A research group, brought together by the Boston-based Center for Integration of Medicine and Innovative Technology, has developed a software platform enabling devices like blood-pressure cuffs and heart-lung machines to share information. The group says standards like requiring a "black box" that collects data similar to what's used on an airplane are a key element in stardards for the new Integrated Clinical Environment.
CMS is demanding that Medicare-contracted health insurance and prescription drug plans stop sending "potentially misleading mailings" to beneficiaries about healthcare reform.
CMS' announcement comes on the heels of Humana, Inc., sending similar mailings to beneficiaries. CMS announced on Friday that it is investigating whether Humana inappropriately used the lists of Medicare beneficiaries for "unauthorized purposes." The feds made the announcement after Sen. Max Baucus (D-MT) spoke out about Humana's one-page letter. The Senator alleged that the insurer was trying to scare seniors.
"It is wholly inappropriate for insurance companies to mislead seniors regarding any subject—particularly on a subject as important to them, and to the nation, as healthcare reform," Baucus said in a statement Monday. "The healthcare reform bill we released last week strengthens Medicare and does not cut benefits covered under the Medicare program—and seniors need to know that."
Jonathan Blum, acting director of CMS' Center for Drug and Health Plan Choices, said Monday that the feds don't want beneficiaries to believe the health insurance plan-generated letter comes from the Medicare Advantage program.
"We are concerned that the materials Humana sent to our beneficiaries may violate Medicare rules by appearing to contain Medicare Advantage and prescription drug benefit information, which must be submitted to CMS for review," said Blum. "We also are asking that no other plan sponsors are mailing similar materials while we investigate whether a potential violation has occurred."
According to CMS, the feds learned that Humana had been contacting enrollees in mailings that CMS obtained, which claimed that current health reform legislation would hurt Medicare beneficiaries. Humana urged beneficiaries to contact their Congressional representatives to protest the reform.
In this Harvard Business Review blog posting, Susan Cramm uses a travel analogy to offer advice on keeping IT projects on time and on budget. She offers nine principles, including only choose projects that support the organization's business strategy, plan for delays, and define clear business objectives.
While much discussion has focused on how insurance companies are trying to influence healthcare reform legislation, Congress has been turning the tables in recent months—looking closely at how medical coverage decisions and denials of claims are made.
On the Senate side, Sen. Jay Rockefeller (D-WV) sent a letter in August to the top 15 health insurance companies requesting information on what insurance companies do with the premium payments they get from consumers and whether this data is shared with policy holders and potential customers.
And last week, in two days of hearings, Rep. Dennis Kucinich (D-OH), as chairman of the Domestic Policy Subcommittee of the House Oversight and Government Reform Committee, turned the spotlight on how private health insurers make decisions on medical care—particularly what Kucinich called "wrongful denial and delay of healthcare."
"The fact is that in America today, you don't know if your health insurance will take care of your serious medical bills until you become seriously ill or injured," he said during the first day of hearings, which featured several witnesses who had been impacted by insurer decisions on the patient and provider sides.
Some spoke of "life-consuming denial and appeal processes," while others such as Linda Peeno, MD, a physician who formerly worked as a company physician for several health plans, talked about "the abyss between what insurance companies say and what they do."
"The primary purpose of health insurance data collected by the state regulators today is to monitor solvency," Karen Pollitz, a research professor with Georgetown University's Health Policy Institute, told the panel. There is little information "on an ongoing basis to monitor the accessibility, affordability or security of health insurance for consumers."
Pollitz, citing earlier data collected by the full committee, said that when queries were sent out to all 50 state insurance departments, only four states could provide data on the number of rescissions—the process of dropping enrollees from insurance plans—that occurred and only 10 states could provide the number of individual health policies.
For the second day of hearings, Kucinich called for executives with six health insurers—and not their chief medical officers—to testify.
"All of the insurance companies here today wanted to be represented" by their chief medical officers, Kucinich said. "Had we allowed that, their preferred representative would have been consistent with the public image companies like to project, but it would have denied the subcommittee the ability to probe how health insurers work." The panel heard from executives of UnitedHealthcare Group, WellPoint, Aetna, Humana, CIGNA, and Health Care Service Corporation.
