Aetna Inc. will offer free credit monitoring for a year to about 65,000 people after some e-mails were copied from the health insurer's job application website. Hartford-based Aetna said Social Security numbers of current and former employees and people who received job offers from the company were stored on the website, which was maintained by an outside vendor.
The Hospital of Central Connecticut has been disciplined by state regulators after inspections found several violations—including a catheter that was left in too long, leading to an infection that may have contributed to a patient's death. Under a consent agreement, the hospital will pay a $2,500 fine and implement a number of changes, including reviews or revisions of policies related to radiology safety for pregnant women, monitoring and removing catheters, medical record documentation, and prevention, monitoring and treatment of bedsores and wounds.
California residents paraded into the state Capitol to plead with lawmakers to spare the programs Gov. Arnold Schwarzenegger has said must be slashed to tame the state's $24.3-billion budget deficit. Cuts in funding would end medical insurance for 2 million Californians, health officials and patients told a legislative panel, and they say some at-risk residents might not survive the loss of programs.
The Massachusetts government Medicaid plan known as MassHealth, which covers low-income patients who can't afford insurance, was the slowest payer of health claims to Massachusetts doctors last year, averaging 56 days, and denied the highest share of claims, 23.8%, according to rankings. Blue Cross and Blue Shield of Massachusetts took an average of 22.8 days to pay physicians who submitted claims last year, the fastest rate among Massachusetts health insurers. Tufts Health Plan, meanwhile, denied 4.9% of its claims, the smallest share among the five large payers billed by Bay State medical providers. The rankings were prepared by Athenahealth Inc., a company that helps doctors handle billing and records electronically.
Under a deal struck by General Motors and the United Auto Workers, 17.5% of the company's shares will be owned by a union healthcare trust, with an option for up to 20% over time. That's down from an earlier offer of 39%. In exchange for getting a 17.5% stake as well as other concessions from GM, the union is making healthcare concessions of its own. Retiree health benefits will be cut immediately, leaving thousands of retirees to pay more out-of-pocket for their healthcare.
Interest groups are spending hundreds of thousands of dollars on television and radio advertisements supporting or attacking healthcare legislation they expect to emerge from Congress. Five Congressional committees hope to approve the legislation next month, and the pace of the advertising has picked up this week.
Despite a weakening economy, Massachusetts continued to measure gains in the share of residents who reported having a steady source of healthcare in 2008, its second year of near-universal coverage, a new study has found. But the annual survey also raised red flags regarding the ability of residents to actually use that care, with growing numbers saying they could not afford needed treatments and many reporting shortages of primary care physicians.
Half of the 6,500 hospitals in the U.S. have never reported any physicians they disciplined for medical competency or conduct problems to a national database in nearly two decades. Many other hospitals exploit loopholes to avoid the requirement, according to a Public Citizen report released today.
"It is impossible to justify the fact that thousands of hospitals, which collectively have granted admitting privileges to hundreds of thousands of doctors, have not reported a single discipline case in 17 years," said Sidney Wolfe, MD., acting president and director of Public Citizen's Health Research Group, which issued the 38-page report.
The widespread practice allows problem physicians with serious performance issues to move their practices to communities in other states and receive staff privileges in hospitals whose medical staffs are unaware of their prior problems. They potentially can cause further harm to more patients or medical teams.
Wolfe says the report, which was coauthored by Public Citizen researcher Al Levine, "shows there is an urgent need for the Obama administration to step in and hold hospital administrators accountable, as well as ensure that hospital medical staffs hold their own physicians accountable for patient safety."
Specifically, Wolfe wants Secretary of Health and Human Services
Kathleen Sebelius to advocate a change in federal law that would allow the Centers for Medicare and Medicaid Services to stop reimbursing hospitals for treating Medicare and Medicaid patients if they failed to report disciplined doctors.
He also wants the administration to advocate passage of legislation that would impose monetary penalties "for each instance of a hospital's failure to report."
Loopholes assist hospitals with getting around the law, he said. For example, rules require reporting to the National Practitioner Data Bank the name of any physician whose staff privileges were revoked or restricted for more than 30 days. To skirt that rule, hospitals revoke or suspend privileges for 30 days or less. Another way around the law is to give a physician a leave of absence in lieu of a suspension or revocation.
The problem is exacerbated by what Wolfe calls "a culture among doctors of not wanting to 'snitch' on a colleague."
Hospital officials support the requirements to report problematic physicians saying that it's an important way to avoid granting staff privileges to someone with ongoing problems, say Dorel Harms, senior vice president of clinical services and Wendy Keegan, legal counsel of the California Hospital Association. But they explain that often, many problems are avoided with interventions that resolve issues within the 30-day period.
