Of the nation's 58 organ procurement organizations, Tennessee has landed in the top five in receiving organs for the past several years.
That's probably why Apple founder Steve Jobs skipped over his home state of California's 3,474-person waiting list and got on Tennessee's 229-person list to get his liver in Memphis two months ago.
In the latest effort to expand its retail clinic business into specialized services, Walgreen Co. confirmed plans to launch a pilot program to treat the growing number of Americans with diabetes. Walgreens' Take Care clinics and CVS Caremark Corp.'s MinuteClinic subsidiary are this year rolling out specialized services that go beyond treating routine maladies. Diabetes is becoming one of the nation's top healthcare concerns and is regularly mentioned by President Barack Obama and members of Congress as a key area for improvement if medical costs are going to be kept under control.
President Barack Obama signaled flexibility on a key healthcare issue, suggesting he is open to an overhaul that doesn't include a government-run program to compete with private insurers. At a White House news conference, Obama said he hasn't laid down any absolutes about what must be included in healthcare legislation except that it must control costs and help those without insurance or with inadequate coverage.
Organizing for America, an arm of the Democratic National Committee that helped elect President Barack Obama, is building a database of complaints from Americans about healthcare to help him push through an overhaul. The group has access to what it calls the "story bank," an online collection of short stories people submitted chronicling their frustrations with American healthcare. It has organized the stories geographically, plotting them on a Google map, and is encouraging supporters to tell others the stories as a way of building support for the president's effort to provide near-universal health coverage and cut medical costs.
Fifty-three physicians, healthcare executives, and Medicare beneficiaries were arrested Wednesday in New York City, Miami, and Detroit by the newly expanded federal Medicare Fraud Strike Force. They were charged with submitting more than $50 million in Medicare claims related to unnecessary or fraudulent procedures.
In a joint press conference in Washington, Attorney General Eric Holder, Department of Health and Human Services Secretary Kathleen Sebelius, and FBI Director Robert Mueller announced the indictments and arrests by the strike force operations in Detroit, which are part of the Health Care Fraud Prevention & Enforcement Action Team (HEAT). HEAT is a renewed joint effort announced last month between the Justice Department and HHS that focuses on enforcement of current anti fraud laws around the country. Programs had been underway earlier in Los Angeles and Miami.
The charges that were unsealed Wednesday were made against 53 individuals accused of various Medicare fraud offenses, including conspiracy to defraud the Medicare program, criminal false claims, and violation of anti kickback statutes.
Federal agents from the FBI and the HHS Office of Inspector General began executing arrest warrants in Detroit, Miami, and New York City as part of an effort to address fraud in the metro Detroit area. The strike force operations in Detroit identified two primary areas--infusion therapy and physical/occupational therapy providers--in which schemes were allegedly organized to defraud Medicare.
According to the indictments, the defendants were charged with submitting claims to Medicare for treatments that were considered medically unnecessary--and many times never provided. The indictments allege that beneficiaries also accepted cash kickbacks in return for allowing providers to submit forms saying they had received the unnecessary--and not provided--treatments. Those indicted included physicians, medical assistants, patients, company owners, and executives.
"As demonstrated by today's charges and arrests, we will strike back against those whose fraudulent schemes not only undermine a program upon which 45 million aged and disabled Americans depend, but which also contribute directly to rising health care costs," said Holder in a statement.
Most physicians, patients, and medical companies "do the right thing and work with the Medicare program to provide access to medical services," he said. "To those who work diligently and ethically to provide medical care through the Medicare program, we will work with you to root out the few who corrupt the system and taint the good reputations of health professionals everywhere."
Without healthcare reform legislation, the number of uninsured in the United States will rise from the current 46 million to 72 million by 2040, according to Christina Romer, chair of the White House Council of Economic Advisers, who was the lead-off witness before the House Education and Labor Committee this week.
