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Health Care Quality Measurement for Doctors' Offices Needs Improvement In the Journal of the American Medical Association, Weill Cornell Researcher Suggests Ways to Improve Patient Safety and High-Level Care In its 2001 report Crossing the Quality Chasm, the Institute of Medicine outlined six domains of quality in medical care: safety, effectiveness, patient-centeredness, timeliness, efficiency and equity. But, Dr. Tara Bishop writes in a new viewpoint article published online March 21, in the Journal of the American Medical Association ( JAMA), current quality measures for the outpatient setting do not include all of these domains. As a result, quality measurement and quality improvement efforts in the outpatient setting have neglected critical areas of high quality care. "The majority of outpatient quality measures focus on preventive care, chronic disease care and, to some extent, timeliness of care and patient centeredness," says Dr. Bishop, an assistant professor of public health and assistant professor of medicine at Weill Cornell Medical College. Dr. Bishop is also the Nanette Laitman Clinical Scholar in Public Health/Clinical Evaluation and an assistant attending physician at NewYorkContinued on page 2
Frost & Sullivan: Growing Reimbursement Challenges Force Hospitals to Reengineer Revenue Cycle Management Ensuring financial stability in an era of transformative change drives demand for next-generation RCM solutions Today, hospitals are facing the twin burdens of Medicare and Medicaid cuts stipulated by the Affordable Care Act (ACA) — estimated at more than $150 billion in reductions over the next 10 years — in addition to the specter of additional cuts from the Budget Control Act of 2011. Most hospitals have long deployed automated systems to address core processes around revenue cycle management (RCM). However, these legacy IT applications often have outmoded technology platforms that lack the advanced functionality needed to address new models of care delivery and reimbursement. In addition, the complexity of medical billing and collections has created fragmented workflows across the patient accounts pathway, resulting in gaps and inefficiencies that lead to lost revenue.
New analysis from Frost & Sullivan's (http://connectedhealth.frost.com) U.S. Hospital Revenue Cycle Management: Overview and Outlook, 2012-2017 research finds the market for RCM applications and services in U.S. hospitals will grow significantly and steadily over the next five years. From the valuation of $1.90 billion in 2012, the total U.S. hospital RCM market is forecast to reach $3.07 billion in 2017, representing a 61.6 percent increase from 2012. The majority of revenues will come from replacements and/or updates of legacy RCM systems, in addition to an increased use of managed services and consultants that provide niche services around specific RCM pain points. For more information on this research, please email Britni Myers , Corporate
Communications, at britni.myers@frost. com with your full name, company name, title, telephone number, company email address, company website, city, state and country. Revenue cycle processes and workflows are receiving unprecedented attention as hospitals seek to ensure maximum collections in the face of growing financial challenges. Healthcare reform and the push for deficit reduction is forcing hospitals to address long-standing inefficiencies and shortfalls around the RCM process, driving the market for a host of next-generation RCM solutions. Frost & Sullivan Connected Health Principal Analyst Nancy Fabozzi , author of the analysis, emphasizes the urgency hospiContinued on page 4
Physicians Unite with Solar Energy Companies to Form New Group: Californians Against Utilities Stopping Solar Energy Utilities' Plans to Stop Rooftop Solar Threaten Public Health, Say Group co-Chairs A coalition of public health leaders and solar energy companies has formed CAUSE (Californians Against Utilities Stopping solar Energy) to combat monopoly utility efforts to kill rooftop solar. CAUSE is dedicated to maintaining a thriving solar industry in California, and to promoting the health and economic benefits that solar delivers to all Californians. The state's investor-owned utilities— PG&E, SDG&E and SCE—are trying to end net energy metering (NEM), a successful policy in 43 states that gives consumers fair credit for the solar they deliver to the grid. In simple terms, it's like rollover minutes on your cell phone bill. The utilities have taken aim at net metering to keep customers from taking action that would save ratepayers and taxpayers money while protecting public health. A January study by Crossborder Energy found that net metering will provide more than $92 million in annual benefits to ratepayers of California's three investor-owned utilities. Los Angeles-area physicians Luis Pacheco and Deonza Thymes are serving as co-chairs of CAUSE to help preserve Californians' ability to switch to clean solar electricity. "Ending rooftop solar in California would be a disaster for local job growth and environmental sustainability," said CAUSE co-Chair Dr. Luis Pacheco . "It would mean more carbon-emitting power sources and more dirty air. That's not a path toward the long-term wellness and economic health that our state needs." Dr. Pacheco is currently Medical Director of the Transitional Care Unit at California Hospital Medical Center in downtown Los Angeles. He has also served as Director of Pre-Doctoral Education for the Department of Family Medicine at the USC-Keck School of Medicine. Pacheco has been recognized for his public health advocacy by the American Diabetes Association, the National Head Start Educational Program, and the University of Southern California Keck School of Medicine's Family Medicine Teaching Program. "I grew up in a part of Los Angeles that is affected disproportionately by dirty air," added co-Chair Dr. Deonza Thymes . "I became a physician, in part, to help people with health conditions caused by pollutants. Now that we are making progress with solar, the utilities are trying to turn back the clock. They should be helping to give Californians the choice to go solar." Continued on page 4
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Seeks experienced MD/DO for immediate opportunity. We provide primary care services with a healthy mix of commercial, Medicare, Medicare Advantage, HMO, PPO, and cash paying patients aged 18 and up. We offer a wide variety of ancillary services including stress testing, cardiac and vascular ultrasound, radiology, and other testing. 1-2 year partnership track and earnings based on percentage of productivity. Full benefits, 401(k), malpractice, and relocation. Apply by sending your CV to hr@cmcb.com. No phone calls or faxes please.
