Even in markets where physician-owned hospitals captured more than 10 percent of admissions, community hospitals’ profit margins appeared stable through 2004, according to a new report by the Medicare Payment Advisory Commission. Using two additional years of data and a larger number of physician-owned specialty hospitals, MedPAC issued an updated report on the cost of inpatient care at specialty hospitals. The number of physician-owned specialty hospitals doubled from 2002 to 2004, primarily in parts of the country with above-average population growth and without certificate-of-need laws, according to the report. Specialty hospitals’ inpatient services are not less costly than community hospitals, with inpatient costs at orthopedic/surgical hospitals running about 20% higher. Both types of specialty hospitals, however, have 20% to 25% shorter lengths of stay. And even though specialty hospitals took profitable procedures away from community hospitals, the study found that competing hospitals found ways to compensate by cutting staff, increasing their own profitable services, and increasing prices. Read the report.
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California lawmakers have cleared the way for a bill that would permit the state to fine hospitals up to $50,000 when they put patients in “immediate jeopardy” for significant injury or death. Less serious infractions would carry fines of up to $17,500. The bill (S.B. 1312), which amends certain sections of the state’s Health and Safety Code pertaining to healthcare facilities, is expected to pass this week, according to the Los Angeles Times. C. Duane Dauner, president of the CHA, told the Times he believes the bill “is reasonable under the circumstances to serve the best interests of patients and of hospitals.”
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A review of 49 states’ pandemic flu plans found widespread disparities in measures to detect and control respiratory disease pandemics, according to a report by the Research Triangle Institute International. The confusion among the state plans prompted the researchers to call for federal health officials to provide additional direction and guidance as well as answers to epidemiological questions so that states are better prepared. The report, published in Emerging Infectious Diseases, found that few state plans included guidelines for personal avoidance steps during a pandemic, such as staying home from work, keeping sick children at home, and avoiding mass gatherings. The state plans also lacked specificity in proposing practical containment measures in the community. Eight states were developing procedures for screening international travelers, but international airport hubs such as Chicago and Atlanta did not yet include plans for international traveler quarantine and testing. State plans also lacked an agreed-upon definition of geographic clustering of cases or the number of people infected that would trigger the declaration of a pandemic.
Adult obesity rates continued to rise in 31 states over the past year while government policy efforts have consistently failed to provide viable solutions to the growing obesity crisis, according to a new report from Trust for America’s Health. In nationwide rankings, Mississippi was the heaviest state, with an adult obesity rate of 29.5%, followed by Alabama and West Virginia. Colorado was the least heavy state, with an adult obesity rate of 16.9%. Obesity rates remained the same in 18 states and Washington, D.C.
The report cites a survey of 26 state-level government experts on disease prevention, who name the three biggest barriers to effectively addressing obesity: inadequate funding of health initiatives, the political view that obesity is more of a personal responsibility issue than a public policy issue, and lack of political will to solve the obesity problem. The report offers numerous recommendations to address the obesity epidemic’s health burden and financial costs. While personal responsibility is critical to adopting and sustaining healthy behaviors, the report notes that “individual behavior change will not work in isolation.”
The percentage of Americans without health insurance coverage rose from 15.6% to 15.9% from 2004 to 2005, to 46.6 million people, according to the U.S. Census Bureau report, Income, Poverty, and Health Insurance Coverage in the United States egion>: 2005, released on Monday. During the same time period, real median household income in the United States rose by 1.1%, reaching $46,326, and the nation’s official poverty rate remained statistically unchanged at 12.6%.
According to the report, the percentage of people covered by employment-based health insurance declined slightly from 59.8% to 59.5% between 2004 and 2005. While the number of people covered by government health programs increased from 79.4 million to 80.2 million, the percentage of people covered by government health insurance remained at 27.3%. There was no statistical difference in the number or percentage of people covered by Medicaid--38.1 million and 13%. The percentage and number of uninsured children increased from 10.8% to 11.2%, or from 7.9 million to 8.3 million children.
The uninsured rate, as well as the number of uninsured, remained statistically unchanged from 2004 to 2005 for whites (at 11.3% and 22.1 million) and for blacks (at 19.6% and 7.2 million). The rate for Asians increased to 17.9% in 2005, up from 16.5% in 2004. The number of uninsured Asians was 2.3 million, up from 2 million. The uninsured rate for Hispanics was 32.7% in 2005--statistically unchanged from 2004. The number of uninsured Hispanics increased from 13.5 million to 14.1 million. Based on a three-year average, 29.9% of people who reported American Indian and Alaska Native as their race were without coverage, and the three-year average for Native Hawaiians and other Pacific Islanders was 21.8%.
The uninsured rate for those in the South increased from 18.2% to 18.6% between 2004 and 2005 and in the West from 17.4% in 2004 to 18.1% in 2005. The Midwest and Northeast had the lowest uninsured rates in 2005, at 11.9% and 12.3%, respectively. Texas had the highest percentage of uninsured (24.6%), while Minnesota had the lowest (8.7%). Read the report.
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Detroit hospitals and clinics are being recognized as leaders in the new field of population health, which explores why some individuals get better care than others and finds ways to improve health for people at risk for not getting adequate care, reports the Detroit Free Press. The University of Michigan is conducting the largest federally funded study of barriers to mental health care among African-Americans, for example, and Eastern Michigan University, among others, is working to overcome privacy issues that prevent Asian Indian women from getting screened for breast cancer. Initiatives to reach individuals who aren’t receiving basic medical care may add as little as $7 million to the $41 million per year spent to reimburse hospitals for uninsured care, according to the Kaiser Family Foundation. Others argue that the nation’s first priority is to beef up its network of outpatient clinics and primary care physicians in order to steer patients away from expensive hospital care, and to let state and local governments find ways to provide care for all their citizens rather than expecting the federal government to extend healthcare coverage to all Americans.
