With the saturation of electronic health records, healthcare organizations have a wealth of patient data that could assist with predicting outcomes and lowering costs. But many aren’t using predictive analytics for clinical or financial outcomes for their organizations.

Predictive analytics is defined as data mining, machine learning, and statistical modeling of historical patient data to predict future outcomes. A 

 of healthcare payer and provider executives by the Society of Actuaries found that 87% of executives say that predictive analytics is important to the future of their business and 60% believe that predictive analytics can save their organization 15% of more in the next five years. Only half of providers surveyed and 45% of payers reported current use of predictive analytics. Within five years, 87% of providers and 83% of payers say they plan to begin or grow use of predictive analytic tools at their organizations.

Most large hospitals and health plans have access to the tools needed to use predictive analytics effectively, but smaller organizations are still falling behind, says Bharat Rao, PhD, principal in the advisory services practice at KPMG LLP.

Three Reasons Managed Care Organizations Should Use Advanced Analytics

“I would say the small physician offices, which are directing a lot of the care in the U.S., are not using predictive analytics in the most effective ways. They have more difficulty getting a handle on their data,” says Rao. “But even the large health systems and stand-alone hospitals, though they may have the tools to use predictive analytics, many aren’t using them effectively.”

With the amount of data being captured, many healthcare organizations are struggling with how to use it in the smartest ways, says Beth Godsey, vice president of advanced analytics and informatics for Vizient, Inc., a member-driven, healthcare performance improvement company, in Irving, Texas.

“Healthcare organizations are sitting on a wealth of patient data and yet have only begun to scratch the surface on utilizing predictive analytics and machine learning to extract its most important insights,” Godsey says. “I frequently hear from some of the top hospitals in the country, ‘how do I thoughtfully bring predictive insights to my clinicians that can improve not only their work flow efficiency, but also patient care?’”

Using predictive analytics for high-risk patients

One of the most valuable use cases for predictive analytics is identifying and engaging high-risk patients. An 

 of raw claims data from the Illinois Behavioral Health Home Coalition to identify and predict outcomes of high users of care was able to reduce inpatient admissions by 57%, emergency department visits by 31%, and total cost of care by 40%. Annual savings associated with the patients in the study was $1 million.

Nate Regimbal, digital transformation senior manager with Grant Thornton, an accounting and consulting firm, says that predictive analytics techniques can identify patients at high risk for being late to or missing an appointment.

“When the analytics predict a risk with a high enough confidence level, it can trigger a work flow that includes contacting the patient, or scheduling (to afford other patients the opportunity to see the doctor), or staffing (to optimize shift schedules). The analytics for this are now straightforward,” Regimbal says. “The harder part is operationalizing the analytics insights and managing the change and performance implications so that the benefits are fully realized.”

Regimbal adds that risk stratification via advanced analytics drives benefits with payers and providers. Predictive analytics applied to claims processing, procedural coding to member policy, and determining adequacy of information to proceed with claims processing can result in higher accuracy overall, which can bring down payer costs and subsequently prices.

“On the provider side, cohort- and predictive-analytics enabling what’s commonly referred to as ‘patients like me’ analytics can provide insights on emerging patterns that a physician may not have had the means or time to have recognized without the analytics,” Regimbal says.

Lowering readmissions using predictive data

Having the ability to predict patients who have a higher chance of readmitting and take into account other factors that can attribute to readmissions, says Michael Simon, data scientist at Arcadia, a population health management company, in Burlington, Massachusetts.

“A patient with multiple comorbidities may already be in a well-established care management program that follows best practices. However, with predictive analytics, providers can understand the risk this patient has for being readmitted to a hospital after a future inpatient admission,” says Simon. “This allows the provider to intervene from the beginning to reduce the chance of that readmission and improve the clinical outcome for that patient.”

Incorporating social determinants of health into predictive analytics of patients can also help to identify additional risk factors in patients’ lives that would adversely affect their ability to adhere to care plans, says Rich Temple, vice president and chief information officer of Deborah Heart and Lung Center in Browns Mills, New Jersey.

How Three Hospitals Use Predictive Analytics to Reduce Readmissions

A 2018 Duke University study published in the 

Journal of Informatics in Health and Biomedicine

 was able to use historical EHR data from more than 4,000 no-show appointments to create predictive analytics models to determine whether a patient is a risk for not showing up their appointments and why.

“Examples of social determinants of health are lack of access to transportation or healthy food and lack of a decent home or supportive family members. Having these types of challenges makes it much harder for people to be able to properly focus on their health,” Temple says. “The science of predictive analytics is beginning to develop algorithms to track who these individuals may be and respond with carefully customized ways of reaching them to help them on their health journeys.”

Rao says as patients become more empowered and informed consumers, the demand for tech-enabled care will continue to grow.

