Donald Small, MD, has been selected to head the Pediatric Oncology Division of the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins. After having spent 32 years at Johns Hopkins, with the last 19 as a member of the faculty, Small has been serving as Acting Director of the Division since September 2006.
John J. McCormack has been named interim CEO at Maine Coast Memorial Hospital. McCormack filled the vacancy created by the departure of former President/CEO Doug Jones, who retired this month. McCormack began his duties at MCMH on July 6.
James I. Marshall has been hired as the new CEO of Mercy Hospital. Most recently he served for two years as the CEO for the Sakakwea Medical Center in Hazen, ND, a critical-access hospital licensed for 25 beds with two rural health clinics, a surgical clinic, and a 32-bed basic-care facility that is community owned and operated under the Hazen Memorial Hospital Association.
Baptist Health System President/CEO Trip Pilgrim has been named senior vice president and chief development officer for Vanguard Health Systems, the parent company of Baptist Health System. Baptist Health System COO Graham Reeve has been named as Pilgrim's replacement. Pilgrim has served as the president/CEO for Baptist Health System since September of 2005. Before that, he served for three years as Baptist's vice president of business development.
Healthcare payers spent a lot more per person to treat those who were obese and overweight in 2006 than they paid in 2001.
That's the message from a new federal report that ranked spending on adult patients categorized by body mass index. The increased spending per person is attributed to greater expense of managing chronic conditions, such as diabetes or high blood pressure.
Those who are obese and overweight tend to have one or more such diagnoses, and also tend to have more of them than they did in 2001.
Spending increased 82% for people who were obese in that period, from $167 billion to $303 billion. For people who were classified as overweight but not obese, healthcare spending increased 36% from $202 billion to $275 billion. For people of normal BMI, treatment costs increased 25%, from $208 billion to $260 billion.
On an average spending per person basis, spending went from $3,458 to $5,148 for those classified as obese. For those who were overweight, the cost rose from $2,792 to $3,636. For each person of normal weight, the average costs rose from $2,607 to $3,315.
Additionally, the percentage of people classified as obese went from 23.6% of the population in 2001 to 27.2% in 2006, or 58.9 million. The number classified as normal or under weight stayed about the same. The percentage of people classified as overweight decreased slightly, from 35.4% to 34.9%, or 75.6 million. The percentage of people classified as normal weight dropped slightly from 39% to 36.1%, or 78.3 million.
The report said variables influencing higher costs included asthma, ischemic heart disease, angina, heart attack stroke, emphysema, and arthritis. Estimates for each year are in that year's dollars. Spending included the cost of doctor, hospital outpatient and emergency room visits, hospitalizations, home healthcare services, dental visits, other medical expenses and prescription drugs.
The report was prepared as part of a series of briefs issued from data from the Medical Expenditure Panel Survey and was written by Marie Stagnitti of the Agency for Health Research and Quality.
The report was among four released in the last week pointing to the growing impact of obesity on the health status of Americans.
The first, issued by Trust for America's Health and the Robert Wood Johnson Foundation, showed that obesity in adults rose in 23 states in the past year and didn't decline in any of them. The state with the most obesity was Mississippi, followed by Alabama, West Virginia and Tennessee.
The second report came from the Centers for Disease Control and Prevention, which said 26% of the population is now fully obese with two thirds of America either obese or overweight.
The third report last week was published in the journal Health Affairs, which said that while the prevalence of obesity in children and adolescents had not increased, hospitalizations and the cost of care for those patients nearly doubled.
The four reports prompted the president of the Massachusetts Medical Society to warn that failure to fight the problem more aggressively could thwart meaningful efforts at health reform. "The impact of obesity on personal health is damaging enough, which such chronic diseases as diabetes, heart disease, and arthritis," said Mario Motta, MD, a cardiologist. "But the public health implications are enormous and the associated costs to treat obesity and its complications could hinder health care reform."
XLHealth, which runs Medicare chronic condition special needs plans, has appointed John R. Mach, Jr., MD, to CMO, effective Aug. 1. Most recently, Mach served as chairman/CEO of United HealthCare's Evercare health plans, the business unit that owns and manages all of United's Medicare special needs plans. XLHealth also has appointed Karl Broussard to serve as its vice president of contracting and provider relations. Before joining XLHealth, Broussard served nine years in various executive roles at Coventry Health Care, most recently as vice president of network development with the company's Vista health plan.
