Debbie Linnes has taken over as president/CEO of Southeast Missouri Hospital. She succeeds James Wente, who retired after 19 years in the hospital's top job. The announcement was made in July. Linnes' first move as hospital chief was to hire James Limbaugh, COO of Montgomery Bank, to become executive vice president of planning and business development. To take the post, Limbaugh resigned as president of the hospital's board of trustees.
James P. Houser, a former Covenant System executive, was named as interim CEO for the organization. Houser said he expects to be in the interim role for six months while Covenant's board of directors completes a search for a permanent replacement. Houser said he will not be a candidate for CEO.
MetroSouth Medical Center CEO Arnie Kimmel has resigned, a little more than one year after leading a group of investors to save the hospital from closure. Kimmel will be replaced by Enrique Beckman, former CEO of the now-shuttered Michael Reese Hospital, according to a letter sent to employees.
If your healthcare organization doesn't have a policy on employee conduct for online communications and social media, it should. Consider a study in last week's Journal of the American Medical Association which found that some students at 60% of the 78 medical schools surveyed had posted unprofessional or inappropriate content online and on social media like Twitter, MySpace, and Facebook.
A breakdown showed that violations of patient confidentiality were reported by 13% of the schools; use of profanity by 52% of schools; frankly discriminatory language by 48%; depiction of intoxication by 39%; and sexually suggestive material by 39%.
No doubt, some of these troubling findings can be attributable to—but not excused by—the relatively young age of the medical students, their inherent Generation Y comfort with online communications, their failure to understand their newly bequeathed gravitas and responsibility as healers, and their inability to comprehend that their risqué comments are in the public domain once they hit the "send" button.
I don't believe this improper use of social media is limited to medical school students. I suspect that normally sober, older, wiser, and dedicated veteran healthcare professionals might occasionally exercise poor judgment and offer online posts that defame colleagues or competitors, or—even worse—identify or provide disparaging remarks about patients.
Privacy rights advocates say your healthcare organization really should emphasize the importance of online discretion.
"You certainly can't control the conduct but you can educate," says Paul Stephens, director of policy and advocacy at the Privacy Rights Clearinghouse, a San Diego-based consumer advocacy group. "The guidelines need to be the same for both verbal communications and communications via social networking because the consequences to the privacy of the patient are the same."
"Part of the problem is many people, particularly the younger generation, are a little bit too open when they are engaged with interaction in social media," Stephens says. "Sometimes they provide information that they might not provide in a face-to-face context. The electronic communication is even worse because if it's a conversation between two individuals there is no record of the conversation. But when it is said electronically, that can be captured and held in perpetuity."
Regular readers know my spiel: Ensuring patient confidentiality is a zero tolerance policy. Employees who violate patient confidentiality—whether in person, online, or however—should be fired, as soon as possible. When practical, every other employee in the healthcare organization should be told why that employee was fired.
Patient privacy is a simple, paramount, and ancient ethic in healthcare dating back to Hippocrates. If your healthcare organization can't be trusted with a patient's privacy, it can't be trusted with a patient's health.
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Despite a less than lightning-speed start this past week, Senate Finance Chairman Max Baucus (D-MT) said he was confident after four days of hearings that the committee was making some progress on the healthcare reform bill.
"We have debated, we have questioned, we have prodded at times, and we have discussed—and discussed. Most important, we continue to move forward."
Overall, "this was a good week. It was a productive week. And next week, our work will continue . . . we will continue to make this a better bill," added Baucus. However, many of the important facets of the legislation addressed in the 564 amendments proposed by committee members—ranging from creation of an independent Medicare commission to creation of insurance cooperatives—received little, if any, discussion.
Oftentimes, Democrats appeared to show signs of frustration with many of the Republican amendments, saying they appeared to slow the markup process. Baucus often tried to shorten debate on these Republican amendments—many of which addressed cuts in Medicare Advantage benefits.
Affordability also appeared to be a subject of concern—particularly whether those with moderate incomes could afford to purchase health insurance even with the subsidies proposed under the legislation.
Sen. Charles Grassley (D-IA), the Finance Committee's senior Republican, criticized the penalty of $1,500 for failure to obtain insurance that could be incurred by families with incomes as small as $25,000 annually. “It’s a pretty heavy burden for low income families,” he said.
This week might provide some higher octane debate when Senators Jay Rockefeller (D-WV) and Charles Schumer (D-NY) are expected to introduce legislation that incorporates a public health insurance option into the bill. Both senators have separate amendment options, so it is not clear if one combined or two separate amendments will be offered.
As the October release of the Minimum Data Set 3.0 data specifications approaches, skilled nursing facilities across the nation become more and more concerned about the additional work this assessment tool seems to require. However, CMS officials and those involved with the development of the MDS 3.0 stand behind the claim that it will actually be easier and less time-consuming than the currently used MDS 2.0.