“Healthcare providers wanting to be competitive in the market will need systems where data and technology provide information,” Rao says. “The patient or the caregiver of the patient will want control of their own data and analytics so that they can feel like a participant in their own care. The opportunity that you have in the large systems is the organization of data to engage the patient or caregiver to jointly manage it.”

Simon says that predictive analytics will be able to help providers identify how prescriptions will impact intervention programs and if that prescription will likely benefit or negate the benefits of the care management program.

Four essential players for your healthcare data analytics team

“For patients with complex medical conditions, the impact of prescriptions on their medical experience can be significant both mentally and physically, so predicting how a patient will respond to the entire intervention will be critical,” says Simon.

Godsey says the possibilities for predictive care using genomic markers and personalized care is on the horizon. “While healthcare is swimming in a sea of data, there is yet an even vaster universe of data we have yet to fully tap,” Godsey says.

Donna Marbury is a writer in Columbus, Ohio.

Articles

Data is only valuable if it’s analyzed correctly. But that’s easier said than done.

Making the Most of Predictive Analytics

Change is inevitable. None more evident than change in leadership. We have all experienced changes in leadership either within the organizations we serve in or personally, if we have had the privilege of serving in a leadership position.

Whether change involves a merger, acquisition, or reorganization, healthcare leaders must constantly evaluate the circumstances of the changes they face so that they can effectively make the right decisions. It is imperative that leaders determine how they respond so that they can help their organizations prepare, manage, and navigate the sometimes violent turbulence of organizational disruption.

With the M&A numbers holding steady at their current pace-due largely to industry conditions that favor large scale systems-it can be a difficult transition when organizations with different organizational cultures combine. This may be especially true since experts say healthcare mergers are increasingly driven by strategic alignment rather than cultural fit. One to watch is the recent 

. Only time will tell whether the $69 billion acquisition/merger will change the healthcare landscape culturally and dynamically.

Not only is change inevitable, its frequency and speed are at unprecedented levels, causing organizations to reexamine strategic direction including leadership. In many cases, as we are seeing, boards of directors are opting to make changes at the top prior to embarking on major organizational changes that drive transformation. This is especially true for healthcare organizations as they make the transition from fee-for-service to risk/population health. These two business models are very different and require vastly different management skills. Many hospital-based systems will try to make this transition under the same leadership, but will learn that it won’t work over time.

The principle drivers of change that will have its greatest impact on leadership will be the convergence of value-based care and digitalization. For healthcare organizations to achieve its value-based care initiatives, they will have to aggressively transition to implementing digital strategies. This means letting go of old established processes and embracing some of the newly emerging technologies.  Telehealth, artificial intelligence (AI)-enabled devices, robotics and blockchain to name a few that will have a dramatic impact on the delivery of healthcare across the entire spectrum.

I believe change will occur in rapid succession decomposing old established organizational structures and the emergence of new healthcare delivery models that enhance efficiency. Along with these changes, new types of leaders will have to emerge possessing more technical, analytical, and collaborative skills.

So, what are the takeaways for managed care executives as the changing face of leadership continues to proliferate? I believe boards and senior leadership ought to consider the following before jumping head long into making a change in leadership. Once a decision has been reached that a change in leadership is necessary, then the organization should take the following steps:

-expectations are discussed and agreed upon by the Board of Directors based on a clearly stated goals and desired outcomes.

-establish a steering committee to coordinate the planning activities including the selection of a search firm and recruiter to conduct the search.

design a communication process that acknowledges the change and be prepared to communicate at the appropriate time to employees and constituents the reason for the change; ensure the staff understands the vision for the future and their role within the organization.

once the new leader has been selected, take every opportunity to show commitment throughout to the new leader and the new direction.

Finally, organizations should only make leadership changes with the intention of improving results related to financial, cultural, or strategic direction. Before making the move, consider nearly 40% of new chief executives fail outright within the first 18 months on the job, and even more of them fail to live up to original expectations.

 Advisory Services, LLC, a management consulting practice focused on helping leadership improve organizational effectiveness and overall performance. He is a former presi

 and chief executive officer of a managed care organization. He is a member of the 

How to cope with a rapidly-changing industry.

How to Prepare for Leadership Changes

Although there isn’t a cure for cancer yet, clinical researchers are making great strides in treating this disease-which can attack any area of the body. Here’s a look at some top treatment developments for cancers that plague men and women specifically, along with a new treatment for prostate cancer.

Novel treatments that limit radiation exposure are now being used to treat breast cancer. Stage 0 breast cancer, the earliest form of breast cancer that can be detected, is called ductal carcinoma in situ because it hasn’t yet found a way to leave the ducts in the breast and become invasive. Approximately 50,000 women are diagnosed with this type of cancer annually.

