AMID COVID-19 HEADWINDS, STEWARD GENERATED MILLIONS IN SHARED SAVINGS FOR MEDICARE

CMS AWARDS STEWARD SECOND LARGEST MEDICARE SAVINGS PAYMENT IN NATION

September 20 2021 – Steward Health Care, owner of Coral Gable Hospital, Hialeah Hospital, North Shore Medical Center, Palmetto General Hospital in Miami-Dade County, and Florida Medical Center in Broward County, ranked first in membership, tied for first in quality, and earned the second highest shared savings payout out of 513 participants in the Center for Medicare and Medicaid Service’s (CMS) Medicare Shared Savings Program (MSSP) through its subsidiary Steward National Care Network, according to recently released CMS data.  As the nation’s largest physician-led health care network and accountable care organization (ACO), Steward generated more than $68 million in total 2020 Medicare cost savings while receiving a perfect 100% quality rating amid the challenges of the COVID-19 global pandemic. 

Since Steward’s Medicare Accountable Care Organization launched in 2012, it has grown into the largest in the country, with more than 161,000 program beneficiaries, while maintaining a multi-year track record of success in delivering high quality clinical outcomes and generating consistent savings. Steward’s Medicare ACO results are part of its large portfolio of value-based success across commercial, Medicare Advantage, and Medicaid risk-based contracts in every state where Steward operates.

Despite significant market headwinds related to the ongoing COVID-19 pandemic, Steward’s 2020 performance year was its most successful — which can be attributed to its physician-led, compassionate, patient-first care model. This model of care has been proven to lower costs while markedly increasing quality of care and patient satisfaction in communities across the country.  

“We are proud of our physicians, and their clinical teams who participate in the MSSP program across our network, who have provided the highest quality care while aiming to keep their patients healthy in the communities where they live,” said Sanjay Shetty, M.D., President of Steward North America. “This important designation validates that our physician-led, patient-centric model consistently delivers best in class outcomes for all stakeholders including patients, payors and communities.”

“Our comprehensive care management programs support recently hospitalized patients with chronic diseases with resources and programs in their communities and have been integral to our ongoing Medicare ACO success and mission to put patients first in everything we do,” said Dr. Joseph Weinstein, Chief Physician Executive for Steward Health Care Network. “The COVID-19 pandemic continues to pose numerous challenges, but our unwavering commitment to providing high quality, value-based care in all the communities we call home is and will remain the central tenet of our work.

About Steward Health Care 

Steward Health Care’s physician-led business model was built to unlock access to the highest-quality care at a sustainable cost, committed to providing personalized, ongoing medical services that positively impact patients’ physical, emotional, and mental well-being. 

Founded in 2010, Steward Health Care is the largest physician-led health care network with more than 5,500 providers and 43,000 health care professionals caring for 12.3 million patients a year through its global network of hospitals, urgent care centers, skilled nursing facilities and behavioral health services. 

Based in Dallas, Steward currently operates 44 hospitals around the world, including 34 across Arizona, Arkansas, Florida, Louisiana, Massachusetts, Ohio, Pennsylvania, Texas, and Utah, as well as five internationally within Malta and Colombia. 



September 20 2021 – The Centers for Medicare & Medicaid Services (CMS) awarded $15 million in planning grants to 20 states to support expanding community-based mobile crisis intervention services for Medicaid beneficiaries. By connecting people who are experiencing a mental health or substance use disorder crisis to a behavioral health specialist or critical treatment, these services—which will be provided by funding from the American Rescue Plan (ARP)— and will be available 24 hours per day, every day of the year, can help save lives. Importantly, these services can also help to reduce the reliance on law enforcement when people are experiencing a behavioral health crisis and, in turn, may help to prevent the unnecessary incarceration of people with serious mental illness or substance use disorders.

The planning grants—funded by the ARP—provide financial resources for state Medicaid agencies to assess community needs and develop programs to bring crisis intervention services directly to individuals who are experiencing a substance use-related or mental health crisis outside a hospital or facility setting. These grants will help states integrate community-based mobile crisis intervention services into their Medicaid programs, a critical component of establishing a sustainable and public health-focused crisis support network.

“The pandemic has taken a serious toll on the mental health of Americans, especially in underserved communities,” said Health and Human Services Secretary Xavier Becerra. “Through these awards, the Biden-Harris Administration is making a bold investment to highlight the importance of behavioral health and ensure states can provide vital services to those hardest hit by the pandemic. This funding from the American Rescue Plan will expand access to crisis care for everyone—and reach people where they are.”

“With these grants, CMS is taking strides to connect individuals in crisis with the high-quality, expert care they need. Providing behavioral health care experts as alternatives to police is an example of how we can better help communities deliver on the behavioral health needs of all its residents,” said CMS Administrator Chiquita Brooks-LaSure.

