While Congress continues its summer recess, the only thing certain about the healthcare reform is that the debate over options, such as a public insurance plan or co-ops, will not be quieting down any time soon. While the Senate Finance Committee has indicated it will not include a public plan in its proposal, talk on Capitol Hill shows that it is not entirely down for the count.
During most of the week, observers were looking closely for indications of whether President Obama was--or was not--backing away from support of a public option. In one comment, he said that "whether we have it or we don't have it, is not the entirety of healthcare reform...this is just one sliver of it, one aspect of it."
On Sunday, Sen. Charles Schumer (D-NY) said on NBC's "Meet the Press" that he didn't think that President Obama was backing away from the public. "I've talked to the president personally about this in the last few weeks. He believes strongly in the public option," he said.
"Obviously he is working hard to get a bipartisan bill, because that would be a better bill," he added. But "at the end of the day, we will have a public option" that "could be passed with the 60 Democratic votes we had...and I think that's the direction we're going to end up in."
While the Democrats are looking for a bipartisan approach, thoughts are being given to a reconciliation approach--which would require only 51 votes. "If we don't have a bipartisan bill, we'll never be able to meet the goal of having a bill signed into law by the end of the year...so yes, we are considering alternatives," he said.
But will the use of insurance co-operatives be the logical solution to expand insurance coverage without creating a government agency--that Republicans oppose?
Sen. Kent Conrad (D-ND), who initially proposed the co-op alternative to the public plan, told "Face the Nation" on Sunday that it is clear that in the Senate, "the public option does not have the votes."
"It does provide not for profit competition to insurance companies, so it has appeal on both sides. It’s the only proposal that has bipartisan support and if we’re going to get 60 votes we're going to need bipartisan support," he said.
But last week, indicators were appearing that Republicans may also oppose the co-op idea as well. Sen. John Kyl (R-AZ) called the co-op idea a "Trojan horse" and encouraged his fellow Republicans not to vote for any healthcare bill.
Hospitals looking to fill physician shortages may want to recruit J-1 visa waiver practitioners. But as recent developments in Nevada illustrate, your organization must adhere to national and state regulations before delving into its own recruitment and credentialing process.
J-1 visa waiver practitioners are typically foreign citizens who have graduated from an American residency program and are seeking work in this country. Without the waiver, these graduates must return to their home country for two years before returning here to find work and possibly to begin the citizenship process. The waiver allows them to skip the two-year gap, as long as they work in a designated area, such as one with a medically underserved population.
In Nevada, some facilities that didn't qualify to use the J-1 visa practitioners were allegedly bringing them on staff and, in some cases, overworking them. The Nevada State Medical Association lacked the resources to stop this exploitation until a series of new laws were enacted earlier this summer.
Numerous problems, including contract irregularities and misleading information about where the practitioners would work, were brought to the public's attention by a series of articles in the Las Vegas Sun starting in fall 2007.
"Over the years, the [Nevada State Medical Association (NSMA)] concerns were primarily about filling the need for primary care physicians in our rural and frontier areas and the difficulties in having them licensed in the state because of procedural issues between the medical licensing board and the federal government regarding the timing of visas," says Lawrence P. Matheis, executive director of the NSMA. "Nevada has rarely recruited anywhere near the maximum number of J-1 [H1B] visa waiver physicians to which we are entitled under the program."
However, after identifying the problems, the state decided to enact regulations.
Not only does the J-1 recruitment process take up a lot of time for hospitals, it can also be costly for medical staffs to pay for primary source verifications, criminal background checks, and other common credentialing verifications. Before you begin that convoluted process, know what questions to ask to ensure that your organization is authorized to contract with these practitioners.
Some U.S. government agencies may apply for a J-1 visa waiver on behalf of a foreign medical graduate. These agencies include:
Appalachian and Delta Regional Commissions
U.S. Department of Health and Human Services
Department of Veterans Affairs
Department of Interior for Indian Reservations
Another popular option for foreign medical graduates is to apply for a J-1 visa waiver through an individual state's department of health "Conrad 30" program (also known as the J-1 visa waiver program). Since 1994, when this program was established, states have been able to accept up to 30 J-1 visa waiver practitioners per year to work in underserved areas.
Recently, a flex waiver program was added whereby 10 of these 30 slots may be used by organizations that aren't in underserved areas, but that treat a significant number of patients who live in underserved areas.
Many practitioners apply for the waivers while they are still in their residency programs because it can take months to process the necessary paperwork.
Any hospital dealing with significant numbers of congestive heart failure patients would want to reduce costly admissions with better management for people in their homes. And Inova Mount Vernon Hospital, a 237-bed facility in Northern Virginia, is no different.
That's why it promptly embraced an idea to monitor its CHF patients' daily weight and symptoms without having to see them in a healthcare setting. So it turned to a concept that uses surprisingly simple technology: a scale and a telephone, to learn the earliest signs of fluid buildup and treat those patients before their disease gets out of control.
