One of three downtown Nashville buildings could be home to a new medical trade center planned by a Dallas-based company. Market Center Management Co. also is seeking to use space in the existing and proposed Nashville Convention Center for healthcare trade shows, seminars, and continuing education programs that it hopes to bring to the city, said Bill Winsor, its chief executive.
The former co-owner and board chairman of City of Angels Medical Center has pleaded guilty to paying illegal kickbacks for patient referrals. Robert Bourseau, 74, admitted in U.S. District Court to paying illegal kickbacks as part of a scheme to defraud Medicare and Medi-Cal by recruiting homeless people from Los Angeles' skid row.
Bourseau is the fourth person to plead guilty in a widespread scheme to exploit those living on the streets for their medical benefits.
Salem, IN-based Washington County Memorial Hospital has filed for Chapter 11 bankruptcy but will continue to operate as it reorganizes its finances. The hospital's operator, Critical Access Health Services Corp., said in a statement that it will pursue an agreement for St. Vincent Health or another company to operate the hospital. St. Vincent will provide management services during the reorganization, according to the statement.
Physicians coming out of residencies last year reported increases in their starting salaries in many specialties, according to a survey by the Medical Group Management Association. The lowest starting salary in 2008 was for pediatricians at $132,500. The other lowest-paid specialties, in ascending order: family practice, geriatrics, urgent care, internal medicine, and infectious disease. The highest specialty salary was for those starting out in neurological surgery at $605,000.
The Latvian health minister has resigned rather than carry out budget cuts that he said would undermine the Baltic country's healthcare system. The government in Riga, the capital, said that the health minister Ivars Eglitis had resigned after he refused to carry out spending cuts. Prime Minister Valdis Dombrovskis said in the statement that Eglitis had "chosen the easiest way as it is clear that the healthcare system is facing a process of complicated, urgent and essential reforms."
Medtronic announced that it had paid nearly $800,000 over an eight-year period to a former military surgeon who has been accused by the Army of falsifying a medical journal study involving one of the company's products. The surgeon, Timothy R. Kuklo, MD, claimed in the study that the use of a Medtronic bone growth product called Infuse had proved highly beneficial in treating leg injuries suffered by American soldiers in Iraq. A British medical journal that published the article retracted it after an internal Army investigation found that Kuklo had forged the names of four other doctors on the study and had cited data that did not match military record.
Washington, DC-based Howard University Hospital is offering free medical treatment for low-income uninsured patients in a new clinic on the first floor of the hospital. The New Freedmen's Clinic will be run, staffed and funded by medical students from the Howard University College of Medicine.
The American Hospital Association's criticism of CMS' proposed -1.9% documentation and coding adjustment came through loud and clear in the comments it submitted to the agency June 15. The association disagrees with the methodology CMS used to draw the conclusion that there was a decline in real case mix between fiscal years 2007 and 2008, stating the agency's findings were "incorrect and overstated."
The proposed pay cut would reduce hospital payments over the next 10 years by $23 billion—not a particularly easy number to swallow given today's economic climate.
To analyze documentation and coding-related increases in FY 2008, CMS, as outlined in the FY 2010 IPPS proposed rule, ran FY 2008 claims data through the FY 2008 GROUPER to obtain a case-mix index (CMI). It then ran these same claims through the FY 2007 GROUPER to obtain a second CMI. It divided the former CMI by the latter to obtain an increase of 2.8%, which it attributed to documentation and coding changes as well as GROUPER changes.
It performed a similar analysis to determine the effect of GROUPER changes (0.3%) and found there was a documentation and coding-related increase of 2.5% in FY 2008.
The agency attempted to use Clinical Data Abstraction Center (CDAC) medical records data to corroborate its findings and to distinguish documentation and coding changes from real case mix changes; however, it was unable to do so because of what it termed "aberrations and significant variation in the data," according to the proposed rule.
CMS said the methodology it used is sound because only one set of claims (i.e., one set of patients) were factored into the analysis. This means that increases to CMI couldn't possibly reflect actual increases in patient severity, according to CMS.
It's a self-fulfilling prophecy, says Kimberly Hoy, JD, CPC, regulatory specialist for HCPro, Inc. in Marblehead, MA. "CMS decided there would be a documentation and coding effect based on data from the skilled nursing facility and home health PPS implementations, so it's no surprise they used data that supports that assumption," she adds. "What is a surprise is that they didn't seem to account for any rise in the real case mix index at all."
In fact, CMS indicated in the proposed rule that its data showed a decline in the real CMI, implying that inpatients have lower acuity in 2008 than in 2007. Hoy adds. "To say that inpatients are less sick than they used to be just doesn't make any sense in an environment that is encouraging more and more outpatient procedures and observation services."
