Health care “disruption” doesn’t have any rules!

Novel strategies often “appear” full blown. Sometimes they appear to be counterintuitive. Often there seem to be conflicting ideas out there. New players enter the competition. There is no continuum within which to place different initiatives.
So DOCTOR is taking a break to try to learn more and perhaps might come back “disruptively”!
Here are some examples I have found in the past few weeks to get myself started.

“What I hear is providing insights into what issues will be top of mind with healthcare leaders in 2018. Thus, here’s a short list of delivery trends to watch for in the coming year:
1. Efficiency will become a top priority. Revenues are flat while expenses continue to rise for most medical providers, so medical groups and health systems must continue to make their practices more efficient…
2. Physician burnout will be a strategic imperative. Addressing physician burnout will become a priority in the boardroom as leaders will demand initiatives to stem this epidemic. Many will add burnout metrics to their dashboards…
3. Competition for convenience will heat up. Patients—especially millennials—will continue to drive the demand for quicker, more accessible options to receive care..
4. Scope-of-practice issues will become more acute. The underutilization of many healthcare professionals―including pharmacists, nurses, physician assistants or behavioral health specialists―will lead to increased demands to expand their ability to treat patients more autonomously…
5. Practices will form more community partnerships. The move to value-based payment systems and the accountability for an attributed population means that healthcare systems will need to work with community partners to address some of the root causes of poor outcomes and resultant higher costs…” (A)

“Medicine currently follows the capitalistic model of other American industries: A fee is paid whenever a service or good is delivered. This incentive-based approach works well in most every industry, but not in health care. Fee-for-service encourages more tests and treatments, some of which are completely unnecessary. More health care does not mean better health care.
Instead of volume, we need to incentivize value by rewarding better health outcomes resulting from efficiently delivered, proactive care that keeps patients healthy.
When providers are incentivized to maintain health rather than respond to illness, they treat patients earlier in low-cost environments, like neighborhood clinics, before health problems become serious and require expensive care in a hospital setting. Those who can deliver more value by keeping patients healthy should be able to share in the savings of the health-care expenditures they have reduced.
Providers who spend more than would normally be expected for a given patient should receive no incentive payments. Furthermore, in this shift to value, there is appropriate fiscal support and incentive for the care that needs to happen in between physician visits (for example, disease education, health coaching and other ongoing care-management work). In this kind of system, the interests of payers, providers and patients become aligned.
Keeping patients healthy and out of the hospital
It can be done. Kaiser Permanente, which serves patients in eight states and the District of Columbia, combines hospitals and outpatient clinics with its own nonprofit insurance plan. Kaiser has a fixed annual amount to care for each member, so there is an inherent incentive to keep patients healthy and out of the hospital, where care is most expensive. Because its structure aligns the interests of payers, providers and patients, Kaiser operates efficiently and they are not alone. In fact, many other health systems, including the Mount Sinai Health System, are creating the same incentive model in partnership with private health plans.
By integrating the mobile and digital technology that is part of our everyday lives, medicine will be able to lower the number of hospital admissions….
Taken one step further, the Hospital at Home concept, which Mount Sinai Health System began in 2014, allows patients to be monitored closely from their own bedrooms and receive daily visits from a doctor or nurse practitioner, as well as home nursing care, lab services and medical equipment in their home, which is far less costly than remaining in the hospital…” (B)

“Oscar Health said its partnership with the Cleveland Clinic to offer individual coverage in Ohio under the Affordable Care Act has greater market share than anticipated in its first year.
The New York-based startup, which has expanded Obamacare offerings this year to more states, said it enrolled more than 11,000 members in its co-branded health plans with the Cleveland Clinic. Executives said the enrollment was higher than expected and accounts for about 15% of the individual health insurance market in the five-county northeast Ohio area. Oscar Health’s total enrollment is up 150% , or more than 250,000, after expanding into several new markets including the Cleveland area.
The enrollment is significant in part because individual health plans need enough customers for their risk pools, paying claims of sick patients and leaving enough to turn a profit and invest in product offerings. Bigger carriers including Anthem, Aetna and UnitedHealth Group scaled back their Obamacare offerings for 2018 after being unable to manage the rising costs of sick patients purchasing coverage.
The Cleveland Clinic-Oscar Health partnership is being watched closely as providers take on more financial risk in forming closer ties with insurance companies. CVS Health and Aetna are expected to offer more co-branded health plans once their deal closes later this year while Blue Cross and Blue Shield plans are also offering an increasing number of plans branded with providers in local markets.
Cleveland Clinic and Oscar describe their partnership as “a true 50/50 profit sharing of premium revenue.” Though early in their first year of operation, executives said one out of three Oscar health plan members have “already chosen a Cleveland Clinic primary care physician through Oscar health’s onboarding platform online.” (C)

