Health Care News

New Jersey a hotbed for hospital consolidation

Karen M. Cheung — Fri, 03 Feb 2012 12:54:32 -0500

With major announcements from five North Jersey hospitals this week to sell or merge, the state is shaping up to be hotbed for consolidation activity, succumbing to a competitive marketplace.

Hackensack University Medical Center and its investment partner, LHP Hospital Group, will purchase Mountainside Hospital for $190 million, the Star-Ledger and Express-Times reported. The Ascension Health Care Network of St. Louis, Mo., the nation's largest Catholic hospital system, is in talks with St. Mary's Medical Center and St. Joseph's Regional Medical Center to create a new potential Catholic health system in New Jersey. St. Luke's Hospital and Health Network announced it is adding Warren Hospital.

And Christ Hospital is considering filing for Chapter 11 bankruptcy after California-based Prime Healthcare Services on Wednesday withdrew its bid to purchase the community hospital, according to the Hudson Reporter. Christ Hospital loses $800,000 a month. Local officials have expressed concern in keeping Christ Hospital nonprofit and under local ownership, but Prime is concerned that bankruptcy filing will hurt the hospital and the community, it said yesterday.

Called a dizzying week for New Jersey hospitals, the Star-Ledger and Express-Times article noted, the recent discussions about consolidation and partnership are fueled by health reform and a "harsh marketplace," New Jersey Hospitals Association spokeswoman Kerry McKean Kelly said.

For more information:
- read the Star-Ledger and Express-Times article
- read the Hudson Reporter article
- here's the Prime press release

Related Articles:
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AHA: Hospitals spend 11.3% on community benefits

Alicia Caramenico — Fri, 03 Feb 2012 12:29:26 -0500

With nonprofit hospitals trying to prove they deserve tax exemptions, comes a new report showing an average of 11.3 percent of their total spending goes toward community benefits, including free care, community health improvement programs and subsidized services.

On average, hospitals devoted 5.7 percent of their total expenses on direct benefits to financially struggling patients, such as spending to cover Medicare underpayments, according the report by Ernst & Young, based on Schedule H tax forms required as of 2009.

According to those figures, a hospital that reported $100 million in total operating costs spent an average of more than $11 million on benefits to the community, with roughly $6 million for patients in financial need, the AHA noted.

The report found that more than 70 percent of hospitals included bad debt expense due to charity care on their Schedule H forms at 0.4 percent of total spending or an average $1.6 million per hospital.

The report also emphasized that hospitals do more for their communities outside of charity care. They finance health improvement programs, health professions education and medical research, as well as give cash and in-kind donations to community groups.

Moreover, the report cautions that Schedule H filings fail to completely measure the tangible and intangible benefits of hospitals improving their communities' health and well-being.

"Dollars alone can never tell the complete story of how communities benefit from programs and services that hospitals provide," AHA President and CEO Rich Umbdenstock said yesterday. "The AHA believes that communities themselves are in the best position to determine whether the benefits provided by their local hospitals match their needs."

To learn more:
- read the AHA press release (.pdf)
- here's the report (.pdf)

Healthcare jobs will grow the fastest of all industries

Karen M. Cheung — Fri, 03 Feb 2012 12:10:13 -0500

Of all industry sectors, healthcare jobs will grow the fastest, the Bureau of Labor Statistics (BLS) said yesterday. In fact, healthcare and social assistance will see an increase of 5.6 million jobs over the next decade, many of which located in health practitioner offices.

Between 2010 and 2020, healthcare support occupations will grow 34.5 percent, personal care and services occupations will grow 26.8 percent, and healthcare practitioners and technical occupations will rise 25.9 percent. Office and administrative support occupations will see the most new jobs at 2.3 million, although at a projected slower-than-average growth of 10.3 percent.

Regarding specific job titles, BLS predicts there will be 712,000 more registered nurses, 706,000 home health aides and 607,000 personal care aides.

The BLS forecasts for the decade's growth might be off to a slow start. Healthcare practitioners and technical occupations posted fewer advertised jobs in January, especially for general internists and family and general practitioner positions, according to Conference Board data released this week.

"One-third of the projected fastest growing occupations are related to health care, reflecting expected increases in demand as the population ages and the health care and social assistance industry grows," BLS said.

However, as the patient population ages and calls for more healthcare workers, the workforce also is getting older, Reuters reported.

