Community Health Network has named Mike Blanchet president and CEO of Community Hospitals of Indiana, Inc., effective June 1. Blanchet, formerly the president of Community Hospital South, had been serving as interim president and CEO of CHI since late 2008. Blanchet's CHI oversight includes Community Hospitals East, North and South; Community Home Health Services; and ambulatory services in the Indianapolis market.
Daniel Fink, the newly named CEO of Riley Hospital for Children, said the top priority in his new job is to ensure the hospital meets Indiana's growing need for specialized pediatric care. Fink, who joined Riley in 2005 as COO, was named CEO. He replaces Ora Pescovitz, MD, who left this month to become CEO of the University of Michigan Health System.
I write a lot about wellness programs because I believe in them. If we are going to alleviate some of the staggering healthcare costs associated with a large and aging workforce, we have to correct many of the poor lifestyle choices we've made over the last few decades. For the sake of the younger workers who'll be saddled with our healthcare bills, we have a civic duty to live healthier lives, and the recession is providing tough motivation for many people to reevaluate their health status.
Front-line experts I've interviewed—the people on the hospital grounds, in the corridors and cafeterias who make these wellness programs work—say everybody wins if you leverage financial incentives like reduced health insurance premiums to nudge your employees to adopt healthy habits like moderate exercise and some diet modification.
Your employees are healthier and happier, grateful, and even a little wealthier with their reduced healthcare costs. Your company sees almost immediate return on investment in the form of reduced sick leaves and loss of productivity, and reduced long-term healthcare costs, particularly for treating obesity and other lifestyle-related diseases like diabetes, high-blood pressure, and osteoarthritis.
If you've yet to adopt a wellness program, now might be the best time. A new survey by the National Business Group on Health found that the recession is having a mixed impact on the way some American workers at large companies view their own healthcare maintenance.
The bad news is that more than one-in-four workers of the 1,500 workers surveyed in March report forgoing healthcare treatments to save money on copayments or coinsurance costs, and many report additional mental stress and anxiety. The better news is that more than half of the responding workers say that living a healthy lifestyle was more of a priority for them than it was one year ago.
"These data confirm that the widespread economic anxiety is cascading onto individual workers' health and well-being," says NBGH President Helen Darling. "The data also show that workers are more aligned with businesses about cost concerns and that individuals are taking demonstrable steps to improve their own personal health. For workers, businesses, and policymakers, this environment presents a 'teachable moment' to inculcate a renewed culture of health, including making healthier food choices and increased exercise."
This recession is a real drag. I don't want to sound glib with dismissive smiley-faced bromides about making "lemonade out of lemons" in the middle of a meltdown that has caused so much grief. But, we're all getting older, and we've known for years that we'd have to start taking better care of our health. Maybe this recession will be the impetus for change.
This dire economic environment is an ideal time to provide your employees with the tools and incentives they need to address their own health. They want to lose weight. They want to quit smoking. They want to eat healthier foods. They want to manage their stress. They need it. They deserve it. Your business will see the immediate and long-term benefits. What are you waiting for?
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While Congress was on recess this past week, work on healthcare reform was not taking a break. Behind the scenes, on Capitol Hill and at the White House, closer examination was being paid on how to how to pay for reforms and keep momentum going.
On Thursday, President Barack Obama spoke on a conference call with grassroots supporters while flying back to Washington to tell them he needs their help to pass healthcare reform legislation this year. "If we don't get it done this year, we're not going to get it done," the president said. "We're going to need to mobilize all of you."
A group linked with Obama—called Organizing for America—is preparing to kick off a national campaign to win nationwide support for Obama's healthcare agenda. The group, part of the Democratic National Committee, is organizing neighborhood meetings to take place this Saturday in homes across the country where healthcare will be discussed.
On Friday, Office of Management and Budget Director Peter Orszag wrote in his White House blog that healthcare reform will likely increase total national spending as healthcare coverage expands under current proposals. However, reform actions eventually will slow the growth of healthcare spending. "What we see is that it takes only 10 to 16 years after reform for federal healthcare spending to be lower than it would have been in the absence of reform," Orszag said.
Also, within the 10 year budget window, the impact of healthcare reform on the budget will be "negligible" because the plan is fully paid for. The short term increase in spending will be offset with greater revenues. Over the longer term, the budget situation "improves considerably" because healthcare spending declines and because taxable compensation increases, Orszag wrote.
A separate brief issued by the Congressional Budget Office on Wednesday looked at how healthcare reform options with varying levels of government involvement would be applied to the federal budget. Those options, discussed by CBO Director Doug Elmendorf in his blog, include an individual mandate, expanding eligibility for existing public programs, health insurance exchanges, and a public plan.
Under one scenario, premium income—either for a public plan (or plans) and for insurance purchased through exchanges or in the private market—should be classified as revenue if there is an individual mandate and tight government controls of the insurance market, wrote Elmendorf. Corresponding expenditures should also be recorded as outlays in the budget.
