Category: Hospitals

Steward moves to Dallas. I’m quoted in the Boston Globe

published date
February 26th, 2018 by
What goes around comes around

Steward Healthcare, one of Massachusetts’ largest employers, is moving its headquarters to Dallas. I’m quoted on the subject in the Boston Globe (Steward Health Care to move top executives to Dallas)

“Steward was always a fish out of water in the Massachusetts health care scene as a for-profit, private-equity owned health care company,” said David E. Williams, president of the Boston consulting firm Health Business Group.

Williams said a corporate relocation to Dallas makes sense for the company: “It’s a less expensive place to do business, it’s more central, and it’s close to some new hospitals they’ve recently purchased and need to focus on.”

This move was no surprise, and has been rumored since November. The company will take up residence in a brand new office tower in Dallas.

A few thoughts:

  • This is unlikely to be negative for Massachusetts. Only a small number of positions are likely to be moved, and many of the current job holders will be offered relocation packages. Anyone left behind is likely in a good position to find another attractive position
  • The vast majority of Steward employees are in the local hospital communities. They will be staying along with their taxes and spending
  • Steward hospitals will continue to pay property and other taxes as a result of their for-profit status. (They won’t be reverting to their non-profit, non tax-paying days from before the purchase)

The main reasons for the move seem to be to get closer to Steward’s center of gravity and to find a lower cost location, consistent with Steward’s overall low-cost philosophy. But there are a couple of warning signs for Massachusetts here:

  • Steward’s decision makers are presumably aware of the proposed ballot initiative to impose a surtax on high income earners. Their move demonstrates that companies have options to help their executives avoid this tax
  • No doubt Steward has been irritated by pressure from the Massachusetts government to surrender financial data that Steward felt should be private. Moving to Dallas is likely to relieve Steward of at least some of that pressure

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By healthcare business consultant David E. Williams, president of Health Business Group.

Amazon: Force the healthcare system to become patient-centric

published date
February 6th, 2018 by

The announcement that Amazon will work with JP Morgan Chase and Berkshire Hathaway to create a new healthcare organization for employees has health plans and providers running scared. Initial press coverage has focused on the impact of this group on the market value of CVS, United Healthcare and the like –but how many people really care about that?

CareCentrix CEO John Driscoll has the right idea when he suggests that Amazon should compel provider organizations to put the patient first –for real, not just rhetorically. His three specific suggestions are good ones: mandate self-service scheduling, introduce  a universal patient portal, and improve the quality of provider reviews. As simple and straightforward as those sound, they would require Amazon and its partners to overcome serious resistance. It will be fascinating to watch what happens.

Assuming Amazon can make those basic but challenging changes come to pass, I have two additional, ambitious suggestions to help patients:

  1. Ensure that patients receive clear, consistent, actionable follow-up information when they leave a doctor’s appointment or are discharged from the hospital.
  2. Use the full set of information available about a patient to anticipate their needs and help them navigate the system.

The first idea is a simple one, which should be happening anyway, and occasionally does. The challenge is to get the provider system to care enough about what happens upon discharge and provide the tools, training, information and support to enable more seamless and empowering transitions. I was shocked at how poor the discharge instructions were after my release from the emergency department a few months ago, after I was struck by a car. I received basically nothing and had to count on family and clients in the medical system to help me. I know I’m not the only one who’s had this experience.

The second idea is broader and vaguer, but starts to draw on the expertise of Amazon’s partners who are in the financial services and insurance industries and have a lot of information about their customers. The consortium could help patients chart their financial path through the healthcare system, helping them identify what insurance to select, how much to save in their HSA and FSA, and where and when to get their care. It could be a virtual concierge for patients, relying big data and machine learning to provide insights and continuous improvement.

If these suggestions were implemented they would have a high impact, even though they would not completely transform the system. It seems like about the right level for this group to shoot for. If they try to be bolder they will likely fail.

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By healthcare business consultant David E. Williams, president of Health Business Group.

Clinical registry solution market heads toward $2 billion

published date
September 20th, 2017 by

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Specialty medical societies such as the American College of Cardiology and American College of Surgeons sponsor clinical registries that collect observational data on patients with specific conditions or procedures, such as heart failure or joint replacement. This “real world” evidence helps hospitals improve quality of care, meet state and federal reporting requirements, and achieve pay-for-performance bonuses.

Q-Centrix, which provides technology and services that enable hospitals to participate in registries, commissioned Health Business Group to conduct a market sizing and growth study. We found that the market will reach almost $2 billion over the next five years. Q-Centrix is offering a complimentary download of the findings.

Clinical registries have been around for decades, but in recent years they have become central to achieving quality in healthcare delivery. Registries have proved their superiority over other approaches such as electronic medical records and traditional clinical trials, and are being embraced by accrediting organizations, commercial health plans and federal agencies such as FDA and CDC.