Kucinich questioned Brian Sassi, executive vice president and chief executive officer with the consumer unit of WellPoint, about $15 million the company recently paid out to settle claims on charges from the California Department of Insurance that 2,330 members were removed from coverage after submitting expensive claims for medical care.
Kucinich specifically wanted to know what the individuals had in common. Sassi, pressed by Kucinich to answer the question, said that they "medically misrepresented their medical history" on their applications during the time they were applying for medical coverage.
"We need information about how your business model works— because people really need to understand that [you] are not charitable organizations," Kucinich told the insurers. "If your medical loss ratio changes too significantly, Wall Street will punish you. We understand that [but] the question is this business model sufficient to provide healthcare to the American people... There's a collision here and you happen to be at that time and place where this collision is happening."
The Joint Commission has made significant strides to improve its performance and culture in 2009, the organization announced during its recent Executive Briefings in New York.
Ann Scott Blouin, PhD, RN, executive vice president of accreditation and certification operations, discussed at length major changes the healthcare accrediting body has taken in recent months to improve the way it works with hospitals, as well as its own internal processes. Among those improvements:
Refocusing surveyors. Blouin told the audience that The Joint Commission has refocused its 500 hospital surveyors to balance their roles as both evaluators and educators/coaches/mentors. According to Blouin, this was received as an invigorating change by "95%" of the surveyors.
Adaptation. The Joint Commission is using Lean, Six Sigma, and "change acceleration" to change its own culture. According to Blouin, there is a new focus on customer service and simplification of processes. The Joint Commission has also changed its tactics on criticality—now only direct impact Requirements for Improvement affect accreditation decisions.
Post-survey reports. The Joint Commission has promised to improve the time frame in which hospitals receive their post-survey reports. A recent study within the organization found that hospitals were on average receiving their reports 16.4 days after survey, with massive fluctuations in those timeframes—despite a requirement that hospitals receive this report within 10 days of their survey (not a 10-day average). A new process has been developed reducing the time to develop the report from 38 hours to 4.4 hours and the average timeframe to receive the report down to 5.4 days.
Periodic Performance Review. The Joint Commission is examining changes and enhancements to the PPR based on feedback from the field that the dates of submission are not working.
And, as was discussed earlier this year, there are no more automatic thresholds—there is "no magic tipping point," said Blouin. They have also made a concerted effort to reduce costs.
Looking ahead to 2010, The Joint Commission is taking a hard look at its National Patient Safety Goals to make sure accredited organizations are getting the most from their efforts to comply with these key requirements. Additional announcements on the NPSGs are expected in early October.
California hospitals are nervously bracing for a court-ordered inmate reduction program that will grant early release to thousands of inmates no longer deemed a threat to society, in part because they are old and medically fragile.
Many of these inmates will need immediate care at hospitals, dialysis units, and behavioral facilities, and their first stop in freedom may be the emergency room.
Just last week, says David Green, CEO of 165-bed El Centro Regional Medical Center, he received notice that "a prisoner with several end-stage diseases" at Centinela State Prison, about 10 miles to the west, was being paroled, to an address that was the same as his hospital's.
"I talked with the Imperial County Health Director and said 'This is nice to know!' I was told they can't find any other place to put this person so they'll have to deposit them on my front door.
"This puts the pressure on us to make our social services departments figure out what to do with these patients," Green says. "I'm stuck having to put them in an inpatient bed while we try to figure out what to do."
With 170,000 inmates, California's prison system is the largest in the U.S. and is dangerously overcapacity by about 190%. In February, a federal court demanded that the state reduce that population by 45,000, to 130,000, after finding that the correctional system could not provide adequate medical and mental health care to such a large number of prisoners.
Although the state has appealed that ruling, Gov. Arnold Schwarzenegger on Friday announced a more modest plan in an effort to appease that will reduce the inmate population by 18,212, in part with transfers to other state prisons and private facilities, commuted sentences, and early release of old and sick inmates.
Whatever number is ultimately granted early release, it will be on top of approximately 10,000 inmates who are already released each month statewide after they have served their sentences. However, the routine release of inmates is in general a healthier population than those who would be granted early release on the basis of senior age or illness.
"Every hospital in California is worried, especially those that are close to these state prisons," says Lynne Ashbeck, regional vice president of the Hospital Council of Northern and Central California.
