Value Propositions

April 2014, Vol 5, No 3
Jayson Slotnik, JD, MPH
Managing Partner
Health Policy Strategies, Inc.
Bethesda, MD
ASH Supports Novel Value-Based Care Coordination Toolkit

The focus on value-based care is growing not only in oncology but in all areas of medicine. The American Society of Hematology (ASH) has joined the American College of Physicians (ACP) in an effort to provide more effective patient care by increasing patient-centered communication between primary care physicians (PCPs) and hematologists. For this purpose, ASH has contributed several products to the ACP’s new resource tool, the High Value Care Coordination Toolkit (http://hvc.acponline.org/physres_care_coordination.html).

This toolkit aims at increasing coordination between PCPs and specialty physicians. The High Value Care Coordination Toolkit includes 5 main components that can facilitate effective, value-based care coordination between PCPs and subspecialist physicians to enhance patient care. These 5 components are:

  • A checklist for referring a patient to a subspecialty practice
  • A checklist for a response from the subspecialist to a referral request
  • Pertinent data sets to include in the referral
  • Care coordination templates between a PCP and a specialist
  • Recommendations on how to prepare a patient for a referral.

Specific ASH contributions to the toolkit include modifications to the ACP’s General Specialty Out-Patient Referral Request Checklist for hematology, as well as pertinent data sets to facilitate effective referrals between PCPs and hematologists for blood disorders, including anemia (or iron deficiency), bleeding and bruising, hypercoagulability, and lymphadenopathy.

The toolkit is part of the ACP’s High Value Care initiative (http://hvc.acponline.org/), which is designed to help physicians and patients understand the benefits, harms, and costs associated with specific tests and treatment options for common clinical conditions in an effort to incorporate these aspects of care and to improve the patient’s health, prevent inappropriate treatment, and reduce wasteful practices. American Society of Hematology Press Release; April 11, 2014


Experienced Nurses Reduce Hospital Stay and Costs, Improve Outcomes

Paying more for experienced nurses pays off in the final analysis, according to the results of a new study. When more experienced nurses leave, hospitals often hire new nurses and contract temporary nurses, which leads to reduced productivity because of the lack of skills and the lack of experience of the new nurses, the researchers found. By contrast, care improves significantly when provided by nurses with extensive experience in their job.

This conclusion is based on a study of 900,000 medical records of admitted patients during 4 years at Veterans Affairs hospitals. A 1-year increase in the experience of a nurse resulted in a 1.3% reduction in hospital stays. Furthermore, paying nurses overtime on a unit is more cost-effective than relying on temporary staffing.

“Reducing length of stay is the holy grail of hospital management because it means patients are getting higher quality, more cost-effective care,” commented senior author Patricia Stone, PhD, RN, Centennial Professor of Health Policy at Columbia Nursing. “When the same team of nurses works together over the years, the nurses develop a rhythm and routines that lead to more efficient care. Hospitals need to keep this in mind when making staffing decisions—disrupting the balance of a team can make quality go down and costs go up.” Bartel AP, et al. Am Economic J: Applied Economics. 2014;6:231-259


Where Is the Value? SGR and ICD-10 Extensions Pose New Obstacles to Improving Patient Care

What was supposed to be a permanent fix to the sustainable growth rate (SGR) that will put a stop to the deep cuts to physicians’ payments by Medicare ended in a temporary fix that delays the decision by 1 year, and even more surprising, this was further linked to a delay (by at least 1 year) of the conversion from the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) diagnostic and procedural codes to the new ICD-10-CM codes. So what was supposed to bring value to the issue of physicians’ pay has instead managed to outrage providers and provider practices by a temporary fix that creates more uncertainty regarding physician reimbursement and disrupts the many months of preparations by physician practices that were getting ready to transition to the ICD-10 coding system by October 1, 2014.

Ardis Dee Hoven, MD, President of the American Medical Association, said, “This bill perpetuates an environment of uncertainty for physicians, making it harder for them to implement new innovative systems to better coordinate care and improve quality of care for patients.”

Lynne Thomas Gordon, CEO of the American Health Information Management Association (AHIMA), said, “On behalf of our more than 72,000 members who have prepared for ICD-10 in good faith, AHIMA will seek immediate clarification on a number of technical issues such as the exact length of the delay.”

Health plans and providers’ practices have spent large amounts of time and money preparing for the transition to the ICD-10—only to be put on hold for another year or so. This is not the best use of healthcare dollars, to be sure. Modern Healthcare, www.modernhealthcare.com/article/20140331/NEWS/301019918; March 31, 2014


NIH Study Sheds Light on Genetic Link between Cancer and Aging—Can We Be on the Way to Prevention?

It is not new that aging is a risk factor for many types of cancer, but why this is the case was not understood. A recent study from the National Institutes of Health (NIH) has shed new light on that question, showing that the accumulation of age-associated biochemical changes in the process that helps to control genes may be at least in part responsible for the increased risk for cancer associated with old age.

Zongli Xu, PhD, and Jack Taylor, MD, PhD, from the National Institute of Environmental Health Sciences, which is part of the NIH, identified DNA methylation sites across the human genome that changed with age. They found that the sites that become increasingly methylated with advancing age are also disproportionately methylated in a variety of human cancers. Their data come from the blood samples of >50,000 women who have had breast cancer.

“You can think of methylation as dust settling on an unused switch, which then prevents the cell from turning on certain genes,” Dr Taylor said. “If a cell can no longer turn on critical developmental programs, it might be easier for it to become a cancer cell.” Dr Taylor said that DNA methylation appears to be part of the normal aging process and occurs in genes involved in cell development. Cancer cells often have altered DNA methylation; however, the team was surprised to find that 70% to 90% of the sites associated with age showed significantly increased methylation in 7 cancer types. Dr Taylor suggests that age-related methylation may disable the expression of certain genes, making it easier for cells to transition to cancer.

“On your 50th birthday, you would have 50 of these sites that have acquired methyl groups in each cell,” Dr Xu suggests. “The longer you live, the more methylation you will have.” NIH Press Release; February 3, 2014

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