For example, three states with the largest Medicare population (New York, Florida, and California) were entrenched in the Recovery Audit Contractor demonstration program during this time frame, Hoy says. "Many people in those states were moving patients to outpatient status out of fear of denials for one day stays," she adds. "Some of those patients may have been a low level inpatient in the past, but moving them out of inpatient status to outpatient status would cause the case mix to drift upward as the sicker patients remain inpatients."
The AHA states the following: "The Recovery Audit Contractor program is encouraging hospitals to carefully scrutinize patients and shift care to the outpatient setting to avoid retrospective denial of short-stay admissions. This change in practice will increase the average acuity within each base DRG of patients that remain in the inpatient setting."
The AHA also cites several other policy changes that could have caused increases in real CMI:
Implementation of the present on admission indicator that leads hospitals to assess patients for a broader array of conditions, likely resulting in the identification, treatment, and coding of additional secondary diagnoses.
Acceleration of beneficiaries enrolling in Medicare Advantage programs due to The Medicare Prescription Drug, Improvement, and Modernization Act of 2003.
Dramatic changes in the criteria for procedures that providers can perform in an ambulatory surgery center. These changes that took effect in calendar year 2008 likely resulted in increased acuity in the inpatient setting.
The AHA advocates for an alternative approach of comparing the overall CMI growth of 1.9% with the historical average for real CMI of 1.2% to 1.3% because this would put the increase in a larger context.
The bad news for hospitals is that this is an across-the-board cut, Hoy says. "In my view, every hospital will see similar negative effects," she adds. "And unfortunately it took congressional action to change their prior proposals related to the documentation and coding adjustments, so I am not hopeful they will change this proposal significantly in the final rule."
The AHA strongly urges hospitals to submit comments on the proposed rule before CMS' June 30 deadline.
Hickory Starr has been working for the Indian Health Service for 28 years, for 14 years as a hospital CEO. And he's used to dealing with very big problems in providing good care.
But when a gust of wind 10 days ago tore down the power lines and incapacitated his Indian Hospital in Lawton, a 28-bed critical access facility in Southwestern Oklahoma, he says, "I just wanted to scream."
He characterized the cascade of system breakdowns that ensued as like a "Trail of Tears," all of which he says were caused by preventable human errors, not because the 40-year-old hospital is "run down."
"Lots of human errors," he repeated. "Lots of human errors."
Here's how the system failed to work, he explains.
About 8:30 p.m. Sunday June 7, a 60 to 70 mile per hour wind storm caused power lines to cross, which caused a short in the electrical lines to the hospital and power was lost. That activated a surge protector and an emergency power generator, just as expected.
But the surge protector only had enough battery power to last two hours. And unbeknownst to Starr, areas of the hospital that provide essential medical services weren't attached to the backup generator, he says. Those portions of the hospital all shut down as well until power lines were fixed the next day.
"When the computer system powered down, it caused some damage (to the computers) and it took until 7:30 p.m. Monday before it was back on line," Starr says.
"We became incapacitated. What if something had happened—a patient brought here because of a car wreck?" he asks. "We would not have been able to take care of them. And that puts everyone at risk."
The computer system wasn't the only thing that wouldn't work. The radiology equipment shut down so patients could not get X-rays or ultrasound tests. The freezers and refrigerators lost power so the kitchen had to be closed. All the food and some supplies of medicine had to be thrown away.
The coil for the $200,000 air conditioner "chiller" system was damaged, leaving the hospital without air conditioning, and the phone system powered off and couldn't be reset until someone who knew how to do it came in the next day.
Luckily, there were only two patients admitted at the time and neither was reportedly harmed by the outage. But for patients awaiting care in the emergency department, which sees about from 100 to 120 on a weekend day, and for about 300 who came to the outpatient clinic on Monday, care slowed almost to a halt, Starr says. "It messed up our outpatient center big time. We couldn't do prescription refills or pull up a patient's chart."
Starr says that "a lot of patients were pretty angry. They had longer wait times because we had to go back and find everything on paper. It slowed everything down."
Just about everything that could go wrong did go wrong. "Trail of Tears. You can call it that, because that's pretty much what it was," says Starr, a member of Cherokee Nation of Oklahoma.
Starr's investigation into the events this last week led him to other unsettling realizations. He learned that his engineers never connected parts of the hospital's electrical systems to the backup generator because the generator wasn't powerful enough to handle them, especially after a 36,000 square foot ambulatory care center was built two years ago.