On Capitol Hill, Sen. Edward Kennedy (D-MA), who chairs the Senate Health, Education, Labor and Pensions Committee, is expected to release this week a proposal that also includes a public plan option. His proposal is expected to include an expanded health insurance program for children—to cover those up to age 26—and higher proposed pay rates (about 10% more than Medicare rates) for physicians participating in a public plan.
Sen. Max Baucus (D-MT), chair of the Senate Finance Committee, who said his panel plans to have a markup of a healthcare reform bill by mid-June, issued a joint statement with Kennedy indicating that they intend to report out bills from their committees that are "similar and complementary" and can be merged quickly into one bill. The goal is to have a bill on the Senate floor before the August recess.
On the White House side, Nancy Ann DeParle, director of the White House Office of Health Reform, met Wednesday with 30 physician leaders from across the country, including medical school deans, teaching hospital CEOs, medical specialty leaders, and practicing physicians, to talk about current reform issues.
The discussions included having a healthcare system that guarantees choice of physician and plans, invests in prevention and wellness, improves patient safety and quality of care, and assures affordable health coverage.
Public health policy scholar Cindy Mann, a key architect of the Children's Health Insurance Program a decade ago, has been named director of CMS' Center for Medicaid and State Operations.
"Cindy Mann has decades of experience in healthcare financing at the federal and state level, and vast knowledge of healthcare policy," says HHS Secretary Kathleen Sebelius. "She has devoted her career to working on behalf of children and families, the elderly and people with disabilities. She will be an outstanding leader at CMSO, particularly as the nation moves forward with healthcare reform."
Mann, who holds a law degree, most recently served as a research professor and executive director of the Center for Children and Families at Georgetown University's Health Policy Institute, where her research focused on health coverage, financing, and access issues that affect poor people.
From 1999-2001, Mann was the director of the Family and Children's Health Program Group at the Health Care Financing Administration, now CMS. She directed the federal oversight of the Medicaid program that covers families, children, and pregnant women, and she oversaw CHIP implementation. Before joining HCFA, Mann led the Center on Budget and Policy Priorities' federal and state health policy work. She also has worked on state-level healthcare, welfare, and public finance issues in Massachusetts, Rhode Island, and New York.
Resident care plans are being written in a new voice as more nursing facilities replace traditional medical-model care plans with "I" care plans.
"I" care plans, also known as resident-centered or person-directed care plans, attempt to move away from the medical model of care planning by focusing on individual residents' needs and preferences. "I" care plans are usually written in the first person, using statements like "I want to complete my rehabilitation quickly and return home as soon as possible."
Under the traditional medical-model care plan, many facilities state a diagnosis or problem, a goal, and then list numerous interventions. The problem with this model is the care plan is often not individualized for the resident, so the interventions don't work, says Bonnie G. Foster, RN, BSN, MEd, a long-term care consultant in Columbia, SC.
Proponents of "I" care plans say the new kind of care plans have the potential to transform care plans from paper compliance products to useful tools for nursing home staff members, improve quality of care, and encourage culture change.
Opponents say "I" care plans are too wordy and represent a semantic change rather than a true change in care. Person-directed care plans can seem like an exercise in semantics when nursing facilities simply replace "Mrs. Jones" with "I," says Michele Nolta, CTRS, ACC, owner of Recreation Therapy Consultants in San Diego and the author of a book about care plans.
To write a true "I" care plan, staff members must use the resident's own statements, Foster says. In other words, staff members can't invent an "I" care plan without input from the resident.
Nursing facility staff members are often concerned about how surveyors will react to "I" care plans. Foster says that while she can't predict what a surveyor will do, nursing facilities must have the proper documentation to support care plans.
"A care plan tells staff members how to take care of a resident," she says. "It doesn't matter how you write it if you don't have the documentation to back it up."
The countless news stories and articles describing the unsafe conditions caused by sleep-deprived medical residents have triggered fear in the public. But now it's hospital administrators' turn to worry because curtailing resident work hours could be more costly than they originally thought.
The Institute of Medicine released a report in December 2008 recommending new standards that would reduce resident work hours to improve patient safety. The IOM report estimated the cost of implementing the reforms at approximately $1.7 billion. But a new cost analysis says shifting residents' work to alternate provides could cost between $1.1-$2.5 billion.
That's about $3.2 million annually per teaching hospital, says Teryl K. Nuckols, MD, lead author on the report, internist at the David Geffen School of Medicine at University of California, Los Angeles, and researcher at RAND Corporation.
Although the IOM's recommendations have not yet been adopted by the Accreditation Council for Graduate Medical Education (ACGME), which implemented the current standards in 2003, graduate medical educators and hospital executives are already asking where funding for new reforms is going to come from. Most GME programs don't have an extra $3.2 million burning a hole in their budgets.
"The question that needs to be answered is whether teaching hospitals should be expected to shoulder [this] financial burden or not, and if not, where should the money come from," says Nuckols.