In California, it often happens faster because disciplinary actions are required to be reported to the Medical Board for practice limitations set forth over 13 days.
"Often the doctors all know each other, seeing each other, and handling things if there are issues, on a person-to-person basis, before it gets to the point where it needs that kind of approach," says Harms, referring to the lengthy administrative hearing process that must take place before a physician loses all freedoms to see patients within the hospital setting.
That process can sometimes be complicated by lawsuits physicians file against the hospital for limiting staff privileges, as in a recent case involving a physician in Los Angeles, they say.
Fear of being sued by a practitioner, as well as the concern that if the physician were not allowed staff privileges, the hospital would lose valued business, are other concerns that thwart the intent of the law, Wolfe said.
"Congress should provide the Office of Inspector General with authority to investigate state medical boards' handling of adverse hospital clinical privilege reports," Wolfe said.
Many of the recommendations in his report were proposed years ago by the Office of Inspector General, but "none of the recommendations have ever been put into effect," he said. "The problems have been recognized for a long time, but nothing has ever been done about it."
Many hospitals fail to observe the full extent of the requirements. Even restrictions on scope of practice must be reported if they are in place for more than 30 days, "such as requiring that a doctor can't do a particular operation without having another surgeon watching," he said.
The highest rates of no reporting occur in hospitals in South Dakota, where 75% of hospitals had not filed a physician disciplinary report since the rule went into effect in 1990. Other states with the highest number of non-reporting hospitals include North Dakota, 70.2%; Louisiana, 68.9%; Wyoming, 69 %; Kansas, 68.7%; Montana, 66.7%; Oklahoma, 65.3%; Minnesota, 63.9%; Nebraska, 63.9%; Texas, 63.4%; Iowa, 62.4%; and Mississippi, 60.8%.
The states with the most hospitals reporting include Rhode Island, where only 18% of hospitals have failed to ever report a physician's name to the bank; Connecticut, where 25% had never reported; and New York, where 28.5% had never reported.
Other states with the highest number of hospitals not listed previously include California, where 31.9% of hospitals had never filed a report; Florida, where 46.3% had never filed; Illinois, 36.4%; Ohio, 42.6%; and Pennsylvania, 42.1%.
Not reporting the information may also allow them to escape disciplinary action within their own states because reporting is required to state medical boards too. "In New York State, for example, 31% of hospital complaints, compared to only 10% of consumer complaints to the Board, result in a medical board action. Failure of hospitals to discipline or report therefore deprives the boards of critical information and creates the potential for patient harm," Wolfe wrote in a letter to Sebelius.
When the data base was launched in 1990, the HHS estimated that 5,000 reports would be submitted each year. The average number has been only 650 and the most ever filed was 830, in 1991.
The rule's focus "is on those instances in which physicians injure patients through incompetent or unprofessional service, are identified as incompetent or unprofessional by their medical colleagues, but are dealt with in a way that allows them to continue to injure patients," according to a House Committee on Energy and Commerce report that predated the regulation.
As examples of physician behavior that went undisciplined and unreported to the national database, resulting in further damage to more patients, Wolfe's report described these incidents:
"An orthopedic surgeon in Cambridge, MA with a history of disruptive behavior and two brushes with the law never underwent peer review until July 10, 2002, when he left the operating room seven hours into a complex back surgery–with the patient under anesthesia and an open incision in his back–to cash a check.
"A physician who had been charged with drug addiction and incompetence had his medical license suspended in Oklahoma and revoked in Texas. In 2001, he was practicing in Hawaii, and during a surgery on a man to stabilize a disc injury, used a screwdriver because he couldn't find a titanium rod. The patient was left bedridden, incontinent, and paraplegic, and subsequently died.
"In one of the most egregious recent examples of the breakdown of hospital peer review, two physicians at Redding Medical Center in Redding, California, performed clearly unnecessary bypass and valve surgeries between 1992 and 2002 on hundreds of patients," Wolfe said.
"Peer review of the cardiac program and discipline of these physicians was not done because of the 'prestige' of one of the physicians involved and the revenue for the hospital generated by the surgeries. Furthermore, although both state and Joint Commission surveys had identified peer review deficiencies at Redding, there was no oversight follow-up."
"Realistically it has to be a mix of spending reductions and revenue increases from a variety of sources," says Edwin Park, a senior fellow at CBPP. "One thing we've been concerned about as an organization is the various interests who're affected by all these spending and revenue proposals that will start saying 'Take this off the table and take that off the table, and do something else.' Definitely all of the items have to stay on the table if you are going to get to paying for health reform."
The CBPP studies did not have an estimate for the revenue that would be generated by the FSA rollback or elimination. However, Park says a penny-per-ounce tax on soft drinks laced with sugar or high-fructose corn syrup could raise $10 billion a year, while increasing the excise tax on alcohol could raise between $27 billion and $100 billion over 10 years.
