There were 83,466 physician assistants practicing in the United States in 2010, a 100% increase over the past 10 years, according to a survey from the American Academy of Physician Assistants.
A further breakdown of the survey found that nearly 30% of PAs practice in single-specialty physician group practices, and 40% have been in their current primary specialty for at least six years.
The census also shows that 66% of PAs said they are satisfied or mostly satisfied with their career. Female PAs outnumber male PAs by nearly 20,000. More than 30% of PAs practice in primary care, making it the largest specialty for PAs, AAPA said in a media release.
"PAs are the only healthcare providers educated and credentialed with a primary care focus, providing a strong foundation for any specialty in which they may choose to practice," said AAPA President Robert Wooten, PA-C. "The information from AAPA's salary and census reports clearly confirm what PAs and the healthcare world have known for years: The PA profession is growing rapidly, and it is key to expanding access to quality healthcare for millions of Americans."
PAs earn a median annual salary of $90,000, up 2.8% from the 2009 survey. The three states with the highest salary increase in 2010 were Rhode Island, South Dakota and Missouri, all with increases of more than 9% over 2009, the survey found.
While most PAs are in clinical practice, an estimated 5,079 PAs work either alone or in healthcare education, administration, research and public health – a figure that Wooten said demonstrates the growing role PAs play in healthcare.
The AAPA annual census surveys both AAPA members and nonmembers. The data collected are used to track PA workforce issues, calculate summary statistics and describe the salary information. AAPA represents more than 81,000 certified PAs across all medical and surgical specialties in 50 states, the District of Columbia, most U.S. territories, and in the military.
Federal authorities on Wednesday detailed an eight-city sweep by the Medicare Fraud Strike Force that netted 91 suspects -- including 11 doctors and two nurses – for various fraud schemes involving false billing.
The value of the sweep represented the single highest amount of false Medicare billings in the four-year history of the Strike Force, which used more than 400 investigators from the Department of Justice, FBI, Health and Human Services -- Office of the Inspector General, and state and local law enforcement agencies for the raids, federal authorities said in a joint media release.
“Today’s arrests are a powerful warning to those who would try to defraud taxpayers and Medicare beneficiaries,” HHS Secretary Kathleen Sebelius said. “These arrests illustrate close cooperation between the Medicare program that identified these fraudsters and the law enforcement officials who acted swiftly to cut them off. And our efforts to stop criminals don’t end here because the Affordable Care Act gives us new tools to prevent Medicare fraud before it is committed – better protecting seniors and the integrity of the Medicare program for generations to come.”
Federal prosecutors detailed the allegations in each city:
In Miami, 45 people, including a doctor and a nurse, were charged in various fraud schemes involving a total of $159 million in false billings for home healthcare, mental health services, occupational and physical therapy, DME and HIV infusion. In one case, 24 people are charged with participating in a community mental health center fraud scheme involving more than $50 million in fraudulent billing. The defendants allegedly paid patient recruiters to refer ineligible beneficiaries to the mental health center. In some instances, beneficiaries who were residents of halfway houses were allegedly threatened with eviction if they did not attend the mental health center.
In Houston, two people were charged with fraud schemes involving $62 million in false billings for home health care and DME. One defendant allegedly sold beneficiary information to 100 different Houston-area home healthcare agencies in exchange for illegal payments. The indictment alleges that the home agencies then used the beneficiary information to bill Medicare for services that were unnecessary or never provided.
In Baton Rouge, LA, 10 people were charged in schemes involving more than $24 million related to false claims for home healthcare and DME. According to one indictment, a doctor, a nurse and five other co-conspirators schemed to bill Medicare for more than $19 million in skilled nursing and other home health services that were medically unnecessary or never provided.
In Detroit, 18 people, including three doctors, were charged last week for schemes to defraud Medicare of more than $28 million. According to an indictment, 14 of the defendants participated in a home healthcare scheme that submitted more than $14 million in false claims to Medicare.
In Brooklyn, three people, including two doctors, were charged for a fraud scheme involving more than $3.4 million in false claims for medically unnecessary physical therapy.
In Dallas, two people, including a doctor, were charged in a scheme to defraud Medicare of approximately $2.1 million, DOJ said.
In Chicago, four people, including a doctor were charged for their alleged roles in schemes to defraud Medicare of more than $4.4 million.