For more information:
- read the Reuters article
- read the BLS press release
- check out the BLS data
- here's the Conference Board press release

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Coincidence: ACO hotspots also Super Bowl regions

Karen M. Cheung — Fri, 03 Feb 2012 11:29:32 -0500

Where are the hotbeds for accountable care organizations (ACO)? The Super Bowl-bound regions of New England, New York City, New Jersey and Indianapolis, according to HealthLeaders-InterStudy. For example, seven provider groups named as Pioneer ACOs are located in New England, also known for the Patriots football team. New Jersey has nine ACOs, and providers in Indianapolis, the Super Bowl host city, also are pursuing ACOs. Press release

Steward strikes deal with Tufts-affiliated docs

Karen M. Cheung — Fri, 03 Feb 2012 11:06:25 -0500

Expanding Massachusetts hospital operator, Steward Health Care System, is affiliating with Manet Community Health Center, a South Shore physician group of about 20 doctors that have been affiliated with Tufts Medical Center's New England Quality Care Alliance, The Boston Globe reported.

The new deal will allow patients, especially in the Quincy area, to see Manet physicians and opens up a larger pool of provider choices for them, Steward Health Care System Media Relations Director Chris Murphy told FierceHealthcare. Steward has grown in the past year, he explained.

The latest system-physician affiliation follows Steward's recent transitions with Whittier Independent Practice Association, in which Beth Israel Deaconess Medical Center in November accused Steward of kickbacks. The following month, Steward struck a deal with Compass Medical, a former physician group of Partners HealthCare.

Under the agreement, Manet physicians, who will not be Steward employees but rather affiliated and maintain their practices, will join Steward's contracting network and use its electronic medical records system, according to Murphy.

Steward was named one of the 32 Centers for Medicare & Medicaid Services-recognized Pioneer Accountable Care Organizations. Earlier this month, Steward withdrew from the state hospital association.

The deal will not affect Steward Community Choice, the Steward and Tufts partnered health plan, he said.

For more information:
- read the Boston Globe article

Related Articles:
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State uses $8M indigent-care funds to settle alleged improper deals

Alicia Caramenico — Fri, 03 Feb 2012 11:05:46 -0500

Instead of using federal matching funds for indigent care, New Mexico will use $8 million to settle claims that nine hospitals made improper deals with county governments, The New Mexican reported.

An investigation by the Centers for Medicare & Medicaid Services found that the state's contributions to leverage federal Sole Community Provider funds in 2009 included "non-bona fide donations or in kind transfers," according to the article.

The CMS review likely was prompted by the U.S. Department of Justice joining a whistleblower lawsuit that accused Eastern New Mexico Medical Center and other Community Health Systems hospitals of making illegal donations to counties to get the biggest county contributions possible, thus upping their federal matching funds.

Although originally seeking to recover $53 million, CMS reached an agreement with New Mexico to settle for $7.9 million.

That amount will come from the state's contributions to the Sole Community Provider program for fiscal year 2012, eliminating the state's opportunity to have the money matched at the 3-to-1 ratio, noted The New Mexican.

The settlement could affect hospitals' ability to adequately care for indigent patients, as the $1.3 million settlement money coming from Santa Fe County's contribution will cause Christus St. Vincent Regional Medical Center to lose almost $4 million in federal indigent-care funds.

Despite the settlement, the nine hospitals have not admitted any wrongdoing.

For more information:
- read the The New Mexican article
- here's the FierceHealthcare article on the whistleblower suit

Recruiting during a physician shortage: Play up mission

Karen M. Cheung — Thu, 02 Feb 2012 13:09:40 -0500

Challenged to find physicians, a 24-bed hospital in southwest rural Kansas found a way to recruit doctors--through a reverse-recruitment model. Ashland Health Clinic, with a city population of 855 people and the closest center 50 miles away, has been recruiting physicians who are "mission-focused," NPR Shots reported.

Ashland Health offers potential candidates eight weeks off to do missionary work overseas.

"When you recruit a mission-focused provider, they want to see the ghettos," CEO Benjamin Anderson told NPR. "They want to know that there's no Spanish-speaking provider in more than a one-hour drive. They want to see houses that are falling down, widows that are uncared for. They want to know that there's need and that by them coming there, they would fill a disparity that would otherwise not be filled."

The appeal of mission-based work has worked, with a recent physician hire, who will continue missionary work in Haiti and Mexico during his eight weeks off.

Under healthcare reform, an estimated 32 million more Americans with health insurance is expected to strain the existing healthcare workforce.

The national workforce committee aimed at fixing the physician shortage problem has stalled due to partisan strife on Capitol Hill over the $3 million slated for the group, The Washington Post reported.

