Neither presidential candidate was viewed as having a complete plan to deal with problems in the nation's healthcare system, during a panel discussion moderated by Tennessee Sen. Bill Frist prior to the presidential debate. Charles "Chip" Kahn III, president of the Federation of American Hospitals and one of the panelists in the discussion, said Democratic candidate Sen. Barack Obama has presented "a bunch of ideas, but I'm not sure where he's going with it." Sen. John McCain, the Republican candidate, leaves uncertainities about coverage, Kahn added.
A new report from the New Hampshire Center for Public Policy Studies says the healthcare industry plays a major, and growing, role in the state's economy and is one of the leading sources of jobs. The report says hospitals often are the largest employer their labor market, and that by 2016 healthcare could account for one out of every nine jobs in the state. The group also suggests the increasing importance of healthcare to the economy and the growing cost of insurance create a public policy dilemma.
The risk and number of errors during biopsy analysis can be drastically reduced by instituting labeling systems for specimen bottles, according to a study conducted by the Mayo Clinic. The Clinic is now proposing that busy labs add radio-frequency identification tags to track and automate identification of biopsy specimens taken during gastrointestinal endoscopic procedures. RFID tags can be applied to or incorporated into an object so that it can be identified by using radio waves.
Few doctors are adequately prepared to help patients navigate "consumer-directed" health plans, according to a survey. The plans are meant to shift more responsibility for healthcare decisions to the individual patient, and often come with high deductibles and include a health savings account. But 43% of doctors surveyed said they have heard little, if anything, about these plans, and less than half feel ready to discuss medical budgeting with their patients. "I think as these plans roll out, it's really important to educate doctors about (them) and about some of the differences between these plans and more traditional models of insurance," said study co-author Dr. Craig Pollack, a Robert Wood Johnson Foundation clinical scholar at the University of Pennsylvania in Philadelphia.
Here in the U.S., the big news is that the financial crisis pushed the Dow Jones Industrial Average below 10,000 yesterday for the first time in four years, but the damage has hardly been limited to Wall Street.
Indeed, the world economy is bracing for a protracted recession, and the New York Times today reports emerging markets took their biggest tumble in a decade.
When the economic outlook points to scarce credit and frightened consumers with less cash on hand, how does a global destination healthcare provider determine whether this is a time to scale back growth projections or exploit weaknesses in other regions?
When half of your business comes from outside your host country, like Thailand's Bumrungrad International, for example, you are exposed to the world's economic and geopolitical events.
"Since we are the hospital to the world, we are more affected by world events than totally local hospitals," Bumrungrad's Group CEO Curtis J. Schroeder told me in a phone interview recently. "Some of those are positive, and some are negative. After the events of 9/11 in New York, we saw a complete shift in the Middle Eastern business from America and Europe to Asia, and we have been the prime recipient of that diversion of business and that drove us to open hospitals in the Middle East as well."
"[I]f something happens to the local economy that pushes down demand from Thais, I still have half of my business coming from the outside," adds Schroeder. "An example of that is when we had a devaluation of the Thai baht. The Thais were stressed, but we simply became cheaper to the rest of the world, so we were able to offset."
Certainly, global destination hospitals need to deal with the pros and cons of their diverse patient populations. For instance, the struggling U.S. economy could continue to pressure U.S. employers to aggressively cut healthcare costs, which are not showing signs of slowing down. As employers seek to limit costs, medical travel to value-based healthcare providers could become a more attractive option. For sure, employers are watching the early adopters of medical travel plans closely. Reports recently that Hannaford Bros. Co.'s medical travel benefit has led to cost cutting by local providers is sure to get the attention of other employers searching for strategies to force healthcare costs down.
In addition, with U.S. taxpayers funding a $700 billion bailout, any plans that either presidential candidate has for expanding health coverage in America will not likely happen in the next president's first term. Those who believe that America's 47 million uninsured represent medical tourism's best opportunity for future growth can be comforted in the knowledge that relief for uncovered Americans is nowhere in sight.
On the downside, global destination hospitals that support medical travel tend to count on service lines that provide elective procedures. With less cash and credit available to consumers, it is safe to anticipate they will forgo even necessary procedures, like spine care, hip, and joint replacement surgery, and bariatric surgery.
Although gloom and doom headlines jump off the business pages these days, the true picture of healthcare businesses that span the globe is complex and fluid. For sure, providers should expect to deal with a long-lasting recession, so it's the perfect time to analyze your organization's strengths and weaknesses in the face of a tough economy worldwide.
Note: You can sign up to receive HealthLeaders Media Global, a free weekly e-newsletter that provides strategic information on the business of healthcare management from around the globe.
Fairview Health Services has announced it is laying off 150 to 200 employees. Fairview is the owner of the University of Minnesota Medical Center, Fairview Southdale Hospital, and other medical facilities in the Minneapolis-St. Paul area, and representatives said the job cuts are across the board and will occur through October. The reductions represent less than 1% of the workforce, and Fairview is also cutting overtime and delaying some maintenance projects.
