Federal officials have charged 20 people with fraudulent Medicare billing in seven cases that total $26 million in unneeded or undelivered medical equipment, the U.S. attorney's office in Los Angeles announced. The charges came out of a joint investigation by the FBI, U.S. Department of Health and Human Services, and California attorney general's office.
A new California study has found that a federal requirement to check the citizenship of all Medi-Cal applicants has imposed significant burdens on California's 58 counties but that officials have not reported any cases of existing recipients who had falsely claimed U.S. citizenship. The study by the California Endowment and the California Healthcare Foundation found that the requirement in particular made it harder for the homeless, mentally ill, people born outside California, and children over age 16 to access public healthcare.
General Electric Co., as part of its $6 billion Healthymagination project, announced it will work more closely with drug maker Eli Lilly & Co. on cancer research and will launch a $250 million healthcare venture-capital fund. The $250 million "Healthymagination Fund" will invest in companies globally that are developing diagnostic, information-technology, and life-science technologies aligned with the Healthymagination campaign GE launched in May, GE officials announced. In a separate initiative, the GE Foundation pledged $25 million over three years in a set of grants to U.S. health centers that focus on primary care for underserved Americans.
Americans have become increasingly alarmed about the swine flu, but many are wary about getting vaccinated against the disease, according to a new Washington Post-ABC News poll. A majority of those surveyed—5%—now say they are "a great deal" or "somewhat" worried that they or someone in their household will be infected with it, up from 39% of those polled in August. At the same time, however, more than six in 10 say they will not get vaccinated, and only 52% of parents say they plan to have their children vaccinated.
In a 53-47 vote on Wednesday afternoon, the Senate turned down efforts to repeal the sustainable growth rate (SGR) formula that is now used to establish annual Medicare physician payment updates. Forty Republicans and 13 Democrats voted against the motion.
Under the bill (S. 1776) proposed last week by Sen. Debbie Stabenow (D-MI), Congress would override the formula it set in 1997 to prevent Medicare costs from rising faster than planned. The formula had called for cutting projected Medicare reimbursements to physicians; however, those cuts were reversed each year. The bill, which would have cost $247 billion, is separate from the current healthcare reform bills which are now being reconciled in the Senate.
The bill, which had received support from the American Medical Association, AARP, and the Military Officers Association of America, failed to gain the support of moderate Democrats such as Senators Kent Conrad (D ND) and Evan Bayh (D-IN) because they said the bill failed to raise revenue to offset its costs.
Republicans had argued, though, that the bill was trying to avoid adding higher costs to the current healthcare legislation. Senate Minority Leader Mitch McConnell (R-KY) said today that, "In the Senate's first vote on healthcare spending this year, a bipartisan majority rejected the Democrat Leadership's attempt to add another quarter trillion dollars to the national credit card without any plan to pay for it."
The AMA said in a statement that it was "deeply disappointed" over the vote. "Permanent repeal of the Medicare physician payment formula is essential to comprehensive health system reform," it said.
In an interview with HealthLeaders Media this week, AMA President J. James Rohack, MD, said that abolishing the current formula would have allowed Congress to develop a new payment system that rewards efforts to treat and control chronic diseases, and reduce hospitalization. "This formula is designed to make cuts as volumes go up. It's an old formula that doesn't reflect what 21st century medicine is and will become even more in the future," he said
The American College of Physicians said that it will continue to insist that Congress repeal the "unworkable and destabilizing Medicare SGR and create a better system for updating physician services." It said that "the practice of enacting short term patches that fail to provide the stability needed to initiate comprehensive physician payment reform ... will not be reduced by devastating physician payment cuts."
Since The National Quality Forum (NQF) released the 2009 Update of its Safe Practices for Better Healthcare, Healthcare Facilities Accreditation Program (HFAP) has adopted the 34 safe practices, which will now be implemented by all HFAP-accredited hospitals, the accrediting organization announced.
NQF has added seven new practices that will be incorporated in the new standards throughout the manual. Two of these will be retired because other measurement strategies are covering the same events. These new practices include disclosure, support of caregivers, pharmacist leadership structures and systems, glycemic control, and fall prevention.
"There is no doubt that the implementation of these 34 practices will improve patient safety," said Mike Zarski, CEO of HFAP, in an official statement. "We studied them in great detail, and they are a vital part of our survey process."
HFAP is one of only three national voluntary accreditation programs (along with The Joint Commission and DNV Healthcare, Inc.) authorized by the Centers for Medicare and Medicaid Services (CMS) to survey hospitals for compliance with the Medicare Conditions of Participation and Coverage.
