Epidemiologists in New York and a few other cities that were awash in swine flu last spring are detecting very little evidence of a resurgence. Officials in New York, which was the nation's hardest-hit city, say that flu activity is no higher than it normally is at this time of year and that school attendance is normal. New York City public health officials are still conducting an extensive immunization campaign, and they agree that it is far too early to draw any final conclusions.
Minority groups are seeking to become a larger part of the healthcare overhaul debate with a new campaign and new ads. Leaders of black and Latino advocacy groups say that because so many of their members favor healthcare reform, they are becoming more forceful as the final drafts near. According to a recent Washington Post-ABC News poll, there is a wide racial gap in Americans' views on healthcare reform, with minorities largely in favor of changing the system and supportive of President Obama's handling of it.
Fort Lauderdale Police are trying to determine if a veteran nurse at Broward General Medical Center committed a crime by allegedly knowingly reusing saline bags and catheter tubing on more than one patient during cardiac chemical stress tests over the past five years.
The nurse, identified by police as Qui Lan, 59, resigned last month after she was confronted by hospital officials, who also reported her to the Florida Board of Nursing.
"We do have an investigation. At this point, we're trying to see if we have criminal charges and determine the number of victims," Sgt. Frank Sousa, Fort Lauderdale Police Department spokesman, tells HealthLeaders Media. "There were definitely hospital violations. Criminally there may not be anything."
BGMC has identified 1,851 patients who received cardiac chemical stress tests administered by Lan dating back to September 2004, when she began working there. The hospital wants the patients to get tested for potential exposure to blood borne infections like HIV and hepatitis, although the risk of infection is believed to be very low.
"This is an individual's unacceptable practice that once discovered was immediately corrected," says James G. Thaw, CEO of BGMC. "We at Broward General Medical Center understand that this is alarming and may be frightening, but want to assure our patients we will assist in every way possible."
BGMC says they learned of the matter when someone called the hospital's Compliance Hot Line and reported seeing the nurse use the same saline bag and a portion of tubing more than once. A review of one nurse's practice when administering intravenous fluids during adult cardiac chemical stress tests was conducted and administrators suspended Lan. Hospital officials told local media in Fort Lauderdale that Lan admitted that she knew reusing the saline bags and tubing was a violation of hospital policy.
"But we still don't know why she chose to do this," COO Alice Taylor told the Sun Sentinel. "This is flagrant disregard of basic nursing principles."
Like many healthcare organizations nationwide, Mountain States Health Alliance (MSHA) is battling rumor and conjecture regarding the H1N1 vaccine—even among its employees. So the 14-hospital, Johnson City, TN-based health system launched an internal communications campaign to set the record straight.
"Many of our caregivers work with the most vulnerable patients who can be dramatically impacted by H1N1," says James Watson, corporate director for MSHA communications and public relations. "Since there is so much misinformation floating around from a variety of sources, we wanted to take an extra effort to make sure each one of them knew the importance of getting the H1N1 vaccine and how it would help them protect the patients they work with each day."
Watson's team has created emails listing H1N1 vaccine facts emphasizing the importance of vaccination to employees. "Without the vaccine, you might spread H1N1 to a patient with COPD or your aunt with diabetes or heart failure," the email states. "It might be the pregnant lady in line at the grocery store. It might be a baby at church or your niece or nephew at Thanksgiving."
Watson says the communications department is using a variety of channels to get the message out.
"From regular emails to daily team meetings inside the organization we call The Mountain States Moment where information is shared from managers in each department with the team, we are working to address the different media venues our team members utilize regularly to make sure they have the most up-to-date information," he says.
Whatever you do, don't show this column to any of the millennials in your office. I'm going to share with you ten tips for communicating with the 20-somethings you work with (and your gen y, millennial, or generation next patients) that I learned at last week's SHSMD conference in Orlando. But millennials tend to get a little outraged if you try to define them. In fact, saying that they get a little outraged when you try to define them would definitely be cause for outrage.
It's said that every generation thinks it is superior to the generations before and after them. Which means the youngest generation gets picked on a lot. I'll admit they are a fascinating and sometimes annoying mystery to me, which is why I attended the very aptly-named "I'll Take the Corner Office, Please: Tips for Communicating with Millennials" session.
