President Bush has made Congress a counteroffer on expanding the State Children's Health Insurance Program. Bush's budget would increase spending on the program, which offers subsidized health insurance to children of the working poor, by nearly $20 billion over the next five years. The new offer would generally limit eligibility to children in families that earn no more than 2 1/2 times the poverty level, howeever. Previous bills surrounding SCHIP vetoed by Bush would have allowed states to set the ceiling as high as three times the poverty level.
President Bush sent the nation's first-ever $3 trillion budget proposal to Congress, contending that the spending blueprint will fulfill his chief responsibility to keep America safe. The $3.1 trillion proposed budget projects sizable increases in national security but forces the rest of government to pinch pennies. It seeks $196 billion in savings over five years in the government's giant healthcare programs--Medicare and Medicaid. But even with those restraints, the budget projects the deficits will soar to near-record levels of $410 billion this year and $407 billion in 2009, driven higher in part by efforts to revive the sagging economy with a $145 billion stimulus package.
Jennings Center for Older Adults in Garfield Heights, OH has headed an innovative project titled REACH, Rewarding Education Through Advanced Careers in Health Care. About $1 million will be spent over three years on the work-force development program, which will include training and other programs for new and existing employees at Jennings, Eliza Bryant Village in Cleveland and Humility of Mary Health Partners in Youngstown. The program is expected to reach 1,120 new hires and 612 existing staff members over the next three years. Funding is primarily by grants, including $155,000 from the Cleveland Foundation, $25,000 from the McGregor Foundation, $15,000 from the Deaconess Community Foundation and $36,000 from the Raymond John Wean Foundation of Warren.
Two of three University of Louisville physicians who made videotaped statements of support for U.S. Sen. Mitch McConnell (R-KY) last year say they didn't realize their comments would be part of a television ad for the senator's re-election campaign. And the third says that he wouldn't have agreed to the taping had he known it would appear on McConnell's campaign Web site. U of L generally prohibits employees from using their affiliation with the university when making political endorsements or taking positions on community issues.
The board of trustees has approved a $108 million building project that would add at least 60 private patient rooms, a new emergency department and 225,000 square feet of space to Columbus Regional Hospital. Two phases of the project to build the five-story pavilion will begin this year, and completion is expected in 2011. Patient rooms will occupy the second and third floors of the pavilion. The fourth and fifth floors will be unfinished but could accommodate an additional 60 private rooms.
Commercial construction continues to defy the real estate slowdown in the Orlando area. This week The Shermen Group LLC, a full-service real estate company with offices in New York, Boston and Celebration, breaks ground on a $17 million project called Celebration Blvd. Medical Center. The 90,000-square-foot, four-story medical-office center, located on Celebration Boulevard, has frontage along Interstate 4 and will house doctors, other medical professionals and healthcare providers serving residents of Celebration, Osceola County and surrounding areas.
Just like with do-it-yourself taxes, a growing software industry lets patients create their own "personal health records." No more answering 10-page questionnaires every time you visit a new doctor--just hit the print button before leaving home to arrive armed with your life's medical history. But can using personal health records actually make patients healthier? The government is spending millions on the first studies to find out--and if so, the findings would give doctors a big push to get on board.
A desperate need for a new hospital in Florida's Clay County has lead to a battle over who should be the one to build it. Two proposals for a second hospital from St. Vincent's Medical Center and the Orange Park Medical Center are now before Florida's Agency for Health Care Administration, which rules on new hospital construction. The debate on who should build the hospital has been going on for several years, and the state's decision isn't expected for another six weeks. Even then, actual construction would not be completed for a couple of years, according to estimates in both proposals.
The benefits of competing successfully in a pay-for-performance environment are relatively obvious-financial incentives, greater public awareness of quality, and improved physician-hospital alignment, to name a few. While the benefits are quite clear, the means to achieve them are often slightly more confusing. In order to successfully compete in a pay-for-performance environment, organizations must ensure they are equipped with the necessary tools.
Organizations that have been successful in implementing pay-for-performance programs show a common trait: significant investment in people, processes, and technology. While making these investments is neither easy nor cheap, failure to make them will greatly hinder an organization's ability to successfully compete in a pay-for-performance environment.
People
From a strategic perspective, organizations need leaders, managers, and clinicians who are committed to superior clinical outcomes and teamwork at every level. Leaders within the organization should develop a culture that encourages open and thorough communication. As organizations transition to this new, competitive environment, strong communication and collaboration between management and staff will be essential. Moreover, organizations will need to create a nonpunitive environment that promotes accountability at every level and encourages team members to bring forth any impending problems.
