News

Hospital uses 'speed dating' model to pair up doctors, patients

Caralyn Davis — Mon, 08 Feb 2010 14:15:01 -0500

Texas Health Harris Methodist Hospital in Dallas-Fort Worth has launched Doc Shop, a new marketing program to connect patients with obstetrician-gynecologists modeled after the speed-dating phenomenon that lets single men and women meet multiple potential dates in brief time blocks.

The first doctor-patient "speed-dating" event occurred on Sept. 24, 2009. Two other Doc Shops have already taken place, and seven more are slated to occur this year. The program has been so successful that the hospital is expanding Doc Shop to include pediatricians and may eventually add additional primary care specialists.

Here's how it works: For two 30-minute sessions over a lunch hour, five to six physicians sit at tables and meet roughly a dozen patients who rotate through. Every five minutes, the patients move to the next physician. Doc Shop is designed as a low-cost way to bring patients to the hospital's affiliated physicians, and it is best-suited to primary care where patient-physician personality matches are most important. Doc Shop is free to patients, and participating physicians aren't paid for their time.

To learn more about doctor-patient dating:
- read this American Medical News article

CHS sued by collections agency

Caralyn Davis — Mon, 08 Feb 2010 14:03:27 -0500

Franklin, Tenn.-based Community Health Systems (CHS) Inc., which operates 122 hospitals with approximately 18,000 licensed beds in 29 states, is being sued by Managed Care Solutions (MCS) Inc. for breach of contract, says the Nashville Business Journal. The Hollywood, Fla.-based collections agency claims it was fired by the hospital chain on the pretext of the alleged arrest of a third-party employee.

MCS says that it signed an exclusive three-year deal in 2003 to manage and collect payments for all CHS hospitals, which then numbered 111, for a 22 percent cut of collections. However, CHS didn't provide adequate paperwork for 109 of the hospitals, and MCS invested more than $1.2 million in collections software to provide services to CHS, the company claims.

The suit alleges that CHS was already trying to find a way out of the deal when it learned that an MCS employee had been arrested for identity theft for stealing patients' confidential information at a New Jersey hospital. CHS then canceled the contract, citing a material breach. MCS maintains that the employee actually worked for a third-party staffing firm and that it has no proof the employee either stole patient information or was arrested. MCS also says that the employee shouldn't have had access to such information, holding CHS accountable and suggesting potential HIPAA violations.

To learn more about the lawsuit:
- read the Business Journal article

Pediatric hospitals find profits, growth

Caralyn Davis — Mon, 08 Feb 2010 13:44:23 -0500

While no sector is Teflon-coated against the ill winds currently buffeting the hospital industry, pediatric hospitals have provided some of the few bright spots on the horizon with news of profits and expansion plans.

The Carolinas HealthCare System is mulling further expansion of 234-bed Levine's Children's Hospital in Charlotte, N.C., reports the Charlotte Business Journal. Levine's, which has been open for less than three years, enjoyed an 18 percent increase in inpatient discharges in 2009, a 32 percent jump in outpatient visits, and a 10 percent climb in pediatric emergency department visits.

With the hospital nearing capacity, options under consideration by Levine officials include possible physical expansion and the addition of new services--including pediatric-urgent care--at other Carolinas HealthCare locations. Levine's more than 30 specialized pediatric services have helped drive growth, say officials. These include heart, liver and kidney transplants; cardiac care; cancer care; neurosurgery; and neonatal intensive care and rehabilitation services.

Cincinnati Children's Hospital Medical Center has opened the Pluripotent Stem Cell Facility to give area researchers a central source for human stem cell technologies, says the Business Courier. Pluripotent will provide cells to researchers at Cincinnati Children's, the University of Cincinnati Medical Center and other research facilities, as well as providing training in stem cell growth and utilization. The center, which is the only one of its kind in the region, could be expanded further as the demand increases for human embryonic stem cells and related services.

Columbus, Ohio-based Nationwide Children's Hospital has opened a Close To Home Center in Mansfield to provide area counties with specialty clinics in pediatric surgery, neurology and urology. Richland, Ashland, Huron, Crawford, Morrow and Knox counties accounted for 22,297 patient visits to Nationwide last year. Nationwide now operates nine Close To Home Centers that offer community-based testing and treatment for pediatric patients.

To learn more:
- read the Charlotte Business Journal article
- here's the Business Courier article
- check out the Mansfield News Journal article

Health reform summit planned; lobbyists eye Medicare-specific fixes

Caralyn Davis — Mon, 08 Feb 2010 13:21:20 -0500

During this weekend's CBS Super Bowl coverage, President Barack Obama announced plans to hold a half-day healthcare reform summit on February 25, bringing together Democrats and Republicans in a live televised event, says the New York Times.

While Obama's stated goal for the summit is "to go through systematically all the best ideas that are out there and move it forward," the summit itself is part of the Administration's strategy to get Republicans involved in policy negotiations and put their initiatives under the media spotlight. Republicans have called for the current plans to be scrapped in favor of starting fresh. Obama declined the chance to start over, and didn't indicate whether he is willing to negotiate on issues Democrats have already settled among themselves.

President Obama still holds out hope that health reform can take place, but in the absence of concrete action, healthcare lobbyists are targeting the Senate jobs bill to move through several key Medicare provisions that were included in the House and Senate health reform bills, reports The Hill.

