Officials with Williamson Medical Center and Saint Thomas Hospital have broken ground on the 45,000-square-foot Tollgate Village Medical Pavilion in Thompson's Station, TN. In the joint venture, the two hospitals are coming together as Williamson Saint Thomas Community Health LLC and will share 30,000 square feet in the three-story building. The remaining 15,000 square feet will be available for custom-designed medical office suites. The facility will house an urgent-care clinic, women's health services center, a sleep lab, primary-care physicians, physical therapy and imaging as well as dentistry, orthodontics, dermatology, pediatrics and orthopedics.
Fewer Tennesseans are without health insurance than a year ago, according to a study by the University of Tennessee's Center for Business and Economic Research. The study found that the estimated number of state residents without health insurance dropped to more than 566,000, or 9.3% of the population. The study credits the decline, in part, to the growth of CoverTN, a state healthcare program that began in 2007.
Despite a sagging economy, one of Tennessee's health insurance programs for low-income residents will expand benefits next year without raising premiums, Gov. Phil Bredesen said. On the same day, healthcare advocates leveled sharp criticism at Bredesen's administration for cutbacks to home nursing services, a change expected to affect as many as 1,000 people with severe disabilities who could be forced into nursing homes. The differing directions of the two programs illustrate the administration's path in trying to provide affordable health coverage while keeping costs down, sometimes raising the ire of those facing cuts.
In developing countries, a scarcity of doctors and trained nurses means there is often no helping hand in times of healthcare need. The health crisis in developing countries is being exacerbated by the West as countries relax stringent immigration regulations to attract doctors and nurses from less developed countries to boost their own flagging health systems while saving money on expensive training, some experts say. This "brain drain" leaves gaping holes in the healthcare systems of developing countries where diseases such as AIDS, tuberculosis, and malaria run rampant and children die daily from diarrhea.
Scores of novice doctors attended a job fair in late September in Manhattan that featured chamber of commerce brochures from small towns and rural areas throughout New York state. Many of the doctors had come from abroad on visas, including the restrictive J-1 exchange visa, which requires them to return home for two years once they finish their studies unless they can get a waiver to work in a medically underserved area. New York state recommends about 30 doctors for J-1 visa waivers annually, and typically half of the visas go to doctors working in urban neighborhoods and half to upstate communities that do not have enough physicians.
The University of Colorado Hospital plans to close its inpatient psychiatric ward in January in order to offer services to other patients, such as those in need of cancer care. The currently 18-bed unit will convert to 22 beds, which officials predict will increase admissions to about 300 annually. The hospital's outpatient psychiatric services will remain unchanged.
A nearly 200,000-square-foot expansion of St. Francis Hospital-Mooresville's emergency department is now complete after years of planning and construction—this is the last piece of the hospital's $42 million overall expansion project. Officials expect the new, larger facility will eliminate delays for patients seeking urgent care.
Northern Kentucky-based St. Luke Hospitals' Nancy Kremer will end her tenure as president and CEO at the close of a merger with St. Elizabeth Medical Center next month. Kremer has agreed to stay on until the deal, which will partner two of the state's largest healthcare systems, is finalized to ensure a smooth transition.
The AMA estimates that up to a quarter of practicing physicians in the United States received medical training abroad. Many of these are foreign doctors who sought visas in order to earn a more comfortable living in a developed nation. For emerging countries, physician brain drain continues to be a serious public health concern. But more recently, critics have emerged complaining about the threat of brain drain from private health systems within developing countries.
The thinking by some goes that physicians in Thailand, India, or Singapore are enticed to take on more patients in budding private hospital settings where they can get paid at a higher rate than in public hospitals and clinics.
But I've often wondered what the alternative would be if these physicians didn't have the option to practice in a private health setting. I've heard anecdotally that physicians in India, for example, are more inclined to practice in their homeland nowadays because they not only receive better reimbursement from the growing private health sector there, but also because they are excited to be part of the region's healthcare story.
"I have 200 physicians who wouldn't even be here if Bumrungrad didn't exist," says Bumrungrad International Group Chief Executive Officer Curtis J. Schroeder. "They wouldn't be in Thailand; they wouldn't be servicing Thais at all."
I had a wide-ranging phone conversation with Schroeder last week. He says that many of the physicians he has on staff also work and teach in government hospitals and take care of the poorest members of the Thai society.