The mobile hospital that treated 7,400 patients in Mississippi during a six-week period following Hurricane Katrina could provide a model for rapid medical responses to future mass casualties, according to an article to be published online in the Annals of Emergency Medicine. For the first two weeks post-Katrina, five emergency physicians, three trauma surgeons, an orthopedist, and two anesthesiologists--as well as nurses, paramedics, pharmacists, and a radiation technician--treated 25 to 300 patients a day. A slightly smaller staff continued to treat patients for another month. The first and only hospital of its kind in the world, Carolinas MED-1 incorporates an emergency department, surgical suite, critical care beds, and general treatment and admitting area. Consisting of two 53-foot tractor-trailers, the unit expands to a workspace of 1,000 square feet and supports an environmentally controlled awning structure that incorporates up to 130 beds. It carries its own generators, oxygen, x-ray and ultrasound capability, and diagnostic lab. “We designed Carolinas MED-1 as a fast and flexible resource to be adapted for use in the event of a weapon of mass destruction or pandemic,” said Thomas Blackwell, MD, of the Carolinas Medical Center in Charlotte, N.C.
The Alabama Supreme Court has ruled that Richard Scrushy must repay HealthSouth Corporation $51.5 million in bonuses he earned while he was CEO of HealthSouth. A Jefferson County Circuit Court judge had ruled in January that Scrushy’s bonuses were based on the false accounting entries that led to the $2.64 billion fraud perpetrated by HealthSouth executives. Scrushy, however, argued that the amount in question was part of his regular pay earned from 1997 through 2002. And although prosecutors insist Scrushy is worth at least $287 million, Scrushy says repaying HealthSouth would put him “on the brink of financial disaster,” reports The Birmingham News. Scrushy was found not guilty of participating in the fraud, but he was convicted of bribing former Gov. Don Siegelman for a spot on a hospital regulatory board. Scrushy’s lawyer says his client has not decided whether he will ask the Alabama high court to reconsider the ruling or appeal the decision to the U.S. Supreme Court.
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Despite having continuous health insurance, 17% of Kansas farmers report having medical debt, according to a report by the Boston-based Access Project. Among individuals under age 65, however, 29% said they had medical debt, compared with only 5% of those age 65 and older. The median amount of medical debt was $2,500. Many respondents with debt reported going without care to avoid accruing new debt, and many struggled to pay down their bills using savings and by transferring debt to credit cards. According to the report, approaches that advocate shifting more of the costs of health care onto policyholders may leave increasing numbers of insured people at risk for financial difficulty. “We were surprised to learn that so many hard-working farm families that thought they were protected by their health insurance had fallen into medical debt,” said William Lottero, an analyst with the Access Project.
Hispanics have mortality rates that exceed those of whites, a phenomenon that has puzzled researchers since the 1970s and runs counter to expectations that a population that is financially disadvantaged is less healthy, reports the Los Angeles Times. According to data from the Centers for Disease Control and Prevention, the national age-adjusted mortality rate for 2003 was 621 per 100,000 individuals for Hispanics, which is 25% less than for whites and 43% less than for blacks. National Hispanic infant mortality rates were about the same as for white infants and 58% less than for blacks. The Times explored research that shows that Latinos’ strong social support and family connections may reduce stress and keep individuals healthier. Immigrants who live in Latino neighborhoods had a 5% incidence of asthma compared with 22% for those who didn’t live among other Latinos, for example. Diet and lifestyle preferences also keep Latinos healthier, although children of immigrants tend to not to follow the habits of their parents. Obesity, for example, is very high in Mexican children, warn researchers.
Hospitals are hoping their construction projects stay on schedule, because a delay of only a few months could add millions to the final cost, reports the Birmingham Business Journal. The construction industry had a 10% cost increase in 2005 and expects another 6% to 10% jump in 2006. Steel prices have skyrocketed by 25% in the past few months, fueled by heavy demand by the Chinese as their robust economy allows them to rebuild the country and prepare for the 2008 Olympics. And oil and copper prices have also increased. HCA Inc. says it forecasts its construction costs by inflating the cost of previous projects by 10% annually, and Vanderbilt estimates that a new patient tower will cost $322 per square foot to build. Average costs for hospital construction range between $265 and $275 per square foot. “I worry about this for our industry because reimbursements haven’t changed and these healthcare guys are having to provide the same quality of care for the same reimbursement, but the costs keep going up and up and up,” Jim Poole of the Birmingham, Ala.-based construction firm Robins & Morton Group told the Journal.
An estimated 800 to 1,000 nurses at the Robert Wood Johnson University Hospital in New Brunswick, NJ, went on strike Aug. 24. Under the contract terms the hospital proposed, nurses would have received a 9% salary increase over three years, a 10% increase in pension contributions, and changes in healthcare coverage that would have “reduced cost and improved access.” But Local 4-200 of the United Steelworkers Health Care Workers Council maintains that the hospital’s health insurance plan is inferior and inadequate, and constitutes a “penalty” for nurses who come from four states to work at the hospital and don’t necessarily live close to the healthcare facilities in the network. “Our 1,300 nurses work with some of the finest physicians in the country to deliver the highest quality health care to our patients,” said local union president Jerry Collins in a statement, “but our health coverage doesn’t provide the same level of care for ourselves and our families.”
The hospital says it has replaced striking nurses for the duration of the job action with nurses it has recruited nationally. The replacement nurses were chosen for their experience in the specialty and subspecialty services that the hospital offers, and they also meet all New Jersey licensing requirements. “Daily reports from the New Jersey Department of Health and Senior Services, as well as feedback from doctors, patients, and their families all confirm that the nurses who have joined our staff are upholding the highest professional standards,” said a statement issued by the hospital.
HHS Secretary Michael Leavitt discussed his vision for a new healthcare system for New Orleans while visiting the 40-member committee of city, state, and private experts charged with planning new hospitals and clinics to rebuild those that were destroyed by Hurricane Katrina one year ago. Replacing the former medical system of separate facilities for the poor and for the insured will be a prevention-based network of primary care clinics that will provide a medical home for every patient. Electronic health records will ensure that doctors can provide seamless care to any patient, and price and quality information will be readily available, Leavitt told The Times-Picayune of New Orleans. Although Leavitt said he is in a hurry to rebuild New Orleans’ medical care, he also acknowledged that changing the way people view health care will take time. “It’s not the thing you build all at once and then flip the switch on,” he said. “There’ll be some bricks and mortar that’ll have to be put into place--clinics to be built, health records to be safeguarded--and it won’t just be systems. It’ll have to be sociology that’ll have to change.”