Both the Senate Finance Committee and the House Ways and Means Committee are working on similar measures to extend at least some Medicare provisions that expired January 1 or will soon expire. Among the fixes being sought: reinstatement of an exceptions process for the annual per-beneficiary dollar cap of Part B physical, speech and occupational therapy services; the restoration of special payments to large rural and small urban hospitals; and the reinstatement of bonuses to rural doctors.

To learn more about the summit:
- read the Times article
- here's The Hill article

AHRQ targets care coordination

Caralyn Davis — Mon, 08 Feb 2010 13:01:22 -0500

Care coordination is the featured topic of the latest issue of the U.S. Agency for Healthcare Research and Quality's (AHRQ) Health Care Innovations Exchange, which is a program AHRQ initiated to speed the development and adoption of innovations in healthcare delivery. Coordinating care between healthcare settings is vital to avoid duplicated efforts, conflicting care plans and medication mismanagement, including overuse, underuse and misuse of medicines. Case studies of providers' care coordination efforts include:

The Children's Hospitals and Clinics of Minnesota uses a Limited English Proficiency Patient Family Advocate as a permanent part of its hematology/oncology care team. This advocate provides traditional interpretation services, as well as helping patients and families as they move across the continuum of care. The program cut the length of the average interpreter encounter in half and generated high levels of patient and provider satisfaction.
The University of New Mexico Health Sciences Center's Care One program provides intensive case management and care coordination services to uninsured, high-cost,medically complex patients. Each enrolled patient is assigned to a physician-led team that includes a social worker and behavioral health specialist. This team helps the patient navigate the care continuum, as well as accessing financial assistance and appropriate community resources. The program significantly reduced inpatient admissions and emergency department visits, as well as boosting patient satisfaction.
In the Bypassing the Blues program at seven Pittsburgh-area hospitals, nurse care managers screen patients after cardiac bypass surgery for symptoms of depression. Patients who exhibit meaningful symptoms receive ongoing telephone-based support over an eight-month period. The nurses use a collaborative care model to educate patients about depression, teach them self-management skills, and explore and promote recommended treatment options. Nurses discuss cases weekly with a psychiatrist, psychologist and internist, as well as routinely communicating with the primary-care physician. The program improved mental and physical health status in both men and women, and men experienced a decline in hospital readmissions.

To learn about the results of these and other care coordination case studies and to find useful tools:
- visit the AHRQ Health Care Innovations Exchange

Creating collaborative environments for success

Christopher Cornue — Fri, 05 Feb 2010 12:10:45 -0500

I've often written about (and will most likely continue to write about) the importance for leaders to be collaborative, seek counsel from many disparate individuals, and to recognize there are varying opinions and views to consider when making decisions. Essentially...to be open to debate. This, coupled with other leadership characteristics (e.g., being decisive), will make one an incredibly effective and impactful leader. I've come across some readings recently that help to reinforce this.

The first comes from the November issue of HealthLeaders, where they talk about creating a new model of leadership for today's hospital environments. They write that "the drill sergeant as hospital CEO is out of style." They further write that the role of CEO at today's hospital has changed to be one that "is operating in collaboration with various constituent groups." Recognition is given to the fact that CEO and healthcare leaders are held accountable for more than just bottom-line performance. They must ensure safe environments, satisfaction across multiple constituencies, and strong clinical performance. The best way to achieve these additional and critical outcomes is to be very collaborative with the groups that have the most ability to impact the end results.

--> CLICK HERE TO READ THE FULL COMMENTARY

Medicaid deals threaten healthcare legislative process

Victoria Forlini — Fri, 05 Feb 2010 11:33:11 -0500

Back-room deals or political horse-trading are standard in Washington, but in the current political environment, as some of those deals become public, the ultimate casualty may be healthcare reform.

Take a look at two senators who had side deals for their states: Nebraska's Sen. Ben Nelson, a Democrat, negotiated an everlasting Medicaid deal for his state. Louisiana's Mary Landrieu, also a Democrat with the support of Louisiana Republicans and Democrats, negotiated, a one-time deal for Medicaid reimbursement for her state.

Nelson ultimately backed away from his deal; Landrieu, however, has not. She insists the $300 million Medicaid boost--supported by Louisiana lawmakers because the uptick in income in post-Hurricane Katrina meant that the state would receive less Medicaid support now or in the short-term future--also is supported by the federal administration.

The senator's stance has raised eyebrows and ire in the pundit community at a time when this is--at the least--another distraction from potential healthcare reform and--at most--a confirmation by Americans that there are too many deals and not enough legislating for the good of the country.

President Obama, in public comments and in his State of the Union address, made mention of messy backroom deals, and said that he could understand how that frustrates Americans. He continues to press congressional leaders to move the stalled healthcare legislation forward.

To learn more:
- read the Washington Post article

Decision to halt malpractice damage caps in Ill. could have national aftershocks

Victoria Forlini — Fri, 05 Feb 2010 11:15:00 -0500

With ramifications that could affect potential national healthcare reform, the Illinois Supreme Court dealt a blow to hospitals and physicians worried about the costs of malpractice lawsuits by striking down a law that limited damages in these cases.

The court on Thursday said that Illinois' medical malpractice laws violated separation of powers, with the legislature taking powers that belong to the judiciary.

