New Census data for the first time confirm unusually high rates of uninsured in Florida's Miami-Dade and Broward counties, and reveal wide disparities in coverage among local communities. Fifty-three percent of adults ages 18-64 in Hialeah lack health insurance—almost three times the national average. Meanwhile, only 13.8% of that age group in Weston are uninsured, the lowest rate in South Florida.
Boston-based Beth Israel Deaconess Medical Center has named Stephen B. Kay the fifth chairman of its board of directors. He replaces Lois E. Silverman, who is stepping down after four years of chairing the board at the Harvard-affiliated teaching hospital.
If the H1N1 flue were to mutate to become much, much more deadly, the need for ventilators would far outstrip the supply. That could create very difficult dilemmas, including whether to take dying patients off of ventilators in order to free the machines up for patients who have a better chance of surviving. State and federal officials have been working out plans for just how to handle those sorts of situations.
Senator Bill Nelson of Florida wants to expand health insurance coverage because one in five Floridians is uninsured. And as a member of the Senate Finance Committee, he can help shape legislation. But the bill taken up this week by the committee would cut Medicare payments to insurance companies that care for more than 10 million older Americans, including nearly one million in Florida. Nelson said he had received 56,000 telephone calls, letters and e-mail messages on the legislation since June.
Current proposals on Capitol Hill for reforming healthcare will not hurt health insurers' ability to compete and earn in the healthcare marketplace, Vice President Joe Biden told a meeting of insurance regulators on Tuesday. However, these companies need to be "held accountable" as they conduct their business.
Biden released a new report from the White House that found health insurance premiums "have gone up between 90% to 150% over the last decade—far faster than wages and inflation."
"This new state-by-state data is astounding and makes the case for nationwide reform," he told the National Association of Insurance Commissioners. From Alaska, where premiums increased 145% while wages grew just 35%, to Florida, where premiums increased 121% while wages increased 43%, "we see these gaps widening."
"This is simply unsustainable--for families, for businesses, for state budgets, and for our national economy," Biden said. As part of this solution, all insurance companies need new ground rules "to abide by [that would] restore stability and security to our healthcare system."
The vice president suggested several basic ground rules:
No discrimination for pre existing conditions
No exorbitant out of pocket expenses, deductibles or co pays
No cost sharing for preventive care
No dropping of coverage for seriously ill
No gender discrimination
No annual or lifetime caps on coverage
Extended coverage for young adults
Guaranteed insurance renewal
"These ground rules don't pick and choose which companies they apply to: They apply to everyone. The playing field is level. Every insurance company doing business in this country will have to play by these basic rules, and competition will remain healthy," Biden said.
He cited recent data from the Kaiser Family Foundation and the Health Research and Educational Trust that found that the average cost of a family health insurance policy increased 5.5%—from $12,680 in 2008 to $13,375 in 2009. If "the status quo persists," these "unsustainable increases" will continue to impact family premiums and cause declines in the number of employers who offer coverage, he added.
Overcoming the cultural boundaries that can divide or prevent a patient-doctor relationship from forming can be a difficult task. If a language barrier exists, or a mutual understanding between the parties cannot be reached, important information can be withheld or misinterpreted.
In a 2004 survey conducted at Albert Einstein College of Medicine in the Bronx, NY, more than half of the staff members said they would benefit from additional support and training on how to teach about cultural disparities and how to overcome cultural boundaries.
"Each residency program was looking for ways to include training on cultural competency in their curriculum," says Nereida Correa, MD, MPH, associate clinical professor, department of OB/GYN and women's health, and family and social medicine, and education core director at Albert Einstein College of Medicine.
With funding from the National Institute of Health (NIH) to eliminate health disparities and faculty members recognizing the need for training, program coordinator Shoshana Silberman and Correa began developing a task force to help include cultural competency training in the curriculum. The resulting program has improved how staff members address patients of many cultures, and has encouraged multicultural patients to ask more questions about their care.
