The purpose of government-imposed furloughs is to save taxpayers money. But in California, dozens of agencies funded exclusively by licensing fees–not state taxes–are being furloughed too, prompting many practitioner groups and hospitals to cry foul.
Why should the state use a hospital's or a physician's licensing fee to help other state programs, they ask. And what will happen to the money those agencies are saving in avoided salaries?
The answer is as yet unclear. Though the money remains as income on those agencies' books, California Gov. Arnold Schwarzenegger may, at least in theory, "borrow" those funds to pay other state debts, leaving many organizations whose members pay those fees not too happy. Who knows when, or if, the state will ever pay it back, they wonder.
By state decree, agencies that license and discipline health practitioners have been forced to take two days a month without pay since February and in July, the furlough mandated three days off, or about 15% of a worker's hours. The result has been an increasing backlog of investigation work, much of it related to disciplinary actions, but also related to initial licensing and hospital seismic retrofit review and construction permits for dozens if not hundreds of healthcare buildings.
Furloughs at California's fee-funded agencies are holding up numerous hospital construction projects, required to meet state-required seismic upgrades and that's costing those hospitals a lot of money. Workers sit idle waiting for reviews and construction permits, while construction costs go up.
"It is obvious we can no longer do business as usual," wrote Paul Coleman, acting deputy director of the Office of Statewide Health Planning Development in a memo last month. "The loss of staff hours resulting from the furloughs is equivalent to losing 34 of the 226 positions in the division."
The agency also has postponed release of key quality, utilization, seismic compliance, and finance data for hundreds of health facilities throughout California. Several programs have also been put off indefinitely.
The Medical Board of California, just one of some three dozen licensing agencies, is losing 5,100 hours of work per month, equivalent to 28 or 29 positions monthly, says spokeswoman Candis Cohen. That also has delayed many aspects of the agency's watchdog functions.
One might think the California Medical Association, which represents many for the 125,000 physicians licensed by the medical board, wouldn't have a public view. But they're not happy about it either.
Spokesman Andrew LaMar says the CMA has not yet issued an official position on the furloughs, but is "very concerned about the Medical Board's growing backlog of work and the impact that is having on patients and doctors.
"We have a shortage of physicians in California, and the Medical Board has been unable to process more than 600 medical license applications in a timely manner. The backlog of applications has increased 50% since the governor ordered furloughs, and that's bad for all Californians," LaMar says.
One state senator has introduced a resolution to exempt fee-based agencies within the state Department of Consumer Affairs and other special-fund health licensing agencies from participating in the furloughs because their full-time employment should have no effect on the state's coffers.
"Whereas, these health care licensing boards and bureaus not only license, register, or certify specified health care practitioners, but also have the authority to investigate complaints and take disciplinary actions against licensees," says the proposal from Sen. Gloria Negrete McLeod. "Requiring employee furloughs of special fund boards that oversee the health and safety of the public and requiring the closure of these regulatory boards inhibits the consumer protection activities of the boards and further slows the enforcement process down, and is completely unnecessary to resolving any of the state's budget problems."
Negrete McLeod says furloughs are partly responsible for delays in disciplining nurses who have been the subject of complaints about their harm of patients and an exposé in the Los Angeles Times. And, she said, personnel with the state Attorney General's office, who handle the legal aspects of disciplinary review, are not on furlough, which means they are sitting idly by waiting for the cases.
"It's just meaning delay, delay, delay, delay, delay," she says.
Other oversight agencies coping with 15% slower productivity include those with purview over the licenses of acupuncturists, barbers and cosmetologists, behavioral scientists, dentists and dental hygienists, hearing aid dispensers, doctors and osteopaths, naturopathic medicine practitioners, and nurses.
Also occupational therapists, optometrists, pharmacists, physical therapists, physicians assistants, podiatrists, psychologists, psychiatric technicians, respiratory care therapists, speech pathologists and audiologists, medical advice service bureau employees, and vocational nurses.
Even purchasing has been put to an end. Last month, the Osteopathic Medical Board was told that even though it ran out of toner for its copier, it was prohibited from buying any more because of a freeze on expenses, although the board is entirely funded by osteopath licensing fees.
Also affected is the Department of Managed Care, which oversees insurance companies. Many other non-health agencies are affected too, such as the State Contractors Licensing Board and the Division of Automotive Repair, although Negrete-McLeod's bill would not apply to those.
A hearing on her proposal is scheduled for Aug. 17.
President Obama and his Democratic allies in Congress have made the healthcare overhaul their top priority, but many Republicans view fighting the president on the issue as a smart political strategy. Here, the New York Times provides an overview of the main healthcare reform ideas, and what it would mean for those involved.
The tumultuous negotiations and the attitude surrounding lawmakers’ town-hall-style meetings will likely result in the demise of bipartisan healthcare negotiations, according to this article from the New York Times. The rowdy start of the August Congressional recess has galvanized activists on both ends of the ideological spectrum, making it tougher for negotiators to stake out a middle ground, according to the Times.
Expanding preventive medical services may well improve public health, but it is highly unlikely to save the government money, the Congressional Budget Office representatives said in a letter to leaders of the House Energy and Commerce Committee. CBO director Douglas W. Elmendorf said the evidence suggests that the cost of making services such as cancer screening, cholesterol management, vaccinations, and wellness training broadly available would far outweigh any savings ultimately generated.
Senior citizens are emerging as an obstacle to President Obama's healthcare reform plans, as discontent in the voting bloc has risen to such a level that the administration is scrambling to devise a strategy to woo the elderly. Proposals to squeeze more than $500 billion out of the growth of Medicare over the next decade have fueled fears that President Obama's effort to expand coverage to millions of younger, uninsured Americans will damage elder care.
As supporters and opponents of overhauling the healthcare system try to shape public opinion, public opinion on the issue is complex. Analysis of a recent USA Today/Gallup Poll finds views on what priority to emphasize, how fast to act and what's important to protect vary and sometimes conflict depending on a person's age and region of the country, whether he or she has insurance, and is healthy or ailing.
Experts estimate that a staggering 98,000 people die from preventable medical errors each year. In addition, a federal Centers for Disease Control and Prevention study concluded that 99,000 patients a year succumb to hospital-acquired infections. Almost all of those deaths, experts say, also are preventable. All of the available research indicates that the death toll from preventable medical injuries approaches 200,000 per year in the United States.
The abrupt shutdown of two aging nuclear reactors that produce a radioisotope widely used in medical imaging has forced physicians in the U.S. and abroad into a crisis. The closings requiring them to postpone or cancel necessary scans for heart disease and cancer, or turn to alternative tests that are not as accurate, take longer, and expose patients to higher doses of radiation. Because of limits on testing produced by the shortage, some patients will undergo heart or cancer surgeries that could have been prevented by imaging, and others will miss needed surgeries because of the lack of testing, experts say.
Eli Lilly has created an online registry detailing payments to 3,400 healthcare providers, including more than two dozen in South Florida in the first three months of 2009. Top on the South Florida list was internist Manuel Suarez-Barcelo, who told the Miami Herald that he earned $65,000 by traveling through 11 states, making 41 presentations about the advantages of the Lilly drug Forteo, used to treat osteoporosis. Seven others in South Florida pulled in more than $10,000 each.
Thousands of patients at Atlanta-based St. Joseph's Hospital won't have to seek hospital care elsewhere or pay higher bills because the facility has reached a last-minute contract agreement with insurer United Healthcare. The two-year agreement keeps the patients of the hospital in the insurer's network and prevents what could have been an interruption in their insurance coverage had the deal fell through.