Meanwhile, the city’s emergency physicians are discouraged by the progress of rebuilding emergency departments, according to a survey conducted by the American College of Emergency Physicians. More than half (52%) report little to no progress in the recovery of the emergency care system in their communities. The vast majority of emergency physicians (93%) said the shortage of beds is at least 25% below what is needed to care for patients, with 29% saying the shortage is 50% below what is needed. More than one-third (36%) of emergency physicians said that if the post-hurricane recovery is not sufficiently improved in one more year, they would consider leaving to practice in another state. “It’s frustrating for patients and doctors to see so little progress in one year,” said James Moises, MD, of Tulane Medical Center.
The Federal Trade Commission has alleged that two Kansas City independent practice associations (New Century Health Quality Alliance, Inc., and Prime Care of Northeast Kansas, LLC) and 18 physician practices engaged in anticompetitive conduct by refusing to deal with healthcare plans, except on collectively agreed-upon terms, including price. According to the FTC’s complaint, the 127 primary care physicians who are members of the IPAs agreed to refuse to deal, and refused to deal, with health plans regarding fee-for-service contracts with individual physician practices. They also acted together to increase their bargaining power with payers and attempted to force payers to accept the terms agreed upon through the IPAs on behalf of their combined membership. The FTC’s complaint charged that their actions unreasonably restrained competition. In settling the FTC’s charges, they will refrain from engaging in such anticompetitive conduct in the future. The commission is accepting public comment on the consent order for 30 days, after which it will decide whether to make it final.
During the entire four-year period from 2001 through 2004, 6.6% of the American population under age 65 (16.9 million people) were uninsured, according to a statistical brief from the Agency for Healthcare Research and Quality. For the last two years of that period, 31.2% of the population was uninsured for at least one month, and 10.3% were uninsured the entire two years. Young adults (18 to 24) were the mostly likely to be uninsured for at least one month during 2003 through 2004 (55.1%), as were Hispanics (49.5%). Although Hispanics comprise 15.4% of the under-65 population, they accounted for 37.9% of the individuals without insurance during 2001 through 2004, making them disproportionately represented among the long-term uninsured.
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Nearly 14,000 hospitalizations in Pennsylvania involved a serious form of staphylococcus infection in 2004, according to new research by the Pennsylvania Health Care Cost Containment Council. Pennsylvania was the first state to publicly report hospital-acquired infection numbers last year. Patients with a methicillin-resistant Staphylococcus aureus infection had mortality rates of 8.9% (compared with 2.1% of patients without the infection), had their hospital stays extended by eight days, and had average hospital charges of $87,990 versus $28,711 for patients without MRSA. The report did not distinguish between community- and hospital-acquired MRSA infections. The report also found that about half of all hospitalizations with MRSA infections were among patients with respiratory diseases, disorders of the circulatory system, and infectious and parasitic diseases, and 54% of hospitalizations with MRSA infections were for patients age 65 and older.
“There is a shared responsibility among hospitals, nursing homes, and physicians to identify and implement best practices and strategies that are most effective at preventing MRSA transmission,” said the Hospital & Healthsystem Association of Pennsylvania in response to the report. Carolyn Scanlan, president and CEO of HAP, enumerated the hospital initiatives under way across the state to prevent hospital-acquired MRSAs and said, “Consumer education is critical, as patients, family members, hospital visitors, as well as community leaders must have access to resources that explain how they can be part of the solution.”
A new report by the Commonwealth Fund identifies several promising practices that hospitals can incorporate in treating their diverse populations. The practices are drawn from the programs of several hospitals that have successfully overcome language and cultural barriers to provide effective healthcare interactions. To conduct the study, the American Medical Association’s Ethical Force Program and the Health Research and Educational Trust, an affiliate of the American Hospital Association, conducted eight hospital site visits to learn about patient-centered strategies being used to improve communication with vulnerable patients. The hospitals were chosen based on several criteria, including location, patient diversity, creativity of strategies, and the potential for using those strategies at other organizations.
The nine practices are based on themes that recurred as the hospitals developed their various approaches to clear communication. They include encouraging passionate champions throughout the organization, collecting information on patient needs, engaging communities, developing workforce diversity and communication skills, involving patients, encouraging awareness of cultural diversity and low health literacy, providing effective language assistance services, using clear language, and evaluating organizational performance over time. Read the report.
As our population becomes more culturally and linguistically diverse, there has been a greater focus on how to deliver high-quality care to patients with limited English proficiency. A policy brief by Mathematica Policy Research found that providing face-to-face interpreters for the 22,000 Medicaid beneficiaries with limited English proficiency in Connecticut would cost $4.7 million annually. A 50% federal matching rate would reduce the cost of these services by $2.35 million. And although Medicaid managed care plans--which cover three-fourths of Connecticut’s Medicaid patients--provide interpreters, Mathematica found that many providers were unaware of the service. To secure federal matching funds for interpreters, Mathematica recommended that Connecticut reimburse interpreter services as a Medicaid-covered expense to allow the state to monitor costs and trends and build on existing payment structure.
WellPoint, Inc., has announced that it will make its consumer-directed health plan products and services available in all states and to all markets beginning Jan. 1, 2007. Previously, WellPoint offered CDHPs only to national employers. Although the number of WellPoint’s members with CDHPs rose 30% since the end of 2005, fewer than 700,000 of WellPoint’s 34 million members have enrolled in CDHPs, according to The Indianapolis Star. CDHPs still have not been embraced by all Americans, a spokesperson for the Center for Studying Health System Change told the Star. “If they’re going to become mainstream, they have to gain more than the toehold they have right now in the employer market,” she said. Read the WellPoint announcement.
A Canadian study of 4 million emergency department visits at 110 Ontario hospitals found that diverting patients without medical emergencies didn’t improve the timeliness of care given to those with urgent problems, reports the Houston Chronicle. According to the study, to be published in the online Annals of Emergency Medicine, each patient without a true emergency increased the wait for other ED patients by just 32 seconds. “Caring for patients with minor ailments doesn’t lead to clinically important delays, and turning them away isn’t very patient-focused,” study author Michael Schull of the Institute for Clinical Evaluative Sciences in Toronto told the Chronicle.
