A Colorado company that approved a fake medical study in a congressional sting operation said it will close, according to the Wall Street Journal. Coast IRB said the disclosure of the sting and an April 14 warning letter from the Food and Drug Administration describing the company's violations led several high-profile customers to pull their business. As a result, "Coast IRB's owners decided, through counsel, to cease future company operations," a company statement said.
A Colorado doctor was sentenced to nine months in jail for practicing medicine in California without a license when he prescribed a generic form of Prozac over the Internet to a Stanford student, who later committed suicide. Christian Hageseth, 68, pleaded no contest to the felony charge in February in San Mateo County Superior Court. Judge James Ellis granted prosecutors' request for a jail sentence, which Hageseth will serve in Colorado while recovering from heart surgery.
E-prescribing jumped 61% in the first quarter of 2009, according to a survey by Surescripts. "In the past two years, the U.S. has gone from 19,000 to 103,000 prescribers routing prescriptions electronically—punctuated by 39% sequential growth in prescriber adoption in the first quarter of this year," said Harry Totonis, president and CEO of Surescripts.
When Deb Howard, 42, of Kingwood, TX was discharged from the military in 1992, she was given eight years' worth of her paper medical records in two tattered and worn out folders. And although the records include valuable health information, including every illness with which she had been diagnosed and every drug for which she had been prescribed during her military career, she says she has no idea where those records are now.
Upon retirement, Howard's husband, a 24-year military veteran, was also given his paper medical record, much of which was illegible and incomplete, Howard says. She says she has watched him carry those records from appointment to appointment ever since.
That's because currently there is no comprehensive system in place that allows for a streamlined transition of healthcare records between the Department of Defense (DoD) and the Department of Veterans Affairs (VA).
Like many other veterans, Howard and her husband must recall in detail their medical histories or simply carry paper medical records to their civilian doctors.
Sounds a bit archaic, right? This process seems especially ineffective, given the often long-term effects of diseases and injuries that veterans acquire or sustain during the course of their careers.
And it's also inefficient. "It's about avoiding unnecessary duplication and wasting valuable time," says Margret Amatayakul, RHIA, CHPS, CPEHR, CPHIT, FHIMSS, president of Margret A. Consulting, LLC, in Schaumburg, IL. "If one provider asks a patient about his or her condition and treatment to date, why shouldn't the next provider have that information?"
When patients must verbally repeat information about their own medical health, providers run the risk of receiving incomplete or inaccurate information on which they could base a potentially harmful decision.
But all of this may soon change as the DoD and VA begin to work together to create a new joint virtual lifetime electronic record that will track veterans' health information from the day they enter the military, throughout their military career, and even after retirement.
The project is a step in the right direction, given the national push for EHRs and interoperability under the American Recovery and Reinvestment Act of 2009. Securely sharing information is the wave of the future, and it will most likely foster more efficient, effective, and personalized patient care than we could ever begin to imagine would be possible today.
"When a member of the armed forces separates from the military, he or she will no longer have to walk paperwork from a [Defense Department] duty station to a local VA health center," President Barack Obama said in the article. "Their electronic records will transition along with them and remain with them forever."
The need for a more streamlined process is critical in terms of patient care and research into new ways to afford active protection and treatment, says Amatayakul. "Hopefully, it should go a long way to solving the problem, although some veterans are treated in private hospitals, which may be more challenging to integrate."
However, universal integration is what will truly make a difference in veterans' lives and healthcare, says Joe Cruz, healthcare technology consultant in Chesterfield, MO. "Unless you enable universal exchange of data, then you will still be missing critical pieces of that military members' chart from when they were seen or provided care at a commercially contracted hospital or private physician," he says.
The DoD contracts out much of its healthcare to private hospitals when its own facilities are either too remote or when the patient volumes do not justify providing certain services, Cruz says. The ideal goal of the project should be to devise a truly interoperable longitudinal record that can accept data from and send data to disparate systems, including a DoD facility, VA hospital, contracted commercial hospital, or TRICARE contracted private physician's office, he adds.
Howard admits that having a centralized record would ease the burden of having to carry paper information to appointments or recall years' worth of personal health information. "The bottom line is that if all your information was located in one place at the touch of your finger tips in any doctor's office across the country, I think your individual care would be better," she says.
The joint virtual lifetime electronic record will hopefully serve as a model for a national EHR system, Amatayakul says. For now, the DoD and VA are logical agencies with which to begin the process because they are both under the federal government's jurisdiction and are mandated to adopt electronic records, she adds.
