Obama administration officials launched a high-level task force to use technology to help detect and prevent healthcare fraud. Attorney General Eric H. Holder Jr. and Health and Human Services Secretary Kathleen Sebelius also directed federal investigators and prosecutors to expand special strike forces to Detroit and Houston, where "erratic" billing data suggest high levels of fraud, waste, and abuse in Medicare and Medicaid programs. The announcement comes a week after the trustees who monitor Medicare's finances predicted that the trust fund that pays hospital bills for elderly patients will be depleted by 2017.
Even as Congress weighed options to finance health insurance for tens of millions of Americans, lobbyists mobilized to head off proposed taxes on employer-provided health benefits, alcoholic beverages, and soft drinks. Two dozen options were considered by members of the Senate Finance Committee as they looked for ways to pay for coverage of the uninsured. Almost every option faces opposition from some quarters. Aides to the committee's chairman admonished lobbyists not to criticize the tax options, for fear that such criticism could sink the legislation before it is unveiled.
America's teaching hospitals would have to spend $1.6 billion each year to cover the costs of replacement workers if reduced work hours for medical residents are adopted, according to a new study by the RAND Corp. and the UCLA School of Medicine on Wednesday.
The study examines the implications of an Institute of Medicine report in December that calls for revisions to medical residents' workloads and schedules to decrease fatigue-related medical errors and improve the educational experience. The IOM didn't recommend further reducing residents' 80-hour work weeks. However, IOM recommended reducing to 16 hours the maximum time that residents can work without time for sleep, increasing the number of days residents must have off, and restricting moonlighting during residents' off-hours.
The RAND/UCLA study's authors say the issues raised by the IOM report are legitimate concerns, but addressing the recommendations won't come cheap. The IOM's recommendations would cost each major teaching hospital about $3.2 million annually on average, the report states.
"Adopting new restrictions on the work hours of physicians in training would impose a substantial new cost on the nation's 8,500 physician training programs," said lead author Teryl K. Nuckols, MD, an internist at the David Geffen School of Medicine at UCLA, a researcher at RAND, and the lead author of the NEJM report. "There is no obvious way to pay for these changes so that's one major issue that must be addressed."
Jay Bhattacharya, MD, an associate professor of medicine and a health economist at Stanford University, was a member of the IOM committee that issued the report. He also co-authored the NEJM study, which he says has left him fearful and hopeful. "The fear is that people will say it's too expensive," Bhattacharya says. "The hope is that it will cause people to think carefully about what they want. They want reduced medical errors for nothing, and that's not possible. I hope it causes some people to say this is a lot of money, but it's a good deal."
Joanne M. Conroy, MD, the Association of American Medical College's chief healthcare officer, says her group does not oppose a reduction in the working hours for medical residents, but would prefer to see "specialty specific" reductions rather than one-size-fits-all reductions now in place. She says some subspecialties, such as anesthesiologists, operate in teams and make it easier for residents to coordinate break times.
She says medical residents expressed concerns about restricting hours and the impact it will have on their training. "Surgery residents actually are very vocal that they don't feel prepared with the current restrictions" that include an 80-hour work week, Conroy says. "Residents as a group are not necessarily in favor of further restrictions. We can't forget that we are training the next generation of physicians."
Bhattacharya says trimming back medical residents' duty hours is a fine line. "If you work too much, you create a set of tired people making life-or-death decisions that could hurt people. If you do work too few hours, you get people who leave residency poorly trained," he says. "The only real right way to get yourself out of this mess is having adequate supervision during the residency process."
Conroy says hospitals will find a way to pay for whatever new restrictions are implemented. "We'll all moan and groan," she says. "But we will figure out how to get it done."
The California Department of Public Health has issued $25,000 penalties against 13 hospitals for serious violations that, in some cases, led to patient deaths. Each violation comes with a $25,000 fine, part of an ongoing effort to hold hospitals more accountable for placing patients at risk of death or serious injury. The disclosures come as a result of a state law that took effect in 2007 requiring hospitals to inform health regulators of all substantial injuries to their patients.
The question of whether hospital residents should be required to work shorter hours and take naps to avoid exhaustion that can bring harm to their patients has created a surprising divide in the medical community. Other industries in which employees are responsible for the lives of others, such as airlines and railroads, have limits on how many hours of continuous work their employees are allowed to do.
The Jefferson Parish Council is urging Louisiana health officials to reverse emergency Medicaid cuts projected to cost the parish's three largest hospitals $20 million this year. Council Chairman Tom Capella said it is "blatantly unfair" that rural hospitals are exempt from the cuts estimated at $345 million statewide. Department of Health and Hospitals Undersecretary Charles Castille told the council that the exemption is rooted in a 1997 state law requiring health officials to maximize funding for rural hospitals.
A long-awaited federal law that shields people from genetic discrimination starts Thursday, May 28. The measure prevents health insurers from denying coverage, adjusting premiums or otherwise discriminating based on genetic information. Experts say the law could put people at ease about having genetic testing or counseling.
Miami Beach-based Mount Sinai Medical Center's loss narrowed in the first quarter, year-over-year, according to a report. It lost $448,000 on operating revenue of $130.3 million in the first quarter, up from a $1.64 million loss on operating revenue of $128 million in the first quarter of 2008. In both quarters, the hospital received a $2.5 million contribution from the Mount Sinai Medical Center Foundation.
Baptist Health South Florida could not climb out of the red in its fiscal second quarter ended March 31 as its investment losses wiped out its operating income, according to a report to bondholders. The Miami-based Baptist lost $24.8 million on operating revenue of $530.2 million in its second quarter. That's improved from a loss of $26.8 million on operating revenues of $470.2 million in the same quarter of 2008.
The Connecticut House of Representatives took a major step toward guaranteeing healthcare coverage to tens of thousands of state residents without health insurance. The House voted largely along party lines, 107-35, for a landmark bill aimed at achieving universal healthcare in Connecticut by creating a public insurance pool that anyone could join, regardless of their health history. The pool would be based on the existing pool for state employees, and is designed to compete with, not replace, private insurance plans.
