As U.S. lawmakers engage in a debate over healthcare reform, Chinese authorities are also attempting to fix their system. Over the past five years, the government has tried to provide coverage to more of its 1.4 billion people. But even people covered by a minimal health insurance program are often left with big hospital bills and must pay for most outpatient services and medication. In addition, more than 300 million people do not have any health insurance. The gap in the quality of care has been steadily growing, too, the Washington Post reports.
Small healthcare entities are more likely to have cases of identity theft. So why exclude them from complying with a mandatory identity theft prevention program?
Randy Berry, B.A., C.P.A., financial leader and Red Flags Rule compliance expert with Columbus Healthcare & Safety Consultants in Columbus, OH, asks that very question.
The House of Representatives unanimously passed a bill Tuesday, October 22, that would exempt a healthcare practice with 20 or fewer employees from the FTC's identity theft Red Flags Rule requirement. The bill now moves onto the Senate.
The Red Flags Rule, which will be enforced starting November 1, 2009, requires healthcare entities considered to be "creditors" to implement an identity theft prevention program.
"The biggest concern that I have is … the smaller the practice, the less internal controls they have and the more apt the smaller practices are to have identity theft," says Berry, author of the Red Flag Manual and Training CD Package. "The most critical thing is protecting patients' identity. It's not about the doctor. It's about the patients' financial identity. The lobbyists forgot that this is not about practices; it's about patients and their customer's financial information."
The bill passed by the House last week, which was filed by John Herbert Adler (D-NJ), Paul Collins Broun, Jr. (R-GA), and Mike Simpson (R-ID), lets off the hook an entity that:
Knows all of its customers or clients individually
Only performs services in or around the residences of its customers
Has not experienced incidents of identity theft and identity theft is rare for businesses of that type
The FTC would determine if a business meets these criteria.
Berry says the larger facilities already have a lot of checks and balances in place in order to prevent identity theft. It's the smaller entities that need to get on board.
"They are more lax than the larger ones with their internal controls," Berry says. "It's literally minutes per day to comply with this Red Flags Rule."
One by one across the nation, small rural hospitals are getting stroke smart.
And around this Thanksgiving, 87-bed Hugh Chatham Memorial Hospital in Elkin, NC, a Mayberry-like town of 4,000 residents, will become one more.
Hugh Chatham and three other rural facilities in the nation's so-called "stroke belt" will link up with a teleneurology system through Forsyth Medical Center, the first North Carolina hospital to receive Joint Commission stroke certification, 45 minutes away in Winston-Salem.
When they do, patients who come to the emergency room exhibiting symptoms of brain attack can be examined through a high-resolution, 30-frame per second camera by a trained stroke neurologist either at Forsyth, or thousands of miles way through a neurology physician service called Specialists On Call.
Their CT scans can be scrutinized by those same distant doctors to see if they are eligible for tissue plasminogen activator or tPA, the clot-busting drug proven to make at least 11% of ischemic stroke patients who receive it almost completely recover when they otherwise would be severely disabled for the rest of their remaining lives.
All told, an estimated 1,500 patients who have a stroke attack each year at the four hospitals will get better care, Forsyth officials say.
"Another unknown number of patients won't be cured, but they will do better than they otherwise would and require fewer resources," says Patrick Lyden, MD, who started a similar stroke network with rural hospitals in California six years ago.
"Every day, more and more rural hospitals are solving this problem for themselves with different models of teleneurology," says Lyden, now chairman of the department of neurology at Cedars-Sinai Medical Center in Los Angeles.
It's important that expert neurologists diagnose which patients who present with stroke symptoms have ischemic stroke, the type that benefits from tPA, and which ones have hemorrhagic stroke, for which administration of the drug could be harmful.
Also crucial, having expertise available to rural communities like these will make it much more likely that patients will be seen within the three-hour window that the drug can help.
At Hugh Chatham, the idea originated when Marc Womeldorf, administrative director of rehabilitation services, wondered why his facility wasn't receiving more stroke patients.
"I checked with North Carolina state statistics for what happens to stroke patients from our primary service area, which includes Wilkes, Alleghany, Yadkin and Surry counties," says Womeldorf. "And I learned that over half of the patients who suffer stroke who live here were going to other hospitals farther away for their care. It didn't make sense."
"Quite often, what these patients are doing is going straight to these other hospitals by driving," which adds another hour of brain cell death and make it nearly impossible for them to be eligible for tPA within the required three-hour window, says Womeldorf.
