Business foes of healthcare overhaul legislation are outspending supporters at a rate of 2-to-1 for TV ads as they grow increasingly nervous about a final bill. Led by the U.S. Chamber of Commerce, opponents of the Democratic healthcare drive have spent $24 million on TV commercials over the past month to $12 million spent by labor unions and other backers. More than half the opposition spending has been by the chamber. With the House narrowly approving its health overhaul on Nov. 7 and Senate Majority Leader Harry Reid drafting his measure behind closed doors, the outpouring of cash underscores how crunch time has arrived for business and other groups trying to shape or scuttle the legislation.
At a time when the nation is struggling to rein in healthcare costs, many small businesses in Massachusetts say they are receiving the largest premium increases in years for their Jan. 1 renewals. Insurers in September said they expect to raise premiums an average of 10% next year, but some employers are facing increases that are double or triple that, or even higher, the Boston Globe reports.
Editor's note: This is the first in a three-part series about breach notifications. The first installment focuses on preventing breaches.
The U.S. Department of Health and Human Services (HHS) on August 19 released its interim final rule on breach notification of unsecure protected health information (PHI) and the acceptable methods for covered entities (CE) and business associates (BA) to encrypt and destroy patient records in order to prevent breaches.
The PHI breach notification regulations took effect September 23. However, HHS will not enforce the rule until February 22, 2010, or thereabouts.
Although CEs and BAs should have breach notification policies in place, they must also know how to prevent breaches.
"You don't get to the HITECH until you have a privacy breach," says Andrew E. Blustein, Esq., partner and cochair of Garfunkel, Wild & Travis' Health Information and Technology Group in Great Neck, NY; Hackensack, NJ; and Stamford, CT. "If you have good things in your privacy program, you should never get to it."
Consider Blustein's tips for how to prepare for a breach so it doesn't happens:
Establish appropriate technical safeguards to protect patient information. Require encryption for laptops and other portable devices. Establish remote access roles specific to applications and business requirements. Prohibit the installation of unsecured "homemade" software on laptops. Develop policies regarding the protection of patient information transmitted from remote locations.
Discuss with vendors their responsibility for protecting patient information. Vendors who are BAs must enter into an agreement with the CE. Further, contact each of your vendors and discuss appropriate safeguards to protect your PHI. If your BA is an agent of the CE, the CE is considered to have notice of the breach at the time the BA has notice. Make clear the lines of communication and responsibility between you and your BA.
Perform routine audits of employee access to PHI. Let employees know you are conducting the audits. Inform them that you intend for the audits to revitalize the organization's policy.
Establish a security incident response team. Assign an individual to be responsible for organizing responses to security incidents. Appoint a core team to conduct the investigation (e.g., representatives from IT, HR, risk management, legal, and security departments). Include technical and administrative staff members, as well as staff members directly involved in the incident. "You can't do this on the fly," Blustein says. Build your team carefully and conduct mock breaches.
Prepare written policies that address the process for internal reporting. Consider what potential breaches need to be reported internally and to whom individuals should report these violations. Set time frames for reporting. "In some cases, you don't want to wait for the investigation team's full report," Blustein says. "Sometimes you want a flash report." Educate staff members and publicize an actual breach in the organization as a teaching moment. Don't keep it quiet.
It struck me as odd to learn this week that in these economic times 67% of patients are unaware they may qualify for free or reduced healthcare expenses, according to a TransUnion survey released last week.
How on earth is that possible? We are in one of the worst economic recessions, and yet people don't know that a hospital can actually help them with more than stitches? I know money is tight for facilities, and number-crunchers have enacted the "charity begins at home" approach to savings, but this percentage should disturb any CFO.
Even a child, let's call him Luke, could easily argue that this stat reinforces why the government is justified in reviewing hospitals' not-for-profit statuses. I'd actually argue something different, Luke, and I'm coming to that. Stay with me for a moment as I switch gears to bill transparency. Since 2006, 30 states have laws requiring some sort of bill transparency, ranging from measures affecting disclosure to general transparency to the reporting and/or publication of healthcare and hospital charges. Interestingly, the TransUnion survey, which polled 654 Americans nationwide in October, notes that two-thirds of adults want to see more transparency in their bills.