"It's a distasteful situation for everybody," says Elizabeth Howard of the California State Association of Counties, which worries about the impact on hospitals, drug, and alcohol services, and mental health units owned and operated by county jurisdictions. "When appropriate places can't be found, it's been our experience that they have been released from prison, right into hospitals in certain areas."
The system has been ordered into federal receivership because of concerns over delays and quality of care within the correctional system over the last decade.
Gordon Hinkle, spokesman for the state Department of Corrections, says not all of the 18,000 to 45,000 inmates that will be released from the prison system to reduce overcrowding are sick or old. In fact, he says, the number is more like 6,000, and includes some inmates who would be released to home arrest.
"There's a lot of fear out there of what's going to happen," he says, "but if you see the total package, which is posted on our Web site, it's not a major component of the proposal."
Hospital officials throughout the state say that they have six major concerns about the impact of early release of older, sicker inmates:
Delays in getting inmates qualified for Medi-Cal or Medicare may take as long as 18 months. "And to the extent that it takes a year or 18 months, that's debt on your books, " says Kelly Brooks, of the State Association of Counties.
Medi-Cal and Medicare reimburse hospitals for far less than their costs, which translates into another unfunded mandate.
Many inmates will not qualify for either program, resulting in a demand for uncompensated care from local healthcare networks.
Many inmates are likely to continue to have behavioral, drug or alcohol treatment needs after their release.
Hospital officials worry quietly that when these inmates are released, they will be in need of much deferred care that wasn't or couldn't be provided during incarceration. Medical problems that might have been more cheaply and more easily managed may have been allowed to get out of control.
California is one of only two states in the country where all inmates are released on condition of parole, and that release is to the area where they committed the crime, unless that region lacks the ability to provide a certain type of care the patient needs. In that case, they would be paroled near that health service they need.
Hospitals in counties with numerous prisons, including Kern, Kings, and Imperial, worry that they may receive more former inmate patients as a result.
"There's no one who wants to step up and pay for this population," says Brooks of the County Supervisors Association. "That's what it comes down to."
Hospital officials are also irritated because of a bill attached to the current budget that capped reimbursement to hospitals for treating prison inmates during their incarceration, a cap that shortchanges hospitals and doctors relative to the cost of providing that care. Not only are health providers not being reimbursed fairly for taking care of inmates while they are incarcerated, but providers will have to absorb the unfair burden after they are released, they say.
For David Green of El Centro Regional, it isn't just Centinela State Prison, population 4,556, that he's worried about. Imperial County also is home to Calipatria State Prison, which incarcerates 4,268 felons.
“Maybe this is hearsay, but I heard at a recent supervisors' meeting they would be paroling 2,500 into Imperial County, and many of them will be paroled right here."
Despite six years of funding and planning, health systems in 10 localities in five sampled states still aren’t ready for a pandemic flu, and levels of readiness vary, according to a pair of reports issued yesterday by the Office of Inspector General.
The first report, based on documents and interviews provided by the selected areas, looked at how well systems can gear up to add beds, medical equipment, trained volunteers, find alternate sites, and triage patient care.
It found that all 10 localities had committees to plan for a pandemic and had coalitions to coordinate care. But "the degree to which coordination occurred varied."
Fewer than half the selected localities had started to recruit medical volunteers and none of the states had implemented an electronic system to manage them. All four of the localities that had started to recruit, register, and train medical volunteers had concerns about using them. States were required by the assistant secretary for preparedness and response to have electronic systems to register medical volunteers by August 2009.
All localities had acquired limited medical equipment for a pandemic, but only three of the states had electronic systems to track beds. Though all 10 had limited caches of medical equipment, many experienced difficulties managing it.
Most localities were in the early stages of planning for alternate care sites, such as schools or convention centers, and few had signed formal agreements. None of the localities that were planning to use alternate care sites had plans that included scope of care, or how these sites would be managed, staffed, and supplied.
Most localities had no guidelines for altering triage, admission, and patient care. Seven localities noted that providers in their areas were concerned they would be legally at risk if they were to alter their standards for triage, admission or patient care.
All localities conducted medical surge exercises, but none consistently documented lessons learned. And most exercises were discussions rather than operations-based.
In neither report did the agency identify the states or localities reviewed.
The second report looked at eight planning areas and 89 preparedness items for vaccine and antiviral drug distribution in the event of a pandemic.