"They're not even accessing the 911 emergency medical system transport. Meanwhile, the clock is ticking and brain cells are dying."
Teleneurology could bring more patients to Hugh Chatham, he reasoned.
North Carolina is one of the so-called "stroke belt" states, along with Arkansas, Alabama, Mississippi, Tennessee and Oklahoma where death rates from stroke are the highest in the nation. North Carolina, the sixth highest stroke death rate, had 52.4 stroke deaths per 100,000 people in 2006, nine more than the national average.
Womeldorf adds that his community needs better stroke care because of the high number of people with COPD, cardiac problems, high blood pressure and obesity, all conditions that accompany a much higher risk of stroke.
Each of the hospitals will pay about $100,000 a year for the Specialists On Call service, Forsyth officials say, but they will more than make up for it with business they receive in additional stroke patients.
Besides, providing better care is just the right thing to do, they say.
Robin Voss, a registered nurse and vice president of neurosciences and orthopedics at Forsyth, says that in the stroke belt, "stroke death rates are two times greater than the rest of the nation.
But most of the smaller facilities "don't have a neurointerventional radiologist who is on call 24/7. This ability to video conference in with these specialists will allow these patients a chance for a better outcome," Voss says.
"If you look in the literature, only about 3% of all the patients who could benefit from tPA get tPA," says Voss. "And if we could just increase that number by 1%, millions of dollars now spent on disability in this country would be saved."
But getting the expertise on board is just the start of the process. Residents will have to be educated not to just take an aspirin and go to sleep when they get a symptomatic "really bad headache."
They will have to be told about the importance of calling 911 instead of attempting to drive or be driven to a hospital for care.
And there will have to be training and monitoring by intensivists after the tPA is given in the rural setting.
For some patients, remote observation in a facility near their homes will enable distant neurologists to determine if the patients might be eligible for other kinds of stroke care, especially if they have exceeded the three-hour window.
At Hugh Chatham, Womeldorf says he has his work cut out to start educating community residents about the new service. He's going to churches, the media, health fairs, and there will be advertising to alert people to the new local stroke service.
And he will do his best to convince them not to even think about driving to the hospital if they think they're having a stroke – even if they're worried about what the neighbors will say when the ambulance pulls up.
Philanthropic giving for healthcare in the United States grew by a modest 2.9% to $8.6 billion in recession-wracked 2008, a rate of growth that was half that of 2007, according to the new Report on Giving issued this week by the Association for Healthcare Philanthropy.
Much of the slight gain in 2008—about $241 million—was attributable to bookkeeping dates. Most nonprofit hospitals and healthcare systems closed their books before the last quarter of 2008, when U.S. gross domestic product plunged more than 5%. Institutions that closed their books on Dec. 31, 2008, actually saw a 0.2% decline in annual giving, the AHP report states.
AHP President William C. McGinly says the tepid results should serve as a "wake up call" to President Obama and Congress, who are considering legislation to limit charitable deductions as tax write-offs.
"The hit that wealthy individuals have taken in the total worth of their portfolios and holdings during the recession takes huge assets off the table and out of the giving equation," McGinly says. "Compounding this scenario would be the Obama administration and Congress' attempts to limit the charitable deduction write off, thus dampening wealthy donors' incentive to give and further reducing charitable contributions to all philanthropic organizations."
McGinly says that while the recession may be technically over, AHP members fear their charitable organizations will continue to feel its negative repercussions throughout the recovery.
The 2.9% increase was about half the growth rate achieved in 2007, when donations totaled $8.3 billion. Total pledges for charity fell 6.2% in 2008, while planned gifts secured but not paid fell almost 13%.
More than eight of every 10 donations came from individuals who donated 60% of all philanthropic funds raised by nonprofit healthcare institutions in 2008. One in 10 donations were made by businesses, including business-sponsored foundations, representing 17.5% of all funds raised, down slightly from 2007. Non-corporate foundations accounted for less than 3% of donors, but almost 14% of revenues. Other giving sources, including hospital auxiliaries, public agencies, and civic groups, accounted for 8.6% of total funds raised in 2008, compared to 7.5% in 2007.
AHP Board Chair J. Gregory Pope says the healthcare entities that have maintained their fundraising efforts despite the recession are the ones that will be poised to benefit as the nation emerges from the downturn. "These institutions are mainstays of the American healthcare delivery system and continue to deserve the support of their communities," Pope says.