"That 'everybody is doing it,' is hardly a litmus test for the constitutionality of the statute," wrote Chief Justice Thomas Fitzgerald for the majority of the seven-member court, referring to the fact that other states are also capping damages.

The 2005 legislation established limits on pain and suffering and other non-economic damages of $500,000 in cases against doctors, and $1 million against hospitals. According to the Congressional Budget Office, reforms, such as capping non-economic damages, would lower the nation's health care bill by only 0.5 percent.

The ruling could affect debate at the federal level. Although President Obama and Democrats have not shown favor to the idea of capping damages, they have spoken about enacting some kind of liability reform. The American Medical Association wrote yesterday that it opposes the ruling.

To learn more:
- read this Chicago Tribune article

State hospital fee could mean less training, hiring freezes

Victoria Forlini — Fri, 05 Feb 2010 10:54:39 -0500

An Ohio fee may achieve what the recession did not do for many hospitals: delay hiring, cutback training and community programs. But federal matching monies that could balance Ohio's budget may mean the fee will stay in place through 2011.

The fee, assessed at 1.52 percent of a hospital's operating budget for 2010, will help the state balance its 2010-11 budget, and is expected to bring in $718 million. The rate is scheduled to increase to 1.61 percent next year.

"We had to do a lot of really bad things to make this budget balance, and this was one of them," said Dale Miller, ranking senator on the finance committee while the hospital franchise tax was being debated. "We certainly knew this was going to cause problems."

The fee helps draw federal money because money raised by the fee is matched with federal stimulus dollars at more than 3 to 1. That federal match is estimated at about $2 billion and can fund the state Medicaid program for two years.

However, that's of little consequence to municipalities worried about the local economy, and hospitals worried about the workforce and maintaining care. At least one municipality, Middleburg Heights, is urging the Ohio legislature to reduce or eliminate the tax because of financial implications in communities through potential lost jobs or non-hiring of vacancies.

Southwest General Health Center, which is in Middleburg Heights, froze pay for its 2,500 employees for 2009. The hospital has also reduced travel and education. "Our labor market is very competitive, so we can't repeat the freeze. This was a one-time fix," said Maryann Freas, chief financial officer of SGHC. With the fee scheduled to continue through 2011, the hospital may have to re-evaluate its capital budget, including equipment replacement. The hospital's fee for 2010 is about $2.8 million.

Under the hospital assessment formula, the state will increase the amount of money, by 5 percent, that it sends to hospitals to cover Medicaid patients. The increase is supposed to soften the blow to hospitals, but SGHC estimates it might "reduce" the fee by $100,000.

To learn more:
- read this Cleveland News Sun article

Proposed 'public option' in Wash. called unfair

Dan Bowman — Fri, 05 Feb 2010 10:22:57 -0500

And here we thought a public option was dead.

The Health Care Authority in the state of Washington is hoping to receive the guidance of private insurers in creating an affordable coverage alternative for the estimated 875,000 uninsured residents throughout the state. According to the Puget Sound Business Journal, such a "public option" would provide a somewhat truncated version of regular health insurance, available for $100 per month.

Benefits that would be available under such a plan include 30 percent coinsurance for inpatient treatment and a yearly max of $75,000 for medical care, as well as maternity benefits carrying a $5,000 deductible for deliveries taking place within the first six months of enrollment. The Health Care Authority wants private insurers to tell them roughly how much they would charge for such a package.

Some, like Donna Steward, human resources director at the Association of Washington Business, call such an idea "an unfair advantage," citing that state regulations currently prevent insurers from offering such low rates. She believes that such a plan essentially could lead to lost customers desiring cheaper insurance.

"The policy they have developed will take all good risk from the individual market and destroy the pool," Steward said.

Republican state Sen. Cheryl Pflug has proposed a measure--SB6812--to essentially level the playing field, which the Association of Washington Healthcare Plans has already said it supports. "It would allow private healthcare insurance carriers in Washington the ability to offer products equivalent to that which the state is proposing to offer," said Sydney Zvara, executive director of the association.

To learn more:
- read this Puget Sound Business Journal article

Deadly hospital infection rates vary within states, hospital systems

Dan Bowman — Fri, 05 Feb 2010 09:26:01 -0500

While U.S. hospitals tend to be a mixed bag when it comes to central-line infection rates--which account for roughly 30,000 deaths annually--105 hospitals throughout the nation were found to have zero central-line infections according to a new study conducted by Consumer Reports.

Data was gathered from both state reports and the Leapfrog Group, which compared statistics from 926 hospitals in 43 states over a minimum of 1,000 central-line days. Twenty-five of the 43 states had at least one hospital with no central-line infections; California (25) and New York (9) had the most hospitals with no such infections.

"Eliminating healthcare-associated infections is a top priority for CDC," said Dr. Denise Cardo, director of CDC's Division of Healthcare Quality Promotion in response to the study. "The tracking and reporting of healthcare-associated infections is an important step toward healthcare transparency."

The study found that there wasn't any sort of pattern when it came to such infections. Wide variations existed, not just at hospitals in the same city, but also for facilities within the same healthcare systems. For example, Kaiser Permanente's Harbor City Medical Center in Los Angeles reported zero central-line infections in the 1,769 days its intensive care patients were on such lines in 2008. However, Woodland Hills Medical Center, also a member of Kaiser's stable, reported 13 infections in 1,937 central-line days-four times the national average rate.

