Managed care-driven changes in care delivery and reimbursement have caused a lot of hospitals to close beds and convert nursing units to outpatient centers. But some health care planners are warning hospitaladministrators not to become myopic: Giving up beds and renovating units now could come back to bite in about 10 years, when baby boomers will need more inpatient services.

That's not to say hospitals shouldn't make improvements to meet today's market, but Jim Hannon, a San Francisco-based senior vice president for the Smith Group consultancy, says meeting immediate needs should be done with flexibility in mind.

When renovating a nursing unit, for instance, "Make sure you're putting things in the right place," he says. Consider whether a departmental expansion will force renovations in an adjacent department that is likely to face change soon because of market conditions.

"We encourage master planning," Hannon says. Rapidly changing reimbursement patterns have led many administrators to say, "I'm going to stop master planing, because my horizon is one to two years out."

This, he says, has led to situations where "winners are supported and others aren't." Community hospitals that offer a range of services are cutting those with declining reimbursement: Mental health, Hannon says, is one example. "We've seen several cases where psych beds are closed and reclaimed for outpatient services, or are converted to med/surg beds."

That's where foresight helps. Create units that can be reconverted easily to inpatient areas, say architects. Some planners also recommend that hospitals hang on to licenses for high numbers of beds — even if beds are closed for many years.

Managed Care’s Top Ten Articles of 2016

There’s a lot more going on in health care than mergers (Aetna-Humana, Anthem-Cigna) creating huge players. Hundreds of insurers operate in 50 different states. Self-insured employers, ACA public exchanges, Medicare Advantage, and Medicaid managed care plans crowd an increasingly complex market.

Major health care players are determined to make health information exchanges (HIEs) work. The push toward value-based payment alone almost guarantees that HIEs will be tweaked, poked, prodded, and overhauled until they deliver on their promise. The goal: straight talk from and among tech systems.

They bring a different mindset. They’re willing to work in teams and focus on the sort of evidence-based medicine that can guide health care’s transformation into a system based on value. One question: How well will this new generation of data-driven MDs deal with patients?

The surge of new MS treatments have been for the relapsing-remitting form of the disease. There’s hope for sufferers of a different form of MS. By homing in on CD20-positive B cells, ocrelizumab is able to knock them out and other aberrant B cells circulating in the bloodstream.

A flood of tests have insurers ramping up prior authorization and utilization review. Information overload is a problem. As doctors struggle to keep up, health plans need to get ahead of the development of the technology in order to successfully manage genetic testing appropriately.

Having the data is one thing. Knowing how to use it is another. Applying its computational power to the data, a company called RowdMap puts providers into high-, medium-, and low-value buckets compared with peers in their markets, using specific benchmarks to show why outliers differ from the norm.
Competition among manufacturers, industry consolidation, and capitalization on me-too drugs are cranking up generic and branded drug prices. This increase has compelled PBMs, health plan sponsors, and retail pharmacies to find novel ways to turn a profit, often at the expense of the consumer.
The development of recombinant DNA and other technologies has added a new dimension to care. These medications have revolutionized the treatment of rheumatoid arthritis and many of the other 80 or so autoimmune diseases. But they can be budget busters and have a tricky side effect profile.

Shelley Slade
Vogel, Slade & Goldstein

Hub programs have emerged as a profitable new line of business in the sales and distribution side of the pharmaceutical industry that has got more than its fair share of wheeling and dealing. But they spell trouble if they spark collusion, threaten patients, or waste federal dollars.

More companies are self-insuring—and it’s not just large employers that are striking out on their own. The percentage of employers who fully self-insure increased by 44% in 1999 to 63% in 2015. Self-insurance may give employers more control over benefit packages, and stop-loss protects them against uncapped liability.