"I asked the engineers, why wasn't the computer system on the emergency generator," Starr says. "I was told, 'It's not large enough to handle the work load. I had to take something off.'"
He says in the past he had repeatedly asked his engineers if the generator was hooked up, and was powerful enough, but says he was told that it was adequate.
"I literally want to scream out of frustration," Starr says.
Starr describes a culture of apathy, anger and despair that pervades the attitudes of some of his key employees, many of whom he says knew of the 40-year-old building's fragility but never discussed it with him. Perhaps, he says, after years of disappointment and seeing so many unmet needs from Indian Health Services, they believed the problems would never be fixed. Better to just work with what you've got.
"But we're a healthcare facility, and patients are going to continue to need us regardless of what's going on with the weather," Starr says. Members of the seven tribes in the region that use the hospital "expect things to be here. But if you don't have your system in place, you can't provide the services you're supposed to. It's just infuriating," he says.
Starr, who has been CEO of Indian Hospital in Lawton for almost seven years, is still in a bit of disbelief that practices he didn't know about made his hospital so vulnerable--to an event so mundane as a change in the weather.
But he is encouraged that additional money from the Indian Health Service budget this year will help him buy another more adequate generator. Hopefully it will be big enough to handle the entire hospital.
The slumping economy has led to surging nurse employment rates that could soon end the nation's 11-year shortage, according to a study released Friday in Health Affairs.
The study that examines the recession's effect on the nursing profession reports almost 250,000 nurses entered the workforce between 2007 and 2008. This is the most significant two-year increase in RN employment in the last 30 years.
The study cites nurses over the age of 50 make up more than half of the increase—many of whom delayed retirement or rejoined hospital settings to compensate for spouses losing jobs or out of fear that they might lose their jobs. In addition, in 2008, there was a hike in foreign born RNs (48,000), RNs between ages 23–25 (130,000), and RNs who came from nonhospital settings (50,000).
Peter I. Buerhaus, PhD, RN, FAAN, lead author of the study and professor at the Vanderbilt University School of Nursing in Nashville, says the unprecedented surge in employment is likely to ease or end the nursing shortage in many parts of the country.
But only momentarily.
"While we see this easing, people need to remember it is likely to be temporary, and last only as long as the economy is bad," says Buerhaus, who projects a nursing shortage will return in 2018 and develop into a loss of 260,000 RNs by 2025.
Buerhaus and a team of researchers analyzed data from 1973 through 2008 for the study. This included nationally representative surveys of more than 100,000 people that are administered monthly by the U.S. Census Bureau. The surveys comprised information of individuals between ages 23–64 who reported occupations as RNs.
The study findings present healthcare policymakers and providers with opportunities to strengthen the workforce, says Buerhaus.
For instance, policymakers must consider the majority of nurses who are supplying the market.
"Older nurses are eventually going to retire, and once they do they will be lost to the workforce unless there are extraordinary circumstances," Buerhaus says. "That retirement will occur over the latter part of the next decade and lead to a shortage of nurses because the demand for healthcare will increase."
Boosting the capacity of nursing education programs is necessary to finding a balance, he says. If more nurses can accelerate into the labor force, they can replace the aging Baby Boomers.
Rose O. Sherman, EdD, RN, NEA-BC, CNL, director of the Nursing Leadership Institute and associate professor at the Christine E. Lynn College of Nursing in Boca Raton, FL, also emphasizes the need for sufficient education as the workforce continues to age.
"It is important we ensure that professional knowledge gets transferred to our next generation of nurses," she says.
Still, right now many novice but educated nurses are finding job opportunities are slim.
"With an increased availability of experienced nurses, many hospitals have elected to either reduce the number of new graduates they are hiring this year or are not hiring new graduates at all," says Sherman.
Despite this, she notes nursing leaders are now able to staff their units with experienced nurses, and turnover in most employment settings has dropped significantly. Furthermore, traditionally hard-to-fill units, such as medical surgical and telemetry, have benefited from these trends.
"In academic settings, we are seeing more nurses returning to school to continue their education and make themselves more marketable," says Sherman. "This is very good for the profession."
Looking to the future, Buerhaus recommends healthcare providers make efforts to improve their ergonomic environment and minimize physical strains on the workforce. As a result, seasoned nurses may be less likely to depart their hospitals once spouses are re-employed and the economy picks up.
Novice or experienced, all nurses are needed to face the challenges ahead.
"Healthcare reform debate is moving forward and my hope is that policymakers and legislators will realize that unless there is an investment in the nursing workforce, the goal to expand healthcare coverage and increase quality will not be met," Buerhaus says. "If we expect large shortages to develop, they will be even larger when 45–55 million people are granted economic access to healthcare."