The intent of the National Health Care Workforce Commission is to analyze primary-care shortages and propose ways to fill the healthcare workforce. However, the group cannot convene, converse or hire staff with the budget opposed by House Republicans.

"The workforce is needed to accomplish health reform," said the commission's chairman, Peter Buerhaus, director of Vanderbilt University Medical Center's Center for Interdisciplinary Health Workforce Studies. "Now the clock is beginning to tick loudly."

For more information:
- here's the NPR report
- read the Washington Post article

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HHS reg changes to lab services, privileges aim to save billions

Gienna Shaw — Thu, 02 Feb 2012 12:41:41 -0500

The federal government is making "significant progress" toward new rules that would save the healthcare industry billions of dollars, increase efficiency and alleviate administrative burdens on physicians, according to the Department of Health & Human Services.

A long list of rules--both proposed and final--address a range of issues, from privileging and credentialing regulations for in-person and telemedicine visits to duties and privileges of advanced practice nurses and physician assistants.

The agency continues to tout the potential cost-savings of its work. "Two of the proposed rules we published are expected to result in significant savings to the health industry," HHS wrote in its most recent update. "The first, a major revision to the Medicare Conditions of Participation for Hospitals, is likely to result in an estimated savings of close to $5 billion over five years. The second, Regulatory Provisions to Promote Program Efficiency, Transparency and Burden Reduction, may result in cost savings that approach $200 million during the first year."

HHS highlighted other cost-saving efforts in the report, including rules that would:

Permit laboratory services to operate on-site at critical access hospitals, saving roughly $15.8 million per year.
Allow hospitals to determine the total number of directors needed for its outpatient services, saving $300 million per year.
Allow hospitals to set their own policies on the duties and privileges of advanced practice nurses, physician assistants and other licensed non-physician practitioners in accordance with state rules, saving hospitals roughly $330 million per year.
Permit hospitals to integrate nursing service care plans into their overall interdisciplinary care plan, eliminating the requirement that nursing staff develop two care plans, saving an estimated $110 million per year.
Allow hospitals to use standing medical orders approved by the hospital's clinical leadership to advance the practice of evidence-based medicine, saving $90 million per year.

Other rules focus on giving patients easier access to information about their healthcare, including a proposed rule that would allow patients to more easily access their clinical lab test results.

HHS also made note of a review that's underway of a Food and Drug Administration rule for medication bar codes. Under the current rule, drug manufacturers must use a certain type of bar code to identify the drug, but since that rule was imposed, many more types of bar codes and bar code readers have hit the market. FDA will conduct an economic review to determine if the rule should be modified to include these new technologies, according to HHS.

To learn more:
- read an overview of HHS' retrospective review project
- read HHS' January retrospective review report (.pdf)
- see a chart listing all of HHS' proposed and final rules (.pdf)
- read the American Hospital Association summary of the report

Hospitals ready for value-based purchasing with higher patient satisfaction

Karen M. Cheung — Thu, 02 Feb 2012 12:15:33 -0500

Despite the dark cloud of reduced reimbursements, hospitals are prepared for value-based purchasing (VBP) with patients reporting higher satisfaction levels, according to Press Ganey.

Noting that the Centers for Medicare & Medicaid Services Hospital Compare public data does not cover the VBP performance period, Press Ganey looked at patient discharge data through October 2011--the most recent available--and found that patients' average "likelihood to recommend" score for hospitals was 1.5 points higher in October 2011, compared to April 2010 through March 2011.

In July 2011, hospitals saw an overall rating average increase of almost three-quarters of a point (0.7) compared to the previous month. Nearly half a million more patients would "definitely recommend" their hospital, compared to the previous year (ending in March 2011), according to Press Ganey, which used American Hospital Association admissions data for more than 36.9 million patients.

Since the VBP performance period began, the overall hospital performance score has continued to improve. The average overall hospital rating in October 2011 was 0.9 percentage points higher than the average score for April 2010 through March 2011, according to Press Ganey.

"Our analysis shows that hospitals prepared well for the start of the value-based purchasing performance period which began in July 2011," Deirdre Mylod, vice president, improvement services at Press Ganey, said in an announcement yesterday. "The sharp rise that we can see in our more recent data--which is not yet visible in the public data--is similar to the increase we saw in our database after CMS initiated a national consumer awareness campaign about the HCAHPS survey in May 2008."

Forty-four percent of U.S. hospitals participate in CMS' HCAHPS survey.