Is it a coincidence that 67% of patients want more transparency and 67% didn't know about charity care? On the surface, this might give fuel to young Luke's case, but his logic would be skewed by the numbers and not by the realities that most hospitals are facing. Most facilities strongly believe in their missions to care for the insured, underinsured, uninsured, and the flat-out broke, but they are actually ill-equipped to estimate bills and discern who can pay them before the services are performed. So, hospitals are less vocal about the "free" option to patients, because frankly they aren't always sure who will qualify.
So, Luke, there likely isn't anything sinister afoot at hospitals. Many facilities don't see these losses as large enough to really focus on, so they are a tad behind on adding the technology necessary to correct this, but to quote the cinematic classic Return of the Jedi, hospitals may "pay the price for their lack of vision."
Use the Force: Technology
Sure 30 states enacted well-meaning bill transparency laws, but they are a tad inane. After all, how can you post the price of something that involves so many different components and is so individualized? Moreover, if you can't provide a fairly accurate estimate of your cost of services, a patient simply can't know whether they can afford the service, nor can the hospital know if they should categorize the individual as charity care candidate.
"To ensure hospitals don't watch the revenue leak out they need to collect from the patient at the point of service, but to do that you have to know how much the patient may owe and then determine if they can pay that bill," notes Jim Bohnsack, vice president of product development at TransUnion health group.
It's technology to the rescue, and just in time for what's predicted to be a difficult year for uncompensated debt; consider these stats:
Uncompensated care costs rose from $21.5 billion (2001) to $34 billion (2007) and hospitals are reporting an 8% increase through Q3 2008, according to the AHA.
Uninsured patient numbers grew from 39.8 million to 47 million from 2001-2007, the AHA notes, and that number is rising.
Unemployment hit 10.2% in October, the DOL estimates, and unemployment and COBRA healthcare benefits will expire for millions of unemployed Americans in the coming months.
These are numbers CFOs know all too well. However, when you put them together they make a strong case that uncompensated care will grow at your hospital in 2010, that is unless you change your approach to collection through bill estimation. Riverside Regional Medical Center, a 570-bed facility in Virginia recently added this type of technology to determine charity eligibility at the time of registration.
"Combining the credit scoring data to determine charity eligibility with a contract based patient liability estimator will equip our patient access team to have a meaningful dialog with patients regarding their specific patient responsibility beyond just co-pays," says Richelle Fleischer, administrative director at Riverside Regional Medical Center. "We expect this to have significant impact on our insured bad debt as we will know who has the ability to pay at the time of service, and who might need some type of assistance."
If your charity care losses aren't enough to get this technology in place, keep in mind that there are throngs of consumer directed health plan (CDHP) and high-deductible health plan (HDHP) members coming your way next year and beyond.
"I would argue that if a hospital isn't doing this [addressing charity care] then they are not meeting their fiduciary duty. Whether it's to drive greater profitability or to meet their not-for-profit status, they cannot afford turn a blind eye to this," says Milton Silva-Craig, executive vice president of TransUnion's healthcare group.
But for those of you that are confident that this isn't a large enough issue to buy the technology or you think healthcare reform will help, I will offer you one additional kernel Return of the Jedi wisdom: It was the emperor's overconfidence which was his undoing. So, maybe you shouldn't put too much stock in the folks in Washington helping to cork the slow-leak in your bottom line; by the time they finish discussing the matter you may have a deluge you're dealing with.
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Despite high taxes, an advertising ban, a tsunami of medical evidence, more than $200 billion in tobacco settlement money for smoking secession programs, and the pariah status of public smokers, one-fifth of U.S. adults still light up, according to new data in the CDC's 2008 National Health Interview Survey.
