Across the country, businesses already strapped by the economy to turn a profit are sacrificing or scaling back employee health insurance plans because of their escalating costs. The crunch has particularly hurt smaller employers, who have become a centerpiece in the debate over how to overhaul the nation's healthcare system, the Associated Press reports. Both the House and Senate versions would offer temporary tax credits to offset a portion of the health insurance costs for businesses with fewer than 25 employees and average wages of less than $40,000. Small businesses also could more easily shop for policies through a new health insurance exchange.
Despite new recommendations that most women start breast screening at 50 rather than 40, many doctors told the New York Times that they were simply not ready to make such a drastic change. The recommendations, issued by a federal advisory panel, reversed widely promoted guidelines and were intended to reduce overtreatment. The panel said the benefits of screening women in their 40s were outweighed by the potential for unnecessary tests and treatment, and the accompanying anxiety. Several doctors said that while they understood the panel's risk-benefit analysis, their patients would not see it that way, the Times reports.
If the U.S. obesity rates continues to rise, obesity will cost the United States about $344 billion in medical-related expenses by 2018, eating up about 21% of healthcare spending, according to an analysis. These calculations are based on the projection that in 10 years 43% of Americans adults may be obese, which is roughly 30 or more pounds over a healthy weight. A study released in July showed that obese Americans cost the country about $147 billion in weight-related medical bills in 2008, double what it was a decade ago. It now accounts for about 9.1% of medical spending.
The Philadelphia VA Medical Center was cited for eight apparent violations in using radioactive materials on nearly 100 veterans, federal inspectors have concluded. The Nuclear Regulatory Commission found that the Philadelphia VA staff failed to evaluate radiation doses or know when to report a mistake, according to a 16-page report. The brachytherapy team, for example, failed to check radiation doses for more than a year because a computer was unplugged from the hospital's network, the report said.
A core tenet of the healthcare overhaul President Obama is pushing through Congress is that medical care can be improved, and costs contained, if the country relies more on experts to determine which procedures and treatments work best, the Los Angeles Times reports. But an expert panel's recommendation that women in their 40s should no longer get annual mammograms to screen for breast cancer sparked an outcry from those who say that the federal government is more interested in saving money than in improving women's health. Some Republicans jumped on the report as the kind of government intervention in medical decisions that Obama's healthcare plan would bring, reports the Times.
White House budget director Peter Orszag pushed back against the notion that the healthcare overhaul will add to the deficit. Orszag said that the healthcare overhaul needs four main pillars that will put the system on a more sustainable path: (1) deficit neutrality, (2) an excise tax on high-cost insurance plans, (3) an independent Medicare commission, and (4) delivery system reforms. The budget chief said that the four main issues will underpin a better system, but "execution is crucially important to success," the Wall Street Journal reports.
Senator Charles E. Grassley wrote to 10 top medical schools to ask what they are doing about professors who put their names on ghostwritten articles in medical journals and why that practice was any different from plagiarism by students. Grassley said ghostwriting had hurt patients and raised costs for taxpayers because it used prestigious academic names to promote medical products and treatments that might be expensive or less effective than viable alternatives, reports the New York Times.
Budgets are tight, but it seems that many healthcare providers are aware that setting aside resources to prepare for RAC audits is non-negotiable.
HCPro's Revenue Cycle Institute examined this concept as a part of its recent nationwide survey of RAC readiness. The study, which was released recently, garnered more than 700 participants from all four RAC jurisdictions. The respondents hailed from various size healthcare providers: 25% came from hospitals with fewer than 100 beds, another 25% came from hospitals with more than 400 beds, with the remaining 50% falling in between. Approximately 14% of respondents had taken part in the RAC demonstration project.
"Respondents seem to have their RAC preparations well under way, although it's not surprising that they are struggling with resources to devote to preparation," according to Kimberly Anderwood Hoy, JD, CPC, director of Medicare and compliance at HCPro, and author of the "RAC Preparedness Benchmarking Report," which details the full results of the survey.
"Providers appear to be crunched for resources to provide to the RAC team, with 50% indicating that departments are just absorbing RAC costs into their current budgets," Hoy wrote in the report. "This may be driving the relatively high number of respondents using homegrown software and tools for risk assessment. Software for tracking requests is a bit of a different story, with providers split roughly equally between homegrown methods and third-party vendor software."
Amounts facilities budgeted to deal with RACs varied greatly, according to the survey. Reported amounts averaged between $200,000 and $600,000, although some survey participants mentioned smaller budgets of $15,000 to $40,000 (often used primarily for adding staff members to deal with the increased workload).
A surprisingly high number of respondents said they already had a RAC preparedness program in place (71%). This number may be inflated by providers with heightened awareness of the RAC initiative that may have been more likely to respond to the survey, according to Hoy. Programs generally appear to still be in their early stages. Of respondents with a program in place, 85% started in the past year, and more than 50% started in the past six months.
"As providers begin to receive routine RAC requests, the teams will undoubtedly continue to develop and become more sophisticated," Hoy says.
Nearly half of respondents already have a RAC coordinator in at least a part-time capacity; and 40% have a full-time coordinator. Out of the respondents who said they don't yet have a RAC coordinator, many are in the process of hiring one for a full-time position. Others hadn't begun hiring yet because they were waiting until RACs become active in their area. Others reported that two or more staff members shared the full-time position. Coding and compliance were the most popular backgrounds for the coordinator position.