“For years, hospital executives have expressed frustration when essential drugs like heart medicines have become scarce, or when prices have skyrocketed because investors manipulated the market.
Now, some of the country’s largest hospital systems are taking an aggressive step to combat the problem: They plan to go into the drug business themselves, in a move that appears to be the first on this scale.
“This is a shot across the bow of the bad guys,” said Dr. Marc Harrison, the chief executive of Intermountain Healthcare, the nonprofit Salt Lake City hospital group that is spearheading the effort. “We are not going to lay down. We are going to go ahead and try and fix it.”
While Intermountain executives would not name the drugs they intend to make, hospitals have long experienced shortages of drugs like morphine or encountered sudden price increases for old, off-patent products like the heart medicine Nitropress. Hospitals have also come under criticism for overcharging for their services, including for some drugs.
Several major hospital systems, including Ascension, a Catholic system that is the nation’s largest nonprofit hospital group, plan to form a new nonprofit company, that will provide a number of generic drugs to the hospitals. The Department of Veterans Affairs is also expressing interest in participating.
In all, about 300 hospitals are now included in the group. Other hospitals are expected to join.
Dr. Harrison said they planned to focus only on certain drugs. “There are individual places where there are problems,” he said. “We are not indicting an entire industry.”
Dr. Kevin A. Schulman, a professor of medicine at the Duke University School of Medicine who has studied the generic drug market and is advising the effort, said: “If they all agree to buy enough to sustain this effort, you will have a huge threat to people that are trying to manipulate the generic drug market. They will want to think twice.”
The idea is to directly challenge the host of industry players who have capitalized on certain markets, buying up monopolies of old, off-patent drugs and then sharply raising prices, stoking public outrage and prompting a series of Congressional hearings and federal investigations. The most notorious example is of Martin Shkreli, the former hedge fund manager who raised the price of a decades-old drug, Daraprim, to $750 a tablet in 2015, from $13.50…”(D)

“The shift toward consumerization in health insurance got rolling with passage of the Affordable Care Act in 2009 and has been gradually gaining speed since then. Now, retail giant CVS’s $69 billion agreement to buy Aetna has put a brick on the accelerator of consumerization in this space.
One driving force behind the CVS-Aetna deal may be the fear that Amazon, the e-commerce juggernaut from Seattle, is plotting a conquest of the pharmacy business. Whatever CVS’s motivations, its entry into the health insurance marketplace will force the industry to become more consumer friendly. That means injecting a huge dose of technology — especially data-analytics technology — along with marketing know-how into a business that has traditionally resisted change and innovation.
CVS will bring Aetna not only a wealth of consumer experience and relationships but also a level of technological savvy that the health insurance industry has never seen. The combined entity will possess massive amounts of data about Aetna’s members. It shouldn’t take long before CVS brings technology to bear that can help Aetna members better manage their prescription medicines, steer them toward CVS’s in-store care clinics, and offer vastly improved tools for managing their care and insurance online.
The deal will leave competing health insurance executives with no choice but to modernize their offerings and provide a user experience that approaches the standards set in the retail and consumer worlds….” (E)

