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Study: Hospital Costs Seen Increasing Because of Opioid Overdoses

January 3, 2019
by Mark Hagland, Editor-in-Chief
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A new study published by Premier Inc. has found a significant cost resulting from opioid overdoses, and impacting the overall cost profiles of inpatient hospitals nationwide

Anecdotal evidence has been mounting for years, but a new study published Jan. 3 is documenting a meaningful increase in hospital costs nationwide, because of the opioid overdoses of individuals that are causing them to be admitted to hospitals.

The Charlotte-based Premier Inc. on Thursday published a report whose analysis has found that total care for patients who experienced an opioid overdose resulted in $1.94 billion in annual hospital costs across 647 healthcare facilities nationwide.

The Premier study found that these costs were concentrated among nearly 100,000 opioid overdose patients with nearly 430,000 total visits across emergency department (ED), inpatient and other care settings. Sixty-six percent of the patients were insured by public programs (33 percent Medicare and 33 percent Medicaid), 16 percent used a commercial payer, 14 percent were uninsured, and 3 percent were covered under other programs, such as workers’ compensation.

Annual hospital care for overdose patients represents a significant portion of healthcare expenditures and can be detrimental to providers in regions with high addiction rates. For instance, by extrapolating the cost trends Premier identified in its analysis, the total added costs to the U.S. healthcare system are estimated to amount to $11.3 billion annually, or 1 percent of all hospital expenditures. If the payer mix remained constant, $7.4 billion of the expense would be borne by the federal Medicare and Medicaid programs.

Opioid overdose patients that present to the ED are at a high risk for multiple organ failure, hospitalization, increased costs due to ICU stays and unplanned readmissions following discharge. According to the Premier analysis, caring for all overdose patients treated in the ED alone amounted to more than $632 million in costs to hospitals. Approximately 47 percent of patients were treated and released, and 53 percent were treated and admitted. Of those that were admitted, nearly 40 percent experienced organ failure. The average cost for an overdose patient who was treated and released totaled $504, but the average cost rose to $11,731 for those that were treated and admitted and to $20,500 for those that required ICU care. Adding these costs – ED, inpatient and ICU – totaled the $1.94 billion in annual hospital charges.

While the analysis used the data from 647 facilities to estimate a national aggregate rate (40.9 per 10,000 visits), there was wide state-to-state variation, ranging from a low of 6.1 per 10,000 visits to a high of 87.5 per 10,000 visits. Of those receiving treatment, 34 percent were treated for heroin poisoning and 8 percent were treated for synthetic opioid poisoning, such as methadone. Likewise, 58 percent of those treated were for undetermined opioid poisoning, including prescription opioids and overlapping or unspecified use, such as if the patient used heroin that was laced with synthetics, e.g., fentanyl.

In a statement contained in the Premier press release, Roshni Ghosh, M.D., M.P.H., Premier’s vice president and chief medical information officer, said, “Opioid addiction has been a public health problem for some time, but we’ve yet to show exactly how hospitals – the entities that treat most of these patients—are financially impacted. This analysis shows that on top of losing family members and friends to this epidemic, it’s costing consumers and taxpayers, as well as hospitals. There is an urgent need to provide health systems and emergency caregivers with frontline solutions that they can use to stem the tide of opioid addiction in our communities.”

Leveraging the Premier Healthcare Database, Premier’s analysis of opioid overdose visits, patient progression, and usage and cost patterns was made available to members via individual hospital and system-level reports. These actionable reports are standardized to help health system leaders easily and quickly benchmark internal patterns, relative to opioid overdoses, to measure their performance based on industry trends and pinpoint opportunity areas. The Premier Healthcare Database leverages the PremierConnect® performance improvement platform, which houses data on 45 percent of U.S. patient discharges nationwide.

“The comparative analyses that Premier provides in these reports are key to supporting health system efforts to address this epidemic,” Ghosh added. “These are detailed, evidence-based insights that help providers create focused and customized pain management and addiction reduction initiatives specific to the patients that need them. Our goal is to support our members in every way possible in reducing overuse and misuse, and improving health outcomes, safety and costs at the same time.”

 

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AI in Imaging: Where’s the Bang for the Buck?

January 23, 2019
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Over the past year much has been written about the capability of Artificial Intelligence (AI), and what it will mean for imaging services.  At last year’s RSNA, AI was the featured topic and received the lion’s share of publicity. 

The glamorous aspect of AI and Machine Learning has been how AI can assist the radiologist with diagnosis of imaging studies.  A key area of focus has been in chest imaging (https://www.auntminnieeurope.com/index.aspx?sec=sup&sub=aic&pag=dis&ItemID=616828) where there has been some success in triaging abnormal chest images.  The upside of such applications is improved diagnostic efficiency, particularly as healthcare moves toward value-based care.  The downside is that such algorithms require substantial amounts of data to validate, and they will need to go through the FDA approval process, which will take time before they can be fully implemented.