Many U.S. emergency medicine experts agree that EDs aren’t crowded simply because people use them as clinics. But officials at Harris County’s public hospitals in Texas, which just instituted a new policy of redirecting ED patients with nonurgent problems, maintain that Canadian EDs cannot be compared with U.S. ones, and said that in just three weeks, significantly fewer individuals with minor medical problems have been showing up at the county hospitals’ EDs.
Although healthcare spending has been predicted to be 25% of the gross domestic product by 2030, some leading economists see little wrong with making health care “the driving force in the economy,” reports The New York Times. Nobel laureate Robert Fogel, at the University of Chicago Graduate School of Business, told the Times that food, clothing, and housing consume only about a third of U.S. household income today, leaving plenty of room to afford health care that will prolong life. Harvard economist David Cutler agrees that the country is rich enough for a 45-year-old to spend $30,000 more to treat cardiovascular disease than he would have spent in 1950 to increase his life span by three years. Other economists argue, however, that spending more on health care doesn’t necessarily result in better health. Half the money spent on health care is wasted, Princeton economist Angus Deaton told the Times. In Medicare, “there isn’t anybody who has responsibility for making sure the money gets spent well,” he says. “Some huge improvements will have to be made as the consequences of that waste get greater.”
HCA has alerted its patients that 10 computers were stolen from a regional office that was a “secured building, protected by keypad lock technology, and video surveillance.” The computers contained “thousands of files listing unpaid bills from Medicare and Medicaid patients for hospitals in eight states,” HCA said in a statement on its web site. Some files listed patients’ Social Security numbers. The FBI has begun an investigation, and HCA reports that authorities believe the computers were stolen for their hardware, not the files. The organization has set up a call center to assist Medicare and Medicaid patients with overdue accounts whose personal information may be contained in the stolen computers.
The Centers for Medicare and Medicaid Services has announced that it is making available Medicare payment information for 61 procedures performed in ambulatory surgery centers. In June, Medicare posted what it pays for 41 inpatient procedures. The ASC data are intended to help consumers select the most appropriate setting for high-quality, efficient care for surgical procedures. The data, posted at www.cms.hhs.gov/HealthCareConInit/, will include charge and Medicare payment for ASC facility costs for commonly performed procedures at the county, state, and national level. CMS is also concurrently releasing data on “Other Commonly Performed Procedures in ASCs,” which contain similar charge and payment data, but for facility costs related to services of high utilization.
CMS also announced a new Medicare pilot project that is intended to provide more comprehensive and personalized information on quality and cost that builds on private-sector quality measurement efforts. The quality information will be based on services provided to Medicare and Medicaid beneficiaries, and individuals with private health insurance in select states--Arizona, California, Indiana, Massachusetts, Minnesota, and Wisconsin--and will be available to providers, other insurers, employers, and the public. Read the press release.
President Bush signed an executive order on Tuesday requiring federal agencies that administer or sponsor federal health insurance programs--the Department of Health and Human Services, the Defense Department, the Department of Veterans Affairs, and the Federal Employees Health Benefits Program--to gather price and quality data on medical procedures they purchase and to share them with each other and consumers by Jan. 1, 2007. Medicare beneficiaries, health insurance beneficiaries at the Department of Defense and Department of Veterans Affairs, and federal employees represent about one-quarter of Americans covered by health insurance. The executive order builds on the federal government’s efforts to release Medicare payment information for individual healthcare providers.
Bush’s order also directs the agencies to collaborate with the private sector and government sources to develop programs that assess medical quality, to identify practices that promote quality, and to use interoperable health IT. Each agency must also require that the health IT systems of providers, health plans, or insurers meet recognized interoperability standards. Consumers will be able to access the pricing and quality information from a variety of potential sources, including insurance companies, employers, and Medicare-sponsored web sites.
On Aug. 21, Aetna announced that physician-specific information on healthcare costs, clinical quality, and efficiency is now available to its members. The roll-out gives online access to price, clinical quality, and efficiency information for physicians in 12 geographic regions: Cincinnati; Cleveland; Columbus, Ohio; Connecticut; Dayton, Ohio; South Florida; southeast Indiana; northern Kentucky; Maryland; Springfield, Ohio; northern Virginia; and Washington, D.C. Price information only is available for physicians in Kansas City, Las Vegas, and Pittsburgh.
The physician-specific clinical quality and efficiency information is taken from Aetna’s Aexcel network option, designed to help consumers select specialists and mitigate increases in medical costs. Aexcel-designated specialists undergo an evaluation process that reviews their care based on measures of clinical performance and efficiency, including prevalence of complications and repeat procedures. Aetna members will see the actual rates specific to their health plan for office visits, diagnostic tests, minor procedures, major procedures, and other services. Rate information is included for up to 30 of the most widely accessed services by specialty. For physicians who are Aexcel-designated, the web page will show whether he or she has met the Aexcel criteria for clinical performance, efficiency, and volume of Aetna members treated.
Nearly all the growth in Medicare spending from 1987 to 2002 can be attributed to the 20% increase in patients being treated for five or more conditions, according to the results of a new study published in Health Affairs. In 1987, 31% of Medicare beneficiaries were treated for five or more conditions, which accounted for half of total Medicare spending. Fifteen years later, more than half of Medicare beneficiaries had five or more conditions, accounting for three-fourths of total spending. The authors of the report point to the rise in obesity as a major contributor to increased Medicare spending. While obesity has doubled in the Medicare population since 1987, medical spending to treat obese beneficiaries has nearly tripled, from 9.4% to almost 25%. An 11% increase in spending for mental disorders can also be linked in part to obesity, say the authors, because patients with diabetes and obesity have a high incidence of depression. In addition, physicians are more aggressively treating patients with five or more conditions. In 1987, 33% of the chronically ill said they were in good or excellent health compared with 60% in 2002. For Medicare to control spending for chronic illnesses, however, it must adopt strategies for lifestyle modification and care coordination, necessitating an overhaul of its fee-for-service payment model, say the authors.
