A Miami man was charged with buying confidential patient records from a Jackson Memorial Hospital employee over the past two years and selling them to a lawyer suspected of soliciting the patients to file personal-injury claims. Ruben E. Rodriguez allegedly paid JMH ultrasound technician Rebecca Garcia $1,000 a month for the hospital records of hundreds of patients treated for slip-and-fall accidents, car-crash injuries, gunshot wounds, and stabbings, federal authorities said.
A majority of California hospitals won't be able to meet state-mandated deadlines for seismic retrofitting because of the nation's credit crunch and their own deteriorating revenues, according to a report by the California Hospital Association. The report, based on a survey conducted in April, found that 64% of hospital chief financial officers said they would not be able to comply with the state's 2013 or 2015 seismic deadlines.
California regulators have ordered two discount health card companies to stop operating in California after the firms failed to get licensed. The state Department of Managed Health Care issued immediate cease-and-desist orders to PrudentChoice and International Association of Benefits. Cindy Ehnes, the department's director, said the action is part of efforts to "rein in operators of discount cards that habitually rip off consumers and lead them to believe they are buying legitimate health coverage." Discount health card companies do not offer health insurance, but provide consumers with cards promising discounted medical services in exchange for monthly fees.
In an effort to measure how American hospitals are caring for their most critically ill patients, the U.S. Centers for Medicare and Medicaid Services analyzed deaths from heart attack, heart failure, and pneumonia at 4,600 hospitals in recent years. Baptist Hospital in Tennessee scored slightly worse than the national average for deaths from heart failure, which the hospital says reflects faulty paperwork instead of poor patient care. Three other Nashville-area hospitals—Maury Regional Hospital in Columbia, Sumner Regional Medical Center in Gallatin and Gateway Medical Center in Clarksville—scored worse than the national average for deaths from pneumonia.
Home for summer recess, lawmakers will be more accessible to constituents worried about the direction of the unfinished healthcare legislation. In addition, supporters and opponents plan to pour millions of dollars into television ads, phone banks, and other efforts to shape public opinion. The House adjourns July 31 and the Senate a week later. Five committees are producing their own versions of the healthcare overhaul, in some cases with big differences.
Government health promotion and prevention programs for pre-Medicare and Medicare populations could save the country as much as $1.4 trillion over 10 years—and add on average as many as 6 years on Medicare beneficiaries' lives, according to a new Center for Health Research at Healthways report.
Today's report, Potential Medicare Savings Through Prevention & Health Risk Reduction, found that focusing on programs that keep people healthy and reduce health risk factors, and manage chronic conditions—before and during Medicare eligibility—can have long-term cost savings. In fact, though these programs could extend beneficiaries' lives, the researchers found the cost savings associated with keeping people healthier would offset the extra years of life and coverage expenses that the federal government would have to pay for under Medicare.
"In this report, we clearly showed that you can, in fact, reduce risk and this does increase life expectancy, but you can still achieve savings over the course of a lifetime," says Elizabeth Rula, PhD, lead researcher at the CHR.
With baby boomers reaching Medicare age, the Medicare population is expected to jump from 45 million to nearly 80 million by 2030. Couple that fact with the healthcare reform debate in Washington and one can see why healthcare thought leaders and policymakers are searching for programs and savings to bend the healthcare cost curve.
In its research, the CHR worked with Ingenix Consulting to develop several scenarios that examined the financial impact of improving beneficiaries' health before they enter Medicare as well as lowering health risks and extending their lives while in Medicare.
The model used Medicare Parts A and B data from the 5% Sample Limited Data Set for the years 2002-2006, Medicare Trust Fund enrollment projections, and Vital Statistics age/gender-specific mortality rates to provide estimates of average Medicare costs based on age and stratified health risk.
The model found that the government spends an average of $174,000 per beneficiary over the course of a life in the program. In other words, the 37.5 million seniors in Medicare fee-for-service in 2005 will cost $6.5 trillion over their lifetimes.
The researchers found a range of potential savings through a combination of health promotion, prevention, and chronic care management initiatives before and after the age of 65. The gross savings estimates ranged between $652 billion and $1.4 trillion over 10 years (in 2008 dollars) and include:
A modest scenario that reduces risk prior to and during the years of Medicare by increasing the promotion of low-risk individuals at age 65 from 54% to 65% and preventing 10% of upward risk transitions.
