Many state and local governments are not adequately prepared to deal with a surge of patients in a flu pandemic or quickly distribute vaccine and antiviral drugs, according to two reports by federal investigators. An analysis of preparations by five states and 10 municipalities found that many had failed to take steps crucial during a pandemic, such as recruiting healthcare workers to volunteer, creating systems to track hospital beds and medical equipment, and determining how to manage a patient load that exceeds what emergency rooms are able to handle.
A lawyer and panelist at last week's 17th annual national HIPAA Summit called HHS' new "harm threshold" in its interim final rule on breach notification a "huge weakness."
Gerry Hinkley, Esq., partner and chair of HIT practice group for Davis Wright Tremaine in San Francisco, presented a talk on breach notification and the new components of HIPAA in the HITECH Act on Day 3 of the conference at the Wardman Park Hotel in Washington, DC, Friday.
Perhaps his most telling comment came about the new "harm threshold" in the HHS interim final rule on breach notification.
Hinkley called it a "huge weakness." If he's a patient, Hinkley said he wants to be the one determining whether information that was disclosed inappropriately could cause significant harm–and not the covered entity.
HHS says in the interim final rule that many commenters on the draft guidance in April suggested HHS add a "harm threshold such that an unauthorized use or disclosure of [PHI] is considered a breach only if the use or disclosure poses some harm to the individual."
HHS agreed. Hinkley necessarily does not.
HealthLeaders Media asked Hinkley at the Summit Friday if he sees instances where HHS will overrule a covered entity's determination of significant harm to a patient.
"You always have that risk because if your determination is not reasonable, you've got a HIPAA violation," Hinkley said. "You're going to be second-guessed so you want to be balanced and conservative in making that determination."
According to the interim final rule, covered entities and their BAs will perform a risk assessment to determine if there is significant risk of harm to the individual whose PHI was inappropriately dispensed into the wrong hands.
According to the interim final rule, the important questions are:
In whose hands did the PHI land?
Can the information disclosed cause "significant risk of financial, reputational, or other harm to the individual"?
Was mitigation possible? For example, can you obtain forensic proof that a stolen laptop computer's data was not accessed?
In certain cases, if the information includes only a patient's name and the fact they've had services at the hospital, that's no harm, no breach. But what if the information includes the patient's oncology treatments? Lots of potential harm there. And that's a breach.
On Day 1 of the conference Wednesday, HealthLeaders Media asked David Blumenthal, MD, MPH, national coordinator for HHS' Health Information Technology, whether the government is concerned about the harm threshold's subjective nature.
Blumenthal deferred the question to the OCR office, but said, "We know there is a balance between practicality and protection in that regard."
Frank Ruelas, director of compliance and risk management at Maryvale Hospital and principal, HIPAA Boot Camp, in Casa Grande, AZ, told HealthLeaders Media that facilities must conduct a risk assessment to determine harm.
Ruelas presented on breach notification on Day 1 of the HIPAA Summit.
"It is certainly reasonable to conclude that given the requirement to document its risk assessment with respect to this harm threshold, each covered entity will likely adopt its own unique perspective on the level of risk it would assign," Ruelas said in an e-mail to HealthLeaders Media Monday. "This same uniqueness will also likely be one determinant on how the same type of incident might be rated differently across the covered entity community."
Ruelas says a risk assessment is "vital so that breach notifications are triggered appropriately. It is the variability of how these risk assessments will be done which is what is drawing my attention. Without clear guidance or a tool to use, each covered entity is left to its own devices."
Suburban Los Angeles' Grossman Burn Centers is launching a controversial expansion trajectory to bring its brand of burn care 100 miles away to Bakersfield, and 1,800 miles away to Lafayette, LA, this fall.
And, while they're at it, Grossman hopes to add to two to four more burn units in hospitals in the next two to four years, says business development director, Roy Forbes.
"There's about 130 burn centers in the country, but their numbers are dwindling, because they're usually loss leaders, centers that require public subsidy or a university or municipal backing," Forbes says. "We're definitely going against trend."
Grossman Burn Centers, a for-profit venture, is able to get around the losing aspect of burn care by treating burns quickly, and by insisting on working only in hospitals that have dedicated units to provide surgical and other care as soon as possible, Forbes says. Its affiliated surgeons are specialists in plastic surgery for burns as well, he says.
For the last 11 years, Grossman has also operated another seven beds at 283-bed Western Medical Center in Santa Ana, CA, and plans to remain.
And in October, it plans to open six burn beds at 267-bed Our Lady of Lourdes Regional Medical Center in Lafayette, LA.