“In that burst of activity, three transactions are of particular note: CVS Health’s (CVS) proposed acquisition of insurance giant Aetna (AET); Humana’s (HUM) intention to take a minority stake in Kindred (KND), a home health and hospice company; and UnitedHealth Group’s (UNH) plan to acquire Colorado-based DaVita’s (DVA) primary and urgent care business.
Interestingly, all of these combinations have a common goal: Keep patients out of high-cost hospitals by providing alternative care settings.
To understand the most recent wave of health care deals and the effect they may have on consumers, it’s important to understand the backdrop, explained Andrea Harris, senior healthcare analyst at Height Securities and a former staffer at the U.S. Department of Health and Human Services. For years, hospitals have been consolidating across the country, and the trend continued with a slew of big regional deals announced in 2017. In many areas, hospitals are now concentrated enough to dictate prices to even the biggest insurance company payers, said Harris
In part to fight back, insurers tried, unsuccessfully, to undergo their own wave of consolidation back in 2016. That’s when mega-insurers Aetna and Humana and Cigna (CI) and Anthem (ANTM) proposed merging, but both deals were blocked by the Department of Justice.
Now the trend has turned toward integrating other types of health care providers and systems in an effort to provide relief from high-cost hospital care, Harris explained. These deals are less likely to face regulatory scrutiny because insurers are expanding their businesses into areas that cause little overlap in services.
The most dramatic example is the $69 billion CVS-Aetna transaction. The hope is the merged companies would provide a willing group of patients to use CVS’ local clinics and disease management services to avoid hospital visits. By the same token, Humana wants a piece of Kindred so it can provide home health services to customers who might otherwise go to the hospital. And UnitedHealth’s alliance with DaVita will add 300 clinics in six states to UnitedHealth’s network of urgent care centers….” (F)

The renovation and expansion of Lucile Packard Children’s Hospital Stanford has been in the works for more than a decade, and this month it moved patients into the new facility for the first time.
The goal of the redesign was to create a facility with patients—and caregivers—in mind, said CMO Dennis Lund, M.D., the hospital’s chief medical officer, in an interview with FierceHealthcare. The hospital has gardens for patients and families alongside balconies and quiet spaces for clinical workers to take a breather.
“That’s especially important,” Lund said. “We can’t have successful patient care if we don’t have happy and satisfied staff.”
When the hospital first opened in 1991, it was designed to serve as a space where children could recover from care, not necessarily as a destination for pediatric care, Lund said. The original facility did not offer imaging services or have any operating rooms, so patients were sent to the adjacent Stanford University Medical Center.
As Lucile Packard began to expand its portfolio, adding complex procedures like transplantation and advanced cancer care, the need for a larger and more advanced space become evident. The new hospital is 521,000 square feet, more than double the previous children’s and obstetrics facility, and has added 149 beds for a total of 361 on the Palo Alto campus.
Alongside spaces designed to ease the stress of the care experience, Lucile Packard has expanded and modernized its imaging and treatment centers. Some elements, like new surgical suites and a neuro-interventional lab, are still under construction and set to open next year, the hospital recently announced.
Lund said the new suites will streamline the care process for certain procedures. Having adjoining spaces for different steps along the care journey will make the process faster and requires less anesthesia for the children, he said.
The investment in imaging includes a new positron emission tomography (PET) and MRI machine. The equipment allows clinicians to better craft care plans to a patient’s needs and can allow them to better monitor the spread of disease. It’s the only PET/MRI dedicated to pediatric care in the northern part of California, the hospital said….” (G)

“Dr. Mitchell H. Katz, the new president of NYC Health & Hospitals, is the system’s third leader in four years. Credit NYC Health & Hospitals
The incoming president of NYC Health & Hospitals wants to turn the nation’s largest public health care network into an agency that focuses less on hospitalized care and more on primary care, similar to initiatives carried out nationwide.
The new president, Dr. Mitchell H. Katz, who begins his job on Monday, also said he would expand the use of eConsult, an electronic health management system to streamline care and reduce wait times for specialty appointments, evaluate staff allocation and consider decreasing administrative services such as “unnecessary consultant expenses” to increase savings and revenue.
“I’m all about trying to strengthen public hospitals,” Dr. Katz, the former director of the Los Angeles County Health Agency, said in a recent phone interview. “Public hospitals are incredibly precious. If you don’t look out for them, they’ll disappear.”
Health & Hospitals, a sprawling system of 11 hospitals, five nursing facilities and more than 70 community-based health care centers and extension clinics, faces many challenges: shrinking state and federal funds, a decline in patient population, a large uninsured and underinsured patient population and a funding gap that is expected to balloon to $1.8 billion by the 2020 fiscal year.
In fact, Mayor Bill de Blasio’s administration warned in a report two years ago that the system was “on the edge of a financial cliff” and proposed restructuring and increased city subsidies.
“This is a deficit operation,” said Stanley Brezenoff, the system’s former interim chief executive. “You’re finding ways to close gaps.”
But more needs to be done to “reinvent and remodel the delivery system of Health & Hospitals,” Mr. Brezenoff said. “We have a long way to go.”” (H