Roshni Rao, MD, FACS, chief of breast surgery, New York Presbyterian/Columbia University Medical Center, New York, New York, is currently enrolling patients in a study for intra-operative radiation after lumpectomy for these patients. The procedure involves removing cancer surgically with a lumpectomy, and then targeting a single high dose of radiation to the affected area. After closing the incision, the patient is finished with their cancer treatment.

Eight Predictions for Cancer Care in 10 Years

“Patients get the benefit of having everything done at one time, and minimizing the side effects from radiation of the entire breast,” she says. In comparison, patients who undergo traditional radiation must have treatments daily for three to six weeks that involve the entire breast.

The survival from stage 0 breast cancer is close to 99% with traditional radiation. However, recurrence can be as high as 20% if the tumor is removed with surgery. With targeted intraoperative radiation, early results show recurrence rates less than 5%.

Proton therapy is an advanced form of radiation treatment that reduces radiation exposure to normal, healthy organs. Although conventional radiation treatment uses photons (traditional x-ray radiation), proton therapy uses protons-positively charged sub-atomic particles.

The main difference between these two treatments is their delivery, says Henry K. Tsai, MD, radiation oncologist, 

, an outpatient facility in Somerset, New Jersey. Protons deliver their radiation at exact depths to precisely target tumors, whereas standard X-ray radiation releases radiation from the moment it penetrates the skin to the other side of the tumor and exits the body. With proton therapy, most radiation is deposited exactly at the tumor site and stops, thereby reducing radiation exposure to surrounding normal, healthy tissue and organs.

Proton therapy is particularly beneficial in treating left-sided breast cancer because of the target’s proximity to the heart and lungs. 

 that patients with left-sided breast cancer may be more likely than patients with right-sided breast cancer to develop heart disease or other complications after receiving traditional radiation treatments.

Because protons deposit their energy directly into the tumor and not the tissue behind it, patients have less risk of unnecessary radiation exposure to the heart, lungs, and healthy tissues. “Less radiation to these areas may lower the risk of developing heart disease, lung disease, and secondary tumors decades after radiation treatment,” Tsai says.

, the risk of developing a solid tumor after radiation treatment increases as the exposure to radiation increases. These secondary cancers tend to develop in or near the area that was treated with radiation. “The breast is one region that’s more susceptible to developing cancer after radiation, so doctors should pay close attention to the amount of radiation a patient receives during treatment,” Tsai says. A study in the 

International Journal of Radiation Oncology

 found that proton therapy reduces the risk of a patient developing a second tumor by nearly half as compared with conventional radiation photon therapy.

For women with advanced cervical cancer, the FDA approved pembrolizumab, a type of immunotherapy for treatment after chemotherapy has stopped working, in June 2018. It is limited to women with tumors that have a marker- PD-L1-indicating an increased chance it will help. About 35% of women with advanced cervical cancer are eligible for this treatment, says Don S. Dizon, MD, FACP, FASCO, professor of medicine, Brown University; director of women’s cancers, Lifespan Cancer Institute; and director of medical oncology at Rhode Island Hospital; all located in Providence, Rhode Island.

Although the immune system typically fights foreign agents like bacteria, for some reason it doesn’t destroy cancer cells. One of the ways that cancer cells escape the body’s immune system is through immune checkpoints, which are literally breaks against the immune system that recognize and destroy cancer cells, says Dizon, who is also the section editor for 

 for UpToDate from Wolters Kluwer. Pembrolizumab, a checkpoint inhibitor, blocks these breaks and allows the immune system to kill cancer cells.

14 Ways to Make Cancer Patients More Comfortable

Data from a trial of 98 women who had progressive cervical cancer after chemotherapy presented at the 2018 American Society of Clinical Oncology meeting showed an overall response rate of 12% with pembrolizumab. This increased 15% if women had PD-L1 positive cancer. Overall, one in four women’s cancer didn’t progress. “While these results were encouraging, it points out how much work we have yet to do to help women living with advanced or metastatic cervical cancer,” Dizon says.

Some good news regarding preventing cervical cancer is that the Gardasil 9 HPV vaccine, which was FDA approved back in June 2006 for men and women up to age 26, is very effective in reducing disease associated with the human papillomavirus in boys and girls. It protects from pre-cancers associated with HPV such as cervical cancer. In October 2018, the FDA expanded the approved use of the vaccine to men and women ages 27 to 45.

The initial treatment recommended for most women with ovarian cancer is surgery to remove all visible disease, followed by chemotherapy and radiation. Recent studies have shown that completely removing all visible cancer is associated with improvements in patient survival.

