In the News: Dec 7–13

AI Could Enhance Colonoscopy Detection and Diagnosis

A recent Medscape report details artificial intelligence (AI) usage during colonoscopy to improve polyp detection and the prevention of colorectal cancers.

Current adenoma detection rates among colonoscopists fall short of the 50% reported prevalence rate among screening-aged populations. Research from UC Berkeley indicates that convolutional neural network technology may be used to identify colonoscopy images with polyps with up to 96% accuracy. Another AI system, ENDOBrain, has been used in Japan to detect neoplastic lesions during colonoscopy at 90% accuracy.

While early detection leads to significantly better outcomes, the national screening rate for colorectal patients falls below 65% of the target population. Sg2 expects IP and OP colorectal cancer services demand to increase by 5% and 11%, respectively, over the next 5 years. To learn about how your organization can best position itself for colorectal growth, as well as other gastrointestinal growth opportunities, read the Sg2 FAQ: Gastrointestinal Program Development.

Observation Care Is Associated With Lower OOP Costs

A recent Health Affairs study focused on 6 conditions—nonspecific chest pain; abdominal pain; syncope (fainting); headache, including migraine; cardiac dysrhythmias; and infections of the skin and subcutaneous tissue—to compare observation stays and short-term hospitalizations of nonelderly, commercially insured adults between 2009 and 2013, finding that the rate of observation care increased rapidly over the study period relative to short-stay hospitalizations for this population. Further, while out-of-pocket (OOP) costs were found to be significantly lower for observation stays than for short-stay hospitalizations, OOP costs for observation stays increased at a much higher rate than short-stay hospitalizations. The study’s authors believe that increases in observation utilization and OOP costs in the commercially insured, nonelderly population may be a response to Medicare policy changes regarding observation care.

Sg2 believes that actively managed, protocol-driven observation care can help prevent ED congestion by providing patients short-term intensive treatment or accelerated diagnostic workup. To learn about potential improvement initiatives organizations can pursue to enhance observation care, read the Sg2 Performance Guide: Optimizing Observation Care.

Kaiser Family Foundation Provides Latest Medicare Models Results

A new resource kit from the Kaiser Family Foundation compiles the latest publicly available information and data on Medicare payment and delivery system reform models, with findings that echo Sg2 expert discussions, as Medicare models have thus far had mixed results. While quality scores for accountable care organizations continue to improve, net savings to Medicare are dampened by the lopsided participation in upside-only models. Similarly, medical home models continue to struggle to achieve savings greater than additional care management fees paid to practices. While bundled payment models have achieved some net savings, one bundle skeptic among Sg2 experts suggested that these models are merely “taking small swings at a big problem.”

Few argue the need for a shift to some form of value-based care, but impatience is mounting as we’ve begun to tally up the actual savings. To learn more about Sg2’s perspective on the future of payment evolution, visit Sg2’s 2017 Executive Summit Materials and Resources and watch Day 1’s Market Forces Driving Payment Evolution video.

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