Computer Sciences Corporation, a global consulting firm, examines the changes underway in U.S. healthcare. CSC makes some predictions about what will happen with healthcare cost inflation, coverage, capacity constraints, changing expectations, and health information technology by the year 2015.
Cardiologist Steven Greenberg recently became the first doctor to implant a wireless pacemaker in a patient. The pacemaker communicates with a monitoring system in the patient's home, vital information is then gathered and automatically relayed to the patient's doctor. Greenberg envisions even more sophisticated devices that allow doctors to monitor other key vital signs to be developed down the line.
Tim Stettheimer, PhD, the senior vice president & regional chief information officer for St. Vincent's Health System in Birmingham AL, discusses the College of Healthcare Information Management Executives? new certification program for Healthcare CIOs. The program acknowledges the changing role of healthcare CIOs by focusing not only on the technological components of the job, but also on the new strategic and leadership responsibilities that CIOs must have today. [Sponsored by Emdeon]
Maybe not to the extent of the recent Supreme Court nominee, but President Obama's selection of David Michaels, Ph.D., MPH, to lead OSHA is a departure from previous administrations.
Michaels is a scientist, an epidemiologist in fact, and author of the recently published book, Doubt is Their Product, that criticizes the business strategy of "manufacturing uncertainty," where polluters and the manufacturers of dangerous products successfully oppose public health and environmental regulations.
The nomination, as all nominations do, has its share of supporters (an editorial in the the New York Times called Michaels, "A Champion for Workers' Safety") and detractors (Pointof Law.com says, "Michaels has demonstrated unremitting hostility toward business, and he has run an advocacy group funded by trial lawyers and the left-wing benefactor George Soros").
The nomination requires Senate approval, and it might make for interesting entertainment on healthcare-related issues, given that the country may be in the throes of pandemic influenza and saddled with indecision on how to best protect healthcare workers, or under pressure from Congress to promulgate an aerosol transmissible disease standard similar to the one that became effective in California this month. The lingering issue of an ergonomics standard and the more recent drive for safe patient handing laws will also attract attention.
But on long range issues, Michaels has already given us view of his to-do list, at least the first page of it. In his essay on OSHA reform for the winter 2009 issue of The New York Committee for Occupational Safety and Health newsletter, Michaels listed these steps for the agency to take:
Issue a workplace injury and illness prevention program requiring every employer to have in place a program aimed at reducing workplace hazards.
Increase workplace health and safety capacity by reallocating funds for training grants.
Develop a new electronic record-keeping and reporting system by junking the antiquated once-a-year-posting in favor of a real time system.
Initiate a campaign to change the way the nation thinks about workplace safety by using mainstream media to get the OSHA message out.
He also wrote, ". . . the objective of the Obama Administration should not be better/smarter enforcement. A bold campaign to change the workplace culture of safety should be initiated. This can't happen unless workers are trained and given the opportunity to play an active role."
That's not exactly the prelude to the enforcement-fest that some experts predicted with the President's appointment of Jordan Barab, who is keeping Michaels' chair warm as interim director. Maybe a scientist is just what the OSHA needs right now.
David LaHoda is the HCPro managing editor of Medical Environment Update, OSHA Watch, and OSHA Healthcare Advisor, an online resource for everything OSHA related in healthcare.
Health providers have been assessed fines totaling $1.43 million for allegedly conducting improper kickback and physician self-referral practices and for filing false and fraudulent claims with the federal government, the Office of Inspector General announced yesterday.
In each case involving a civil monetary penalty that is resolved through a settlement agreement, the settling party "has contested the OIG's allegations and denied any liability. No CMP judgment or finding of liability has been made against the settling party," the OIG said in a statement.
Most penalties are resolved through settlements with no decision made on the merits of the allegations or the respondents' defenses.
Ediberto Soto-Cora, MD, of Texas agreed to pay $534,000 for allegedly submitting false or fraudulent claims by using CPT codes that would generate higher reimbursement than justified by the medical documentation, or Soto-Cora submitted claims without any supporting medical documentation.