, in West Lafayette, Indiana, is developing a tumor-targeted molecule (OTL38) which allows a surgeon, with the use of a near-infrared camera, to see in real time hard-to-detect cancerous tissue that would otherwise go undiscovered during surgery. “By illuminating cancers, surgeons are better equipped to identify and remove more visible disease for more patients,” says Martin Low

MBA, chief executive officer, On Target Laboratories. “Furthermore, OTL38 is simply administered via intravenous injection (IV) during the pre-operative phase of the procedure. If the FDA approves it, it will be the first and only intraoperative ovarian cancer-targeted imaging molecule in the United States.”

OTL38 is a molecule that highlights cancerous lesions for surgeons. It works by linking a tumor-targeting molecule with a fluorescent dye. This molecule selectively binds and is taken into cancer cells, illuminating them in contrast to the surrounding tissue. This enables surgeons to clearly identify and distinguish cancer from healthy tissue. “Because OTL38 functions at a cellular level, even extremely small cancerous lesions may be identified under near-infrared light,” Low says. “Furthermore, the near-infrared characteristics may also enable surgeons to detect cancerous tissue obscured below the surface of healthy tissue.”

Clinical studies exploring the benefits of OTL38 are ongoing. Results from an early development program were very promising and indicate that OTL38 contributes to more removal of cancer tissue during surgery that was not identified visually or tactilely. The phase 1 study demonstrated that OTL38 enabled surgeons to resect an additional 29% of malignant lesions. On Target Laboratories is currently confirming these results in a phase 3 clinical study.

In 2018, personalized medicine took on a new meaning in the treatment of prostate cancer patients. The approach includes performing genetic testing on men with prostate cancer to look for genetic abnormalities. “We look for something they inherited, known as a germline defect, or something they acquired, known as a somatic defect,” says Nancy Dawson, MD, professor of medicine and oncology, and director of the Genitourinary Medical Oncology Program, Georgetown Lombardi Comprehensive Cancer Center, Washington, D.C., who notes that several novel therapies show great promise for treating prostate cancer. “We look for a genetic abnormality that we can target.” Having a genetic abnormality called microsatellite instability, seen in 3% to 5% of men with prostate cancer, can predict which new immunotherapies may be effective. It can help approximately 50% of men with the abnormality.

Also in 2018, two hormonal drugs-enzalutamide and apalutamide-were approved to treat non-metastatic, castration resistant prostate cancer. They delay the time it takes for prostate cancer to spread to other areas of the body. A third drug called darolutamide appears to be just as effective with much less toxicity, however it is not yet FDA approved but is on the fast track for approval. All three are oral drugs that block androgens-hormones that play a role in male traits and reproductive activity. “Compared to a placebo, patients using these three drugs had a longer timeframe of approximately two years before they developed metastatic cancer that spread to the bones and other organs,” Dawson says.

Finally, anti-prostate-specific membrane antigen (PSMA) therapy, which is currently in clinical trials, shows great promise. Most prostate cancers produce prostate-specific antigens (PSA) and PSMAs. The treatment works intravenously, by using an anti-PSMA antibody that allows physicians to target anything in the body that makes PSMA. The antibody is delivered with small doses of radiation to wherever cancer is located. Although it doesn’t cure prostate cancer, patients are seeing positive effects from it such as decreasing the PSA, making the cancer shrink, and making pain improve or resolve.

Spectrum Health, Grand Rapids, Michigan, recently began a clinical trial that uses hepatic artery infusion chemotherapy in addition to systemic chemotherapy to treat pancreatic cancer to the liver.

To understand how the treatment works, it’s important to know that the liver receives a dual blood supply. Most of the blood flow comes from a vein (portal vein) and a smaller amount from an artery (hepatic artery). Metastatic tumors to the liver, however, receive most of their blood supply from the hepatic artery. “Hepatic artery infusion chemotherapy leverages this fact by delivering high-dose chemotherapy directly into the artery via a surgically placed pump,” Wright says. The pump is implanted under the skin of the abdominal wall and attached to a catheter that delivers the drug directly into the hepatic artery. The delivered drug has special properties that allow it to stay within the liver so there are very few, if any, side effects to the rest of the body. It can hurt the liver, however, as can any standard chemotherapy.

The Alternative Cancer Treatments Health Execs Are Talking About

The clinical trial is ongoing for patients with metastatic pancreatic cancer and is the first of its kind in this patient population. “We have seen excellent responses in other tumor types (with this treatment) such as colon cancer spread to the liver; a partial response was seen in over 70% of patients,” Wright says. “The success in treating metastatic colon cancer to the liver came when systemic chemotherapy improved and could be combined with liver-directed therapies like the hepatic artery pump. I have seen a similar trend in recent years for pancreatic cancer, where systemic chemotherapy has become more effective.”

Despite these improvements, the median survival for people with metastatic pancreatic cancer remains less than one year. “We have a long way to go toward improving survival, but are hoping that this new treatment paradigm can help move the needle in a positive direction,” Wright says.