Task forces and workshops to educate and inform
Staff members from Einstein's two campuses were included in the first brainstorming session of the Albert Einstein College of Medicine's Faculty Task Force for Elimination of Disparities and Cross-Cultural Training.
The main purpose of this brainstorming was to get a better feel for the level of resistance each department was getting from the faculty, what those department leaders wanted to do, and what kind of tools would help them implement a program in their department that would be acceptable to students and residents.
From this first brainstorm, the task force decided the first step toward a better implementation of cultural awareness would be through conducting workshops. From the start, the department heads and medical directors at Einstein-affiliated hospitals supported the work of the task force.
"Prior to our first workshop, the chief medical officer had been on call and came to the brainstorming session telling us of the stories from the night before," says Correa. "He believed that something should be done because while he was on call, he had three patients, all from different nationalities, that did not speak English."
From there, the group invited Debbie Salas-Lopez, MD, an expert in cultural competency and chief of the division of academic medicine, geriatrics, and community programs at New Jersey Medical School, to help with the workshops.
Correa felt that an outside expert would have more of an effect than someone who was on Einstein's staff. Students and staff members find it easier to tune out department leaders, simply because they are used to hearing them repeatedly convey the same messages, says Correa. Salas-Lopez grabbed the attention of staff members partially because she was a new voice.
In the task force's first workshop, Lopez helped develop cases dealing with cultural competency along with asking workshop members to bring in patient cases of their own.
Here, the task force was divided into work groups and each group developed their own scenarios around the patient cases that were brought to or developed at the workshop. Once each group developed its own patient case, it presented to the other members of the task force. After the presentation of the idea, the group received critiques.
At the conclusion of the workshop, the task force members were asked to go home and develop the case further and give suggestions on how these topics could be taught.
Each group had to come up with the learning objectives of the case, a narrative or case summary, a teacher's guide (explanation of case background), and then provide a bibliography and any visual aids that may have been acquired.
For example, one group created a case scenario on a pregnant HIV-positive patient who wanted the obstetrics team to lie about her condition, while another team explored issues of culture and trust: human trafficking, gynecology, and contraception.
"The biggest frustration of the task force was that they still did not know how to implement these processes," says Correa. "So we brought Lopez back, and did a role play with the case studies we had developed from the first workshop."
In this workshop, two or three work cases were chosen to role play. Members of the task force would take one of the cases, and then act it out. The group would then critique the case that was acted out, and learn how to actually put this into practice with their teachings.
To learn more about the cross-cultural residency training program that Albert Einstein College of Medicine developed, see the November issue of Briefings on Patient Safety.
For healthcare in rural America, there has never been a better time to confront policymaker bias against providers working in Out There Yonder parts of the country.
With key members of the Senate Finance Committee and the Blue Dog Democrats hailing from predominantly rural states, advocates for non-urban regions are more hopeful than ever that they are finally getting their message across.
"There are biases against rural areas out there," acknowledges Maggie Elehwany, vice president for rural affairs and policy for the National Rural Health Association, a national nonprofit, nonpartisan, membership organization with more than 18,000 members that provides leadership on rural health issue. "But this time, we're very fortunate to have members who get rural America. And they really do."
After all, she says, 25% of the nation's population lives in rural America, which takes up 90% of America's land mass.
Elehwany took some time out of her busy week analyzing the hundreds of amendments to the Senate Finance Committee proposal to explain what her group hopes to achieve.
And she didn't waste any time. No health reform bill will be effective, she says, unless it deals with the workforce shortage and the inequitable rural Medicare reimbursements that lead to that workforce shortage.
Here are some essential reform measures that hospitals, physicians, community clinics, and other care providers in rural parts of the country say are needed to correct inequities for providers in low-population areas of the country, Elehwany says.
