Pennsylvania hospital officials reiterated their estimate that a budget bill passed by the Senate and now under discussion in the House could lead to the loss of about 8,300 jobs in healthcare. They said proposed cuts to Medicaid could lead to cuts in trauma, burn, and obstetrics care and even force some hospitals to close.
Atlanta-based Grady Memorial Hospital officials approved a plan that would close its outpatient dialysis unit and shift the patients to a private care provider. The Grady board instructed management to draft a contract with Fresenius, a major provider of dialysis services in the United States, with about 60 centers in metro Atlanta. The plan would close the existing clinic at Grady and shift its 90 patients to a new location by Sept. 14. The financial burden on the patients would not change.
Atlanta-based St. Joseph's Hospital recently notified patients that it may end its relationship with medical insurance giant United Healthcare, effective Aug. 7, unless a new contract is reached. Kirk Wilson, St. Joseph's president and chief executive officer, said the two parties were "still negotiating in good faith" and expect an agreement to be reached.
California Gov. Arnold Schwarzenegger replaced most members of the state Board of Registered Nursing, citing the unacceptable time it takes to discipline nurses accused of egregious misconduct. The move came a day after The Los Angeles Times and the nonprofit news organization ProPublica published an investigation finding that it takes the board an average of three years and five months to investigate and close complaints against nurses. During that time, nurses accused of wrongdoing are free to practice and move from hospital to hospital.
Most major cancer centers offer support groups and individual counseling for patients, and the field of "psycho-oncology"—which addresses the psychological, spiritual and emotional aspects of cancer—is booming around the world. New York City-based Memorial Sloan-Kettering's meaning-centered psychotherapy is still in the research phase, but early results are encouraging. In a pilot study of 90 patients presented at the International Psycho-Oncology Society in Vienna, the authors reported that meaning-centered group therapy significantly boosted patients' spiritual well-being and reduced their anxiety compared with traditional support groups.
Regina Benjamin, MD, a physician who practices family medicine at her clinic in the small town of Bayou La Batre, AL, was nominated yesterday by President Barack Obama as U.S. surgeon general.
In her opening remarks at the White House Rose Garden, Benjamin, 52, reflected on her desire—if confirmed as the surgeon general—to "work toward a solution" to the healthcare crisis. "I promise to communicate directly with the American people to help guide them through whatever changes may come with healthcare reform," she said.
"Public health issues are very personal to me," Benjamin said. She reflected how health issues had impacted her family—how her father with diabetes and hypertension had passed away, how a brother died of an HIV-related illness, and how her mother died of lung cancer after years of smoking.
"My family is not here with me today—at least not in person—because of preventable diseases. While I cannot change my family's past, I can be a voice in the movement to improve our nation's healthcare and our nation's health for the future."
"These are trying times in the healthcare field, and as a nation we have reached a sobering realization: our healthcare system simply cannot continue on the path that we're on," Benjamin said. "Millions of Americans can't afford health insurance or they don't have the basic health services available where they live."
Benjamin has had an opportunity to see firsthand how the lack of insurance and availability of healthcare has impacted individuals, especially in underserved communities, following her medical education at the University of Alabama and Morehouse College.
She spoke about how she returned to Alabama, her home state, as part of her obligation to the National Health Services Corp. "The Corp paid for my medical school education and in return [I went to] an area that desperately needed physicians. I stayed."
She founded a clinic in Bayou La Batre (population 2,500) in 1990. "However it's not been an easy road," she said.
She became the only physician in Bayou La Batre, a town where about 80% of the population lives below the poverty line. Many times, she often treated patients for free or asked them to pay when they can.
The clinic was severely damaged by two hurricanes—Hurricane George in 1998 and Hurricane Katrina in 2005. Before it was scheduled to reopen in 2006 after repairs, the clinic was destroyed by fire. However, she continued to treat patients at their homes and in area hospitals.
Benjamin, though, has had personal successes. In 1995, she became the first black woman elected to the American Medical Association's Board of Trustees; in 2002, she became the president of the Alabama Medical Association, making her the first African American woman to be president of a state medical society in the U.S.
Last year, Benjamin was one of 25 recipients of the MacArthur Foundation's "Genius" grant, which rewards people who have demonstrated "extraordinary originality and dedication in their creative pursuits."
