Arizona-based Banner Health will provide the space and money and share medical control over its latest venture in exchange for star power and name recognition in cancer healthcare. Banner has unveiled a pact with the University of Texas M.D. Anderson Cancer Center to build a $90 million cancer hospital and clinic in the Phoenix area. Many expect the center to bring a competitive force that will shake up the lucrative business of cancer care among healthcare providers in the region.
Many hospital marketers create their own do-it-yourself print ads for their local newspaper, magazine, and phone book. But the results are often ineffective and the ads waste a hospital's money. These six tips will help healthcare marketers create print ads that will turn a result in any medium.
On the heels of meeting with major healthcare providers the day before, President Barack Obama met Tuesday with several employers at the White House to discuss ideas that are being adopted in the workplace to improve employee health and to hold the rising healthcare costs.
"What we've done here today is to gather together some of these stories and best practices to make sure that they are going to be informing the healthcare reform discussions that take place here in Washington," Obama said. "There's no quick fix, there's no silver bullet."
These best practices could provide new structure to federal healthcare reform efforts and to improving Medicare and Medicaid reimbursement strategies, he said. "We're not just doing this in the abstract, but we're actually taking proven measures that have been applied in the private sector and seeing how we can apply those, for example, to federal employees and our employee health care system."
Among the individuals meeting with the president was Johnson & Johnson Chairman and CEO Bill Weldon. The company was cited for its long-running workplace health program and its use of a sophisticated set of disease management and prevention interventions, risk-based incentives, pedometers/exercise goals, treadmills for offices, and other health-related programs.
According to its recent employee health scorecard for American employees, Johnson & Johnson avoided an estimated $15.9 million in healthcare costs in 2007 by implementing these health initiatives. Also, from the late-1990s to 2006, smoking declined from 12% of its workforce to 4%, high blood pressure dropped from 14% to 6%, and high cholesterol went from 19% to 6%.
Safeway's President and CEO Steven Burd noted how Safeway has created a benefit design to reward employees’ healthy behaviors and improve adherence to recommended treatments for chronic diseases. More than 74% of Safeway’s 30,000 nonunion workers have signed up for its "Healthy Measures" program.
With this program, participants undergo screening tests (including cholesterol, blood pressure, and weight control); employees who score well pay lower health premiums. Safeway has saved millions by making employees accountable for their weight, smoking, cholesterol, and blood pressure, according to the company.
Safeway also offers a free fitness center at its headquarters, gym membership discounts, and a 24-hour nurse health hotline. In 2006, Safeway’s efforts reduced total healthcare spending by 13%, and employees who signed up have saved more than 20% on their premiums.
In addition, Microsoft creates personalized health goals and has a staff of physicians that make house calls to avoid an emergency room visit, according to Cecily Hall, director of US Benefits for Microsoft.
Microsoft's obesity program also assigns employees to a primary care physician, behavior health specialist, and nutritionist, and Microsoft provides free meals consistent with diet recommendations to eat onsite or at home. The result of its initiatives has been very low premium growth and a healthier workforce than other companies with workers of similar ages, according to the company.
South Florida bolstered its reputation as the Medicare fraud capital of the nation this week when two Miami-based operators of 19 sham medical clinics run out of empty store fronts and post office boxes in five states were arrested and charged with fraud, conspiracy, and money laundering.
The defendants, Michel De Jesus Huarte and Ramon Fonseca, each face up to 20 years in prison on the charges, after they allegedly filed $22.8 million in false claims under the Medicare Advantage program, the US Attorney’s office in Miami says.
A criminal affidavit says the two men controlled 19 medical clinics “purportedly operating” in Florida, Georgia, Louisiana, North Carolina, and South Carolina that collectively submitted $22.7 million in bogus claims for services they didn’t provide to several private insurance companies that cover Medicare Advantage beneficiaries.