In addition, nearly two-thirds of respondents reported having a physician on their RAC team.
When it comes to managing RAC appeals, two-thirds of survey respondents have a program in place to handle the process, but their methods differ:
Nearly 50% indicated that they will manage the process with no outside help
One-third said they would use a combination of internal staff members and external help
Four percent would entirely outsource their appeals to a third party
Survey results also indicated that providers are taking advantage of RAC education available in a multitude of formats, and it appears that cost is not necessarily a barrier for many when it comes to taking advantage of RAC education. Fifty-seven percent of respondents reported listening to paid audio conferences or Webinars; 43% reported learning about the RAC program from a live seminar.
To download a free copy of the "RAC Preparedness Benchmarking Report," visit the Revenue Cycle Institute Web site, and click on "White Papers."
Editor's note: This is the second in a three-part series about breach notifications. This installment focuses on handling breaches.
Your facility has a breach of unsecure PHI. What do you do?
In addition to following requirements spelled out in HHS' interim final rule on breach notification, consider these tips for handling the breach:
Initiate an investigation immediately. The team leader, or point person, must be ready for action, says Andrew E. Blustein, Esq., partner and cochair of Garfunkel, Wild & Travis' Health Information and Technology Group in Great Neck, NY; Hackensack, NJ; and Stamford, CT. Immediately consider whether the organization needs to make a report to authorities. Ask the following questions: What information was potentially disclosed?; What technical safeguards were in place? How many people were affected? Could the information be used adversely against such individuals?
Determine whether an exception to the notification requirement applies. Was the breach such that the person receiving the information would not be able to retain and use it? Was it an unintentional disclosure in good faith or an inadvertent disclosure to another individual at the same facility?
Determine the need to notify the individual. Check the regulations contained in the HHS interim final rule and state breach notification laws. Consider whether notification could mitigate any harmful effects on the individual. If a patient's credit card or Social Security information was stolen, it may be appropriate to offer him or her credit monitoring services, Blustein says.
Determine appropriate sanctions. Following through on appropriate internal sanctions can send a chilling message throughout your organization, Blustein says. "Also, if [the Office for Civil Rights] comes in, and something egregious occurred and you've done nothing about it, what are you doing about mitigating the problem in the future?" he says. Depending on the employee involved and the type of violation, consider offering additional HIPAA training, issuing a warning, putting the employee on probation or suspension, or, in extreme situations, terminating the employee.
The Joint Commission's 2010 National Patient Safety Goals (NPSG) will take effect January 1, which begs the question: What is your plan for training residents on the NPSGs?
All too often, hospital and graduate medical education (GME) administrators overlook teaching residents about NPSGs. Instead, they educate attending physicians, assuming the message will trickle down to the residents. Unfortunately, that doesn't always happen.
Everyone in the hospital should view residents as a critical part of the hospital's care delivery team. It's just as important to teach residents about the NPSGs as it is to educate nurses, attending physicians, and other healthcare providers, says Constance K. Haan, MD, MS, senior associate dean of educational affairs and designated institutional official at University of Florida College of Medicine—Jacksonville.
Not only is the training important for maintaining patient safety, but it is also critical for compliance with Joint Commission standards, says Bud Pate, REHS, vice president of The Greeley Company, a division of HCPro, Inc., in Marblehead, MA.
"The NPSGs apply to all staff. There is no difference in expectation for residents than anyone else when it comes to complying with the goals," Pate says.
The following are suggestions on how to train residents on the NPSG:
Campus-wide grand rounds. At Haan's institution, residents must attend a campus-wide grand rounds presentation that covers the NPSGs.
"We made this a mandatory training because we wanted to send the message that patient safety is important," Haan says.
Make the information stick by showing residents how NPSGs affect their daily patient care responsibilities. Haan distributes and posts online a handout that describes the goals and how residents apply them on a local level.
For example, the handout describes what The Joint Commission (formerly JCAHO) expects hospitals to do to comply with NPSG.02.05.01, regarding handoffs. It then lists the facility's procedure for handoffs and outlines what happens if residents violate one of the policies or procedures.
Joint Commission educational resources. The Joint Commission frequently offers satellite video training on the NPSGs. Many institutions treat these as town hall sessions and invite everyone—residents, attending physicians, and other healthcare staff members—to listen in.
Residents' schedules make it difficult for them to participate in every session. The GME office should work with the office responsible for Joint Commission accreditation to present training during specific department meetings or grand rounds, which residents will most likely attend.
Quality improvement projects. Encourage residents to develop quality improvement initiatives that will help the hospital meet the NPSGs.
"Being on the frontline of care delivery, they're often the ones that see the error potential," Haan says. "They often have the best ideas for how to solve problems."
To develop successful quality improvement projects, residents must have an understanding of how the healthcare system works. Several NPSGs call on organizations to consider evidence-based practices—a component of practice-based learning and improvement—when developing processes and determining their effectiveness.
Hospital committees. Invite residents to sit on hospital committees. This is a great way to expose them to patient safety initiatives. These committees routinely develop system-wide policies dictated by the NPSGs.
Resident members learn and offer input as the committee reviews hospital systems and creates processes to ensure they're in compliance.
Julie McCoy is editor for the Residency Department at HCPro, Inc. Find more graduate medical education news at www.residencymanager.com.
