Nurses are an essential part of hospitals and can function as a communication lifeline to patients, doctors, and others in the facility, according to this posting from the LPN to RN Blog. While there are lots of different tools you can use to communicate, Twitter is an exciting one to consider because it holds so much potential, writes the author. The post provides 101 different ways hospitals can use Twitter.
Medicaid expansion as a vehicle to insure more Americans is seen by many as a compromise to the public insurance plan.
Supporters of the move think expanding to the lower middle class is a way to provide coverage to millions of Americans, while not creating a government plan. Plus, Medicaid programs already know how to reach out to at-risk populations, including those who have little or no experience with the healthcare system maze. It's only natural to allow those plans to take in lower-middle class families.
Margaret A. Murray, executive director of the Association of Community Affiliated Plans, which represents 45 nonprofit safety net plans that serve 7 million enrollees, says safety-net plans already understand the "unique needs of the low-income population." The plans offer programs targeted to those individuals, such as health literacy, multi-lingual staff, and transportation services to doctor appointments.
But expanding Medicaid programs isn't a cure-all—especially if permanent federal dollars aren't involved.
For instance, just over the past week, two states proposed making cuts to their Medicaid programs as a way to help bridge budgetary gaps.
In Massachusetts, the state may require Medicaid recipients to pay more for visits to specialists, require prior authorization in order to receive psychiatric medications, and limit dental care to cleanings, X-rays, and emergency services. The state is doing this as a way to make up part of the $307 million shortfall in the state's MassHealth program.
The federal government picks up 62% of the program's costs, so MassHealth needs to cut about $117 million. More than 1.2 million residents are covered by Medicaid, which is up 115,000 from a year ago, mostly because of the state's health reform program that requires all Bay State residents to have health insurance.
But it's not only Medicaid beneficiaries who are facing uncertain times. Indiana announced last week that it plans to cut Medicaid payments to hospitals by 5% as a way to deal with the state's budget problems. The move would save $10.6 million.
In my column last week, I predicted that Medicaid expansion would be part of health reform and I still think Congress will view expansion as a better alternative than creating a public option. The feds will then be able to pass the coverage issue onto the states, while providing seed money to help them out for the next few years.
But federal policymakers can't think short-term. This past week's events are a reminder that Medicaid is often the program that states cut during difficult times.
Medicaid beneficiaries don't have the powerful lobbying groups that other population segments enjoy and the general public is not as offended when programs for the poor are cut, though they are outraged when senior programs are sliced.
Maybe it's because most Americans expect they will grow old, but they don't think they'll ever need Medicaid.
If Medicaid expansion is a part of the final health reform plan, Congress will need to create long-term (if not permanent) additional funding to help states pay for the new Medicaid beneficiaries.
The House reform bill includes $23.5 billion in short-term assistance to help states cover Medicaid costs because of rising unemployment. Plus, states received a huge chunk of the federal stimulus money this year to help with Medicaid funding. These are short-term fixes.
If Congress decides to extend Medicaid eligibility but not include long-range Medicaid funding, don't be surprised if states return to Medicaid cuts as a way to bridge budgetary gaps once the federal seed funding dries up. Also expect health insurers to question whether Medicaid is worth the money, and doctors and hospitals to start rethinking whether they can continue to lose money by accepting Medicaid beneficiaries.
More than $98 billion in taxpayer money spent by government agencies was wasted in fiscal 2009—with nearly half of it ($54 billion) coming from improper payments related to Medicare fee-for-service, Medicaid, and Medicare Advantage, according to government findings released Tuesday night by the White House.
President Obama is expected to sign an executive order within the week that will focus on eliminating government waste and fraud, particularly in Medicare and other benefit programs. In 2009, the government reported questionable Medicare payments of roughly $36 billion. However, that amount is expected to be revised upward to about $48 billion next year when the Department of Health and Human Services (HHS) converts to a new methodology that will use stricter documentation requirements.
Under the executive order, explained Peter Orszag, director of the Office of Management and Budget (OMB), all federal agencies will maintain a Web site to track improper payments, error rates, and outstanding payments. If an agency fails to meet targets for reducing error rates for two consecutive years, the agency director will be required to directly report to OMB about what new actions they will take to prevent it.
The Obama administration also has indicated that it will seek to impose penalties on government contractors who receive improper payments—giving them incentives to return the money, Orszag said.
The White House announcement came a day after Sen. Charles Grassley (R-IA) introduced legislation addressing Medicare fraud. It calls for giving the federal government more time to pay Medicare providers when waste, fraud, and abuse are suspected.
The current federal law requires that Medicare send payment within a short timeframe—even when there is risk of fraud, waste or abuse, Grassley said in a statement when introducing the bill. "Because of this prompt payment rule, the government puts itself in a position of having to pay and chase Medicare fraud, instead of working to prevent it in the first place."