The process, using Pharos Innovations' Tel-Assurance Remote Patient Monitoring Platform, takes only three minutes.
"We don't have firm metrics yet, but patient satisfaction is high, and initial results favorable in terms of decreased admission rates," and for those who were admitted, their lengths of stay and acuity were reduced, as well as their cost of care, says Harvey Sherber, a cardiologist and medical director of Inova's heart and vascular program.
The health system is so encouraged by the results, it is adopting the system in its four other Inova Health System hospitals: Inova Fairfax, Inova Alexandria, Inova Loudon, and Inova Fair Oaks, Sherber says.
The program began enrolling CHF patients last October. They were told to weigh themselves daily, and call in their weight to a special number. They would also report any symptom changes daily.
If they do report such symptoms, a case manager calls them back promptly to schedule a visit to see if a medication adjustment is necessary. And, the patients are reinforced on a daily basis to watch their sodium intake and make sure they are medication compliant.
"If there are any variances, their physician's practice is promptly notified," Sherber says.
Lynne Weir, physical therapist and the Inova cardiac program's clinical coordinator who works with the program, says the patients answer five questions on the phone:
Are they short of breath more than usual?
Did they notice swelling or bloating more than usual?
Did they wake up with shortness of breath?
Did they have to sleep in a chair or propped up with pillows?
Were they light-headed or dizzy?
If the patients don't call the designated number by noon, a case worker calls them back directly. During the first six months of the program, 47 patients complied consistently.
Also, if they don't own a scale and don't have the means to buy one, Inova will take care of that too.
Compared with another set of patients who were not enrolled in the program or who were enrolled but for some reason dropped out, the CHF project reduced rehospitalizations as well as the cost of each hospitalization, from $10,305 to $6,536.
"We avoided a lot of panic calls to doctors offices, too," Weir says.
Also compared with another set of patients with CHF seen by the health system a year earlier, the hospital was able to reduce all-cause admissions by 31%.
The return on investment is favorable as well, Weir says. With an average cost of $50 per patient per month, the savings were worth it, even considering start-up costs, she says.
The program's cost was estimated at $74,300 for the first six months, with an estimated saving from avoided hospitalizations, or avoided more acute hospitalizations, of $99,291.
Now, the health system has expanded the program 150 patients.
Sherber says that for these patients, who tend to be older with multiple medical issues, taking the time to weigh themselves daily and monitor their symptoms may be something they otherwise would not want perform.
"This is an example of an implementation of a program that not only helps patients, but also helps physicians deliver care they want to give and helps the hospital to decrease unnecessary utilization at the same time," Sherber says. He adds that a similar call-in template is now being developed for patients with diabetes.
"A year from now, we'll be enrolling a lot more patients in this program," he says.
While the White House acknowledges that hospital medical errors are a "a big and serious problem," a senior administration official says President Obama does not favor a mandatory reporting system for all medical mistakes, just for infections acquired in hospitals. While car accidents, airplane crashes, and workplace injuries are regularly tallied, there is no national system for tracking deaths from medical care.
Casa Olga Intermediate Care Facility in Palo Alto, CA, a 35-year-old center that provides care to psychiatric patients, began the difficult process recently of telling its 88 residents that it would have to shut down in three months because of the economic impact of state budget cuts. The private, for-profit center is in a relatively small category of facilities that provides inpatient intermediate care for people who cannot live independently but do not need the higher-level, continuous medical services provided by skilled nursing homes.
President Barack Obama has complained that health insurance companies are making record profits "at a time when everybody else is getting hammered." Health insurers are increasingly vilified in the healthcare debate. But is there any truth among the hyperbole? That depends on how you slice the numbers.
Lashed by liberals and threatened with more government regulation, the insurance industry nevertheless rallied its lobbying and grassroots resources so successfully in the early stages of the healthcare overhaul deliberations that it is poised to reap a financial windfall. The half-dozen leading overhaul proposals circulating in Congress would require all citizens to have health insurance, which would guarantee insurers tens of millions of new customers.
Indiscriminate use of antiviral medications to prevent and treat influenza could ease the way for drug-resistant strains of the novel H1N1 virus to emerge, which could make the fight against a pandemic harder, public health officials warned. Already, a handful of cases of Tamiflu-resistant H1N1 have been reported this summer, and there is no shortage of examples of misuse of the antiviral medications, experts said.
Parasitic infections and other diseases usually associated with the developing world are cropping up with alarming frequency among U.S. poor, especially in states along the U.S.-Mexico border, the rural South, and in Appalachia, according to researchers. Government and private researchers are just beginning to assess the toll of the infections, which are a significant cause of heart disease, seizures, and congenital birth defects among black and Hispanic populations.<
President Barack Obama continued to confront critics of his healthcare overhaul proposal in his recent radio and Internet address, charging them with making "phony claims meant to divide us." Obama appealed to Americans to summon "what's best in each of us to make life better for all of us," and support the plan, which Republicans in their response called a "government takeover" of the U.S. healthcare system.