I'm a Gen X-er on the cusp of being a Boomer (though I definitely identify with the younger generation—40 is the new 30, you know). So I knew right away that the session would be spot-on when the slide popped up that said one of the characteristics of generation X is that they are annoyed by millennials.
They're self-involved and entitled, yet insecure and easily distracted and bored. They're disloyal workers who play on the computer instead of doing their work. They're squeaky wheels who demand raises and promotions without paying their dues. They need constant praise and coddling. They see slights in every interaction. And they use funny acronyms that the rest of us don't understand and they don't get our jokes, either.
OK, so those are stereotypes, and I know they drive millennials crazy. And I know many millenials do not fit those descriptions. But stereotypes don't come out of nowhere.
Meanwhile, they're probably not going to change anytime soon. So, we old folks might as well learn to deal.
Session speakers Kim Blake and Deborah Myers, senior account executive and executive vice president, respectively, of CRT/tanaka in Norfolk, VA, shared the following tips for me and others who find the millennial generation to be a monumental challenge:
1. Be their Google. I like to put my head down, pull my socks up, and get my work done. When I don't know the answer, I usually try to figure it out on my own. And I hate to be micro-managed. Not so with millennials, Blake and Myers say. Having grown up in the information age, they want you to give them all of the information they need to succeed. Let them ask as many questions as they need to—even if it drives you a little crazy.
2. Give them a spoonful of sugar. Millennials also want instant feedback—they're used to being graded on every assignment. But if you plan to deliver criticism, you'd better include some positive feedback, too. It's so cliché, but this really is the generation whose shelves are lined with participation trophies.
3. Create meaningful experiences. Millennials are very civic-minded. As Marianne points out in her MarketShare post, at many schools volunteering is a requirement for graduation. Inviting them to join—or, better yet—create a program that gives them the opportunity to give back is a great motivator and helps them connect with an organization.
4. Consider short attention spans. They're smart and work fast but they are short-sighted and easily bored. So break their work into small projects—multiple deadlines mean more opportunities for that positive feedback, instant gratification, and sense of accomplishment they love so much.
5. Chat them up.This generation is all about social media. And social media is all about conversation. They're used to it and expect it in the workplace, Blake and Myers say. When they are part of the conversation they will be more engaged. Allow them to contribute and cultivate areas of expertise.
6. Mentor, don't manage. Just because you manage a millennial doesn't mean you have their respect, according to Blake and Myers. They respect experience, but don't want to hear "this is how I do it." Instead, you should couch your advice in terms of "this is what I've learned." The eye-rolling I get from my younger co-workers when I try to impart upon them my pearls of wisdom is ample proof that teaching millennials anything is a challenge. One way to overcome the challenge is reciprocal mentoring—they appreciate the opportunity to share their expertise.
7. Push their desks together. The current trend in education is group work—what we would have considered cheating in my day they now call cooperative learning. Fostering teamwork in the workplace and communicating team objectives in addition to individual performance expectations is an effective tactic, Blake and Myers say. Tell them how their performance effects and contributes to team success.
8. Teach them how to treat customers. Millennials are, without a doubt, a generation of consumers. And they expect to be treated like valued customers not only at the mall, but also in the workplace. Managers may have to teach them the skill of customer service—how to deliver it and who to consider a customer—from mangers to co-workers to vendors and suppliers to patients and their families. As noted previously, they don't automatically respect senior managers and won't automatically make the connection that managers are also customers who should be treated as such.
9. If you can't beat 'em, join 'em. It might be time to stop being so uptight about social media at work. Millennials are using chat platforms and checking their Facebook and Twitter pages at work (whether they'll admit it or not). Blake and Myers suggest creating a social media code of participation, but you might as well take advantage of the fact that social media can be a useful tool—and that millennials can teach you how to use them to be more productive.
10. Be flexible, but don't baby them. At the top of this column, I said that millennials get outraged when we try to pigeonhole them—the whole debate about whether millenials need to be coddled is one of the most contentious. This is the one that interests me the most. Blake and Myers say to strike a balance: don't kowtow to them or change the way you run your hospital, but if you can stand to be more flexible, you may find it makes your millennials more productive.
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In the last six months with HealthLeaders Media, I've written and read a fair amount about allegations of fraud and abuse among Medicare and Medicaid providers.
Durable medical equipment charge irregularities, nursing home billing errors, fabrication of services, referral kickbacks, hospital upcoding claims, imaging overcharges, and exaggerations of patient severity are some of the recurring themes found in audits and inspection reports.