Grassley estimated that of the $470 billion spent on Medicare, about $60 billion of that spending each year is lost to fraud, waste and abuse. And Medicare expenditures are projected to increase at an average annual rate of 7.1% this year, that rate will grow as well, he said.
Under the bill, called the "Fighting Medicare Payment Fraud Act of 2009," the HHS secretary would be given authority to extend the time period in which payments must be made under the prompt payment rule if it is determined there is a likelihood of fraud, waste or abuse. With this additional time, HHS would be required to conduct closer reviews of the claims in question to make certain they are legitimate.
Despite the slow economy, the number of healthcare retail clinics has increased about 15% during the past two years, according to a new report released by the Deloitte Center for Health Solutions. And more of these clinics are beginning to ally themselves with established healthcare organizations.
The current growth rate pales in comparison to when the retail clinical market rocketed to a 350% increase in 2007. The economic downturn in December 2007 changed this course dramatically. Retail clinic market growth will likely slow from 10% to 15% from 2010 through 2012, but accelerate above 30% from 2013 2014 as the economy improves, according to the report, "Retail Clinics: Update and Implications."
As of July 2009, 1,107 retail clinics were in operation nationwide, according to the report. Most retail clinics operated in retail pharmacy settings (82%) or as departments or wholly owned subsidiaries of host organizations, such as grocery stores (12%) or big box discount stores (6%).
"Retail clinics represent a new channel that can deliver primary care services more conveniently and at lower cost to consumers," said Paul Keckley, PhD, executive director of the Deloitte Center for Health Solutions.
The growth rate hides the fact, though, that some clinical retail chains saw reductions in the number of their sites. Nearly 150 clinics closed in 2008, with 55% of those closings linked to smaller retail operators and start ups that eventually left the market. RediClinic reduced from a high of 50-plus clinics in 2007 to 35 in mid 2008 to only 20 clinics by mid 2009.
MinuteClinic—the largest retail clinic chain which is now owned by CVS Pharmacy—shed 27 clinics and closed 104 of its clinics during the summer months. It has 451 clinics in operation.
Also, 2009 saw increased activity by large acute care organizations entering into retail medicine via contractual arrangements with drug store and grocery chains. One example was an agreement announced late last month between MinuteClinic and Allina Hospitals and Clinics of Minnesota. MinuteClinic has 24 locations in the Twin Cities area.
Approximately 20% to 25% of the retail clinics now are already owned by healthcare providers, says Mary Kay Scott, a California healthcare consultant, who has studied and written about the retail clinic trend. Many of the clinics, such as MinuteClinic, have begun to "more formally align" themselves with larger healthcare providers.
"All retail clinics, no matter who they are owned by, make sure they can refer you to a primary care physician and make sure that they can get you treatment somewhere if it's not appropriate in the clinic," she says.
Some of the more recognizable health systems now in the "retail clinic mix" are Intermountain Healthcare with access to five clinics within grocery stores in Utah; Mayo Clinic with two clinics in Minnesota; and the Cleveland Clinic with a primary referral channel for nine MinuteClinics operating in the Cleveland area.
The key to the successful operation of the retail clinic is back up and ancillary support from a local provider organization that is "responsive to its need for a medical director to review charts, manage referrals, oversee quality controls, and write orders for drugs, tests, and follow up care," the report said.
Increasingly, retail clinics' patient data will be warehoused in the electronic health records held by providers. Therefore, retail clinics will require ongoing collaboration with a local provider organization while resisting pressure to modify their operating model to accommodate "traditional" approaches to care.
At current demand levels, the retail clinic industry is "marginally profitable." Clinics in appropriately targeted locations and settings typically break even in 12 to 18 months, the report noted.
The Joint Commission and the Department of Health and Human Services last week released a 30-minute series of videos titled Improving Patient-Provider Communication. The videos, designed for organizations and healthcare providers, spell out what is required by The Joint Commission and by federal law in terms of effective communication and language access, and how the intent of the law can be met.
Those hospitals that accept federal funding are required to comply with Title VI of the Civil Rights Act of 1964, which prohibits discrimination based on race, color or national origin. This includes providing a translator for those patients who are not proficient in English. Similarly, Section 504 of the Rehabilitation Act of 1973, which protects the rights of individuals with disabilities, requires healthcare organizations that receive federal funds to provide effective communication for patients who are deaf or hard of hearing.
The videos are part of a larger Joint Commission research study called Hospitals, Language, and Culture, undertaken with funding from the California Endowment. The goal of the study, which has been ongoing since 2003, is to better understand the issues of culture and language and how they play out in patient populations in hospitals. The Joint Commission has already published a few reports from study findings and plans to publish more in the future.
"We were interested to know how these issues were identified, what was challenging to hospitals about addressing these issues, how they were meeting the challenges, and looking at promising practices for meeting those challenges," says Amy Wilson-Stronks, MPP, project director in the Division of Standards and Survey Methods and principal investigator for Hospitals, Language and Culture study at The Joint Commission.