In Los Angeles, six people, including two doctors, were charged in a scheme to defraud Medicare of more than $10.7 million.
Since its inception in March 2007, Strike Force operations in nine cities have charged more than 1,140 people who collectively have falsely billed the Medicare program for more than $2.9 billion.
An El Segundo, CA-based medical billing company has agreed to pay the federal government $4.6 million to settle fraud allegations stemming from overcharges at the company's Medicare and Medicaid operations in California and Louisiana, the Department of Justice said.
Federal prosecutors alleged that Janzen, Johnston & Rockwell Emergency Medicine Management Services Inc. inflated claims that it had coded on behalf of emergency room physicians in Louisiana and California.
From approximately 2000 through 2007, JJ&R used a coding formula that tended to generate claims for a marginally higher level of evaluation and management service than physicians had actually provided. JJ&R also routinely added charges to the evaluation and management claim for minor services, such as pulse oximetry, which had been provided by hospital nurses or physicians, DOJ said in a media release.
All the while, JJ&R allegedly often failed to comply with Medicare's coding rules governing claims for teaching physicians, resulting in claims that were not properly payable. The coding practices had a relatively small impact on the reimbursement of any particular claim. Over time, however, they generated significant overpayments from Medicare and Medicaid, DOJ said.
"Inflating individual healthcare claims by even small amounts can cause significant losses to Medicare and Medicaid," Tony West, Assistant Attorney General for DOJ's Civil Division, said in a media release. "Taxpayers should not be on the hook for charges that shouldn't have been added or claims that shouldn't have been submitted."
Attempts by HealthLeaders Media to contact JJ&R on Tuesday afternoon were not successful.
The settlement resolves whistleblower allegations brought by Le Jeanne Harris, a former employee of JJ&R, who will get $774,450.
DOJ said it has used the False Claims Act to recover more than $5.9 billion since January 2009 in cases involving fraud against federal healthcare programs.
A study showing that hand washing increases among medical professionals when the organizational emphasis is on patient safety is hardly breaking news, but it should be a key motivator for other infection control practices, one infection control advocate says.
Russ Olmsted, president of Association for Professionals in Infection Control and Epidemiology, Inc., said in an email to HealthLeaders Media he was "encouraged" to see social scientists "share an interest in the behavioral aspects of patient care" and Olmsted said he welcomed additional research.
The study Olmsted cited,It's Not All About Me: Motivating Hospital Hand Hygiene by Focusing on Patients,found significantly better compliance with hand hygiene when hospital signage encouraged healthcare professionals to consider the health and safety of their patients, rather than themselves. The study will appear in Psychological Science.
"Clearly we have a healthy supply of products to support hand hygiene. The 'missing ingredient' however is perhaps a better understanding of human behavior in the healthcare environment and then the application of interventions that use findings such as this from social sciences," Olmsted said.
"The knowledge from social sciences can also be applied to other interventions aimed at preventing cross infection, such as use the of personal protective equipment when caring for patients on isolation precautions, implementation of infection prevention "bundles" for devices needed for patient care, e.g. central venous catheters, and even hygiene for the inanimate environment," he said.
The study posted one of three signs – each with a different emphasis -- at 66 hand-washing stations at several hospitals. The signs read: "Hand hygiene prevents you from catching diseases;" or "Hand hygiene prevents patients from catching diseases," or "Gel in, wash out." The study measured soap dispenser volumes over two weeks and found that staff used 33% more soap when the signage emphasized patient safety.
While he was encouraged by the study' findings, Olmsted says that emphasizing patient safety first in infection control is not a new idea. It has long been the centerpiece of hand hygiene initiatives adopted by the World Health Organization , the U.S. Centers for Disease Control and Prevention, and by APIC itself.
"Overall therefore while the findings of this study are useful it's important (to) understand there is a fairly high level of penetration of the message that hand hygiene = patient safety across providers in North America and beyond," Olmsted says.
Despite those recommendations from WHO, CDC, APIC and other organizations, study co-author David A. Hofmann said there is no definitive answer for why significant numbers of healthcare professionals continue to neglect hand hygiene.
"That is the $64 million dollar question," says Hofmann, a professor of organizational behavior Kenan-Flagler Business School, University of North Carolina at Chapel Hill.