Critical Access Hospitals (CAH) – Eliminate the requirement that a CAH must be located more than 35 miles from another hospital, but allow them that CAH designation, which provides for higher levels of reimbursement, if they serve a critical need in the community. Also, allow such facilities to go over the 25-bed rule if they have unexpected peaks in patient demand without losing advantageous reimbursement rates.
340B Program – Expand this program so that not just certain types of nonprofit hospitals can purchase prescription drugs at reduced rates. Elehwany says if rural hospitals and clinics can purchase prescription drugs at the same lower rates, it would save them $2.5 billion over the next 10 years.
Payment Cap – A Rural Health Clinic payment cap must be raised from its current $76.84 per patient, a rate set in 1970 that does not come near the cost of reimbursing for the cost of care, to $92.
Ambulance services – Eliminate the requirement that a critical access hospital can only be reimbursed for ambulance services within 35-mile drives, an unrealistic distance in expansive rural areas.
Disproportionate Share – Give parity to rural hospitals by removing a cap that blocks them from receiving more than 12% in disproportionate share add-on payments. Urban hospitals are not subjected to such a cap.
Health Information Technology – Provide the same incentives for rural hospitals to adopt HIT systems as Prospective Payment System (PPS) hospitals. CAHs should have priority access to grant funds offered in the federal stimulus package.
Physician Reimbursement – Provide an additional 5% payment to physicians working in rural areas, with an additional 10% for primary care doctors who practice in shortage areas to help recruit and retain doctors.
Anesthesia – Close loopholes that allow certified registered nurse anesthetists standby and pass-through costs and change policies so that CAHs are properly reimbursed for anesthesia services.
Rural Residency – Increase reimbursement caps on rural residency training programs in primary care and general surgery by 30% and provide appropriate funding for faculty to train additional residents. Also, create interest-free loan programs and tax credits for those practicing in rural and underserved locations.
Unused Residency Slots – Preserve unused slots in rural residency programs, slots they now lose because rural programs struggle to fill their slots. Provide incentives to help fill them.
Area Health Education Centers – Reauthorize these centers, which provide health career recruitment programs and provide training. Under the Senate Health Education Labor and Pensions Committee proposal, AHEC would receive $125 million annually between 2009 and 2014.
National Health Service Corps – Make a significant investment in this program and allow more flexibility, so health professionals can fulfill their commitment by working part-time.
Telehealth – Create a telehealth advisory committee to be administered by the Centers for Medicare and Medicaid Services and which would include practitioners from a variety of geographic regions.
508 Hospitals – Extend this designation that would enable certain hospitals to continue to receive better Medicare rates. These hospitals generally operate in rural areas, but are so close to high-priced urban areas that they must pay salaries that are similarly higher.
Therapists – Make marriage and family therapists and mental health counselors in rural areas eligible for Medicare reimbursement to improve provision of their services in areas where there is a vast shortage.
Of course, Elehwany acknowledges, "The biggest obstacle is in finding the offsets; we have to find a way to pay for some of these important provisions." That's going to be tough, she says.
"These are not health facilities in big urban areas with independent, expensive lobbyists."
But as her organization says on all its health reform fact sheets, "for any health reform to be a success, the healthcare crisis in rural America must first be resolved – for it does not matter if you have health insurance coverage if you do not have access to a physician or health provider.
"Legislation that finally addresses the long-standing inequities and disparities in rural America must be included as part of federal healthcare reform."
It's impossible to know which of these provisions –contained in a variety of legislative packages, amendments or separate bills – will end up in the final health reform bill passage.
For rural America, however, she hopes it will be all of them.
When Geisinger Health System in Danville, PA, was having trouble recruiting gastroenterologists earlier this year, Cathy Connolley knew it was time for an innovative strategy.
"When recruiting gastroenterologists we traditionally would do print ads in different medical journals and direct mail," says Connolley, Geisinger's associate vice president of marketing. "But this time, we weren't getting the types of responses that we were looking for."