The current version of the Senate Finance Committee's America's Healthy Future Act seeks to put a stop to a very large amount of that fraud. The proposal includes 13 pages of measures that will not just recover money after it has been fraudulently billed and erroneously paid out, but would keep scheming crooks from participating in federal programs from the start.
No one really knows the dollar amount in fraud, abuse, or false claims. And no one knows whether stopping all that billing mischief could ever be enough to bend the cost curve. Estimates range from 3% to 10% of healthcare dollars spent, depending on the program and the agency.
But is $500 billion–the amount of fraud, waste, and abuse that some believe can be sliced from federal programs without hurting quality–a realistic number?
There are concerns that if federal agencies go deeper in their effort to find more fraud, they will end up spending a lot more on the effort than it recovers. And what would be the cost of prosecuting these scofflaws, and perhaps putting them in jail for a long time? What's the return on investment for the taxpayer?
The National Health Care Anti-Fraud Association thinks a huge amount of fraudulent spending is there for cost-effective recovery, if not the entire $500 billion, some significant portion of that.
Its executive director, Louis Saccoccio, says that of the $2.26 trillion spent on healthcare, "conservatively" 3% or $68 billion "is lost to fraud." And that's not even considering what might be further categorized as waste or abuse, he says. Just talking fraud, he says, some recovery efforts recapture $17 for every $1 spent.
The federal Office of Inspector General's policy does not give out any such estimates.
However, it does boast successes every year. For the fiscal year ending Sept. 30, 2008, the Department of Justice says it recovered $1.34 billion in fraud and false claims, bringing the total to $21 billion recovered since 1986. An official with the agency, who asked that he not be quoted, said that internally, federal agents believe that's "the tip of the iceberg."
New numbers reflecting fraud and false claim recovery for the 2009 fiscal year will be released next month.
So it's natural that in health reform, a big effort will be made to recover dollars from fraud, waste, and abuse.
In the Senate Finance Committee's America's Healthy Future Act , "Title V – Fraud, Waste and Abuse," the following measures are among those that would tighten control of federal spending and keep crooks from participating in the program from the start.
1. Certain groups of providers and suppliers of healthcare services and goods would be subject to screening measures, such as fingerprinting, criminal background checks, and multistate data base inquiries before being able to bill Medicare. Surety bonds of up to $500,000 may be required. States would be given similar authorities for Medicaid programs. And states that fail to create effective screening programs would have their Federal Medical Assistance Percentage reduced.
2. Current provider databases would be greatly expanded and integrated to allow data sharing between multiple government agencies. The databases would include information on providers' quality of care under managed care, fee for service and waiver programs, Medicaid encounter data, health plan performance, survey and certification, resident or patient neglect or abuse, adverse actions, site visits, penalties and settlements, and results from other program monitoring.
3. Providers working under Medicare Condition of Participation agreements would first have to establish core elements of compliance. Physicians and suppliers would have to keep documentation of referrals to programs at high risk of fraud and abuse, and provide that to officials upon request. Physicians must have a face-to-face encounter with a patient before making a referral for home health or durable medical equipment.
4. The maximum period for submission of Medicare claims would be reduced to 12 months from 36 months for Part A and Part B.
5. Hospitals that fail to report an adverse action affecting physicians' clinical privileges would face civil monetary penalties.
6. Penalties for submitting false claims and for submitting false statements in false claims would be increased, as would penalties for delaying inspections or obstructing program audits. For Medicare Advantage and Part D, penalties would be enhanced for marketing violations, as well as submitting false information.
7. Recovery Audit Contractor programs would be extended to Medicare Parts C and D and Medicaid.
8. The Health Care Fraud and Abuse Control Program, now funded at $376 million, would increase by $10 million each year for 10 years.
If this bill passes as is, providers will have to spend a lot more and use a lot more personnel resources just to qualify for participation in Medicare programs. And once in, they'll have to account for their spending in much more detail.
And there may be push back with political consequences. Says Saccoccio, "There may be a tipping point where if you push too aggressively on fraud, you may get push back: ‘Why are you going after all of us, when there are just a few bad apples out there?"
Only time will tell whether all the extra effort by many honest providers will turn out to be worth it.