Two New Orleans-area clinics–Best Cure Company LLC, and Fast Cure Company–were described by prosecutors as “empty store fronts with handwritten business signs.” Two other clinics–Ziallet Services Inc., and Magestic Group Service Inc.,–“were merely post office boxes in North Carolina and South Carolina, respectively, with no real business activity,” federal prosecutors say.
Most of the fraudulent billings were for pricey cancer and HIV medications administered through infusions. Several Medicare Advantage beneficiaries who the clinics reported were patients at Ziallet and Magestic told investigators they had never heard of the clinics and never received treatments.
When Huarte and Fonseca allegedly received their fraudulent payments, they would deposit the checks with two Miami-area check cashing stores, which would hold the checks until they cleared, and give the money to the two defendants. “The typical cash deliveries were between $30,000 and $80,000, and occurred multiple times per week,” federal prosecutors say.
South Florida has long been considered by federal investigators to be a hotbed for Medicare fraud. In 2007, the federal government established a Medicare Fraud Strike Force for the area to identify, and prosecute durable medical equipment suppliers and infusion clinics suspected of Medicare fraud. As of April, the strike force has convicted 146 people and secured $186 million in criminal fines and recoveries.
While only 2% of the nation’s Medicare beneficiaries live in South Florida, the region accounted for 17% of spending for inhalation drugs. Medicare spent $143 million to treat respiratory cases in Miami-Dade County, which is 20 times more than the amount spent in Chicago, which as twice the number of beneficiaries.
For 62% of inhalation drug claims in South Florida, the beneficiary did not have a Part B service visit during the last three years with the physician who reportedly prescribed the drug. Medicare paid $114 million (71% of total South Florida payments) for these inhalation drug claims in 2007.
In 2007, Medicare’s average per-beneficiary spending on inhalation drugs was five times higher in South Florida than in the rest of the country. Among beneficiaries with paid inhalation drug claims, Medicare spent approximately $4,400 per South Florida beneficiary on inhalation drugs, compared to just $815 per beneficiary on inhalation drugs in the rest of the country.
Supplier billing patterns for inhalation drugs differed substantially between South Florida and the rest of the country. Beneficiaries in South Florida were more likely to have multiple suppliers. Thirty-one percent of South Florida beneficiaries had more than one supplier providing inhalation drugs during 2007, as compared to 12% of beneficiaries in the rest of the country.
Medicare paid for inhalation drug claims that did not comply with LCD guidelines. The average Medicare payment for a 90-day supply of budesonide in South Florida was more than double the payment amount for the maximum milligrams listed in the LCD.
Certain ordering physicians in South Florida were associated with a large volume of inhalation drug claims. In 2007, 10 South Florida physicians were each listed as the ordering physician on more than $3.3 million in submitted inhalation drug claims. Each of the 10 physicians reportedly ordered inhalation drugs for an average of 745 South Florida beneficiaries in 2007. These physicians had Medicare-paid office visits in 2005 through 2007 with between 1% and 53% of the beneficiaries for whom they reportedly ordered inhalation drugs for in 2007. Medicare paid a total of $28 million for inhalation drugs reportedly ordered by these 10 physicians during the year.
As a new employee with HealthLeaders Media, I joined the company health plan, and needed to transfer my prescriptions from a mail-order pharmacy in Florida.
It turned into a bureaucratic hassle.
So I e-mailed my internist asking if he would write me a new prescription that I could send to my new plan's pharmacy.
"Of course," he affably replied.
No need to schedule an appointment for an office visit. No need to wait three to six weeks. No need to waste his time or mine for something so routine. My prescription was in my snail mailbox a short time later.
Just as the Obama administration this week is encouraging providers everywhere to be creative in reducing unnecessary costs, it seems as if both my doctor and I were doing our small part too.
