For people lacking health insurance in the Washington, DC, region, where they live can make all the difference in getting affordable healthcare, the Washington Post reports. Washington, DC, has taxpayer-funded health insurance for everyone within generous income restrictions. But about 10% of eligible adults remain uninsured, and the city wants to find and enroll them. But in Prince George's County, MD, recent Census Bureau statistics show that one in five working-age adults is uninsured. The census statistics also underscore wide regional differences in how many people are uninsured, the Post reports.
Although still used in doctors' offices and emergency departments, "rapid influenza diagnostic tests" actually do a fairly poor job of sniffing out H1N1, a growing body of evidence shows. Scientists reported in The Journal of the American Medical Association that one-third of California patients hospitalized with H1N1 flu had a negative rapid test, which looks for influenza A virus in a sample swabbed from the nose and gives results in a half-hour or less. However, a different test that uses the more sophisticated polymerase chain reaction technology, which can take a single piece of DNA and generate thousands to millions of copies, confirmed they had influenza A or H1N1 in particular.
Doctors around the country are using social networking tools to bring patients' families and the general public into operating rooms, sometimes sharing step-by-step medical procedures. They favor the real-time updates and videos as a way to reduce the fear factor of surgeries and educate people about the realities of certain procedures, especially new ones. For example, earlier this year surgeons at a Detroit hospital used Twitter to report the blow-by-blow steps of an operation to remove a kidney tumor.
More than $1.5 million has been awarded to the West End Medical Centers and the Medical College of Georgia Research Institute to help uninsured children in the state. The grant, awarded by the Centers for Medicare & Medicaid Services, will be used to find and enroll eligible children in Medicaid or the Children's Health Insurance Program, or PeachCare for Kids. The funds are part of $40 million in grants recently given to 69 organizations across the nation.
MetroWest Medical Center has told employees it may end its contract with Blue Cross and Blue Shield of Massachusetts unless the insurer narrows the gap in payments between the hospital and its competitors, the Boston Globe reports. Leaders of the hospital and its physicians organization said rates paid for their services are as much as 40% lower than what other healthcare providers receive. MetroWest, owned by Vanguard Health Systems, operates Framingham (MA) Union Hospital and Leonard Morse Hospital in Natick, MA, which have a total of about 300 beds and more than 740 affiliated physicians.
The House healthcare bill would repeal an exemption from federal antitrust oversight that the health-insurance industry has enjoyed for decades, but the move alone might not make local insurance markets more competitive. The repeal is necessary to inject competition into regional insurance markets, according to Rep. Diana DeGette (D., CO), one of several members of Congress behind a push to repeal the exemption. She cited American Medical Association figures showing that 94% of those markets are highly concentrated.
The business world found plenty to complain about as it assessed the House bill that would make sweeping changes in the healthcare system and extend insurance coverage to millions more Americans, the New York Times reports. Insurers do not like the provision to create a new government-run insurance program. Drug makers oppose billions of dollars in rebates they would have to give to the government over 10 years. Medical devices are not happy about the proposed 2.5% tax on their products. And employers oppose rules that, for many of them, would make healthcare coverage a federally mandated obligation.
It takes more than one method to bring a hospital's hand-hygiene compliance rate up over 90%. At Barnes-Jewish St. Peters Hospital (BJSPH) in St. Peters, MO, it was a matter of trial and error to reach its compliance goal.
"We started collecting hand-hygiene observations back in 2004," says Kathleen Dougherty, RN, MSN, manager of professional practice and leadership development at BJSPH. "We wanted to see where we were with compliance for guidelines from the Centers for Disease Control and Prevention."
The organization took several leaps forward over the next few years, but it was in 2007 they found several tactics that truly brought them closer to the level of compliance they were looking for.
You've been spotted
"In 2007, we knew we had to do more, and we wanted to do more," says Dougherty. "We wanted to be at 90% hand-hygiene compliance by the end of that year."
BJSPH increased frequency of the audits to at least 100 a month.
"In February 2007, after a brief discussion with a Joint Commission surveyor, we learned of the idea to use cards as a method of feedback during audits. We tool this idea and developed it further, into a very simple, but highly effective, concept: ‘You've been Spotted' cards."