“New Jersey is now home to two mega health care systems, which account for nearly half of all acute care hospitals in the state.
But declaring one the biggest in the state is difficult.
Hackensack Meridian Health said it was in the top spot after officially announcing JFK Health has joined the system last Wednesday.
But it is difficult to determine what numbers back that claim up.
HMH, with JFK joining its network, will have a total of 16 hospitals, 4,520 beds and employs nearly 33,000, including 6,500 staff physicians.
RWJBarnabas Health, which was previously touted as the largest system in the state, also has a total of 16 hospitals, 5,066 beds, 33,000 employees, plus 9,000 physicians.
HMH now has a total of 160 locations of all kinds in New Jersey. RWJBarnabas said it has 242 licensed patient care locations.
Both are claiming annual revenues at or near $5.5 billion…” (I)

“The City Council is attempting to recuperate millions of dollars from tax-exempt property owned by the Hackensack University Medical Center.
The city has filed an omitted assessment appeal for the non-profit hospital and its properties. By filing the appeal, the city wants to prompt negotiations with Hackensack Meridian Health, which owns the city hospital. City officials want to have the company pay some of the estimated $19 million in tax dollars it would owe the city if its land was not exempt from property taxes.
“There’s a lot of pressure on these hospitals at this time to make some payment of taxes to the host communities,” said Art Carlson, the city’s tax assessor. “We realize that the hospital is a great asset to the city, but that doesn’t preclude it from some kind of payments in lieu of taxes being assessed.”
Mayor John Labrosse declined to comment on the city’s appeal, citing his employment as a safety specialist at the hospital. Nancy Radwin, a Hackensack Meridian Health spokeswoman, declined to comment.
The appeal comes in the wake of a landmark tax court decision against the Morristown Medical Center in 2015. In a years-long case, Morristown council sought payments from tax appeals it filed against the hospital as far back as 2006. The hospital’s designation as a tax-exempt, charitable institution had shielded it from paying taxes on the properties it owned in town.
Ultimately, Judge Vito Bianco ruled that the medical center ran more like a for-profit corporation than a non-profit, charitable institution.
In a 2016 settlement, the hospital agreed to pay Morristown $15.5 million for 10 years of taxes and interest. The hospital also agreed to pay additional taxes for 10 years on spaces leased to restaurants, shops and private doctors. (J)

“Fairview Health Services CEO James Hereford called Epic Systems Corp. an “impediment to innovation” and said there is an opportunity for health care executives to exert more influence over the Wisconsin-based electronic-medical-records giant.
Epic, a privately held company with about $2.5 billion in annual revenue, is a dominant player in the EMR business and counts most major Twin Cities health systems among its clients. (Outside the metro area, Mayo Clinic is spending more than $1 billion to migrate all its medical records onto Epic’s platform.)
“I will submit that one of the biggest impediments to innovation in health care is Epic, because the way that Epic thinks about their [intellectual property] and the IP of others that develop on that platform,” Hereford said at a panel discussion hosted by the Business Journal last week. “There are literally billions of dollars in the Silicon Valley chasing innovation in health care. And Yet Epic has architected an organization that has its belief that all good ideas are from Madison, Wisconsin. And on the off chance that one of us think of a good idea, it’s still owned by Madison, Wisconsin.”
Epic is headquartered in Verona, which is about 10 miles from Madison.
Hereford spoke on a panel made up of CEOs from Twin Cities health care organizations such as HealthPartners Inc., Medica and Summit Orthopedics. He said health care executives collectively could do more to encourage Epic to change its approach.
“There is an opportunity for us to go to Epic and say, ‘Look, you have to open up this platform,’ ” he said. “It’s for our benefit in terms of having an innovative platform where all these bright, amazing entrepreneurs can actually have access to what is essentially 80 percent of the U.S. population that is cared for within an Epic environment. I would love for us to get together to see how we march on Madison.”
Critics have long argued that Epic takes an overly closed-off approach to its software, hindering the sharing of data to outside organizations and patients, as well as between health care providers…” (K)