Ultimately, AI imaging applications will pay off.  But, what about the other potentially less-glamorous aspect of applying AI/Machine Learning to the diagnostic process?  By that, I am referring to its use in terms of workflow orchestration.  Aside from interpreting imaging content, AI/Machine Learning applied to workflow orchestration can provide valuable information and assistance in preparing a case for interpretation. 

Take for example Siemens Healthineer’s AI-Rad Companion application (https://www.healthcare.siemens.com/infrastructure-it/artificial-intelligence/ai-rad-companion).  The application provides automated identification, localization, labeling and measurements for anatomies and abnormalities.  Such a capability can improve the radiologist’s efficiency without necessarily employing an algorithm to assess the image.

Other workflow applications can assess the study and mine relevant information from the EHR to present to the radiologist, again with the goal of improving their efficiency and efficacy.  Still other applications match radiologist reading assignments with available studies to improve reading efficiency.  In another twist, one company has demonstrated a capability to further analyze cases, using AI to assign the next appropriate case to a radiologist without the need for a worklist. 

As healthcare providers consolidate, there is a growing need for improvement in resource utilization across facilities.  Smart worklists that can present cases to individual radiologists across facilities can improve the overall efficiency and efficacy of interpretation.  Rule sets that address radiologist availability, reading sub-specialties, location, etc. can help “level-load” reading resources. 

My point is that while AI applications that manipulate images may hold great promise for the future of diagnosis, areas such as workflow orchestration might offer more immediate results in an environment of changing healthcare.  Providers should take a close look at these applications to assess whether they can achieve a more immediate impact on imaging operations.

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National Library of Medicine Creating Scientific Director Position

January 23, 2019
by David Raths, Contributing Editor
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New position will oversee Lister Hill National Center for Biomedical Communications and National Center for Biotechnology Information

As part of a reorganization of its intramural research activities, the U.S. National Library of Medicine (NLM) has launched a search for a scientific director. The scientific director will oversee a group of 150 scientific personnel, developing new approaches to data science, biomedical informatics, and computational biology.

In a blog post on the library’s website, director Patti Brennan, R.N., Ph.D., called the move a big step in revving up its intramural research operation.

One of the 27 Institutes and Centers of the National Institutes of Health (NIH), NLM creates and hosts major digital resources, tools, and services for biomedical and health literature, data, and standards, sending 115 terabytes of data to five million users and receiving 15 terabytes of data from 3,000 users every weekday.

NLM’s strategic plan for 2017-2027 positions it to become a platform for biomedical discovery and data-powered health. NLM anticipates continued expansion of its intramural research program to keep pace with growing demand for innovative data science and informatics approaches that can be applied to biomedical research and health and growing interest in data science across the NIH.

A Blue Ribbon Panel recently reviewed NLM’s intramural research programs and recommended, among other things, unifying the programs under a single scientific director. That shift also aligns the library with NIH’s other institutes and centers, most of which are guided by one scientific director.

NLM’s  intramural research program includes activities housed in both the Lister Hill National Center for Biomedical Communications (LHC) and the National Center for Biotechnology Information (NCBI). The researchers in these two centers develop and apply computational approaches to a broad range of problems in biomedicine, molecular biology, and health, but LHC focuses on medical and clinical data, while NCBI focuses on biological and genomic data.

But the Blue Ribbon Panel noted that the boundaries between clinical and biological data are dissolving, and the analytical and computational strategies for each are increasingly shared. “As a result, the current research environment calls for a more holistic view of biomedical data, one best served by shared approaches and ongoing collaborations while preserving the two centers’ unique identities, wrote Brennan, who came to NIH in 2016 from the University of Wisconsin-Madison, where she was the Lillian L. Moehlman Bascom Professor at the School of Nursing and College of Engineering.

She added that having a single scientific director should lead to a sharper focus on research priorities, fewer barriers to collaboration, the cross-fertilization of ideas and the optimization of scarce resources.

The new scientific director will be asked to craft a long-range plan that identifies research areas where the NLM can best leverage its unique position and resources. We’ll also look for ways to allocate more resources to fundamental research while streamlining operational support. “Down the road, we’ll expand our research agenda to include high-risk, high-reward endeavors, the kinds of things that raise profound questions and have the potential to yield tremendous impact,” she wrote.

Besides the scientific director, the NLM is also recruiting three investigators to complement its strengths in machine learning and natural language processing.

 

 

 

 

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Survey: Digital, AI Top Priorities in 2019, but EHRs Will Dominate IT Spend

January 22, 2019
by Heather Landi, Associate Editor
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Digital, advanced analytics, and artificial intelligence (AI) are top spending priorities for healthcare executives in 2019, but electronic health record (EHR) systems will dominate technology spending budgets, according to a recent technology-focused healthcare survey.