Tenet Healthcare Corp. has appointed Joe Thomason as CEO of Tenet's Centennial Medical Center, a 118-bed acute care hospital in Frisco, TX. Thomason, 49, has served as the hospital's interim CEO since March. Thomason recently served as CEO of RHD Memorial Medical Center in Dallas and Brownsville Medical Center in Brownsville, Texas. Before that, he was COO for Sierra Medical Center, a 354-bed acute care hospital in El Paso, TX.
The AARP has decided to suspend its 401(k) match for at least nine months. According to a recent study by the Grant Thornton compensation and benefits consulting practice, 29% of employers have altered or intend to alter their 401(k) match this year. Two-thirds of those will eliminate it (often temporarily), 22% will reduce it, and 11% will bump it up.
Yolanda Salas always wanted to be an RN. The Chicago native and billing clerk at St. Anthony Hospital had plans to go to college after she graduated from high school in 1995, but then life happened. She got married, had two kids, and with each passing year college seemed a little more remote.
In the last eight months, however, that lifelong ambition has gone from a dream to a reality. After graduating next month from St. Anthony's new in-house "School At Work" program, Salas, 32, will begin classes this fall at nearby Wright College with the short-term goal of becoming an LPN, and then incrementally working toward her RN certificate.
Salas was one of 18 employees picked from the 950 full- and part-time employees at the 150-licensed-bed community hospital in Chicago's gritty west side for the first 32-week SAW course in February to brush up on their reading, language, computer literacy, and math skills, and to introduce them to basic medical terminology, anatomy, physiology, and medical ethics.
"What I gained the most is getting confidence because I had so much time out of school," Salas says. "I was starting to get nervous about how different it would be back in school so many years after I left. The program gave me a lot of confidence, especially my coach and my classmates and the whole hospital gave us the support to go back to school."
While School at Work is new at St. Anthony's, the idea was developed about 15 years ago by Lynn Fischer, founder/CEO of Catalyst Learning Center. SAW gives employers the tools to "grow their own" workforces, which will reduce turnover, improve morale, and give entry-level employees the opportunities to improve their lives. Everybody wins.
SAW wasn't designed specifically for hospitals, it just seems that way. It's hard to imagine a better environment for the program to flourish. The demand for healthcare workers—although slowed of late because of the recession—is expected to grow as the nation ages. Hospitals routinely hire dozens of entry level employees, many of whom crave the opportunity to improve their lives. About 370 hospitals in 41 states have adopted the program, which uses job coaches, mentors, DVD and Internet classes, and traditional workbooks. The students also used the class time to prepare for college entry tests, fill out admissions applications, and organize their finances so they could apply for financial aid.
Of the 18 employees who began the SAW course at St. Anthony's in February, all 18 will graduate on Aug. 13, and all of them are either planning to attend college or prepping for the GED, with the expectation that they will attend college eventually. That 100% success rate has surprised even Pamela Jones, a veteran workforce development manager at St. Anthony's who was hired to run SAW.
"Usually, with different programs in workforce development, you might get 75% retention," Jones says. "With this one the reason why they've hung in there is they have a lot of support internally at the hospital and it came from the top down."
Perhaps the most critical components in the success of SAW, Jones says, is the top-to-bottom support of the hospital leadership, and the decision to conduct the two-hours-a-week classes on hospital grounds immediately after the employees' shift is completed.
"If you let them get home, that's it. Lights out. Nothing is happening," Jones says. "They are surrounded by everything and anything that can distract them from their studies. I believe that piece is really what makes this model work. They are in a different environment at work. They clock out and come upstairs to class. There are no gaps."
Even with "no gaps," getting employee-students to show up for class isn't easy because of any number of problems outside of work. If one of the students is absent, Jones will stop class and find out where they are. When Jones learned that one student was severely ill, she went to the student's home with her homework. One student was "living in and out of her car," so Jones secured a two-year rent subsidy. One man had amassed more than $10,000 in motor vehicle fines because his license plate had been stolen. Jones went to court with the man to get the tickets resolved.
