Keep going. You don't have to fix all of it now. Just please don't let it stall. That's the essence of the message that Senate Democratic leaders have for their Finance Committee senators, who plan to start voting Tuesday on a remake of the nation's healthcare system. Democrats on the pivotal committee are disappointed with the bill from the chairman, Sen. Max Baucus. Republicans see a chance to deliver a stunning blow to President Barack Obama's top domestic priority.
More than three million doses of swine flu vaccine will be available by the first week of October, a little earlier than had been anticipated, federal health officials announced. But nearly all those 3.4 million doses will be of the FluMist nasal spray type, which is not recommended for pregnant women, people over 50 or those with asthma, heart disease or several other problems, officials from the Centers for Disease Control and Prevention warned. Nonetheless, it will still be possible to vaccinate people in other high-risk groups: healthcare workers, people caring for infants, and healthy young people.
President Barack Obama pushed back against the argument from liberal Democrats that the leading healthcare bill in the Senate would place a new financial burden on the middle class, saying in a series of television appearances that insurance would be made affordable through a competitive exchange and subsidies. As the Senate Finance Committee prepares to take up the legislation this week, the White House is trying to hold together fractious Democrats, particularly those who believe that the plan is not generous enough for people required to buy insurance.
After months of closed-door negotiations with a handful of senators on the Finance Committee, the full panel now gets to put its imprint on what could be landmark legislation to overhaul the health system. Senators have offered 564 amendments and the Republican proposals generally reveal seemingly irreconcilable differences. While they would gut the bill, one Republican, Senator Olympia J. Snowe of Maine, wants important changes, but appears ready to get behind it, provided Baucus can keep his fellow Democrats in line.
Although cast as a tax on gold-plated insurance policies for the well-heeled, a tax on the most expensive insurance plans has prompted anxiety among the middle class. The idea, proposed by Senator Max Baucus, is to help raise money for the nation's healthcare overhaul. The tax is meant to raise more than a quarter of the $774 billion needed to pay for the Baucus plan. As it turns out, though, many smaller fish would get caught in Baucus' tax net.
Federal health officials say only about 42% of all healthcare workers get an annual flu shot. That is little better than the overall national average of 33% and far below the 65 to 70% rate for the elderly. That's why the New York Health Department is requiring that all hospital, home health, and hospice workers get seasonal and swine flu vaccinations. No other state or city health department has such a rule. Local unions have reacted angrily, saying they had not been consulted.
At Mercy Medical Center in Merced, CA, where roughly four patients a day are Hmong from northern Laos, healing includes more than IV drips, syringes, and blood glucose monitors. Because many Hmong rely on their spiritual beliefs to get them through illnesses, the hospital's new Hmong shaman policy, the country's first, formally recognizes the cultural role of traditional healers, inviting them to perform nine approved ceremonies in the hospital, including "soul calling" and chanting in a soft voice.
A new study shows Medicare's policy against paying for hospital-acquired conditions (HAC) will only save $1.1 million to $2.7 million.
California researchers conducted the study, which analyzed discharge data from California Medicare beneficiaries in 2006, looking for six conditions the authors deemed definable. Out of the total 767,995 cases, there were 828 cases of those conditions, and 26 would have been subject to lower payments, according to the Wall Street Journal.
"If it's designed to recapture money, it's poorly designed," says Keith Siddel, PhD (c), founder, president, and CEO of HRM in Creede, CO, a national healthcare financial service organization.
A patient's condition upon admission usually generates multiple codes, so if a patient develops a HAC, the nonpayment for that condition will not heavily impact the total reimbursement because of legitimate payment for the rest of the codes, Siddel says.
For example, if a patient develops a urinary tract infection (UTI) in the hospital, CMS will not pay that hospital for treatment of that condition. But if that case includes 10 or 15 other codes, dropping one code for a UTI will not decrease the payment by much.
Siddel says he has tested the impact of HACs for clients and came up with similar "marginal results" as the California researchers.
Although CMS officials acknowledged that projected savings are not large, they suggested the study may be "limited and speculative." They added the penalties have been effective in changing behavior and improving hospital care.
Hospitals will have a clear process for reporting physicians struggling with a substance abuse or mental health disorder once Governor Schwarzenegger signs California Senate Bill 820 into law.
This bill is intended to fill the gap left when the state last year dissolved its physician diversion program, which funneled physicians with substance abuse and mental illness through a structured rehabilitation process. Although the bill only applies to California hospitals, the state is often at the helm of healthcare trends, and other states may develop similar regulations.
"Hospitals are not intentionally doing things wrong, but I think there was a gray area when our diversion program went away and the existing law about reporting was still on the books," says Linda Whitney, chief of legislation for the Medical Board of California.
Whitney adds the Senate Bill is intended to provide hospitals with a clear and early reporting mechanism and protect the public from impaired physicians. "This language is very similar to the language that was in law related to reporting to our diversion program," she says.
