Congress is planning to give employers sweeping new authority to reward employees for healthy behavior, including better diet, more exercise, weight loss, and smoking cessation. Congress is seriously considering proposals to provide tax credits or other subsidies to employers who offer wellness programs that meet federal criteria. In addition, lawmakers said they would make it easier for employers to use financial rewards or penalties to promote healthy behavior among employees.
Millions of patients each year leave the hospital only to return within weeks or months for lack of proper follow-up care. But even when hospitals find ways to greatly reduce the return trips and save money for Medicare and other insurers, their efforts go unrewarded. In fact, because insurers typically pay hospitals to treat patients, hospitals can actually lose money by providing better care because empty beds mean lost revenue.
Television ads that began airing last week featured horror stories from Canada and the United Kingdom about patients who allegedly suffered long waits for surgeries, couldn't get the drugs they needed, or had to come to the United States for treatment. The ads are the brainchild of Rick Scott, founder of a group called Conservatives for Patients' Rights. Scott, a multimillionaire investor and controversial former hospital chief executive, has become an unlikely and prominent leader of the opposition to healthcare reform plans that Congress is expected to take up later this year.
In the world of protecting your patients' private data, you need more than the fancy equipment, the best encryption software on the market, and firewalls galore.
Take, for instance, The Virginia Prescription Monitoring Program (VPMP). A computer hacker reportedly removed more than 8 million patient records and 35.5 million prescriptions from the state-run VPMP Web site last week and demanded $10 million to return the information.
What happened and how can your company protect against a future problem? Lou Nardo, vice president of product management for Netcordia, a network configuration and management solutions company in Annapolis, MD, that specializes in HIPAA compliance, says IT folks worry too much about firewalls and security products rather than internal processes and controls.
"This may not have been a hacker," Nardo says about the VPMP case. "This may have been internal."
Netcordia surveyed clients recently about internal systems and networks. More than 40% said they were worried about internal IT folks leaving a "back door" way into a system inappropriately.
A third said their greatest threat to network availability is from the outside, but 49% said from the inside, though inadvertently.
VPMP's greatest threat may not have been a hacker across the globe. It could have been the coworker in the next cubicle at the VPMP.
"A disgruntled employee. That's the classic case," says Kate Borten, CISSP, CISM, president of The Marblehead Group in Marblehead, MA, who specializes in HIPAA privacy and security. "The insiders know where your vulnerabilities are and where your assets are. Someone in the IT department could have done a bunch of things there. Set up bogus accounts, all kinds of things. It's pretty easy to do and get away with."
So how do you not let that happen?
Borten says you should make sure your internal database is buried deep inside your internal network with lots of firewalls behind it.
If the potential Virginia hackers "deleted the database, that shows some serious flaws," she said. "Leaving the database out front is a huge security mistake."
Naturally, if you encrypt the data well enough, "you're home free," Borten said. For Netcordia experts, it always comes back to internal processes.
Yama Habibzai, vice president of marketing for Netcordia, says facilities need to have systems in place that track who makes changes, when they were made, and why. And constant monitoring and auditing is key.
Also crucial, Borten says, is configuring a system that has strong protections in the "buffer zone," or the area between your internal network and the Internet.
"How we configure and manage that buffer zone is very critical," Borten says. "It's something we call hardening the server. You need to make sure you know how it's being set up."
In other words, to avoid a potential historic breach of patient privacy:
David Blumenthal, MD, HHS' national coordinator for health information technology, was one of three men appointed today by HHS to the Health Information Technology Policy Committee, an advisory panel that meets for the first time on Monday in Washington, DC.
Joining Blumenthal as HHS selections to the committee are: Michael J. Klag, MD, dean of Johns Hopkins Bloomberg School of Public Health; and Deven C. McGraw, director of the Health Privacy Project, at the Center for Democracy & Technology. A list of the policy committee members named so far and the May 11 agenda can be found at http://healthit.hhs.gov .
The HIT Policy Committee will make recommendations to Blumenthal's office on a policy framework for the development and adoption of nationwide interoperable HIT, including security standards for patient medical information.
Also Friday, HHS released the names of members of the HIT Standards Committee, which, like the policy committee, was established under the stimulus bill. The committee will also make recommendations to Blumenthal's office on standards, implementation specifications, and certification criteria for the electronic exchange and use of health information. Their first meeting is May 15.
Thirteen members were appointed by the acting comptroller general of the United States. Four members appointed by the majority and minority leaders of the Senate and the speaker and minority leader of the House. President Barack Obama's appointees from federal agencies will be announced before the committee’s second meeting in June.
