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CPBJ Extra Blog

Catching up with PinnacleHealth's leader

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Construction has been going on for a long time now, and if you don't drive right by it, you may have forgotten, so here's your reminder: PinnacleHealth System will be opening its West Shore Hospital this year.

We wanted to ask PinnacleHealth President and CEO Michael Young some questions in advance of the opening, so we did; that article is coming out in tomorrow's print edition.

However, for you loyal readers of the blog, we have a special video preview. ("Special" in this case means that I shot it myself and then, in quick succession, personally forgot and remembered the microphone I left in Young's office. Making videos is harder than it looks.)

Staffing a new hospital: PinnacleHealth leader details plans from Central Penn Business Journal on Vimeo.

I also want to share with you what Young said about PinnacleHealth's problems with Obamacare now that Jan. 1 has hit and people are starting to use the new coverage that they may or may not actually have. You may recall there was talk of the potential for mass confusion.

In three words, there wasn't any, at least at Pinnacle. Young said by way of explanation that, as far as he knows, the number of area residents who have signed up through so far is "very, very small" and thus the chance of them both thinking erroneously that they have coverage and having health problems serious enough to warrant admission in the past few weeks are pretty slim.

The issue may rear its head eventually, he said, but for now it's definitely not a problem at Pinnacle.

(By the way, that reminds me that we're still waiting for official numbers on how many of the people reported as enrollees actually made it official and completed the process by paying up. Highmark reported on Jan. 13 that it had 37,132 Pennsylvania enrollments, but that included people who had not yet paid their premiums. Any guesses on how many of those fell through?)

Three other things, and then I'll stop.

• Young said River Health ACO, of which Pinnacle is a large part, covers about 41,000 people, which puts it in the ranks of the largest accountable care organizations in the country. Pinnacle sees about 50 of those patients in its facilities per day.

• As health care reform progresses and more people get coordinated care, Young said, he expects there will be fewer double PET and CT scans and fewer double MRIs. Patients treated in medical home settings should be going to the emergency department less and suffering fewer hospital readmissions, he said — slipping in a mention that Pinnacle's readmission rate is already pretty low. That will be good in many ways but hard on a hospital's bottom line, he said, "so we have to learn to live on that lower number."

• I mentioned Obamacare's goal of expanding health care access, and he said he doesn't expect anything like a tidal wave of people suddenly getting access in Central Pennsylvania, because the health systems have long been providing that care. "Because of my knowledge of Lancaster when I worked there and York and here, anybody who needs care gets it," he said.

• • •

The Centers for Medicare & Medicaid Services recently issued an informational bulletin titled "Reducing Nonurgent Use of Emergency Departments and Improving Appropriate Care in Appropriate Settings." I found its contents a lot more interesting than its title.

• "Medicaid beneficiaries use the ED at an almost two-fold higher rate than the privately insured. This is not due to widespread inappropriate use of the ED amongst Medicaid beneficiaries, who tend to be in poorer health than the privately insured population; at least two studies found that the majority of ED visits by nonelderly Medicaid patients were for symptoms suggesting urgent or more serious medical problems. These studies estimate that non-urgent visits comprise only about 10 percent of all ED visits by Medicaid beneficiaries, and suggest that higher utilization may be in part due to unmet health needs and lack of access to appropriate settings."

• "Two-thirds of emergency visits occur after business hours (weekdays 9 am - 5 pm)."

• "Frequent ED users (often defined as individuals with 4 or more visits per year) comprise 4.5% to 8% of all ED patients across payors but account for 21% to 28% of all visits."

• "About 12.5% of all ED visits across payors are due to mental health and/or substance abuse treatment needs."

• • •

Ever wonder what the costliest IT incidents for hospitals are? According to this article, the answer is security breaches at $810,189 per incident, data loss at $807,571 per incident, and unexpected IT outages at $432,000 per incident, on average.

All that makes this story of a missing hard drive more horrifying to me. I mean, who among us doesn't know from experience how easy it is to lose a flash drive ­— and where flash drives go missing, can hard drives be far behind?

• • •

For those of you who want to play the hindsight bias game known as "How the ACA should have been different," this is me officially inviting you to have a go.

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