“Amazon is looking to hire an expert in a set of health privacy regulations known as HIPAA, according to a new job listing.
The company is looking for a professional who can “own and operate” the security and compliance aspects of a new initiative. The person will also ensure that it meets HIPAA business associate agreement requirements, meaning Amazon intends to work with outside partners that manage personal health information.
It is also hoping the new hire will provide a consultative resource for all health-care regulatory issues.
Amazon is the latest technology company, after Apple and Alphabet, to make moves in health care. As CNBC reported in spring 2017, the company strategized how it could carve out a slice of the multibillion-dollar pharmacy market. It also has a health-care team at in Seattle, known by many names including “1492.”
One more immediate reason that Amazon might be looking for a health privacy expert is to augment its efforts to bring its Alexa voice assistant to health care.
The technology is not yet HIPAA compliant, which means developers aren’t able to record patients’ lab results or other types of health information in a clinical setting.
Amazon Web Services’ health lead acknowledged the gap in September at an event to promote Alexa in hospitals. “While Alexa and Lex (the technology powering Alexa) are not HIPAA-eligible, this (challenge) has provided us an opportunity to envision what is possible,” she said.
In the summer, Amazon hired Missy Krasner, herself an expert in health policy, who formerly ran Box’s health care initiatives.” (L)

“If you’ve ever struggled to access your medical information, like a lab test or immunization, Apple is trying to make your life easier.
On Wednesday, the company is releasing the test version of a new product that lets users download their health records, store them safely and show them to a doctor, caregiver or friend.
“We view the future as consumers owning their own health data,” Apple Chief Operating Officer Jeff Williams said in an interview with CNBC.
It all works when a user opens the iPhone’s health app, navigates to the health record section, and, on the new tool, adds a health provider. From there, the user taps to connect to Apple’s software system and data start streaming into the service. Patients will get notified via an alert if new information becomes available.
In June, CNBC first reported on Apple’s plans, including early discussions with top U.S. hospitals. The company confirmed that it has contracts with about a dozen hospitals across the country, including Cedars-Sinai, Johns Hopkins Medicine, Penn Medicine and the University of California, San Diego.
The medical information available will include allergies, conditions, immunizations, lab results, medications, procedures and vitals. The information is encrypted and protected through a user’s iPhone passcode.”…(M)

“Google CEO Sundar Pichai believes artificial intelligence could have “more profound” implications for humanity than electricity or fire, according to recent comments.
Pichai also warned that the development of artificial intelligence could pose as much risk as that of fire if its potential is not harnessed correctly.
“AI is one of the most important things humanity is working on,” Pichai said in an interview with MSNBC and Recode, set to air on Friday, January 26. “It’s more profound than, I don’t know, electricity or fire.”
Pichai went on to warn of the potential dangers associated with developing advanced AI, saying that developers need to learn to harness its benefits in the same way humanity did with fire.
“My point is AI is really important, but we have to be concerned about it,” Pichai said. “It’s fair to be worried about it—I wouldn’t say we’re just being optimistic about it— we want to be thoughtful about it. AI holds the potential for some of the biggest advances we’re going to see.
“Whenever I see the news of a young person dying of cancer, you realize AI is going to play a role in solving that in the future. So I think we owe it to make progress too.”” (N)

