There is major concern among lawmakers crafting healthcare legislation on Capitol Hill that employers will drop private coverage and dump their workers onto federally subsidized health plans. But the experience with the healthcare overhaul in Massachusetts suggests those worries may be overblown: The state has allowed businesses who chose not to cover their employees to get by with just a minimal fee. Yet even without the threat of a serious penalty, employee dumping has not been a problem, said architects of the Massachusetts plan.
The Centers for Medicare & Medicaid Services has released the proposed 2010 rules for the Medicare Physician Fee Schedule, the Hospital Outpatient Prospective Payment System, and the Ambulatory Surgery Center Payment System. The technical component of imaging reimbursement is yet again a prime target for legislators, says Sg2 Vice President Henry Soch, and here Sg2 provides a preview of what might be in store for imaging in 2010.
Harford, CT-based Aetna is introducing new health plans for small employers in some states that charge no co-pays for preventive care such as routine physicals, vision and gynecological exams, and well-child visits. Aetna says it's pricing the new zero co-pay plans the same or nearly the same as what the existing plans would have cost. But the catch is the higher co-pays or deductibles on certain other benefits could offset at least part of the savings for some members.
Senate Democratic leaders appeared open to establishing a non-government cooperative as part of a U.S. healthcare overhaul.
Senate Majority Leader Harry Reid and Sen. Charles Schumer said they were amenable to considering a cooperative to compete with private insurers as part of the effort to reduce the country's healthcare costs and expand coverage to uninsured Americans.
Twenty people were arrested in a $4.6-million Medi-Cal fraud scheme that law enforcement officials allege used unlicensed individuals to provide in-home nursing care for disabled patients. About 75 patients, many of them children with cerebral palsy or developmental disabilities, were treated at home or at school by the unlicensed individuals who stole identities to pose as licensed nurses, according to the United States Attorney's office.
New York Times columnist Pauline M. Chen says that while the discussions at disciplinary meetings and at morbidity and mortality conferences tend to focus on the effects of these physicians' errors on patients, there is rarely any time devoted to how such errors affect doctors and their subsequent interactions with patients. Doctors who are depressed are as much as two times more likely to make subsequent errors than doctors who are not, Chen says.
Hospital readmission rates that occur within 30 days after discharge for Medicare patients with heart attacks, heart failure, or pneumonia are now available for viewing for the first time on the Hospital Compare Web site.
The readmission rates are being added to information already available at the site on how often hospitals take guided steps to provide care for these patients, as well as updated information on mortality rates. The information is offered by the Centers for Medicare and Medicaid Services and is supported by the Hospital Quality Alliance, a national public/private collaboration.
More than 4,000 hospitals—including almost all acute care hospitals—have voluntarily submitted quality information to share with the public through the Web site.
Hospitals are placed in one of three categories based on their readmission rate compared with the national readmission rate. These categories are: "no different than the U.S. national rate," "better than the U.S. national rate," or "worse than the U.S. national rate."
Each hospital's readmission rates for the specific condition also can be compared to its state's average.
Each rate is presented as a single number, along with a confidence interval that indicates the range of certainty in which the hospital's true performance falls.
Hospital Compare shows how often a Medicare patient with one of these conditions returns to the same hospital or a different hospital within 30 days following their initial stay.
The methodology used to calculate the readmission rates uses Medicare billing records from July 2005 to June 2008. The information is designed to be a starting point for providers who want to take any necessary steps to reduce readmissions.
Hospitals, other healthcare providers, and community organizations could use the readmission data to understand what may be contributing to hospital readmissions, such as the availability of primary and hospice care in the community or transportation challenges patients might face in getting to follow up appointments.
The new update joins a growing collection of clinical care information on the Hospital Compare Web site. HQA members work together to improve the quality of care provided by the nation's hospitals by measuring and publicly reporting information about hospital care.
The American Hospital Association and other large hospital groups have made a "quid pro quo" deal with the Obama administration and Democrats in Congress to support healthcare reform in exchange for legislation that would prove "devastating" for physician-owned hospitals, the industry trade group Physician Hospitals of America claims.
"To put this anti-competitive issue into the deal between the Administration, Congress, and the hospital associations makes no sense and demonstrates the desperation of many hospitals to remove healthcare decisions from the hands of those who should have the biggest say, the physicians and patients," says Molly Sandvig, executive director of the Sioux Falls, SD-based PHA, which represents about 220 physician-owned hospitals in 32 states.
Sandvig says draft language in the 852-page House healthcare reform legislation is nearly identical to "anti-physician hospital language" placed in the SCHIP bill in January, and the language is expected to be included in the Senate Finance Committee bill too.