Karen Appold is a medical writer in Lehigh Valley, Pennsylvania.

From breast cancer to prostate cancer, the state of oncology care and how it will evolve.

Top Women’s and Men’s Cancer Treatment Developments

CMS Hospital Readmissions Reduction Program

 (HRRP) in October 2012 thrust readmission reduction into the mind of every health executive.

 an admission to a participating hospital within 30 days of a discharge from the same or another hospital.

six conditions and procedures as part of HRRP

Coronary Artery Bypass Graft (CABG) Surgery

Chronic Obstructive Pulmonary Disease (COPD)

Elective Primary Total Hip Arthroplasty and/or Total Knee Arthroplasty (THA/TKA)

Each of these conditions is vital for healthcare organizations to measure-falling behind on only one can still result in penalties.

How readmissions penalties are calculated

 hospital data based on hospitals’ performances during a three-year period from July 1, 2015 through June 30, 2018.

The payment adjustment factor (PAF) is the reduction applied to CMS payments. It is calculated using an excess readmission ratio (ERR), which CMS calculates by looking at a hospital’s expected readmission rate (based on other similar hospitals) and comparing it to a hospital’s actual readmission rate.

Nine Ways to Reduce Hospital Readmissions from Hospital Executives

Hospitals that perform better than average will have an ERR less than 1.0 (and are not penalized), while hospitals performing worse than average will have an ERR of greater than 1.0 (and are penalized). The PAF is generated using ERR and 

. The minimum PAF is 0.97 (which would account for a 3% penalty, the maximum penalty allowed).

Payment reductions are calculated by subtracting the PAF from 1.0 and multiplying by 100. So for example, a hospital with a PAF of 0.975 would have a payment reduction of 2.5%:

1.0 - 0.9750 = 0.025 x 100 = 2.5% reduction

CMS has doled out $2.5 billion in penalties

readmission rates in a variety of condition types are improving

, of the 3,241 hospitals evaluated for readmissions between October 2017 and September 2018, 

The maximum penalty for hospitals is 3%. However, very few hospitals have penalties this high levied against them-in FY 2017, just 

1.8% of hospitals paid the highest penalties

 will be bringing you the ultimate guide on reducing readmissions for each of the six conditions CMS tracks. This first part will take an in-depth look at how hospitals can prevent heart-failure readmissions.

To help your organization successfully reduce heart failure readmissions, here is the complete guide to heart failure, including:

Real-world strategies for reducing readmissions.

The reasons for readmission are multifactorial and it is difficult to predict individual causes for readmission. 

Catherine J. Ryan, PhD, clinical associate professor, college of nursing, University of Illinois at Chicago Department of Biobehavioral Health Science, Chicago, says one way that readmissions have been categorized is simply as preventable or unpreventable. Others have categorized reasons for readmission as clinical, behavioral, and patient-centric, recognizing that the responsibility of readmission may reside with the patient, provider, hospital system, or any combination thereof. 

“Heart failure readmissions have been associated with a variety of factors or characteristics,” she says, adding that the most common include advanced age, history of renal disease, history of diabetes, or a heart failure admission within the past year. Other factors include admission to a teaching hospital, discharge against medical advice or discharge to home, receiving Medicaid, and being of African American ancestry.

The SDOH Factor That Impacts Heart Disease

 (HSPH) found that elderly black patients were more likely to be readmitted to the hospital after a prior hospital stay for heart failure due to disparities related to both race and the hospitals where patients were treated.

The Prevention of Hospital Readmissions in Heart Failure

” by the David Geffen School of Medicine at UCLA, Los Angeles, showed that among readmitted Medicare patients with HF, the five most common primary diagnoses-HF, renal disorders, pneumonia, arrhythmias, and sepsis-account for 56% of the readmissions with no other diagnoses accounting for more than 5%.

“Readmission potentially reflects a failure of the discharge process; thus, discharge planning should start at the time of admission,” says Karen M. Vuckovic, PhD, advanced practice registered nurse, division of cardiology, 

University of Illinois Hospital & Health Sciences System

, Chicago. “Health-related quality of life, or an individual’s perceived physical and mental health over time, predicts readmissions in patients with heart failure.”

“For the past several years, there has been a heightened national focus on reducing readmissions and thus identifying patients with the highest risk for readmission,” Ryan says. “Although there have been reductions, readmission rates remain high.”

In the skilled nursing market, Zachary Palace, MD, medical director of RiverSpring Health 

 at Riverdale in Bronx, New York, says the shift to patient-driven payment model (PDPM) provides facilities with higher reimbursement for more complex Medicare Part A patients, explaining the amount of care needed correlates more directly to the reimbursement received.

The ACA authorized the federal government to penalize hospitals for poor readmission rates for Medicare patients with heart failure, and this has caused many to rethink their strategies.