The hearing, the first full committee hearing this week of the three House committees that released an 852-page healthcare reform draft last Friday, focused on the potential impact of reform on a variety of groups: Small business, consumer, academic, and healthcare. The Energy and Commerce Health Subcommittee held hearings as well.
Romer noted that healthcare expenditures are currently 18% of the gross domestic product (GDP), "by far the highest of any country," she said. By 2040, without reform, healthcare could roughly account for one-third of the total output of the American economy, she said.
For Medicare and Medicaid, government spending for healthcare would lift from 6% to 15% of the GDP by 2040. Only about one-quarter of that increase would be related to demographics; the rest of that increase would be linked to healthcare spending that is rising more quickly than the GDP, she said.
"When we talk about slowing growth rate of cost, we talk about doing it through efficiency. And the crucial part is that as good as the American system is, we do feel there is a lot of inefficiency," Romer said. The current healthcare system has up to about 30% that is "just being wasted," which means there is “a lot of fat that can be cut out without diminution of care."
If inefficiency was eliminated at the rate of about 1.5% a year, it would take about 25 years to totally eliminate it. "One-and-a-half percent may sound small, but it's enormous in terms of its effects of the economy," she said.
One way to achieve this would be through bundling of care when a patient is hospitalized and then released into the community for a 30-day period--where the providers are given the right incentives so patients aren't sent home too early. "That is such a win-win for patients and cost-effective," she said.
Insurance exchange
In additional testimony, a recent survey of small business owners in 16 states that was released at the hearing found that 81% of small business owners would support a health insurance exchange and that 66% of small businesses would be willing to share responsibility for paying for it.
"A system requiring an employer contribution--with appropriate levels of tax credits, sliding scales, and exclusions--will give small businesses the relief they need, potentially saving as much as $855 billion over the next 10 years, reducing lost wages by up to $339 billion and minimizing job losses by 72%," said John Arensmeyer, founder and CEO of the Small Business Majority.
Public plan
Jacob Hacker, a professor and co-director of the Berkeley Center on Health, Economic and Family Security at the University of California at Berkeley, encouraged the committee to consider public plans--particularly from the aspect that they could promote cost control.
"Medicare has a better track record than private health plans in controlling costs while maintaining broad access to healthcare, especially over the last 15 years," he said. As a way of illustrating this, he said that between 1997 and 2006, health spending per enrollee for comparable benefits grew 4.6% annually under Medicare compared with 7.3% annually under private insurance.
The committee also received feedback from its Republican members--many of whom had been closed out from the draft's creation. Rep. John Kline (R-MN), the new ranking minority member of Education and Labor, voiced a common sentiment among GOP lawmakers that the process was being rushed to meet a goal of completing a bill in the House before the August recess.
"That doesn't give us much time," Kline said.
He suggested that lawmakers consider a Republican proposal unveiled last week by the GOP Solutions Group.
"Today may be our first hearing but I hope it won't be our last. The proposal we are debating today is clearly partisan but I continue to believe that Republicans and Democrats can and should come together to develop an American plan,” he said.
A new branding effort at the Massachusetts-based Caritas Christi Health Care network included a "street team" component where people dressed in Caritas hospital T-shirts and hats dispensed coffee and newspapers in neighborhoods surrounding the hospitals. The rebranding campaign was the work of Beth Rice and The Rice Co. Here, Rice is interviewed about the effort.
While at first blush healthcare may appear to be a consumer business, says marketing consultant Barbara Bix, in actuality it is the quintessential professional services business that depends on a complex web of professional referrals. In this article, Bix outlines the steps one surgeon took to increase referrals 25%.
Small medical practices provide nearly 75% all ambulatory care in the United States, yet many lack the resources to improve the quality of care delivered or install electronic health records to serve an increasingly diverse patient mix, according to a report released today by the National Committee for Quality Assurance.