Greater exchange of health information between physicians and patients through e-mail is the wave of the future, says Joe Scherger, MD, vice president for primary care at Eisenhower Medical Center, in the Coachella Valley near Palm Desert, CA. It's one of many easy ways to reduce unnecessary health costs for providers, health plans, and patients. In rural areas or places where transportation is a challenge, it can save hours of time for patients and avoid many hours of lost time from work or family responsibilities.
It can also improve patient care by increasing the linkages and communication between patients and their physicians. It makes patients more pro-active about taking responsibility for their health. Given the ability to e-mail their physicians, they are more engaged in the process.
Scherger and many other physicians who use e-mail to advise their patients say that 50% or more of visits to the doctor aren't necessary; they're just traditional. It's not always essential for the patient to return to the office for the results of a test, for example.
The care is necessary, absolutely, they say but providing that at all times in an office setting is not.
According to an article in the March/April Health Affairs, Kaiser Permanente documented a decline of costly office visits to primary care providers by 25% and to specialists by 21% for specialists. The improved efficiencies were seen between 2004 and 2005 in an ambulatory population of 225,000 enrollees after implementation of a comprehensive electronic health record system including secure e-mail messaging and telephone office visits.
But that's a closed system that many providers think is not transferrable to the typical physician practice.
Doctors and payers have to figure out a way to get paid for their time looking through their patients' e-mail throughout the day, double-checking with charts and records and responding appropriately. For the most part, insurance plans and government programs so far won't pay for it although Medicare has launched some demonstration projects.
The system also must devise a way to educate patients on what are appropriate topics for e-mail, and what should have them calling 911 or getting themselves quickly to an urgent care setting. Conveying information about a rash or a blood glucose reading may be entirely appropriate via e-mail, but complaining about chest or sharp abdomen pain is not.
Soon to come to Palm Desert under Scherger's direction is a program called "Eisenhower Personalized Care-$365," a plan by which patients pay $1 a day for "open-ended e-mail communication with their physicians that's apart from necessary office visits," he says. The endpoint is "better management of chronic illnesses resulting in reduced hospitalizations, and reduced costs."
Scherger, and a growing number of physicians around the country, say this hybrid model of physician practice, by which patients pay a fee out-of-pocket for the right to get e-mail care in addition to office visits reimbursed by their health plans or other payers, is the best bang for the buck.
"This is the sort of system that works best for people with chronic conditions such as diabetes, asthma, heart disease, and depression," says Scherger, former editor of the journal Hippocrates, a member of the Harvard/Kennedy School of Government Health Care Delivery Policy Project.
You'd only have to be an Eisenhower patient to be eligible.
Certainly the concept–sometimes called "concierge medicine" is not new, and according to recent reports, even the slumping economy has not dampened patients' willingness to participate. The very name implies that only people who can afford expensive hotel rooms would sign on.
Not so anymore, says Scherger, who formerly worked with Revolution Health and E-Doc, and who has held a special interest in the redesign of office practice using IT. For patients with multiple issues, there would be vast savings in avoided co-payments, for example.
Scherger says he borrowed the model for Eisenhower from Charles Kilo, MD, of GreeenField Health in Portland, OR, an internist he called a "guru" on the hybrid model of healthcare.
Kilo says he launched the concept in 2001 after spending time creating "idealized clinical office practice design" with the Institute for Healthcare Improvement.
"Most primary care physicians for the most part are on a hamster wheel, seeing a new patient every 15 to 20 minutes," he says. "There are multiple visits for multiple problems in the same patients and a high rate of physician burnout, which is not also healthy for the patient."
"We are very deeply engaged in system change," he says. GreenField health's success, he says, is in part because of its full electronic health record, secure messaging system, and efficient connectivity to laboratory results. Patients receive responses to e-mails within 24 hours, but usually within three or four, Kilo says.
"I order a lab test, it gets done, it's generally back on my desktop in 12-18 hours. I can sign off on it and get results back to the patient," he says.