For more information about the study:
- read the Consumer Reports article
- here's a list of the 105 hospitals with no infections
- check out this CDC press release
- find out where your hospital ranks

HealthNet's $49M loss for 2009 attributed to lower enrollment, decreased revenues

Victoria Forlini — Thu, 04 Feb 2010 13:38:58 -0500

Lower enrollment numbers and decreased revenues--as well as an increased percentage of revenue used for medical care--were major reasons behind a $49 million loss for HealthNet, Inc., for FY2009. In the fourth quarter of 2009 alone, HealthNet's losses amounted to $45.2 million.

Some investors weren't surprised by the news, considering HealthNet sold its Northeast business in Q409. "Sale of the Northeast business makes comparison with our estimates challenging," Citigroup analyst Charles Boorady said in a note to clients, according to MarketWatch. "[B]ut pro-forma information allows for same-store trend analysis that did not look surprising."

HealthNet COO James Woys tried to put a positive spin on the losses, saying that the company was "very pleased" with its performance in such a "challenging environment."

Boorady, however, believes that more pain could be in HealthNet's future, considering California's already stretched budget and problem with delayed payments.

Overall, the company's adjusted net income for the 2009 was $235.1 million, compared with adjusted net income for 2008 of $199.1 million. Enrollment in HealthNet's Western health plans dropped to 3 million in 2009 from 3.1 million at the end of 2008. The lower numbers are attributed to higher unemployment.

Total revenues dropped a little year over year, as well. Q4 2009 total revenues were $3.8 billion, compared with $3.9 billion in Q4 2008. Health plan services revenues were $3.0 billion in the Q4 2009 and $3.1 billion in Q4 2008.

Regardless, the company has raised its 2010 profit forecast to a range of $1.92 to $2.02 a share from its previous view of $1.90 to $2.00 a share.

To learn more:
- read this HealthNet press release
- here's the MarketWatch article

Healthcare spending could reach $4.5 trillion by 2019

Victoria Forlini — Thu, 04 Feb 2010 13:02:40 -0500

Healthcare spending jumped 1.1 percentage points in 2009, and now accounts for 17.3 percent of the economy. Within two years, though, government spending on healthcare is projected to be more than private spending for the first time, according to a report published in Health Affairs. The report also pointed out that by 2019, overall healthcare spending could reach $4.5 trillion.

The figures, released in a report by CMS actuaries are "a reminder of the challenges ahead of us, particularly with regard to the huge, unfunded liability of Medicare," said Gail Wilensky, a former CMS director who is now a fellow at Project Hope--which published the report. She added that the real danger lies in growth if the program isn't significantly redesigned.

The almost $2.5 trillion in healthcare spent in 2009 was $134 billion more than the previous year, when healthcare consumed 16.2 percent of the gross domestic product, according to the report. The record spending increases are attributable to the recession and government efforts to expand public health care programs, such as Medicaid. The actuaries anticipate health spending will level out slightly after the next few years, compared to previous estimates. The increased spending related to the recession is expected to taper off next year.

To learn more:
- read the Health Affairs report
- check out this New York Times article
- read this Los Angeles Times piece

Whistleblower lawsuit could cost Ohio health system $424M

Victoria Forlini — Thu, 04 Feb 2010 12:39:46 -0500

The federal government and Christ Hospital have reached a settlement in a whistleblower lawsuit that accused the hospital of giving cardiologists time at Christ's Heart Station between 1999 and 2004 based on both the number of coronary bypass procedures referred to the facility and catheter lab revenue generated. While terms have not been disclosed as of yet, Christ's liability could be as much as $123 million. Christ's former parent company, Health Alliance, could be on the hook for $424 million.

The suit was brought under whistleblower statutes by Dr. Harry Fry, who previously had provided service to Christ. The hospital insisted it had done nothing wrong, but settled to "avoid the risk of the multibillion-dollar award sought by the government."

If the parties do not finalize their agreement by March 30, the case can be reopened, according to the U.S. District Court for the Southern District of Ohio. Fry hopes to receive compensation in the settlement.

For more information:
- check out this article in the Business Courier of Cincinnati

UCLA Medical System posts a record $1.5B revenue

Victoria Forlini — Thu, 04 Feb 2010 12:14:40 -0500

Majority funding by insurance companies, with little coming from the state of California, is one key credited with helping UCLA Medical System post record revenue.

High patient satisfaction and the closing of numerous community hospitals also helped lead the group to $1.5 billion in revenue with a $100 million surplus for the 2008-09 fiscal year. Even with the increased revenue numbers, there are some challenges within the system.

Some areas of UCLA, such as the David Geffen School of Medicine, were more affected by state cuts than others. Of the $100 million surplus, $53 million went to the medical school.

Other surplus money focused on infrastructure, including:

beginning the conversion to electronic medical records;
upgrading patient rooms;
and investing in medical technology aimed at patient safety.

Specifically, over the next few years, $180 million will be dedicated to the EMR initiative.

While the revenue uptick is positive, UCLA's administrators know that expense challenges will mount in April as the University of California implements pension contributions, requiring a minimum 4 percent contribution per year by the medical center.

