Grady Health System must pay $20 million to Georgia due to Medicaid overpayments made to the center years ago, officials said. Grady CEO Michael Young said the hospital is paying for desperate decisions made by his predecessors. Grady officials in 2004 and 2005 aggressively maximized the amount of Medicaid they received, leaving the current regime to pay back the extra millions, Young said.
A top spine surgeon at the University of Minnesota who has reaped more than $1 million consulting for Medtronic Inc. is facing questions from a U.S. senator investigating financial conflicts in medicine. In a July 24 letter, Sen. Charles Grassley also asks the university questions about how it monitors potential conflicts of interest involving medical school doctors who receive consulting payments from medical device companies.
Senate Democrats debating how to overhaul America's healthcare system are moving toward a showdown over whether to create a government-run insurance program or set up a system of cooperatives instead. A bipartisan group of centrists on the Senate Finance Committee is leaning toward cooperatives, saying that alternative could offer customers more choice without enlarging the government's role in the healthcare market.
The Chicago doctor who treated President Barack Obama for more than two decades is entering the debate over healthcare reform, leveraging the connection to Obama to act as a spokesman for advocates of a British- or Canadian- style single-payer healthcare system. David Scheiner, MD, will speak on behalf of a single-payer healthcare system at a rally on the National Mall in Washington.
A lawyer for Josef E. Fischer, a Boston doctor accused of sex discrimination, criticized a Massachusetts Supreme Judicial Court ruling that will allow a lawsuit filed against his client to go to trial rather than be resolved through arbitration. The suit, filed by Carol Warfield, former head of anesthesiology at Beth Israel Deaconess Medical Center, accused Fischer of abusive and demeaning treatment. A few months after it was filed, Fischer was asked to resign as chief of surgery because of what the Boston hospital termed an inappropriate management style.
During a forum, President Barack Obama sought to reassure senior citizens that squeezing billions of dollars from Medicare spending won't hurt their benefits. He also defended a proposal aimed at encouraging Americans to make plans in advance for end-of-life medical care. AARP sponsored the forum in which President Obama took questions from a small audience of seniors, as well as by phone and Internet.
Congress' ideas to pay for covering the uninsured do not raise revenue as quickly as health costs rise, according to this article in the New York Times. A plan to impose a surtax on top earners, for instance, pays a decent chunk of the bill but the revenue from the tax roughly rises only as fast as the United States economy grows. Health costs, on the other hand, are growing much more quickly than the economy, according to the article.
Japan's government tells BusinessWeek that it has an idea for creating jobs in its healthcare sector--competing for medical tourists against Singapore, Thailand, the Philippines, and India. Japan's Ministry of Economy, Trade and Industry has a plan for luring wealthy patients from Asia and Russia to Japan for advanced medical treatment. Countries such as India, Singapore, and Thailand are already a popular destination for Americans, Europeans and Japanese who are looking for specialized medical procedures but don't want to pay the high costs.
The August recess for the U.S. Congress is fast approaching, possibly leaving behind the deadline President Obama set for health reform. The President has been playing the role of head cheerleader for reform for many weeks now, trying to get healthcare stakeholders and voters excited about a bill that he says could expand access, improve quality outcomes, and decrease costs.
But as a cheerleader, Obama isn't much of a quarterback.
He's left that job to Senator Max Baucus, D-MT, chairman of the Finance Committee. As the debates continue to swirl over how to achieve the three broad reform goals, Obama has supported many ideas: he says he wants a public plan, but he's open to insurance exchanges; he was against taxing health benefits, but said he'd consider a bill that includes such taxes; and he's open to mandating coverage, if there are affordable options and insurers won't discriminate against preexisting conditions.
In short, the President appears to be rooting for any plan that he can call reform, so long as it expands access. Still, Obama is having trouble rallying the Blue Dogs in his own party because the Congressional Budget Office says that, at best, the House's Tri-Committee bill is budget neutral.
Before the end of the week, Baucus and his group of six senior senators might reach an agreement-but it will likely result in a much more moderate bill that slashes liberal plans like public insurance and employer mandates.
Hearing and reading about the reform rhetoric on a daily basis, it's hard to believe that just a year ago medical travel was the hot healthcare story. Starting with the August recess, analysts say healthcare associations, insurance lobbyists, and other stakeholders will spend billions on healthcare reform advertising and lobbying efforts.
But whatever comes out on the other end of the reform debate, insurers and employers should not count on the eventually watered-down version of health reform-assuming some plan actually becomes law-to help change the direction of healthcare's cost curve.
No, it is wiser to exhaust the tangible options at hand. A truly progressive employer is striving today for a mix of employee wellness efforts and contracts with healthcare organizations-both home and abroad-that bring down the cost of some of the most pricy and common procedures.
At the same time, insurers should not get distracted by the daily reform rhetoric, and should actively seek out how they will respond to requests by employers to offer national and international medical travel as one way of limiting cost.
One day this health reform movement seems to gain momentum, and then the next day it loses traction. We've seen this play out the last time we had a first-term Democrat as President. Obama certainly is taking a different approach from Bill and Hillary, but we can expect that any bipartisan reform law will fall short of being truly universal and offer only modest, if any, cost controls.
So work today to bend your organization's cost curve. No one is going to do it for you tomorrow.
Saturday marks the enforcement date of the Federal Trade Commission's Red Flags Rule—barring another delay, of course.
The FTC set enforcement three times: November 1, 2008; May 1, 2009; and August 1, 2009.
The latter looks like it will stick. That means starting Saturday, the FTC can officially audit your facility if you haven't complied with the Red Flags Rule, the mandate that all healthcare facilities considered "creditors" have an identity theft prevention program in place.
The Red Flags Rule forces any organizations to implement programs to identify, detect, and respond to patterns, practices, or specific activities that could indicate identity theft.
That regulation falls under the Fair and Accurate Credit Transactions Act of 2003 (FACTA), which defines "creditors" as agencies that regularly extend or renew credit–or arranges for others to do so–and includes all entities that regularly permit deferred payments for goods or services.
Chris Apgar, CISSP, president of Apgar & Associates, LLC in Portland, OR, writes in his white paper, Red Flag Rules & Physicians – Overview and Program Requirements, the key requirement to comply with Red Flags is adopting an umbrella policy and procedure.
"The policy and procedure needs to be approved by the highest authority in the practice or clinic such as the board of directors, partners, sole owner, etc.," Apgar writes. "… The umbrella policy indicates the program has been adopted and approved by the highest authority for the practice or clinic. It also outlines the components of the Red Flag Rule program for the practice or clinic. Any supporting policies and procedures need to be reviewed and/or developed by senior management and the program needs to be reviewed at least annually."
Apgar says the Red Flags requirements are similar to the HIPAA Security Rule and state/federal breach notification requirements. His suggested "required elements" of a compliant Red Flag Rule program that can be incorporated into existing policies are:
Risk analysis
Threat or vulnerability identification ("Red Flag" identification)
Alerts, notification requirements and investigation
Mitigation as necessary (including breach notification)
Documentation of investigations and, if appropriate, mitigation
Workforce member training
Business associate implementation and maintenance of an identity theft protection program (requires an amendment to the business associate contract)
And if there ever were a time to be compliant, it's now–especially with new HIPAA laws signed into the American Recovery and Reinvestment Act of 2009 (ARRA).
"Given the expansion of federal enforcement included in ARRA and the significant increase in civil penalties," Apgar says, "it is important now to make sure the security program is sound and reasonably ensures patient PHI is protected from inappropriate access, breach or exposing the patient to identity or medical identity theft."