Forty-two percent of Americans reported experiencing poorly coordinated, inefficient, or unsafe care at some time during the past two years, according to a new survey of 1,023 adults from The Commonwealth Fund Commission on a High Performance Health System. Respondents reported that they received unnecessary care or treatment recommended by a physician, received duplicate tests, were victims of medical errors, and/or that their physicians or nurses failed to receive test results or important information about their care. The survey found strong public support for efforts to improve care coordination, and a belief that expanded use of IT and teams could improve the quality of care.
The survey also revealed that 48% of respondents in middle-income families ($35,000 to $49,999 annual income) reported serious problems paying for health care and health insurance. One-third of adults with family incomes between $50,000 and $74,999 a year, and one-fifth with incomes over $75,000, also reported serious medical bill problems. Three-quarters of respondents--both Republicans and Democrats--said the healthcare system needed either fundamental change or complete rebuilding, a view that was shared across income groups and regions of the country. The four top priorities for the president and Congress, according to respondents, are: ensuring that Medicare remains financially sound long term, controlling the rising costs of medical care, ensuring that all Americans have adequate and reliable health insurance, and lowering the cost of prescription drugs. Read the report.
Emergency patients who require follow-up outpatient treatment frequently don’t receive it, putting patients with chronic diseases such as diabetes and asthma at extreme risk. Two articles in the Annals of Emergency Medicine depict a healthcare system inadequate to the needs of emergency medicine’s most vulnerable patients: the uninsured and the suicidal. With only 68% of physicians willing to provide charity care, the uninsured or underinsured often don’t have access to physicians outside the emergency department. The situation is even worse for patients who have attempted suicide. Studies show that patients who survive suicide attempts are at risk for repeat attempts with more lethal methods. More than 50% of the study’s respondents in California said their ED had no mental health professional to evaluate suicidal patients. “Emergency physicians provide care to many of our nation’s most at-risk patients,” said Frederick Blum, MD, president of the American College of Emergency Physicians. “Unfortunately, once they leave the emergency department, they have to fend for themselves.”
A new study by the Joint Commission on Accreditation of Healthcare Organizations found that hospitals ranked as the “best” for heart care by U.S. News & World Report are among hundreds of hospitals across the country where patients can receive care that measures up to or exceeds the care provided in those facilities. The study, published in the American Heart Association journal Circulation, compared the performance of 774 hospitals, 41 of which were listed among U.S. News & World Report’s 50 best heart and heart surgery hospitals. The hospitals were compared with each other using 10 measures that are based on clinical treatment guidelines from the American College of Cardiology and the American Heart Association.
The researchers found that 13 hospitals not in the magazine’s list of top performers did better in adhering to the treatment guidelines than any of the top 41 identified by U.S. News & World Report. Furthermore, when all 774 hospitals included in the study were ranked based on their adherence to specific evidence-based care practices, 313 nonranked hospitals did as well as the top half of hospitals ranked by the magazine.
Three medical systems in Texas alone have spent $110 million on electronic health records, reports the Houston Business Journal in an article that documents the progress of several large hospital systems in adopting EHRs. Texas Children’s Hospital will spend $60 million over five years to switch over from paper records to electronic ones, a transition that “will result in cultural and organizational process changes,” David Finn, Texas Children’s vice president, told the Journal. “We’re considering this a capital project that is really part of an expansion of our healthcare services,” he said. M.D. Anderson Cancer Center couldn’t find an EHR system that would support both research and clinical applications, so it built its own. “Other people have tried to develop their own in-house system, but the labor was so horrendous, most gave up,” said Lynn Vogel, M.D. Anderson’s chief information officer. The Methodist Hospital is spending $43 million over eight years and is rolling out the system all at once instead of department by department, as many other hospitals have done. Many of the 4,000 Methodist staff who have already been trained in the new EHR report that the conversion is overwhelming. And Baylor College of Medicine has spent $10 million so far to make EHRs operational in all internal medicine departments. Within the next year, all Baylor clinics plan to use EHRs.
Heart transplant centers may be lucrative for hospitals, but five in the Philadelphia area is just too many, charge critics who maintain that there aren’t enough patients requiring transplants to allow surgeons to do enough of the procedures to ensure good outcomes, reports The Philadelphia Inquirer. The region has the same number of heart transplant centers as Los Angeles, but with only half the population. Last year, three of the Philadelphia-area programs did fewer than 12 transplants, the minimum Medicare sets for funding. And although surgeons at the smaller transplant centers expect their numbers to grow, heart transplants have been decreasing as less invasive procedures have been developed to treat heart failure. In 2003, there were 93 heart transplants in the Philadelphia area compared with 175 in 1997. Five transplant programs “is not competition. It’s just stupid,” Abraham Shaked, director of the University of Pennsylvania Transplant Center, told the Inquirer. Two programs would be sufficient, he said.
A state panel in Massachusetts has set proposed rates for the state’s landmark health insurance law that passed in April. According to The Boston Globe, lower-income single adults would pay between 1% and 4.5% of their income, depending on how much they earn annually, and lower-income couples would pay between 1.5% and 6.6% of their income. Children will receive coverage through Medicaid. The law mandates that all Massachusetts residents have health insurance by next summer. Other states are watching Massachusetts closely as they try to find solutions for their uninsured populations. State regulators will vote on the proposed rates later this month.
Although medical quality experts advocate that medical errors be disclosed in order to ultimately improve patient safety, more than half the physicians in a recent study were not willing to admit an error to a patient when presented with scenarios that clearly put the physician at fault. The survey of 2,637 Canadian and American physicians by University of Washington researchers and published in the Archives of Internal Medicine found that 56% of the physicians would tell the patient there was an adverse event without using the word “error,” and only one-third would offer an apology. Although surgeons expressed more of an intent to admit to an error than medical physicians, the researchers found that they actually disclosed less. The study attributed physicians’ unwillingness to disclose mistakes to the desire for perfectionism ingrained in the “culture of medicine.”
Fear of being sued for medical malpractice had little bearing on rates of error disclosure, the researchers found in a companion study. Even though Canadian physicians are sued much less often than American physicians and have caps on pain and suffering, Canadian physicians were equally hesitant to report errors, reports The Seattle Times. “This code of silence, this conspiracy of silence does not work for reducing errors,” Eric Larson, one of the study’s authors, told the Times. “What we know now is it does nobody any good to bury a mistake or cover up a mistake; you can’t correct what led to the mistake unless you deal with it explicitly.”