“Reducing diagnostic errors is a crucial component of improving care quality, but current methods of monitoring such mistakes may be time consuming. Now, researchers at Johns Hopkins have developed a strategy that uses big data to speed up the process.
David Newman-Toker, M.D., director of the Center for Diagnostic Excellence at Johns Hopkins’ Armstrong Institute for Patient Safety and Quality, and his team developed a new approach called SPADE (Symptom-Disease Pair Analysis of Diagnostic Error) to allow providers to harness databases instead of having staff members comb medical records for more information, according to a study published in BMJ Quality & Safety.
SPADE uses statistical analyses to find and flag patterns that can predict diagnostic errors. It mines available databases for common symptoms that lead patients to visit a doctor and then compares those data with diseases that are often misdiagnosed.
For example, SPADE would illustrate how frequently patients who visit a provider with dizziness are sent home because doctors believe the condition is minor, when they had actually suffered a stroke, Newman-Toker said in an announcement. Having these data available would improve outcomes and could refine quality measures to better reflect patients’ concerns.
“Being able to do that using big data is an important innovation for diagnostic quality and safety,” he said.
Diagnostic errors are an industry-wide issue. A recent Mayo Clinic study suggested that more than 20% of patients are misdiagnosed by their primary care doctors. Physicians can mitigate the risk by seeking out a second opinion or taking a “time out” prior to surgery to ensure the correct patient is on the operating table.
SPADE’s approach is likely to be most effective with acute or subacute conditions for which a misdiagnosis could have serious consequences: hospitalization, disability or death within six months. Newman-Toker said it would likely be effective for the “big three” conditions that lead to death or disability after a diagnostic error: infections, cancer or vascular events.” (O)

Consolidation is one of the most important trends shaping the healthcare industry today, but hospital and health system leaders rarely approach these ambitious actions with a clear sense of what makes an effective deal. Though partnerships, affiliations and joint ventures have become increasingly prevalent, as well as the acquisition of ambulatory service centers and other outpatient facilities, this article will focus on the mechanics of hospital acquisition.”
As president and CEO of Northwell Health, I have seen our health system expand to 23 hospitals. From my experience, I can say there are four essential factors to consider before pursuing a hospital acquisition.
Is the mission of the hospital you are in discussions with consistent with yours?
Would the acquisition add value to your organization?
What is the relative health of the hospital you are targeting? That encompasses not only financial health, but its reputation for clinical quality, its standing in the community, and the political dynamics of the hospital’s governing board and leadership team. Understanding a hospital from a holistic standpoint requires a full diagnostic analysis.
Does the deal help you competitively? And what are the repercussions if one of your competitors acquires the hospital instead?
Three red flags
There are three red flags we always examine when looking to acquire a hospital.
Lack of transparency. If leaders are not fully transparent with you, they are trying to hide something.
Micromanagement by the governing board. If the board doesn’t allow its management team to oversee day-to-day operations without interference, you could have major problems. Ask yourself if you can change that culture, and if so, how difficult would it be? How can you make a board understand its responsibility to hold management accountable but not insert itself in day-to-day management?
Long-term contracts with physicians and administrators. If contracts with clinical and administrative leaders are long and unbreakable, you could have trouble making changes and recruiting a new team if problems arise.
If you go back 10 years and look at the C-suites of hospitals Northwell has acquired, few of the same leaders are around today. Sometimes you need to make leadership changes quickly because the incumbents may be poisonous to the transition process. Other times, we have found leaders of newly acquired facilities to be very adaptable and open to change. The same standards must also be applied to physician leadership…
Consolidation is an essential and beneficial move if you want to provide broad-based, holistic, coordinated care. If your main priority is improving patient outcomes, the advantages of consolidation outweigh its disadvantages. However, organizations that simply collect hospitals without properly integrating them or coordinating care are destined for failure. There are many health systems that are simply a collection of points on a map — freestanding silos independent of each other. The concept behind effective acquisition should be preventing duplication and enhancing efficiency, because if your only aim is to make yourself look big, employees and patients will be the ones to suffer.” (P)