These cards—adorned with a Dalmatian to go along with the "spotted" theme—came in two varieties. At a distance, they appeared indistinguishable, but up close the two varieties were distinctly different.
For positive reinforcement, some of the cards were flagged for incidents where the receiver has been spotted using good hand-hygiene practices. These cards includes a $2 coupon good in the hospital cafeteria or gift shop—enough for a cup of coffee or candy bar, or they can be saved up to buy lunch. Funding for these coupons came from the infection prevention budget.
On the spot
And then there are the other cards, which read, "We are putting you on the spot for not using hand hygiene."
The reason the cards look nearly identical is to prevent any sort of embarrassing scene for the people involved. It's impossible to tell from a few feet away whether you've received a positive card or negative.
"We needed something non-confrontational," says Dougherty. "We wanted something with positive reinforcement, but also something to notify you if you got caught. We didn't want this to be a public display."
The dynamic is an interesting one—especially because the auditors can be from any area of the hospital hierarchy. Secretaries have had to give cards to physicians, lab techs to nurses.
Again, the introduction of the cards showed an increase in compliance—but again, not enough of a jump to be completely satisfied.
"We saw an increase that year. We made it to 90% one month, but for year to date we were at 86%," said Dougherty.
The next step toward improvement: posting names.
"We continued the positive rewards program, but … we started reporting both those who did well, and those who needed to improve," says Dougherty.
The good with the bad
There was a great deal of deliberation within the leadership team on this concept. Leaders made a conscious decision to hold everyone accountable while continuing to "use the carrot instead of the stick," staying with positive reinforcement to motivate employees to higher hand-hygiene compliance.
So, to temper the negative reinforcement of posting names—which helped improve compliance as well—BJSPH added an additional, and very public, way of rewarding those who were spotted using proper hand-hygiene processes. /p>
"Any [month] we meet or exceed our goal, we will take the names of everyone who was recognized as doing a good job, put their names into a drawing, and have a 'hand hygiene hero' drawn in the cafeteria," says Dougherty.
The cafeteria is shared by staff and guests alike, so the congratulatory ceremony—including Bonnie Tyler's 1980s hit "Holding Out for a Hero" playing loud and clear—can be witnessed not only by staff, but also the people using the hospital and their visitors. There's a gift involved for the winner of the drawing as well (a $25 gift certificate) and, in months where the goal is exceeded, multiple names are drawn.
Winners' pictures are taken and posted throughout the building—even built into screen savers on hospital computers. The tactic has been well-received by the staff, and when a winner is present in the cafeteria during the drawing, cheers have been known to break out.
Even as the nation's unemployment rate hit 10.2%—the highest in 26 years—hospitals reported a surge of 10,000 payroll additions during October. This represents the largest single month of hospital job growth in nearly one year—as the overall healthcare sector continues to be one of the few job engines in the sluggish economy, according to new Bureau of Labor Statistics seasonally adjusted preliminary data released this morning.
The healthcare sector—from physicians' offices, to residential mental health homes, kidney dialysis centers, and blood and organ banks—reported 28,500 payroll additions during October, and 597,000 payroll additions since the start of the recession in December 2007. The healthcare sector has created 233,600 new jobs in the first 10 months of 2009, an average of 23,360 new jobs each month, according to BLS' preliminary data. In the first 10 months of 2008, the healthcare sector grew 288,900 new jobs and averaged nearly 29,000 new jobs per month, data show.
Ambulatory healthcare services continue to be the major driver of healthcare sector job creation, with 12,500 payroll additions reported in October, and 144,700 payroll additions in the first 10 months of 2009, according to BLS preliminary data.
All data for October and September at BLS is considered preliminary and could be considerably revised in the weeks ahead.
Hospitals' 10,000 payroll additions in October represent the largest single month of job growth since December 2008. In September, the hospital sector added 7,300 jobs, preliminary data show. Those 17,300 new payroll additions reported in the last two months represent nearly half of the 37,500 hospital payroll additions reported in the first 10 months of 2009. In June, the hospital sector actually lost 200 jobs. Over all, there were more than 4.7 million hospital jobs at the end of October, preliminary BLS data show.