Damo Consulting, a Chicago-based healthcare growth and digital transformation advisory firm, surveyed technology and service provider executives and healthcare enterprise executives about how the demand environment for healthcare IT is changing and will impact the industry in the coming year. Damo Consulting’s third annual Healthcare IT Demand Survey also analyzes the challenges for healthcare organizations and the perceived impact of macro-level changes.

The report indicates technology vendors will continue to struggle with long sales cycles as they aggressively market digital and AI. For the second year in a row, the rise of non-traditional players such as Amazon and Google will have a strong impact on the competitive environment among technology vendors while EHR vendors grow in dominance.

Among the key findings from the survey, IT budgets are expected to grow by 20 percent or more, with healthcare executives indicating they are more upbeat about IT spend growth than vendors. All the healthcare executives who participated in the survey said digital transformation initiatives are gaining momentum in their enterprises.

However, the majority (75 percent) agree that rapid change in the healthcare IT landscape makes technology decisions harder and only 58 percent believe there are plenty of viable and ready-to-deploy solutions available today in emerging technologies such as AI and digital health solutions. Seventy-one percent agree that federal government policies have provided a boost to healthcare IT spend this past year.

Top IT priorities for healthcare enterprise executives in 2019 are digital, advanced analytics and AI. Of the survey respondents, 79 percent said accelerating digital health initiatives was a top priority and 58 percent cited investing in advanced analytics and AI capabilities as top priorities. However, modernizing IT infrastructure (25 percent) and optimizing EHRs (21 percent) are also significant priorities.

Technology vendors also see AI, advanced analytics and digital transformation as top areas of focus for next year, as those areas were cited by 75 percent and 70 percent of technology and service provider executives, respectively. Thirty-three percent of those respondents cited EHR optimization and 25 percent cited cybersecurity and ransomware. Thirteen percent cited M&A integration as a top area of focus in 2019.

However, EHR systems will dominate technology spending budgets, even as the focus turns to digital analytics, the survey found. Technology and service provider executives who participated in the survey identified EHR system optimization and cybersecurity as significant drivers of technology spend in 2019. Sixty percent of respondents said enterprise digital transformation and advanced analytics and AI would drive technology spend this year, but 38 percent also cited EHR optimization and cybersecurity/ransomware. One executive survey respondent said, “For best of breed solutions, (the challenge is) attracting enough mindshare and budget vs. EHR spends.”

When asked what digital transformation means, close to half of healthcare executives cited reimaging patient and caregiver experiences, while one quarter cited analytics and AI and 17 percent cited automation. As one executive said, “The biggest challenge for healthcare in 2019 will be navigating tightening margins and limited incentives to invest in care design.”

Healthcare executives are divided on whether digital is primarily an IT-led initiative, and are also divided on whether technology-led innovation is dependent on the startup ecosystem.

The CIO remains the most important buyer for technology vendors, however IT budgets are now sitting with multiple stakeholders, the survey found, as respondents also cited the CFO, the CTO, the CMIO and the chief digital officer.

“Digital and AI are emerging as critical areas for technology spend among healthcare enterprises in 2019. However, healthcare executives are realistic around their technology needs vs. their need to improve care delivery. They find the currently available digital health solutions in the market are not very mature,” Paddy Padmanabhan, CEO of Damo Consulting, said in a statement. “However, they are also more upbeat about the overall IT spend growth than their technology vendors.”

Looking at the technology market, healthcare executives perceive a lack of maturity in technology solution choices for digital initiatives, as well as a lack of internal capabilities for managing digital transformation. In the survey report, one executive said, “HIT architecture needs to substantially change from large monolithic code sets to an API-driven environment with multiple competing apps.”

A majority of healthcare enterprise executives view data silos and lack of interoperability as the biggest challenges to digital transformation. And, 63 percent believe the fee-for-service reimbursement model will remain the dominant payment model for the foreseeable future.

In addition, cybersecurity issues will continue to be a challenge for the healthcare sector in 2019, but not the biggest driver of technology spending or the top area of focus for health systems in the coming year, according to the survey.

Healthcare executives continue to be confused by the buzz around AI and digital and struggle to make sense of the changing landscape of who is playing what role and the blurred lines of capabilities and competition, according to the survey report. When asked who their primary choice is when looking for potential partners to help with digital transformation, 46 percent of healthcare executives cited their own internal IT and innovation teams, 17 percent cited their EHR vendor and 8 percent cited boutique consulting firms. A quarter of respondents cited “other.”

For technology vendors, the biggest challenge is long cycles, along with product/service differentiation and brand visibility.

The rise of non-traditional players, such as Amazon, Apple, and Google, will have a strong impact on the competitive healthcare technology environment, the survey responses indicated. At the same time, deeply entrenched EHR vendors such as Epic and Cerner will grow in dominance.

 

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