Indiana's human services agency announced it will slice $10 million from its budget by paying hospitals less to treat Medicaid patients. However, the Family and Social Services administration will not reduce its Medicaid payments to doctors or cut "vital services" to the young, elderly, disabled, and needy Indiana residents who receive social safety-net benefits, agency officials said. The president of the Indiana Hospital Association, though, said the cuts in Medicaid reimbursements "represent a significant blow" to hospitals' ability to serve their communities.
The University of Kansas Hospital set records for patient volume in its most recent fiscal year, according to audited financial statements provided to the hospital board. The inpatient discharges for the year that ended June 30 were 24,209, up more than 8% from 22,393 the previous year. The hospital reported 337,359 outpatient encounters in fiscal 2009, up about 13% from 298,920 the prior year.
According to the first estimate of the healthcare sector's carbon footprint, the healthcare industry emits less than its share of the gases that promote global warming, compared to its size in the economy. Hospitals, nursing homes, drug companies, and the rest of the sector contributed 8% of U.S. emissions, according to an analysis. Healthcare makes up 16% of U.S. gross domestic product. The University of Chicago analysis, based on federal data, takes into account emissions from the manufacture of goods used by the industry and the power needed to run hospitals and other health facilities.
While Miami-based Jackson Health System's governing body struggled to find more ways to cut costs and increase revenue, University of Miami President Donna Shalala made an appearance before the Public Health Trust to "personally apologize for statements by members of the university leadership team last week." She was referring to UM Board of Trustees Chairman Phillip George's comments to Jackson leaders that he was disturbed about the quality of doctors that Jackson had been hiring in recent years. Jackson leaders are now trying ways to reduce an anticipated loss of more than $100 million this year. On Nov. 9, Chief Executive Eneida Roldan ordered the closing of six units and laying off of 93 employees.
Primary care doctors in the U.S. spent more time with patients during office visits in recent years despite declining paychecks because of lower reimbursement from insurers, a study found. General practitioners, family doctors and general internists increased their time with patients to almost 21 minutes for an average office visit in 2005 from 18 minutes in 1997, according to the research. The physicians' 2003 average income of $146,405 was a 10.2% drop adjusted for inflation from 1995, according to a 2006 report.
Nationwide, about one in four Medicare patients hospitalized for heart failure is readmitted within a month of being discharged. The feds started reporting the figures for individual hospitals online earlier this year, and a team helped figure out how to adjust the data to account for factors like varying patient populations, in an effort to allow fair comparisons between hospitals. Now the House bill and the Senate Finance bill both call for docking Medicare payments to hospitals with high risk-adjusted readmission rates.
UnitedHealth Group's HIT subsidiary Ingenix finalized its second major acquisition in less than six months today with the announcement that it will purchase CareMedic Services Inc., a revenue cycle management specialist for hospitals and health systems.
Terms of the cash deal were not disclosed.
"With CareMedic, we will transform [revenue cycle management] RCM from a group of fragmented, claims-centric processes to a more comprehensive, patient-centric financial information management system," said Bill Miller, executive vice president of health care delivery at Ingenix. "The RCM systems available today lack interoperability between front-end and back-end functions, slowing cash flow and impeding a hospital's ability to collect payment for services that have been provided. Our vision and combined capabilities will create a customizable enterprise-wide analytics solution for hospitals that seamlessly connects to other systems."
CareMedic CEO Sheila Schweitzer said Ingenix's experience in reimbursement, health information management, and consulting will complement CareMedic's experience in RCM. "We will create a unified solution that makes hospitals more efficient at managing cash flow and enhances our commitment to helping clients get paid," Schweitzer said. "As part of Ingenix, we will be able to provide clients with additional services and continued innovations that help them use capital more effectively and improve operational efficiency."
CareMedic has contracts with more than 2,500 providers in the United States and Puerto Rico.
The news was just the latest announcement for Ingenix, which has had an eventful year.
In June, Ingenix acquired Franklin, TN-based medical bills auditor AIM Healthcare Services Inc., and its Netwerkes and Ingram & Associates affiliate. The terms of the all cash sale were not disclosed.
In January, Ingenix and parent UnitedHealth agreed to a $400 million settlement with the New York Attorney General's office to resolve what investigators called "an industry-wide investigation into a scheme to defraud consumers by manipulating reimbursement rates."