Clifford Koon, Jeffrey Cowan, and William Dorvall of Florida, former owners and officers of Matrix Diabetics Inc., (a durable medical equipment company) agreed to pay $260,000 for allegedly causing Matrix to pay telemarketing firms to make unsolicited calls to Medicare beneficiaries to market medical equipment on behalf of Matrix. The company in turn submitted claims for these items for Medicare reimbursement, contrary to the Social Security Act.
The act prohibits equipment suppliers from making unsolicited phone calls to Medicare beneficiaries regarding the furnishing of covered items "except in certain situations that were not present in this case." The law prohibits payment to a supplier who knowingly submits a claim generated pursuant to prohibited telemarketing calls.
Inova Health Care Services, also known as Inova Fairfax Hospital in Virginia, agreed to pay $528,158 for allegedly making payments to Arrhythmia Associates in the form of services provided by certain physician assistants, in violation of rules prohibiting kickbacks and physician self-referrals. "Specifically, Inova provided PA services to AA without written contracts in place and failed to bill and collect for those PA services. Inova disclosed this conduct to the OIG.
Kahuku Hospital in Hawaii self-disclosed to the OIG and agreed to pay $75,000 for entering into agreements with emergency room physicians. In the agreements, payments allegedly were made in excess of the amount provided for in the agreement. The hospital also allegedly entered into other arrangements with emergency room physicians that were not in writing, in violation of provisions applicable to rules prohibiting kickbacks and physician self-referrals.
In another self-disclosure, Memorial Hospital of Union County, Ohio agreed to pay $31,202 for allegedly providing excess non-monetary compensation to physicians and the immediate family member of a physician who referred patients to Memorial Hospital. The conduct allegedly violated prohibitions against kickbacks and physician self-referrals.
The new fines bring the total of OIG fines so far this year to 21, five of which involved charges of kickbacks or improper physician self-referral practices and 16 of which involved charges of false and fraudulent federal claims.
The OIG says that when a healthcare provider "appropriately self-discloses potentially fraudulent conduct, the OIG takes the self-disclosure and the provider's level of cooperation into account when determining the appropriate settlement terms."
Doug Farrago MD doesn't just rail against insurance plan denials, Joint Commission rules, hospital, doctor and patient stupidity, health reform arguments, or drug marketing ridiculousness.
He ridicules and satirizes it. All of it.
For the last nine years, he has lampooned it and tweaked its nose like the Three Stooges routine he believes the trenches of medicine too often imitate.
The 44-year-old family doctor in the small town of Auburn, ME is the founder and publisher of Placebo Journal, "idiopathic wit and wisdom," a kind of "Mad Magazine" for practitioners.
With his colorfully cartooned, 40-page issue published once every two months, Farrago hopes to help providers use humor to better cope with the infuriating obstacles they encounter trying to help their patients.
"Humor itself can't make the situation improve. But maybe poking fun of the stupidity in some of the situations, even some of the serious stuff, can alleviate some of the anxiety and stress we all feel," Farrago says. "If you don't have a sense of humor today, you'll become a robo-doc."
He is not at a loss for material. With the health reform debates, hysteria over H1N1, the increase in Joint Commission regulations, and the decline in physician reimbursement, Farrago says, "It's insane. Finding humor in everyday practice is like shooting fish in a barrel."
There's a feature story on "How to torture a managed care executive," and another on his pompous doctor colleague whose toupee was blown off by a patient who coughed hard, right in the middle of a code.
"In Memorium, Stupid Pharmaceutical Tricks. 2001-2009" spoofs the censure on pharmaceutical gifts to physicians. The display includes a fishing lure labeled "hydrocodone combinations," a toy bathtub labeled Cialis, tiny plastic Mr. and Mrs. Mucus for Mucinex and a plastic bottle of ordinary water labeled "Lipitor."