Health Care
Great opportunity to join faith-based hospital-owned Urology practice in Calhoun, Georgia. Conveniently located 45 minutes south of Chattanooga, Tennessee and one hours north of Atlanta, Georgia, Calhoun offers many big city amenities, yet enables you to enjoy the abundant convenience of a relaxed southern lifestyle. Waiting patient population! * Competitive Salary (based on experience) * Sign-on bonus * Full benefits; relocation and malpractice. For more information email tracy.farriba@ahss.org or call 800.264.8642.
Do you share this intent? 35+ year old practice devoted to these guiding principles. Low malpractice and cost of living, on-site surgery center, mission minded, vibrant community with a university, great schools, low crime rate, and many ways to make a difference. New surgical hospital opening in 2011. Won’t you contact us? Kearney Orthopedic & Sports Medicine, Kearney, NE; Contact; Administrator, Vicki Aten, at 308865-2512 or vaten@kearneyortho. com.
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Faith based Family Practice in New Wilmington, PA seeking additional Family Physician CRNP, and or PA. FT/PT positions. Rapidly growing, currently 3 provider practice. Excellent salary and benefits. Prayerfully consider. Contact Jim Gardner III, M.D. 724-946-3564 (Ask for Lynn) or Email:jamesgardner3@mac.com.
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Presbyterian Hospital/Weill Cornell Medical Center. "But safety, high-level effectiveness, coordination and efficiency are not captured in the current measures of outpatient quality." Dr. Bishop notes that other health services researchers have pointed out that problems can arise when quality measurement centers on a small aspect of care and neglects others. These problems include the potential for unmeasured quality to be reduced and conclusions about overall quality to be drawn from a small segment of measured quality. For example, clinicians who are evaluated only for providing preventive care and chronic disease management might focus less on
equally (if not more) important aspects of care such as diagnostic accuracy and appropriateness of testing. "There are many changes being discussed and tried out in this country concerning how health care is paid for and delivered," says Dr. Bishop. Accountable care organizations (ACOs), primary care models such as the patient-centered medical home, paymentfor-performance and bundled payments all tie payment into measures of quality. Therefore, Dr. Bishop stresses it is important to revisit the issue of what quality is measured and consider ways to improve and expand quality measurement.
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"The medical community needs to focus more attention on patient safety measures and measures of high-level care," adds Dr. Bishop. "To begin, outpatient safety measures could be similar to ‘never' events that have been defined for the inpatient setting, such as surgery performed on the wrong site. In the outpatient setting, ‘never' events include prescribing errors that could lead to dangerous consequences; failure to inform patients of important test results; medicalsetting acquired infections; and failure to properly monitor for adverse effects of treatments. Examples of higher-level quality measures include diagnostic accuracy and diag-
nostic error prevention, treatment decisions for complex conditions or in the face of uncertainty, and judicious use of resources." Dr. Lawrence P. Casalino, the Livingston Farrand Associate Professor of Public Health and chief of the Division of Outcomes and Effectiveness Research at Weill Cornell says, "Dr. Bishop makes important suggestions for adding neglected areas of outpatient quality measurement to the current measures being used. Her strategies, if implemented, could significantly help to improve patient care." "This article explores the concept of ‘highlevel quality,' which is not sufficiently Continued on page 3
Family Practice Physicians Mission driven community health center system in Central VA has
several openings for dedicated Family Practice physicians. Whether you like the urban areas, the river life or the rural life, we have an area that needs your experience. CVHS has been serving the communities of Central Virginia since 1970 with 14 different locations.
Most of our sites offer comprehensive primary care as well as dental and behavioral health services. We offer a competitive compensation practice that includes a generous benefit plan, matching retirement benefits and time off. Check out our website at www.cvhsinc.org or email hr@cvhsinc.org for more information on our practice opportunities.