"Our research shows that small practices are willing to change and adapt their practices to best meet their patients' needs, be more accountable, improve quality and reduce disparities. However, they will need significant support," says NCQA President Margaret E. O'Kane. "When considering how to implement health reform that will work for America, small practices need special attention."
Training and development for physicians and staff on cultural competence, language needs, and quality improvement.
Tools, templates, and information resources, such as patient education materials in various languages, clinical practice guidelines, and templates for organizing medical information.
Shared services or staff to support interpreter needs, quality improvement initiatives, data management, and technical support.
Networking opportunities and learning "collaboratives" to hear from other practices, stakeholders and local, state, and national policy makers.
As more hospitals cut their budgets, it's important for staff members who work in quality and patient safety to understand what points to illustrate when making a case for joining a new initiative, launching a new quality improvement program, or asking for increased resources in the name of patient safety.
Depending on the size of the facility, people in different positions may be in charge of determining how to divvy up the budget or advocate for how to best use existing resources. That decision will usually include some involvement from the chief financial officer or other members of the hospital's executive team.
"Realize that CFOs now are more abreast of the clinical issues, and not just a number cruncher as they were 10, 15, or 20 years ago," says John Domansky, CFO at Knoxville (IA) Hospital and Clinics. "There's a lot more of a balanced approach now in the CFO world than there was in the past."
How to make your case
Domansky, who makes financial decisions for a critical access hospital licensed for 25 beds, says that he is interested most in programs that will minimize the hospital's risk, and in that vein, he'll pay more attention to those programs emphasizing a proactive approach to patient care (e.g., arguing for a bar-coding program for medications to prevent potential medication errors). However, if a staff member from quality or patient safety is presenting an idea to him, he stresses that he is interested in the hard facts of why that program is necessary.
"Make sure they have all their facts—what are we avoiding?" asks Domansky. "What are we saving here? How can we potentially justify this? If it was your money, how would you spend it? Try to anticipate the questions ahead of time." Specifically, he points to data concerning the number of incidences of a specific error and information gained from any root cause analyses done.
That same sentiment was echoed by Corey Reeves, CFO of Gordon Hospital, a 69-bed facility in Calhoun, GA, owned by Adventist Health System.
"It's important to be well-prepared," says Reeves. "Come with having thought through multiple sides of the argument, so that they can talk through and show that they have thought through all that that entails, the value added." It's apparent to Reeves and other members of the leadership team when someone has not anticipated these questions and prepared answers for them, he said.
During the actual presentation, Reeves says that whatever the topic, he prefers when he is briefed on the topic at a higher level, and then can asked more detailed questions about the points he is interested in.
"I would suggest you always start out at a very high level, and allow them to ask questions, to dig down deeper, and be prepared to answer those," Reeves says. "I would say something short to get their attention, and if they continue to want more, you're prepared to give more."
Don't forget to relate it to costs
Think about patient safety and satisfaction, but also financial impact.
"Give to-the-point, financial impact—especially if it's a positive financial impact, that will get their attention and they'll want to know more and how that's going to happen," says Reeves.
Hospital leaders making decisions about what new initiatives to take on each year are faced with the task of prioritizing, often in a world where seemingly every potential project could keep patients safer. One hospital leader cautions those pitching initiative ideas to use "the right thing to do" as the sole reason for taking it on.
"Don't hinge your whole pitch on just 'the right thing to do,'" says John Kane, vice president for quality and patient safety at Catholic Health in Buffalo, NY. "There [are] so many 'right things to do.' It's a given that patient-centered care is the right thing to do, but you don't need to make the assumption that quality always costs more."
Kane recommends tailoring a proposal to focus on the "dark green dollars" at stake. This term, being popularized by the IHI, refers to the money that can be attributed directly to the bottom line.
"As reform is coming down the line and it's really centered on cost reduction, as well as waste reduction, we're finding issues that give you strong motivation to go out there and try and figure out how you can get a return on investment through quality," says Kane. By focusing on safety within the organization, Kane says it is possible to reduce costs.