Standards Committee members appointed so far are:
Jonathan Perlin, MD, Chair, Healthcare Corporation of America
John Halamka, MD, Co-Chair, Harvard Medical School
Dixie Baker, Science Applications International Corporation
Anne Castro, BlueCross BlueShield of South Carolina
Christopher Chute, MD, Mayo Clinic College of Medicine
Janet Corrigan, National Quality Forum
John Derr, Golden Living, LLC
Linda Dillman, Wal-Mart Stores, Inc.
James Ferguson, Kaiser Permanente
Steven Findlay, Consumers Union
Douglas Fridsma, MD, Arizona Biomedical Collaborative
C. Martin Harris, MD, Cleveland Clinic Foundation
Stanley M. Huff, MD, Intermountain Healthcare
Kevin Hutchinson, Prematics, Inc.
Elizabeth O. Johnson, RN, Tenet Health
John Klimek, National Council for Prescription Drug Programs
Though the Obama administration's proposed 2010 rural health funding for the Health Resources and Services Administration was cut by $44 million, the budget also includes many increases for rural health, according to the administration.
In fact, the overall reduction from the 2009 budget of $125 million comes primarily because of the elimination of two programs, the $26 million Delta Heath Initiative in Mississippi and the $20 million Denali Project in Alaska.
"It was felt that the needs in the region were largely met through prior investments," says Health Resources and Services Administration spokesman David Bowman.
He says the full funding for rural health includes many increases, much of them found in budgets for other parts of the administration that serve urban areas as well as rural. For example, health centers will receive $2 billion, and while some health centers are in urban areas, "most health centers are located in rural areas," Bowman says.
Professional training, grant support and scholarships for physicians, dentists, and other types of health providers will receive $2 billion, largely through increases of National Service Corps, which received $135 in 2009, but will go up $34 million in 2010. The NSC provides scholarships for medical and dental school and helps physicians and dentists repay loans.
Many of those who benefit will agree to serve in rural underserved areas, Bowman says. The clinic and physician support line items are in other portions of the budget, he says.
Indian Health Services, meanwhile, which serves a large number of Native Americans in rural areas, would be a big winner, with a total of $4.58 billion under the proposed 2010 budget. Clinical services would receive an additional $324 million ($3.74 billion), preventive health support would receive an additional $9 million ($144 million), and Indian health professionals would receive an additional $3 million ($41 million). The administration's line items also include $4.98 billion for Indian health facilities, a $454 million increase.
Alan Morgan, CEO of the National Rural Health Association, says he is "excited to see that the President's budget includes increases to rural health grant programs. I am optimistic that we will see this support for improving our nation's rural health system continue as the debate begins on Capitol Hill."
Morgan also says the Denali Project and Delta Health Initiative programs are very important, but are earmarks. He suggests Congress will put them back in because both programs "have had great results—and they have great champions on the hill too."
Bowman says the Denali Project has received more than $300 million since 2000 for construction of health facilities in rural Alaska. The Delta Health Initiative, launched in 2006, brought seed money to projects providing chronic disease management, pharmacy, dental, school-based mental health services, and teenage pregnancy prevention to rural areas of Mississippi.
Bowman emphasizes that large increases in health center and health professional training, highlighted in other portions of the federal budget, will make up for most deficits in those areas.
Other programs classified as rural received small increases or stayed the same. The budget for Black Lung Clinics, which screen coal miners for the disease and provide treatment and rehabilitation for active and retired coal miners remains at $7 million.
Funding for cancer screenings for workers and residents adversely affected by mining, transportation, and processing of uranium products primarily used in the nuclear arsenal, mostly in the Four Corners area of the West, also stayed the same at $2 million.
Additionally, the administration yesterday released a budget overview that promised $55 million for rural healthcare services grants to improve quality and $8 million for rural efforts to expand telehealth. The $55 million is a $1 million increase over 2009 funding.
The Obama administration's proposed budget also promises to help 50 million underserved Americans, who live in rural and poor urban neighborhoods.
Hospitals are cutting costs. They're doing it in a variety of ways. Some are engaging their employees to help rein in significant costs, while some are taking a top-down approach to cost cutting. It's essential and painful, but it has to be done. Not a day goes by that I don't see a news story about some hospital cutting labor costs through layoffs, through supply reorganization, through revenue cycle initiatives—but mainly through layoffs.
Still, cost-cutting is not a long-term strategy with much staying power. Once you've wring out all the excesses, where do you go for further stabilization, and further, where do you go for growth? Cost-cutting's like sugar. It offers a heckuva high, and its results taste sweet, but it's a short-term fix that might mask other shortcomings.
Without more long-term strategies to pick up the slack when the relatively easy cuts have been made, you're only buying time. Yet some CEOs want special congratulations for the cost issues they've solved. My question as I read many of these stories is why did it take a recession of this magnitude to focus you on waste? Shouldn't you have been running a tight ship all along?