"For all that she's seen and all the tremendous obstacles that she has overcome, Regina Benjamin also represents what's best about healthcare in America—doctors and nurses who give and care and sacrifice for the sake of their patients," Obama said yesterday in announcing her nomination.
Healthcare will remain the largest source of job growth in the coming years, with 3.5 million new jobs across the sector expected by 2016, and perhaps even more jobs coming if universal health insurance is implemented, according to a new study released today by the President's Council of Economic Advisors.
"Healthcare reform is expected to slow the growth rate of health spending as efficiency is improved. However, even with a slower growth rate of spending, the expected expansion of health coverage could lead to increased demand for workers–including physicians, non-physician clinicians, healthcare support workers and nurses–to cover the newly insured population."
"Healthcare practitioners and technicians, which include physicians, registered nurses, and other health professionals and technicians, are expected to be in increasing demand," the report stated. Investments in health information technology will bolster job growth in that area, while the healthcare support sector–including physical therapists, medical social workers, and home healthcare aides–is projected to see even faster job growth as the nation's population ages.
The study's findings are consistent with Bureau of Labor Statistics data, which show that the healthcare sector continues to be one of the few areas of job growth amid the recession, although that growth has slowed considerably when compared to recent years. Overall, the healthcare sector—from physicians' offices, to residential mental health homes, to blood and organ banks—reported 20,800 payroll additions in June, and 127,300 new jobs in the first half of 2009, BLS preliminary data show. In the first half of 2008, the healthcare sector grew 179,400 new jobs, and averaged about 30,000 new jobs per month.
The fastest area of job growth in the healthcare sector continues to be in the ambulatory healthcare services, which reported 12,400 new jobs in June, and 83,700 new jobs in the first half of 2009, BLS preliminary data show.
Even with the slowing payroll additions, the hospital and healthcare sectors are still outperforming the overall economy. BLS preliminary data show that nonfarm payroll employment fell by 467,000 as the nation's unemployment rate remained at 9.5%. Since the start of the recession in December 2007, payroll employment has dropped by 6.5 million jobs and the unemployment rate has risen by 4.6%, BLS data show.
Today's report said that well-trained and highly-skilled workers will be best positioned to secure high-wage jobs. Occupations requiring higher educational attainment are projected to grow much faster than those with lower education requirements, with the fastest growth among occupations that require an associate's degree or a post-secondary vocational award.
Employers will value workers who can think critically and solve problems, with many occupations requiring good analytic and interactive skills.
The report noted that the nation's post-high school education and training system provides valuable skills and access for workers hoping to land jobs in high-growth areas, but that those institutions need to respond better to the needs of the marketplace, and encourage students to complete their studies.
The report added that worker flexibility is critical because of the dynamic nature of the U.S. labor market and ongoing technological change. In 2003, the report noted, a quarter of American workers were in jobs that were not even listed among the Census Bureau's Occupation codes in 1967, and technological change has only accelerated since then.
Environmental-related occupations–which are expected to experience tremendous growth over the next decade–did not exist in comparable data prior to 2000.
The infection control partnership between Johns Hopkins University and the Michigan Health & Hospital Association is getting praise from federal officials, who are calling the program a "success story" and a national model for healthcare reform.
The Michigan Keystone ICU Project has reduced healthcare-associated infections in Michigan, saving more than 1,500 lives and $200 million in 18 months. HHS Secretary Kathleen Sebelius says Michigan Keystone ICU Project will serve as the first in a series of periodic "success story" reports that federal officials will issue to identify healthcare reform models from across the nation that are worth emulating.
"We know there are tremendous examples of efficient, high-quality healthcare in America today. Our challenge is spreading these good examples across the country," Sebelius says. "Our reports will showcase success stories like the Michigan Keystone ICU Project and highlight how health reform can improve the quality of care for all Americans."
Medical errors, including healthcare-associated infections, kill nearly 100,000 patients in America every year and patient safety measures have worsened by nearly 1% each year for the past decade. The Michigan Keystone ICU Project pushed patient safety in more than 100 ICUs in Michigan. The project targeted catheter-related bloodstream infections and worked to ensure clinicians used a simple checklist when inserting catheters into ICU patients.
Following the checklist, there was a 66% reduction in these infections throughout Michigan, saving more than 1,500 lives and $200 million in the first 18 months. The project was funded by the Agency for Healthcare Research and Quality, and for every dollar invested, about $200 was saved.