The larger savings were found by increasing the low-risk population at 65 from 54% to 75% and preventing 50% of upward risk transitions that otherwise occur during the Medicare years.
Though the savings projected are gross and not net savings, Wilkins says that costs of these wellness and prevention programs should not eclipse more than 30% of the savings.
The researchers did not have any specific prevention and disease management programs in mind, but they suggested some examples, such as smoking cessation, cardiac disease management, and health club memberships for older adults with diabetes.
Anne Wilkins, executive vice president, chief strategy officer at Healthways, says the programs could be split into three categories: keeping healthy people healthy; helping people with modifiable lifestyle risks, such as being overweight and lacking physical activity, change their behaviors; and assisting people who already have health conditions, such as diabetes, better manage their conditions.
"This paper opens up the discussion on prevention and wellness for the pre-65 population," says Wilkins.
The researchers said the government has tried "supply-side" solutions, such as reducing payment and coverage, as a way to try to control costs. But the feds have been largely unsuccessful.
One barrier for prevention programs is that the Congressional Budget Office has cited there is not sufficient evidence in the areas of preventive programs.
The researchers said this is because there isn't a "clearly delineated model of what the impact of a successful program would be. The model proposed here demonstrates the potential for considerable savings from the implementation of programs that can achieve risk reduction results."
The researchers concluded that the scenarios presented in their study showed that have a larger percentage of healthy or low-risk individuals entering Medicare would lead to lower health costs.
"Although the levels of risk reduction tested in these seniors could not be achieved immediately after implementation of health and wellness programs, they represented a spectrum of possible outcomes that could be achieved over time and make a case for implementing such programs in the near term so that savings can be realized as soon as possible.
"If it can be demonstrated that the magnitude of these potential savings is significantly greater than the cost of the interventions needed, there would be significant net savings to the taxpayer," according to the CHR researchers.
Baystate Medical Center, a 653-bed hospital in Springfield, MA, made insulin safety a priority after rolling out its bedside medication bar coding program in September 2008. Staff members continued to see insulin as a problem medication when monitoring event reporting data on medication storage as well as scan rates of medications and patients. Direct observation on the nursing units validated that there were problems with the insulin administration work processes.
"The drug is dispensed as a vial, so it's traditionally handled multiple times for multiple doses," says Gary Kerr, MBA, PharmD, director of pharmacy services for Baystate Health. "There are several issues surrounding the scanning process—the vial can be left unsecured, on the automated dispensing cabinet (ADC) or in another area altogether. Nurses can travel with the vials in their pockets or not return them to the dispensing cabinets rendering the inventory tracking systems useless." The flawed process started with withdrawal of the multi-dose vial from the ADC, included movement through multiple patient rooms for administration of the medication, and ended with numerous temporary disparate storage locations.
Bar-coding at the bedside in itself is designed to manage down medication administration errors. However, in addition to complying with Joint Commission patient safety standards related to insulin, Baystate was struggling with:
Storage: Accounting for lost vials was a safety concern
Inventory costs: Accounting financially for lost vials
Medication scan rates: Scanning each medication vial by barcode
Nursing administration technique: Using nurses' time most efficiently for medication administration
To resolve the insulin safety problems, the pharmacy leadership team implemented a project to improve Joint Commission compliance, smooth nursing workflow, and reduce the number of potential medication errors associated with insulin.
"This style of approach to patient safety issues is what separates organizations that just want to 'pass' their accreditation survey with those that embrace the concept of ensuring safe patient care every day" says WendySue Woods, RN, MHSA, CSHA, senior consultant for The Greeley Company, a division of HCPro.
Kerr and his team investigated the possibility of affixing a small roll of scannable bar-coded labels to each vial of insulin to control some of the above mentioned issues. Baystate chose two nursing units to pilot test this plan. Both the pharmacy and nursing departments collaborated to come up with the best process for both parties.
The hospital aggressively measured and monitored the data surrounding this process starting in September 2008. After six months, the process was rolled out hospital-wide.