"Malingerers Say the Darndest Things," trots out whacky excuses real patients used to try to falsify Workers Compensation Insurance claims.
The Joint Commission and insurance companies are regular targets, Farrago says. "We always rip the Joint Commission any chance we get" because of their rules, like the one that prohibits him from taping Christmas cards on his office door. Fire hazard, he says. "Where's the evidence on that?"
A feature in a recent issue asks the question "What if managed care companies were honest" in the letters they send doctors.
"Dear Doctor ____. We recently received a medical claim on your patient, _______and we are trying to figure out a way not to pay it. One method to accomplish this task would be to determine if you think that _____in any way had a pre-existing condition that would exclude him from these services..."
Subscriber Kevin Pho who blogs as KevinMD, says he corresponds with Farrago frequently. Farrago, he says, is "a sharp wit." And his journal serves an important function especially now during the whipsaw of contradicting opinions on health reform.
"Doctors are dispensing news that's not always that good. And in the health reform debate, doctors are especially worried about reimbursement. A recent Annals of Internal Medicine report says half of doctors are burned out," says Pho.
"Practicing medicine can be intense high pressure activity. Without an outlet to share and laugh with other doctors, it will become unbearable," Pho says.
Placebo Journal is replete with what Farrago acknowledges is a "sophomoric" brand of pre-pubescent, toilet bowl humor, often with sexual innuendo not that much unlike that found in Mad Magazine in the 1960s. On the surface, some features don't seem like they would have an appeal to the health profession.
For example, there's a regular parody on medical advertising, such as one fictitious ad for Spermo, a dating service for doctors, a spoof of the physician online group Sermo. And another ad promotes Sexapro, the only drug that treats both depression and erectile dysfunction.
But there are other features that resonate with experiences physicians frequently encounter, like the feature on one practitioner's "Favorite Munchausen."
Among the "Top 10 Things You Don't Want to Hear in the OR" is the line, "Should we just throw these two units of blood on the floor or should we run it through the patient first?"
For each issue, Farrago includes real radiology films depicting glass in the gluteus or a bottle of Tabasco sauce unfortunately lodged in someone's groin.
"A lot of what we have in the PJ is what doctors are thinking, but not saying. And they tell us they feel good that someone knows, and someone else is laughing with them," Farrago says.
Farrago accepts no advertising, but supports his 5,000 to 10,000 circulation with a $28 subscription fee.
For example, there's a feature on a head injury patient with cortical blindness, who after eight years, received a letter denying him disability because of a determination that he could actually see.
But Farrago says that he is careful about what he uses. All the stories are supplied by real doctors, nurses and patients, he says. That is, if Farrago, or his three writers don't contribute original material.
Is he making any money? Not much, Farrago says. "But I will say this, all the money it makes goes to a good cause: Me."
The 230 hospitals participating in the Centers for Medicare and Medicaid Services and Premier healthcare alliance Hospital Quality Incentive Demonstration (HQID) value-based purchasing project raised their overall quality by an average of 17.2% during the fourth year of the project on delivery of 30 selected quality measures—and will share $12 million in bonuses, according to data released by CMS on Monday.
An estimated 4,700 heart attack patients have been saved during those four years, according to a Premier analysis of mortality rates at hospitals participating in the project. In addition, more than 1.5 million patients treated in five clinical areas at the participating hospitals also received about 500,000 additional recommended evidence based clinical quality measures—such as smoking cessation, discharge instructions and pneumococcal vaccination during that same timeframe which ended Sept. 30, 2007. The program itself will run through Sept. 30, 2009.
Additional research by Premier—using the Hospital Compare dataset showed that by March 2008, HQID participants scored on average 6.9 percentage points higher (94.64% to 87.36%) than non participants on 19 performance measures used by Hospital Compare, the government's scorecard for hospital quality.
The HQID project has served as a basis for CMS's proposal to Congress for a national value-based purchasing or pay for performance program. The project has also been cited as a test area for reform by the Senate Finance Committee as part of healthcare reform.