"Physicians are potentially overconfident in their own immune systems and the lack of a one-to-one causal between hand washing and them getting sick creates a situation where they don't perceive the risk as that high," he says. "When we shift the sign message to the patient it highlights a very vulnerable person in the context that could be affected by this behavior and it may also trigger going back to the Hippocratic Oath which is 'First do no harm.'"
And while there was an immediate short-term uptick in hand-hygiene that could be related to the signage, Hofmann says it's not clear if the message might become muted over time. "We did a two-week study and found an effect but it does beg the question of 'over time do the signs fade into the environment and no longer impact behavior?'" he says.
Olmsted says he'd like to see a study measuring the longer-term effects of patient-centered signage for hand hygiene. "An investigation of longer duration and perhaps involving a wider range of healthcare facilities would be helpful to verify that their findings can be sustained," he says.
The healthcare sector has again provided about the only bright spot in an otherwise drab report on job growth in August from the U.S. Bureau of Labor Statistics.
Healthcare employment rose by 29,700 jobs in August, and the sector has created 205,100 new jobs in the first eight months of 2011, accounting for 22% of the 930,000 non-farm payroll additions in the overall economy in 2011, BLS preliminary data show.
A further breakdown of BLS preliminary data show that within the healthcare sector, hospitals gained 7,700 new jobs in August, after recording 11,000 new jobs in July. Hospitals lost 1,900 jobs in June, but have created 52,600 new jobs so far in 2011. By comparison, in the first eight months of 2010, hospitals created 15,800 new jobs, BLS data and preliminary data show.
Ambulatory services created 18,100 new jobs in August, and have been responsible for 58% (119,600) of new jobs in healthcare so far in 2011. Ambulatory services created 110,900 new jobs in the first eight months of 2010, BLS data and preliminary data show.
Physicians' offices reported 5,600 payroll additions in August and 30,600 new jobs so far in 2011. Physicians' offices created 39,600 new jobs in the first eight months of 2010, BLS data and preliminary data show.
BLS data from July and August are preliminary and may be considerably revised in the coming months.
Nearly 14.1 million people worked in the healthcare sector in August, with more than 4.7 million jobs at hospitals, more than 6.1 million jobs in ambulatory services, and more than 2.3 million jobs in physicians' offices, BLS preliminary data show.
Beyond the healthcare sector, nonfarm job growth in the larger U.S. economy was flat in August. The stagnant job market was blamed largely on a two-week strike affecting about 45,000 telecommunications workers at Verizon who were taken off the payroll in August. Those workers are now back the job.
The nation's unemployment rate remained essentially unchanged at 9.1%, where it has been since April, with 14 million people unemployed.
The number of long-term unemployed—people jobless for 27 weeks or longer—was 6 million in August, and represented 42.9% of the unemployed, BLS preliminary data show.
Online advertised vacancies for healthcare practitioners and technical occupations increased by 26,300 in August, breaking two consecutive months of declines, The Conference Board reported.
Among the top 10 occupation groups in the overall economy with the largest number of online advertised vacancies, healthcare practitioners and technical occupations posted the only increases in August.
The highly skilled health occupations posted 513,700 online job ads for the month and made up some ground lost from July's decrease of 61,200 postings. However, demand for healthcare practitioners and technicians dropped by 98,800 job postings since January, according to The Conference Board Help Wanted Onlinereport.
The board's Help Wanted Online Data Series tracks more than 1,000 online job boards across the United States.
August job posting gains were reported for registered nurses, speech-language pathologists, licensed practical and licensed vocational nurses, family and general practitioners, and occupational therapists. For those occupations, there were more than two jobs available for every job seeker, with an average hourly wage of $34.27.
Healthcare support positions fell by 500 listings to 116,000 in August. There were 2.6 healthcare support job seekers for every job opening, and the positions paid – on average -- $12.94 an hour, The Conference Board reported.
In the overall economy, on line job listings fell by 163,000 listings in August, to 3.9 million. The August decline follows a drop of 217,000 job listings in July and 100,000 job listings in June. There were more than three unemployed people for every online advertised vacancy in July, the latest monthly data available for unemployment.
"Following a very strong first quarter (+763,000), labor demand has fallen off in the second quarter and into the third quarter (-456,000), reducing the earlier gains," June Shelp, Vice President at The Conference Board, said in a media release.
