Anti-abortion groups are gearing up for a battle in the fall over healthcare legislation, another headache for Democrats who already face concerns about the measure's cost and reach. Most versions of the Democratic health plan would create subsidies for lower-income people to buy private health insurance. If that insurance includes coverage for abortion, as many existing private plans do, it effectively means federal taxpayers are subsidizing abortion, critics of the legislation argue. While it gets less attention than some other parts of the plan, abortion has often been raised by critics at town hall meetings during the August congressional recess.
The death of Senator Edward M. Kennedy has quickly become a rallying point for Democratic advocates of a broad healthcare overhaul, a signature Kennedy issue that became mired in partisanship while he fought his illness away from the Capitol. Yet Democrats have serious internal differences on how to approach healthcare, and Republicans and Democrats remain deeply divided on the policy proposals—a gulf some say Mr. Kennedy was uniquely equipped to bridge.
As many as two-thirds of adults underwent a medical test in the last few years that exposed them to radiation and in some cases, a potentially higher risk of cancer, a study in five areas of the U.S. suggests. It is the latest big attempt to measure how much radiation Americans are getting from sometimes unnecessary medical imaging. Though the annual average radiation exposure from X-rays, CT scans, and other tests was low, researchers found about 20% were exposed to moderate radiation doses and 2% were exposed to high levels.
The White House is asking doctors to help promote its drive to overhaul healthcare, marking another effort by President Obama to regain momentum on one of his top-priority issues. White House health advisers held an hour-long conference call Tuesday night with nearly 3,000 physicians and officials of the American College of Physicians and the American College of Surgeons in which they tried to drum up support by answering questions and describing the administration's goals, participants said.
Region B, get ready. RACs may begin auditing at any time in several Region B states.
CGI Federal, the RAC for Region B, has posted its first set of issues eligible for RAC audits in Indiana, Michigan, and Minnesota.
The approved issues target outpatient hospital and physician claims and correspond with those approved for many states in RAC regions C and D that were posted over the past few weeks:
Blood Transfusions. Blood transfusions should be billed with a maximum of one unit per patient per date of service.
Bronchoscopy Services. Bronchoscopy services should be billed with a maximum of per unit per patient per date of service.
CGI provides additional information about each issue on its Web site, including claim types and codes affected, and whether it is looking for over- and/or underpayments. For these three issues, CGI is looking solely for overpayments.
Indiana, Michigan, and Minnesota are the three "yellow" region B states where RAC audits were scheduled to begin first. The remaining states in the region, Wisconsin, Illinois, Kentucky, and Ohio, were part of the second wave of "blue" states that were scheduled to begin after August 1.
Employers' healthcare costs are expected to increase 10.5% on average in the next 12 months, which is slightly lower than last year, according to a survey of leading health insurance companies.
Aon Consulting's semi-annual survey of more than 60 large healthcare insurers, covering more than 100 million people, found that healthcare costs are projected to increase by 10.4% for HMOs, 10.4% for POS plans, 10.7% for PPOs, and 10.5% for CDH plans. These are slightly lower than one year ago, when HMO cost increases were 10.6% and POS plans were 10.5%. PPOs and CDH plans remain steady at 10.7% and 10.5%, respectively.
"While we're seeing a slight decrease in the trend rates, it's still at double digits, and this year, it's compounded by a struggling economy, lower wage increases, and in some cases, salary freezes," says John Zern, Aon Consulting's U.S. Health & Benefits Practice director.
Aon Consulting CMO Paul Berger, MD, says wellness and health promotion initiatives are critical in the next phase of lowering the medical trend rate. "Approximately 30% of workers have chronic medical conditions, which account for 65% of this nation's medical spend," he says. "Wellness programs provide a strong platform for effectively managing chronic conditions and preventing future problems, but it's up to the individual to take advantage of the programs offered. Behavior change is never easy, but those willing to make changes in this capacity benefit from better health and lower healthcare costs."
Prescription drug costs are expected to increase 9.3%, which is slightly lower than the 9.4% trend rate one year ago. The specialty pharmacy trend rate is 13.2%, up from 12.4% one year ago. Aon Consulting points to the sluggish rate of drug adoption across the board, compounded by the FDA's reduced rate of drug approvals—especially for new molecular entities and biologic products—as the contributing factors leading to this decline.
Healthcare rate increases for retirees over the age of 65 are projected to be 6.6% for Medicare Supplement plans and 7.3% for Medicare Advantage plans, down from 7.3% and 7.7%, respectively, one year ago.