Park says policy makers and politicians must also consider Medicare/Medicaid reforms, taxing employer-sponsored health plans, targeting health savings accounts, and capping itemized deductions to cover the cost of healthcare reform.
Kathleen Stoll, deputy executive director at Families USA, says her organization has adopted the same strategy of keeping every potential revenue source in play. "We do believe we need to generate revenues to pay for healthcare reforms," Stoll says. "We are trying to be open to keeping all paid-for possibilities on the table and under discussion. We aren't taking a position on any specific one, but we aren't opposing anything…
"Part of the debate is about whether the 'pay-fors' have to come from within the healthcare system itself or whether we can look beyond the healthcare system at other areas of the tax code that don't directly impact on healthcare delivery," Stoll says. "We think we have to look both within and outside the healthcare system."
Michael Cannon, director of health policy at the libertarian Cato Institute, says that for groups like Families USA and CBPP, the answer to the nation's healthcare crisis is to throw more money at it.
"Does anyone think it's peculiar that while the Left usually lectures us that America spends too much on healthcare, here they are trying to get us to spend even more," says Michael Cannon, director of health policy students at the Cato Institute.
"It's a flawed premise–that the problem with healthcare in America is we aren't spending enough," Cannon says. "If you want to make healthcare more affordable, you don't throw more money at it. You use every tool at your disposal to try to build efficiencies. We are doing that because we are allowing the political process to paralyze that effort."
Cannon says he's dead-set against raising taxes to pay for healthcare reform. But he says the political process would block any attempt to generate savings by reforming the healthcare system from within.
"If we are to come up with health insurance coverage for every last person in the United States just by finding savings in the healthcare sector, you've got to reduce the services that people get. That is rationing and Americans don't like that. You'd have to cut payments to providers. The providers aren't going to like that," he says.
Critics of the Massachusetts healthcare reform charge that the program has not kept costs under control and simply forces Bay Staters to get health insurance, which results in more customers for health insurers.
However, a new report released this month shows the state's costs to fund the reform "has been relatively modest and well within early projections." Massachusetts' health reform's "shared participation" has reduced the number of uninsured residents while having "a marginal impact on state spending," according to the report, Massachusetts Health Reform: The Myth of Uncontrolled Costs.
The Massachusetts Taxpayers Foundation report found that the state's health reform spending will grow by a projected $707 million between fiscal 2006 and fiscal 2010—half of which is being supported by federal reimbursements. So, in fact, the state has paid an extra $353 million or $88 million annually for health reform while adding more than 432,000 residents to health insurance, according to the report.
The program's hallmark has been "shared participation," including transferring uncompensated care funds to subsidize coverage for low-income adults and children and encouraging enrollment in employer-sponsored and individual health insurance plans, wrote the nonprofit fiscal watchdog group.
"This 'shared participation' approach to reform was instrumental in solidifying support for Chapter 58 from a broad spectrum of stakeholders, including hospitals, physicians, insurers, employers, unions, and community groups, and it has helped keep the support solidly intact despite occasional but significant disagreements over some aspects of implementation," wrote Alan G. Raymond, who was the principal author of the Massachusetts Taxpayers Foundation report.
Since implementing the health reform program in 2006, about 148,000 newly insured residents enrolled in employer-based insurance, while another 169,000 joined Commonwealth Care, which is the unsubsidized state reform program. An additional 76,000 joined MassHealth, which is the subsidized state program, and another 39,000 bought individual health insurance plans.
The health reform uses individual and employer incentives and responsibilities to "build on the state's historically high level of employer sponsored coverage," according to the report.
The report adds that "strong, steady growth in privately funded coverage has helped dispel concerns that public programs would replace, or 'crowd out,' private coverage. In fact, the Foundation estimates that the added cost to Massachusetts employers for newly insured employees and dependents is at least $750 million—more than double the $353 million increase in state spending since health reform was enacted."
Jon Kingsdale, executive director of Commonwealth Health Insurance Connector Authority, which oversees the Massachusetts reform program, says the report shows that shared responsibility is "really the theme of our landmark reform legislation and it works."
"The financial framework is working as envisioned: because everyone is sharing responsibility—individuals, employers, and government—[and] it is reasonably affordable," says Kingsdale.
The Massachusetts Taxpayers Foundation report comes after concerns about whether the healthcare reform program can last. In fact, government and industry officials have charged that the program may not be sustainable over the next 5 to 10 years if Massachusetts does not control health spending. In response, state officials are exploring a bundled physician and hospital payment system that would reward prevention and keeping people out of the hospital. Advocates for bundled payments believe changing the way the system pays doctors and hospitals could help control healthcare costs.