Sanford Health is expanding its presence in international health care by extending services to seven countries. This year, Sanford Health will enter New Zealand, Ireland, Vietnam, Costa Rica and South Africa and increase its presence in China and Ghana. This expansion follows last year’s acquisition of a minority stake in ISAR Klinikum, a hospital leader in stem cell therapies, located in Munich, Germany.
Sanford Health’s international health care arm, Sanford World Clinic, will now be in nine countries with more than 30 locations. Supported by philanthropy and launched in 2007, the initiative is designed to foster partnership with health care leaders in the development of sustainable services around the world.
“With these partnerships, we are creating unique opportunities for shared learning,” said Kelby Krabbenhoft, president and CEO of Sanford Health. “This is not something we are pursuing for financial gain, but we believe this type of collaboration will help further our mission of health and healing.”
Each partnership is unique in terms of scope of service and type of agreement. The focus of the collaborations range from primary and pediatric care to research and health system operations.
“We want to go where we can be impactful and create partnerships that will stand the test of time,” said Dan Blue, M.D., executive vice president of Sanford World Clinic. “We have outstanding partners in each of these countries who share a common goal – to advance health care around the world.”… (Q)

“When most hospitals close, it’s plain to see. Equipment and fixtures are hauled out and carted away. Doctors and nurses leave and buildings are shuttered, maybe demolished.
But another fate befalling U.S. hospitals is almost invisible. Across the country, conglomerates that control an increasing share of the market are changing their business models, consolidating services in one regional “hub” hospital and cutting them from others.
In recent years, hospitals across the country have seen their entire inpatient departments closed — no patients staying the night, no nursery, no place for the sickest of the sick to recover. These facilities become, in essence, outpatient clinics.
Hospital executives see these cuts as sound business decisions, and say they are the inevitable consequence of changes in how people are using medical services. But to patients and local leaders who joined forces with these larger health networks just years ago, they feel more like broken promises: Not only are they losing convenient access to care, their local hospitals are also getting drained of revenue and jobs that sustain their communities.
“It’s not even just betrayal. It’s disgust, frankly,” said Mariah Lynne, a resident of Albert Lea, Minn., where Mayo Clinic is removing most inpatient care and the birthing unit from one of its hospitals. “Never would I have expected a brand of this caliber to be so callous.”
In 2015, the most recent year of data, these service reductions accounted for nearly half of the hospital closures recorded around the country, according to the Medicare Payment Advisory Commission. (By MedPac’s definition, the loss of inpatient wards is equivalent to closure.) These data do not capture more discreet closures of surgical and maternity units that are also happening at local hospitals.
And the trend doesn’t just affect nearby residents. It represents a slow-moving but seismic shift in the idea of the community hospital — the place down the street where you could go at any hour, and for any need. Does the need for that hospital still exist, or is it a nostalgic holdover? And if it is still needed, is it economically viable?”…(R)

(A) Hospital Impact―Ear to the ground: 5 healthcare delivery trends to watch in 2018, by Jerry Penso,
(B) The real reason health care is bankrupting America, by Kenneth L. Davis,
(C) Oscar Health Grabs Share With Cleveland Clinic Branded Obamacare Plan, by Bruce Japsen,
(D) Fed Up With Drug Companies, Hospitals Decide to Start Their Own, by REED ABELSON and KATIE THOMAS,
(E) Innovative health insurers must learn to think like Amazon, by MARK NATHAN,
(F) What health care companies are doing for their health, by WALECIA KONRAD,
(G) A look inside Lucile Packard’s new 521K-square-foot ‘patient-centered’ hospital, by Paige Minemyer,
(H) City’s New Public Hospitals Chief Will Focus on Primary Care, by JAN RANSOM,
(I) HMH and RWJBH: 2 big systems, but which is bigger?, by Anjalee Khemlani,
(J) Hackensack University Medical Center’s tax exemption appealed by City Council, by Rodrigo Torrejon,
(K) Fairview CEO says Epic an ‘impediment’ to innovation, calls for ‘march on Madison’, by Katharine Grayson,
(L) Amazon is hiring a health privacy expert for ‘new initiative’, by Christina Farr,
(M) Apple will let you keep your medical records on your iPhone or Apple Watch, by Christina Farr,
(O) Johns Hopkins researchers use big data analytics to target diagnostic errors, improve quality, by Paige Minemyer,
(P) Michael Dowling: The prizes and pitfalls of hospital acquisitions, by Michael J. Dowling,
(Q) Sanford Health increases global presence with expansion in seven countries,
(R) Paying more and getting less: As hospital chains grow, local services shrink, CASEY ROSS,