Perhaps that's why I'm reminded of a particularly harsh routine by one of my favorite stand-up comics, Chris Rock, in which he talks about the various efforts for which many of us want special credit or recognition, but really don't deserve much. Check out 1996's Bring the Pain, or this clip from it, for some decidedly un-PC, but hilarious takes that I thought of when I was writing this column. In reality, like cost-cutting, what Rock talks about are efforts that most people with common sense and a touch of responsibility for their actions always do. His tagline after he brings up one of these scenarios: "What do you want, a cookie? That's what you're supposed to do!"
Fresh off my long stint as the senior editor of finance here at HealthLeaders, I'm inclined to give cost-cutting and fiscal responsibility a lot of weight, especially in this faltering economy that we've had to get used to over the past couple of years. It's responsible, for you as a leader, to charge your lieutenants with turning over every stone to try to find ways to save money. Cost cuts are quick and often successful, especially after a long period of relatively good times in the healthcare industry. Of course, eliminating waste in healthcare is a laudable strategy from a macroeconomic standpoint. But let's be honest: while you need to do it, cost-cutting is not a long-term strategy.
Perhaps that's why it received such short shrift in the CEO breakout survey contained in the 2009 HealthLeaders Media Industry Survey. When asked to rank their organization's top three priorities for the next three years, cost-cutting ended up pretty low on the list, behind such stalwarts as quality and patient safety, revenue cycle efforts, physician recruitment, reimbursement, and consumer satisfaction.
You'd think it would be higher in this environment.
But after some reflection, I realized that cost-cutting was in its rightful place on the list. Good leaders, which I'm assuming were most of the people who answered our survey, rightly recognize that some of the other strategies I've mentioned work better to solve healthcare's long-term issues. Cost cutting is a quick fix, so it's not a top long-term priority.
So perhaps I'm preaching to the choir here, but it's a good idea to remind yourself not to get distracted by the fact that you have made strides in cost cutting.
What, do you want a cookie? That's what you're supposed to do!
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Hospitals only added 600 new jobs in April, according to Bureau of Labor Statistics data released today. By comparison, the hospital sector added 11,300 jobs in April 2008, and 7,300 jobs in April 2007.
The healthcare sector—from physicians' offices, to residential mental health homes, to blood and organ banks—added 17,000 jobs in April. That's in line with its average monthly gain since January, but well off the average gain of 30,000 payroll additions per month in 2008, according to BLS.
In the first four months of 2009, the nation's hospitals increased payroll by 8,300 jobs, compared with 43,700 jobs in the first four months of 2008, and 25,300 jobs for the same period in 2007. BLS reports that there were 4.7 million hospital jobs at the end of April 2009.
If hospital payroll increases continue at this pace, fewer than 25,000 new jobs will be created in 2009, as compared with 137,100 new hospital jobs in 2008; 105,700 new jobs in 2007; and 81,400 new jobs in 2006, according to BLS data.
Within the larger, overall healthcare sector, April payroll growth and contraction varied sharply depending upon specific services. For example, ambulatory healthcare services payrolls grew by 17,700 jobs, while nursing in residential care facilities lost 1,600 jobs for the month, BLS data show.
Although job growth is slow in the hospital and healthcare sectors, they're still outperforming the overall economy. BLS reports that "job losses were large and widespread" across almost all industries as the nation's unemployment rate rose from 8.5% to 8.9%.
Overall private sector employment fell by 611,000 jobs in April, and the economy has shed 5.7 million jobs since the recession began in December, 2007. The numbers of unemployed people increased by 563,000 in April and now stands at 13.7 million.
If your nursing facility is looking for new software, chances are your team will spend a significant amount of time drafting a request for proposal for vendors, a lengthy document that specifies your software requirements. But the selection process could soon become simpler for long-term care providers.
The Certification Commission for Healthcare Information Technology (CCHIT) announced in April that it aims to begin certifying long-term care electronic health record (EHR) software products by July 2010.
A certification establishes standards for long-term care software, giving long-term care providers a fast, reliable way to know what a software product can do. And with more nursing facilities adopting electronic records and new policies placing an emphasis on electronic health records in healthcare, a long-term care software certification could be a useful tool for providers.
A long-term care certification will give providers a shortcut through the software selection process, says Nathan Lake, RN, BSN, MSHA, director of clinical design for American Health Tech in Jackson, MS. Lake is also a member of the CCHIT Advisory Task Force, a volunteer group of industry stakeholders that will advise the work group CCHIT will form to create the long-term care certification.
When providers look for a new software program, they typically spend a good deal of time vetting new products, he says. Some providers send vendors hefty documents outlining their specifications for software. With a certification, long-term care providers can simply determine whether a product is certified to find out if the software meets key performance requirements, Lake says.
The long-term care industry has adopted electronic records at a rate that is comparable, if not higher, than acute care and private physician practices, says Majd Alwan, PhD, director for the Center for Aging Services and Technologies in Washington, D.C.
