For Republicans, the Saturday vote on healthcare in the Senate was the first skirmish in a longer battle aimed at frustrating White House ambitions and ensuring that Democrats bear full responsibility for legislation the GOP sees as increasingly unpopular with Americans. With the 2010 election year looming, Republicans forced Democratic leaders to demonstrate that they can pull together a 60-vote majority for the bill. All 58 Democrats and the two independents allied with the party joined together, voting to avert a Republican filibuster that threatened to stall action. The defeat isn't likely to cause a fundamental rethinking in Republicans' strategy of delaying the bill and pointing to what they see as its flaws. Even if a bill ultimately passes, Republicans hope to delay that moment until well into 2010—when all seats in the House and one-third of those in the Senate will be contested.
Most Americans don't expect healthcare overhaul to affect their lives directly, but those who worry about the fallout outnumber those expecting to come out ahead, according to a recent poll by the nonpartisan Robert Wood Johnson Foundation. The poll found that Americans are tuning in to the debate in Washington, with 60% saying they're following it very closely or fairly closely. Most see a change ahead for the nation, and they're divided on whether that will be for good or ill. But when it comes to their own personal lives, Americans say they don't expect much of an impact.
A group of part-time community college instructors filed a lawsuit against the commonwealth of Massachusetts, saying that hundreds of adjunct faculty in the state's public higher education system are unfairly denied healthcare coverage. The lawsuit, filed in Suffolk Superior Court on behalf of five instructors, follows nearly a decade of unsuccessful wrangling with state legislators to get an adjunct health insurance bill enacted into law. It also comes as schools, particularly community colleges, are increasingly turning to adjuncts amid burgeoning enrollment.
A new statewide survey by the Ohio Hospital Association found 18% of responding hospitals plan to lay off additional employees. The survey also found that about half of respondents plan to leave future vacancies unfilled, 39% plan to reduce or eliminate services, 49% plan to cancel or delay expansion or renovation projects, and 64% will take more cost-cutting steps.
Essent Healthcare said that it is consolidating acute care services offered by its Paris Regional Medical Center in Paris, Texas, at one campus. Under the transition to be completed by next fall, the North campus will become home to an emergency department, women's services, the Heart Hospital at Paris Regional, pediatrics, and labor and delivery among other operations.
The administrator and chief operating officer of the Pike County Hospital in Texas have been arrested on felony check charges for allegedly writing bad checks to a physician. Authorities say 61-year-old Robert Hicks of Oklahoma City and 63-year-old Arthur Clyde Benson Jr. of Richardson, Texas, wrote two checks for nearly $8,900 for salary payments to Dr. George Gray of Little Rock. Hicks serves as the chief operating officer for the hospital while Benson is the administrator.
Iowa's Medicaid program will be the first to receive federal matching funds for "planning activities necessary to implement" the electronic health record incentive program, which is part of the American Recovery and Reinvestment Act of 2009, according to CMS.
CMS called the awarding of $1.16 million in federal matching grants "another key step toward developing a robust" health information technology infrastructure.
"While Iowa is the first state to receive approval of its plan for implementing the Recovery Act's EHR incentive program, a number of other states have submitted plans as well," said Cindy Mann, director of the Center for Medicaid and State Operations at CMS. "Meaningful and interoperable use of EHRs in Medicaid will increase healthcare efficiency, reduce medical errors, and improve quality outcomes and patient satisfaction within and across the states."
Iowa will use the federal funds for planning activities, such as conducting a "comprehensive analysis to determine the current status of HIT activities in the state." The state will explore existing barriers to EHR use and provider eligibility for incentive payments, create a state Medicaid HIT plan, and gauge the need for consumer-managed personal health records, according to CMS.
The Recovery Act, which is also known as the stimulus package, provides a 90% federal match for "state planning activities to administer the incentive payments to Medicaid programs, ensure their proper payments through audits, and participate in statewide efforts to promote interoperability and meaningful use of EHR technology statewide, and eventually, across the nation," according to CMS.
Health insurers can breathe easier. The Senate health reform bill no longer includes a provision to wipe out health insurance companies' anti-trust exemption.
The proposed change would have stripped away insurers' anti-trust exemption, which is part of the McCarran-Ferguson Act, a 1945 law that allows states to regulate insurers without federal government interference.
Democratic leaders pushed the idea of taking away insurers' anti-trust exemption after America's Health Insurance Plans released a report last month that said Democrats' health reform proposals would increase health costs. Health reform proponents bashed AHIP for the report and questioned the findings.
Meanwhile, others have charged that the Democrats' plan to remove the exemption was a political ploy and a possible bargaining tool against the health insurance industry.
Robert Zirkelbach, director of strategic communications at AHIP, says health insurance is one of the most regulated industries in the country and McCarran-Ferguson Act "has nothing to do with the issue of competition within the health insurance industry."
"The focus on this issue was nothing more than a political ploy designed to distract attention away from the real issue of rising healthcare costs," he says.