As the largest private hospital in Southeast Asia, with 554 beds and more than 30 specialty centers, Bumrungrad clearly has a lot to gain by partnering with the best physicians in Thailand. It is, after all, the physician-patient relationship that is at the center of the system's care model that has earned Bumrungrad's international reputation for service excellence.
The Bangkok hospital reports that it cares for about 400,000 international patients annually—nearly half its patient population—but Schroeder holds firm that Bumrungrad isn't profiting at the expense of the Thai people. He points out that across Thailand only 0.3% of the healthcare delivered goes to non-Thais. Without the private sector to support Thailand's physician work force, it's likely that many would seek greener pastures in the West.
"A fully tenured professor of surgery at a major university in Thailand makes about $600 a month," says Schroeder. "Now if we think they are able to buy their cars and take care of their kids for that, we're of course fooling ourselves. Virtually all of them have sources of income through the private health sector. It's a well-known public-private subsidization."
Entrepreneurs continue to develop private health systems in emerging markets, serving international patients as well as the rising middle-class that suddenly can pay for better healthcare options. No doubt the goal of profitability is not lost on the CEOs of these hospitals, but through physician recruitment and retention efforts, perhaps these regions will be all the better because of these private networks.
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Think the new tamper-proof prescription rules don't affect e-prescribers? Think again.
Tomorrow is the deadline by which all written Medicaid prescriptions must be on tamper resistant pads. Although proponents of e-prescribing have added the new guidelines to the laundry list of benefits of switching from paper to computer (since the rules don't apply to electronic, faxed, or telephone prescriptions), in most cases e-prescribers and electronic health record-users will still have to make some adjustments to their prescribing practices.
While it's true that the Centers for Medicare and Medicaid guidelines do not apply to electronic prescriptions sent via fax or computer directly to the pharmacy, there are still a good number of instances in which an e-prescribing physician will need to print the prescription out and hand it to the patient, says Peter Basch, MD, medical director of ambulatory clinical systems at MedStar Health.
"Physicians still must print prescriptions for controlled substances, and there are those patients who would prefer a paper printout rather than the prescription being sent electronically to their pharmacy, or those who do not know the exact pharmacy where their prescription will be sent. And you can't post-date an e-prescription, so those patients that need their prescriptions filled at a later date will need a printout," he says.
Unlike their prescription pad-using counterparts, who can replace the old pads with new tamper-resistant pads from vendors, medical providers who e-prescribe would likely be forced to invest in expensive tamper-proof paper (standard printing paper costs—on average—less than a dollar per sheet, while tamper-proof paper can cost several dollars per sheet), and laser printers capable of printing to multiple trays at a high resolution. For an eight-hospital system like MedStar, Basch estimates that process would have cost $1.5 million upfront to become compliant, with ongoing costs of about $200,000 annually.
Basch, an early adopter of e-prescribing and a proponent of electronic health records, says he foresaw those costs becoming a barrier to adoption of e-prescribing and EHRs and decided to form a coalition to push for revised anti-tampering requirements that focus on using new print technologies, rather than using expensive tamper-proof paper, as originally mandated by Medicaid. "We are all for this change, but we want to do it in a way that works and a way that is consistent with the federal mandate by the president to encourage adoption of EMRs and e-prescribing. Our concern was, if you create a new barrier by adding tens of thousands of dollars to a physician's budget, you are sending the opposite message," says Basch.
The first, called a digital void pantograph, incorporates a hidden security word or image into the background of a computer printed prescription. The image will show up if the prescription is copied or scanned. The second, called microprinting uses a strip of minute type that can be read with a 5X magnifying glass or loupe. The type will appear smeared when photocopied on most machines. Neither of these technologies requires special paper or printers, says Bausch, eliminating the need for that potentially large upfront investment.
While Bausch says he's pleased that CMS and the NCPDP were able to come up with a less expensive, effective alternative to the government's original plan, the group's work is not done. He says within a short time-frame (read months, not years) the prescription information itself will become tamper-proof. "What we will do is make the information tamper resistant. The physician will send that information electronically to a network and print a receipt for the patient. The pharmacist can then check the patient's receipt against the stored information, if the two match, the prescription is filled."
Hopefully by now providers have already figured how to become compliant with the new guidelines, but if you're considering the move to e-prescribing or implementing an electronic health record, now might be a good time to talk to your suppliers about the latest print technology options.
Kathryn Mackenzie is technology editor of HealthLeaders magazine. She can be reached at kmackenzie@healthleadersmedia.com.
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