Many organizations will need to hire new staff and train existing staff to excel in a pay-for-performance environment. This will require staff to understand the goals of pay-for-performance programs so objectives such as the collection and reporting of quality and safety data can be met in an efficient manner. Organizations that do not invest in training and hiring staff members who understand the pay-for-performance environment will find it rather difficult to achieve success.
Process
Success under pay-for-performance requires standardized processes on both the clinical and business sides of the enterprise. Organizations equipped with standardized processes, an innovative approach to solving problems, and a well-executed implementation plan will likely succeed with pay-for-performance.
Successful organizations will not perceive pay-for-performance programs as an arduous and costly investment of resources and capital, but rather, they will see it as an opportunity to pursue innovation in both clinical and business settings. As these programs continue to grow and the demand for quality care continues to increase, organizations that have taken the time to develop efficient processes and methods to solve problems will come out ahead.
Technology
Just as important as securing the people and processes necessary to succeed under pay-for-performance is securing the information technology required for participation. Hospitals that fail to do so will be lacking a critical tool for competing in such an environment.
Internally held provider data often resides in multiple clinical and business information systems, or worse, in paper charts. This makes the collection and merger of clinical and financial data difficult. Hospitals will have to adopt effective technologies to sufficiently collect and report data to be successful. Hospitals will begin to adopt business intelligence systems already prevalent in other industries.
Pay-for performance programs will change the way healthcare is delivered. The rewards for organizations that are able to successfully compete in such an environment will be handsome. While there are some barriers to entry in terms of investment of capital and resources, organizations will more than realize their investments if they can successfully compete in these programs.
Pay-for-performance will provide substantial financial rewards for organizations that are able to meet best practices and efficiently report quality data. However, the financial rewards are just the beginning, as pay-for performance programs will allow organizations to increase public awareness and improve physician-hospital alignment. Yet before any of these benefits can be realized, organizations need to be equipped to compete in a pay-for performance environment. They must have the people, processes, and technology in place before they can enter these programs. A failure to obtain the right tools will make success in pay-for-performance difficult to achieve.
Those who decry the plight of the nation's 47 million uninsured--if that's the number you believe--are gaining some fresh new allies of late.
The Federation of American Hospitals, a trade group that represents the for-profit hospital industry, has joined the fray, recommending a plan that would require all people to carry health insurance--a proposal modeled most closely after the recently-enacted Massachusetts law, which was itself modeled after many state laws that require motorists to carry auto insurance. While the jury is still out on whether the Massachusetts plan will actually reduce bad debt and cover more people without a substantial increase in state funding, the fact that the FAH weighed in with a plan earlier this year may signal that something will eventually be done on a national basis about this seemingly intractable problem.
The fact that so many people don't carry any kind of health insurance is an enormous problem that causes untold market distortions. No matter what demographic groups are represented in that 47 million number (illegal immigrants, upper middle class young people, the poor), the fact that so many don't have health insurance makes healthcare more expensive for us all in the long run. Lack of health insurance has driven up bad debt rates to unprecedented levels. Some estimates show the total bad debt burden among all hospitals approaches $40 billion a year--one reason most investors would much rather buy shares of Chinese Internet companies or Russian oil companies with opaque accounting standards than those of American hospital companies.
FAH's proposal would require individuals to take health insurance if it is offered through their employer, buy it on their own or receive it through existing government programs for the poor. Meanwhile, major corporations are getting involved that never paid much attention to bad debt or covering the uninsured. Wal-Mart, for example, is cooperating with the Service Employees International Union, and other large companies are recognizing the healthcare insurance burden is hurting their ability to compete globally and doesn't provide any sort of cost certainty in the future.
In essence, the federal government has been offloading its responsibility to pay for the medical care of its citizens to the commercial insurance market for so many years that the model is finally breaking down. I can't believe I just typed those words, but by the government's "responsibility," I mean that the government requires hospitals to incur the cost of treating the uninsured, yet a variety of bureaucratic and systematic burdens make it difficult or impossible for hospitals to collect even the cost of that care. Congress can't have it both ways. If you require hospitals to provide care on one hand, it has to be paid for, and if you don't find some way to require or provide health insurance for the vast majority of the uninsured, your bill is coming due.