GreenField's nine physicians charge prices for e-mail privileges ranging from $250 for children under age 10 to $650 for patients age 60 to 70. Today, he says, his four-physician practice has several thousand participants.
Questions come in about diarrhea, sore throat, or rashes, sometimes accompanied by digital photos, he says. Patients e-mail from as far as Mexico City and Italy, he says, and some 1.5 hours away on the Oregon coast. Many patients with blood pressure issues can e-mail their results.
The system also improves efficiency and communication with patients and instills better compliance with their prescribed regimens. That may be in part because patients may be more eager to use what they're paying extra to have.
That goes for patients in his practice who are on Medicaid and Medicare as well, many of whom are allowed e-mail privileges for free, he says.
He predicts a much more expansive use of e-mail by physicians to interact with their patients in the next few years. "Surveys say many doctors are already doing it, but what that means is that they gave their e-mail addresses to 10 patients. Today, most doctors are not doing it as a core part of the way they practice. I hope we get there. We need to get there," he says.
Does he have any proof that he's saving money?
"We have data from one insurer who says that we're 20% less expensive than the average practice in the area," Kilo says.
In time, he says, many more physicians will be using e-mail with their patients. And newer models of reimbursement will actually pay for it.
Health insurers are so concerned that a public insurance option could destroy their business that they have made concessions over the past few months that would have seemed impossible only a year ago.
While gender disparity in insurance premiums is not allowed in employer-based and government-sponsored health plans, most individual health insurance plans do not follow those laws. In fact, individual plans, which cover about 18 million Americans, are subject to state laws and only about a dozen states have limits on gender ratings, according to Claire Miley, member of the healthcare practice area of Bass, Berry & Sims law firm in Nashville.
In addition to concern about the healthcare reform train barreling down the tracks in Washington, DC, insurers have also taken notice of Sen. John Kerry's (D-MA) recently proposed bill to outlaw the practice of setting premiums in individual insurance based on gender.
Lawmakers are looking at individual health plans closely because they are the only area of growth for health insurers. Newly unemployed are turning to individual health insurance as a safety net, but individual plans are quite different from the employer-based system that most know. These differences, including charging higher premiums for women and individuals who are sicker, have caused some lawmakers and advocates to take a closer look at individual plans.
Moving away from gender-based ratings is just the latest move by the insurance industry, which has gradually tweaked its fundamental foundation of charging members based on risk.
In the public's view, uneven gender ratings are unfair and call to mind earlier controversial industry practices. "The insurance industry abandoned ratings based on race decades ago, even though race-based ratings were once justified on the basis of actuarial statistics," says Miley. "And some commentators have noted that, while women are the only gender capable of bearing children, healthy children benefit society as a whole and therefore society as a whole should support the costs."
The latest proposal to end higher premiums for women follows on the heels of the insurance industry's recent announcement that it would not charge higher premiums to sick members and would accept all Americans, regardless of illness or disability, if the feds mandated that everyone have health insurance coverage.
The bottom line is that health insurers think they could be in trouble if the Congress and president create public competition. Part of the problem is that Obama and Congress have not developed a specific public insurance plan. Without knowing the specifics and how to compete against a public plan, health insurers are making concessions in hopes that policymakers will remove a public option off the table.
It appears to be working. While a public option seemed like a real possibility two months ago, the likelihood is less today. I spoke to Robert Laszewski, president of Health Policy and Strategy Associates, LLC, in Washington, DC. Laszewski, one of the leading healthcare thought leaders in Washington, DC, offered me a surprising view on healthcare.
While many outside of the beltway think a comprehensive healthcare reform package will pass this year, Laszewski says there simply isn't the money to fund Obama's $1.2 trillion reform package over 10 years. Instead, he believes lawmakers may pass smaller reforms that won't tackle the major issues.
But Miley is not so sure. She sees the public option as a "realistic possibility." Nevertheless, health insurers are playing defense and view the public option as a threat to their survival. In turn, they are using the logic of the great philosopher Mick Jagger—You can't always get what you want; you get what you need.
