Previously, the U.S. Department of Health and Human Services shut down a study at Michigan Hospitals that used checklists to prevent errors in the intensive care unit. At the time, HHS's Office for Human Research Protections said the study violated federal ethics requirements. Now however, the acting director of the agency said that the HHS should not have inhibited the activity and encouraged the hospitals to continue using checklists to improve patient safety.
Pay-for-performance bonus payments from health plans to California medical groups totaled $65 million for 2007, $10 million more than the bonuses distributed in 2006, according to the Integrated Healthcare Association. The quality bonuses typically average about 2 percent of annual reimbursements to the participating groups, which critics say is not significant enough to give medical groups a financial incentive to improve quality.
Des Moines, IA-based Mercy Medical Center has begun caring for patients using Mercy eICU Connect--the first Iowa-based electronic intensive care unit. The system allows doctors and nurses keep track of critical care patients remotely, 24 hours a day, seven days a week. The eICU enables those at the monitoring center to treat patients before complications take place, and the hope is that patients will spend fewer days in the hospital and that costs will decrease, officials say.
The South Carolina Hospital Association has launched myschospital.org, which contains information on roughly 65 hospitals throughout the state. Representatives from the Hospital Association said they hope the Web site will help steer consumers to the best hospital to treat their needs.
Since St. Charles County, MO, opened its newest hospital in 2007, all but one of the county's other hospitals have announced major construction projects. Hospital finance experts often question whether competition spurs expansion of unneeded medical services. Healthcare executives in St. Charles County, however, say the projects they're focusing on modernize necessary services and expand capacity at already busy hospitals.
How can I provide high-quality, comprehensive and affordable healthcare to my community with an aging facility, minimal staff and limited funds? This is a question that community hospital leaders grapple with every day--and it is why these executives are forced to make some difficult decisions. Should we remodel the lobby or invest in an electronic medical record? Should we get rid of a skilled nursing unit that is a money loser but ranks high on patient satisfaction surveys? The struggle to balance cost and quality is why leaders are continually searching for innovative ways to meet the needs of the communities they serve--visiting specialists, mobile MRI units, health fairs, telemedicine and educational programs come to mind, as well as cancer, dialysis and cardiac centers.
Likewise, we at HealthLeaders Media want to provide the most helpful, informative and timely content in a way that best suits the needs of our readers. To that end, our Community and Rural Hospital Weekly newsletter received a face-lift. First, we improved navigability. We also added audio interviews, links to additional content, live article commenting and RSS feeds. And now with the addition of my weekly column the transformation is complete. Don't worry, I will still be offering best practices and stories from healthcare leaders that have successfully implemented IT, recruited healthcare workers, financed new construction, or improved quality scores. But I will also try to capture the views and concerns of community and rural hospital leaders in this space.
Many top-of-mind issues appear unchanged since I left for maternity leave last year. Adequate reimbursement is still a major concern, of course--and will likely remain so given President Bush's budget proposal, which aims to rein in Medicare costs by cutting hospital reimbursement. Finding access to capital for IT projects, new construction or facility upgrades continues to be a headache, as does the recruitment and retention of physicians, nurses and other healthcare professionals. Many community hospitals are still struggling to measure and improve their quality, which is becoming increasingly important in light of transparency and public reporting initiatives. And determining which services to offer or discontinue as new partnership opportunities arise--or direct competition moves in next door--will continue to challenge healthcare executives who are trying to ensure their communities will have access to the care they need for years to come.
These are some of the topics that I will be exploring in the months ahead. But to ensure that I'm covering what matters most to you, I would like to hear from you, the reader, on the issues that top your list for 2008. What service lines are you growing? How are you financing new construction? What types of technology are you investing in? Please drop me a line at cvaughan@healthleadersmedia.com. In addition, I hope that our readers will continue to submit opinions, analysis and solutions in our Leaders Forum section, and use our discussion board, Community Call, as a resource to connect with peers, post questions or offer solutions to the unique challenges that community hospital leaders face.
Carrie Vaughan is editor of HealthLeaders Media Community and Rural Hospital Weekly. She can be reached at cvaughan@healthleadersmedia.com.
Massachusetts sparked the American Revolution, founded the first public schools, and led the movement to abolish slavery. Since those heady early years, Massachusetts has been known not as a leader, but for corrupt politicians, bloated public projects, and the Red Sox.
