CT hospitals well below US average in patient satisfaction

Patients at New Haven hospitals are the most satisfied in CT, but the bar is pretty low. New Haven’s hospitals ranked 204th out of 295 hospital referral regions in patient satisfaction, according to a calculation by Kaiser Health News based on HHS data. Hartford’s hospitals ranked 215th and Bridgeport’s were 227th. If you were thinking of going out of state for a better experience, you’ll have to go far. Only Maine and New Hampshire among the eight Northeastern states had hospital regions with better than average patient satisfaction ratings. To see how specific CT hospitals fared, go to CT Health I-Team’s hospital search page. Medicare will soon begin paying hospitals based, in part, on patient satisfaction.
Ellen Andrews

New regional patient safety organization created

NEVER is a new collaboration of New England consumer advocates working to improve the safety of health care services in our region. Connecticut’s Jean Rexford, founder of CT Center for Patient Safety, is a leader in the new effort. The group is working to give consumers tools to improve their care, compare providers and facilities in quality, and reduce costly, harmful overtreatment.
Ellen Andrews

CT asthma rates up, cities hit hardest

A CT Health I-Team analysis of new DPH data finds that almost one in ten CT adults had asthma in 2009, up from 7.8% in 2000. Adults in CT’s five largest cities are three times more likely to visit an ER or be hospitalized for asthma than the state average. We often forget that it can be a fatal disease; urban adult state residents are also twice as likely to die of asthma. The urban/suburban divide is also reflected among children – 19.2% of children in Hartford, Waterbury, New Haven and Bridgeport suffer from the disease while only 7.4% of students in Darien, Madison and Greenwich are affected. It’s also very costly – CT spends over $17 million and $6 million annually on asthma hospitalizations and ER visits, respectively, mainly paid for by Medicaid and Medicare. The article describes nine programs and initiatives aimed at helping patients manage and prevent the disease.
Ellen Andrews

Advocates file ethics complaint over health insurance exchange insurance reps

A group of eight organizations, led by Citizens for Economic Opportunity and including the CT Health Policy Project, have requested an inquiry into the appointment of three members of the CT Health Insurance Exchange. The letter asserts that the appointments violate the law that created the Exchange which excludes membership by anyone “affiliated with or otherwise a representative of” insurance companies. The three members outlined in the letters have long work histories with insurers and little evidence of significant or recent experience outside the insurance industry.
Ellen Andrews

Super Committee and HEP, PCMH webinar videos and slides online

Webinar slides and videos are now posted for our last two webinars. Last week we heard from Kate McEvoy of the State Comptroller’s Office about the state employee plan’s Health Enhancement and Patient-Centered Medical Home Projects. Chris Whatley from CSG’s Washington office talked Monday about the Congressional Super Committee, federal budget negotiations and the impact on states.

CSG/ERC Webinar – update from the Congressional Super Committee

Join Chris Whatley from CSG’s Washington office Monday, Nov. 14th at 10 am to hear where the Congressional “Super Committee” is in their deliberations and what it means for states. The Super Committee (Joint Select Committee on Deficit Reduction) was formed as part of the budget deal this summer and includes 12 members evenly divided between the parties and the houses of Congress. The committee is scheduled to report on its recommendations by the 23rd of this month to save $1.2 trillion over the next ten years. If the committee doesn’t report or their recommendations are not adopted by the full Congress, significant budget cuts are automatically triggered. To register, go to https://www1.gotomeeting.com/register/535091305

Advocate and small business concerns about CT insurance exchange

Together with Small Businesses for a Healthy CT, the CT Health Policy Project has been meeting with CT Health Insurance Exchange Board members. The Board has been criticized for lacking consumer representation. Our concerns center on rebuilding public trust, effective outreach and public education, active purchasing to use the collective power of the exchange to get the best value for members, maintaining an even playing field inside and outside the exchange, a grownup conversation on mandates, and coordination with Medicaid. We are finding a lot of overlap and some of our best support is coming from unlikely sources. The Board is currently seeking a CEO.
Ellen Andrews

Medicaid PCMH update

Today’s Care Management Committee meeting (formerly the PCCM Committee) in Hartford was frustrating. DSS and their consultants outlined their final plan for CT Medicaid’s person-centered medical home (PCMH) transformation. Unfortunately the final plan is not substantially different than the original proposal which raised concerns among advocates. Most contentious was DSS’ refusal to match consumers and PCMHs prospectively, and to pay providers based on that linkage. Based on strong evidence of improved health outcomes, advocates argued for an enrollment/attribution process to ensure that every person knows who their personal PCMH is -- who they should call first with a problem, who is watching out for their health. It is equally important that every PCMH understand, up front, which people they are responsible for. The lack of attribution also creates the possibility that NCQA-certified PCMHs will get enhanced payment rates for services provided to patients whose care is being coordinated by another practice, similar to criticisms of retail clinics by primary care practices. DSS raised some operational issues within the department as barriers to creating that essential linkage and remains committed to an enhanced fee-for-service (FFS) payment system. Advocates and others have criticized FSS for encouraging duplication and over-utilization of services, and discouraging care coordination and non-traditional care delivery such as email, phone communication, group visits, etc. Enhanced FFS also provides practices with incentives to hire more clinicians to drive more visits while per member per month prospective payments support whatever resources are most effective to improve care, including hiring care managers. The modest increase in payment rates (10% to 20%) DSS is proposing will occur in the context of much larger Medicaid primary care rate increases in 2013 under national reform when, for example, adult medicine rates will double on average, for all providers regardless of whether they are PCMHs or not. DSS acknowledged the issue and stated that they intend the program to serve only as a bridge to a wider transformation of Medicaid and will likely only appeal to providers who already serve a significant Medicaid population and are already planning PMCH transformation. While improved over the last version, the proposal’s reimbursement model budget justification continues to emphasize physicians over other members of the PCMH team, devoting almost half of total on-going costs to physician time. They did increase upfront payments to small practices (5 FTEs or less could get up to $25,000 per year for 3 years) above the original glide path payments before practices are PCMH certified. While providers and consultants were intimately involved in development of the plan and their concerns are reflected in added costs for the proposal, advocates strongly objected to representations that the process was respectful and inclusive of all voices.
Ellen Andrews