"The language included in the draft House healthcare reform proposal, if passed as is, would have a devastating effect on physician hospitals. Existing physician hospitals would 'whither on the vine' since they would not be able to grow to meet the needs of the healthcare marketplace," Sandvig says. "From Jan. 1, 2009 on, hospitals owned by physicians that do not yet have Medicare Provider Numbers, would not receive their certification if the physician-owners refer patients to their hospitals. Obviously, many hospitals currently under development would be unable to open and hundreds of millions of dollars could be lost."
On Wednesday, AHA President/CEO Rich Umbdenstock, Catholic Health Association of the United States President/CEO Sister Carol Keehan, and Federation of American Hospitals President Chip Kahn, issued a joint statement of support for healthcare reform.
They also specifically said they were "pleased to see restrictions on physician self-referral to hospitals in which they have an ownership interest" in draft legislation.
Rick Wade, a spokesman for the American Hospital Association, says AHA has been consistently opposed to physician-owned hospitals. "Our members have an enormous problem with physician self-referral, and we've been consistent in trying to rein that in in the legislative process," Wade says. "We think there is an enormous conflict-of-interest problem here, and we are not doing anything differently in the health reform debate that we haven't done all along on this issue."
Sandvig cited five areas in the House draft bill that would damage physician-owned hospitals:
Existing hospitals would not be forced to "buy-down" physician ownership but would rather be able to remain at the aggregate percentage of physician ownership that they had as of date of enactment.
The majority of existing hospitals would not be allowed to grow or expand in any way. Provisions allowing expansion based upon very stringent and limiting requirements are included in the bill, but according to PHA calculations, would only allow nine physician hospitals in the country to apply to HHS for the right to grow.
All under development hospitals that did not have a Medicare Certification number by Jan.1, 2009, would not be grandfathered. In other words, they would not be allowed to continue to take Medicare and Medicaid patients if the physicians who own the hospital continue to refer to that hospital.
The whole hospital exemption to Stark laws would not apply for any hospitals not in existence as of Jan. 1, 2009. This would not allow a physician to refer a Medicare/Medicaid patient to a hospital in which he or she owns an interest, and thus, severely restrict the future growth of physician owned hospitals.
Diane Meier, MD, director of the Center to Advance Palliative Care, was invited to the White House last month for a stakeholder discussion with physicians on the topic of prevention and costs. "I was scratching my head about that one," she said.
According to that great source of knowledge, Wikipedia, palliative care (derived from the Latin word palliare—meaning to cloak) is any form of medical care or treatment that concentrates on reducing the severity of disease symptoms—rather than halting, delaying, or reversing progression of the disease itself or providing a cure. The goal is to prevent and relieve suffering—while at the same time improving the quality of life for people facing serious, complex illness. Palliative care is not considered the same as hospice care.
So what did palliative care have to do with wellness and costs? "Suddenly, it finally hit me—the light bulb went on: They invited me because palliative care is also about prevention of the wrong care," Meier said. In the stakeholders discussion, Meier said she was able to join into the conversation by pointing out "that if we don't prevent the wrong care, there will be no money for anything else."
She explains that palliative care--which is distinct from end-of-life care and from hospice care—is not limited by prognosis. "It has an enormous potential to dramatically improve the quality of care for 23% of Medicare beneficiaries with five or more chronic conditions who drive 67% of total spending," she said.
Recent studies have shown that palliative care can provide clearer treatment goals—redirecting physicians and patients away from more expensive procedures when they are not desired. This can hold down costs—and satisfy the patients with the serious illnesses.
However, the workforce to provide palliative care and the educational assistance for those seeking to make a career in palliative medicine currently is not there. Any mention, though, of palliative care is missing from the two healthcare reform drafts circulating on Capitol Hill—the House tri-committee draft and the Senate House, Education, Labor and Pension draft.
But, other pieces of legislation have emerged which might give the use of palliative care a boost including a bill from Senators Jay Rockefeller IV (D WV) and Susan Collins (R ME) who reintroduced an expanded version of their Advance Planning and Compassionate Care Act in May that calls for:
Improving consumer access to hospice and palliative care through consumer information.
Requiring the development of quality measures to assess end of life care.
Developing and implementing accreditation standards and processes for hospital based palliative care teams.
Establishing the National Center on Palliative and End of Life Care at the National Institutes of Health.
So in the great debate about cutting costs through health reform, maybe it's time to consider how to do it compassionately toward the end—when patients need it the most—through palliative care.
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An international survey of physicians suggests that more than two-thirds of doctors in the U.S., Europe, Mexico, and Brazil are either unfamiliar with social networking sites or do not use them. But among those who do, Facebook dominates—40% of doctors in the U.S. who use social networking sites use Facebook.