PRIVATE PRIMARY CARE PRACTICE BEAUTIFUL VIRGINIA MOUNTAINS Family Health Care Associates In The Heart Of Beautiful Southwest Virginia, a progressive, multi-specialty, primary care practice located in the beautiful highlands of Southwest Virginia is seeking qualified, Board Certified/Board Eligible Internal Medicine and Family Medicine physicians. Since 1980, the founding partner & practitioners have actively served the families of the county and surrounding area. FHCA consists of a board certified family and geriatric physician and two certified family nurse practitioners. FHCA features EMR, moderate complexity lab, digital radiology, and staff dedicated to treating patients both physically, spiritually and emotionally. Enjoy an outstanding quality of life and work. In return, a VERY competitive income guarantee, sign-on bonus and relocation expenses, vacation and CME. Loan repayment and monthly stipend during final year of training – negotiable.
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For information contact: Robbie W. Colley, Regional Director, Medical Staff Development, Mountain States Health Alliance: 276-378-1291 ColleyRW@msha.com
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CHRISTIAN RECRUITER TENNESSE GREAT OPPORTUNITY
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On the coast of Virginia (Virginia Beach, and Chesapeake area) in well established/lucrative practices. Mild climate, population base 1.6M, variety of cultural community, and outdoor activities, tertiary care center/medical school. Strong economic base with steady population
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WASHINGTON NORTHWEST PEDIATRIC CENTER
Located in beautiful Western Washington, is seeking a full time Board Certified/Board Eligible Pediatrician or Advanced Regis tered Nurse Practitioner for a growing Pediatric practice. Currently Northwest Pediatric Center consists of 4 offices, 7 Pediatricians, 1 Psychiatrist, and 5 ARNP’s. All of our facilities are certified Rural Health Clinics and we have several outreach clinics. Main location is Centralia, Washington which is situated halfway
between Seattle and Portland along the I-5 corridor. For more information please contact Lisa McKay. Phone: (360) 736 -6778, Fax: (360) 736-6522, Email: lmckay@nwpeds. com. Visit our website at www. nwpeds.com.
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May be taken in person or online. June 11-August 2, 2013. Sponsored by West Virginia University School of Medicine Office of Continuing Education and the Global Health Program. Contact Nancy Sanders (304) 293-5916, email nsanders@ hsc.wvu.edu for more information.
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addressed in current measures of patient care quality," says Dr. Alvin I. Mushlin, the Nanette Laitman Distinguished Professor and chairman of the Department of Public Health at Weill Cornell. "As Dr. Bishop alludes, the emphasis on higher level quality measures like diagnostic accuracy and eliminating diagnostic errors has the potential to garner more support from practicing physicians since this is a goal that they all strive for." "And this may be an optimal time to push the outpatient quality envelope," says Dr. Bishop, and she outlines why. According to Dr. Bishop, the medical community is defining more and more quality measures through comparative effectiveness research and through expert panels when that research is incomplete or inconclusive. Also, electronic medical records can now more easily capture clinical data that are not captured in claims. In addition, there is interest in new measures and increasing funding for development of these measures through organizations such as the PatientCentered Outcomes Research Institute (PCORI). "Although it will be challenging, improving quality measurements of outpatient care needs to be a priority for the medical com-
munity, and more work must be done to develop, test and use new measures," says Dr. Bishop. This study was supported by a National Institute on Aging Career Development Award and in part by funds provided to Dr. Bishop as a Nanette Laitman Clinical Scholar in Public Health. Weill Cornell Medical College, Cornell University's medical school located in New York City, is committed to excellence in research, teaching, patient care and the advancement of the art and science of medicine, locally, nationally and globally. Physicians and scientists of Weill Cornell Medical College are engaged in cutting-edge research from bench to bedside, aimed at unlocking mysteries of the human body in health and sickness and toward developing new treatments and prevention strategies. In its commitment to global health and education, Weill Cornell has a strong presence in places such as Qatar, Tanzania, Haiti, Brazil, Austria and Turkey. Through the historic Weill Cornell Medical College in Qatar, the Medical College is the first in the U.S. to offer its M.D. degree overseas. Weill Cornell is the birthplace of many medical advances -- including the development
of the Pap test for cervical cancer, the synthesis of penicillin, the first successful embryo-biopsy pregnancy and birth in the U.S., the first clinical trial of gene therapy for Parkinson's disease, and most recently, the world's first successful use of deep brain stimulation to treat a minimally conscious brain-injured patient. Weill Cornell Medical College is affiliated with
NewYork-Presbyterian Hospital, where its faculty provides comprehensive patient care at NewYork-Presbyterian Hospital/Weill Cornell Medical Center. The Medical College is also affiliated with the Methodist Hospital in Houston. For more information, visit weill. cornell.edu.