The White House has not yet released details of how the DoD and VA will achieve lifetime electronic record; however, the administration has stated that the project is part of an overall increase in funding for the VA that includes $25 billion over the next five years to honor the nation's veterans and expand the services they receive.
Lisa Eramo, CPC is a senior managing editor in the health information management division of HCPro, Inc. She is located in Rhode Island and writes content for the company's flagship newsletter, Medical Records Briefing. Contact her at leramo@hcpro.com.
A controversial proposal to tax California hospitals in order to garner as much as $3.6 billion in additional federal Medicaid matching funds recently died because the hospital leaders couldn't agree on how much each facility should be assessed.
The California Hospital Association proposal would have imposed a so-called "provider fee" on most of its 450 member facilities based on patient bed days. As much as $1.8 billion generated would be sent to the state, which would use it to collect the matching funds. The money would in turn come back to the hospitals in the form of higher Medicaid payments.
But CHA officials say they are regrouping to consider other strategies that will be less divisive, echoing a trend among health providers in many other states who have adopted or are considering similar taxes because they are desperate to find more money for dwindling coffers.
Without such a tax, the federal match would be left "on the table," CHA President C. Duane Dauner says in an April 3 statement, because California's general fund doesn't have anywhere near enough money to put up the amounts required.
California officials said they have budgeted $40.5 billion in total funds for the Medi-Cal program (the Medicaid program in California), with $20 billion attributed to federal matching funds. The $40.5 billion is allocated for a variety of Medi-Cal services, from mental health to nursing care.
"We remain interested in increasing Medi-Cal reimbursement rates and recognize that provider fees are a means toward that end. We continue to be willing to work with hospitals and other providers to address Administration concerns and anticipated federal interests," says Department of Health Care Services Director David Maxwell-Jolly.
California hospitals have a critical need to get more money to take care of 6.5 million patients enrolled in Medi-Cal. In 2008 alone, hospitals "lost more than $3.8 billion in unpaid" Medicaid costs, Dauner says.
"This is the state's responsibility to come up with this money," adds Jan Emerson, spokeswoman for the CHA. "But that's not going to happen. And if we don't do this, look at all the money we're not going to get."
She points out "California is dead last in the country" in Medicaid payments per enrollee, spending a mere $847 per adult annually, according to Kaiser Family Foundation research. That's because for years, "the state has been unable or unwilling to put up all the federal money to get back what we're entitled to," she says.
Nationally, provider taxes are in place in 43 states to varying degrees and growing, despite initial reluctance to embrace them. They are imposed on hospitals in 22 states (up from 19 in 2008), on skilled nursing facilities in 34 states, on managed care organizations in 15 states, and on intermediate care facilities in 31 states.
Mary Kahn of the Center for Medicare and Medicaid Services says her agency must approve each state's plan to use that revenue as its state share of Medicaid costs, adding that Illinois, New York, Missouri, Kansas, Idaho, and Oregon are among those that have hospital-based taxes in place.
The crux of the issue in California, and many other states where provider tax plans have not succeeded, is the direction of the flow of money required by law. Federal rules specify that what each hospital contributes in taxes cannot dictate what they receive back in Medicaid payments. That means private hospitals with few Medicaid patients might contribute more than they eventually receive while public hospitals, such as the University of California system, would receive much more than they contribute.
In California, some hospitals would be "net contributors" or losers, while others would absorb what one hospital official called "windfall profits" amounting to tens of millions of dollars.
Distribution of funds is also a stumbling block in Pennsylvania, where the governor's provider tax proposal won support in the city of Philadelphia, where 16 hospitals treat large numbers of Medicaid patients. But the plan is heatedly opposed by the Hospital and Healthsystem Association of Pennsylvania, which represents nearly 200 hospitals throughout the state, many of which have low numbers of Medicaid patients.
"We oppose provider taxes on hospitals because the [matching funds they produce] are redistributed, and we don't believe it's the proper way to fund the Medicaid program," says Jim Redmond, the Pennsylvania association's senior vice president for legislative services.
While for some hospitals, the plan means coming up with 50 cents, and getting $1 back, Redmond says, “for others, it means giving the state 50 cents, and then watching the state give it to a competitor.”
Pennsylvania association spokeswoman Julie Kissinger adds that many Pennsylvania hospitals “are suffering incredibly as a result of the economic recession. To add a tax on them at this point would be simply devastating.”