To learn more:
- read this Daily Bruin article

Related Article:
Pfizer to fund Stanford med school curriculum

Procter & Gamble now has full ownership of health concierge service

Dan Bowman — Thu, 04 Feb 2010 12:04:07 -0500

Is superior healthcare service really worth an extra $1,500 per year? Consumer-goods company Procter & Gamble is um, gambling on it. It plans to charge customers of its recently acquired "MDVIP" health concierge service as much annually in exchange for more personal, round-the-clock care, reports the Cincinnati Enquirer.

Beginning this month, the company now has full ownership of MDVIP. (It previously have a 48 percent stake.) With 350 doctors in 28 states, it's the largest concierge health practice in the U.S. Each doctor within the MDVIP network is limited to only 600 patients, allowing for more time to be dedicated to each patient. On top of a $1,500 annual fee that covers the cost of an "in-depth physical," an assessment of family and social history and help constructing a health improvement plan, doctors also bill health insurance companies and collect regular co-pays.

While some, like customer Bob Wildermuth of Ohio, think that the service is "probably worth the fifteen hundred bucks," others, like Dr. Lori Heim, president of the American Academy of Family Physicians, believe that such clinics tend to "skim" healthier and wealthier patients, leaving the rest for regular doctors.

"This may add to the growing disparity of healthcare in this country," Heim said. "It reflects the frustration we have with a dysfunctional healthcare system."

Another concern critics could take issue with is the possibility of Procter & Gamble hawking its products--like Prilosec and Pepto-Bismol--to patients of the clinics, although the company says it has no plans to do so. P&G does plan grow its business though, considering that in the four years since it initially became a minority investor in MDVIP, its customer base grew by 70,000 patients.

To learn more:
- read this Cincinnati Enquirer article

Surgical assessment calculators save millions of dollars, improve patient care

Victoria Forlini — Wed, 03 Feb 2010 13:08:02 -0500

With patient outcomes an increasing driver of quality patient care--and a potential payment indicator in the future--the American College of Surgeons (ACS) recently launched a program that assesses the risk of surgeries on the colon and pancreas through the use of a calculator, and is designing similar tools for 18 other procedures, including gastric bypass, hernia repair and prostate surgery. While entering surgical complication risks into a calculator may seem simplistic, doing so has reduced complications to the tune of $3 million annually for hospitals participating in the program, reports the Wall Street Journal.

"If these results were translated across all U.S. hospitals, we would have the potential to prevent millions of complications a year, save potentially billions of dollars a year and provide evidence to health-care reformers that higher-quality care can cost less," said Clifford Ko, a colorectal surgeon at the University of California, Los Angeles, and director of research and optimal patient care for ACS.

ACS's quality-improvement plan was adapted from a program used by the Veterans Health Administration shown to reduce deaths at VA hospitals from surgery by 27 percent, and complications by 45 percent. A study published in the Annals of Surgery found that 118 hospitals involved in the program (outside the initial VA work) prevented between 262 and 524 complications per year, saving each hospital $3 million.

Given the cost of complications--estimated at between $12,000 and $35,000 per patient, or as much as $10 billion annually, by the Centers for Disease Control and Prevention--the savings and patient outcome increases are staggering. There are more than 30 million operations performed annually in the United States, and the Institute for Healthcare Improvement, which works with hospitals to improve the quality of care, estimates that 2.5 million to 3.5 million surgical patients each year experience unintended harm resulting from surgical care.

To learn more:
- read this Wall Street Journal article

In Maryland, base for a health insurance exchange may already exist

Victoria Forlini — Wed, 03 Feb 2010 12:40:50 -0500

One state's health infrastructure is not the same as another's, as Massachusetts and Maryland are learning. While Massachusetts passed legislation for universal healthcare coverage, Maryland is learning it may already have a healthcare infrastructure to handle the uninsured.

Today, the National Association of Insurance and Financial Advisors of Maryland and the Maryland Association of Health Underwriters Major issued a report saying that the state may not need a "health exchange" program. The study, in which an architect of the Massachusetts program studied Maryland's healthcare landscape, found that Maryland's system already includes intermediaries that can supply information to individuals and small businesses, and can connect them to coverage.

The Maryland structure also includes help for administrative services such as billing and handling of government subsidies. All of these functions are included in health exchanges.

"Maryland is well-positioned to leverage the existing private-sector infrastructure rather than expend scarce public resources to establish a new public entity to help organize and structure the market," the report said. The Maryland legislature isn't likely to decide whether to create an exchange during the current session, said Del. Peter A. Hammen, a Baltimore Democrat who is chairman of the Health and Government Operations Committee.

To learn more:
- read this Baltimore Sun article

Doctors cut back hours when malpractice risk rises

Victoria Forlini — Wed, 03 Feb 2010 12:25:44 -0500

When physicians perceive a risk of malpractice, it affects the number of hours they work and the number of patients they see to the equivalent of working two fewer hours per week for every 10 percent increase in liability, a study in the Journal of Law & Economics finds. While such a change may not seem great, it means that over the course of years, the lost work amounts to the equivalent of one physician out of 35 retiring without a replacement.

"When you aggregate that across all physicians, the total effect is quite large," says Mark Showalter, an economist who coauthored the study entitled "The Impact of Liability on the Physician Labor Market". Perceived change in liability could include, for example, an increase in the maximum damages that patients can receive in a case. The study showed that if there was a less perceived threat of malpractice, doctors would see more patients.

While there has been discussion for years about a federal law capping the amount of damages a patient can receive in a malpractice claim, a cap would probably not affect a doctor's perception of risk, given the huge swing in income levels between states.