At the same time, Grossman is transferring its entire 30-bed burn unit from Sherman Oaks Medical Center, where it has operated for the last 40 years, to a 212-bed West Hills Hospital in West Hills, which is 13 miles away.
Prime Health Services, which purchased 153-bed Sherman Oaks a couple of years ago, has a business model that focuses on the emergency room, Forbes says. "They don't want to be in the burn business." So Grossman is moving on.
Forbes says the business model is to contract with hospitals to either take over their burn units or create a new burn unit business within the hospital's existing license. Patients are stabilized in the hospital's emergency room or trauma center, sometimes at another facility, and then transferred to the Grossman surgical units.
Forbes explains that many hospitals are closing their units because "they aren't making money. In the last five years, there have been perhaps 25 burn centers around the country" that have closed down.
His efforts are preventing more units from closing down, he says.
But business models like Grossman's are not without controversy. Some burn specialists around the country say they worry that operations like Grossman's, which don't undergo verification credentialing by the American Burn Association and American College of Surgeons, may siphon off profitable burns and leave the unprofitable ones to others.
The ABA/ACS has granted verification status to some 60 burn centers around the country, but Grossman isn't one of them.
"Burn units have a slim narrow margin to stay viable; you wouldn't want to see the little burns siphoned off—that would be an equation that would end up hurting some programs," says Robert Sheridan, chief of burn medicine at Shriners Hospital for Children in Boston and president of the American Burn Association.
Sheridan acknowledges that for many smaller, non-academic hospital centers, "It's not cost-effective to maintain beds waiting for burn patients to come in."
How does Grossman Burn Center care make money with burn patients when hospitals can't?
"For lack of better term, we market our services to the community, not just, say, at a community safety fair. But we also market to self-insured companies, and to payer referral sources. And let them know we have a service for them," Forbes says.
Forbes says Grossman doctors specify that they be given dedicated units to care for their patients, so wounds can be closed quickly. "We attack big burns with a whole team, to get them in and out quickly with minimal anesthesia," he says.
Why are there fewer burn beds?
David Greenhalgh, chief of burn surgery at UC Davis Medical Center and a member of the ABA/ACS verification team, listed several reasons why the number of burn beds has declined over the years.
For starters, there are fewer burns, because safety and prevention messages are getting through. Second, the trend throughout the country is for burn units to be larger, with more specific expertise available around the clock.
"It's not only having doctors and the beds, but you need the whole team, nutrition and respiratory therapists," Greenhalgh says.
"It's a concern. Burn centers need to take care of all levels of burns and handle all levels of trauma and critical care that goes along with them."
Forbes says that Grossman's policy is to take all types of burn patients, regardless of the extent of their burns.
"We're plastic surgery based. That's a distinction from other burn units in the country. Theirs are general surgery based or resident run. We take a longer-term view of patients care. We're not just about the acute, initial phase, but everything we do is toward a mission of restoring patients to as much of their pre-injury status as possible. Emotionally, physically, functionally. And cosmetically."
Cleveland Clinic CEO Toby Cosgrove, MD, has been taking heavy flak since he told the New York Times that he would not hire obese people if it was legal.
Cosgrove, a surgeon, apologized to staff last week in an e-mail message, but he didn't back away from his essential point. "My objective was to spark discussion about premature causes of death, but some of my comments were hurtful to our community. That was certainly not my intent, and for that I apologize," he told employees. "Those of us who care for patients are deeply motivated to heal, but medicine and surgery can only go so far. There is much more we could do to prevent chronic diseases if we take measures to eat healthier, exercise and quit smoking."
Critics have interpreted Cosgrove's remarks as a form of blame the victim—that society is being asked to pick up the increased medical costs for obese people who lack the discipline to take care of themselves—even as new medical research shows that obesity may be linked to heredity and other factors that may be difficult or even beyond an individual's control. Obesity also disproportionately affects poor and working class Americans who may not have the awareness of proper nutrition, nor the money, nor ready access to nutritious, fresh, and healthy fruits and vegetables.
As the CEO of a prestigious health system, Cosgrove's words carry extra weight, the points he raises cannot be dismissed in the name of sensitivity or political correctness. Obesity is killing this nation, literally and financially. About 60% of Americans are either overweight or obese. According to the Centers for Disease Control and Prevention, obesity-related medical care costs the nation about $147 billion a year, and obese people spent $1,429 (42%) more for medical care in 2006 than did normal weight people. This is not a static cost. The CDC study notes that the proportion of all annual medical costs that are due to obesity increased from 6.5% in 1998 to 9.1% in 2006. Does anyone expect that—left ignored—this alarming trend will reverse or even slow down as the nation ages?