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Dr. Thymes is a lead physician at Western Medical Center's Department of Emergency Medicine in Anaheim, CA. She completed her Emergency Medicine residency at King/ Drew Medical Center in south central Los Angeles and holds a medical degree from Ohio State University College of Medicine. Dr. Thymes is a frequent guest speaker at Los Angeles area health fairs, churches, and schools, lecturing on topics from health and aging to diabetes and diet/nutrition. As people use more rooftop solar, they buy less electricity from utilities. By trying to stop rooftop solar, utilities are betraying public health and economic benefits to protect their profits.Two-thirds of California home solar installations now occur in low and median income neighborhoods, according to a July 2012 California Solar Initiative report issued by the California Public Utilities Commission. California has installed more than 1,400 MW of rooftop solar capacity – the equiva4
lent of nearly three dirty, coal-fired power plants. This solar electricity is pollution-free and generated from an inexhaustible source. The California solar industry employs more than 43,000 workers and has driven $10 billion in private investment in the state over the past five years. Industry analysts credit net metering as the cornerstone policy for continued solar growth. "We are proud to stand with California companies like Sunrun, SolarCity, and others in our community to save solar and the green economy," continued Dr. Thymes. "More rooftop solar means cleaner air, and healthier communities. That's something we can all stand behind." Californians Against Utilities Stopping Solar Energy www.prnewswire.com
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About Frost & Sullivan Frost & Sullivan, the Growth Partnership Company, works in collaboration with clients to leverage visionary innovation that addresses the global challenges and related growth opportunities that will make or break today's market participants. Our "Growth Partnership" supports clients by addressing these opportunities and incorporating two key elements driving visionary innovation: The Integrated Value Proposition and The Partnership Infrastructure. The Integrated Value Proposition provides support to our clients throughout all phases of their journey to visionary innovation including: research, analysis, strategy, vision, innovation and implementation. The Partnership Infrastructure is entirely unique as it constructs the foundation upon which visionary innovation becomes possible. This includes our 360 degree research, comprehensive industry coverage, career best practices as well as our global footprint of more than 40 offices. For more than 50 years, we have been developing growth strategies for the global 1000, emerging businesses, the public sector and the investment community. Is your organisation prepared for the next profound wave of industry convergence, disruptive technologies, increasing competitive intensity, Mega Trends, breakthrough best practices, changing customer dynamics and emerging economies?
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tals are feeling around the need to ensure financial stability for the future. "The focus in recent years was clearly on installing or upgrading clinical systems, particularly electronic health records (EHRs), and that is still a top concern for many healthcare providers," explained Fabozzi. "But the reality of 2014 is sinking in fast." Legacy RCM solution providers, particularly the large, diversified healthcare IT (HIT) vendors, failed to innovate over the past decade, which opened the door for vendors of point solutions that provide added functionality to core systems. "However, as competitive pressures heat up and the market for clinical systems matures, the large, established HIT vendors will increasingly take on more of an entrepreneurial spirit and broaden their efforts to drive innovation across all their product offerings, not just clinical solutions," continued Fabozzi. "This scenario will likely create a highly dynamic market characterized by robust M&As as large vendors seek to quickly add new functionalities required by healthcare reform." The hospital RCM market is primarily a replacement market, and this may or may not include a switch in vendors. Explained Fabozzi, "hospitals, in general, are rather conservative and most would prefer not to rip and replace unless they must." U.S Hospital Revenue Cycle Management: Overview and Outlook 2012-2017 and its companion analysis, U.S. Physician Revenue Cycle Management: Overview and Outlook, 2012-2017, are part of the Connected Health Growth Partnership Service program, which also includes research in the following markets: health information exchange, health data analytics, telehealth, emerging wireless technologies, acute care information systems, enterprise clinical information systems, and billing and revenue cycle management systems. All research ser-
EDITORIAL Editor ..................................................................Andrea Coulter PRODUCTION & CIRCULATION Production Manager ...........................................Andrea Coulter Graphic Designer ..............................................Andrea Coulter Circulation ..........................................................Andrea Coulter Publisher .................................................................Will Johnson ADVERTISING SALES Director of Sales ...................................................Will Johnson HOW TO CONTACT CHRISTIAN RECRUITER Mail: Christian Recruiter, PO Box 30327 Portland, OR 97294-3327 Telephone: (503) 221-1260 Fax: (503) 221-1545 E-mail: cpr@propubinc.com Web site: www.cprclassifieds.com LETTERS TO THE EDITOR Please send your comments, questions or suggestions to the Editor. We reserve the right to edit all submissions; letters must include your name, address and daytime telephone number.
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