The study combined data gathered by insurers about medical liability risks in each state and medical specialty, with physicians' responses to surveys about their workload and income. The study also found that doctors over 55, and those that have their own practices, are far more sensitive to changes in liability risk.

To learn more:
- read this press release
- here's the Journal of Law and Economics study

Antitrust legislation for health insurers now the big reform issue

Dan Bowman — Wed, 03 Feb 2010 12:11:42 -0500

In an attempt to get some sort of a win out of the seemingly lost health reform situation, House Democrats now are looking to reverse antitrust legislation for insurance companies. Those steps, however, appear to be the only ones being taken in what once was considered to be the most important issue facing America, the Wall Street Journal reports.

By repealing antitrust laws for health insurers, the hope is to reduce insurance prices in areas where one insurer gets the bulk of patients' business. Overall though, Democrats appear to be backing off of the notion of health reform, as a whole.

"Don't pin me down as to days or number of weeks," Senate Majority Leader Harry Reid (D-Nev.) said in regards to getting reform passed, who added that the plan is to get something done this year.

Several groups--including the AARP and the AMA--want the health reform efforts to continue. They feel that the more the issue gets pushed to the back burner, the more it ultimately will be forgotten completely.

Some Democrats believe that reconciliation--in which the House would have to pass the version of the reform bill passed by the Senate on Dec. 24 with a few "modifications"--is the best chance for something to get done.

For more information:
- here's the Wall Street Journal article

Most hospitals don't budget, plan for social media

Dan Bowman — Wed, 03 Feb 2010 11:25:19 -0500

While a majority of hospitals (nine out of 10) have jumped on the social media bandwagon, a good portion of those facilities (two-thirds) have no formal ideas for how that media should be used, a study released in January by Greystone.Net found. Some healthcare bloggers, however, fear that the number of hospitals with a plan could be even less.

"Greystone.Net's percentage of engaged hospitals seems overly optimistic," said blogger Jennifer Riggle, associate vice president at PR firm CRT/tanaka, according to Healthcare IT News. "I hazard to guess that many hospitals are simply setting up Twitter accounts, posting videos on YouTube and creating Facebook pages without thinking how they can use these tools to support their service lines and improve communications with the community they serve."

Riggle's concerns may be valid ones, as the study showed that Twitter, YouTube and Facebook were the most popular forms of social media used. While 92 percent of hospitals and health systems cited a desire to bring in new patients as the reasoning behind engaging in social media, just under 13 percent had any success doing so.

The study also found that few hospitals even do so much as budgeting financially for social media, meaning most facilities currently aren't hiring employees to handle such tasks. In fact, 70 percent of the hospitals surveyed reported that they had no more than three people dedicated to social media.

To learn more:
- check out this press release
- read this Healthcare IT News article

Two hospitals preparing to go 'all-digital'

Caralyn Davis — Tue, 02 Feb 2010 14:15:45 -0500

Two Ohio hospitals--Magruder Hospital in Port Clinton and Fisher-Titus Medical Center in Norwalk--soon will be among the top 5 percent of the most automated, fully digital hospitals in the United States, reports the Port Clinton News Herald. The hospitals will implement wireless, all-digital patient care systems from Cerner Corp. that will give caregivers "instant access to real-time patient information," says Fisher-Titus President Pat Martin.

Both hospitals will go live with the new technology April 27. Magruder will spend about $10 million over the next 10 years to implement the system, while Fisher-Titus' costs will come in at about $20 million. The price tag includes hardware, room remodeling, software, training and other costs.

Patient information will be available in each patient room via a customizable, digital television screen that uses biometric fingerprint identification. Hospital officials cite improved patient safety as the primary impetus for the move. For example, the system includes a digital medicine cabinet that tracks patient drugs and cross-checks prescriptions, as well as a wireless scanner that verifies that nurses administer the right drug to the right patient.

To learn more about the hospitals' transition to an all-digital environment:
- read the News Herald article

No-smoking trend picks up steam

Caralyn Davis — Tue, 02 Feb 2010 14:08:18 -0500

In January, news broke that Chattanooga, Tenn.-based Memorial Health Care System would begin screening potential new hires for tobacco and nicotine use and withdraw job offers when candidates test positive. That bold move was simply 2010's opening salvo in the hospital industry's ongoing march toward extinguishing all tobacco use by employees. While hospitals are at various stages of implementing no-smoking policies, there is a definite trend apparent in recent news reports.

Parma (Ohio) Community General Hospital has had a smoke-free campus since 2006, but now it too will require job applicants to be tested for nicotine as part of the pre-employment physical exam, reports the Cleveland Plain Dealer. Job offers will be withdrawn in the event of a positive result. The hospital will offer quit-smoking resources to spurned candidates, who can be reconsidered 90 days after a re-test is negative. Current staff members won't be impacted by the new policy.

The Cleveland Clinic and Akron Children's Hospital already have similar policies in place, enacting bans on hiring smokers in 2007 and 2008, respectively, says the Plain Dealer.

Five hospital systems in Knoxville, Tenn., have banded together to announce their facilities will be smoke-free workplaces by Jan. 1, 2011, says the Knoxville News Sentinel. The systems include Children's Hospital, Covenant Health, Mercy Health Partners, University of Tennessee Medical Center and Maryville's Blount Memorial Hospital. With the ban, hospital employees won't be able to use tobacco products on campus, but patients and visitors will still be allowed to smoke in designated areas. The hospital systems will individually decide when to take the next step and go completely smoke-free.