The deal also required UnitedHealth to close two databases run by Ingenix, and to help fund a new independent database to collect price information.
Critics of Ingenix had said the old databases did not provide the correct charges for out-of-network services and they complained that a health insurer-owned company should not have overseen the databases. UnitedHealth Group did not acknowledge any wrongdoing in the settlements.
A number of other health insurers that used Ingenix to find out-of-network costs also agreed to pay to help create the new independent database that will be run by a nonprofit company, FAIR Health, which will work with Syracuse University and a group of other state universities.
With its approval of HR 3962 Saturday night, the House of Representatives cleared a major hurdle, but there are still plenty of barriers in place before health reform becomes a reality.
Attention now switches to the Senate, which will soon debate its own health reform legislation.
Many Democratic leaders praised the House bill, though many liberals remain disappointed in the legislation. Republicans, meanwhile, largely panned the bill that they see as an avenue toward government-run health insurance without ways to control costs.
Healthcare leaders' opinions are as diverse as those on Capitol Hill. Here is what seven health leaders think of the House's reform plan:
Craig E. Samitt, MD, MBA
President and CEO
Dean Clinic and Dean Health System
"Admittedly, my feelings about recent passage of the House healthcare bill are mixed. On one hand, I applaud the fact that we're finally seeing progress toward significantly broadening access and reforming healthcare, particularly the insurance market. The U.S. healthcare system needs repair and true healthcare reform is long overdue.
"On the other hand, the healthcare bill that marginally passed in the House is not true reform, and frankly does not go far enough to address what is truly broken in our healthcare system. If we truly want to reform healthcare, this would involve four critical elements.
"First, solve the uninsured dilemma by assuring that healthcare for all Americans is an equal right, not a luxury. Second, significantly improve clinical quality, patient safety, customer service, and access. Third, solve the 'cost conundrum' that has resulted in our system being an unfathomable 50% more costly than any other country. Fourth, preserve and protect the strengths of the current system and create a combination of carrots and sticks to address what is truly wasteful, fraudulent or broken.
"While the House healthcare bill assures broader coverage for the uninsured, which is good, it does little to address concerns about quality, service, safety, access or cost. If we truly wish to reform our healthcare system into one that assures better care at a lower cost, we need to go further."
Rich Umbdenstock
President and CEO
American Hospital Association
"While the House bill makes important progress in expanding coverage, an important goal for hospitals, there are areas for improvement. In the days ahead, America's hospitals will work to improve upon the bill for patients and families.
"While the House bill using negotiated rates within parameters is an improvement, we remain concerned that the program would still, in part, be based on historically low Medicare rates. We also are concerned about expanding eligibility for Medicaid to 150% of the federal poverty level at a time when states are struggling with severe budget shortfalls.
"Lawmakers also should restore a provision that would expand the outpatient $340 billion drug discount program to inpatient services for all eligible hospitals. Lawmakers should revise the $20 billion medical device manufacturer tax so it cannot be passed on to hospitals, narrow the hospital readmissions policy to address only truly avoidable readmissions, and improve accountable care organizations to give hospitals the opportunity to play a leadership role."
Lori Heim, MD
President
American Academy of Family Physicians
"The House passage of the Affordable Health Care for America Act is an important step toward needed change in the healthcare system.
"This legislation will provide health insurance coverage for 96% of Americans. It will provide peace of mind for millions of people who cannot get health insurance due to cost or pre-existing conditions. It will provide health security for millions more who fear loss of coverage if they get sick.
"Family physicians appreciate the bill's provisions that would help re-establish primary medical care as the foundation of our healthcare system. Investment in primary care will yield not only better health for everyone, but also more efficiencies, less waste, and less duplication.
"By creating a pilot program that helps physicians provide patient-centered medical home services and eliminating out-of-pocket expenses for preventive services, the legislation will encourage Medicare beneficiaries to get the comprehensive, whole-person care that improves their health while helping control the cost of their care.
"HR 3962 also begins rectifying the growing payment disparity between primary care and subspecialty care physicians. The bill provides a Medicare-wide, 5% bonus (10% in underserved areas) for physicians whose Medicare practice is more than 50% primary care services. This bonus sends a signal that the nation does, in fact, recognize and value the medical expertise and comprehensive care provided by family physicians and their primary care colleagues."
