Labor unions and Catholic leaders have reached an agreement designed to end years of bitter hostilities that often surrounded union efforts to organize workers at Catholic hospitals. The accord seeks to apply Catholic teachings that recognize the right of workers to "freely and fairly" decide whether to join a union. One of the key principles directs both employers and unions to refrain from harassing, threatening, intimidating, or coercing workers.
Lawyers for a South Dakota urology clinic have asked a judge to dismiss a lawsuit filed by five Iowans who might have been exposed to blood-borne infections. State health officials warned patients in April that there was a risk of infection because some medical equipment at the clinic was being reused. Five former patients from Iowa sued the clinic for emotional distress even though they were never exposed to a virus or infection. The clinic's attorneys argued in their motion to dismiss that exposure was needed before most courts would allow the patients to sue.
A $20,000 procedure to replace a knee ravaged by arthritis in the elderly is generally a good deal for both patients and the federal Medicare program that pays the bill, according to a study. In the study, based on a computer model using Medicare claims and other data, total knee replacement provided about one year of better quality of life compared to that experienced by patients who didn't have the procedure, researchers said. The analysis found that the year of benefit cost about $18,300. Researchers said the amount fell well within the threshold of $50,000 per year of better-quality life generally considered as cost-effective.
Of course, BAs must comply directly with the HIPAA Security Rule and components of the Privacy Rule by February 18, 2010.
One HIPAA privacy and security officer told us in a focus group she's concerned because it's not clear what a covered entity's role should be as far as educating BAs. (Technically, covered entities have no obligation to train BAs).
That same HIPAA officer is working on a final draft of a BA contract, and her facility is unsure whether it will have one standard contract or individual language for each BA.
It makes sense for a covered entity to develop a template, and then only change some of the details; in particular, the description of what uses and disclosures of PHI the BA is permitted, according to Kate Borten, CISSP, CISM, president of The Marblehead Group and a HIPAA privacy and security expert.
John C. Parmigiani, MS, BES, president of John C. Parmigiani & Associates, LLC, sees some BAs abandoning healthcare because they fear they can't fully comply with HIPAA.
Perhaps the most telling news is that some covered entities don't know all of their BAs, and they're trying to identify them.
All this with a crucial eight-month road ahead for covered entities and BAs as they get ready to comply.
In the next eight months, HHS will define the meaning of unsecure PHI, which goes hand-in-hand with new breach notification requirements. CMS will also publish its definition of "meaningful use" regarding EHRs.
And then the big date–February 18, 2010–which is the compliance date for BAs under the Security Rule and HITECH.
If you don't have a grip on your BAs by then, you'll not only be behind the 8-ball but the entire rack on the pool table.
Borten says there is "absolutely no excuse" to not know all your BAs.
She reminds covered entities they must not only know their BAs, but also must already be entered into contracts with them per the HIPAA Privacy and Security rules.
"You absolutely have to know who they are," Borten says. "And you have to make sure you have legal contracts, and that they have all the language required in the Privacy and Security rules. This should all be in place now. Imagine an auditor walking through the door and asking for this, and you can't produce it? You're in big trouble right off the bat."
Potential BAs are organizations that provide data transmission of PHI, such as Regional Health Information Organizations.
The act also clarifies that personal health record vendors who contract with covered entities to provide a PHR to their patients or health plan members are another example of BAs.
With travel budgets slashed, some of you probably didn't make it to this year's HFMA conference in Seattle. While traveling to a conference across the country may be a pain, I find that once I'm there I'm energized by the crowd's enthusiasm and this year was no different, especially given all of the new pressures hospitals are facing.
One of my colleagues said he had heard that attendance was down and people seemed depressed—a logical conclusion given the economy. However, as I noted in my post last week, the exhibit floor was the perfect setting for an antidepressant commercial, while the session hall was upbeat. This year's conference was especially important because many of the sessions were covering issues that hospitals are trying to understand better, such as RACs, patient collections, and tax-exempt status.
Here's a wrap up of some of the more interesting topics and conversations that made it to the top of my list.
Estimate your tax bill now!
There are still more questions than answers when it comes to knowing how to prepare your finances in the event of a loss of tax-exempt status. Provena Health's Gary Gasbarra, system vice president, chief accounting officer, and corporate controller, along with other panelists, discussed Provena Covenant Medical Center's loss of tax-exempt status and challenges that other hospitals face. Of chief concern is that all nonprofit hospitals' tax-exempt status may go away if Sen. Grassley (R-IA) and other legislators have their way once healthcare reform passes.
While some hospitals are taking a wait-and-see attitude, panelists urged hospitals to be proactive and at least take the steps to estimate their property tax bill should their tax-exempt status be revoked. Along these lines, panelists talked about roadblocks associated with finding someone who can help you assess the value of your real estate. Another issue, says Gasbarra, is tax authorities' lack of understanding in whether they should be measuring gross or net revenues. Some states, he says, are measuring net.
Getting RAC ready
"You are going to get a RAC audit and it will be a three year look-back. You need systems in place today," said Elizabeth Lamkin, CEO of 93-bed Hilton Head Regional Hospital, in her opening remarks to an audience that was eager to learn about her experiences as a RAC audit survivor. As noted in our earlier coverage last week, Lamkin said in preparing for an audit, organizations must first have the right physician advisor in place to handle medical necessity cases and this person must have a strong relationship with case managers. Panelist, Rudy Braccili, senior director, national Medicare center for Conifer Health Solutions, also noted that appeals cost an average $3,000 to $7,000 to file, which is not reimbursed if you win. There are five opportunities to appeal and it takes five years to exhaust all levels of appeals, he said.
