South Florida's reputation as the capital of Medicare fraud came under the congressional spotlight with U.S. Attorney R. Alexander Acosta telling a Senate panel the best tool for fighting scams is tightening oversight at the top. Acosta, who since 2006 has prosecuted more than 700 people responsible for more than $2 billion in fraudulent Medicare billings, told the U.S. Senate Special Committee on Aging that he started focusing on fraud because he was "absolutely disgusted" by the level of scams in South Florida.
Jefferson Parish's three large hospitals stand to lose a combined $20 million from recent emergency cuts to Louisiana's Medicaid reimbursement rates, a hospital administrator said. The state Department of Health and Hospitals issued emergency rules cutting Medicaid reimbursement rates on Feb. 20 by 3.5%, and again May 1 by 7.2%. Nancy Cassagne, chief executive officer for West Jefferson Medical Center, said the cuts will aggravate brutal market conditions that have left New Orleans hospitals operating in the red since Hurricane Katrina.
A former Orange County, CA, real estate developer has donated $21 million to University of California-Irvine for the school's new hospital. The posthumous donation was made by M.A. Douglas, who died last June. The hospital will now be renamed UC Irvine Douglas Hospital. UCI had reached $32 million of its $50-million fundraising goal for the new 424-bed hospital before Douglas' gift.
General Electric Co. plans to announce an initiative for its healthcare business. The company has said that it will unveil GE's new efforts to improve "sustainability of global healthcare systems" involving health technology, independent living, rural health, and cost containment. People familiar with the matter said GE's effort focuses on how GE is improving access and quality to healthcare globally while lowering costs.
The Obama administration is weeks away from a critical decision on whether to trigger mass production of swine-flu vaccine, which could affect the bottom lines of big vaccine makers as well as public health.
Besides determining whether a vaccine would be effective and safe, government officials and private laboratories will need to answer whether it makes sense to order hundreds of millions of doses and organize a mass vaccination campaign for a virus that, so far, isn't widespread and doesn't seem particularly lethal.
The New Jersey attorney general has announced a settlement with a medical device maker accused of failing to disclose financial conflicts of interest among doctors researching its products. The attorney general's office said it had issued subpoenas to five major device makers, although it did not publicly identify the companies.
The nation's cosmetic surgeons are being hurt by the sagging economy, but hope is rising. The first competitor to Botox was approved last week and there are potentially revolutionary new treatments on the horizon, including stem cell injections and a cream that can remove unwanted facial lines. The number of cosmetic procedures in the United States last year fell 12.3% from 2007, to just over 10.2 million, according to the American Society for Aesthetic Plastic Surgery.
Two annual government reports show that progress in improving the quality of healthcare and narrowing health disparities among ethnic groups remains agonizingly slow, and that patient safety may actually be declining. One of the reports, compiled by the Agency for Healthcare Research and Quality, found measurable improvement in fewer than half of the 38 patient safety measures examined. The agency concluded that one of every seven hospitalized adults on Medicare had experienced at least one adverse event, calling the finding "disturbing." A separate report on healthcare disparities noted some improvements in closing the gaps between ethnic groups but found little progress in addressing the most glaring differences.
At the Senate Finance Committee roundtable hearing on expanding healthcare coverage on Tuesday, Sen. Charles Grassley (R-IA) summed up the tempo of the day when he said "there are no easy issues when it comes to coverage."
In comparison to the first roundtable two weeks ago on reforming the delivery system, discussions veered back and forth on public and private solutions—under a variety of different names.
Sen. Deborah Stabenow (D-MI) brought up the term "consumer driven public plan," which focused on support of a public insurance option. Sen. John Cornyn (R TX) responded by nicknaming it the "Washington directed unfair competition" plan.
And Sen. Charles Schumer (D-NY) introduced toward the end of the three-hour hearing his "Plan USA" that looked to shift the committee's discussion from whether to create a public health insurance plan to how a public plan could work.
"We don't want the public plan to be the same as the private plan. There are certain advantages that the public side has . . . [but] it is almost like you're saying let's preserve advantages of private plan but not of public plan," Schumer said. "Let them compete."
Some Hill observers view the Schumer plan as a compromise to help bind up the disagreements between Democrats and Republicans over public plans dividing the Finance Committee. Without some type of agreement, the panel could be held up from having a bill completed by June, as desired by Chairman Max Baucus (D-MT).
