BioCrossroads drops dreams for hospital innovation

Sorry, IU Health.

There’s almost no chance of you becoming the next Cleveland Clinic, according to a report released last week by BioCrossroads, the Indianapolis-based life sciences business development group.
That’s because of the new demands for cost-cutting in health care, which are coming from Congress’ budget battles, the influx of baby boomers into the Medicare program and now Obamacare.
There simply isn’t the money available anymore for a hospital to replicate the 65-person staff and dedicated investment funding that Cleveland Clinic uses to turn medical innovations into high-growth companies.
This is not what IU Health or BioCrossroads wanted to hear. The leaders of both organizations had thought that IU Health individually or Indianapolis-area hospitals collectively could become engines of innovation to produce new life sciences companies.
BioCrossroads CEO David Johnson first mentioned the idea to me in early 2008, when I wrote a story about a researcher at Franciscan St. Francis Health who had stumbled on a way to diagnosis and potentially reverse autoimmune diseases.
That research did turn into a company, Redox Reactive Reagents LLC, which is trying to commercialize the technology as a diagnosis for Alzheimer’s disease. But Franciscan decided it wasn’t going to be in the startup game. It sold its stake in the company to the other owners and walked away.
About a year earlier, IU Health CEO Dan Evans had tapped his longtime friend Matt Neff to launch a venture capital arm, CHV Capital Inc., funded by some of IU Health's large endowment.
The firm has backed several Indiana life sciences companies, including Endocyte Inc., Nico Corp. and Perfinity Biosciences Inc. But it’s one attempt to commercialize research from within the IU Health system—a 2008 investment in CS-Keys Inc.—went nowhere.
The BioCrossroads report concludes that “classic innovation models such as the one resident at the Cleveland Clinic are too capital intensive to replicate.”
But BioCrossroads still sees opportunities for local hospital systems to play a major role in health care innovation, not so much by launching companies themselves, but rather by helping entrepreneurs understand the challenges that need to be fixed and then helping them test, refine and scale up their proposed solutions.
The Infuse Accelerator for digital health startups, which is being launched in Indianapolis, is trying to do exactly that. And so is the Hoosier Healthcare Innovation Challenge, an annual event where health care organizations present problems they have to IT entrepreneurs, who try to invent a solution.
A good example is Indianapolis-based Diagnotes Inc. It won the 2012 Healthcare Innovation Challenge and then worked with Community Health Network to pilot its mobile app, which allows doctors and patients to swap key medical records and images over mobile phones—yet without violating federal medical privacy laws.
Community has now signed a contract to use Diagnotes among some of its physicians.
BioCrossroads also thinks Indianapolis’ hospitals can replicate the kind of collaboration that led to the 2004 launch of the Indiana Health Information Exchange Inc., which allows hospitals to swap electronic patient records as needed from one health system to another.
Indianapolis’ hospitals could collective pitch themselves to drug and device companies to attract more of the clinical trials those companies fund, the BioCrossroads report suggested.
The hospitals could also consider forming a joint clinic that would conduct research, clinical trials and education, such as the Orthopedic Capital Clinic being launched by OrthoWorx, a BioCrossroads offshoot, in Warsaw, Ind.
None of those would have the impact of a Cleveland Clinic. But, as I’ve written elsewhere, in this age of austerity, the nature of health care innovation is going to be different than before.

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Would Medicaid expansion have saved hospital jobs?

An alert reader asked a good question earlier this month about the painful expense cuts local hospitals are undergoing right now.

Would these cuts be so deep, or even necessary at all, if the state of Indiana had already committed to expand the Medicaid program to insure more Hoosiers? Indiana Gov. Mike Pence has refused to expand Medicaid to Hoosiers with incomes up to 138 percent of the federal poverty limit, as called for by Obamacare, unless the Obama administration agrees to let Indiana use health-savings account to do it.

But when I posed this question to a variety of hospital sources, none of them said the lack of Medicaid expansion has played any significant role in their decisions to cut expenses. Instead, hospital executives have been more focused on cutting expenses to the point that they can make money on Medicare payments, which are usually higher and never less than Medicaid payments.

One reason for that is that the Medicaid expansion, even if it had been approved by Pence, would not yet have taken effect. It was scheduled to kick in in 2014, and slowly ramp up to cover an additional 232,000 Hoosiers.

Still, I think the question is a good one. Since uninsured patients, on average, pay roughly 12 cents on the dollar of what hospitals say it costs them to provide care, having more of those patients pay via Medicaid could certainly shrink those losses.

Medicaid is a money-losing program for hospitals, too. According to the American Hospital Association, Medicaid pays 95 cents for every dollar it costs to treat Medicaid patient. That figure, however, includes disproportionate share dollars--special payments to hospitals, such as Indianapolis-based Wishard Health Services, that treat a large percentage of the poor and uninsured.

So hospitals that do not receive such payments lose even more money on Medicaid. And under Obamacare, the Disproportionate Share payments are effectively going away.

A strong assurance by Pence that Indiana would expand Medicaid would have given these hospitals some confidence that the loss of Disproportionate Share money would be offset by newly insured patients on Medicaid. But for hospitals that never have been receiving Disproportionate Share payments, they typically lost about 40 cents for every dollar they spend to treat Medicaid patients, according to local hospital accountants.