Managing heart failure risk factors: Successful strategies

David Majure, MD, medical director, mechanical circulatory support program, 

 at North Shore University Hospital in Manhasset, New York, says reducing readmissions is about a strong system approach and doing good heart failure care.

At his hospital, a group known as Health Solutions targets patients subject to the Heart Failure HRRP umbrella and efforts are made to connect with them at home.

The way it works, he explains, involves calling the patients at home and ensuring they have adequate resources at home and following up appropriately. By doing this, it helps reduce readmissions and the hospital’s decreasing numbers have shown it’s a success.

“If they become readmitted, they help them identify factors to help minimize their readmission,” Majure says.

 program is a hospital-based quality improvement program that provides assistance for providers to maintain current practice guidelines.

The guidelines noted that scheduling an early follow-up visit (within seven to 14 days) and early telephone follow-up (within three days) of hospital discharge are reasonable. In response to this recommendation, most HF programs include a discharge follow-up phone call though data in response to this recommendation is mixed. Therefore, Vuckovic notes each program needs to evaluate what works for their population.

“Studies which have included follow-up phone calls usually include other interventions,” she says. “There is a handout for TARGET-HF which guides the process and scripts the call.”

For example, a clinician-initiated discharge phone call is a simple and cost-effective method that allows clinicians to connect to the patients after their hospital discharge to check on their well-being, review or reinforce discharge instructions, and address issues that may potentially lead to adverse outcomes.

“Dealing with heart failure patient’s basic needs is essential in helping them manage their disease,” Vuckovic says. “For example, one inner-city teaching hospital recognized that providing housing for those who are homeless during the transition phase led to patients being more likely to attend follow-up appointments.”

Hebrew Home utilizes the AMDA’s (The Society for Post-Acute and Long-Term Care Medicine) 

 as its protocol for treating CHF patients. Palace explains the guidelines are in a small handbook, easy to read, and provide clinicians with key points to identify heart failure, assess it, and treat and monitor achievements. This keeps everyone on the same page with best practices and ensuring they are practicing the most current medicine.

“We also have full-time physicians on staff and provide comprehensive training to all of our clinical teams on what to look for and what steps to take,” he says. “Through these efforts, we are able to manage the majority of patients in our facility and thus have a low number of readmissions.”

How Health Systems Use Pharmacists to Reduce Readmissions

Anecdotally, he shares families often talk about how their mom or dad when at different facilities, would end up in ER every few weeks with heart failure, but since coming to Hebrew House, they haven’t gone out at all. It’s a credit, Palace says, to managing these patients in-house.

Hebrew Home has also invested in technology, such as contact-free continuous vital sign monitoring, to help it identify patients at risk for CHF exacerbation. This is a trend that others are following and Palace says it’s important because it acts as the eyes and ears when the nurse is not in the room, which is a large part of the time.

“In CHF patients, a key risk to look for is an increase in fluids. Fluid builds up and when patients lie down, this fluid moves from their legs and collects in their lungs. An indicator we look for is shortness of breath,” Palace says. “We also monitor weight, a quick increase in weight is another way to monitor for fluid retention. We are also seeing a lot of new technology coming to the market specifically designed to help identify changes.”

, a recently-approved technology. The technology is a vest a nurse applies a patient which has a built-in sensor that reads across the chest from front to back and can quantify total lung water volume. That is also significant in helping to identify heart failure patients.

Hospitals successful at reducing readmissions that were enrolled in the American College of Cardiology’s 

, a resource for hospitals and cardiovascular care providers committed to improving transitions from hospital to home and reduce their risk of federal penalties associated with high readmission rates, created a summary of 10 key practices. Of the 10 practices, three centered on medication management.

“Education about the purposes of each medication, changes in doses/frequency, which to stop, which are new, and how to take them correctly were identified as essential to self-management. Medication reconciliation is essential,” Vuckovic says.

Palace says medication compliance is much easier to manage in a skilled nursing facility where physicians are keeping a close eye, and the clinical staff is helping to ensure adherence.

Vuckovic says that culturally appropriate multidisciplinary discharge planning and education has been shown to facilitate compliance and decrease readmissions. 

 that self-care (e.g., diet, medication, and symptom management) is largely insufficient in ethnic minority populations, indicating an area where more emphasis is needed-especially as self-care can be a 

“We need to shift our approach from hospital care to providing self-care at home since the majority of the patients’ care takes place in the home, not the hospital,” she says. “Providers should seize every opportunity to reinforce self-care principles and education.”

Keith Loria is an award-winning journalist who has been writing for major newspapers and magazines for close to 20 years.

The ultimate guidebook on everything you need to know about reducing hospital readmissions-the most common risk factors, the reimbursement issues, and how real-world hospitals are solving the problem.