Current practice and results
Today, labels are generated in the pharmacy and then affixed to the vial. When nurses have to retrieve medication order from the ADC, they have everything they need in one place, says Kerr.
"The nurse basically prepares the patient dose at the cabinet, the syringe is labeled right there with the scannable label, and the vial is returned to the ADC, maintaining safety and appropriateness as a high-alert medication," Kerr says. "Then the nurse can go to the patient's bedside with the barcode-labeled dose-ready syringe in hand, knowing that he or she has the appropriate medication and dose."
Nurses no longer travel with multi-dose vials of insulin because the vials do not leave the ADC area. This has resulted in better storage and accountability for insulin vials. Nurses are also reporting higher rates of satisfaction with the process changes.
The facility noted a spike in insulin purchases in correlation with the hospital-wide implementation of bar-coded medications in September 2008. Medication scan rates with insulin have risen dramatically since the hospital started attaching scannable labels to the insulin vials, and the number of insulin purchases has since dropped. The hospital has also realized an unexpected financial savings, a nice added bonus, says Kerr.
"It wasn't really our purpose, but we ended up saving money in insulin inventory costs. One of the particular brands of insulin is $70 a vial," says Kerr.
Success through collaboration
Kerr insists that this process improvement was only possible because both nurses and pharmacists wanted to improve insulin safety. Nursing is in charge of reporting their monthly scan rates. If one unit's reported scan rate is significantly lower than another's for that month, a member of the pharmacy department goes to the unit to discuss the appropriate process and observe medication workflow.
"You can look at all of the reports you want, but until you go up and talk to nurses and watch how they do it, you're really not in a position to recommend process changes," says Kerr. "We intentionally sent a pharmacist to work with key nurses in key areas." Any fixes to the process came from this collaboration, says Kerr, and not from a top-down practice.
Baystate Health has made it a priority as an institution to engage all relevant staff members in an improvement project to ensure optimal outcomes, says Kerr.
"This is a conscious and intentional method of process management and process improvement, the overall company is spreading this staff engagement phenomenon strategically," says Kerr. The insulin safety project is one example of that philosophy in action.
"When disciplines such as pharmacy and nursing work together to improve processes, the patient is ultimately the winner," says Woods.
Physician alignment has become a hated buzz phrase with wildly different definitions, depending on whom you talk to. This week, I speak with Nick Sears, MD, chief medical officer for MedAssets, about physician alignment in the hospital setting. We delve into his personal experience with physician alignment strategies, and the latest thinking behind why such projects so often fail to generate savings and better relationships between management and physicians.
Even though the economy has forced many hospitals and health systems to delay or cancel capital projects, there is still a bright spot on the horizon. Yes Virginia, there is a silver lining in healthcare construction. That bright spot is reduced costs. Commodities, materials, and land have all seen recent and fairly dramatic drop in prices.
2009 can be a year in which hospitals and health systems benefit from lower material costs and the availability of construction trade labor. If these entities can get the necessary funds to start projects, then they will be able to get them constructed with prices more favorable than in the past two years. Even projects currently under way may have a chance to realize great savings over earlier cost projections.
Construction costs have fallen since late 2008. According to a recent report in the San Francisco Business Times, the costs of concrete and steel have dropped by as much as 15% to 20% since late 2008. The price drop is a nice boost for hospitals and health systems that are about to begin construction on major projects and for those who may still be ordering their materials.
Price index shows declining costs
Some examples of falling prices can be seen on the U.S. Labor Department's February 2009 producer price index report :
The index for materials and components for construction moved down 0.7% in January 2009 after falling 1.2% in December.
Prices for paving mixtures and blocks declined 6.2% in January subsequent to an 8.3% drop a month earlier.
The index for structural, architectural, and pre-engineered metal products decreased 2.6% in the first month of 2009 compared with a 1.1% decline in December.
Make the economy work to your advantage
There is no better time to plan for healthcare developments than right now. But while you're in a "time-out" state, you should revisit what you had planned at the end of last year because you can probably re-price it or re-buy it better. What you don't want to do is do nothing for the next three months or six months until the market turns around and wish you had the drawings done so you could bid the project now.