"Having been a part of the MDS 3.0 development team, I really believe that it shouldn't take any more time than the MDS 2.0," says Rena Shephard, RN, president of RRS Healthcare Consulting Services and founding chair and executive editor of the American Association of Nurse Assessment Coordinators. "In fact, during the demonstration study, nurses timed how long it took to complete the MDS 3.0 and MDS 2.0 for the same residents, and it took them less time to do the MDS 3.0."
However, given the length, required resident interviews, and other features of the MDS 3.0, many SNFs are skeptical that this seemingly cumbersome assessment will actually take less time. Fortunately for SNFs, things are not always as they seem.
"When people downloaded and printed the MDS 3.0 draft item set from the CMS Web site, many were shocked at how long it was. However, the draft item set is very deceptive," Shephard says. "Compared to the MDS 2.0, the font on MDS 3.0 draft item set is a lot bigger, there is a lot more white space, and the physical layout is different. This makes it appear to be much longer than the MDS 2.0 when, in actuality, it isn't."
SNFs should also understand that the MDS 3.0 draft item set includes every MDS item that could appear on any MDS assessment or tracking form. "You would never complete every single item included in the draft for one assessment," Shephard says.
Even some items that will be included on full MDS 3.0 assessment form will not be completed every time. For example, there will be a screening process under the MDS 3.0 to determine if a resident is able to complete the interviews for mental status, mood, pain, and daily preferences. If he or she is not capable of completing the interviews, the staff assessment would be completed instead. A facility would never complete both the interview section and the staff assessment section.
Although completing the MDS 3.0 may actually require less time and effort than the MDS 2.0, adapting to the new assessment tool will be a time-consuming task for many SNFs.
"Change, in general, often is chaotic and it may take facilities a little while to develop policies and procedure that work with the MDS 3.0," Shephard says. "I really encourage facilities to begin training staff early on the interview items and thinking about the policies, procedures, and other things that will have to be changed once the MDS 3.0 is implemented."
So, will all the initial work be worth it? Shephard seems to think so.
"As with any new system, we will fumble with the MDS 3.0 at first," Shephard says. "But once everyone becomes comfortable with it, facilities should see how much of an improvement it is and they, along with their residents, will reap the benefits of a better assessment and an easier and faster assessment process."
The National Association of Insurance Commissioners has joined CMS in warning insurance companies to end practices that alarm senior citizens about federal health reform efforts, and is calling on Congress for changes to end marketing and sales abuses. In a letter to Senate Finance Chairman Max Baucus (D-MT) and Ranking Member Charles Grassley (R-IA), the NAIC cites indication from CMS of possible "misleading communications" to policyholders.
"State insurance regulators take scare tactics directed at senior citizens very seriously," said NAIC President and New Hampshire Insurance Commissioner Roger Sevigny. "To the extent that state insurance agents and brokers may be participating in these communications or insurance companies are contacting non-Medicare Advantage policyholders, state regulators will remain vigilant and take appropriate action."
Sandy Praeger, chair of NAIC’s Health Insurance and Managed Care Committee and Kansas insurance commissioner says "state regulators believe that these troublesome practices are directly tied to excess payments made to Medicare Advantage plans, and support changes made to federal law that would reign in these abuses."
"In addition to changes to payments made to Medicare Advantage plans, we urge you to restore state insurance regulatory authority over Medicare private plans," Praeger says.
On Sept. 22, CMS demanded that Medicare-contracted health insurance and prescription drug plans stop sending the mailings to beneficiaries. CMS' announcement came on the heels of Humana, Inc., sending similar mailings to beneficiaries. CMS announced on Sept. 18 that it is investigating whether Humana inappropriately used the lists of Medicare beneficiaries for "unauthorized purposes." The feds made the announcement after Baucus spoke out about Humana's one-page letter. The Senator alleged that the insurer was trying to scare seniors.
As the Senate majority leader, Harry Reid, takes on the task of melding two competing versions of major healthcare legislation, aides say he will lean on President Obama to arbitrate a number of contentious issues that still threaten to divide liberal and centrist Democrats and derail a final bill. Reid's challenge is to bring together legislation that can win 60 votes to stop a Republican filibuster.
After years of trying to cut Medicare spending, Republican lawmakers are now championing the program, accusing Democrats of trying to steal from the elderly to cover the cost of health reform. The hospital associations, AARP, and other powerful interest groups that usually oppose Medicare cuts have also switched sides. Last week, they stood silent as the Senate Finance Committee debated a plan to slice more than $400 billion over the next decade from Medicare, notes this article from the Washington Post.
A New York hospital group is set to announce a sizable investment intended as a linchpin in the group's $400 million commitment to digitize patient records throughout its system, including 13 hospitals. North Shore-Long Island Jewish Health System plans to offer its 7,000 affiliated doctors subsidies of up to $40,000 each over five years to adopt digital patient records. That would be in addition to federal support for computerizing patient records, which can total $44,000 per doctor over five years.