None of the 10 localities had started planning for distribution or dispensing. "Localities plans generally were not actionable. For example, localities did not generally have valid and detailed formal agreements, such as a Memorandum of Understanding, with partnering agencies."
Between September 2006 and July 2008, the localities conducted 63 exercises related to distribution and dispensation of vaccines and antivirals. But most did not create action reports and improvement plans after these exercises.
All localities collaborated with community partners to develop and exercise plans.
The agency recommended that the Centers for Disease Control and Prevention step in to determine the cause of any delays in preparedness and provide assistance. The CDC also should emphasize the importance of localities developing actionable vaccine and antiviral drug distribution and dispensing plans, according to OIG.
A new compendium of community based prevention programs released Monday by the Trust for America's Health and The New York Academy of Medicine is designed to help show how certain types of preventive services can yield substantial net savings—"largely because the initial costs are low and the long-term benefits are large," said Jeff Levi, PhD, the Trust's executive director in New York.
Last year, the Trust released a report that found that an investment of $10 per person per year in proven community based programs—to increase physical activity, improve nutrition, and prevent smoking and other tobacco use—could save the country more than $16 billion annually within five years, Levi said. This is a return of $5.60 for every $1 spent.
The new report is sending a message that "a strong evidence base [exists] for prevention efforts . . . as we move toward the goal line of the healthcare reform debate," said Jo Ivey Boufford, MD, the Academy's president. "We do believe that there will be significant improvements in health and significant savings for the health systems by really integrating these kinds of proposals into any healthcare reform proposal."
For instance, heart disease, stroke, and diabetes account for 36.6% of deaths in the United States, but this could be significantly reduced by changing just three risk factors—decreasing smoking, increasing exercise, and improving eating habits, Boufford said.
Despite the high rates of preventable death, investment in prevention has been "historically modest in this country—accounting for only 4% of all healthcare expenditures," said Boufford. "The good news is that community based prevention programs work. Well designed community interventions can change behavior. They help people take responsibility for their health and make healthy choices that reduce both the incidence and severity of disease."
The academy identified 84 articles with evidence showing how community based prevention programs could reduce disease rates or disease progression. Some examples are are:
In Pawtucket, RI, the Pawtucket Heart Health Program conducted an intervention to educate 71,000 people about heart disease through a mass media campaign and community programs. Five years into the intervention, the risks for cardiovascular disease and coronary heart disease had decreased by 16% among community members.
Researchers at Ohio State University recruited 60 women in their 40s for a 12 week walking program that took place on the college's campus. At three months, the intervention group reported a 1% decrease in body mass index, accompanied by a 3.4% decrease in hypertension, a 3% decrease in cholesterol, and a 5.5% decrease in blood glucose.
The Rockford (IL) Coronary Health Improvement Project is a community based lifestyle intervention program aimed at reducing coronary risk, especially in a high-risk group. The intervention included a 40 hour educational curriculum delivered over a 30 day period with clinical and nutritional assessments before and after the educational component. At the end of the 30 day intervention period, analyses of total cholesterol, triglycerides, blood glucose, blood pressure, and weight showed significant reductions.
Recent studies have "questioned the cost-effectiveness of prevention proposals within healthcare reform legislation, [but] we think that there is strong evidence that community based prevention . . . [does] offer a very high return on investment," Boufford said. "By changing the infrastructure in these communities where people live, learn, work, and play, we really can create sustainable change to prevent disease before it occurs and see that return on investment."
Seeking to lock down votes before a meeting of the Senate Finance Committee, Chairman Max Baucus began reworking his healthcare overhaul to ease the financial burden on middle-class Americans who would be required for the first time to have health insurance. Baucus said that his revised bill would offer more generous subsidies to low- and middle-income people to buy coverage through a network of private insurance exchanges. He also said he may cut the maximum penalty facing middle-class families who do not buy insurance.
As the Senate Finance Committee begins reworking Sen. Max Baucus' healthcare bill, the focus will be on keeping the final price tag below $900 billion—a target considered crucial to winning over moderate Democratic votes. But the cost estimates in the proposal—like those attached to many of the 500-plus amendments lined up for committee consideration—involve budgetary sleights-of-hand designed primarily to serve political ends, according to the Los Angeles Times.