Insurers have opposed changes to gender ratings in the past. However, if cutting this kind of bedrock practice means they don't have to face a public option, health insurers are willing to change the way they do business.
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In its third and final roundtable addressing healthcare reform issues, the Senate Finance Committee on Tuesday discussed how to pay for it—a decidedly difficult task.
Chairman Max Baucus (D-MT) noted that the first place to look for savings is within the healthcare system itself.
One area the panel examined is whether tax breaks should continue to be offered to hospitals if universal coverage is approved. Federal tax breaks for charitable hospitals amount to billions of dollars each year for those organizations, said Sen. Charles Grassley (R-IA), the committee's ranking minority member.
"If as a result of healthcare reform, everyone has health insurance- presumably hospitals should see a steep decline or elimination of uncompensated care," he said. So, given this trend, does it make sense for the federal government to retain those tax exemptions, he asked.
Since healthcare reform legislation was approved in Massachusetts, uncompensated care has sharply dropped in the state, according to Jonathan Gruber, PhD, a professor of economics at Massachusetts Institute of Technology.
However, under any reform, some type of uncompensated care provisions are needed—even in Massachusetts, he said.
"About a third of uncompensated care today actually goes to insured [individuals] who don't pay their copays and deductibles," Gruber said. Also, the number of uninsured is not going to be zero—either in Massachusetts or the nation as whole. "We can definitely move to a more rationalized system [of healthcare], but it has to be a system that recognizes that there will be some need for uncompensated care—even in a universal coverage world."
In the average community hospital, uncompensated care is on average between 2% to 4% of their revenue, although some hospitals may see it as high as 12% to 15%, said Stuart Altman, PhD, a professor of national health policy at Brandeis University in Waltham, MA.
"[But] the issue isn't going to be that part—it's going to be the extra payments that we now give these institutions -[under] disproportionate share ... We need [to take] a substantial look at that," Altman said.
But the hospital tax breaks provides community benefits "far in excess of just the issue of uncompensated care," Altman said. "I think it would be a mistake to totally wipe it out—but we can substantially reduce it.”
"At the same time as we are asking for an enormous change from the hospital industry in terms of restraining costs," removing the tax exemptions could "destabilize the basic delivery system," said Gerald Shea, assistant to the president for governmental affairs with the AFL CIO in Washington.
Shea suggested focusing on reform efforts first—then focusing on tax exemption issues later. "We should not try to do two things together."
The Senate Finance Committee on Thursday will meet behind closed doors and "walk through" policy options on expanding healthcare coverage. These options are found in the second of three papers on healthcare reform released this week by the Finance Committee; the panel is looking to mark up healthcare reform legislation by June.
An introduction to the paper, which follows a Finance Committee roundtable on coverage issues on May 5, notes that it is "intended to spur discussions regarding proposed options." Not all of the options have the support of Committee Chair Max Baucus (D-MT) or ranking minority leader Charles Grassley (R-IA).
Many of the policy options are aimed at reforming individual and small group health insurance markets. This, in turn, would create a competitive insurance market "where health plans compete on "price and quality"—rather than segmenting the market by risk and discriminating against individuals with preexisting conditions, the paper said.
The paper presents three alternatives for a public health insurance option—an area that has created heated debate in Congress. One alternative is a Medicare-like option that would be administered by the Department of Health and Human Services (HHS). The government would set payment rates for that plan, and Medicare providers could participate in the plan. This public health insurance option would not have solvency requirements.
Another alternative is a public health insurance option that would be administered through multiple, regional, third-party administrators (TPAs). These TPAs would be required to report to the HHS secretary. The TPAs would establish networks of participating medical providers and would negotiate payments for providers participating in the option. This public option would be required to adhere to solvency requirements.