Originally created in 1945 to conduct an objective review of services provided by osteopathic hospitals, HFAP has maintained its deeming authority continuously since the inception of CMS in 1965 and meets or exceeds the standards required by CMS/Medicare to provide accreditation to all hospitals, ambulatory care/surgical facilities, mental health facilities, physical rehabilitation facilities, clinical laboratories, critical access hospitals, and stroke centers.
For further details these changes, visit HFAP at www.hfap.org.
In a world where a consumer can collect encyclopedic knowledge about a car or home electronics purchase, the need for useable, measureable quality data grows every day, particularly in healthcare.
More organizations are focusing on quality data collection, said Stephanie Iorio, RN, CPHQ, CPC, during her presentation "The Impact of Quality Data on the External Environment" during September's National Association for Healthcare Quality national conference in Grapevine, TX.
Current themes in quality measurement include an absence of standardization of measures and data element definitions, a need to harmonize measures across healthcare settings, a growing demand for measures of efficiency, and use of administrative and other electronic data.
There has also been a movement toward "episodes of care," Iorio said. Other themes include:
Data quality (particularly self-reported data)
Pay for reporting and pay for performance
Process versus outcomes measures
Patient privacy and confidentiality
The growing role of consumers
"Are we measuring the right processes?" said Iorio.
There are more than a half-dozen regulatory or reporting agencies tracking quality data in the acute care setting—not just CMS and The Joint Commission, but such staples as the National Quality Forum, the Agency for Healthcare Quality Research, the Institute for Healthcare Improvement, Leapfrog, and Healthgrades.
And yet, "today you can find out more about a TV you want to purchase than about your own healthcare online," said Iorio.
The crux of quality is data, Iorio said. Data analysis reveals a great deal about quality and patient safety. Reviewing data can show trends in appropriateness of care, variations in practice and outcomes, and resource utilization.
Movement away from manual chart reviews—which are both time- and resource-intensive—to the electronic record has revolutionized the availability and usefulness of administrative data, said Iorio.
So where does The Joint Commission play into all of this? In 2009, ORYX reporting required four measure sets. Additional measure sets are in development, and measures are being reworked for capture through the electronic health record system.
Also beginning this year, The Joint Commission considered introducing "paired mandatory reporting requirements"—that is, certain measures would be tied together in required reporting. For example, if your facility reports cardiac care measures, either myocardial infarction or heart failure measures would also be required. Alternately, surgical services measures would then mean Surgical Care Improvement Project infections would need to be reported.
Most hospitals would meet the remainder of reporting requirements by choosing to report some combination of nursing sensitive, pneumonia, children's asthma care, and pregnancy measures, said Iorio.
It's an expensive French door model from Sears, the kind with an alarm that goes "beep" after the door is left ajar more than one minute.
Saturday morning, the refrigerator cried for a cleaning. I opened the doors, removed the food and sponged down all the shelves and drawers.
Beep-beep-beep. Beep-beep-beep. Beep-beep-beep.
Good thing I bought the model with the option to turn that annoying sound off, I thought.
Later the next day, something didn't smell right. I had forgotten to turn the alarm back on. If I had, I would have known that the doors hadn't completely closed. Now the ice had melted. The milk was sour. The beer was warm. And the tuna salad would have to go. All because I erroneously deprogrammed my error detection system.
Maybe my refrigerator should have come with another sound—perhaps a bell—that would have alerted me to turn the alert back on? Or better still, maybe refrigerator designers should make any beep deactivation automatically expire after 30 minutes, enough time to clean those shelves.
It's that kind of "mistake-proof" thinking—of course on a much bigger scale—that's now on the minds of designers of healthcare systems, medical devices, and processes.
It certainly must be on the minds of those at Cedars-Sinai Medical Center, where 206 patients received CT brain scans with excess radiation exposure, as well as those officials for GE Healthcare, which manufactured the scanners.
In a letter to the U.S. Food and Drug Administration, Cedars-Sinai CEO Thomas Priselac has suggested some changes in the auto default settings on the scanners, among other design modifications.
GE officials say there's nothing wrong with their machines, but they are undoubtedly thinking of ways to produce additional error-proof features on their next equipment models.
A decade after the Institute of Medicine's famous report, "To Err Is Human," the Agency for Health Research and Quality continues to give mistake-proofing a tremendous amount of attention. This week, an AHRQ official pointed me to an illuminating catalogue containing 155-pages of error-proofing solutions. It is titled "Mistake-Proofing the Design of Health Care Processes."
The document was compiled by John Grout of Berry College in Rome, GA, an associate professor of business administration who has spent the last 12 years thinking about mistakes, and how to program into the process a system failure that will stop the mistake from being made.
