Hospitals have won a reprieve from a change in Medicaid regulations that would trim hospital payments by an estimated $5 billion over the next five years. Hospitals filed a federal lawsuit in March to void the regulations, and U.S. District Court Judge James Robertson voiced exception to procedures that federal health officials used to put the regulations into effect. The ruling set aside the regulations, and hospitals officials who filed the lawsuit said it's now up to the Bush administration to decide whether to republish the rule.
Critics say a recent spike of hospital consolidations in Illinois could translate into rising prices as these bigger institutions gain more negotiating clout with health plans and self-insured employers. The hospitals say they are thinking of consumers by coming together to become more efficient in the face of reductions in spending by government insurers and rising numbers of uninsured. Independent hospitals also say they can better afford capital improvements and new technology if they are part of a larger, cash-rich system. But Illinois' largest health insurer said it has not noticed lower costs from hospitals once they become part of larger organizations.
Whether there are enough doctors to care for patients, particularly if the nation moves toward a new scheme for universal health coverage, is the elephant in the room of the presidential campaign debate on health reform, says Joseph B. Martin, PhD, in his column for the Boston Globe. The solution will require educating doctors and care givers in new collaborative ways, as well as developing new models of healthcare delivery that focus on teamwork, he says.
Patients in the Czech Republic can now see a doctor for about $1.85, and a day in the hospital can verge on $4. This is not cause for celebration. Czechs visit their doctors more often than anyone else in Europe, and the prices have led to great outrage. All countries struggle with how best to provide affordable healthcare to their citizens without breaking the bank, and in places like the Czech Republic the state long took care of them. Now, there is a sense of betrayal due to the fees because many Czechs see it as a matter of principle that healthcare should be free.
The Securities and Exchange Commission has told companies they must allow shareholders to vote on a proposal for universal health insurance coverage. Shareholders have offered the proposal in an effort to draw the nation's largest corporations deeper into a debate over the future of healthcare. The SEC has told Boeing, General Motors, United Technologies, Wendy's International and Xcel Energy that they may not omit the healthcare proposal from their proxy materials. This surprised many executives, who said the agency had allowed companies to exclude similar proposals in the past.
The National Nurses Organizing Committee has joined forces with Concerned Citizens of Broadlands in fighting the HCA proposal to construct the proposed Broadlands Regional Medical Center in Virginia. The Concerned Citizens of Broadlands and the nurses union said they would prefer to see a hospital built in another location, where it would have less impact on residents. The union has also formed the HCA RN Network to protect HCA nurses from what representatives said are poor working conditions.
A partnership between Austin, TX, hospitals, government groups, nonprofits and the Travis County Healthcare District is working to alleviate a severe shortage of psychiatric beds and a shortage of psychiatrists willing to see inpatients.
The shortage has resulted in psychiatric patients landing in emergency rooms where there are no contracted psychiatric consultants and where physicians have little experience with anti-psychotic drugs, hospital officials say.
Jim Van Norman, MD, medical director of Austin/Travis County Mental Health and Mental Retardation Center, says the county has recently been able to contract for 11 beds per day at two private non-profit psychiatric hospitals, funded by $3 million from the healthcare district. That is in addition to its allocation of 63 beds per day at the Texas State Hospital. Van Norman says that is still about 65 beds short of what is needed for Travis County's population of nearly a million.
During 2006 and 2007, the county used significantly more than its allocated inpatient days at the state hospital, garnering itself a $2.5 million bill for the excess coverage. Recently, the state has waived those fees because the coalition added 11 beds at Seton Shoal Creek Hospital and The Lakes, located adjacent to St. David's Hospital. Travis County MHMR has also launched an Integrated Behavioral Health Program, funded by St. David's Foundation, at People's Free Clinic, a non-profit primary care center in Austin. They also created a mobile crisis team to help head off the need for inpatient care.
Van Norman says mental health services in the county have suffered from chronic under-funding exacerbated by explosive population growth, a situation made worse by the fact that none of the city's general hospitals have inpatient psychiatric beds. "That's in striking contrast to most counties," says Van Norman. Also, Travis County has a shortage of psychiatrists, and many of those practicing in the county do not see hospitalized patients.
Trish Young Brown, president and CEO of the healthcare district, says the coalition is focused on finding the money to pay for 27 new beds, which could be available at The Lakes and Shoal Creek. The Department of State Health Services has awarded the county a $1.9 million grant for 2008, and those funds are expected to be ongoing, says Young Brown. That leaves another $5.1 million needed to fund the 27 beds. "That's a big gap. And that's if we can find psychiatrists and psychiatric nurses to staff the beds," says Young Brown.