Starting in October, Medicare reimbursements to hospitals will be based on performance measures, according to rules from CMS issued last year. Patient satisfaction will determine 30 percent of the incentive payments, while improved clinical outcomes will decide 70 percent.

The measure is troubling, Martin Ciccocioppo, vice president of research for the Hospital & Healthsystem Association of Pennsylvania, told the (Scranton, Pa.) Times-Tribune in January. "There's no clear scientific link between (patient satisfaction) and the quality of care they received," he said.

For more information:
- here's the Press Ganey announcement
- read the Times-Tribune article

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No one-size-fits-all fix to patient experience

Karen M. Cheung — Thu, 02 Feb 2012 11:22:28 -0500

When deciding strategies for patient experience improvement, most hospitals look to the common Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey, yet no two hospitals follow the same plan, Jason Wolf, executive director of The Beryl Institute, a patient experience community, wrote in a Hospital Impact blog post. "I encourage you not to be fooled by a one-size-fits-all solution," he wrote. However, there are some common themes to be gleaned from current literature on the patient experience. Wolf said that noise reduction, discharge process and pain management are consistent tactics around the globe. --Read the full blog post on Hospital Impact

Hospitals, nurses grapple with overtime

Alicia Caramenico — Wed, 01 Feb 2012 13:21:29 -0500

State-mandated caps on nursing overtime hours improve patient safety and care quality, concluded a new study, reported Renal Business Today. The regulations prevented fatigue from long shifts and the associated errors that endanger the safety of patients and nurses alike.

In the 16 states regulating overtime as of 2010, newly registered nurses were 59 percent less likely to work mandatory overtime than those in unregulated states and worked an average of 50 fewer minutes per week, according to the RN Work Project study.

The study also found that limiting mandatory overtime enhanced nurse retention, enticing nurses to remain in their jobs and in the profession longer. The researchers suggest other states could see similar benefits with nursing overtime regulations.

Hospitals and nurses in Massachusetts, one of the 34 unregulated states, are arguing over mandatory nurse-to-patient staffing ratios, reported 22News.

"I've worked 16 hour shifts," Donna Stern, a Baystate Franklin Medical Center registered nurse, said in the article. "I have been [on] mandatory overtime and every time that that happens, the safety is put to test."

But the hospitals, not wanting to confine nurse care to a "one-size-fits-all" ratio, want a collaboration between hospitals, physicians and nurses to create best practices based on quality, not volume, noted 22News.

Meanwhile, the majority of nurses (78 percent) are spending one quarter of their 12-hour shifts on nonpatient care, such as completing checklists and paperwork, according to a survey conducted by Atlanta-based Jackson Healthcare between July and November 2011.

According to the nurse respondents, reduced nurse-to-patient ratios and increased ancillary support staff could help shrink the amount of time they spend on indirect patient care.

To learn more:
- read the Renal Business Today article
- here's the 22News article
- read the Jackson survey summary

IOM: Chronic conditions a public health 'crisis'

Karen M. Cheung — Wed, 01 Feb 2012 13:02:33 -0500

Despite existing national initiatives to help patients with chronic illnesses, the Institute of Medicine (IOM) indicated in a report yesterday the industry still isn't doing enough for patients in what it calls a matter of public health.

IOM didn't recommend specific illnesses to target but did identify nine "exemplar" conditions that significantly affect the nation's health and economy: arthritis, cancer, chronic pain, dementia, depression, type 2 diabetes, post-traumatic disabling conditions, schizophrenia, and vision and hearing loss.

The costs of people with chronic illnesses such as these represent 75 percent of the $2 trillion in U.S. annual healthcare spending, according to the report.

Chronic conditions are reaching a boiling point, the IOM suggested. Calling it an "epidemic," IOM said chronic illness is steadily moving toward crisis proportions. "Yet maintaining or enhancing quality of life for individuals living with chronic illnesses has not been given the attention it deserves by health care funders, health systems, policy makers, and public health programs and agencies," the report summary states. "Moreover, the aging of the population will only increase coming challenges."

Although a range of public policies have helped individuals with chronic illness already, it's important to design and implement new public policies that further promote living well with chronic illnesses, according to the report. In recent decades, the focus has not only been for patients to live longer but also live well.

The IOM committee pushed evidence-based interventions in community disease prevention, such as ending smoking, eating nutritious food and limiting weight gain, recommending that federal and state governments monitor progress through comprehensive surveillance. The IOM also recommended the U.S. Department of Health & Human Services support states in developing population strategies, as well as the Centers for Disease Control and Prevention selecting a variety of illnesses that merit public health action, paying attention not to duplicate existing efforts.