The planning grants provide funding to develop, prepare for, and implement qualifying community-based mobile crisis intervention services under the Medicaid program. Grant funds can be used to support states’ assessments of their current services; strengthen capacity and information systems; ensure that services can be accessed 24 hours a day, every day of the year; provide behavioral health care training for multi-disciplinary teams; or seek technical assistance to develop State Plan Amendments (SPAs), demonstration applications, and waiver program requests under the Medicaid program.

On April 1, 2022, thanks to the ARP, all states will be eligible for a temporarily enhanced matching rate for implementing a qualified community-based mobile crisis intervention option in their Medicaid programs.
The period of performance for this grant will be from September 30, 2021, through September 29, 2022.

To view the list of CMS Award Recipients, please visit: https://www.medicaid.gov/medicaid/benefits/behavioral-health-services/state-planning-grants-for-qualifying-community-based-mobile-crisis-intervention-services/index.html.



September 20 2021 – That self-diagnosed “only a wrist sprain” could well prove to be an injury in need of surgical repair, according to Miami-based orthopedist Alejandro Badia, who says ligament and cartilage damage or fractures of one or more of the wrist’s small bones are oftentimes an underlying cause of joint pain and stiffness, especially after a fall or other trauma.

“Ligament and cartilage lesions and severe joint fractures are types of problems frequently requiring minimally invasive arthroscopic surgery by an experienced orthopedic specialist,” says Dr. Badia, who is noted for treatment of upper-limb joint disorders. “Patients with persistent wrist pain should contact an orthopedic surgical specialist immediately. Delays in care may result in further wrist damage and ultimately affect a patient’s quality of life. Assuming ‘it’s just a sprain’ or seeking help from primary care or emergency medicine physicians who have no expertise treating musculoskeletal disorders could prove costly and hinder a patient’s eventual recovery and return of wrist strength and mobility.”

Arthroscopic surgery is so named for a surgeon’s use of an arthroscope, a tiny camera that can be inserted into the joint or other area of the body to aid visual examination and diagnosis and ensure pinpoint surgical correction of any disease. The camera provides 3-D images that are projected onto a monitor for the surgeon to view. When performing arthroscopic surgery, the specialist cuts several incisions of less than a half inch through which he can manipulate micro-instruments. Advantages of this kind of minimally invasive surgery include less postoperative pain, quicker recovery, and reduced risk of infection, Dr. Badia says.

“The arthroscope can be used in combination with open surgery for repair of serious bone fractures extending into the wrist joint.    However, the majority of patients with wrist joint pain have sustained a subtle cartilage or ligament tear, which many times can only be clearly detected with an arthroscope. That makes the scope both an important diagnostic and therapeutic tool in the treatment of these joint injuries,” says Dr. Badia, a sports medicine expert and the founder and chief medical officer of the Badia Hand to Shoulder Center and OrthoNOW®.

He adds that an arthroscopic approach is most useful in removal of cartilage or other joint tissue that has loosened or become diseased due to trauma and the mending of tears in ligaments and cartilage, particularly in the triangular fibrocartilage complex (TFCC). The TFCC is located in the wrist between the forearm’s two long bones – the radius and the ulna – and is what stabilizes the forearm bones and controls wrist and forearm motion when rotating the arm or using the hand to grasp something, Dr. Badia explains.

He cites recent studies — one just published in the June 2021 Journal of Hand Surgery – reporting on “revolutionary” advances in arthroscopic wrist surgery, with emphasis on new techniques for ligament reconstruction, repair of the TFCC, and bone grafting when a wrist fracture, including the scaphoid bone, fails to heal. The scaphoid, one of the wrist’s small carpal bones, frequently cracks in a fall.

Another recent arthroscopic technique – arthroscopic thermal annealing, a process involving application of heat – is proving effective as a treatment for instability of the wrist joint at a notch between the forearm’s distal radius and ulna bones, according to research published in 2021 in the Journal of Wrist Surgery

Dr. Badia points to falls, in both sports and everyday activities, as a leading cause of wrist damage. In fact, statistics show that, across all age groups, the upper limbs are generally more susceptible to injury in a fall. “Wrists frequently take the worst of the impact because persons instinctively extend their arms and hands out to brace themselves in an effort to break their fall,” he says. “Severity of injury depends on the force of the blow to the wrist joint and the extent to which the wrist is bent backwards.”

Of much concern to Dr. Badia and other orthopedic specialists is physician overuse of magnetic resonance imaging (MRI) to diagnose wrist pain. 

“Oftentimes, MRI scans fail to show the pathology causing the problem. That’s because the tear affects the joint interval only when the patient’s joint is in motion – something not seen on MRI images,” Dr. Badia advises. “A negative MRI does not necessarily mean the patient has no treatable problem.  In fact, a negative scan can cause difficulties in a patient obtaining needed financial coverage for correction of what is later determined to be a real injury. Insurance companies have far too much control of the treatment process in this country.”