Under California's current peer review system, a medical staff peer review committee only alerts the Medical Board of California after it has conducted a full investigation into a physician's conduct and performance, which could take weeks or months. Unless the medical staff peer review committee has summarily suspended a physician for an egregious act, the physician is allowed to continue practicing during the investigation, which some argue poses patient safety—and thus malpractice—risk. The medical staff peer review committee may determine that the physician can continue practicing if he or she undergoes some type of corrective action, or the medical staff can revoke the physician's privileges if it determines that the physician poses substantial patient safety concerns.
Under the process outlined in the bill, medical staff peer review committees will be required to report physicians to the executive director of the Medical Board of California within 15 days of launching a formal investigation. Within 60 days, the executive director follows up with the medical staff peer review committee to gauge the progress of the investigation and deem whether the corrective action the committee has imposed on the physician is adequate.
"If the executive director determines that the progress of the investigation isn't adequate to protect the public, that case would be turned over to the chief of enforcement so that we can start our own investigation," says Whitney.
"Senate Bill 820, among other things, reminds us that the diversion program is gone," says John Harwell, a lawyer specializing in medical staff issues based in Manhattan Beach, CA. "Overall, I'm sad that the medical board and the legislature have decided that they will no longer be in the rehabilitation business, but rather they will be in the enforcement business."
Harwell says the vast majority of physicians who participate in rehabilitation programs successfully return to practice. "I really don't like the idea that there isn't some centralized process of seeing that this is done and it is now left to the individual hospitals," he says.
Harwell explains that medical staffs will still be permitted to refer physicians to medical staff-run physician wellness committees without having to report to the Medical Board of California. However, if certain physicians do not benefit from the wellness committee's guidance, the only other option is to report those physicians to the medical board.
One of the biggest barriers that prevent physicians struggling with substance abuse or mental health disorders from seeking help is their fear that their condition will not be kept confidential. Under most state laws, any information unearthed by a medical staff peer review committee investigation is kept confidential, and Whitney says any investigations conducted by the Medical Board of California will also be done with an eye to privacy. "Once we file any kind of disciplinary action, that is no longer confidential, but certainly the investigation is confidential," she says.
Liz Jones is an associate editor with HCPro. She writes Medical Staff Briefing, Hospitalist Leadership Advisor, and co-writes Credentialing and Peer Review Legal Insider.She can be reached at ejones@hcpro.com.
President Obama signed into law the $787 billion American Recovery and Reinvestment Act of 2009 that included provisions for heightened HIPAA enforcement and stiffer penalties for privacy and security violations.
The next day, the Department of Health and Human Services (HHS) and the Federal Trade Commission (FTC) announced that CVS, the nation's largest retail pharmacy chain, had to pay the U.S. government $2.25 million and take corrective action in a settlement for potential privacy breaches affecting millions of patients.
Seemed as if they were serious about enforcement. After all, it took them less than 24 hours to act.
But today, seven months later, there is uncertainty about that promised HIPAA enforcement.
Certainly, HHS has made moves in the direction of increased enforcement. In August, it announced it would expand its privacy enforcement team with two HIPAA "privacy specialists," who will help the public better understand their rights under HIPAA and enforce compliance among covered entities and business associates.
The "senior health information privacy outreach specialists" are operating under the Office for Civil Rights (OCR), which enforces the HIPAA Privacy Rule and Security Rule and the Patient Safety and Quality Improvement Act's confidentiality provisions through its Division of Health Information Privacy; HIPAA Security came under OCR's umbrella on July 27.
That news came a little less than a month after HHS announced it would advertise a position for two "Health Information Privacy Specialists." Those positions, according to the job posting at the time, are "responsible for reviewing, analyzing, implementing, promoting, or improving proposed or existing programs or policies needed to implement OCR's authority for ensuring compliance with the privacy of health information."
But when will this enforcement affect your organization? And how regular will they be? Random audits? Planned, coordinated ones?
The HITECH Act calls for "periodic audits" to ensure HIPAA privacy and security compliance, but the government itself doesn't know what that means—yet.
At the 17th annual national HIPAA Summit at the Wardman Park Hotel in Washington, DC, on Tuesday, government officials directly involved in HIPAA said the enforcement process has yet to be determined.
David Blumenthal, MD, MPH, national coordinator for HHS' Health Information Technology, deferred a question posed by HealthLeaders Media to his Office for Civil Rights (OCR) colleagues.
Sue McAndrew, the OCR deputy director for Health Information Privacy, asked later in the day by HealthLeaders Media, said she did not yet know the process by which HHS will conduct audits.
OCR may build on existing types of audits or perhaps partner with the inspector general, McAndrew speculated.
"We are basically in the process of doing some scanning and weighing our options of what kinds of audit programs are out there and what turns out to be the most effective," McAndrew said.
OCR has only levied two major fines—Providence Health & Services in July 2008 ($100,000 fine and corrective actions) and CVS in February 2009 ($2.25 million fine).
According to HHS, the federal government will spend about $24.3 million on privacy and security efforts, including:
Audits
Reports to Congress
Training for state attorneys general
Carrying out regulatory and enforcement requirements of HITECH