Currently, inpatient psychiatric coverage at Shoal Creek is provided by the faculty and residents in the Austin Graduate Medical Education program. "We hope to increase the number of residents in the near future, to add more psychiatrists to the Austin area," says Young Brown.
Texas-based JPS Health Network has appointed Senior Vice President Robert Earley, a former state representative and healthcare consultant as interim chief executive. Earley said he will listen to JPS board members, the medical staff and taxpayers in determining how to move the public hospital forward. Recent revelations have roiled the taxpayer-financed healthcare system, particularly concerning scathing reports by Houston-based consultant InSight Advantage.
Several big insurers are stepping up efforts to sell coverage to Nevada's uninsured with plans offering individual policies that let consumers elect higher deductibles and savings accounts, among other components, to lower premiums to as little as $54 a month. Observers say the expanding individual-insurance market is due to the rise in the number of companies that have pared coverage as a result of double-digit cost increases. When employees aren't losing coverage altogether, they're facing restricted plans that don't insure dependents and are seeking other options, said Ellen Laden, a spokeswoman for Golden Rule Insurance Co., a UnitedHealth Group subsidiary.
This week Google released the much-touted Google Health, an online resource for organizing personal healthcare information. As a healthcare journalist, I've eagerly awaited the unveiling, but as a patient and healthcare consumer, I'm skeptical.
In theory, online health records like this are supposed to help my doctors coordinate care, improve communication between caregivers, eliminate risk of medical errors, and ultimately reduce the cost of care, but I'm just not sold.
How can I really be sure my information is safe? I know this is the most basic of questions, and Google has attempted to answer it in a privacy policy. But if history is any indication, online information isn't safe.
In March, a Maryland dental group accidentally posted the names, addresses, and Social Security numbers of 75,000 members on its Web site.
In April, WellPoint announced that protected health information for about 130,000 members had somehow become publicly available on the Internet.
And, earlier this year here in Massachusetts, 4.2 million credit and debit card numbers were stolen from Hannaford Brothers, our local grocery chain. Now everybody knows about my box-a-week Grape-Nuts habit.
I'm sure all these companies had privacy policies, too. So, if the Social Security Administration and the Internal Revenue Service can't protect me, sorry, Google, I don't have much faith in you.
Who will enter all that data and update it going forward? Entering 30+ years of medical history into a format that I'm not sure my doctor will use seems an arduous task. Google hopes to ease that burden by partnering with labs and physicians, who, I guess, will enter my information for me (at least going forward).
I can't get a complete copy of my paper records from my doctor's office without a lot of phone calls and a $15 fee for photocopying. So I'm not confident that they'll be diligent about updating my record. That said, I married almost two years ago and half of my credit cards are still in my maiden name. I'm not sure I'll be very good at updating my records either.
Who will ensure the integrity of my health record? Forget entering the data; who will double-check that it's right? What if I mistakenly say I take a medication only once a day when I actually take it twice? Will anyone correct that? And does it even matter?
How do I know I'm not just playing into Google's corporate hands? I know, I know, Google would never sell my private information to a third-party vendor. But, how do I know three years from now they won't sell my e-mail address? And Google's privacy policy does leave room for interpretation if, for example, Google Health is sold in five years (in which case, they will "provide notice before personal information is transferred and becomes subject to a different privacy policy").
Will this really help the people who need it? While I'm not eager to enter three decades of health history into a Web site, I'm confident that I can tell you every detail, year by year. The people who can't do that—my parents and grandparents, for example—may not be willing or able to update it on a Web site. Just today I called my father to ask if he'd ever had an endoscopy (long story). He couldn't remember. But he also can't get his new laptop to print and he doesn't know how to reply to e-mails. Something tells me he won't be on Google Health this week, entering his health data.
Before you e-mail me, explaining why all of these concerns are baseless and naïve, let me clearly say that I am not a techie. But neither is most of America.
Online health records, for all their potential, can create a lot of problems for healthcare leaders. Although they're supposed to save money for hospitals, insurers, and employers, they also create new challenges and a lot of questions. So, before you blindly embrace Google Health (and other online resources), make sure you're prepared to answer all the questions—from patients, physicians, the board, and your staff.
Molly Rowe is leadership editor with HealthLeaders magazine. She can be reached at mrowe@healthleadersmedia.com.
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