California's Legislature is considering barring health insurers in the state from "gender rating," under which women typically pay more than men for the same health plan. Insurance companies argue that the practice, barred in 10 states nationwide but allowed in the 40 others, is legitimate and based on actuarial calculations of risk. Proponents of the change say it is discriminatory and reflects an outdated perspective on healthcare.
Those whose medical insurance coverage falls far short of their needs are a crucial part of the debate over comprehensive healthcare reform Connecticut. Among the many ideas in the patchwork of reforms is a "catastrophic medical expenses pool" advancing through the Connecticut legislature to help some insured families meet their kids' vast health needs. The pool wouldn't be state-financed but would raise about $2.5 million a year through a $1-a-year levy on each state resident who's covered by private health insurance.
A couple is suing Nashville-based Southern Hills Medical Center for $5 million following the death of their 18-month-old son. According to the lawsuit, the child was taken to Southern Hills in June of last year after he was found to be unconscious and unresponsive. Upon arrival, the child was flatlining and, despite attempts by the medical staff, was eventually pronounced dead. The parents arrived at Southern Hills a short time later, and claim hospital staff told them they would be able to see the child after answering questions. The complaint says that the family was barred from identifying the body and "saying goodbye" despite never having been charged with any role in death.
Hollywood Presbyterian Medical Center in Southern California has been fined $25,000 by the state after nurses failed to follow blood transfusion protocol and a patient died as a result. A state Department of Public Health investigation found that in October 2008, a patient at Hollywood Presbyterian was given a blood transfusion that wasn't needed and was the wrong blood type. The transfusion lasted for 15 minutes before hospital staff realized the error. The patient later died.
In March, Loyola University Medical Center began opening earlier and keeping later hours at its outpatient clinics throughout the western and southwestern Chicago suburbs. Loyola doctors also opened offices on Saturdays at many of the more than two dozen clinics. In March, Loyola's clinic visits jumped 11% after more than 250 doctors added hours. By comparison, most months dating back to last fall had little or no growth, Loyola executives said. Since doctors began staying open later on March 17, clinic visits throughout the system are up on average about 1,100 a week based on past experience and projections through the end of June.
A key Senate leader appears to be leaning toward proposing a new tax on employer-provided insurance benefits and creating a new federal agency modeled on one in Massachusetts to make it easier for individuals and small groups to buy insurance. The Senate Finance Committee is discussing a series of policy options for sweeping healthcare legislation. The committee released options for insuring the nation's 47 million uninsured, including expanding Medicaid, subsidizing private insurance for low-income people, and creating a public insurance plan.
Virginia state officials have begun the arduous task of identifying people who may be affected by the theft of medical and personal data that was stolen from a state Web site by a computer hacker, who is now demanding a $10 million ransom.
"They're in the beginning process of going through the data base," says Kathy Siddall, a spokeswoman for the Virginia Department of Health Professions. She says the internal investigation so far indicates that no other state Web site was hacked.
While there is no tally yet on the numbers of people impacted by the breach, Siddall says advisory letters may soon be mailed to people whose Social Security numbers and other personal data may have been compromised. "The Social Security number is the main thing we’re concerned about," she says.
Siddall declined to update the criminal investigation and referred inquiries to the Richmond, VA office of the FBI, where a media spokesman official would only say that "the investigation is ongoing."
The hacker broke into the Virginia Prescription Drug Monitoring program Web site last month and left a ransom note that read: "I have your [stuff]! In *my* possession, right now, are 8,257,378 patient records and a total of 35,548,087 prescriptions. Also, I made an encrypted backup and deleted the original. Unfortunately for Virginia, their backups seem to have gone missing, too. Uhoh :(For $10 million, I will gladly send along the password."
Despite the hacker's claims, Siddall says it's not clear how many records were breached at the site, which is used by pharmacists and other health officials to monitor prescription drug abuse. "The number of records doesn't necessarily equate to the number of individuals in the database. An individual could have more than one prescription," she says.
The VPMP Web site has been closed since the breach, but the state hopes to reopen it soon. "We are in the process of doing that," Siddall says. "I would expect you are going to see it up very soon, but I don't have a date on that."
Eight million Americans are covered by health savings account-eligible insurance plans, an increase of nearly 2 million people since last year, according to the industry trade group America's Health Insurance Plans.
As part of its ongoing effort to defend HSAs from accusations that they are merely tax havens for the wealthy, AHIP released another report today that claims that HSA account holders have a broad range of incomes across the country.
That study, Estimated Income Characteristics of HSA Accountholders in 2008, claims that 49% of accountholders live in neighborhoods with median incomes under $50,000, and that the average total deposits for all HSA accounts were $1,634, while the average total withdrawals were $1,063.
"HSA plans provide coverage to a number of consumers of all ages and incomes across the country," says Karen Ignagni, president and CEO of AHIP. "They represent an important choice for employers and individuals when looking at the portfolio of coverage options available."
A Government Accountability Office report in May 2008 found that the average adjusted gross income of taxpayers with HSAs was $139,000 in 2005, compared with an average of $57,000 for all other filers. Critics have used those GAO figures to contend that HSAs–created under the Bush Administration–are tax shelters for wealthy Americans, rather than a means to access affordable health insurance.