For Indiana hospitals, those losses were recently cut in half by a new hospital assessment fee program, which was created by the Legislature in 2012. It raised Medicaid rates for inpatient procedures to match Medicare rates, which draws down extra money from the federal government. The hospitals then pay a fee to the state government to offset its costs, but the fee is smaller than the extra federal revenue, giving the hospitals a boost.

But the hospital officials I talked to said that the gains in Medicaid funding affect only a portion of hospital budgets, and are simply not enough to offset the other pressures they face.

Consider St. Vincent Health, which laid off more than 850 people last month. In its most recently reported fiscal year, it lost $95.4 million on payments from Medicare and Medicaid that were below its costs. That amount was more than 4 percent of St. Vincent's total revenue from patients. If St. Vincent served more Medicaid patients, those losses would grow.

What might shrink is the amount of charity care St. Vincent provides, which totaled nearly $60 million, or less than 3 percent of its patient revenue in its most recently reported year. St. Vincent might also see a reduction in its bad debt expenses, which totaled more than $120 million in its most recent year, or 5.5 percent of its patient revenue.

Odds are, shifting from patients paying 12 cents on the dollar to patients paying 60 cents or even 80 cents on the dollar would provide a big boost to the balance sheet. But since we're talking, at least in the case of St. Vincent, about only 12 percent of its budget, it just doesn't seem to move the needle that much.

Still, if, as hospital accountant Ed Abel recently predicted, the recent cuts at St. Vincent and its peers were just the 'first pass', perhaps Hoosier hospitals will be clamoring for Pence to expand Medicaid.

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Hospital screening tool for suicide risk among self-harmers should be ditched, UK

Main Category: Mental Health
Also Included In: Psychology / Psychiatry;  Medical Devices / Diagnostics
Article Date: 30 Jul 2013 - 0:00 PDT Current ratings for:
Hospital screening tool for suicide risk among self-harmers should be ditched, UK

A screening tool used in general hospitals to detect suicide risk among patients who have self harmed should be ditched, concludes a study published online in Emergency Medicine Journal.

The technique (SADPERSONS Scale) fails to pick up most of those who require admission to a psychiatric unit, community psychiatric aftercare, or to determine those at risk of self harming again, say the researchers.

The SADPERSONS Scale was developed in the USA in 1983 as a means of assessing suicide risk among patients who had self harmed. It is based on 10 major risk factors, but has changed little since it was first devised, say the researchers.

National guidance in England stipulates that all patients who go to hospital after an episode of self harm should be given a full psychosocial assessment. But current pressures in hospitals to meet waiting time targets, combined with a reduction in the availability of mental health services, mean that emergency care staff are increasingly minded to use rating scales to find out which patients can be discharged without a full psychosocial assessment, say the researchers.

They therefore assessed SADPERSONS scores that had been recorded for 126 patients consecutively admitted to one emergency medicine department in a major general hospital in Oxford during the summer of 2011, to see how accurate it was at predicting how these patients were subsequently managed and treated.

This included admission to a psychiatric unit, a proxy for psychosocial assessment; the provision of community psychiatric aftercare; and bouts of repeated self harm in the following six months.

Self harm was defined as any act of poisoning or injury, irrespective of its purpose. Most of the patients (102; 81%) had taken an overdose; around one in 10 (11%) had cut themselves; and the remaining 10 patients (8%) had inflicted other forms of injury on themselves.

Admission to a psychiatric unit was required in five cases (4%) and community psychiatric aftercare in just over half (55%; 70). One in four patients (24.6%) self harmed again at least once.

The SADPERSONS Scale only picked up 2% of those requiring admission to a psychiatric unit, around 6% of those needing community psychiatric aftercare, and just over 6.5% of those likely to self harm again.

The authors point out that for the purposes of suicide prevention, any technique designed to spot potential suicide risk must have a low rate of false negative results - in other words, it must be accurate and not miss most of those at risk of killing themselves.

While the small numbers of patients in this study don't allow any conclusions to be drawn about the Scale's usefulness in predicting suicide risk, the scores did not pick up very accurately those most at risk of further self harm, which is particularly associated with suicide risk, say the study authors.

Twenty three out of 31 of the episodes of self harm occurred within the first three months of the first visit to emergency care. But only two of these patients had high scores on the SADPERSONS Scale; the rest had low to moderate scores, suggesting they were not at high risk.

"The results clearly show that the SADPERSONS Scale has a very limited role, if any, to play in the assessment of patients presenting to the emergency department following an episode of self harm," write the authors.

"Indeed, arguably, our results show that reliance on the scale for determining who should receive a psychosocial assessment or otherwise using it for prediction is not only misleading, it could be dangerous," they add.

The use of rating scales has become increasingly widespread in response to the need to standardise practice for ever increasing numbers of patients. But these tools often overlook individual dynamics, they say.

"A greater focus on clinical judgement is needed, accompanied by the necessary education, training and supervision, if we are to more accurately fully identify and intervene with those who are at greatest risk following self harm," they conclude.

Article adapted by Medical News Today from original press release. Click 'references' tab above for source.
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9 kids die in 2 days in Odisha hospital; probe ordered

Sorry, I could not read the content fromt this page.

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