

“We wanted to stay ahead of the curve so the transition to ICD-10 would be as streamlined as possible,” said Goldman. “Our practice coding specialist, as well as all of our physicians, finished a course this year all about ICD-10 and the new diagnosis codes. Even though the list of codes will be the size of 10 Manhattan phone books, we are prepared. In fact, Europe has been using ICD-10 codes successfully since 2002.”

The Centers for Medicaid and Medicare Services (CMS) has stressed that ICD-10 will provide more specific data than the 30-year-old ICD-9 and better reflect current medical practices. CMS indicated that the added detail embedded within ICD-10 codes will inform health care providers and health plans of patient incidence and history, which improves the effectiveness of case management and care coordination functions.

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