St. Anthony's SAW is funded by a $130,000 grant, half of which comes from the hospital's foundation, and the remaining money is from two Chicago-area organizations. It seems like money well spent.
These are exactly the kinds of targeted grants that should be encouraged, because they're not just throwing money at a problem, they're designed to succeed. First, the talent pool has already cleared the first hurdle, merely by having a job. If you've got a job, you've got enough ambition to get out of bed every day. Second, the hospital screens a pool of applicants to determine the best candidates, thus furthering the chances for success. Then, the program director aggressively insists on attendance and compliance from the students, working to ensure they get their preparatory work completed while instilling confidence.
On Aug. 13, Jones says, St. Anthony is planning a SAW graduation ceremony and a reception. CEO Guy Medaglia and other hospital leaders will be there too. Jones wants to invite the foundations that funded the grant, and she wants some local politicians to come too, so they can see a successful program up close and personal.
Of course, the guests of honor will be the 18 SAW students. "They are really excited about that," Jones says, "because it looked like a place they could never enter."
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With so much noise about how to prepare for a RAC audit, maybe its best to go directly to the source for your intel: hospitals that have suffered a RAC attack. These hospitals are a few steps ahead of the rest of the country in that they have first-hand experience in what kind of charts are being reviewed, what types of diagnoses are being targeted, and what's being turned down on appeal.
In San Francisco, CA, Alan Rosenstein, MD, a practicing physician, and vice president and medical director of VHA Inc., west coast operations, has spent the last year surveying 31 VHA hospitals in California, New York, and Florida that have gone through RAC audits as part of the CMS demonstration project. The idea is to let hospitals in non-demonstration states know what will happen as RAC moves through the rest of nation, says Rosenstein, who partnered on the project with VHA colleague Michelle O'Daniel.
"Some of the results we found were astounding," says Rosenstein, noting that the hospitals paid back a total $45 million to CMS. A total of 47,243 charts were requested by RAC auditors. One-third were turned down and didn't meet criteria, which was a lot, says Rosenstein. "The main reason was a failure of appropriate documentation and coding that supported medical necessity," he says.
Rosenstein says 50% of the retracted charts were submitted for appeal and a third of those were upheld. This number could be even higher today, he says as the data is six months old. Part of the problem with the appeals process is RAC auditors were looking at 2005 and 2006 charts using 2008 and 2009 criteria. Still, the hospitals won so many appeals, says Rosenstein, because they were able to extract information from the charts that supported clinical necessity, which the reviewers didn't take into consideration.
The VHA data also revealed that the RACs targeted three primary areas: less than 24-hour care, inpatient stays, and rehabilitation. Rosenstein says the RACs also targeted medical diseases such as respiratory, cardiac, metabolic, and nutritional diseases over surgical diseases.
So what can hospitals learn from their colleagues in demonstration states? "It's a wake up call for better documentation and coding," says Rosenstein. "It is illegal to retrospectively go back and change any of the charts, so hospitals are stuck, and whatever the auditors pull out and review that is what you are under pressure to, if appropriate appeal."
Moving forward, he says, it is all about physician education. "The physician is the one who writes in the chart that supports documentation." Of course how to bring physicians on board for anything has turned into a full-time role on most hospital management teams. Rosenstein says it's important to appeal to their concern for quality and reputation rather than the bottom line. "Physicians don't really care about the hospital losing a dollar or saving a dollar, but quality rankings and reputation stimulates their interest." Hospitals must also enhance processes like coding and case management that help physicians to be more compliant.
At the same time, Rosenstein says he is sharing RAC and other VHA data with hospital CFOs. "We are on the quality side but there is really big financial impact of what this data means, and so it is making a case that we need more resources to make this happen," he says, such as technology and personnel.
Hospitals that have been audited are beginning to understand the full reality of the RAC process, the consequences of decisions made today, and hopefully even the best strategies for appeals. Still, with RAC being so new, some hospitals, and rightfully so, are in reactive mode, struggling to educate their boards, physicians, staff, and coders. Perhaps before hospitals can even begin to address educational needs, they must—as Rosenstein recommends—break down barriers, bureaucracy, and tradition.
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