To avoid "needless squandering of resources and significant disruption to the nation's healthcare system," federal officials must change the definition of "meaningful use" as it applies to health information technology implementation.
That's the concern expressed in a five-page letter released today from William F. Jessee, MD, president and CEO of the Medical Group Management Association, to David Blumenthal, MD, national coordinator for HIT for the U.S. Department of Health and Human Services.
"It is clear that the key goals of these health IT investments are to improve healthcare quality, control growth in costs, enhance the efficiency of healthcare administration, stimulate innovation, and ensure the privacy and security of patient information," wrote Jessee, who leads the MGMA, which has 22,500 members.
"At the same time that the definition supports these goals, meaningful use should also be verifiable without creating an undue burden on clinicians and physician practices" especially in the first year of implementation.
Jessee made 15 detailed recommendations for implementation that will help physicians better manage their time and improve quality. Among these are:
Focus criteria on value and achievability. Targets should be measurable. Goals for improving health should go hand-in-hand with the ability for physicians to integrate these measures into their workflow with minimal disruption or cost.
Don't impose arbitrary thresholds, such as the requirement that physicians report percentages of patients undergoing specific tests. "Physicians clearly cannot force patients to undergo tests which (i) may be physically uncomfortable for the patient, (ii) one that the patient objects to, or (iii) one for which the patient's health plan covers only part of the cost or none of the cost," he wrote.
Avoid imposing criteria that do not have widespread experience in small and rural clinical settings.
Select appropriate administrative criteria. "Those outlined do not take into account the reality of current practice workflow or the inefficiency of the current standards themselves," he wrote.
Institute a pilot before the 2011 program start date with a small number of vendors and in a variety of physician practice settings.
Provide logistical support prior to implementation, such as through guaranteeing timely response from the Centers for Medicare and Medicaid Services once data are submitted and allow acceptance of meaningful use data in late 2010 so doctors can send test data and receive feedback.
Give physicians a report on meaningful use achievement and sufficient time to restructure their systems rather than providing "simplistic pass/fail" structure.
In releasing a new compliance document for inspectors visiting healthcare facilities treating H1N1 patients, the Occupational Safety and Health Administration (OSHA) makes two primary statements:
Hospitals must follow the Centers for Disease Control and Prevention's (CDC) guidelines on protecting healthcare workers from H1N1 exposures
There must be a good-faith effort to provide workers with N95 respirators, and if there is a legitimate shortage of these respirators, there should be evidence of ongoing monitoring of N95 supplies
OSHA's compliance directive, which the agency posted online Friday, outlines various deficiencies of H1N1 protection that could result in citations for hospitals.
H1N1 inspections will follow the traditional procedures of any OSHA visit, with an opening conference, document reviews, and tours of affected areas. It is unusual, though, to see OSHA issue a directive so squarely aimed at healthcare facility compliance.
"OSHA has a responsibility to ensure that the more than 9 million frontline healthcare workers in the United States are protected to the extent possible against exposure to the virus," acting Assistant Secretary of Labor for OSHA Jordan Barab said in a statement. "OSHA will ensure healthcare employers use proper controls to protect all workers, particularly those who are at high or very high risk of exposure."
OSHA classifies those two levels as follows:
Very high exposure risk—Generally, healthcare workers performing aerosol-generating procedures (e.g., bronchoscopies) on suspected or confirmed H1N1 patients or healthcare workers present during autopsies
High exposure risk—Generally, healthcare workers working within 6 feet of suspected or confirmed H1N1 patients or entering a small room shared with such a patient
What to expect during an OSHA visit
OSHA will conduct H1N1 inspections in response to worker complaints, referrals (including from media reports), and related employee fatality investigations. Remember, OSHA is strictly interested in worker well-being, not patient safety.
During H1N1 inspections, OSHA representatives will meet with infection control and safety managers, review information about the hospital's exposure risk assessments, evaluate pandemic flu plans, and scrutinize worker training programs related to H1N1 protection.
Citations related to worker exposure to H1N1 can fall under a variety of OSHA standards, including requirements to report occupational illnesses, ensure workers wear personal protective equipment, and provide proper respiratory protection for employees.
Don't focus only on respirator availability
Hospitals could also be cited for not providing workers with N95 respirators or not properly fit-testing the equipment.
However, in the event of an N95 shortage, workers may extend the typical use of respirators and substitute surgical masks for N95s under some circumstances, OSHA said. Hospitals must make "a good faith effort to obtain other alternative respirators [during a shortage], such as N99, N100, or reusable elastomeric respirators," according to the compliance document.
Respirators are only part of a more comprehensive approach to H1N1 worker protection promoted by the CDC and OSHA. Ideally, hospitals should approach H1N1 precautions through these steps, in order:
Eliminate potential worker exposures (e.g., limits on ill visitors entering the hospital)
Using engineering controls (e.g., partitions in triage sites and closed-suctioning systems for intubated patients)
Observing administrative controls (e.g., flu vaccinations and respiratory hygiene steps)