Whether the deficits separately forecasted in mid-year reviews by the Congressional Budget Office (CBO) and the White House on Tuesday spell a threat to healthcare reform initiatives on Capitol Hill probably will depend on an individual's political slant. Agreement, though, emerged that immediate action was needed now to stem costs related to escalating Medicare and Medicaid costs.
Overall, the news on the economy was grim. The CBO estimated that the federal budget deficit for 2009 will total $1.6 trillion, which, at 11.2% of the gross domestic product (GDP), will be the highest since World War II. Changes being considered to the "provision of health insurance and healthcare services in the United States could either add to or reduce that imbalance over the long term," CBO said.
Spending for Social Security, Medicare, and Medicaid is expected to rise rapidly over the next 10 years, outstripping the growth of GDP, CBO said. By 2019, this spending was projected to total nearly 12% of GDP, which compares with the current 9% of the GDP. Beyond the 10 year budget window, CBO said the nation would face "further significant fiscal challenges posed by rising healthcare costs and the aging of the population."
Meanwhile, White House Office of Management and Budget (OMB) Director Peter Orszag, wrote in his blog that its mid-season review showed a "smaller 2009 deficit but larger out year deficits" than previously predicted: The 2009 deficit is projected, he said, to be $1.58 trillion--or 11.2% of GDP, which is down from a previously projected $1.84 trillion or 12.9% of GDP.
Orszag added that to avoid making the deficit any worse, the key driver of these long term deficits needs to be addressed: Healthcare costs. "The federal government simply cannot be put on a fiscally sustainable path without slowing the rate of healthcare cost growth in the long run," Orszag said.
He added that is why the president "is insistent that healthcare reform not only be deficit neutral over the next 10 years, but also incorporate changes that will help reduce the deficit thereafter."
This perception was reflected on Capitol Hill as well. Senate Budget Committee Kent Conrad (D-ND) said there "was not much news in the reports” because CBO had projected deficits several months ago. However, he said the current numbers "reinforce the fact that the status quo on healthcare is not an option."
Since healthcare costs continue to grow much faster than inflation, "reform simply must be paid for over the next 10 years and also significantly reduce the projected cost of healthcare over the long term," Conrad said. In addition, he said that "a special process [is needed] that deals comprehensively with all of the causes of our growing national debt--including Social Security, healthcare, and our outdated and inefficient revenue system."
Sen. Judd Gregg (R-NH), the ranking minority member on the Budget Committee, said that the "trillion dollar deficits will only compound the looming crisis on the horizon." He said while the healthcare system does need to be reformed, "we cannot ignore the fiscal realities of our situation...we are in a very deep budgetary hole."
While supporting healthcare reform, he criticized the Democrats for proposing plans that "would only increase government spending on healthcare, not lessen it," and said the country should "proceed with extreme caution" before putting in place a huge and costly new program."
Robert Blendon, ScD, professor of health policy and political analysis at Harvard's School of Public Health, said that the current budget projections will put pressure on the healthcare reform measures "to be deficit-neutral in the real sense."
Since the bulk of the money of the reform bills goes into subsidizing coverage for people who are uninsured, Congress is likely to face a dilemma of how much it will subsidize coverage for people who are uninsured--and if cutbacks are necessary or raised taxes are needed. "You're in a situation where the pressure is on"-- where it may not be possible for Congress to subsidize as "generous a package or as many people as it did before," Blendon added.
It isn't every day that rural hospital officials eagerly discuss their abysmal practice scores in crucial care areas like heart failure or hip and knee surgery.
That's because that poor performance is now history. Today, four years later, the facilities have improved their care of patients so dramatically in four important categories, they've become innovators for other hospitals throughout the country.
Cleveland and United are two of 40 rural hospitals and 190 urban hospitals participating in the Centers for Medicare and Medicaid Services' "pay for performance" demonstration project, organized by Premier Inc.
Ironically, officials for the two hospitals say, the "pay" for their performance isn't the motivator for their participation. Improving care and getting recognized for it, however, are.
The effort is now in the fifth of a six-year run to see if the 230 participating facilities can be motivated by financial rewards to increase their performance in 33 process measures that correlate with better outcomes. But the first year results were a shocker.
"After the first year, we found out we were in the worst decile of all the hospitals in our heart failure discharge instructions," says Liz Popwell, Cleveland's vice president and chief ancillary officer.
Her 241-bed hospital's rates of readmissions were much too high. Scores for other quality measures in heart attack care, pneumonia and hip and knee replacement surgery were not something to advertise either.
Mark Povroznik, director of quality initiatives for a 318-bed United, acknowledges similar lackluster quality. "We ranked in the bottom deciles in nearly everything," he says.
