Utah hospitals Covid: Proposed critera would ration health care at overwhelmed facilities

A group of administrators representing Utah’s hospitals presented Gov. Gary Herbert with a list of “criteria they propose doctors should use if they are forced to decide which patients can stay in overcrowded intensive care units,” The Salt Lake Tribune reported.

They told Herbert that they’d need to put the criteria in place if the coronavirus trend continues, Greg Bell, president of the Utah Hospital Association, told the Tribune.

To triage care, the proposal would take into account a patient’s age, health, situation and ability to survive, Bell told CNN affiliate KUTV on Sunday night.

“At the end of the day, some senior person, versus some healthy young person, probably would not get the nod,” Bell said.

Bell said Utah is suffering from a “phenomenal case growth and spread rate” of Covid-19.

The state reported more than 1,000 new cases per day for the last 12 days. On Sunday, Utah had its highest seven-day average for new daily cases, according to data from Johns Hopkins University.

Since the beginning of the pandemic, more than 104,882 people in Utah have been infected with coronavirus, and at least 572 people have died.

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Even before a formal rationing of health care, one Utah mother who suffered a heart attack was delayed in getting adequate treatment due to the Covid-19 surge.

Researchers: Bad national Covid-19 response meant at least 130,000 US deaths could have been avoided
Laurie Terry needed special equipment in a hospital’s intensive care unit. But a doctor told the family there weren’t enough resources available amid the growing Covid-19 surge.

Eventually, Terry was taken to a hospital that had the specialized care she needed, but her condition has gotten worse.

“We’ve seen, in the past couple of weeks, that our health care system is at capacity,” state epidemiologist Dr. Angela Dunn said.

“I don’t know what to do anymore,” she said. “I’m really not trying to scare anyone. I’m just trying to inform you of what’s going on and give you the facts.”

Herbert had one wish for the public:

“I would hope that people will take this seriously,” the governor said.

CNN’s Holly Yan and Martin Savidge contributed to this report.

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HSG Foresees Major Potential Financial Impact on Employed Physician Networks and Medical Groups from 2021 Proposed Medicare Physician Fee Schedule

Healthcare Consultants Urge Hospitals and Health Systems to Start Planning for Impact on Physician Compensation and Medicare Payments for Professional Services.

Neal D. Barker, Partner at HSG, a national healthcare consulting firm is the author of "Changes to the 2021 Medicare Physician Fee Schedule Could Have Major Impact on Physician Compensation." The article is available for download at the website, hsgadvisors.com.
Neal D. Barker, Partner at HSG, a national healthcare consulting firm is the author of “Changes to the 2021 Medicare Physician Fee Schedule Could Have Major Impact on Physician Compensation.” The article is available for download at the website, hsgadvisors.com.
Neal D. Barker, Partner at HSG, a national healthcare consulting firm is the author of “Changes to the 2021 Medicare Physician Fee Schedule Could Have Major Impact on Physician Compensation.” The article is available for download at the website, hsgadvisors.com.

Louisville, KY, Oct. 21, 2020 (GLOBE NEWSWIRE) — HSG, a national healthcare consulting firm, has published a detailed evaluation of the Centers for Medicare & Medicaid Services (CMS) 2021 Medicare Physician Fee Schedule (MPFS) Proposed Rule, which is scheduled to take effect on January 1, 2021, if approved in the Final Rule. The advisors at HSG believe the proposed changes may have a significant potential impact on physician compensation and urge healthcare executives to start planning for these proposed changes. The agency’s Fee Schedule changes cover everything from Work Relative Value Unit (wRVU) values for specific Current Procedural Terminology (CPT) codes to changes in the scope of practice policies for Advanced Practice Providers (APPs) and changes related to CMS’s quality payment program.

With more than a 10% decrease in the MPFS conversion factor, services that do not have any change in Relative Value Unit values will see a decrease in Medicare payment at the projected rate of more than 10%. The decreased reimbursement will not be fully offset by any reimbursement increases realized through the Quality Payment Program paths. Changes related to outpatient and office evaluation and management (E&M) service code determinations and requirements, along with permanent and temporary additions to telehealth codes, will add to compensation complications. The redefined E&M code selection criteria will now be driven by medical decision making (MDM) or time spent alone – with no direct contribution by history and/or exam elements.

“Assuming these changes are included when the Final Rule is published in early December, many industry organizations, consultancies, and provider advocacy groups are projecting significant increases in provider productivity-based compensation if the providers’ E&M profile remains unchanged,” explained Neal Barker, Partner at HSG. “Ultimately, hospitals and health systems may face a situation in which payments from Medicare will decrease while their physician compensation requirements will significantly increase based on the widespread use of wRVU-based compensation models for employed physicians and APPs.”

As the roll-out date for the new Fee Schedule grows closer, HSG is working with healthcare systems to help them gain an understanding of the potential impact on the network.  Then HSG works with the organization to build a model to address changes to wRVU targets and bonus conversion factors that yield productive compensation levels that are financially sustainable and uphold fair market value and commercial reasonableness. Coincident with the compensation impact review, HSG conducts a series of provider

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