A third alternative would be a state-run public health insurance option. The policy paper also presents the option of not creating a public health insurance option, but expanding coverage through a reformed and more regulated private market.
The policy options also would standardize Medicaid eligibility for all parents, children, and pregnant women below 150% of the Federal Poverty Level (FPL) or $33,000 a year for a family of four.
The paper also calls for creating options for people ages 55 to 64 years old and for changing the Medicare 24-month disability waiting period. The policy options would not make changes to the Children's Health Insurance Program (CHIP) until after September 30, 2013. After that time, CHIP would be offered through a health exchange and would provide additional benefits for low-income children not eligible for Medicaid.
The paper also suggests making wellness visits available to Medicare beneficiaries once every five years and providing a personalized prevention plan. The options also would provide incentives for Medicare beneficiaries to use preventive services.
Examples of these incentives include reducing or eliminating cost-sharing for screenings and offering rebates for completion of health promotion programs, such as smoking cessation. The policy options call for aligning Medicare coverage for preventive services with scientific evidence to ensure patients receive appropriate screenings.
President Barack Obama's proposed healthcare workforce development funding for fiscal year 2010 would bring incentives to nurses both in the field and in the classroom.
Of $1 billion in the budget devoted toward strengthening healthcare professions, $125 million is allocated to the Nursing Education Loan Repayment Program (NELPN)—an $88 million increase from the 2009 budget. Funds for the Nurse Faculty Loan Program (NFLP) would increase by 40%.
"Right now community colleges are on the forefront of creating cost-effective access to nursing," says Tagliareni, adding that about 60% of new graduates nationwide come from associate degree programs. "The issue is academic progression; we need these incentives to bring people into nursing in a variety of ways, build the ability of the workforce, and also help them move academically."
The shortage of nursing faculty available to provide education currently halts the cycle of nurses advancing in healthcare and college settings. NLN statistics illustrate an estimated 99,000 qualified applications (almost 40%) submitted to prelicensure RN programs were rejected between 2006-2007 because of a lack of space for students. The demand for more faculty—which Tagliareni states is one of the biggest concerns for NLN—is vital to moving nurses through the pipeline.
Bolstering programs, such as NELPN and NFLP, provides nurses with the financial means to press forward professionally. NELPN contracts RNs with the federal government to work full-time in a healthcare facility with a nursing shortage in return for repayment of qualifying educational loans. NFLP funds eligible schools of nursing offering advanced education nursing programs to prepare graduates to serve as nursing faculty.
Along with these programs, scholarships and stipends are major to recruiting nursing faculty, says Tagliareni who has been an educator for 27 years. Nurses must obtain a master's degree to teach and are paid less than they would as practicing nurses.
"Academic institutions manage salary, but since salary can't be managed from a national perspective, loan repayment and scholarships lessen the burden of extensive loans they have to repay," says Tagliareni. "It is in a sense increasing their salary."
Other benefits that could come to nurses in 2010 with Obama's budget include increased diversity. The proposed budget allots funds to Title VII and VIII of the Public Health Service Act health professions training, which are federal programs geared toward training healthcare providers in interdisciplinary settings to meet the needs of underserved patient populations, and increasing minorities in the profession.
Research shows mortality decreases when there are more nurses available in healthcare settings, says Tagliareni. "We also know that active clinical practice nurses who move onto master's and doctoral programs bring with them an understanding of the practice environment that gets disseminated to students. That knowledge will be infused into nursing curriculum and improve the quality of the healthcare workforce."
A report issued by the trustees who monitor the government's two main forms of help for the elderly shows that Medicare has become more fragile and is at risk of imminent fiscal collapse. Starting eight years from now, the report says, the health insurance program will be unable to pay all its hospital bills. The trust fund that pays for hospital care under Medicare is now predicted to run out of money in 2017, two years earlier than forecast a year ago. That fund does not involve the parts of Medicare that cover doctor's visits or coverage for prescription drugs.