Now after the fourth year, in the four categories of care that Cleveland and United provide--hip and knee surgery, pneumonia, acute myocardial infarction, and heart failure care--the hospitals' scores have vastly improved.
During the four years of the project, Cleveland has received just about $200,000 in rewards, while United has received $333,770, out of a total of $36.5 million paid by the federal government to those best-scoring hospitals.
But if money was supposed to be the motivator, it turns out to not be very important. First of all, the prize money doesn't amount to that much. Public recognition, however, was the key. And neither hospital knew its initial scores would be relatively poor.
The "financial reward was not the motivator. The motivation was that this was the right thing to do," Povroznik says.
Now what's more important, they both say, is the recognition they received from their patients, physicians and peers, and knowledge that they are providing better care that drives all hospitals to keep up the good work.
Another motivator was the idea that they could be innovative.
"To make these changes, we had to start thinking outside the box," says Dotty Leatherwood, vice president of Cleveland Hospital's community relations.
One of the strategies that helped, for example, was to ask case managers to follow their patients back to their homes to find out why they have such high readmission rates.
The story of one patient illustrated the difficult problems in their rural area. She had so little money for food, much less medications; her cabinet contained but one can of soup. Other patients who were advised to limit their salt intake didn't know that meant sodium too.
"It's sometimes especially hard for our elderly to manage that, or to understand," Popwell says. More counseling and one-on-one sessions helped educate them to change their diets.
Another remedy to seeing rapid improvement was to hire special nurses to do real time chart reviews, instead of waiting six months to look for mistakes, Popwell says.
"They'd look at a patient's chart and see things that had slipped through the cracks, such as a patient who had not received an ejection fraction test. That way, we could fix it while the patient was still with us in the hospital rather than catching those mistakes in retrospect on the chart review," she says.
A culture shift was important to make as well, she adds. "The challenge was that now we had these nurses looking over everyone's shoulder, including the physicians. And sometimes they'd say, ‘Hey, you're aggravating us!' But they stopped saying that when they could see the improvement."
At United, an important reason to participate in the project was an internal assessment done several years ago that "found that the hospital tended to react when problems occurred, rather than work proactively to improve quality," said a June report on United's success by the Commonwealth Fund.
"Staff failed to collaborate to set clear priorities" and the system was "data rich, information poor," in that it did not use proven core measures.
Another important key to improvement was to change some ways in which the hospital provided surgical care, including bringing more surgeons and anesthesiologists into the planning process.
"The quality improvement director held one-on-one discussions with the orthopedic surgeons" to focus on appropriate and timely antibiotic administration during hip or knee surgery, the report said.
When appropriate documentation required by the surgeons was routinely missing, the hospital staff took a tougher stance.
"Once, when it was clear that a particular surgeon was negatively affecting a department's performance, Povroznik announced in a department meeting that, ‘Your group efforts are noted and appreciated, but achievement of the department's goal is being held back by one of your colleagues; we're hoping we won't have to disclose who this is," according to the Commonwealth Fund report. The surgeon's compliance improved immediately.
Says Povroznik, "UHC had a long track record of being the lowest cost provider in WV. This alone shows commitments of our executives and associates to the community we serve. So pioneering into the field of quality reporting was not a fear, but a challenge we were eager to embrace. Regardless the initial outcome in performance, we knew we had the team philosophy and medical staff support to overcome and improve."
The 33 quality measures were developed by government and private organizations such as the National Quality Forum, the American Hospital Association and the Leapfrog Group, which found that adherence is highly correlated with better outcomes and improved survival. Coronary artery bypass graft surgery is measured for hospitals that perform open heart surgery.
The strategies include such best practices as always making sure heart attack patients get a beta blocker as soon as they arrive or administering pneumococcal vaccination to patients with pneumonia, giving aspirin to patients treated for heart attack as they are being discharged and making sure heart failure patients have a solid discharge plan.
They measures are "based on scientific evidence and, for continued effectiveness, are often reviewed to account for medical breakthroughs and new research," said Richard Bankowitz, MD, Premier vice president and medical director.
Overall, rural hospitals started out in the first year with aggregated scores in almost every category that were slightly lower than their urban counterparts participating in the project. But one of the most surprising findings after the first three years was that rural hospitals improved at a rate that kept pace with facilities in urban settings, Premier officials said.
For example, in the treatment of patients with heart attack or AMI, rural hospitals started out in year one with a compliance rate of 87%, but improved to 94% by the end of year three. Urban hospitals started out at 89.8% and ended year three with 95.6%
Rural hospitals still have more improvements to make overall, says Alven Weil, spokesman for Premier. During year four awards, the 190 urban hospitals received on average five awards per hospital while the 40 rural facilities received only four.