Overall, 1,258 awards were given to top providers in the fourth year of the project, a five fold increase from previous years due to a new payment model that placed bonuses on additional improvements. Through the project's first four years, CMS has awarded more than $36.5 million to top providers.
The new payment model is based on lessons learned during the first three years of the project, according to Susan DeVore, Premier's president and CEO, trying to move the payment system to pay-for-quality and not just volume "makes sense—especially when we have substantial evidence to prove that this payment model creates the right incentives to drive continuous improvement."
Several leading Democrats objected to signals from senior Obama administration officials that they would abandon the idea of a government-run insurance plan if it lacked the backing to pass Congress. President Obama had pushed a nonprofit, government-sponsored insurance plan as an alternative to existing insurance companies. Over the weekend, he minimized the importance of a public option, saying at an event in Colorado that it was "just one sliver" of his overall effort to reduce healthcare costs and expand coverage. One Democrat predicted that without the provision, the bill could lose as many as 100 votes in the chamber.
What's the best way to find fresh, new leaders? Should you grow them at home or recruit from outside of your organization? Finding those midlevel managers, clinical leaders, and future system leaders must be part of any viable and sustainable talent program. For two high performing health systems at opposite ends of the country, growing talent from within has kept the pipeline full with the next generation of leaders.
At Scripps Health in San Diego, offering employees the opportunity to participate in the hospital system's leadership academy has been instrumental in identifying and nurturing leadership talent from within the organization. Chris Van Gorder, president and CEO, and a featured "Talent" panelist at the HealthLeaders 09: Hospital of the Future Now conference, says these employees have truly changed the culture of the organization. The year-long program is open to all employees, from front line supervisors to C-level leaders.
The program is in its eighth year and includes a new COO and CNE in this year's class, says Van Gorder. The academy includes sessions with leaders throughout the system, including chief executives, chief nursing officers and medical group leaders.
"In one session the leaders of our affiliated medical groups come in to talk about their leadership style, challenges, and values," says Van Gorder, who also participates, giving students an opportunity to do Q&As with him throughout the program.
"In these Q&As, we encourage them to ask the toughest questions," says Van Gorder. Over the year, the trust builds and program graduates go on to challenge the organization and their peers to do a better job, he adds.
The training has been so popular that leadership academy graduates have gone on to form an alumni group and have created their own secondary and third certification levels to continue their own continuing education and leadership, says Van Gorder. "There is no question that people will come out of it and into the executive offices at Scripps," he says. "It is a very different type of leadership academy and it has been our ace in the hole."
In Rochester, MN, the Mayo Clinic also has its own brand of leadership development. Like Scripps Health, Mayo develops most of its leaders from within. "Leadership development is extremely important," says Kent Seltman, marketing division chair emeritus and also a "Talent" panelist at the HealthLeaders 09: Hospital of the Future Now conference. "Every leader is expected to identify his or her successor," says Seltman.
At the same time he says, "We have a curriculum and a cultural process of identifying people and giving them little assignments. If they do well then they get bigger assignments and then ultimately they qualify for the training courses."
Perhaps what really sets Mayo apart from other organizations is that leadership positions are rotated. "It is rare for anyone to be in a leadership position more than 8 or 10 years. This enables freshness to come into the leadership positions," says Seltman.
"A leader in one area is considered to be someone who can take on a new or different assignment." Seltman, the co-author of "Management Lessons from Mayo Clinic: Inside One of the World's Most Admired Service Organizations," believes this unique approach has helped Mayo continue to be a high performing organization. Seltman also says there is no financial impediment in moving around. For example, on the physician side of the organization, any person moving into a department chair position receives that same salary level for the rest of his or her career even if they give up their leadership position.
As prospects fade for a public option as part of healthcare reform, key senators are considering member-owned, nonprofit health cooperatives to create competition for private insurers. Cooperatives, however, would face potentially greater difficulty getting off the ground and obtaining discounted rates from doctors and hospitals, some observers say.