The research component has mostly focused on racial and ethnic health disparities and the role that culture and language may play in that issue, says Wilson-Stronks. However, as the study has evolved, the issue of effective communication between patients and providers relating to quality care for all patients has stood out as the primary safety imperative that is inherent in any discussion about cultural and ethnic healthcare disparities.
A different, but related Joint Commission project aims to take the lessons learned from the Hospitals, Language, and Culture study and revise and update the existing Joint Commission standards concerning effective communication, cultural competence, and patient centered-care. This 18-month grant was funded by The Commonwealth Fund and the funding runs through January 2010.
"As we've considered how to actually implement what we've learned from that, we realize we have to look at these issues in a broader context and really believe that patient and family-centered care is a little more encompassing and probably better reflects that concept of meeting patient needs as a way to improve quality and safety," Wilson-Stronks says.
An expert multidisciplinary advisory panel has also been working together to provide input on what should be included in the proposed requirements. The board represents many parties, including patients from many cultural backgrounds, patients with disabilities, and patients who are gay, lesbian, bisexual, and transgendered.
"We're looking at this idea of culture more broadly, and communication more broadly, as we're looking at the role of the standards," says Wilson-Stronks.
The Joint Commission expects to announce a set of proposed requirements concerning cultural competence, effective communication, and patient-centered care in January 2010. Hospitals will not be responsible for implementing them until January 2011 at the earliest, says Wilson-Stronks.
In addition, the Joint Commission will be producing an implementation guide that will focus on what the new standards require, focus on promoting effective communication and culturally competent care, and provide some examples to help organizations meet the standard, says Wilson-Stronks.
Overall, Wilson-Stronks says addressing linguistic and cultural needs in the context of healthcare communication is not just an issue for a minority population. Understanding the need for open lines of communication and removing any barriers to a trusting patient-provider relationship are key in any healthcare scenario.
"In some ways, I think this is a misunderstood issue," says Wilson-Stronks. "We often think of diversity and cultural competence and language access as what is needed to provide care to a subset of our population. But we really realize that it's not just a nice thing to do to be respectful of patients' values and beliefs, that it's important because we want to make sure our health system is responsive to those needs because they do indeed have an impact on physical quality of care and safety."
Senate Majority Leader Harry M. Reid scrambled to lock down votes behind a healthcare bill that he may present as early as Nov. 18, the Washington Post reports. Reid would not confirm that he had received commitments from all 60 members of his caucus to overcome GOP procedural objections and bring the bill to the Senate floor, but said "I feel cautiously optimistic that we can do that. I think we're together as a caucus." He added that "Of all the bills we've seen, it'll be the best: saves more money, is more protective of Medicare, is a bill that's good for the American people," the Post reports.
In 1997, a federal committee of medical experts recommended against routine mammograms for women in their 40s, sparking a political uproar that led to congressional hearings and a unanimous Senate vote challenging the findings, the Washington Post reports. Now, a similar drama is playing out around a different federal medical panel, which this week recommended against routine mammograms for women younger than 50. The findings underscore a decades-long debate in the medical community about the benefits and risks of routine breast cancer screening for younger women, the Post reports, and plunges the advisory panel into the middle of a strident Washington discussion about healthcare.
Senator Ben Nelson, Democrat of Nebraska, says he is not sure he is ready to help a Democratic healthcare proposal gain the 60 votes his party's leaders need to open debate on the measure later this week. Two of his fellow Democrats, Senators Mary L. Landrieu of Louisiana and Blanche Lincoln of Arkansas, are on the fence as well, raising the prospect that one or perhaps all three of them could scuttle the bill before the fight over it even begins on the Senate floor, reports the New York Times. Inability by the Democrats to advance the plan could require them to redraw the measure or switch to a more contentious procedural shortcut around the need for a 60-vote majority.
Continuing to mold a new team to lead the Miami-based Jackson Health System, Chief Executive Eneida Roldan said she is bringing in a new vice president of business development and hopes to have a new chief operating officer by the end of the year. Mike Casanova, a veteran South Florida healthcare consultant, will lead the effort to bring in new business, a key because Miami-Dade's government system hopes to find new ways to bring in revenue to make up for losses from treating growing numbers of the uninsured, the Miami Herald reports. Casanova has been an executive with Surgical Park in Miami and PCA Health Plans of Florida.
Conservatives have opened a new front in the healthcare debate with the assertion that under the Democrats' plan, people who refuse to buy health insurance could spend five years in prison. Supporters of a health overhaul called that a scare tactic along the lines of last summer's uproar over "death panels," and said that scenario would virtually never happen, the Wall Street Journal reports. The notion has its origins in the bill's requirement that most Americans must get health insurance, with the help of government subsidies if necessary, or pay a special income tax of up to 2.5%. If someone refuses to get insurance and refuses to pay the tax, that person would be guilty of tax evasion.