Alan Morgan, MPA
Chief Executive Officer
National Rural Health Association
"For health reform to be effective for the quarter of the population that resides in rural America, the access to care crisis in rural areas must be resolved. To do that, health reform must address the workforce shortage crisis in rural areas and correct long-standing payment inequities.
"The House healthcare reform bill takes positives steps toward both of these goals, but falls short of truly ensuring that the access to care crisis will be significantly reduced."
J. James Rohack, MD
President
American Medical Association
"The AMA hails the passage of the House health reform bill, which will help improve the health system for patients and physicians and calls for swift passage of HR 3961 to secure the stability of the Medicare program. Passage of the House health reform bill is a big step forward as we work for comprehensive health reform this year. The AMA will continue its work with Congress and the administration to strengthen and improve health reform legislation as the process continues for patients and physicians.
"The bill will significantly expand health insurance coverage to Americans; empower patient and physician decision making; institute meaningful insurance market reforms; make substantial investments in quality; institute prevention and wellness initiatives; provide incentives to states that adopt certificate of merit and/or early offer liability reforms; and reduce administrative burdens.
"As Congress considers new coverage commitments to the American people through health reform, it must ensure that commitments already made are fulfilled through passage of the Medicare Physician Payment Reform Act of 2009 (HR 3961). This bill will permanently repeal the broken physician payment formula and preserve access to care for seniors, baby boomers and military families."
Karen Ignagni
President and CEO
America's Health Insurance
"Health plans strongly support comprehensive healthcare reform, and we have contributed to this discussion by proposing a complete overhaul of how health insurance is provided. Earlier this year, we proposed guaranteed coverage, elimination of pre-existing condition exclusions, no longer basing premiums on a person's health status or gender, and an effective personal coverage requirement to get everyone covered. We also have proposed far-reaching administrative simplification reforms that will improve efficiency, reduce costs, and free up time for physicians to focus on patient care.
"The current House legislation fails to bend the healthcare cost curve and breaks the promise that those who like their current coverage can keep it. A new government-run plan will cause millions to lose their existing coverage and draconian Medicare Advantage cuts will force millions of seniors out of the program entirely.
"This bill imposes inflexible mandates before getting everyone covered and new regulations that duplicate what is already in place at the state level. Many of these reforms begin in 2010 after employees have already chosen their plans and contracts have been negotiated. The result will be increased costs and massive disruptions in the quality coverage individuals and families rely on today."
Margaret A. Murray
Chief Executive Officer
Association for Community Affiliated Plans
"The labels 'historic' and 'landmark' are often overused, but they certainly apply to the House's passage of health reform legislation. This courageous action is a giant step forward and a major victory for reform over the status quo. The House bill takes the right approach to expanding access to affordable coverage, making all Americans more secure, and protecting critical programs for the most needy and vulnerable.
"The most positive aspect of the legislation is the largest expansion of Medicaid since the program was created more than four decades ago. Expanding Medicaid to cover everyone up to 150% of the federal poverty line is the most straight-forward and cost-effective way to provide coverage to those who reform should help the most—low-income Americans who have been the most ill-served by the deficiencies in our current system. This change alone will provide coverage to at least 15 million more Americans. And it will ensure that they get the kind of high-quality, comprehensive services they need and deserve at a price they can afford.
"The Senate should follow the House's lead and pass a strong reform bill without further delay."
I had the pleasure of moderating the design panel for the HealthLeaders Media Hospital of the Future Now conference held in Chicago last month. One of the learning objectives that was discussed is how should organizations be designing or renovating their facilities so they are equipped for a digital healthcare system. Here are some highlights of that discussion.
Greg Walton, chief information officer at El Camino Hospital in Mountain View, CA, shared his vision of the future and how healthcare organizations should start preparing now. "The world you are going to design for is going to be a different world than we live in today," he says. "One principal is information will be everywhere and it will be extremely mobile."
Recently, Walton had the experience of both retrofitting an older hospital and building a state-of-the-art facility from the ground up. The new facility, El Camino Hospital Mountain View will be opening its doors next week on November 15. He discussed some characteristics of that facility and how they fit into his vision of the future, for instance:
Everything is on the network. Not just the standard things like air conditioning and security, but even the fountain out in front of the hospital is on the network.
It has biometric patient identification system. "Patients love it, because in this era of identity theft we don't have to guess who you are—we can confirm who you are," says Walton.