6 Strategies for Your Hospital Readmissions Reduction Program

Although the number of new drug shortages in the United States has declined to 186 in 2018 since a high of 267 in 2011, there have been 80 for the first half of 2019, according to the 

University of Utah Drug Information service

“Shortages continue to be on the rise and in talking with our customers, we’ve discovered the problem continues to get worse. More medications are going on allocation or unavailable and what used to be short, periodic shortages have become long and drawn out, making it a continuous challenge for clinical leaders,” says Patrick Yoder, PharmD, CEO, 

, a Minneapolis-based clinical process improvement and control software provider.

“Some medication shortages have been going on for years with no real sign of recovery,” he says.

“While the number of drug shortages has declined substantially in recent years, any drug shortage places substantial burdens on healthcare, providers who may have to ration medicines or identify alternative treatments,” says Andrew Powaleny, director, public affairs for Pharmaceutical Research and Manufacturers of America (PhRMA).

Four Ways Hospitals Can Deal with Rising Drug Costs

“The issue of drug shortages demands attention and collaboration from all stakeholders involved in providing life-saving medicines to patients. This includes the biopharmaceutical companies producing brand-name medications, as well as generic drug and biosimilar manufacturers, wholesalers, distributors, pharmacies, and healthcare providers,” he says.

 conducted between March 6 and April 4, 2019 of 365 acute and non-acute care facilities across the country-members of Vizient, a healthcare performance improvement company headquartered in Irving, Texas-confirms the ever-present problem of drug shortages and their ramifications.

Nearly two-thirds of respondents report they managed at least 20 shortages from July through December 2018; 64%, more than 21; 33%, six to 20; and 3%, up to five. Thirty- eight percent report one or more medication errors directly related to a drug shortage in that same time period.

The most commonly reported items facing shortages, according to the survey, are controlled substances, local anesthetics, antibiotics, electrolytes, and emergency injectables such as “crash cart” drugs, many of which are low-cost generics.

Injectables comprise 39% of drug shortages in 2019, according to the University of Utah Drug Information Service.

The FDA primarily attributes shortages to quality/manufacturing issues but also points to production delays, some caused by not receiving raw materials and components from suppliers, and drug discontinuations. An estimated 70% of shortages are caused by manufacturing and quality problems, according to the Healthcare Supply Chain Association.

“The FDA can't require a firm to keep making a drug it wants to discontinue. Sometimes these older drugs are discontinued by companies in favor of newer, more profitable drugs,” says Charlie Kohler, spokesperson for the FDA. “With fewer firms making older, sterile injectable drugs, there is a limited number of production lines that can make these drugs. Raw material suppliers also are limited in the amount they can make due to capacity issues at their facilities.”

Kohler says that these limitations, along with long lead times and the complexity of the manufacturing process for injectable drugs, result in shortage vulnerabilities. “When one company has a problem or discontinues, it is difficult for remaining manufacturers to increase production quickly, and a shortage occurs,” he says.

Dan Kistner, PharmD, senior vice president, pharmacy solutions for 

Too many lines offered, making it difficult to maintain capacity.

Aggregate product quota preventing other manufacturers who might enter the space from making more product.

Low ROI. If a product is not profitable, manufacturers might switch to other drugs.

Powaleny attributes drug shortages to shifts in clinical practices; wholesaler and pharmacy inventory operations; changes in hospital and pharmacy contractual relationships with suppliers and wholesalers; and manufacturing issues, such as an unforeseen breakdown in manufacturing equipment that disrupts production.

“The difficulty is identifying what medications will be impacted by any of these things and how that will affect care delivery and patient safety, along with understanding when any particular shortage will occur,” Yoder says.

“The biggest risk is patient safety and potential harm to patients when clinicians cannot deliver appropriate care because of a medication shortage. Deferring procedures, adverse drug events, medication errors, cost of alternatives, and the time clinical teams spend managing shortages are all results of shortages,” Yoder says.

The Vizient survey focuses on the impact of drug shortages on U.S. hospital labor forces. Responses indicate that shortages are costing these institutions $359 million a year in labor expenses, or about 8.6 million hours of additional labor, to seek supply, update technology, and implement mitigation strategies that enable continuity of care. Survey participants attributed labor costs to triaging patients and making changes in the ordering system.

The repercussions of drug shortages not only impinge on financial resources but also on patient care, from delay or cancellation of a medication or treatment to medication errors. The Institute for Safe Medication Practices conducted a 

 primarily of hospital-based pharmacy directors and managers, purchasing agents, and technicians from August through October 2017. It found that the majority (71%) were unable to provide patients with a recommended drug or treatment, and 47% thought this resulted in patients receiving a less effective drug. In addition, 75% stated that patient treatments had been delayed because of drug shortages. 