"Be sure to only appeal cases in which you have sound reason to appeal because you have to pay interest on payments." The highest dollar take-back is from medical necessity cases, he said.
What happens after reform?
While the healthcare reform debate came up often during the conference, Brenda Snow, executive vice president of strategic planning and analysis at MedAssist, a revenue cycle services company, is proposing that the conversation start to move past "will there be healthcare reform?" and begin to focus on "the order of magnitude" reform will have on healthcare. Healthcare organizations need to be thinking about what will hit them first, she says.
"Do we identify first and second phase activities and if so when do we raise issues like tax exempt [status] and how do we respond to that as industry?" asks Snow, formerly with Geisinger Health System. If near universal coverage happens and if tax exempt status reform happens, it may take providers at 3% margins down to zero, she says. "A lot of small community hospitals are not only the primary provider of services but they are also a primary employer. Are providers thinking in those terms?"
Moreover, says Snow, the industry is still at the phase where it is trying to understand buzz words like "administrative simplification" and "meaningful use" when it needs to move to the next level of tactical information. "A draft on meaningful use was released from David Blumenthal. Well, from a provider perspective how will that impact their spending if they cannot demonstrate that added technology brought about better outcomes?" As an industry we should be thinking about those "what if" questions, says Snow, "not just trying to understand the buzz words."
Is your team operating in peak condition?
Think your leadership team is a peak performer when it comes to communicating with one another? Patrick Lencioni, who gave the keynote address on day 1 (read the wrap up) of the conference is the author of The Five Dysfunctions of a Team. He says the absence of trust on even the best of leadership teams can ruin a company. Identifying trust issues is tricky. Management teams often fall into the trap of believing that trust exists among its members, simply because they have known each other for a long period of time.
But true trust, he says, comes when human beings on a team can be vulnerable and say things like I don't know the answer." As Lencioni tells it, one famous CEO, who ran his company into the ground, was brilliant but so intimidating nobody on his team would give him truthful feedback." This company spiraled out of control," he says. "When the Wall Street Journal says a company had a product issue, the real issue is there was no trust and vulnerability on the executive team."
Finding the right approach to patient collections
A lot of talk this year involved improving patient collections, from front to back end, especially with the continued growth in the self-pay population. As this population continues to grow, it will become critical for hospitals to have a strong program that not only segments patients on the front end, but is automated front to back. Some hospitals, in an effort to be as patient friendly as possible are carrying large balances in their patient payment plans and operating like a bank, while others are developing programs that offset some of that debt, at least temporarily, onto banks.
In Birmingham, AL, St. Vincent's Health System drove down accounts receivable days from 50 to 34 by implementing a patient credit card program that allowed the system to immediately collect on the debt from the issuing bank. "When you look at the parameters around the loan program and the no qualification score, you are rolling dice and hoping the patient will come through. You can do this intelligently by monitoring your recourse rates closely," said Jerry Smith, vice president of revenue cycle at St. Vincent's.
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Stephen D. Faro joins North American Spine as the company's new COO. Faro has 15 years of healthcare experience, specializing in the development, growth, and operations of surgical facilities. Faro most recently served as COO of Nashville-based Neospine, a company that partners with neurosurgeons and orthopedic spine surgeons to develop and manage outpatient spine care and surgery centers. In 2001, Faro helped found Surgical Alliance Corp., a Nashville company that developed musculoskeletal specialty surgical hospitals and outpatient surgery centers.
Judith Rich, RN, has been appointed president and CEO of TMC HealthCare. Rich has served as executive vice president and hospital administrator since July 2007. Rich, a graduate of the University of Pennsylvania, began her career as a hospital staff nurse. From there, her positions progressed from a public health nurse to leadership positions at TMC. She served as COO from 2003-05 and returned to the hospital in 2007 as executive vice president and administrator. In addition, Rich has been named a member of the 2009 board of directors of the Arizona Hospital and Healthcare Association.
Allina Hospitals & Clinics' president Ken Paulus officially added the title and duties of CEO with the retirement of Richard Pettingill. Paulus has served as Allina's COO since joining the organization in 2005. He was named Allina president and CEO-designate last summer when Pettingill's retirement plans were announced. Paulus came to Allina from Massachusetts-based Health One Care System and the Harvard Vanguard Clinic, where he was president and CEO.
The National Quality Forum has tapped Thomas B. Valuck, MD, as its new senior vice president of strategic partnerships. Valuck comes to NQF from CMS, where he was both medical officer and senior adviser in the Center for Medicare Management.
National Rehabilitation Hospital founder, president, and CEO Ed Eckenhoff will step down effective Oct. 1. Current NRH COO John Rockwood has been named President, succeeding Eckenhoff. Rockwood has been with NRH since 1992. Eckenhoff founded NRH in 1986. In his new role as president emeritus for the hospital, Eckenhoff will serve as a consultant to both the Board and the new president, chair the long-range planning effort, and continue to assist with fund raising efforts.