The Philadelphia version is still under CMS review.
But many other states are desperate for funds, and are considering the idea or have already adopted it.
“States are looking very aggressively for ways to raise money,” says Molly Collins of the American Hospital Association. “A provider tax is one way to do that.”
In Maryland, where most hospitals take care of Medicaid patients, a hospital provider tax was launched successfully this year. Hospitals supported it “because it allowed the state to expand Medicaid” acquiring an additional $40 million for expanded Medicaid coverage and funding for the state health insurance program for those difficult to insure, says Nancy Fiedler, spokeswoman for the Maryland Hospital Association.
Last month, Colorado lawmakers gave preliminary approval to a provider fee amounting to 3% of hospitals’ total patient revenue in order to bring $1.2 billion back to the state healthcare system. An article in the Denver Business Journal last month quoted Rep. Cory Gardner, R-Yuma, saying he’s worried that affluent hospitals will bear the brunt of the cost. “It’s clear who will pay, he said. He called the plan a “legislative colonoscopy.”
In Washington state, health officials orchestrated a broader based tax generating “hundreds of millions” of dollars not just on hospitals, but on health insurance companies, cigarettes, and liquor, says Leo Greenawalt, president and CEO of the Washington State Hospital Association. “The money not only increased the federal match, but it also included a large subsidy for a health insurance program for the working poor, allowing small businesses to purchase health insurance for their employees at a very subsidized rate,” he says. “It also funded coverage for nearly every uninsured child in the state and care for pregnant women.”
Some hospitals “resented” the fact that public hospitals were exempt from being taxed, Greenawalt says, and in the end, the association board vote was not unanimous.
In California, meetings held to discuss the issue were allegedly so tempestuous, hospital officials spoke only on background. The now languishing proposal would have imposed taxes ranging from $50 on Kaiser hospitals per patient bed day to $250 for some other nonprofit hospitals. Care for indigent and Medi-Cal patients would also be taxed, according to hospital officials who said they saw the tax allocation chart.
Plus, hospital chiefs worry the state would use the money on roads and jails instead of healthcare, that fees would change in year 2, that funds would not support other providers, such as physicians, or that the state would demand more time-consuming hospital public disclosure.
The CHA’s Emerson says she doesn’t know if the plan will ever materialize, but there’s more money at stake this year in matched dollars because of federal stimulus funds. “It’s all back on the table,” she says. “There’s a continued commitment to explore it.”
The Florida House has overwhelmingly voted to restructure the panel that recommends how to distribute roughly $2 billion a year in Medicaid money. The proposal by Rep. Jimmy Patronis would revamp the Low-Income Pool Council. The panel was created in 2005 to advise the Legislature on the distribution of Medicaid funds. Miami-Dade County currently contributes more money than any other local government. But this session, groups such as the Hospital Corp. of America and federal health clinics have pushed to change the makeup of the council, arguing for more transparency.
A new federal subsidy designed to help laid-off workers pay for health insurance could be out of reach for thousands of jobless workers because they worked for a small company or their former employer has gone out of business. The subsidy, part of the economic stimulus package, covers 65% of COBRA premiums for individuals laid off between Sept. 1, 2008, and the end of this year. The subsidy is available for up to nine months.
Years of verbal volleys, grabs for physician practices, and disputes over reimbursement rates came to a head this week as the West Penn Allegheny Health System filed suit in federal court against rival University of Pittsburgh Medical Center and insurer Highmark. West Penn Allegheny accuses UPMC and Highmark with antitrust violations that it says have illegally raised prices for consumers in the region while trying "to destroy West Penn Allegheny." The suit lays out various acts against West Penn Allegheny dating back to 2002 that health systems officials say were meant to ensure Highmark's continued dominance in return for higher payment rates for UPMC and Highmark's help to "eliminate" West Penn Allegheny.
Aetna Inc. Chief Executive Ronald A. Williams got $3.14 million in compensation for 2008 and was awarded stock rights that could be worth an additional $10 million, the company disclosed. The compensation information was reported in the proxy filing for Aetna's annual shareholders meeting May 29.The proxy said Williams' compensation was based in part on Aetna's "superior operating performance" and his leadership in differentiating the company from its competitors by launching new products and services and expanding health information technology.
Layoff notices went out to 60 employees of Ministry Health Care, which operates hospitals, clinics, and other medical services in central and northern Wisconsin. Saint Joseph's Hospital in Marshfield got the most layoffs, with 23 workers put on notice.