So the Geisinger marketing team worked with Zero-In Recruitment Marketing, a Bloomsburg, PA, firm, to create a social media physician recruitment campaign.
Zero-In began integrating social media into many of their clients' recruitment efforts because it realized that the majority of physicians use the Internet to conduct their job search. According to a 2008 New England Journal of Medicines study, 71% of respondents said they hunted for jobs online. And the popularity of Sermo, a social networking site just for physicians, gives marketers some insight into how doctors spend their time online.
Geisinger wanted to develop a convenient, cost-effective way to communicate with physicians, Connolley says. "So we sat down with Zero-In and they walked us through what it would take to put a Facebook page up and direct gastroenterologists who met the criteria we were looking for to our page—and that tactic outpaced our direct mail approach and our email blasts."
Geisinger and Zero-In launched a Facebook page in January, which includes photos, recruitment event information, and links to the health system's site.
Attracting followers on Twitter
Seaboard Health Care Search, a physician recruitment firm based in Nashville, also worked with Zero-In to promote their brand via social media. But Seaboard focused their efforts on a different channel: Twitter.
"We're in a marketplace that is now shifting to people who are very young," says CEO William Herrington. "I'm always looking at how to position my organization to take advantage and get to physicians-in-training earlier."
Herrington's experience with physicians taught him that they have very little time to keep on top of medical news and other hot topics, so Twitter was the best medium for Seaboard to disseminate that information to busy physicians while building its brand.
The key to building a successful Twitter campaign is to provide people with useful information and not only promote your business, says Todd Cole, recruitment marketing specialist at Zero-In.
"You run a big risk of alienating your population by using social media as sales tools," he says. "We've been using Twitter to share information that's valuable to physicians and physician organizations and making Seaboard's name synonymous with those."
Seaboard's Twitter account posts links to articles that physicians may find interesting from a variety of sources.
"We're trying to develop an educational aspect to let physicians know what's going on," Herrington says. "We want to get to the point where they don't have to use us and we can still educate them and they will have a positive viewpoint on Seaboard healthcare because we're actually giving them something."
Turning fans and followers into employees
In addition to promoting positive brand awareness, social media sites are effective marketing tools because there are many ways to track their results. Though Geisinger and Seaboard's campaigns are in the early stages, both organizations have already seen an impact on their recruitment efforts.
Geisinger, for example, sent out a direct mail piece to a list of gastroenterologists with a link to a job listing page. Just four people who received the mailing visited to the Web page. When Geisinger posted the same job-page link on their Facebook page, 17 people clicked on it.
The health system has since hired three gastroenterologists, one of which can be directly attributed to the success of the Facebook page.
Seaboard has heard a lot of positive feedback from physicians and clients about their Twitter account, Herrington says.
"People are actually clicking on the information we're putting out and sharing it with the people who follow them," Cole says. "We can track the trend and the effectiveness of what we're putting up and the traffic that we're getting through URL-shorteners. We're sprinkling the business information in right now, and eventually we can make it a 60/40 split [between news and recruitment information]."
Before embarking on a social media recruitment campaign, healthcare organizations must commit resources to update the sites at least daily and decide how to bring useful information to their target audience, Cole says.
"The first thing people need to realize is it's not meant to be a job board," he says. "If you're going to take it on by yourself, you have to make sure you have someone who's going to dedicate time to it daily. You have to make sure your light is always on so people know to stop by."
Pepsi is targeting African-American moms with a digital community where such consumers will be asked to share personal and inspirational thoughts. The effort, promoted across various media with the tagline "We inspire," will serve as the cornerstone of Pepsi's African-American marketing outreach for 2010.
Marketers' top priorities for 2010 will be customer acquisition and retention, followed by thought leadership, according to a survey by virtual events provider Unisfair. Six in 10 marketers polled said acquiring new customers would be critical in 2010, while 48% would focus on retaining current customers, the survey found.