Meanwhile, “plain x-rays can tell us if a patient has incurred a wrist fracture, although such fractures rarely require arthroscopy,” Dr. Badia says

Dr. Badia describes the wrist as an “engineering marvel whose motion is critical to the ability of the hand and fingers to grab, grasp, twist, and pick up objects.” The joint is actually a complex of several small joints consisting of eight irregularly shaped bones. These bones are joined by ligaments and tendons, with cartilage at the ends of bones providing the “oil” that allows them to glide around each other.

“The importance of the wrist joint cannot be understated,” Dr. Badia says. “It engages in a wide range of movements required for everyday activities like simply tying a shoe or buttoning a shirt.” He offers the following tips to protect the wrists:

·      Consider wrist-strengthening activities. For example, experts recommend extending a towel out in front of you with both arms and then wringing it out for about 20 seconds as if trying to remove excess water from it and then repeating this activity four or five times. Also occasionally exercise the wrist joints by rotating them in a circular pattern, especially when using them to type on a keyboard for prolonged periods of time.

·      Introduce simple wrist exercises to a warm-up routine before engaging in sports, particularly those involving repetitive wrist motion like tennis and golf.

·      Avoid sleeping positions that bend or curl the wrists.

·      Practice good posture when seated and adjust your chair or tabletop so that the wrists do not bend upwards or downwards when working at the computer.

“And, if wrist pain develops and persists, call an orthopedic surgeon – today,” Dr. Badia advises. Alejandro Badia, MD, FACS, internationally renowned hand and upper-limb surgeon and founder of Badia Hand to Shoulder Center and OrthoNOW®, a walk-in orthopedic care clinic. He is a member of the American Society for Surgery of the Hand, American Association for Hand Surgery and the American Academy of Orthopedic Surgeons and an honorary member of many international professional hand societies. Dr. Badia specializes in treating all problems related to the hand and upper extremities, including trauma, sports injury, joint reconstruction, nerve injuries and arthroscopic surgeries. www.drbadia.com and www.orthonowcare.com



September 20 2021 – Taking a tumble is a risk for those who climb ladders or trees. For older adults, staying on their feet can also present a challenge. While falls are not a normal part of aging, every second of every day in the United States an adult 65 years or older suffers a fall. According to the Centers for Disease Control and Prevention (CDC), one out of four older adults will fall each year in the U.S.[1]

“As we age, gravity is not our friend,” said David A. Summers, RN, CFRN, EMT-P, Trauma Nurse Outreach Coordinator with the Health Care District of Palm Beach County who conducts educational outreach events that instruct senior adults how to keep on their feet and avoid the risk of a fall. “In Florida, over 3,700 people died last year as the result of a fall, most of them someone’s grandparent.”

This year, Florida Governor Ron DeSantis recognizes the week of September 20th as Falls Prevention Awareness Week. In Palm Beach County, Florida, patients who fall account for 44% of all traumatic injuries treated within the county’s Trauma System. Summers said over the past 12 months, 134 of those falls were fatal and of those, 116 were patients 65 years or older. According to the CDC, each year at least 300,000 older people are hospitalized for hip fractures.[2] Falling once doubles your chances of falling again.[3]

“Many factors can lead to a fall, such as loss of vision, being off-balance and not lifting your feet,” Summers said. “The use of blood thinners can worsen the outcome of a fall. Many people who fall, even if they are not injured, become afraid of falling. That leads to less activity, becoming weaker and ultimately, more prone to falling again and having a more serious outcome.”

Summers said senior adults most often fall while getting in and out of bed, when getting on or off the toilet, or walking at night when the lights are off. While falling can be painful and costly, the good news is that falls are preventable. Summers recommends family members get involved as well. Together, they should ensure there is adequate lighting and eliminate any trip hazards in the home, like area rugs or power cords. Seniors should have their hearing and vision checked annually and update their eyeglasses.

“Encourage the use of assistive devices, like walkers, and install grab bars, especially in bathrooms and showers,” Summers said. “It’s also important to wear proper footwear like flat, rubber-soled shoes. In addition, review medications and make sure physician orders are properly followed.”

Family members should also talk to their loved one’s provider about checking for Vitamin D deficiency and advise the physician of any recent falls since seniors often withhold that information from their doctor. One of the best tips to prevent falling is to remain physically active. Flexibility, strength-training and building balance are key. Seniors can benefit from taking yoga, tai chi and other exercise classes with friends and family.

“Motivating your loved ones to keep moving at a slow and steady pace is important as they age,” said Summers. “Being observant and engaged can ensure they remain active and stay safe.”