Brazosport Regional Health System in Lake Jackson, Texas, has banned smoking campus-wide, including outdoor areas, effective this month, and nearby Angleton Danbury Medical Center and Sweeny Community Hospital are already smoke-free, says The Facts.

Southampton (NY.) Hospital also will ban smoking campus-wide on Nov. 18, removing all outdoor designated smoking areas, reports Hamptons.com.

To learn more:
- read this Plain Dealer article
- here's the News Sentinel article
- check out The Facts article
- read this Hamptons.com article

Hospitals to get help paying for Haiti survivors' treatment

Caralyn Davis — Tue, 02 Feb 2010 13:51:11 -0500

U.S. hospitals will get some help providing care for critically ill survivors of the Haiti earthquake thanks to the U.S. Department of Health and Human Services' (HHS) activation of additional components of the National Disaster Medical System (NDMS).

With the activation, hospitals will receive federal reimbursement for costs they incur for treating survivors who meet the criteria for evacuation with life-threatening injuries and who have a reasonable chance of surviving the flight and the treatment in the United States.

"Accredited hospitals, usually over 100 beds in size and located in large U.S. metropolitan areas, are encouraged to enter into a voluntary agreement with NDMS," says HHS. "Hospitals agree to commit a number of their acute care beds, subject to availability, for NDMS patients. Because this is a completely voluntary program, hospitals may, upon activation of the system, provide more or fewer beds than the number committed in the agreement. Hospitals that admit NDMS patients are guaranteed reimbursement at 110 percent of Medicare rates by the federal government."

In related news, the Centers for Medicare and Medicaid Services (CMS) has published some Frequently Asked Questions addressing Medicaid coverage for earthquake evacuees.

To learn more about the NDMS activation:
- read the HHS press release
- for Medicaid FAQs, visit the CMS website

Medicare, Medicaid are 2011 budget gorillas at HHS

Caralyn Davis — Tue, 02 Feb 2010 13:23:06 -0500

Mandatory outlays for the Medicare and Medicaid programs far outweigh discretionary spending in President Barack Obama's proposed 2011 budget for the U.S. Department of Health and Human Services (HHS), says the Wall Street Journal. Medicare and Medicaid funding totals $489.3 billion and $264.5 billion, respectively, while discretional funding comes in at a measly $82.8 billion.

Hallmarks of the HHS budget include:

$995 million to address provider shortages in underserved areas;
$290 million in increased funding to expand services at Health Centers;
$80 million to spread the adoption and use of health information technology;
$1.7 billion to fight fraud, which HHS expects to recoup $9.9 billion in savings;
$102.5 million to boost caregiver training and assistance so the elderly can remain in their homes longer;
$1.4 billion to improve food safety;
$954 million to help prevent smoking and tobacco use;
$20 million for a new Centers for Disease Control and Prevention initiative to help prevent chronic disease; and
A $1 billion increase in research funding for the National Institutes of Health.

To learn more about discretionary vs. mandatory spending:
- read the WSJ article
- here's the HHS press release
- check out the HHS budget webpage

No health reform could mean more mergers

Caralyn Davis — Tue, 02 Feb 2010 13:10:41 -0500

The top three publicly traded hospital chains--Community Health Systems Inc. in Franklin, Tenn., Health Management Associates Inc. (HMA) in Naples, Fla., and LifePoint Hospitals Inc. in Brentwood, Tenn.--may become more aggressive in acquiring financially precarious medical centers weakened by the recession and unable to project an increase in patient volume without the rush of newly insured patients that health reform would bring in, reports Bloomberg.

With roughly one-third of community hospitals posting operating losses in 2008, the going price for many medical centers has plunged by as much as half in the past three years, giving well-funded for-profit chains such as HMA "increased opportunities," says Senior Vice President Robert Farnham.

Irving Levin Associates Inc. in Norwalk, Conn., identified 52 hospital mergers in 2009 vs. 60 in 2008. This year, most acquisitions should occur among nonprofit rural and urban hospitals with heavy volumes of Medicare, Medicaid, and uninsured patients, suggest industry watchers.

But it's not just the three largest chains that are making moves. Deals announced within the last week include:

Northwestern Memorial Healthcare, the parent of Chicago-based Northwestern Memorial Hospital, has completed its acquisition of 215-bed Lake Forest (Ill.) Hospital, according to the Chicago Tribune.
In Louisiana, Shriners Hospital and Louisiana State University Health Sciences Center-Shreveport have entered into a memorandum of understanding that could merge most hospital operations this year, reports the Shreveport Times.
In New York, SUNY Downstate Medical Center in Crown Heights plans to acquire Long Island College Hospital from current operator Continuum Health Partners, notes the Brooklyn Report.

One bright side to all of this that could give more hospitals access to capital and alleviate financial stress is that the U.S. Department of Housing and Urban Development (HUD) has issued a proposed rule to allow hospitals to refinance existing non-Federal Housing Administration-insured loans "without requiring such refinancing to take place only in conjunction with the expenditure of funds for construction or renovation, which is the existing program requirement."