As in previous years, the AHP Report on Giving found that funds raised for healthcare institutions in 2008 were largely used to support construction and renovation of facilities, although to a lesser extent than in 2007, followed by the purchase of equipment, general operations and community benefit programs.
AHP, established in 1967, is a not-for-profit organization whose more than 4,900 members direct philanthropic programs in 2,200 of North America's not-for-profit healthcare providers.
A copy of the AHP Report on Giving is available by contacting Kathy Renzetti at (703) 532-6243 or via e-mail at kathy@ahp.org.
At first glance, 'The Warrior" ad looks as if it's promoting yet another Spartan-era Hollywood epic. But then there's the fine print: "The Saint Joseph's Film Group presents a Heartfelt Production ‘The Warrior.' Written and directed by the patients themselves."
The cinematic ads are part of the St. Paul, MN, hospital's 2008 image campaign, which won the medium hospital best in show award in this year's HealthLeaders Media Marketing Awards. Minneapolis agency Interval worked with St. Joseph's on the effort.
The campaign concept was to "Mirror the proven model of promoting a theatrical release to create buzz and generate interest," the marketing team wrote in its award submission form. "Spinning the traditional patient testimonial, the campaign features three actual patients promoted as heroes in their own movies."
Marketers set campaign goals of creating top-of-mind awareness for the organization and key service lines and building excitement for the opening of the newly expanded and renovated hospital tower.
"A marvelous thought executed to perfection," one judge wrote. "Teasing the campaigns like movies was a stroke of brilliance. This is an edge-of-the-envelope campaign that few would have risked."
The integrated effort produced several positive results, such as a 60% increase in volumes in three service lines versus the previous year, 16,000 unique visitors to campaign microsites, more than 5,000 attendees at the new facility opening, and a .5% increase in market share for the organization as a whole.
"Thunderous applause for the ROI," wrote another judge. "The 60% increase in service line volume is evidence of how well the campaign hit the market."
A marketing campaign for Georgia-based North Fulton Regional called "We Specialize in You" included several dozen photos of medical staff being posted at the North Point Mall for all the mall visitors to see. The second phase was to replace those photos with more pictures, but this time of patients.
Did your healthcare facility cover the spread on H1N1 respiratory protection? If not, your facility is probably scrambling to acquire N95 respirators and figuring out how to fit-test and educate employees on their use.
At the risk of delving into Monday-morning quarterbacking, did you really think the CDC was going to say it was OK to use surgical masks over the more highly-protective N95 respirators in protecting U.S. healthcare workers from H1N1 influenza? Apparently, others thought so, too.
Since the CDC first promoted the use of respirators in its interim guidance during the pandemic preseason in May, there has been controversy about whether H1N1 infectious transmission dynamic were essential droplet or airborne.
Droplet argues well for masks while an airborne dynamic suggests N95 respirators. And many fans lined up on both sides. Of note, the Society for Healthcare Epidemiology of America (SHEA) and the AHA favored masks; for the most part, nurses associations, labor organizations, and the Institute of Medicine (IOM) cheered on N95s. Some experts believed the IOM was better with more recent scientific studies than SHEA when developing their positions.
The ruling on the field, which the CDC revised on October 14, is for "respiratory protection that is at least as protective as a fit-tested disposable N95 respirator for healthcare personnel who are in close contact with patients with suspected or confirmed 2009 H1N1 influenza." Close contact, as defined by the CDC, means "working within 6 feet of the patient or entering into a small enclosed airspace shared with the patient (e.g., average patient room)."
The interim guidance does recognize that respirator shortages may occur and allows for healthcare facilities "to develop a risk assessment by which respirators in clinically short supply can be issued on a priority basis," according to the interim guidance. Also the interim guidance applies to both inpatient and outpatient settings, including home heath and clinical setting within non-healthcare institutions such as schools.
Meanwhile, OSHA was warming up on the sidelines as it issued an announcement—on the same day as the interim guidance—about an upcoming "compliance directive that will closely follow the CDC interim guidance to ensure uniform procedures when conducting inspections."
Within an hour after the news, the HCPro OSHA Compliance hotline started receiving inquiries about the possibility of cutting the fit-testing requirement. The answer, according to OSHA: "Where respirators are required to be used, the OSHA Respiratory Protection standard must be followed, including worker training and fit testing."