The Center for Medicare and Medicaid Services has unveiled a new draft quality standard for suppliers of durable medical equipment, prosthetics, orthotics, and supplies. According to CMS, suppliers must comply with the quality standards in order to furnish any DME, prosthetics, or orthotic services paid under Part B and in order to receive or retain a supplier billing number.
In developing the draft quality standards, CMS conducted a wide variety of activities that involved stakeholders and the public. As a result, the agency received more than 5,600 comments on the draft quality standards. Based on these comments, CMS made revisions to reduce the burden on small suppliers, such as eliminating the requirement to be open for 40 hours per week and replaced it with a requirement to maintain posted business hours. In addition, the agency clarified requirements for performance management to allow suppliers flexibility in determining indicators related to their products and services.
CMS said the quality standards would be used as part of the accreditation organization selection process. Comments on the draft quality standards will available on the CMS web site at a later date.
The U.S. not-for-profit healthcare sector performed well in the first half of 2006, according to a Standard & Poors Ratings Services report on rated hospitals and health systems. S&P reported that ratings upgrades outpaced lowered ratings by a small margin through June 30. The real story, says S&P, is the sector’s stability--of 265 rating actions in the first half of the year, 83% were rating affirmations. The favorable credit environment should continue through 2007, possibly 2008, despite some negative trends, according to S&P. Bad debt, charity care, and capital spending are important concerns, but S&P says well-managed organizations should be able to overcome these potentially harmful factors.
The 2006 median healthcare ratios for not-for-profit health systems and stand-alone hospitals also demonstrated improvement. Gains were attributed to stronger income and cashflow measures, growth in liquidity, and improvement in balance sheet measure across most rating categories. According to S&P’s U.S. Not-for-Profit Health Care 2006 Stand-Alone Hospital Medians, stand-alone not-for-profit hospitals that it rated had an overall profit margin of 5%, up from 4.1% in 2005; operating margin of 3%, up from 2.4% in 2005; and an operating cashflow margin of 10%, up from 9.6% a year earlier. In another report, U.S. Not-for-Profit 2006 Health Care System Medians, not-for-profit health systems (three or more hospitals with some risk dispersion) that S&P rated showed similar gains. Overall, from 2005 to 2006, profit margin increased from 4.3% to 5.2%; operating margin grew from 2.5% to 3.2%; and operating cashflow margin rose from 9.2% to 9.7%. A key factor in determining future credit quality will be changes in government reimbursement. For more information, call 212-438-6667.
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Even though Medicaid payment rates and enrollment have increased, the proportion of U.S. physicians who accept Medicaid patients has decreased slightly over the past decade. In a new report, the Center for Studying Health System Change writes that 14.6% of physicians said they received no revenue from Medicaid in 2004-05, up from 12.9% in 1996-97. However, the report’s authors said a more striking trend is that the care of Medicaid patients increasingly is concentrated among a smaller proportion of physicians who practice in large groups, hospitals, academic medical centers, and community health centers. Low payment rates and high administrative costs likely discourage physicians in solo and small group practices from accepting Medicaid patients.
Read “The Challenges of Medicaid” by Gail R. Wilensky.
The Duke Endowment has awarded a three-year $21 million grant to foster high-quality health care. The grant was awarded to Health Sciences South Carolina, a statewide collaborative of institutions that are working to advance health sciences education and research. The grant is targeted at advancing research in the areas of patient safety, clinical effectiveness, and healthcare quality. The largest award ever made by the Duke Endowment’s healthcare division, the grant will support the establishment of the Center for Healthcare Quality and Clinical Effectiveness and will enable HSSC to implement Centers of Economic Excellence Endowed Chairs programs.
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New Fitch Ratings figures show that operating profitability of not-for-profit hospitals and health systems rated by Fitch improved substantially in 2005, exceeding expectations from the previous year’s median ratios report. Fitch’s portfolio includes ratings on 256 hospitals, healthcare systems, or related institutions. Information from 222 of them is included in the new median ratios report. The median operating margin increased to 2.8 percent last year, the highest level since 1997 and the third consecutive year of growth. In the report, titled 2006 Median Ratios for Nonprofit Hospitals and Health Care Systems, Fitch attributes the improved operating margins to solid revenue growth, better control of expenses, and improved efficiencies resulting from investment in information technology and quality initiatives. Also, some hospitals have sold off non-core, unprofitable business lines. Operating improvement was spread across all rating categories, including the lower investment-grade and below-investment-grade grade categories. Liquidity ratios and capital-related ratios also showed improvements in 2005. For information, contact Fitch at (800) 753-4824.
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With the House and Senate deadlocked on immigration reform, panelists and witnesses at a Congressional field hearing in Dalton, Ga., this week debated the impact of undocumented immigration on the state’s Medicaid program and its healthcare delivery system. The hearing was one of 20 such meetings that House Republicans have scheduled throughout the country this summer to boost support for their reform bill, which concentrates on border security. Supporters of the bill, including U.S. Rep. Charlie Norwood, R-Ga., say Medicaid budgets cannot support care for poor Americans and undocumented immigrants. The Atlanta Journal-Constitution reported that Georgia spent $114 million in Medicaid funds in 2005 for emergency care for 23,972 illegal immigrants. A new law enacted earlier this year requires proof of U.S. citizenship to receive Medicaid benefits, except in emergencies. Critics of House Republicans’ reform measures say undocumented immigrants are scapegoats for a troubled U.S. healthcare system.
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A new health plan being offered to employers in Minnesota will link lifestyle choices directly to the amount of deductible that employees pay. Insurer Preferred One and Aon Risk Services Inc., the plan’s developers, say it could save employers millions while encouraging employees to adopt healthier lifestyles. The plan would allow employers to give workers time to change some of their health habits, according to the Minneapolis/St. Paul Business Journal. But then nurses from an independent laboratory would evaluate employees’ blood pressure, body-mass index, tobacco use, and cholesterol and glucose levels. Based on those indicators, deductibles could range from nothing to $2,500. Regular health evaluations would allow employees to reduce their deductibles. No penalties would be levied for chronic illnesses.