Under the Schumer proposal outlined at the hearing, any public plan discussed:
Should be self sustaining--paying claims only with money raised from premiums and copayments.
Should pay physicians and hospitals more than what Medicare pays.
Should not compel physicians and hospitals to participate in a public plan just because they participate in Medicare.
Should have separate officials who manage a public plan and who regulate the insurance market.
Should be required to establish a reserve fund, just as private insurers must maintain reserves to pay claims.
Should be required to provide the same minimum benefits as private insurers.
But discussion turned also to regulation of the current healthcare system. Surprisingly, this was brought up by America's Health Insurance Plans (AHIP), which represents the country's manage care organizations. It had noted in its testimony that "a new public plan" was not necessary to achieve healthcare reform.
Instead, AHIP's President and CEO Karen Ignagni acknowledged that it's "radical for an industry working in a market" to say "renovate the rules," and "here's the road map," she said.
"In our proposals, we have recommended a full-scale reform and complete overhaul of the rules associated with the individual market," she said.
The problem that health insurers have faced over the years is that people in the individual markets generally have waited until they needed insurance to purchase, Ignagni said. "So we stepped back and said how do we solve this problem?"
AHIP's proposals were to: "guarantee that everyone gets insurance coverage; nobody falls through the cracks because of preexisting conditions; and no health status rating would be placed on an individual so that no one would be discriminated against or penalized because of their prior healthcare status.
"This would level the playing field . . . This would be wholesale reform," Ignagni said.
Four years after the Patient Safety and Quality Improvement Act of 2005 authorized the creation of Patient Safety Organizations (PSO), hospitals can now join a PSO of their choice. Ultimately, what this provides hospitals around the country is a chance to receive stronger data analysis and solutions surrounding quality- and patient safety-related errors, enabling them to create better systems for patient care.
Many hospitals already have event reporting systems, allowing data analysis at a hospital or hospital system level to occur, and some states also have reporting systems. But PSOs allow for data aggregation and trending to occur at a broader level.
"Once PSOs receive [patient safety work product (PSWP)], it's not just holding it, but really beginning to do some analysis and providing information back to the hospital or provider so that they can use the information to implement new solutions," says Amy Helwig, MD, MS, medical officer at the Agency for Healthcare Research and Quality (AHRQ), which oversees the PSO system. "The PSO can provide the expertise in looking at different types of patient safety event information and help guide the hospital."
The final rule, which was issued November 21, 2008, and went into effect January 19, 2009, stipulates which types of organizations can become PSOs and details the system that must be set up between the PSO and the facilities with which it has contracted. Those hospitals and hospital systems that have contracts with PSOs can provide data to PSOs in the form of PSWP. Data considered PSWP must be identified as such by the facility.
PSWP can be collected or translated by a hospital or PSO into what the AHRQ has termed "Common Formats" so that all data a PSO receives are standardized and can be easily compared.
Those data can then be aggregated, analyzed, and sent back to the provider. In addition, if the data are made nonidentifiable, they can be sent to the Network of Patient Safety Databases, a central location where PSOs around the country will share data. PSOs supply analyzed data and solutions to individual providers based on their own data, as well as the pool of data shared across organizations with which the PSO has contracted.
Data protections offer many benefits
In addition to aggregation of PSWP, the PSO system affords PSWP certain protections. These legal protections allow any adverse event–related data identified by providers as PSWP to be sent to a PSO, making the data flow confidential. These protections were set up to encourage organizations to share data from more serious events and near misses so the industry as a whole can benefit, says Helwig. The Office for Civil Rights is responsible for enforcing the final rule.
One of the things that has prevented this data flow in the past was the lack of protections given to data surrounding adverse events, says Ken Rohde, senior consultant at The Greeley Company, a division of HCPro, Inc., in Marblehead, MA, which has partnered with Peminic, Inc., to create the Peminic-Greeley PSO.
"People from one hospital were not real comfortable sharing their problems with people from another hospital because of the risk of liability, discovery, and litigation," says Rohde. "As part of the PSO process, there is increased confidentiality and protection of the data to help facilitate people's willingness to share the data, and once we share that data and aggregate it, it reduces our cost of learning. This approach is really not new; many other industries, even competitive industries, have shared their occurrences and problems in order to help them move forward more effectively."