The use of HSAs by lower-income Americans also has been criticized because of concerns that they can't afford upfront costs associated with high-deductable plans. The GAO says more than 40% of HSA-eligible people with high-deductible health plans say they don't have HSAs because they don't understand how the plans work, say the plans are too expensive, or don't think they need them.
The AHIP survey found that:
Approximately 1.9 million Americans have enrolled in an HSA plan since January 2008. Previous AHIP census reports found that 6.1 million were enrolled in January 2008, 4.5 million were enrolled in January 2007, 3.2 million were enrolled in January 2006, and 1 million were enrolled in March 2005.
30% of individuals covered by an HSA plan were in the small group market, 47% were in the large-group market, and 23% were in the individual market.
83% of HSA enrollees are covered by PPOs, and 10% are covered by HMOs. For individual coverage, almost 92% of HSA enrollees were in PPOs, while 85% of large-group enrollees, and 76% small group enrollees were in PPOs.
States with the highest levels of HSA/HDHP enrollment were California (854,000), Florida (524,000), Illinois (497,000), Texas (476,000), Ohio (464,000), and Minnesota (388,000).
Patient satisfaction and patient experience are hot right now. Part of reason is the government's focus on patients' own perceptions of the care they receive, measured through HCAHPS. The public and press have easy access to the results. And because they're standardized, it's easy to see who's doing well—and who's not.
And no one wants to be in the latter category.
Still, a lot of questions remain about how best to measure, manage, and define patient satisfaction.
For starters, healthcare organizations are still trying to figure out how best to measure patient satisfaction. Should you pay attention to HCAHPS data exclusively? Do your own surveys and focus groups? Or hire a vendor to gather and compile additional data for you? Some combination of the above?
Novant Health in Winston-Salem, NC, conducted a year-long experiment in which it focused exclusively on HCAHPS to measure patient satisfaction, Sean Keyser, vice president of organizational improvement said at the recent PRC client education conference in New Orleans. The conclusion: HCAHPS alone wasn't enough to measure all of the different ways that hospitals can impact the patient experience.
Another question hospitals are trying to answer: Who should be in charge of patient satisfaction? Should responsibility be assigned to the very top leaders in the organization? Or should marketing take the helm? Maybe it's a job for the chief quality officer. Maybe you should create a whole new position, as did the Cleveland Clinic when it hired Bridget Duffy to be its chief experience officer.
You can weigh in on the debate by answering the question "Who is ultimately responsible for managing (day-to-day accountability) customer/patient satisfaction?" in an online poll by healthcare marketing executive Reed Smith, who frequently tweets about healthcare marketing.
At press time, marketing was in the lead at 40%. (I'm going to go ahead and guess that's because at least 40% of the respondents are healthcare marketers.)
Finally, there's still lots of confusion over what, exactly, patient satisfaction is. Is it the same as patient experience? Customer service? Service recovery? Patient-centered care? All, some, or none of the above?
There was a healthy debate over these questions on the MarketShare blog recently in response to a post by Mark Tomaszewicz, director of experiences at Starizon, an experience design and staging firm based in Keystone, CO. Read "The Difference Between Patient-Centered Care and Patient Experience" and make sure to check out the comments at the end.
I'd love for you to add your voice to the discussion, as well.
Note: You can sign up to receive HealthLeaders Media Marketing, a free weekly e-newsletter that will guide you through the complex and constantly-changing field of healthcare marketing.
Marketers at Fauquier Health in Warrenton, VA, knew they needed to advertise their organization's emphasis on personalized care to gain market share, but there was one problem: The hospital's patient experience was not up to par. So the staff began implementing experience improvements first so they could live up to their brand promise once the advertising campaign launched.
"Teamwork was the key," says Christy Connolly, vice president of strategic services at Fauquier. "Every staff member was involved in carrying out the plans—accountability is built in."
The hospital first decided to embark on a patient experience overhaul in 2007 because it was losing market share in a competitive and growing healthcare market near Washington, DC. Marketers began working with Cleveland, OH, ad agency Point to Point in the fourth quarter of that year to strengthen its brand strategy.
After analyzing focus group research, a consumer preference survey, and priority indexes from patient satisfaction surveys, Connolly and her team concluded that the key to winning over consumers is providing customized care.
"We were looking for those opportunities that were consistent with our vision and our culture—individualized care really accomplishes that," Connolly says.
Once each department had outlined its problems and began implementing the solutions, marketers worked on an advertising campaign to communicate the improvements to local consumers. Marketers created a series of print and outdoor ads that told patients they can be themselves at Fauquier.
"When you enter Fauquier, you can eat when you're hungry, sleep when you need to sleep," says Robin Segbers, vice president of Point to Point Healthcare. "You're not working with their schedule; they're working with yours. 'Be yourself' allows you to be who you are even when you're in the hospital."
The message has been a hit with consumers. The hospital has grown market share by two percentage points since the campaign launched in the second quarter of 2008, reversing a two-year decline.
The ED has seen the most drastic results, Connolly says. It now ranks in the 94th percentile compared to all Press Ganey facilities, and 74% of ED patients who were surveyed said they were very likely or likely to recommend the hospital, well above Press Ganey's 68% target number, according to a Fauquier employee newsletter.
"Once we identified what differentiated us, we looked for a way to articulate our brand," Connolly says. "Individualized care is woven into all of our messaging now."