The American Recovery and Reinvestment Act earmarks $50 million in grants for states to help fight HAI. Sebelius wants hospitals to reduce central line-associated blood stream infections in ICUs by 75% over the next three years by using the Michigan checklist.
Michael J. Sniffen has assumed the position of president/CEO at St. Mary's Hospital in Passaic, NJ, following the recent departure of Colene Y. Daniel.
An insurance-free primary care "direct medical home" that requires patients to pay low monthly fees, but gives them 24/7 access and cheaper healthcare costs has the potential to save hundreds of billions of dollars if it's included in the national healthcare reform model, one advocate says.
Norm Wu is CEO of Qliance Medical Management, Inc., which operates one direct medical home that employs nine physicians serving about 2,500 patients in Seattle and has hopes to expand nationally. Even though their numbers are small, Wu is an unabashed enthusiast. He says the direct medical home model on a national scale could save patients and employers $300 billion to $500 billion a year "in hard-dollar, upfront savings" largely in the form of lower health insurance premiums.
"With that savings, you can provide comprehensive health coverage for every man, woman, and child in America," Wu says. "But it is hard to get that message out. People consider insurance synonymous with healthcare and it's hard to break out of that box."
Wu insists that the direct medical home model is not another form of concierge medicine that cherry picks healthy patients and shoos away the chronically ill. "We don't like that term because it smacks of elitism. We provide concierge-level service at prices that everyone can afford," Wu says.
"The people who are really attracted to us are the high utilizers," Wu says. "If you have a chronic illness we are a God send. For a flat monthly fee, you can see us as many times as you need to. We are available for phone conferences and e-mail. There is 24/7 access."
"We also have a lot of people who are reasonably healthy," he says. "They don't get sick that often, but they are health conscious so they want preventive care and when they do get sick they want to see a physician who knows them as soon as possible."
For monthly fees ranging from $39 to $79 depending upon age, Wu says Qliance patients get unrestricted primary care for vaccinations, checkups, pneumonia, minor fractures, women's health exams, and ongoing care for chronic illnesses, such as diabetes, hypertension or obesity. No one is denied care for preexisting conditions, there is same- or next-day service for urgent care, and visits with salaried, physician-employees can last 30 minutes to an hour.
Medicare/Medicaid/SCHIP patients are accepted; their coverage is not.
Lab tests, pharmacy, and durable medical equipment are not covered by the monthly fee. Instead, Wu says Qliance "passes on our wholesale costs, so there is no incentive for us to be pushing stuff off on patients that they don't need." The patients' higher out-of-pocket expenses for ancillary care are offset, Wu says, by the savings of 40% to 50% for patients, and 20% to 35% for employers when they swap their low-deductable, high-premium health insurance for either high-deductable or wrap-around coverage.
Robert Zirkelbach, spokesman for America's Health Insurance Plans, says the industry trade group doesn't have "any thoughts yea or nay" about direct medical homes, in part, because "there aren't that many of them either."
"There are a small number of physicians who choose not to contract with health plans and that is fine. But the majority of people are participating in health plan networks and they're reporting high satisfaction," he says. "People want peace of mind so that if they have a serious accident or illness they have financial protection and coverage for their medical bills, and that is what health insurance provides. That desire of individuals and families is not going to go away."
Wu says direct medical homes make "the best partners" with health insurance companies. "It allows them to do what they do best, which is to diversify risk," he says. "If they are selling an insurance product and their customer has us on the front end, their payout is going to come down substantially."
While insurance companies might lose money from premiums when their customers switch to high-deductable plans, Wu says insurance companies shouldn't get too upset because they "don't make the money on the low-dollar, transaction value, routine visits that primary care provides."
Wu says the direct medical home model is an attractive alternative for primary care physicians who've become burned out by decades of haggling over insurance claims that don't even cover costs.
"We have several physicians with us who were looking at early retirement because they couldn't stand the hamster wheel existence with the insurance world," Wu says. "Reimbursements at primary care are so low and the overhead is so high, you've got to see 25-30 patients a day to cover the overhead. They can't spend the quality time they want to with patients."
He says that any national healthcare reform effort that doesn't take low reimbursements and high hassles of primary care delivery into consideration will make matters worse. "If you just expand insurance to another 50 million people that don't have coverage now, instead of seeing 25-30 patients a day, primary care physicians are going to be asked to see 40-50 patients a day," he says. "It is going to accelerate the exodus of primary care docs."