Also overall, there is still more room for improvement throughout all participating hospitals in many areas, such as pneumonia, Weil says.
For Leatherwood, Popwell and Povroznik, at least, there is the drive to continue to improve. "We now have the culture that likes being the very best," says Leatherwood. "And we know being just 'good' is not good enough."
The smirking, ruddy-faced boy featured in one of Seattle Children's Hospitals "Hope. Care. Cure." campaign's print ads doesn't look like he suffers from mitochondrial disease—and that's the point. The hospital's rebranding campaign used patients, families, physicians, nurses, staff, and volunteers to spread the word about its quality of care, foundation, and research.
"We wanted to create a campaign that that would help us enhance our national presence," says Katharine Fitzgerald, Seattle Children's director of advertising and partnerships. "And we wanted something that honored the 101-year history that we have here in the Pacific Northwest."
The campaign launched in April and includes TV, radio, outdoor, print, and online elements and ran in Washington, Idaho, and parts of Alaska. It is scheduled to run through 2010.
The Seattle Children's marketing team worked with local ad agency Copacino + Fujikado to choose patients, staff, and volunteers to include in the campaign.
"Since the campaign was based on storytelling, we wanted patients that had a great story and a willingness to tell that story," Fitzgerald says. "We wanted a patient that could talk about how it's important that we provide uncompensated care, we wanted a patient who had benefited from research here, and we wanted a patient who could benefit from our clinical care."
Each ad features one word from the "Hope. Care. Cure." tagline and tells a story that exemplifies its corresponding principle.
"The 'Hope. Care. Cure.' anthem really represents and ties together the three peer entities for our organization," Fitzgerald says. "Seattle Children's is a hospital, a foundation, and a research institute so the campaign relates back to those three entities."
Since the campaign launched, Seattle Children's has heard a good amount of positive feedback, she says. It has also seen an increase in traffic to its Web site and has received high awareness scores for the campaign in statewide polls.
Is it possible that there are some positives when it comes to marketing in a recession? That there is a silver lining to the mess we're in now? There are, according to sources I interviewed for my story in the August issue of HealthLeaders Magazine, "What Resonates Now." From a surge in creativity to an opportunity to make some beneficial business deals to a chance to do the right thing, there is an upside to marketing in a recession.
A Cycle of Creativity
"Nature runs in cycles and this is a cycle," says Elizabeth Cogswell Baskin, CEO and creative director of the Atlanta-based ad agency Tribe, Inc. "The important things about the recession is to use it as a time for planning and building as a brand or marketer."
It's also "a great time to reinvent, to zig where you've been zagging," she adds. "It can be a very creative time for brands and companies."
A Renewed Focus on What Counts
The recession can even provide marketer's with a "teachable moment" for service line directors and others who clamor for marketing attention, even if their department isn't performing. Healthcare organizations should be putting their marketing dollars behind those services that which will bring them the greatest revenue in the shortest period of time, says Rob Rosenberg, president of Springboard Brand & Creative Strategy, Ltd. in Arlington Heights, IL. The recession "gives good marketers an excuse or a reason to be even more disciplined in using the criteria and educating service line managers to step up."
And, he adds, "When the market swings back, they're going to see the benefit."
A Bevy of Business Opportunities
Stewart Gandolf, founding partner of HealthcareSuccess.com, a healthcare marketing consultancy based in Irvine, CA, says marketers should reevaluate their vendor and supplier contracts in tight times. "This is an opportunity to renegotiate longer contracts and get a much better rate," he says. "If you want to negotiate, cash is king and longer-term contracts are better."
A Chance to Give Back
And sometimes tough times present an opportunity to do the exact opposite of what your gut—and your budget—tells you to do, with excellent results. Early this year, Lehigh Valley Health Network, a 988-licensed-bed hospital system in Allentown, PA, renewed its focus on marketing the organization's financial counseling services—a department of six full-time employees who work with patients to help them find ways to pay for care.
"To be blunt, it doesn't make financial sense to do this," says Charles G. Lewis, senior vice president of development, marketing, and public affairs at Lehigh. But, he adds, "It's very fulfilling and quite frankly I'm proud to be part of a network that makes its programs and services more available—not less available."
The campaign helped generate a 128% increase in calls from people asking for more information about the program over the same study period last year. Charity applications jumped 17.5%.
"It wasn't without risk. But life's about risk. We felt good about doing the right thing," Lewis says.
Read more advice from Baskin, Gandolf, Lewis, and Rosenberg about marketing in a recession in the article, "What Resonates Now."