However, many nursing homes are not using fully integrated or interoperable electronic records, Alwan says. "Interoperability" refers to the ability to share information with other healthcare providers.
A certification would ensure buyers that certified long-term care software products would work seamlessly with other certified software products, Alwan says.
The American Recovery and Reinvestment Act, also known as the economic stimulus package, is putting a lot of emphasis on standards-based interoperable health IT to guarantee every American has a health record that is portable or can allow the exchange of information, Alwan said. The certification is an indication that the investment in a software product is somewhat protected and the system will not become obsolete because it is not compliant with national standards for interoperability, he says.
Achieving interoperability in long-term care EHRs is especially important because the sector serves residents who often have multiple chronic conditions and multiple care providers, such as physicians, pharmacists, and long-term care providers, Alwan says.
The population also tends to move across the several care settings. For example, if an elder falls and breaks a hip, he or she may move from a hospital to a skilled nursing facility for rehab before transitioning to an assisted living facility within a relatively short period of time, he says. Also, sharing electronic records may be useful because seniors in long-term care facilities may have a primary care physician or geriatrician who works outside of the long-term care facility.
"The benefits of interoperable HIT across settings would be maximized in this segment of the population," Alwan says.
Although certification is voluntary for software vendors, the marketplace is starting to request it, says John Morrissey, communications director for CCHIT.
Certification will become critical for software vendors in the next five years, Lake says, adding that when a software certification is established, nursing homes will be less likely to consider uncertified products.
"Five years from now, the first question out of a facility's mouth is going to be 'Are you certified?'" Lake says. "If you [a vendor] say 'yes,' you're going to be in the door for testing. If you say 'no,' they're not even going to continue talking to you."
Some vendors may choose not to become certified, and may ultimately go out of business.
Certification may raise the cost of software, Lake says.
Certification is an expensive process for vendors, costing acute care software vendors around $25,000 to initially become certified, Lake says. Vendors also need to become re-certified every two years, although recertification isn't as costly, he says.
Lake's group is examining how to make certification less expensive for the long-term care sector because the industry's profit margins are lower than those in acute care.
In the summer of 2006, Bellin Home Health Care in Green Bay, WI, created a tool to assess patients' likelihood and risk of falling by utilizing resources from hospital-affiliated home care.
However, the policy did not capture what was needed to assess home care patients, and Melissa Smits, RN, team leader, administrator for home health/home infusion and Emily Nelson, RN, BSN, quality/regulatory coordinator, sat down to draw up a new fall assessment policy for home care patients.
Using the original policy and building on that, Nelson and Smits worked with physical and occupational therapists, as well as nurses to help draw up the new policy.
The original care plan had staff members specifically initiating the process themselves, along with going in and having to document the assessment on three different plans.
After sending out the first draft and receiving feedback from the facility that it was too lengthy, it was decided Bellin needed something more cut and dried.
"In January 2007, the Joint Commission came in and felt as if we needed to have the program beefed up, as it appeared our staff was not consistently following the policy," says Smits.
"We needed to live it and breathe it and follow it completely," says Nelson. "We had it going, but it wasn't where it should have been."
Using the original assessment policy, key pieces were pulled over that needed to be documented. Also, the update tried to make it easier for staff members by reducing the number of steps, says Smits.
The updated fall assessment policy was introduced in February 2007, and was Bellin's first formal policy that staff members had to sign off on and begin implementing.
The policy specifically outlines what is expected of each staff member. It covers the purpose, policy itself, what staff members perform the fall risk assessment, the procedure for doing a fall risk assessment, and finally how to document the fall risk assessment correctly.
Upon reading the new policy, staff members would be required to sign a form saying the policy had been read and understood. Once the employee had signed the policy, it was noted on his or her file, and thus holding the staff member accountable for anything that happened to the patient.
In August 2007, not long after the policy was introduced, Nelson and Smits decided to revisit the policy.
Nelson says the verbiage change focused on assessing on admission, when the patient leaves a healthcare facility, and any significant change in condition.
"We were assessing patients in home care and taking a step back," says Nelson.
In addition to changing the verbiage, a post test for all staff members was created to ensure that the new policy was read and understood. Once the staff member had read the policy, he or she was required to take the test and receive a perfect score.
"By creating a post test, we could validate their accountability to the policy and process," says Nelson.
Now, each new staff member is required to read the policy at orientation, take the test, and sign a document that he or she has read the policy.
Nelson and Smits also believe that the Joint Commission's visit to Bellin Home Health gave staff members another reason to be compliant with the new fall assessment policy.
"The timing of the Joint Commission's visit, and all the hype that surrounded the development of a better fall risk assessment policy helped to get the staff on the right track," says Nelson. "Coming only from us, there may not have been quite an impact [on the staff], but with the Joint Commission coming in, we were able to reiterate the importance of the new policy."