For more information:
- read the IOM report brief
- check out the IOM report (.pdf)

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Bristol Hospital settles Stark violation claims

Karen M. Cheung — Wed, 01 Feb 2012 11:24:21 -0500

Bristol (Conn.) Hospital and Bristol Gastroenterology Associates agreed to pay $157,830 to settle allegations that they violated the Stark law and the False Claims Act by improperly billing Medicare, the Office of Inspector General announced yesterday. The physician group allegedly occupied a suite of the hospital without a written lease and without having to pay rent for two years, while the physicians regularly referred Medicare patients to Bristol Hospital, reported the Hartford Courant. Neither the hospital nor Bristol Gastroenterology admits liability in paying the settlement. Article

No difference in safety-net length of stay

Karen M. Cheung — Wed, 01 Feb 2012 10:12:43 -0500

Despite arguments that safety-net emergency departments are at an inherit disadvantage, a new Journal of the American Medical Association study found that there's little difference in length of stay between safety-net hospitals and non-safety nets.

"Although concerns have been raised that performance measures, particularly those linked to payment, may ultimately penalize safety-net institutions that are already underfunded and that care for a disproportionate volume of patients with poorer health care status, our findings suggest that those concerns about ED length of stay will not penalize safety-net institutions," the authors wrote, according to a JAMA press release yesterday.

The study did confirm that patients treated at safety-net EDs were more likely to be young and minority than those treated at non-safety-net EDs, and were less likely to need emergency or urgent care in both admitted and discharged populations.

However, the study could suggest that safety-net EDs aren't predisposed to disadvantages and shouldn't use their population mix as an excuse in failing to meet performance measures, such as length-of-stay targets.

Researchers found that median ED length of stay was 269 minutes for safety-net EDs, only 12 minutes shorter than 281 minutes for non-safety-net EDs.

In critical care admissions--which made up 12.5 percent of all safety-net admissions and 13.2 percent in non-safety-nets-- the median ED length of stay was 236 minutes, compared to 248 minutes, respectively. For discharged patients, the median ED length of stay was 156 minutes versus 148 minutes, 355 minutes for observations versus 298 minutes, and 235 minutes for transfers versus 239 minutes.

The study pointed out that compliance with proposed ED length-of-stay measures for admissions, discharges, transfers and observations did not differ significantly between safety-net and non-safety-net hospitals.

For more information:
- read the study abstract
- here's the press release

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Salinas Valley Memorial reveals exec retirement payouts over $1M

Karen M. Cheung — Tue, 31 Jan 2012 12:15:27 -0500

Amid public scrutiny over executive pay and layoffs in the past two years, Salinas Valley Memorial Healthcare System on Monday disclosed the retirement benefit figures of its top executives.

Executive pay at the California health system has come under fire since it laid off hundreds of workers to turn around its finances. In April 2011, Salinas Valley paid out nearly $4 million in retirement compensation to former CEO Sam Downing--one of the largest public pensions in state history, the Los Angeles Times reported.

Now, two of the executives will receive more than $1 million in supplemental retirement payments, according to the article. Recently retired Chief Financial Officer John Fletcher, who made $340,897 a year, will see an annual pension of $108,552 with a $1.08 million lump sum payment, according to the Monterey County Herald. Similarly, Vice President and Chief Operating Officer Bev Ranzenberger, who is making $340,897 a year, will earn an annual pension of $97,500 with a $1.33 million lump sum payment.

As for the other executives, Vice President and Chief Medical Officer David Perrott, who was making $340,897 a year, will have an annual pension of $50,616 with a $371,194 lump sum payment. Vice President of Business Development Liz Lorenzi, who was making $340,897 a year, will have an annual pension of $54,012 with a $357,873 lump sum payment. And Vice President and Controller Frank Katsuda, who made $272,051 a year, is not eligible for a regular pension, but he will receive a supplemental pension of $5,029 a month instead of a lump sum payment.

The compensation packages for the five executives, who have spent from six to 33 years at Salinas Valley Memorial, are in line with national standards for the hospital industry, according to spokesperson Adrienne Laurent. The hospital awarded the compensation packages when the hospital was thriving, Laurent said. Salinas has since discontinued the controversial executive retirement plan.

For more information:
- read the Los Angeles Times blog post
- read the Monterey County Herald article
- read the Californian article

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