Japan has begun recruiting hundreds of nurses and caregivers from Indonesia to work in the nation's hospitals and nursing homes, where there's a severe labor shortage. Tokyo is also preparing for similar arrangements with nations such as the Philippines and Thailand as part of broader bilateral economic-partnership agreements. Japan is striving to figure out how to care for its growing population of elderly as the number of young workers who can support them is dwindling.
Maryland Gov. Martin O'Malley has signed into law a bill establishing an independent authority that will seek a new owner for the Prince George's County hospital system. The state and the county have each agreed to pay $12 million annually for the next two years to keep open the system anchored by Prince George’s Hospital Center in Cheverly. The authority will oversee the search for a new owner for the system, which is now managed by the nonprofit Dimensions Healthcare System. In an effort to lure bidders, the county and state must now agree to pledge operating money and funds to help refurbish outdated facilities.
Anthem Blue Cross and Blue Shield in Ohio has released detailed price information on medical procedures on its members-only Web site for the Central Ohio market. OhioHealth Corp., a health system in the state, has also debuted a section on its Web site that compiles information for its hospitals on patient care procedures and customer satisfaction. The OhioHealth site draws the data from the Centers for Medicare and Medicaid Services Hospital Compare site, but presents them in a bar graph format.
A House-Senate work group will begin meeting to resolve legislative differences over changes in pricing and access to Michigan's growing individual health insurance market. Observers expect the group's work to focus on establishing a system of "rate bands" that set the minimum and maximum premium an insurer could charge each month, based on a person's age and health. Currently, 1 million Michigan residents have no health insurance, often because the monthly costs are too high, and more do not have coverage because they lost workplace benefits.
The Blue Foundation for a Healthy Florida has launched an $8 million, four-year statewide initiative to determine what's causing nearly one-third of Florida's children to be either overweight or obese.
"We are taking action beyond traditional nutrition and fitness programs," says Susan Towler, executive director of The Blue Foundation, the nonprofit philanthropic affiliate of Blue Cross Blue Shield of Florida. "Through strategic philanthropy, Embrace a Healthy Florida will foster environments that promote healthy lifestyles for children."
The rate of childhood obesity in the United States has more than tripled since 1980, and Florida's kids are leading the way. About 32.5% of Florida children between the ages of 10 and 17 are either overweight or obese. Along with numerous physical health risks, overweight and obese children are shown to suffer higher rates of depression, greater difficulty in peer relationships, and poorer quality of life than their normal weight counterparts.
The Blue Foundation's four-year strategic initiative will address the causes of childhood obesity through public-private partnerships with community nonprofit, nongovernmental agencies, governmental agencies, and leaders who are already addressing childhood obesity. The initiative will support community-based programs that promote change in families and parenting, childcare centers and schools, neighborhood recreation opportunities, and other influences on the accessibility of healthy food and physical activity.
Focusing on Jacksonville, Miami, Orlando, Tampa, and Tallahassee, the threephase effort will provide grants to nonprofit organizations, fund research, and foster community collaboration.
Julie Wright, CEO of Sound Family Medicine, a 28-provider practice in Puyallup, WA, discusses the importance of understanding current and future patient needs and disease trends within a community or service area.
One of the best physician-to-physician strategies currently in existence is the development of ancillary services within an existing practice, whether it is a single-specialty or multispecialty group. In fact, one reason hospitals employ physicians is to keep from having to compete with physicians for ancillary dollars.
Most practices are looking to ancillary services as an opportunity to augment revenue and enhance their bottom line as a result of declining reimbursement for most basic clinical services. Practices also look to ancillary services to broaden the service offerings provided to their patient base, which eventually creates loyal and satisfied patients.
Depending on the type of ancillary services involved, the revenues associated with them can quickly become a substantial portion of overall profit and physician compensation. Many ancillary ventures are capital-intensive because they require expensive medical equipment. But if the practice generates enough volume to operate such equipment at or near capacity, the investment in such equipment is likely worthwhile.
Of course, these initiatives require a substantial amount of due diligence and financial projection to ensure that the investment is worthwhile. Some of the necessary due diligence required includes the following:
Research of the equipment alternatives and financing opportunities
Volume projections based on the number of applicable procedures referred out to other organizations in the past
Consideration of reimbursement for the procedures considered and potential changes to reimbursement in the near future
Assessment of all costs to acquire and operate the equipment, such as leasehold improvements, increases in staffing and facilities, and other, more minor costs
Determining when the ancillary venture would break even and what the return on investment would be
Assessing any regulatory requirements associated with providing the ancillary services
Just as with starting up a new medical practice, developing an ancillary service is often a stressful venture due to the risk and uncertainty involved. With careful planning, much of the risk can be removed to the extent that success is almost certain.
This article was adapted fromPhysician Entrepreneurs: Strength in Numbers, a new HealthLeaders Media book about consolidation and collaboration strategies to grow physician practices.
Will Congress stop the cut in time? What if they don't? How will it affect my practice? Should I stop seeing new Medicare patients?