"The traditional approach within medicine has been to stress the responsibility of the individual and to encourage the belief that the way to eliminate adverse events is to get individual clinicians to perfect their practices," he writes. "This simplistic approach not only fails to address the important and complex system factors that contribute to the occurrence of adverse events, but also perpetuates a myth of infallibility that is a disservice to clinicians and their patients."
The AHRQ document treats the field of mistake proofing as a scientific pursuit, a way of understanding the essential pathway to the mistake. When are mistakes made? How are mistakes made? And how can health providers lock in systems to prevent mistakes from occurring or from causing harm?
Here are three tips gleaned from the report, but there are hundreds of others.
Keep items commonly used in plain sight, and remove items that are rarely used, or for which usage requires more skill, preparation, or knowledge.
Keep standard operating procedures as simple as possible. The more complex the rules and procedures, the more there exists the chance for errors. "Design changes can prevent mistakes by simplifying or clarifying the work environment, making mistakes less likely," the report says.
Instill a blame-free culture that values accountability, but that allows people to report errors and question processes without fear of retribution or punishment. "A policy of not blaming individuals is very important to enable and facilitate event reporting, which in turn enables mistake-proofing.
The document provides numerous examples of thoughtful mistake-proofing to prevent potentially lethal mistakes.
For example, a prescription filling area at a Norfolk, VA, hospital is marked by red line barrier, indicating a quiet, no interruptions zone for pharmacy workers needing to concentrate in silence. After it was instituted, dispensing medication errors fell by 64%.
A new breed of radiation machine in use at Elbert Memorial Hospital in Georgia can detect the amount of radiation that has penetrated a patient. It automatically terminates exposure when a predetermined level has been reached.
X-ray detectable sponges are increasingly used in surgical settings because when they are left in muscle or fat tissue, they can be easily detected.
A wristband checklist in use at Virginia Mason Medical Center in Seattle uses symbols to show whether heart attack patients have received widely-accepted treatment regimens. Patients can't be discharged until all their wristband records are checked.
And Target has begun using a flat pill bottle that is color-coded and allows flat rather than rounded sides to allow the name of the medication to be more easily read, and so drugs intended for one family member aren't mistakenly taken by another.
The era of the error failure system is here. And clearly more solutions are coming from creative problem solvers.
Maybe they have an idea for a better system to alert when the refrigerator door is left open too long, too.
Hiring the right physician to work in your practice for the long haul can be daunting, especially if you’re replacing a successful partner who is retiring or if your practice has a high turnover rate. Before you write a job description or call any candidates for an interview, take the time to create a detailed plan for effective and sustainable physician recruitment and retention.
Determine your need
The first step in the recruiting process is determining why you need to hire a new physician. It may sound simple and obvious, but it is something that requires a lot of thought.
“A good sourcing strategy is a necessary piece of the puzzle for physician searches,” writes Kay B. Stanley, FACMPE,vice president of Coker Group in Atlanta, in its Crafting a Sustainable Model for Physician Recruitment and Retention white paper. “It begins with determining what type of people you need and then deciding the best way to reach them.”
Just because a physician retires doesn’t necessarily mean your practice needs to hire a new doctor. It’s important to consider your practice’s finances and determine whether hiring a new doctor makes sense.
“You need to look at it from a financial perspective and ask, ‘Are we going to be able to manage it and get an appropriate return on investment?’ ” says Craig Hunter, senior vice president at Coker Group. “Then start looking at whether it is going to be the same specialty, a different specialty, what are the parameters, if there is an income guarantee from a hospital, and if you’re going to recruit on your own.”
Once you’ve decided that you absolutely need to hire a new physician, create a timeline for hiring and decide how you’re going to go about the recruiting process. Most practices use some combination of recruitment firms, professional organizations, networking, or job postings.
Emphasize your strengths
Drafting a strong recruitment strategy is critical because physician recruitment is highly competitive.
“The existing and anticipated shortfall of physicians has already created stiff competition among healthcare providers across geographic locations,” Stanley writes. “The competition is especially heated for cardiologists, gastroenterologists, and oncologists because fewer new practitioners are coming into the system. Meanwhile, millions of aging baby boomers require predictable needs for specialty medical care as they reach their 50s and 60s. The competition, therefore, is on the local, state, and national level, as specialists can expect to receive hundreds of offers.”