Despite the two-month spike in hiring, the pace of job growth in the hospital sector in 2009 is well off that of recent years. Based on average monthly payroll additions, hospitals will create 45,000 new jobs in 2009, compared with 136,700 new hospital jobs in 2008, 105,700 in 2007, and 81.400 in 2006, according to BLS data.
Even with the slower payroll additions, however, the healthcare sector is still outperforming the overall economy. BLS preliminary data show that the nation shed 190,000 jobs in October, and that nonfarm unemployment rose to 10.2%, the highest rate since April 1983. Since the start of the recession in December 2007, 8.2 million people have lost their jobs, and the unemployment rate has increased by 5.3%.
Since December 2007, the healthcare sector has created 597,200 new jobs. BLS preliminary data show that there were more than 13.7 million healthcare sector jobs in October. Hospitals created 174,600 new jobs during the recession.
Seasonally adjusted data, which are used in this story, allow for better month-to-month comparisons that better reflect changes in economy, rather than seasonal employment patterns. Payroll growth also reflects the number of new jobs, not the number of new employees, because one person can have more than one job.
I was talking to a health system CEO the other day, who was angry at the deals being struck between leaders of industry lobbying groups and government leaders. Never mind that these "deals" are just handshake agreements not to oppose the president or Congress' idea of healthcare reform—whatever shape it eventually takes.
Angry may be a strong word. Let's just say he was dissatisfied. We talked about the $80 billion in dubious cost cuts over the next 10 years that drugmakers agreed to with President Obama earlier this year in order to buy not only their silence, but their support, in the face of healthcare reform. It's hard to argue that that deal hasn't since been exposed as a not-so-well-hidden gift to drugmakers.
We then talked about the $155 billion in cuts the main hospital lobby, the American Hospital Association, agreed to in principle in July, which doesn't seem nearly as lucrative, as I'll get to in a minute. In short, it doesn't look like hospital negotiators did quite as well.
Finally, we talked about the one big lobbying group that hasn't made a deal on healthcare reform: insurers. Predictably, that industry has become the villain du jour in the raucous healthcare reform debate we've been following all year. Hospitals have avoided that fate, but at what cost? My purpose is not to defend health insurers, but to ask whether any "deal" agreed to under pressure is really a good deal.
Take the hospitals. In return for agreeing not to oppose healthcare reform, the AHA, representative of the nation's more than 5,000 hospitals, said its members would collectively accept $155 billion in reimbursement cuts over 10 years in return for a reform plan that would insure effectively all of the currently uninsured—presumably through a combination of a mandate requiring all citizens to carry health insurance and a public option health plan that would facilitate that coverage.
The announcement of the deal came after administration heavies not-so-quietly suggested that $200 billion in cuts would be about right, causing hospital representatives to gulp—hard.
The health system CEO I was talking to was angry that there was no provision to keep such a public option from ratcheting back reimbursement further once it's in place. He was off about that. In fact, the deal contains a promise that "public option" reimbursement rates would not reach the low level of Medicare and Medicaid reimbursement rates, which, depending on whom you believe, come in at somewhere near 90% and 60%, respectively, of the cost of providing that care.
Further refinements of the bills in both houses revealed that the public option would have to negotiate rates with hospitals in a similar way that commercial plans do now. Fine. But nothing in the intervening time period has spelled out at what level the public plan might think is a fair reimbursement. Never mind the difficulties of negotiating with a payer that can effectively put you out of business, or, at the very least, make life very difficult for those who don't like what the government plan is offering.
So back to the question I asked in my headline. What if all your reimbursement came from Medicare? I'm guessing you wouldn't like it very much, considering that all I've heard over the years is how Medicare significantly underfunds the cost of care in its reimbursements, leaving hospitals to cross-subsidize by negotiating deals with commercial insurers that pay better. That's a hidden tax that we all currently pay for the fact that government reimburses poorly.
But if healthcare reform passes, and even if the public option pays you as much as 99% of costs, much higher than Medicare, you still come out way behind over time. And that was the crux of my friend's point.
And don't count on commercial insurers to continue making up the difference. Why should they? They haven't made a deal with the president, after all.