Overall, 2011 has seen a 308,000 increase in labor demand, but the average monthly gain this year (+38,000) is less than last year's average monthly gain at this point (+62,000), Shelp said.
More than 10,000 nurses from coast to coast are planning to attend demonstrations Thursday at the district offices of members of Congress in 21 states, urging them to support a tax on financial transactions.
The nurses, members of National Nurses United, want Congress to impose a 0.5% levy on financial transactions involving stocks, bonds, currency trading and derivatives. The nurses say the tax is already in place in more than 40 countries, and could raise up to $350 billion a year in the U.S. to rebuild the infrastructure.
"Congress is willing to bail out Wall Street because they get political contributions but they aren't willing to take care of Main Street. We are taking care of Main Street every single day so we felt it was our job to step up," NNU Co-president Deborah Burger, RN, told HealthLeaders Media.
"Nurses are doing this because they are sick and tired of seeing patients coming into the hospitals and community clinics who can't afford healthcare, who have lost their home and jobs, and who can't afford the drugs to take care of themselves and their families," Burger says.
"If they're asking everybody for shared sacrifice it is time for Wall Street to step up to the plate. We aren't asking for a lot. We are asking for a tiny transaction tax to rebuild Main Street."
In addition to the district rallies, the nurses are holding other events such as soup kitchens for the hungry, community forums, and street theater skits in Boston – where a town crier in will read a litany of complaints against Wall Street malfeasance – and in Chicago, San Francisco, and Orlando, and smaller cities, such as Corpus Christi, TX, Marquette, MI, and Dayton, OH.
While unions generally rely on a more sympathetic reception from Democrats, Burger says NNU will press both parties to support the transaction tax because NNU does not believe it is a partisan issue. "We are pressuring Republicans and Democrats. We are not out there fronting for the Democratic Party," she says. "We are holding both sides accountable because both sides have been pandering to Wall Street and have bailed them out with trillions of dollars."
"We want to make sure that everybody understands that you aren't off the hook just because you're a Democrat or a Republican. We are targeting the entire system, because the entire system is morally bankrupt."
Burger says NNU will release data contrasting contributions Democratic and Republican lawmakers have received from Wall Street even as the lawmakers' districts suffer from economic woes.
Rep. Paul Ryan (R-WI), for example, allegedly has accepted $2,417,672 in campaign contributions from Wall Street financial institutions over the past 12 years. In the meantime, NNU says 69,241 people in Ryan's district are uninsured, 22,884 use food stamps, and 20,394 children and 7,939 seniors live in poverty.
Sen. Michael Bennett (D-CO) allegedly has collected $2,409,806 campaign contributions from Wall Street while Colorado is among the top 10 states for home foreclosures, has 184,689 children in poverty, 116,941 people using food stamps, and 13,390 homeless, NNU says.
Burger says NNU is not supporting a specific bill right now. "What we know is that legislation always gets watered down. We aren't endorsing a particular piece of legislation until we are assured that it will raise more money than what I would consider 'couch change,'" she says. "Right now there are some lukewarm financial tax proposals out there, but they would only raise $1 billion or so and that is not sufficient to make a credible different in rebuilding the infrastructure."
Burger says the NNU does not want the tax applied to transactions such as home mortgages, loans, initial public offerings, publicly traded short-term debt, or mutual fund or 401(k) accounts. "Basically it is geared toward the in-and-out, speculative transactions," she says.
The estimated $350 billion in revenues that a financial transactions tax would raise was taken from a study done by the Political Economy Research Institute at the University of Massachusetts-Amherst. Robert Pollin, an economist at PERI and an author of the study, says the $350 billion estimate -- while possible -- probably is overly optimistic. "I myself would not argue that you are going to raise $350 billion at this rate because we have to assume some reduction in trading volume," Pollin says. "Nobody really knows how much trading volume would go down with such a tax. In my opinion probably a better estimate would be in the range of $200 billion."
NNU cites estimates that the $2.4 trillion in government bailouts to financial and other institutions already spent would have funded 63 million jobs at the national median level of about $39,000 a year.
Union organizers say the 61 members of Congress were targeted for the demonstrations both because of their high-profile on Capitol Hill, and because they lived in districts with high numbers of NNU members.