Healthcare providers are finding themselves and their reimbursement claims accountable to more and more auditors as CMS steps up its Medicare and Medicaid auditing activities. And CMS is unlikely to decrease auditing for incorrectly paid claims anytime soon; it too is being held accountable—by the Office of Inspector General (OIG).
In 2010, the OIG plans to review the progress of many Medicare and Medicaid auditing programs, as well as CMS' oversight of several of the programs, according to the 2010 Work Plan, released October 1.
OIG plans to continue its review of how CMS is managing of the RAC program. The OIG also plans to review the number of cases referred to CMS as well as its processing of those referrals and its guidance and training to national RACs on appropriately reporting potential fraud, according to the Work Plan.
The OIG will also continue to monitor the transition from Program Safeguard Contractors to Zone Program Integrity Contractors (ZPIC), entities that are assuming the responsibility for ensuring Medicare claim integrity—a transition that is expected to be completed by March 2010
The Work Plan also indicates that OIG will be watching over Medicaid auditing activities. The OIG will review Medicaid Integrity Program (MIP) efforts "to determine whether states proactively manage overall program risks at the state agency, payment contractor, and provider levels."
In addition, the OIG plans to monitor the following in 2010:
How states prioritize actions to prevent improper payments
How providers and/or payment areas are identified for an audit
Whether improper payments are collected and properly reported to CMS
The OIG also plans to review claims from certain provider types that are "high risk" for submitting improper Medicaid claims. It will identify specific high-risk providers for review based on past Medicaid program work and Payment Error Rate Measurement (PERM) program error rates.
CMS' oversight of the Medicare and Medicaid Data Match Project (Medi-Medi) is also on the OIG's list for review. Medi-Medi seeks to improve the coordination of Medicare and Medicaid program integrity efforts by proactively identifying vulnerabilities or fraud and abuse that may have gone undetected if the data was analyzed separately. According to the Work Plan, the OIG plans to determine whether CMS "is meeting contractual requirements outlined in the Medi-Medi task orders." Task orders were in place for 10 states as of 2007.
The first doses of the H1N1 vaccination have arrived in the United States, with a nurse being one of the first Americans to receive the vaccine. Holly Smith, pediatric nurse with two daughters, works at Le Bonheur Children's Medical Center in Memphis, TN.
Le Bonheur, which has been on the front lines of the epidemic since late August, has received 100 doses of nasal spray vaccine. The vaccines were given to healthcare workers working in an outdoor tent set up to treat children with flu symptoms. Recently, the hospital has already seen at least 3,000 children with flu symptoms.
Marion County, IN, and Indianapolis had a similar vaccine rollout program and distributed 5,200 doses of the vaccine to local hospitals. Public health authorities in 21 other states and four large cities; Chicago, New York, Philadelphia, and Washington, have been shipped the swine flu vaccination, roughly totaling 600,000 doses.
The nasal spray vaccine is only approved for people between the ages of 2 and 49 with no health problems. Health officials expect 10 to 20 million doses, in either the nasal spray or injectable form, to be delivered each week until December.
State health departments will set up hotlines and Web pages as more vaccines become available and vaccination sites are selected. The Web pages will inform anyone of the nearest center offering vaccines once a ZIP code is entered.
Dr. Anne Schuchat, director of immunization and respiratory disease for the Center for Disease Control and Prevention, said in an official statement to the New York Times, that eventually there will be a similar page on flu.gov, the federal Web site.
Health insurance industry foes often point to insurers as a barrier to healthcare reform that could result in lowered costs and increased efficiency.
Health insurers are nothing more than third wheels that complicate the healthcare system, critics charge. But if a pilot program in Ohio takes off, the foes may have to revise that statement.
America's Health Insurance Plans, Blue Cross and Blue Shield Association, eight health insurers, and five Ohio physician organizations will begin a pilot project next month that will look to reduce health insurance paperwork and free up physicians' offices from administrative headaches. The project, which was announced this week, will create a one-stop Web portal for electronic transactions. Ninety-one percent of all Ohio residents insured through private carriers will be part of the project.
Mark Jarvis, senior director of practice economics at the Ohio State Medical Association, one of the five physician groups taking part in the pilot, said the project includes about 20,000 of the 30,000 licensed doctors in Ohio. Though five physician organizations are taking part, hospitals are not included in the initial pilot but organizers hope to bring hospitals on board once they see the program's benefits.
