Excellence in American hospital care is rare. It is common knowledge that many hospitals fall alarmingly short on safety, quality, effectiveness, patient satisfaction, and cost. As Mark Chassin wrote in Health Affairs, "quality and safety problems in health care continue to routinely result in harm to patients. Desired progress will not be achieved unless substantial changes are made to the way in which quality improvement is conducted." What exactly should those "substantial changes" look like? Hospitals seeking excellence are pursuing various paths, but the best documented and most comprehensive is the "Baldrige journey"
Federal officials are planning a wide range of audits into billing and government spending on managed health care in the new fiscal year, ranging from private Medicare Advantage groups that treat millions of elderly to health plans rapidly expanding under the Affordable Care Act. The Health and Human Services Office of Inspector General, which investigates Medicare and Medicaid waste, fraud and abuse, said it would conduct "various reviews" of Medicare Advantage billing practices with an eye toward curbing overcharges. Results are due next year. The Inspector General also announced from five to ten new audits into Obamacare, ranging from the accuracy of "financial assistance" payments for new enrollees to controls to prevent fraudulent sign ups.
Alameda County supervisors approved hiring a consultant Tuesday to examine the county's financially strapped public hospital system after agreeing last week to give the system a break in paying off its $162 million debt. The Alameda Health System, a five-hospital public consortium, will get its finances and operations reviewed by Concord-based Toyon Associates Inc. The move is the latest push from the Alameda County Board of Supervisors for more control and oversight over the semiautonomous hospital system that is in financial trouble and unable to pay down its long-term debt to the county.
Dignity Health, a hospital chain that operates in three states but is based in San Francisco, will be paying $37 million as settlement to the government for alleged overbilling under the Medicare and military health care program. The malpractice has been going on for years, with Dignity, formerly named Catholic Healthcare West, submitting medical bills for inpatient care at 13 of the 39 hospitals where it operates in Arizona, Nevada and California. The bills, as found by the Justice Department, should have been charged with outpatient rates, which are less expensive than the inpatient rates that the hospital charged on the medical bills.
Texas will allow all but "high-risk" health care workers returning from Ebola-stricken areas to self-quarantine, Gov. Rick Perry announced Tuesday, less than a week after employing the strategy with a nurse who recently cared for patients in West Africa. The guidelines, recommended by the blue-ribbon task force Perry created after the nation's first case of Ebola was diagnosed in Dallas, set forth nuanced "exposure" categories. They call for the issuance of a state-enforced control order requiring that a symptom-free returning worker stay home for 21 days only if the worker had particularly risky, direct contact with the virus.
The Department of Veterans Affairs is moving to slash patient wait times following reports linking delays at agency-run healthcare clinics to a series of deaths in recent years. Regulations proposed Tuesday are designed to speed healthcare for veterans by expanding access to private providers. The draft rule would map out a new Veterans Choice Program, laying out new guidelines for covered services, eligibility requirements, reimbursement rates and criteria that non-VA providers must meet to participate. To qualify, healthcare providers must already participate in the Medicare program and must able to offer timely, qualified care within a reasonable distance from the veteran's home.