A federal jury has convicted Robert A. Urciuoli, former president of Providence, RI-based Roger Williams Medical Center, of corruption charges but acquitted another former hospital executive, Frances P. Driscoll. After deliberating for just over four days, the jury convicted Urciuoli of one count of conspiracy and 35 counts of mail fraud. A lawyer for Urciuoli vowed to continue the fight with an appeal.
With clinics and healthcare centers sprouting along U.S. Highway 27 in Florida, the area is being dubbed a "medical destination." Billboards and business signs line the highway advertising dozens of cancer-treatment and eye-care centers, chiropractors, dentists, and podiatrists. And these providers are attracting people from the area where Lake, Orange, Osceola and Polk counties meet. More than 100,000 people called this "Four Corners" home at the end of 2007. By 2020, it is estimated that the population will top 250,000, and the healthcare industry is booming as the population grows.
Cuyahoga County, OH, hopes to bolster the MetroHealth System's lean budget by offering employees $500 to sign up for a low-cost health plan with the hospital and its doctors. County government employees who pick one of two MetroHealth plans will have no monthly premiums or annual deductibles and pay only $5 for a doctor's visit. MetroHealth would benefit from the deal because more insured patients would be coming through its doors. The public hospital has struggled in 2008 because of the growing number of uninsured and Medicaid patients.
CMS announced the new Medicare Recovery Audit Contractors (RACs) for its permanent nationwide program Monday, October 6. The four contractors and their selected regions are:
Diversified Collection Services, Inc. of Livermore, CA: Region A, initially working in Maine, New Hampshire, Vermont, Massachusetts, Rhode Island and New York
CGI Technologies and Solutions, Inc. of Fairfax, VA: Region B, initially working in Michigan, Indiana and Minnesota.
Connolly Consulting Associates, Inc. of Wilton, CT: Region C, initially working in South Carolina, Florida, Colorado and New Mexico.
HealthDataInsights (HDI), Inc. of Las Vegas, NV: Region D, initially working in Montana, Wyoming, North Dakota, South Dakota, Utah and Arizona.
CMS said it chose the contractors and their regions based on three values:
A "best value determination" that includes a strong technical approach and "exceptional" customer service
Conflict of interest reviews
Lowest contingency fee
Connolly and HDI worked on the initial RAC demonstration project that spanned over six states, collected more than $900 million in overpayments, and returned nearly $38 million in underpayments to healthcare providers, according to a CMS press release.
PRG denied contract
CMS said it chose not to select PRG-Schultz (PRG), which had the lowest percentage of appeals overturned in the demonstration project (2.1%). CMS had awarded PRG the California contract. In a press release, PRG said it received one of the highest technical scores but was denied a permanent contract because of its high contingency fee bid.
Tanja Twist, director of patient financial services at Methodist Hospital in Arcadia, CA, said she is "very glad to see that PRG wasn't selected as one of the ‘Permanent 4' given their track record here in California." The California Hospital Association released a memorandum in July citing several concerns over PRG's work on inpatient rehabilitation facilities (IRFs).
Lowdown on returnees
CMS reports through June 30, 2008 that HDI led all contractors in the demonstration project with 239,205 overpayment determinations. Providers have been the most successful with appeals against HDI (11.5%). Connolly was second with 110,635 and had 4.2% overturned on appeals.
CMS did not release information on the two new RACs – Diversified Collection Services (DCS), Inc. and CGI Technologies and Solutions, Inc. However, the federal government is familiar with DCS. In fiscal year 2007, the government awarded them $36,590,770 in contracts, according to www.fedspending.org, the Freedom of Information Web site on government spending.
Getting prepared
Facilities need to plan immediately for the RACs' arrival, said William Malm, ND, RN, partner at Health Revenue Integrity Service LLP. Connolly, which had the New York contract in the demonstration project, and HDI, which had the Florida contract in the demonstration program, will not be in those states for the permanent program. So those providers in the demonstration states should be prepared for a different contractor in the permanent program.
The new RACs will begin to educate and inform providers later this month and in November about the program, CMS said. Kimberly Anderwood Hoy, JD, CPC, director of Medicare and Compliance for HCPro, Inc., said one of the new elements of the permanent program is the RAC Validation Contractor, which will approve issues for review by the new RACs. In addition, the contractors will create a Web site to post new topics the RACs are investigating.
NYU Medical Center worked with Connolly during the demonstration project. Robert Tipton, NYU's RAC liaison and its director of inpatient revenue cycle operations, said Connolly established a solid working relationship with the hospital during the process. Stacey Levitt, RN, MSN, CPC, director of patient care management at Lenox Hill (NY) Hospital, agreed.
"This might sound contradictory, as the RAC's primary function is to identify overpayments and potentially recoupment money from the hospitals," Tipton said. "But the reality is that the RAC is here to stay, and creating a working, professional relationship benefits both sides at the end of the day."
Editor's note: For more about the differences between the permanent program and the demonstration project, and to learn tips from providers who were part of the demonstration project, read the October 16 issue of The RAC Report.
This story first appeared as a breaking news item from the editors of The RAC Report, a biweekly e-newsletter from HCPro, Inc.