Physicians, who reportedly spend three-and-a-half hours per week dealing with health insurance eligibility, benefit, and claims information, have long complained about how health insurance paperwork is a drag on their time and how it distracts them from focusing on their patients.
The current system is cumbersome and forces physician offices to devote time calling insurers and toggling through myriad health insurer Web sites.
In this pilot, the insurers will create one online home in which physicians can find eligibility and benefit information, as well as up-to-the minute claims data. If this kind of program became the norm throughout the healthcare system, AHIP suggests "hundreds of billions of dollars" could be saved via automation and consistent business practice efficiencies.
Karen Ignagni, president and CEO of AHIP, likened the project to bank ATMs.
"It's a step that will ultimately transform our system into one that takes advantage of the technology for the benefit of clinicians and their patients," she said.
The program will provide physicians real-time information, which will:
Allow office staff to quickly determine key eligibility and benefit information, such as copays, co-insurance, and deductibles, and differences in coverage for services provided in- versus out-of-network
Give physicians access to current and accurate information on the status of claims submitted by physician offices for payment by insurers
Test real-time referrals and timely pre-authorization of services
Provide online healthcare claims submissions
"We can see all the elements being in place to actually achieve the kind of simplification that physicians are looking for that will help patients because physicians will have more time to focus on them, which is exactly as it should be," says Ignagni.
Jarvis said the project will reduce claim denials because physicians will be able to quickly find eligibility information. This is much easier than having to make phone calls to health insurers or search for that information on the insurers' sites, he added.
Given the timing of this pilot project, many cynics will ask: If physicians want administrative simplification, why has it taken so long for health insurers to develop this pilot? And are health insurers developing this pilot in response to healthcare reform?
Ignagni said the reason the pilot is happening now is not because of health reform, but because the technology is now available and AHIP has been focused on creating the pilot program for "a number of months."
Ignagni added that a similar project in New Jersey is also in the works, and the collaboration could spread to other parts of the country.
This pilot program has the potential to serve as a trailblazing project that could change healthcare administration processes. These aren't small, regional health insurers that we're talking about. It's Aetna, Anthem Blue Cross and Blue Shield, CIGNA, Humana, Kaiser Permanente, Medical Mutual of Ohio, UnitedHealthcare, and WellCare Health Plans, Inc. These are some of the largest and most influential health insurers in the country.
If they find successes and cost savings through this pilot, these insurers will likely look to expand the program to other states.
Administrative simplification is not an exciting topic, but it could serve as a way to reduce health costs, improve physician/health plan relations, and remove some of the complexity in a healthcare system that so many Americans don't understand.
The Joint Commission has released the prepublication versions of its 2010 standards for all programs, now available online.
The Joint Commission traditionally unveils the standards for the coming year a month or more in advance. These will remain posted until December 1, 2009, at which point both the electronic (e-dition) and print version of the 2010 manual will be distributed to hospitals.
In conjunction with the release of the prepublication standards, The Joint Commission has also released a report, free of charge, detailing CMS-related changes to its standards and survey processes. The report—distributed as part of a free edition of Perspectives—looks back through March 2009 at various changes made as part of The Joint Commission's application to CMS for renewed deeming authority this year.
What have we seen in terms of changes this year?
The Accreditation Survey Findings Report has been modified as of July 1, 2009. It now includes requirements surveyed as below fully compliant for both Joint Commission standards and CMS requirements.
We have also seen changes to CMS Certification Numbers. Though this change effects only a small group of hospitals, it is a pivotal change for those organizations—and The Joint Commission will contact directly every hospital impacted by this change, which will go into effect on July 15, 2010.
The Joint Commission's Medicare recommendation letter has been altered. It now informs CMS if a new or existing Medicare provider has participated in a deemed status survey. Also, it states whether The Joint Commission, as a result of that survey is making a recommendation about that provider's Medicare status.
Finally, the hospital standards have been updated to improve "equivalency" with CMS hospital requirements. Elements of Performance were both added and revised to improve this balance.
Of note for the credentialing world: along with the prepublication standards, The Joint Commission has released details on credentialing and privileging with regards to proxy and telemedicine. Changes are expected to be implemented July 15, 2010. Please note that The Joint Commission is still in talks with CMS about telemedicine credentialing, and until a formal agreement can be reached, hospitals will be surveyed according to existing CMS requirements.