As policy makers determine how to fund duty hour reform, they may consider the cost of implementing reforms to society versus those of teaching hospitals. The cost analysis looks at the financial implications associated with both increases and reductions in medical errors for society and teaching hospitals.
For example, if duty hour reforms lead to fewer medical errors, the costs associated with those errors are reduced, such as the potential for lost wages if a patient cannot return to work, additional medication, or in-home medical care.
Nuckols calculated that a hypothetical 10% increase in preventable adverse events will cost teaching hospitals $183 per admission, and $266 for society if hospitals employ alternative care providers, such as attending physicians, midlevel providers, nurses, and laboratory technicians.
A 10% decrease would result in a $99 cost per admission for teaching hospitals and $17 for society. The cost for society is free if there is an 11.3% decrease in preventable adverse events.
"Even if these reforms are extremely successful, teaching hospitals will be out a substantial amount of money," Nuckols says.
Because these costs are based on hypothetical scenarios, there's a chance the actual amount hospitals will have to pay alternate providers will be much higher, says Kenneth S. Polonsky, MD, chairman of the Department of Medicine at Washington University in St. Louis School of Medicine.
For example, the report stated that the base case hourly wage paid to an attending physician to cover residents would be $58. "In areas where there are physician shortages, people are not going to be lining up for the opportunity to earn $58 to cover the shift from midnight to 5 a.m. so that the resident can get some sleep," Polonsky explains.
"It's either going to get passed on to patient, paid by the government, or picked up by the hospital, leaving less available for a variety of other things that could be useful," Polonsky says. Or, it could be a combination of all three of those entities.
The cost analysis report lists possible options for funding new duty hour mandates, such as reducing residents' salaries, increasing faculty physicians' workload without additional compensation, allowing profitability or quality of care to decline, cutting clinical services, or not implementing the recommendations.
"None of [these] are very attractive options," Nuckols says.
With such a large cost associated with these reforms, Polonsky says hospital executives should be weary of the fact that there's no strong evidence to demonstrate that the IOM's recommendations will actually improve patient care. This is a large sum of money to throw at a problem without a guarantee that it will work.
Instead, Polonsky urges hospitals to implement pilot tests of some of these recommendations. Once evidence exists to determine whether their effectiveness, they should become requirements.
Hospitals plan to begin a lobbying campaign to prevent Congress from including charity care requirements in legislation to overhaul the healthcare system. The Senate Finance Committee is considering a bipartisan proposal that would require hospitals to provide "a minimum annual level of charitable care" as a condition for getting or keeping the tax-exempt status available to charitable organizations. In a bulletin, the American Hospital Association urged hospital leaders around the country to contact Congress by telephone or e-mail.
Senate committee chairmen Senators Edward M. Kennedy of Massachusetts and Max Baucus of Montana issued a joint statement saying they would "seek common ground on health reform legislation," despite reports that they disagreed on the shape of a new public health insurance plan that many Democrats want to create. The statement came a day after a report that the two Democrats disagreed over the details of a government-sponsored plan. The statement did not mention the proposal for such a plan, which would compete with private insurers.
Up until now, much of the quality data collected by health plans on children nationwide focused on measures that indicated if care was received—for instance, were immunizations up to date or had well-child visits been completed. Changes may be afoot, though, as the National Committee for Quality Assurance, working with The Commonwealth Fund, looks to get a broader view of well-child care with expanded quality measures.
These older process measures "don't tell us what happened," said Sarah Scholle, DrPH, NCQA's assistant vice president of research and analysis and co-author of NCQA's new report on Quality of Child Health Care: Expanding the Scope and Flexibility of Measurement Approaches released on Thursday. For instance, did a child have a specific developmental screening during a visit or was an adolescent counseled about risky behaviors or vehicle safety?
Over the years, the public and private sectors have invested less in quality measurement and standardization for children than for adults, according to Scholle. However, the recent passage of the Children's Health Insurance Program Reauthorization Act is expected to change that. The legislation directs the Health and Human Services secretary to identify a core set of quality measures for all state-run Medicaid and CHIP programs to collect starting in 2010.
In order to decide which measurement tools to include, a panel of child health experts was convened last year to identify a strategy. To start out, NCQA is evaluating a framework for prevention that includes measures at specific milestone ages: before an infant turns six months old and by a child's 2nd, 6th, 13th, and 18th birthdays. The areas of focus are: protection of health, healthy development, safe environment, and management and follow-up of health problems.
Incorporating these measures would mean, for instance, monitoring if an infant had a newborn metabolic screening or physical growth assessment; if a toddler had a lead screening or an autism screening; or if an adolescent had a blood pressure assessment or weight assessment or counseling.
"NCQA would consider incorporating measures in our HEDIS (Healthcare Effectiveness Data and Information Set) data set for health plan reporting, as well as whether there are opportunities to use it for evaluating care at the physician level," Scholle said.
NCQA is currently preparing detailed measure specifications and will conduct a field test of proposed comprehensive well-care topic areas. An issue brief on the quality of child healthcare is available from the Commonwealth Fund.