Kistner recommends some strategies for mitigating drug shortages: increase competition; ramp up supply and capacity; reward quality in generics; expedite manufacturer approval processes; provide real-time analytics about what is purchased and which supplies are dwindling; and apprise hospitals of potential drug shortages so that they do not become a repeat problem.

Among Vizient’s solutions are Novaplus, which provides access to 15,000 individual, high-demand line items encompassing a broad range of categories.

Respondents to the Vizient survey had a say in what they believe to be effective solutions to the drug shortage problem: implementing processes to restrict duration of therapy; increasing stock of medications that were anticipated to be limited in supply; utilizing unit dosing to prevent waste; using alternative ways of administering a drug; and implementing one or more taskforces or committees dedicated to addressing drug shortages and allocations.

LogicStream has introduced the Drug Shortage App that identifies shortages and their impact on hospitals and automates the entire life cycle of managing a shortage. It provides clinical information that allows teams to understand and mitigate the ramifications for shorted medications. Yoder says that although most hospitals have a drug shortage management process, they tend to be manual, time-consuming, and costly.

“FDA responds to potential drug shortages by taking actions to address their underlying causes and to enhance product availability. It determines how best to address each shortage situation based on its cause and public health risk,” Kohler says.

To address manufacturing/quality problems, FDA works with manufacturers to resolve issues, from an incorrect expiration date on a package to finding a particulate in a product. “Regulatory discretion may be employed to address shortages to mitigate any significant risk to patients,” he says.

The agency also assists manufacturers with drug shortages in ramping up production if they are willing to do so. Kohler says this often necessitates approval of new production lines and raw material sources to help increase supplies. FDA expedites review of these to help resolve shortages of medically necessary drugs; however, the agency can't require companies to increase production.

If a manufacturer has data to support extension of an expiration date for inventory that is close to expiration or has already expired, FDA is able to review this information and approve the extension, helping to increase supplies until new production is available.

In addition, FDA could turn to other manufacturers that are willing and able to redirect product to the U.S. market if a shortage involves critical drugs needed for U.S. patients. This requires an evaluation of a product to ensure efficacy and safety, including the formulation and other attributes of a drug and the quality of the manufacturing site where a drug is made.

Kohler says that while the FDA looks for ways to mitigate drug shortages, there are a number of factors that can cause or contribute to the problem that are outside of the FDA’s control.

The agency issued a long-term, strategic plan to outline its priority actions and efforts drug manufacturers and others can take to prevent drug shortages by promoting and sustaining quality manufacturing, along with launching the Drug Shortages Task Force July 2018, to study reasons why shortages continue.

Drug shortages might be decreasing, but their continued existence is urging the pharmacy industry to maintain its vigilance.

Drug Shortages Continue to Burden Healthcare

It’s a good time to apply for a job in healthcare.

Per the U.S. Department of Labor’s Bureau of Labor Statistics, 

-but there have been particularly notable gains in the healthcare industry. But despite-or perhaps because of-some of the lowest unemployment numbers in decades, many hospitals and health plans are struggling to attract and maintain quality employees.  As noted in a 2017 

survey, there is “unprecedented” employee turnover among hospitals and other healthcare organizations-for both clinical and non-clinical staff. Joseph Parente, a principal with KPMG’s Management Consulting Practice who works specifically with provider and payer organizations, says this not surprising.

“These results are a couple years old, but they are pretty representative of what we’re seeing in the industry even now,” says Parente. “The 

survey found that more than one-third of employees were planning to leave their hospital within two years. Nearly 70% said they’d be leaving in the next five years. And, although we talk a lot about physician and nursing shortages these days, it’s not just clinical staff who are looking to leave their positions. The survey also found that, when asked if they plan to leave their current job, it’s non-clinical administration staff that are most likely to say yes.”

The downstream effects of this kind of employee turnover results in the sort of vicious cycle that leads to even more employee dissatisfaction and turnover, says David Wilkins, chief strategy officer for HealthcareSource, a healthcare talent management firm, in Woburn, Massachusetts.

Health Execs Share Their Favorite Interview Questions

With a rapidly-growing employment environment, how can healthcare orgs best recruit and retain the right employees?

Vol 29 No 9

Making the Most of Predictive Analytics

How to Prepare for Leadership Changes

Top Women’s and Men’s Cancer Treatment Developments

6 Strategies for Your Hospital Readmissions Reduction Program

Drug Shortages Continue to Burden Healthcare

Finding-and Keeping-Good Employees

Featured Exec John Baackes, CEO of LA Care Health Plan

Life-Altering Gene Therapy Pipeline Poses Challenges

The Future of Healthcare Leadership

Do Certificate-of-Need Laws Still Make Sense in 2019?

Contemplating the Future of List Prices

Top 6 Things Health Execs Need to Know About LinkedIn