On average it takes four months to get drawings completed, so hospitals and health systems shouldn't wait. Otherwise inflation could hit right when the drawings are done and you've missed the window. In order to take advantage of a commitment for the lower material prices for six months you need bona fide drawings in your hands. Then you can pull the trigger on your project when you are ready to go.
In central Kansas, the start of construction on the planned $10 million Hillsboro Community Hospital was delayed, at least in part, to take advantage of falling construction prices in both material and labor. The hospital's parent company, HMC/CAH Consolidated Inc., decided in late 2008 to delay the project until early 2009, from a previously planned construction start date of August 2008. As the economy started to worsen and prices began falling, the company decided to implement the delay.
"We will hopefully benefit from having lower costs across the spectrum, whether it is concrete or copper, architect fees, labor—whatever might be part of that new construction," says Mike Ryan, CEO of Hillsboro Community Hospital. "The economic downturn is not a good thing for anybody, but sometimes, with any kind of an unfortunate occurrence like this, there are some silver linings."
Project review the best investment for the future
Unfortunately, capital "frosts and freezes" are a reality for many hospitals today. However, these tough economic times represent a great opportunity for health systems to take advantage of this "pause period" and re-evaluate the projects in their queues.
While resources are down, needs remain and continue to grow. Inpatient medical office and other ancillary facilities continue to be essential investments. Hospitals can use this time to do a capital project review. This allows them to take a new, clean look at capital projects. As a result, when the market turns around and it is time to move forward, the project has been appropriately rethought, resized or rescaled in scope.
When a capital project review is performed, a team of experts takes a critical look at every aspect of the project. Reviews can be performed on projects at any phase of development, from the initial concept to those already under construction.
Questions like the following ones should be asked and answered:
Is this conceptual solution the best for these times?
Is the size and scope of the project appropriate?
Have all the possible alternatives been examined objectively?
How do we wind down or slow down a project already under way?
What is the priority level of the project compared to the others in the hospital's lineup?
Within 90 to 120 days, the team develops a report to help a hospital understand whether it should cancel a project, put it on hold, or consider whether it needs a whole new destiny.
Al Seeley is executive vice president of development at Lillibridge Healthcare Services, Inc. He may be reached at al.seeley@lillibridge.com.For information on how you can contribute to HealthLeaders Media online, please read our Editorial Guidelines.
For many providers, self-auditing has become an important RAC preparation tool. Certainly, internal audit results can show where additional education is necessary to ensure appropriate coding, billing, and documentation practices. And this will result in fewer RAC denials, because if practices are correct, the RACs will find fewer errors to deny.
But many providers also assume that reporting errors (and refunding identified overpayments) discovered while self-auditing will protect those claims from RAC review.
Not so, says CMS.
In a recently released FAQ on the CMS Web site, CMS clarified that only one type of self-audit will ensure RACs may not later review the claims, and it probably isn't the kind of self-auditing that most providers are doing, says Debbie Mackaman, RHIA, CHCO, regulatory specialist for HCPro, Inc.
The FAQ states:
"There are two types of self audits. One is commonly called a voluntary refund and is claim based. If the required claim information is included along with the amount of the improper payment, the claim will be adjusted by the claim processing contractor. The RAC will be aware of the adjustment, but the refund does not preclude future review. The second type of self audit may involve the use of extrapolation. If extrapolation is used the claim processing contractor will review the case file to determine if it is acceptable. The claim processing contractor will accept or deny the extrapolation for the issue identified by the provider. If the claim processing contractor accepts the extrapolation, those claims in the universe will be excluded from RAC review."
In other words, if a provider uses an extrapolation that its MAC or FI accepts, the claims are off-limits for RACs. Otherwise, individual claims corrected after a self-audit are fair game.
"This will come as a surprise to a lot of providers," says Mackaman. "Providers assume if they do a self-audit and correct and report errors, that [the claims] are excluded from future RAC audits. But they're not."
Those providers who review claims individually may feel a little less incentive to report errors and refunds they discover since the claims aren't protected from RACs, but not doing so is a compliance problem. Ignoring a false claim is never a good idea, says Mackaman.
Nor should this news discourage providers from self-auditing in the first place. Providers can use audit results to better understand their risks, to change internal processes regarding areas of concern, and to appropriately return reimbursements for claims paid in error, according to Mackaman.