Competition and choice apparently have held the line on premiums for Medicare prescription drug coverage. The New York Times reports that next year’s premiums will be about $24 a month, the same as this year and about 40 percent less than initial estimates for 2007. CMS Administrator Dr. Mark McClellan said some individual insurers that offer coverage under contract to Medicare may increase prices, but that the “vast majority” of beneficiaries will pay the same or less than in 2006. The government estimated in March 2005 that average drug premiums would be $37 a month in 2006 and $41 in 2007. Five months later the government lowered its 2006 estimate to $32 a month and in June this year reported the average premium is $24. Private insurers compete for market share by offering low premiums and extensive benefits. But some consultants have warned that insurers may be operating at or below cost to attract beneficiaries and will not be able to maintain low premiums.
A national back-to-school campaign is linking thousands of eligible students with healthcare coverage through Medicaid or the State Children's Health Insurance Program. The Covering Kids & Families back-to-school campaign is a nationwide effort encouraging parents to obtain health insurance for their children as part of their preparations for the new school year. The back-to-school campaign is a project of the Robert Wood Johnson Foundation's Covering Kids & Families initiative. The initiative is supported by HFMA. The goal of Covering Kids & Families is to reduce the number of uninsured by helping those who are eligible for Medicaid or SCHIP receive the coverage they need. Since 1997, Covering Kids & Families has helped reduce the number of uninsured children from 11 million to 8.5 million in 2005. This year's back-to-school campaign activities focus on encouraging parents to take the necessary steps to find out if their children are eligible for healthcare coverage. The 2006 campaign kicked off on Aug. 9. Find out how your organization can support this initiative.
California’s independent health insurance purchasing pool for small businesses will close at the end of the year because too many health plans have pulled out. Pacific Health Advantage, commonly called PacAdvantage and based in San Francisco, is notifying 6,200 employers and 116,000 workers that their coverage ends Dec. 31. PacAdvantage officials said in a statement that the pullout of three major health plans—Kaiser Permanente, Blue Shield of California, and Health Net of California—prompted the closure. In 1994, 10 health plans had participated.
The purchasing pool was created by the state in 1992 and taken over in 1998 by the Pacific Business Group on Health to help keep health insurance affordable and available for employees and owners of small businesses. The pool was open to employers with two to 50 employees. Peter Lee, CEO of PBGH, said every effort was made to maintain the health plans’ participation. “Unfortunately, market forces kept that from happening,” he said in a statement.
CMS has published new quality standards for suppliers of durable medical equipment, prosthetics, orthotics, and other supplies. Vendors of these products must comply with quality standards to receive billing numbers from providers or other suppliers that are used to submit claims for reimbursement through Medicare. After a 60-day public comment period that ended Nov. 28, 2005, CMS had received more than 5,600 comments on a draft of the new standards that was posted on the CMS web site. Some changes that resulted from the comments include streamlining the standards from 104 pages to 14 pages, replacing a requirement for suppliers to be open 40 hours a week with one to only maintain posted business hours, and reducing the number of product-specific standards from 15 to three. CMS said it expects that many suppliers already comply with the new standards.
A new report from the HHS Office of the Inspector General indicates that some 9,200 medications are missing from the FDA’s National Drug Code Directory and that about 34,200 prescription drugs are listed incorrectly or no longer are manufactured. Most of the problems stem from pharmaceutical companies’ failure to comply with a federal law that requires them to list the medications they make with the FDA, according to the report. FDA officials said they agree with much of the report and that they are beginning to address problems noted in the report by revising they way pharmaceutical manufacturers list their products with the agency. As of February 2005, the directory included 123,856 medications, compared with about 39,000 in 1990.
Many of the marketing materials that Medicare Advantage plans use for advertising and enrollment do not meet standards CMS has set so that beneficiaries can make informed plan decisions, according to the Office of the Inspector General. After reviewing marketing materials from 36 Medicare Advantage plans, the OIG found that some of the materials did not contain required information on prescription drug benefits. For example, 55 percent of benefit summaries of the plans surveyed did not state that formulary contents could change. Some of the materials also did not have basic information such as operating hours and customer service numbers that beneficiaries need to access plan information.
In its report on Medicare Advantage marketing materials, the OIG noted that CMS is working to improve its reviews of marketing materials. CMS regional staff will perform consolidated reviews of Medicare Advantage and Medicare Part D plan marketing materials, and a contractor will review the materials for consistency.
Opposition to the Bush administration’s proposed rules to cut Medicaid reimbursements to public hospitals and nursing homes is growing. The National Governor’s Association, more than 330 members of Congress and 50 senators have expressed opposition to the proposal as a threat to state budgets and the health of low-income people who rely on Medicaid programs, according to The New York Times.
The plan, part of President Bush’s 2007 budget, would cut the rate that states can tax hospitals and nursing homes and would limit Medicaid reimbursements to the actual cost of the services that hospitals and nursing homes provide. The Bush administration contends that these changes would reduce improper accounting methods that increase states’ share of federal matching Medicaid funds.
Read "The Challenges of Medicaid" by Gail R. Wilensky.
As it attempts to recover from an accounting scandal, HealthSouth Corp. of Birmingham, Ala., has announced that it is exploring ways to reposition itself in the post-acute care sector. Some possibilities include the sale or spin off of the company’s surgery centers and its outpatient rehabilitation and diagnostic divisions. HealthSouth’s inpatient division accounts for most of its revenue: 58% of consolidated net operating revenues and 86 percent of operating earnings for the quarter that ended June 30, 2006. Jay Grinney, HealthSouth president and CEO, said in a statement that the outpatient, surgery, and diagnostic divisions “compete in sectors with good growth potential. However, we have concluded that there are very few strategic or financial synergies in operating these divisions as one company.”
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Experts and advocacy groups have urged Congress to add more stringent patient privacy safeguards to proposed electronic medical records legislation, the Los Angeles Times reports. A bill now in the House would establish a national structure for computerized health records, including stipulations for applying current privacy laws to information that is stored or transmitted electronically as well as reconciliation of differences in state and federal privacy laws.