Because of this intense competition among practices, you should create a detailed outline that includes the strongest aspects of your practice that you can list in a job posting or explain in an interview. The following are possible highlights:
Your geographic area
Work-life balance
Compensation
Benefits package
Practice expertise
Practice size
Practice diversity
Awards or other recognition
“Because of stiff competition, you must present your practice opportunity favorably, responding to the physician’s prospective needs and presenting a longer-term view of what the practice and the community offer,” Stanley writes. “During the next several years, there will be important trends in the medical industry that will affect the careers and future earning power of most physicians practicing in the United States. In order to maximize their fullest potential, physicians will have these trends in mind before entering the job market. Adequate compensation is certainly one component, but clinical autonomy and control over their time and work environment tend to be more important over the long term. As younger physicians move into the medical industry, expect quality of life to become an increasing consideration.”
Recruit to retain
Throughout the recruiting process, keep in mind that you’re looking for a physician who will stay with your practice for many years. If your organization has had a problem with high turnover for physicians, you need to determine the reason and come up with a solution before you begin recruiting.
Stanley’s white paper lays out many reasons physicians may become unhappy with their practice, such as:
An unstable organization
Limited professional growth opportunities
Office politics/work culture issues
Demands that make it difficult to balance between work and personal lives
Patients, cases, and career choices
Location and lifestyle
Compensation
“The majority of physician retention starts in the recruitment process,” Hunter says. “During that process, practices create a series of expectations that they may or may not be able to live up to, and if they can’t live up to them, the doctor and their family won’t be happy and he or she will leave.”
Keep your new hire busy and happy
Once you’ve hired the perfect physician, you’ve got to keep him or her at your practice. Once your new hire is settled, take some time to explain the business side of your practice to him or her, especially if it is a younger doctor who may not be familiar with practice business techniques.
“You need to make sure doctors understand the growth and the development side of the practice,” Hunter says. “It’s important that doctors go out and try to establish their place in the community. As a business, you can’t afford to allow the doctor to sit back; they need to get out and the organization needs to appropriately communicate to the new doctor about promoting and marketing the practice.”
You may suggest that the new physician:
Set up face-to-face meetings with potential referring doctors
Network with community physician leaders
Promote him- or herself through educational programs or community service
Engage in speaker outreach programs
Once you’ve ensured that your new physician is active in the community and working on bringing in new business, you should set up a process to check in regularly with the doctor.
“Reviewing progress and developing a more formal practice growth process and discussing that proactively with the new doctor on a monthly basis is important,” Hunter says. “Say, ‘Here’s where we expect you to be in month six in this organization, and we’re going to sit down in month three and month four and talk about where we are compared to those goals.’ That’s where you have the difficult questions about how are we going to meet those goals.”
“Closely associated with the retention and support phase are the efforts that examine and monitor levels of satisfaction,” Stanley writes. “Periodic surveys are one tool. Developing a structured plan of action for a physician relations program and implementing it are ways to achieve and maintain a smooth program.”
This article was adapted from one that originally appeared in The Doctor's Office, a HealthLeaders Media publication.
Healthcare advertising campaigns that set clear objectives, met or exceeded them, and showed positive ROI were honored at last week's HealthLeaders Media Marketing Experience event in Chicago.
In the meantime, I'll give you a sneak peek with some highlights from the three campaigns our judges chose as best in show.
PeaceHealth Siuslaw Region
PeaceHealth Siuslaw Region in Florence, OR, was our small hospital best in show winner for their "Community Image Campaign." Our judges were impressed with the results the campaign garnered. "The ROI was well-defined and I liked the fact that they had established metrics based on a previous image survey," one judge wrote.
St. Joseph's Hospital
Our medium best in show winner was St. Joseph's Hospital in St. Paul, MN, for their 2008 image campaign. "Thunderous applause for the ROI," one judge wrote. "Great tracking. [A] 60% increase in service line volume is evidence of how well the campaign hit the market."
Meridian Health
Our large hospital best in show winner was Meridian Health in Neptune, NJ, for its "Doctor Bernard and the Pawsitive Action Team," campaign. Again, the campaign's ROI set it apart. The judges were impressed that keyword searches for Children's Hospital increased by 600%. "The 1,725 members and counting enrolled in the healthy living program truly shows how engaging the campaign is," wrote one of our judges.
The campaign also elicited one of this year's best comments from a judge: "Although I don't have the opportunity to use such a great idea, it's still fun to think I might steal this one."
You can read more about Meridian Health's best in show campaign—and see a sample of the creative—in today's campaign spotlight by Healthleaders Media editor Marianne Aiello. She'll feature the St. Joseph's and PeaceHealth campaigns in the next two issues.
Note: You can sign up to receiveHealthLeaders Media Marketing, a free weekly e-newsletter that will guide you through the complex and constantly-changing field of healthcare marketing.