Physicians have many questions on their minds as the July 1 deadline for the 10.6% reduction in Medicare payments draws near and physician groups and associations are intensifying their advocacy efforts in hopes of sparking Congressional intervention on their behalf.
But the 40-day window is deceiving—the time for Congressional action actually is a little shorter. CMS would need a couple of weeks to "amend payment instructions and send them to Medicare carriers," says CMS Deputy Administrator Herb Kuhn, and the Bush administration has asked Congress to pass a bill by mid-June. Any later and physicians would likely receive the reduced payments and then receive full reimbursement retroactively, if at all.
But to be honest, I'm not all that concerned about the payment reduction. It's not that the cut wouldn't have serious consequences. In fact, a significant portion of physicians would likely follow through on their promise to drop Medicare patients and the financial squeeze on practices, particularly small ones, would tighten. But Congress is fully aware of the repercussions and for that reason your representatives have little choice but to intervene. In fact, I'm willing to go on record with a prediction: Congress will freeze (or perhaps slightly increase) payments by mid-July.
That's not exactly a bold prediction (and it's only good news compared to the current alternative). It's the same course of action Congress took earlier this year, and again the year before that, and it has been the only course of action for so long that the hand-wringing, calls to action, warnings about reduced patient access and last-minute legislation have become an annual late-December tradition. The only difference is this time it's happening in the middle of the year.
It's as if we're aboard a leaky ship and the only tool the federal government can find is a bucket. Yes, they've been diligently scooping out the water to keep the ship afloat for longer than it would have been on its own, but at some point they have to try a different tactic. Like plugging the holes.
It's too late this time. It is unclear what the final legislation will look like, but Max Baucus, chair of the Senate Finance Committee, has been spearheading the issue, and his proposal would freeze payments for the rest of 2008 and provide a slight (most likely 1.1%) increase for 2009. There's also talk of attaching an e-prescribing mandate to the bill.
But like the fixes before it, this one is only temporary. It would rely on "balloon financing ," meaning physicians might face another 21% payment cut in 2010. The good news is the 18-month window should provide time to develop a sustainable fix to the payment system.It's a tall order, but if physicians keep up the pressure and play an active role in developing a new system, it's feasible. Who knows? This may be the last article about a pending Medicare fee cut I'll ever have to write.
Elyas Bakhtiari is a managing editor with HealthLeaders Media. He can be reached at ebakhtiari@healthleadersmedia.com.Note: You can sign up to receive HealthLeaders Media PhysicianLeaders, a free weekly e-newsletter that features the top physician business headlines of the week from leading news sources.
The private health information of 1900 local patients may have been compromised when a Francis D. Ong, MD, resigned from his position as a University of Florida and gave his computer away. UF privacy officials say Ong stored his patients' health records on a computer, which he eventually gave to some acquaintances. The computer has been returned to the school, and UF officials say the risk of anyone using the information for unlawful or mischievous purposes is extremely low.
There was a lot of talk at last week's National Patient Safety Foundation Congress in Nashville about strong leadership and how important leadership is to an organization's mission to deliver quality healthcare. As we all know, it's easy to talk about leadership, but one session in particular offered the results of a study that looked at top performing hospitals and what they all have in common.
Barbara Youngberg, vice president for insurance, risk, quality, and legal for the University Health System Consortium, said an in-depth study of UHC's member organizations shows that top hospitals have strong leaders who share the following characteristics:
They have a shared sense of purpose. Top leaders are the first to tell you that patient care is the most important mission of their organization. They're constantly working to improve quality and safety scores, regardless of how high the scores already are. These leaders consider top-notch customer service, quality care, and patient safety a competitive advantage for their organization.
They lead by example. Youngberg said top leaders have an "authentic, hands-on style." They're not above greeting patients at the door or guiding a visitor who has lost his or her way. Leaders of top hospitals are often seen in hospital departments, talking to nurses and physicians about the challenges of their jobs. They don't just appear to be interested. They are interested.
They focus on results. Top performers are relentlessly working to improve the care offered at their facilities. They're not waiting for a new building or a new technology infrastructure to improve—their organizations are in a state of constant improvement.
They collaborate to get results. Top leaders recognize that everyone in the hospital—whether a physician, nurse, or front desk clerk—contributes to the quality healthcare experience. They appreciate the contributions of employees at all levels and often recognize those who do their job well. The result is that employees value each others' critical knowledge when problem solving.
They have an accountability system for service, quality, and safety. As I mentioned above, top leaders are "hands on," but that doesn't mean that they don't expect their department chairs to accept responsibility for their individual unit's improvement. Prioritizing, developing measures, and settings goals and targets are centralized functions, while tactics to improve are decentralized. The result? Hospital units that are accountable and innovative.
These qualities are the building blocks of top performing organizations that are consistently defining new levels of excellence in quality and patient safety, Youngberg said. How many of them do you recognize in yourself?
Maureen Larkin is quality editor with HealthLeaders magazine. She can be reached at mlarkin@healthleadersmedia.com.
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