To learn more about preventing falls, visit the CDC’s website, the National Council on Aging’s website and the Health Care District of Palm Beach County’s Falls Awareness page where you can print the flyer “Six Steps to Prevent a Fall.

[1] Bergen G, Stevens MR, Burns ER. Falls and Fall Injuries Among Adults Aged ≥65 Years — United States, 2014. MMWR Morb Mortal Wkly Rep 2016;65:993–998. DOI: http://dx.doi.org/10.15585/mmwr.mm6537a2

2 Healthcare Cost and Utilization Project (HCUP). 2012. Agency for Healthcare Research and Quality, Rockville, MD. http://hcupnet.ahrq.govExternal . Accessed 5 August 2016.

3 O’Loughlin J et al. Incidence of and risk factors for falls and injurious falls among the community-dwelling elderly. American journal of epidemiology, 1993, 137:342-54.

About the Health Care District
The Health Care District of Palm Beach County provides primary medical care and dental services for adults and children at the C. L. Brumback Primary Care Clinics, a coordinated and lifesaving Trauma System that includes two FAA-certified Trauma Hawk air ambulances, registered nurses in nearly 170 public schools, short and long-term skilled nursing at the Edward J. Healey Rehabilitation and Nursing Center in Riviera Beach, and acute care at its teaching hospital, Lakeside Medical Center, which is accredited by The Joint Commission and serves the rural Glades’ communities.



One in Five Florida Kids Suffer Mental Health Conditions; Three in Five Experienced Stress During Previous Year

September 20, 2021 – The Florida Chapter of the American Academy of Pediatrics (FCAAP), in partnership with Simply Healthcare, launched today SimplyHealthyMinds.com, a toolkit of resources to help children, families, healthcare providers and others navigate mental health challenges facing children.

“At Simply Healthcare, we work to support the whole-health of Florida’s kids– physical, mental and emotional health,” said Holly Prince, President of Simply Healthcare Medicaid Plan. “It can be challenging to start a conversation about mental health or find programs that are available to support children in a particular part of the state.

SimplyHealthyMinds.com brings all the trusted resources together in one place.”

“There are real consequences when children who need support don’t have access to it,” said Dr. Lisa Gwynn, President, Florida Chapter of American Academy of Pediatrics. “That’s why we wanted to make it easy to find the resources available and help Floridians navigate the challenges of mental health struggles among children.”

The Simply Healthy Minds toolkit is available at a pivotal time, when children are returning to school, but still face the risk of COVID-19. In addition, September is Suicide Prevention Awareness Month, an opportunity for families to consider the devastating consequences that could result from mental health struggles left unaddressed. The Simply Healthy Minds toolkit provides resources to help kids, families, healthcare providers and others navigate mental health challenges facing kids.

  • The goals of SimplyHealthyMinds.com are to support children by breaking down barriers, increasing understanding of mental health and reducing the stigma associated with mental illness and improving access to resources and care.

At SimplyHealthyMinds.com, users can find a variety of resources to support mental health in children, including:

  • Guidelines for parents to talk to teens;
  • Conversation starters for parents to talk with children;
  • Journal entry prompts to help children express their feelings in writing;
  • Access to local community assistance programs by searching zip codes; and
  • Suicide prevention hotline.

The resources are curated by Simply Healthcare in partnership with the FCAAP, a trusted organization for the health and well-being of children in Florida. The online toolkit is the result of a partnership between the two organizations to pursue initiatives toward their common mission of caring for children in Florida.

Both organizations recognize the growing need to support children struggling with mental health issues.

According to Jed Foundation Report: Fluent Family Wellbeing Study, 60% of parents report that children have experienced distress during the last year. Since COVID began, Florida experienced a 30% increase in Baker Acts – the action of committing an individual to a mental health treatment center – among kids ages 12 to 17.

In addition, the findings of the inaugural State of the Nation’s Mental Health, a report issued in May by Simply Healthcare’s parent company, showed that while more people, including children, reported increased pandemic-related stress and anxiety last year, there was not a corresponding increase in diagnoses and treatment. This indicates that children may not be getting the help they need.

Mental health problems can affect many areas of children’s lives, including their happiness, physical health and academic performance.

Visit SimplyHealthyMinds.com to find the guidelines, best practices and local programs.

About FCAAP

Through its more than 2,500 members, the Florida Chapter of the American Academy of Pediatrics promotes the health & welfare of Florida’s children and supports pediatricians

& pediatric specialists as the best qualified providers of their healthcare. Learn more by visiting www.fcaap.org.

About Simply Healthcare

Simply Healthcare is a Managed Care Plan that offers plans in Florida for residents eligible for Medicaid, Medicare and Florida Healthy Kids benefits. To learn more, visit  www.simplyhealthcareplans.com.