It has a fleet of robots. Walton predicts the use of more robots in the future—not just for transportation, but for clinical applications, as well.
Patient rooms designed like a television studio. "People will expect world wide communication with their families," he says. "If you go to colleges today and talk to freshman, they are all Skyping, which is a video system on the Internet." Having the ability to provide those types of services from the patient's room will be the norm, he says.
In order to realize this digital vision of the future, however, there are some fundamental design principals that hospitals should consider first.
Heat.The heat that these smart hospitals generate is extraordinary, says Walton. So whether you are renovating or building from the ground up, you have to consider the amount of power that is being generated by these systems and what impact that will have.
Cable trays. Regardless of which category of cable organizations are using today, it will be obsolete in two years, says David Greusel, a principal at the design firm Populous, which is know for it's work in sports venues and convention centers. "We've seen building after building that didn't have a robust infrastructure for technology and ended up with itty bitty cable trays that are overflowing after five years because it had been rewired so many times," he says, adding that organizations should think about their technology infrastructure the same way they think about plumbing. Plumbing is stacked up so that all the pipes can work together and technology infrastructure should be designed the same way. "Wireless is not the magic wand either, because it has a big hairy infrastructure behind it as well," he says.
Redundancy. If you go down the EHR path, you can't skimp on redundancy, says Walton. "An hour of downtime is almost a life threatening event. We have just reached that tipping point where falling back to paper is not an option much longer."
When designing the digital hospital of the future, organizations should "think about the facility as coming alive and the expectations that patients and families will want from technology," says Walton.
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Quality improvement initiatives need the support of staff nurses to achieve their aims, but most staff nurses don't have time to read reports about how their individual unit is progressing. But they do have time to look at a dashboard that tells them at a glance whether their unit is meeting objectives or still has work to do.
Many organizations are finding that quality data dashboards can be an excellent way of communicating information throughout an organization and can be customized to drill down to individual unit data or show organizational objectives as a whole.
One organization that is using dashboards to communicate with staff nurses about nurse-sensitive quality indicators is Portsmouth-based Southern Ohio Medical Center.
SOMC color-codes the dashboard so that indicators are red or green, providing instant feedback on quality performance and nurses need only take a quick glance to see how their unit is doing. If objectives are being met, the indicator is green, but it is an eye-catching red if objectives are not being met.
"We can tell at a glance how we're doing," says Karen Marshall Thompson, RN, MS, CNS, director of home care services. "My boss, the CNO, can just glance at our dashboard and see how we're doing."
Each nursing unit at SOMC has a unit-specific dashboard, and all unit dashboards tie into the SOMC nursing dashboard. Some of the indicators roll into the SOMC organizational dashboard.
Some indicators are common across all unit dashboards, including pain management and patient satisfaction with the education they receive. Units also choose indicators that pertain to their unique patient population. For example, the ED monitors door-to-doctor and door-to-discharge times, which are crucial for keeping patient satisfaction scores high. The pediatric unit chose to include an indicator that measures the skills of nurses starting IVs—a crucial factor when trying to minimize pain and distress for the hospital's smallest patients.
Indicator objectives are chosen through methods such as examining national benchmarks or conducting a literature review to find best practices. "Sometimes, an indicator or process is so new that maybe we just compare our performance internally," says Thompson. "But ideally, we want to compare our performance to national benchmarks on any given indicator."
The indicators on the dashboards are periodically swapped for new ones. Indicators may be changed if the unit's staff members feel their performance is so consistently high on an objective that it is time to focus on a new objective or improvement opportunity. Or they may add a new indicator based on a new National Patient Safety Goal or innovation in nursing science.
The units try to not focus on too many issues at once. "We don't want to drown in data," notes Thompson. "We want it to be meaningful and focused and move the nursing unit and the organization in the direction of our strategic values."
If a unit's indicator had been green and turns to red or the team notices a drop-off in performance, staff members immediately initiate a rapid cycle action plan, which generally involves developing a 90-day goal of focusing on the issue and raising performance for the goal.
The team will brainstorm how to improve performance and will look to nursing literature and research to find best practices about how to reach the goals.
Thompson says the dashboards are an extremely effective tool for the organization. "It just kind of gets everyone pulling in the same direction," she says. Ultimately, the dashboards are also a matter of pride for each unit, which uses the dashboards to measure their performance.
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