It's been a long time since Massachusetts took the lead, but The Bay State has grabbed the reins on the top domestic issue--healthcare.
The Massachusetts health insurance experiment, which is called Commonwealth Connector, is closing in on the two-year mark since the Health Care Reform became law on April 12, 2006. There have been some successes as hundreds of thousands of previously uninsured residents now have health insurance, but the initiative has also needed to maneuver around some Boston potholes. The latest dispatch from the epicenter of healthcare reform is that the subsidized state program is struggling with costs and bursting enrollment. While officials predicted a 5 percent premium increase for the nonsubsidized (and less popular) Commonwealth Choice plan, the subsidized Commonwealth Care could see as much as a 14 percent premium increase and doubling of copayments.
The subsidized plan, which insures Massachusetts residents below 300 percent of the poverty level, has been inundated with a larger than expected elderly population. With four months left in fiscal year 2008, Commonwealth Care already has 33,000 more enrollees than predicted by the end of the fiscal year.
Supporters and foes should not reach conclusions about the program's success or failure just yet. Keep in mind that Commonwealth Connector is still in its infancy and with any new venture there will be speed bumps.
Over the next few years, there will be a number of questions that need answering in the Massachusetts experiment and in healthcare reform in general:
Experts are already pointing to primary care physician shortages, and having more insured Americans with access to primary care physicians will surely exacerbate that problem. Things are already tough for doctors in Massachusetts. What impact will more insured residents have on the already burdened healthcare system?
Will state leaders--faced with spiraling costs--take a bite out of health insurers and/or cut physician payments rather than raise premiums? And if this happens, will managed care walk away from the initiative? Will doctors stop accepting Commonwealth Connector patients?
Gov. Deval Patrick, a Democrat who took over January 2007, rode his way into the corner office campaigning as an outsider who wanted to shake up the State House. He has experienced a bumpy ride during his year in office--even though the legislature is largely Democratic. Patrick is a proponent of Commonwealth Connector and recently proposed an increase in Commonwealth Care spending from $471 million in fiscal 2008 to $869 million in fiscal 2009. With costs and enrollment on the rise, will that kind of support remain? Is there the political will to suffer through the peaks and valleys of this unique program?
Several governors have presented their own healthcare plans in order to control costs and offer insurance to the estimated 47 million uninsured Americans. States have presented health reform legislation that is different than Massachusetts' individual insurance requirement. Instead, they have implemented cost controls, taxed businesses that don't provide health coverage, required employers to allow parents to have their children (in some cases as old as 30) on their health coverage, and forced insurers to give coverage to those who switch from group plans to individual plans.
Massachusetts' requirement caused enrollment in the Commonwealth Connector programs to go from a mere trickle to a flood once the penalty deadline grew near. Five years from now, how will Massachusetts' requirement compare with other state initiatives? Can leaders find a way to create healthcare coverage to the uninsured without it crippling state budgets, managed care, and the healthcare system?
The Bay State's insurance plan faces some major hurdles, and Massachusetts finds itself as a national leader. For those who live in the commonwealth and observe its leadership, that realization is frightening.
Here's hoping today's Massachusetts leaders can take some inspiration from the commonwealth's forefathers and create a healthcare system that doesn't sink into a morass of mandates, regulations, political infighting, and costs. The last thing we need is for the Commonwealth Connector to become the healthcare version of The Big Dig--an endless money pit that is an embarrassment, potentially unsafe, and destroyed by incompetence and greed.
James Peake, the incoming secretary of Veteran Affairs, has pledged to address "systemic" issues that hobble the quality and accessibility of rural healthcare. During a meeting with about 100 Montana veterans, the group told Peake they face months-long waits for appointments, arbitrary rejections of claims and 500-mile trips to receive care. Peake said he wanted to "reach out to rural America" and help those veterans not getting adequate care.
Vince Kuraitis, principal and founder of Better Health Technologies in Boise, ID, and Dr. Thomas Wilson, founder and president of Trajectory Healthcare and board chairman of the Population Health Impact Institute in Loveland, OH, discuss the Centers for Medicare & Medicaid Services' recent decision to end the Medicare Health Support project this year. This is part two of the podcast.
Brian Jacobs, MD, describes why the HIMSS Davies Award encourages innovation. Jacobs, the chief medical information officer at Children's National Medical Center, Washington, DC, spearheaded the contest this year.