The survey found that 20.6% of American adults—46 million people—smoke cigarettes, essentially unchanged from the 20.9% of Americans who said they smoked in 2004. The CDC says smoking is the leading preventable cause of death, kills more than 443,000 people every year, and costs the nation $96 billion annually in healthcare costs. The discouraging results of the survey were released as the American Cancer Society prepares to hold its annual Great American Smokeout on Thursday.
"Today tobacco will kill more than 1,000 people, but we can reduce smoking rates," said CDC Director Thomas R. Frieden, MD, in a media release announcing the findings. "We must protect people from second-hand smoke, increase the price of tobacco, and support aggressive anti-tobacco campaigns that will reduce smoking and save lives. If every state had smoking rates similar to places which have implemented effective programs, there would be at least 10 million fewer smokers in the U.S., and millions of heart attacks, cancers, strokes, and deaths would be prevented."
According to the study, the people hardest hit by the tobacco epidemic are those among vulnerable populations, including people with lower levels of education. In 2008, 41.3% of people with a general education development certificate smoked cigarettes, compared to 5.7% of people with a graduate degree.
Another study in last week's CDC Morbidity and Mortality Weekly Report reports that smoking prevalence was highest in West Virginia (26.6%), Indiana (26.1%), and Kentucky (25.3%), and lowest in Utah (9.2%), California (14%), and New Jersey (14.8%).
CDC also reported significant variation among 11 states in the proportion of adults protected by smoke-free workplace policies and the proportion of adults who protect themselves and their families from secondhand smoke in their homes. Smoke-free laws in public places encourage people to adopt smoke-free policies in their homes, according to CDC.
In the 11 states examined, home exposure varied widely from 3% of adults exposed in their homes in Arizona to 10.1% and 10.6%, respectively, in Mississippi and West Virginia. Two-thirds of smokers in Arizona live in households where smoking is not allowed in the home, compared to 41% and 36% in Mississippi and West Virginia.
Nationwide, 21 states and the District of Columbia have implemented smoke-free laws covering workplaces, restaurants, and bars, but more than half of the country still lives in areas without comprehensive smoke-free laws, CDC reported.
"Despite states having received more than $200 billion in tobacco-generated funds over the past 10 years, many Americans—particularly those with low educational attainment levels, and those who work in the hospitality, service, and other industries are exposed to smoke in their workplaces, and they do not have equal access to the support needed to help them quit," Matthew McKenna, MD, director of CDC's Office on Smoking and Health, said in the media release. "We need to make the investments so all people receive the same protections and adequate information to help them quit successfully."
The MMWR report also found that smoking rates among low-income adults enrolled in Medicaid programs are much higher than the general population (33% vs. 19%), and that only six Medicaid programs provided full access to all proven means to help smokers quit.
Friends Hospital, the 200-year-old psychiatric hospital in Northeast Philadelphia, has appointed Joseph Garbely, MD, as CMO. In his new role, Dr. Garbely is responsible for the leadership of the medical staff and overall clinical operations of the hospital.
Kevin B. Sneed has been appointed the founding dean of the USF School of Pharmacy. Sneed, associate professor of family medicine and assistant dean and clinical director of the College of Medicine's Division of Clinical Pharmacy, was selected for the high-profile position following a nationwide search.
Ellie Henry has joined Passport Health Communications, Inc. as a revenue cycle analyst. She was previously senior director of access at Geisinger Health System in Danville, PA.
Blue Shield of California announced two executive appointments. The not-for-profit health plan named John Hedberg as CFO/vice president of finance and underwriting for the company's Individual, Small Group, and Government Business Unit. Mike Sears was named vice president of customer service. Hedberg most recently served as business finance officer at Cigna HealthCare. Sears most recently served as senior vice president for customer care at Vonage.
Richard S. Fletcher was appointed COO at Manatee Memorial Hospital. He previously was associate administrator at the hospital and director of pharmacy for Manatee Healthcare System. The 319-bed acute care facility, which opened 55 years ago, is owned by a subsidiary of Universal Health Services, based in King of Prussia, PA.