Burger says NNU elected to stage multiple rallies at legislators' home offices because they would be harder to ignore than a mass rally in Washington, DC. "Groups rally at the Capitol all the time and the get brushed under the rug and Congress is off the hook. But back in their communities, that is where they take notice," she says. "That's where their voters are."
Dead batteries, bad connections, and other malfunctions of automated external defibrillators have been linked to more than 1,000 cardiac arrest deaths over the last 15 years, a study has found.
"Survival from cardiac arrest depends on the reliable operation of AEDs," lead study author Lawrence DeLuca, MD, said in the study, which was published online in Annals of Emergency Medicine. "AEDs can truly be lifesavers but only if they are in good working order and people are willing to use them."
DeLuca's team analyzed reports to the FDA about all adverse events connected to AEDs between January 1993 and October 2008. Of the 40,787 AED-related events reported to the FDA, 1,150 of the events were linked to fatalities. Forty-five percent of the failures occurred during the attempt to charge and deliver a shock to the person in cardiac arrest.
Problems with pads and connectors accounted for 24% of the failures and battery power problems accounted for 23% of the failures.
Odds of surviving cardiac arrest decline by 7% to 10% per minute of delay in defibrillation. AEDs have become common in public places such as airports and offices, but bystanders are reluctant to use them. An Annals of Emergency Medicine study published earlier this year found that less than half of people in public places reported being willing to use an AED and more than half were unable to recognize one.
"AEDs are like any other piece of medical equipment: They can experience unexpected failures," DeLuca said. "I would recommend that people maintain AEDs as recommended by the manufacturer."
DeLuca, a physician at the University of Arizona Department of Emergency Medicine in Tucson, said that if a device fails, both the manufacturer and the FDA should be contacted. "Then be sure to return the unit and accessories such as pads or batteries to the manufacturer immediately so that it can be analyzed and a cause for the failure identified and fixed," he said.
Temporary emergency room nurses who are unfamiliar with their surroundings may inadvertently be a threat to the patients they serve, according to new research from Johns Hopkins University School of Medicine.
The study found that the temporary help was twice as likely as permanent staff to be involved in medication errors in the hectic and fast-paced environs of the ER. However, the study's authors stressed that temporary nurses should not necessarily be blamed for those shortcomings, which the researchers said are complex and diffuse.
"A place that uses a lot of temporary staff may have more quality of care issues in general," study leader Julius Cuong Pham, MD, an assistant professor of anesthesiology and critical care medicine and emergency medicine at the Johns Hopkins University School of Medicine, said in a media release. "It may not be the temporary staff that causes those errors but a function of the whole system."
The nation's hospitals have become more reliant on temporary nurses and other temporary clinical staff because of widespread shortages of healthcare professionals. Temporary nurses generally earn higher wages than their permanent coworkers, but they don't receive benefits, and could be cheaper in the long run.
"It's one of those necessary evil sorts of things," Ann Marie Papa, RN, president of the Emergency Nurses Association, tells HealthLeaders Media. "Temporary help can be tremendous when you are struggling with nursing shortages but the key is that these temporary nurses are properly trained and they have proper orientation, mentoring, and supervision."
The Johns Hopkins study examined a national Internet-based voluntary medication error reporting system and data from 2000 and 2005, encompassing nearly 24,000 emergency department medication errors among 592 hospitals.
Medication errors made by temporary workers were more likely to reach the patient, result in at least temporary harm and also be life-threatening, they found. The findings appear in the July/August issue of the Journal for Healthcare Quality.
Pham said temporary personnel are often not familiar with local staff, care management systems, protocols, or procedures. This may hamper communication and teamwork that causes them difficulty in retrieving important medical information and leave them unsure of which procedures to follow.
Temporary help may be less likely to speak up if they see problems and also lag behind the latest knowledge because, unlike permanent employees, temps typically manage their own continuing education.
Papa agreed with that assessment, and said it underscores the need for hospitals to embrace their temporary staff for the time they're there, and give them the same consideration and training they would offer permanent staff.
"It is up to the organization to ensure that the new nurses, the temporary nurses, the new graduates, are properly trained about procedures, protocols, and the culture of the hospital and the department in which they are working," Papa says.
It starts with frontline charge nurses making assessments of the people they supervise to ensure their competency. "Watch them put the IV line in. Watch them interview a patient. Someone has to verify their competency," Papa says.