So, when Cosgrove talks about rejecting obese job applicants, he is just saying out loud what a lot of employers are thinking, and probably already doing. I would not be surprised to learn that many employers who are otherwise color blind and gender neutral give obese job applicants rigorous scrutiny. Small businesses that have seen triple-digit increases in the cost of providing health insurance over the last decade might be particularly susceptible to such a trend. If this is happening, it's not because these businesses think overweight and obese people are undisciplined or unattractive. It's because overweight people cost businesses more money in higher health insurance costs, sick days, and lost productivity. A study in California released in July estimated that the lost productivity and other economic fallout associated with overweight, obesity, and physical inactivity cost that state $20.3 billion in 2006.
That brings us back to Cosgrove. No one sees the devastating effects of obesity on a human body more so than the healthcare professionals who deal with the damage. As a surgeon, Cosgrove is speaking from a front-row seat when he talks about obesity as this generation's great public health menace, with the potential to harm tens of millions of Americans. In that respect, he's dead right. His sense of urgency is understandable.
This nation has a pretty good record for raising public awareness on health issues like smoking, pollution, alcohol abuse, drunken driving, and wearing seatbelts. So far, we've talked a lot about obesity but we haven't done much beyond that. It's time for a coordinated national dialogue on obesity, from which could emerge an action plan that must include raising public awareness. The challenges will be daunting, because the issues around obesity are far more complex than any other public health issue. Not everyone smokes. Not everyone drinks alcohol. Not everyone drives a car. Everyone eats.
If we are going to recognize substantial savings from any healthcare reform, the healthcare consumers have to be on board, committed to healthier living. At the same time, taking action on overweight and obesity cannot mean demonizing the 60% of Americans who fall into either of those categories.
A pharmacy technician Babette Perry is suing her former company for scaring her during a mock robbery reportedly without telling her beforehand. While training with Hampton Behavioral Health Center near Philadelphia, a masked gunman burst in, told Perry he was holding a coworker hostage, and demanded OxyContin. Afterward, Perry found out the incident had been staged.
A surgical technician convicted of firing a gun into an occupied car was back on the job this month at Harbor-UCLA Medical Center, just days after being released from jail, despite vows by county officials to crack down on medical personnel with criminal records. Harbor-UCLA officials declined to speak with the media about the convict's return, but noted that the gun violence was not "work related."
The new St. Luke's Lakeside Hospital in The Woodlands, a 30-bed specialty hospital dedicated to cardiology, sports, and orthopedic medicine, will open on Sept. 28. Hospital officials say 120 employees and physicians are already on board the staff at St. Luke's Lakeside Hospital. According to Mona Tucker, director of human resources for St. Luke's The Woodlands, over 4,000 employment applications were submitted for the first 100 positions that have been filled at Lakeside Hospital. Diane F. McNamee, RN, has been named CNO for Lakeside Hospital. Brant Lipscomb, MD, has been appointed CMO. Vincent Aquino, MD will serve as chief of cardiology. Kelly Blevins, MD, has been named chief of surgery. Wael Asi, MD, was named chief of medicine.
Premier Health Partners announced the appointment of new CFOs for each of its three hospitals. Scott Shelton has been named CFO for Miami Valley Hospital, effective Oct. 1. He succeeds Tom Duncan, whose appointment as CFO for Premier Health Partners was announced in July. Tom Curtin has been named CFO for Good Samaritan Hospital, succeeding Shelton, effective Oct. 1. Since 1999, Curtin has been vice president and CFO of Fidelity Health Care. Tom Maloney has been named CFO for Middletown Regional Hospital, effective Sept. 10. He is currently CFO of Miami Valley Hospital's Dialysis Centers of Dayton. He succeeds Kevin Murphy, who left Premier Health Partners this month.
Doris Kirchner will be the Vail Valley Medical Center's new CEO. Kirchner has been the medical center's acting CEO since John Cassin resigned in early July. Kirchner is the hospital's fifth CEO since 1998. Kirchner served as COO at the hospital for the past 18 months, as well as for eight years from 1986 to 1994.
Daphne David has been named COO for Garden Park Medical Center in Gulfport, MS. The 130-bed hospital is part of the Delta Division of HCA Inc. Daphne has held several positions at Garden Park over the past 10 years, most recently as an assistant administrator. Her responsibilities include oversight of all ancillary and support services.