But advocates—labor unions, consumer groups, and AARP—say the legislation currently does not allow patients to decide who can see their health records or to exclude their records from the system. The legislation also should include a provision that would require patients to be notified if a security breach occurs, advocacy groups say. A House-Senate conference to reach consensus is likely to be contentious, says the Times.
The Fox Networks Group and the Kaiser Family Foundation are partnering on a new multi-platform public education campaign targeting young people (ages 15 and older) to promote smart choices and healthy life-styles. The campaign, called PAUSE, will help teens understand the power they have to make difficult decisions on a range of issues including teen pregnancy and sexually transmitted diseases, alcohol and substance use, and online safety. In addition to broadcast and cable public service announcements, the campaign will use media platforms popular with teens, including MySpace.com, and conduct health information briefings for Fox producers and writers to help incorporate messages across the network’s entertainment programs.
CMS is reminding providers that a brief hold will be placed on Medicare payments for all claims during the last nine days of the federal fiscal year (September 22 through September 30, 2006). During this nine-day hold, no interest will be accrued, no late penalties will be paid to an entity or individual, payments will not be staggered, and no advance payments will be allowed. All claims held during this time will be paid on October 2, 2006. The policy only applies to claims subject to payment and not to full denials, no-pay claims, and other non-claim payments such as periodic interim payments, home health requests for anticipated payments, and cost report settlements. Read the CMS reminder.
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Pennsylvania is poised to become one of the few states in the country to provide health coverage for all children, reports the Philadelphia Inquirer. The Pennsylvania legislature has agreed to pass the Cover All Kids bill by October and the federal government has given the program a tentative approval. The program would offer insurance to all children, with the state subsidizing the $145/month premiums based on parents’ income starting next year. Initially 15,000 uninsured children will be covered at a cost to the state of $4.4 million, expanding by another 75,000 children and $50 million by the fifth year. Illinois has already begun its universal health insurance program for children, and Massachusetts has passed a law requiring all residents to have insurance or pay a penalty.
The California Department of Managed Health Care has assessed a $2 million fine to Kaiser Foundation Health Plan for failing to provide adequate oversight of its Northern California kidney transplant center, which resulted in processing delays of patient transfers on the national transplant waiting list. In addition, Kaiser will provide $3 million in funding to Donate Life California, an organ and tissue donor registry program, to conduct a media and outreach campaign aimed at increasing organ donations. The fine was assessed after consumer complaints prompted a DMHC investigation, which found that Kaiser had inadequate oversight of its medical group, which administers the kidney transplant program; that it failed to ensure that its medical group had the administrative capacity to transfer patients from other transplant center to the Kaiser program; that it failed to provide timely accessibility to specialists in the program; and that it didn’t respond promptly to patient complaints. Kaiser is now transitioning its patients awaiting a kidney transplant to the University of California at San Francisco and at Davis.
DMHC is also conducting an additional medical survey to determine the quality and adequacy of Kaiser’s enrollee grievance and quality of care systems to determine why Kaiser officials did not hear or respond to patient and physician complaints about the transplant program. Kaiser told the Los Angeles Times it has learned from its mistakes. "This experience really has caused our organization to reflect on how we can continue to improve moving forward," said Mary Ann Thode, president of the Kaiser Foundation Health Plan and Hospitals in Northern California. Kaiser said it would not pass the fine on to enrollees in higher premiums.
CMS has posted to its web site the final version of the home health advance beneficiary notice (HHABN) (CMS-R-296) and its accompanying instructions.The form is approved by OMB for use through August 31, 2009. Home health agencies must begin using the new forms by September 1, 2006. More detailed instructions for using the new HHABN is included in chapter 30 of the CMS manual.
Oregon Health & Science University has announced that its transparency initiative will be among the first in the nation to share aggregate outcomes and patient experience data with the public. OHSU is making new data available that reflect the experiences of all its hospital patients, not just a sample. The aggregate data are for 20 individual clinical service lines at OHSU, including number of patients, mortality, and performance comparisons with similar health centers. OHSU will also release some NRC+Picker Patient experience data. OHSU’s public reporting web site compiles other public data and contains descriptions of OHSU patient safety and improvement programs along with educational material. The educational material is important, says OHSU, so that patients can correctly interpret the quality data. OHSU officials say that although current quality measures are imperfect, starting the process of measuring and comparing healthcare quality will allow providers to “respond to patient demands for better kinds of data.” Read the announcement.
Consumers shopping for prices for healthcare services aren’t always finding the information as easily as they might wish, despite growing efforts by Medicare and hospitals to provide greater pricing transparency, reports the Chicago Tribune. In some instances, consumers who have queried insurers on what they can expect to pay out-of-pocket for various procedures have been told that the prices negotiated with hospitals and physicians are confidential. And the restaurant-type rating system that some insurers are using to compare hospitals’ “cost efficiency” isn’t meaningful, say consumers. “The market just isn’t ready yet to deliver on the promise of these new insurance products,” Larry Boress, president of the Midwest Business Group on Health, told the Tribune.
A handful of insurers, however, are experimenting with providing consumers with more meaningful price data. The Tribune highlights projects by Blue Cross and Blue Shield of Illinois that will calculate average out-of-pocket hospital costs this fall; a pilot project by Aetna that posts negotiated physician prices for more than 100 procedures; and an initiative by the Business Health Care Group of Southeast Wisconsin to get Humana to disclose bundled prices for physician and hospital services for 30 inpatient procedures and six outpatient procedures, revealing huge price variations among providers.
CMS has issued a proposed rule for payments to hospital outpatient services to make them more accurate and to promote higher quality and for ambulatory surgical centers to better align payments with hospital outpatient departments. The outpatient prospective payment system rule is based on a 3.4% inflation update in Medicare payment rates, which will result in hospitals receiving an overall average increase of 3% for outpatient services in 2007. Payment will also be tied to the reporting of quality measures. To receive the full update on outpatient payments, hospitals will be required to report quality measures for inpatient services; those that fail to do so will receive the OPPS update minus 2 percentage points. The rule also proposes to increase from three to five the number of payment levels for visits to a hospital clinic or emergency department, with payment rates based on historical hospital claims data. The maximum payment for clinic visits would increase from $92 to $133, while the maximum payment for ED visits would increase from $2