That alone is not enough, she says. Temporary staff needs to know they have the support of management. "Sometimes temporary nurses tell me 'I go into an organization and nobody talks to me.' There is the reason why the nurses are going to have an error, because they are afraid to ask a question," Papa says. "We have to embrace temporary nurses and help them and be their life line. There should be a charge nurse or a supervisor ready so that if the temporary nurse could say 'I am not familiar with this' or 'I don't know your policy on this,' they are ready to help."
And it's not just the temporary nurses, Papa says.
"You can take a nurse from the same hospital and move [him or her] from the ICU to the post-anesthesia unit and they still need to have a different type of orientation because the equipment and the style of patient is different. It's important that the organizations recognize this. Proper mentoring and supervisions are critical," she said.
The egregious lapses in patient safety and basic hygiene at Parkland Health and Hospital System in Dallas, TX have been the subject of well-deserved and very negative reviews this summer from the state and federal government and from the news media. Just read some of the astonishing deficiencies detailed in the state and federal audits – a combined 600 pages – and it's hard not to get angry, if not horrified.
As HealthLeaders Media'sMargaret Dick Tocknell pointed out last week, the sweeping deficiencies among nine broad categories at Parkland include:
Failure to dispose of soiled gloves and gowns and wash hands after treating patients
Failure to properly dispose of infectious waste, including used syringes, body fluids, used respiratory equipment and used suction equipment
Lack of stabilizing treatment in emergency department before a transfer to another acute care facility
Lack of ER screening by a qualified medical professional
Failure to identify or assess emergency severity index
Medical residents unsupervised during clinical care by either an attending physician or faculty member
ER patients in a high level of pain provided with maps and directed to go to other parts of the hospital for treatment without benefit of any other assistance
Failure to provide 24-hour nursing services
Failure to change bed linens between emergency room patients
Failure to dispose of expired medications
These deficiencies were not incidental mistakes that can not be explained away as regrettable, but understandable oversights at a major safety net hospital which is understaffed, underfunded, and stressed to carry out its mission.
Sadly, the audits paint a picture of a major health system in complete disarray. After reading these findings, it appears that a significant number of staff at Parkland simply have stopped caring. How else can we explain such fundamental flaws?
These aren't just violations of safety standards. These are violations of common sense and compassion. Nothing says "I don't care" like unwashed hands and soiled bed sheets. If Parkland Hospital had been a fast-food restaurant, inspectors would have closed it down and strapped the doors shut with yellow biohazard tape.
It is encouraging that Parkland's executives have accepted responsibility for the shortcomings, and have vowed to revamp hospital operations. It is also sad that it took allegedly at least one patient death, government audits, volumes of negative publicity, and the threat of the loss of about $417 million in Medicare and Medicaid funding before a correction plan was unveiled last week.
The Parkland audit raises larger questions about the quality of care at our nation's safety net hospitals. If it happened in Dallas, what's to say that it isn't happening elsewhere?
The audit adds weight to uncomfortable assertions about the economic tiers in U.S. healthcare delivery, and the perceived lower standard of healthcare for society's most vulnerable – the poor, the uninsured, the indigent. Those stubborn assertions might not be fair, but they are understandable, and they can't be dismissed.
Audits such as these also undermine assertions that "frivolous" medical malpractice lawsuits are driving up healthcare costs. It's a hard sell for hospitals to claim they're the victims of opportunistic trial lawyers when hospital workers aren't doing something as basic as washing their hands. Before asking patients to surrender their right to legal redress, healthcare needs to clean up its act.
A detailed study of the workplace culture at Parkland Hospital should be conducted to determine what led to this breakdown in fundamental operations, chain-of-command, accountability, and employee engagement. It is important that we know why because what happened at Parkland could happen -- and has happened -- elsewhere.
There must be caring, compassionate and competent healthcare professionals at Parkland. So, where were they? How could staff allow such wholesale chaos to occur? Were attempts to bring these potentially lethal threats to patient health and safety to light ignored or discouraged by hospital leadership? Or were the systemic failures at Parkland so great that staff simply gave up trying?
What would drive a considerable number of educated, competent, compassionate and decent healthcare professionals at Parkland to ignore the safety and well-being of their patients? How did these healthcare professionals get to this painful point?