Hospitals continue to gain experience with registries and are deriving more and more value from them over time. However, in a digital, automated world, participating in registries is still a remarkably manual and time consuming process. Each patient record for the registry must be “abstracted” according to the specific requirements of that registry and then submitted securely and accurately. Some registries provide software tools to help, but even then the tool is only useful for a specific registry. That’s cumbersome for hospitals that participate in multiple registries, a big issue since hospitals often participate in 10 or more.

Hospitals have rationalized other manual, labor intensive administrative processes by outsourcing. Medical transcription is a good example, where the use of outsourcing and automation are now the norm.  The same approach is being taken in the registry world, which is why companies such as Q-Centrix are thriving.

At Health Business Group, we were excited to conduct research into this dynamic and growing market, especially since there was very little information published about the topic. To formulate our projections we reviewed secondary data sources, leveraged the Health Business Group knowledge base, and conducted interviews with dozens of hospitals, specialty societies, market experts, and industry participants. We also fielded an online survey of hospitals to develop a detailed understanding of industry trends and their root causes.

Health Business Group specializes in the assessment of healthcare markets and development of growth and M&A strategies for healthcare companies and investors. To learn more, contact us or visit our website.


By healthcare business consultant David E. Williams, president of Health Business Group.

 

Tufts nursing impasse: I'm quoted in the Boston Globe

published date
July 13th, 2017 by
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Who “wins” in a strike?

The first nursing strike in Boston in three decades is an ugly situation. I feel badly about it, especially for patients and their families who are collateral damage. Even if the quality of care is the same with the replacement nurses, the extra stress and aggravation really are a problem.

I’m quoted on the dispute in today’s front page Boston Globe story (At Tufts Medical Center, pressure to cut costs in a city rich with hospitals). I’m not directly involved with Tufts management or nursing leadership, so I commented on the overall environment in which its occurring.

“I think the root cause is that Tufts has to compete with the other academic medical centers in the city, and they don’t get the same level of reimbursement,” said David E. Williams, a consultant at Health Business Group in Boston. “The disparities of the payments actually cause friction in the labor market.”

The story of unequal payments to Boston area hospitals is not a new one, and people have heard about it so often that they’ve tended to zone out. But this is the first time I can think of that labor relations have taken a public hit as a result, so perhaps it will reinvigorate the debate.

Meanwhile, few of the articles about the strike provide broader context about where nurses fit in to hospital finances. A couple of statistics are worth mentioning:

  • A 2015 study published in the Journal of Nursing Administration (Hospital Nursing Workforce Costs, Wages, Occupational Mix, and Resource Utilizationconcluded that nursing labor accounts for just over 30 percent of total hospital costs. That means nursing costs are central to hospital finances and it explains why Tufts isn’t just giving in in the face of the strike.
  • Nurses in Boston earn six-figure incomes. According to Tufts, its senior nurses (which represent 60 percent of the total staff) “earned an average of $152,000 in 2016.” That’s comparable to what some primary care physicians make.

I hope the dispute is resolved soon, so that the nurses and the rest of the Tufts team can get on with the job of caring for patients. If the strike ends up stimulating a serious debate about inequities in hospital reimbursement, that will be its only silver lining.

By healthcare business consultant David E. Williams, president of Health Business Group.

Steward buys IASIS. I'm quoted in the Boston Globe

published date
May 22nd, 2017 by

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Steward Health Care is taking control of IASIS Healthcare, which owns 18 hospitals in Western and Southern states. This deal follows on the heals of Steward’s purchase of eight hospitals in the midwest and Florida a few weeks ago.

Here’s what I told the Boston Globe (Steward merger would make it nation’s biggest private for-profit hospital system):

Some health industry analysts said the company has been ahead of others in investing in so-called accountable care.

The business model relies on payment contracts with insurers that are designed to encourage cost-efficient care, replacing the traditional fee-for-service model, which critics believe promotes unwarranted use of medical services.

“Steward is essentially betting that it can apply its model of accountable care and cost containment to a hospital system in other geographies,” said David E. Williams, president of the Boston consulting firm Health Business Group.

“This is a very interesting contrast with some of the mergers and acquisitions undertaken by the other major hospital systems in Massachusetts. While others have focused on bulking up to increase their market power over local health plans — which can drive up costs overall — the Steward/IASIS arrangement poses no such concerns,” he said.

As a scrappy, lower cost –and private equity owned!– community based system, Steward isn’t popular with the big, academic-based health systems in Massachusetts. Those systems may actually breathe a sigh of relief to see Steward turn its sights out of state.

There is some irony, though, that while the academics’ idea of innovation is to band together to maximize local market power and beat up on health plans, Steward is applying its expertise out of state, where it expects to improve the efficiency and effectiveness of the acquired assets. Brass knuckles style market power approaches are not part of Steward’s expansion playbook.

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By healthcare business consultant David E. Williams, president of Health Business Group.