That kind of last-minute-reprieve thinking isn’t unusual, even though readers of the OSHA Healthcare Advisor have known about this issue for some time. The problem is that unlike football, pandemic influenza preparation is not a spectator sport. And time has expired for healthcare facilities that thought the CDC was going to produce a comeback win in the last two minutes of the respirator-mask game.
Medical practitioners presented ardent and disparate views to a Vermont state panel reviewing the merits of free medicine samples provided at doctors' offices, the Associated Press reports. Curbing or even eliminating the free samples could be the next stop for Vermont, a state that already holds drug companies accountable for their marketing efforts. The Vermont attorney general's office held the hearing, part of a broader study to be submitted to the state Legislature in December.
In this post on "Valley PR Blog" about industry-specific PR challenges, Debra Stevens, director of marketing and communications for the Phoenix Children's Hospital notes that communicating about pediatric healthcare means telling stories of children with a variety of health conditions. But federal health privacy regulations under HIPAA laws sometimes restricts the ability to tell these stories, Stevens says.
Sonia Rhodes, vice president of customer strategy, The Sharp Experience & The Sharp University for Sharp HealthCare in San Diego, tells a story about her organization's CEO, Mike Murphy, that will always stick with me. Talking to an assembly of employees about his vision of Sharp as the best place to work and the best place to receive care, he told the assembled audience: "We don't have all the answers or know exactly what it's going to take, and I am going to need each of you to help. What I do know is that I'm confident that the wisdom is in this room—that the people of Sharp have the creativity, initiative, and expertise to make this happen."
I was reminded of that memorable phrase, "the wisdom is in this room," at our HealthLeaders Media 2009 Marketing Experience event, held earlier this month in Chicago. In the morning session, Rhodes and co-presenter Gary Adamson, chief experience officer of the Golden, CO-based experience design firm Starizon, gave a wonderful presentation about how to improve the patient and employee experience at hospitals and health systems.
Tapping the experience in the room
And then they turned the event over to the room and the wisdom within. In one of the two afternoon sessions, Adamson and Rhodes led the group in what they call a "braindorming" exercise. Attendees submitted questions before the event and those questions were posted on 12 doors around the room. Armed with pens and sticky notes, attendees made their way around the room, posting their answers to each question on the doors.
Their ideas, opinions, and solutions were nothing short of amazing.
For example, one of the questions was one that many hospital leaders are asking today: "What can we do to stand out so that when patients need our services they will remember us?"
Among the answers:
Provide exceptional service—that is the best marketing.
Make sure you market the doctors—they drive most volume.
Ask your patients and staff—they will tell you.
Ask patients at discharge, "What could we have done better?"
Stress consistent competitive advantage message.
Implement consistent and concise messaging of what you do best.
Understand their needs and exceed them.
Market in a way that differentiates you from competitors.
Anticipate their questions and be consistent with answers.
Don't ask patients how they feel when they are laying on a gurney.
Do something meaningful, memorable, and unexpected.
Find something that patients generally identify with and follow that theme.
Put the patient first.
Personalize patient experiences every time.
Give team members "permission" to customize the experience.
And one of my personal favorites for its elegance and simplicity: "Tell them what you will do. Do it. Follow up."
And, by the way, that's only about one-third of the answers to this question.
So what's the takeaway here? It's that sometimes all you have to do to start your organization on the path to an exceptional experience for every patient, every time, at every touch-point is to tap the wisdom in the room—including your executive team, your physicians, your staff, and your patients and their families.
Transforming the patient experience
Adamson and Rhodes, authors of the latest HealthLeaders Media book for marketing and other healthcare leaders, The Complete Guide to Transforming the Patient Experience, contributed much of their own wisdom and experience to the room, as well.
They stressed that creating a better patient experience is not incremental work—it's transformational.
"This is about reminding yourself that we are the leaders that are going to move this forward for your organizations and the industry. We are on the precipice of changing healthcare," Rhodes said. "This is transformation in who we are in the roles we play and also transformational for our patients, because if we can customize and personalize their experience we create something altogether different for them and they can be transformed by that experience."
"Healthcare is going to change whether the leaders want to make that change or not," Adamson said. Baby boomers, in particular, will be the drivers of this change, he added. They'll change healthcare from "impersonal and dehumanizing" by demanding a different kind of experience.
Luckily, you have access to all of the wisdom you need to meet those demands—all you have to do is ask.
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