Partners Healthcare, the largest hospital and physician network in Massachusetts, has agree to pay $2.7 million in overtime back wages to 700 employees. The agreement resolves a lawsuit filed by the U.S. Department of Labor alleging violations of the federal Fair Labor Standards Act, which requires workers be paid time and one-half their regular wage for hours worked beyond 40 in a week.
A growing numbers of Americans are seeking alternative medical care, and now an influential group of U.S. senators believes the time has come to embrace an array of alternative therapies. Senator Tom Harkin of Iowa is the cosponsor of an amendment that says healthcare plans will not be allowed to "discriminate" against any healthcare provider who has a license issued by a state, an amendment Senate aides said was designed to provide coverage for alternative medicine. Backers of the amendment say it could save tens of billions of dollars in the long run by providing less expensive and better alternatives to drugs and surgery in a variety of cases.
President Barack Obama holds the Cleveland Clinic up as an institution that can be a model for delivering high-quality and cost-effective healthcare. But trying to replicate the clinic's approach across the U.S. would pose difficult challenges, according to this article from the Wall Street Journal.
As Congress considers requiring small businesses to provide health insurance for their employees, Massachusetts provides an example of how such a law affects companies. The 2006 Massachusetts universal health-insurance law requires businesses with 11 or more full-time employees to offer coverage or else pay a penalty of $295 per employee per year. While most companies have complied, many say they are cutting elsewhere to cover the cost.
As reimbursements decrease and department budgets are slashed, hospital leaders may want to work a little harder to ensure teaching faculty members are still feeling fulfilled.
If faculty members leave, not only will you be faced with the cost of recruiting new physicians, but residency and fellowship accreditation may be jeopardized. The Accreditation Council for Graduate Medical Education (ACGME) has standards for how many teaching faculty are sufficient to teach and provide supervision to trainees. Additionally, an insufficient number of faculty members can lead to other accreditation red flags, such as inadequate number of patient cases for residents to participate in and a lack of evaluation and feedback.
The issue for hospital leaders is that faculty dissatisfaction may not always be obvious. Disgruntled faculty members won't throw up their hands and stop caring for patients. Instead, they're more likely to find little ways to express their frustrations, says Barbara Schuster, MD, MACP, campus dean of the Medical College of Georgia and University of Georgia Partnership Medical Campus in Athens.
According to Schuster, faculty members usually show their discontent by missing meetings and deadlines, and showing a general disregard for their teaching responsibilities.
If you notice these behaviors, have a conversation with the faculty members involved before their poor behavior escalates and formal action needs to be taken. If you deal with their actions early on, a casual conversation can typically solve problems. Do not approach faculty members in an accusatory manner. You're more likely to find a solution when faculty members perceive concern rather than criticism, Schuster explains.
Patient acuity and turnover are two more reasons why faculty members may consider looking for a new job elsewhere.
"Patients in the hospital are of higher acuity and turn over faster than ever before," Schuster says. "Faculty and residents say it's like a rotating door: You admit patients; you discharge them. There's no break."
If this is an issue at your hospital, leadership should look into providing more ancillary services, such as nurse practitioners, PAs, or hospitalists. Having more support staff members can bring a positive effect on quality. Although there will be an initial cost to adding personnel, a higher quality of care can lead to benefits, such as better reimbursements rates.
Setting clear expectations for faculty members before hiring them also staves off discontentment. It can be disconcerting for faculty members when expectations and reality do not match.
"If a clinical faculty member comes on board with a job description divided 70% clinical and 30% teaching, the people at the top have to be very supportive of that time distribution," Schuster recommends.
Before you hire faculty members, ensure that you can keep up your end of the bargain.
When Congress passed the Fair and Accurate Credit Transactions Act of 2003 (FACTA), little did healthcare organizations suspect that they would be on the hook for yet another government mandate. But that's exactly what's happened, and the August 1 deadline for implementing procedures to comply with the regulations, known as the Identity Theft Red Flags Rule (16 CFR 681.2), is fast approaching.
Section 114 of FACTA required six regulatory agencies to create rules mandating organizations that deal with consumer information to monitor for identity fraud, says Robin J. Fisk, Esq., principal of Fisk Law Office in Ashland, NH. Since the agencies primarily regulate the financial industry, healthcare organizations were slow to discover that the rules might apply to them.
The Red Flags regulations define a pattern, practice, or specific activity that could indicate identity theft. In addition to financial institutions, they apply to creditors, defined as "any person who regularly extends, renews, or continues credit; any person who regularly arranges for the extension, renewal, or continuation of credit; or an assignee of an original creditor who participates in the decision to extend, renew, or continue credit."
Typical creditors include consumer organizations such as banks, auto dealers, and utility and cell phone companies. However, the Federal Trade Commission (FTC) has interpreted the regulations to apply to other organizations, including nonprofits and government agencies, Fisk says. Although the FTC usually has no jurisdiction over nonprofits, the agency has taken the position that it holds jurisdiction when a nonprofit performs functions that are similar to a for-profit. "Any person that provides a product or service for which the consumer pays after delivery is a creditor," the FTC's enforcement policy states.
To be subject to the Red Flags regulations, healthcare organizations must also maintain covered accounts, which may include consumer accounts and any other type of account that presents a reasonable risk of identity theft that could harm the patient or provider.
Although the Red Flags Rule went into effect November 1, 2008, the FTC agreed to defer enforcement until August 1 "so that creditors and financial institutions have more time to develop and implement written identity theft prevention policies," according to an April 30 press release.
To comply, healthcare organizations must develop and implement a written identity theft prevention program designed to detect, prevent, and mitigate identity theft in connection with covered accounts, Fisk says.
The prevention program may be scaled to the size and complexity of your organization, as well as the nature and scope of your exposure. However, your program must also consider guidelines regarding the Identity Theft Red Flags that were originally published in the Federal Register November 9, 2007.
These guidelines, which will be updated periodically, are intended to assist creditors in creating and maintaining a program that satisfies the requirements of the Red Flags regulations. The guidelines cover risk factors for identifying red flags, categories of red flags, and methods for preventing and mitigating identity theft.
Your board of directors, or your senior executive if your organization doesn't have a board, must appoint someone to develop your compliance program, Fisk says. The Red Flags compliance officer's first order of business is to determine whether your organization maintains covered accounts.
Next, the compliance officer must conduct a risk assessment of your covered accounts, including the methods you provide to open and access accounts and your organization's previous experiences with identity theft.
Your compliance program must include reasonable policies and procedures to identify red flags for covered accounts and ensure that the program adequately addresses them. The program should instruct staff members on how to respond appropriately to prevent identity theft and to mitigate any effects from identity thefts that occur. The program must also include a process that incorporates updates to keep pace with changes in patient risk and to your organization's programs.
This article was adapted from one that originally appeared in the July 2009 issue of The Doctor's Office, a HealthLeaders Media publication.