To learn more:
- read the Bloomberg article
- here's the Tribune article
- check out the Shreveport Times article
- peruse the Brooklyn Paper article
- read the proposed rule

Process-of-care measures help hospital stand out nationally

Caralyn Davis — Mon, 01 Feb 2010 14:25:53 -0500

Western Baptist Hospital in Paducah, Ky., scores in the top 3 percent in a composite of seven pneumonia process-of-care or core measures among more than 2,800 hospitals with 50 or more beds. Western Baptist Hospital: Problem-Solving with Pneumonia Care Performance Improvement Teams, a new case study by the Commonwealth Fund, details the strategies the hospital used to achieve this distinction.

One key: Western Baptist has multidisciplinary performance improvement teams for each core measure set, and every team has a physician champion with a formalized, compensated role. "The hospital contracts with physicians to: 1) provide reports and updates at medical staff meetings on core measure performance and proposed quality improvement initiatives; 2) review core measure performance data and instances of noncompliance; and 3) meet one-on-one with the physicians involved in cases that fall out of compliance," says the report.

Action steps taken by the hospital include conducting a vaccination assessment screening for all patients upon admission. "When the hospital implemented the policy, many of the community physicians expressed concerns that they would have no way of knowing whether their patients had been vaccinated. Physician champions from the pneumonia performance improvement team spoke at medical staff committee meetings about the issue," says the report. "Eventually, Western Baptist created a vaccination database and agreed to notify physicians each time a patient received a vaccination at the hospital. To do so, the hospital sends a letter to community physicians and scans the letter into the patient's electronic medical record. Physicians and other clinical staff have access to these electronic records from remote locations."

Western Baptist also added vaccination reminders to pneumonia preprinted order sets; set up a system for discharge expeditors to track vaccinations on a dry-erase board behind the nursing station; and allowed nurses to administer pneumococcal and influenza vaccinations using a preprinted protocol without a physician's order.

To learn more about the hospital's path to success:
- read the case study

Contracting practices create Mass. hospital pricing disparities

Caralyn Davis — Mon, 01 Feb 2010 14:08:08 -0500

Contracting practices that "reinforce and perpetuate disparities in pricing" have created problems in the commercial healthcare marketplace in Massachusetts, raising concerns that existing systemic disparities in reimbursement may, over time, create a provider marketplace dominated by very expensive 'haves' as the lower and more moderately priced 'have nots' are forced to close or consolidate with higher paid systems," says a preliminary report from the Office of Inspector General Martha Coakley.

Health insurers paid Massachusetts hospitals within the same geographic area significantly different prices for similar services. These pricing variations cannot be explained by: quality of care, the complexity of patient populations, whether hospitals are caring for heavy Medicare or Medicaid populations, or whether the hospital is a teaching or research facility, according to the report. Differences in hospital costs for delivering services also can't explain the pricing differences.

"Price variations are correlated to market leverage as measured by the relative market position of the hospital or provider group compared with other hospitals or provider groups within a geographic region or within a group of academic medical centers," says the report. "Price increases, not increases in utilization, caused most of the increases in healthcare costs during the past few years in Massachusetts."

To learn more about healthcare cost trends and drivers in Massachusetts:
- read the report

CDC emphasizes infection control during spinal procedures

Caralyn Davis — Mon, 01 Feb 2010 13:53:45 -0500

Healthcare providers should follow established infection-control recommendations during spinal procedures, including the use of a mask and adherence to aseptic technique, says the Centers for Disease Control and Prevention (CDC) in the January 29 issue of Morbidity and Mortality Weekly Report (MMWR).

The CDC issued the reminder because two small clusters of bacterial meningitis after spinal anesthesia occurred during 2008-09 even though the Healthcare Infection Control Practices Advisory Committee issued related infection-control recommendations in 2007. The clusters involved three cases in New York and two in Ohio. All five female patients received intrapartum spinal anesthesia, and four of the five were confirmed to have Streptococcus salivarius meningitis.

The two cases of bacterial meningitis in Ohio occurred at Mary Rutan Hospital in Bellefontaine, reports the Columbus Dispatch. The patients, one of whom died, both delivered babies at the hospital on May 21, 2009. The CDC confirmed that the anesthesiologist at Mary Rutan was a carrier. Changes made at the hospital as a result of these cases include requiring hospital workers to wear masks when they are within two arms' length of patients during spinal procedures.

To learn more about the CDC recommendations:
- read the MMWR
- read the Dispatch article

Badges track hand-washing compliance

Caralyn Davis — Mon, 01 Feb 2010 13:48:25 -0500

Princeton Baptist Medical Center in Birmingham, Ala., is testing new surveillance technology developed by Birmingham-based Proventix Systems Inc. to track whether its healthcare workers are meeting hand-washing protocols, reports National Public Radio (NPR). Hospital nurses wear special badges that track when nurses enter a patient's room and whether they wash their hands upon entering and leaving the room. This information is then wirelessly transmitted to hospital officials, including the CEO.

Hospital workers have expressed concerns about how this information will be used. Workers who are habitually noncompliant could receive an email or text message alerting them to the problem, but the system isn't designed for enacting punitive measures, says Proventix CEO Harvey Nix.

The Centers for Disease Control and Prevention is studying how the surveillance impacts healthcare workers, examining such questions as whether they like it and whether the technology could change workers' behavior.

To learn more about hand-washing surveillance efforts:
- read this NPR article
- visit the Proventix website