Ventilator-associated pneumonia (VAP) has been a constant headache for hospitals around the country, and on the list of IHI interventions since the inception of the 100,000 Lives Campaign in 2006. It is one of the most-acquired conditions by intensive care unit (ICU) patients on ventilators and its presence exacerbates existing conditions, as well as adds costly days spent in the ICU.
UPenn Health System (UPHS) in Philadelphia utilized an electronic ICU (eICU), which uses telemedicine to monitor patients, already in place to help lower its rates of VAP and realized a cost savings of more than $138,000 over a two-year span.
An eICU can add an extra level of monitoring for ICU patients. Not only does it provide visual surveillance, but it offers a level of data and analysis that simply utilizing bedside caregivers cannot.
"Telemedicine receives alerts and alarms through a software package," says Joseph DiMartino, BSN, RN, outcomes coordinator for UPHS. The eICU monitors different quality initiatives at the Hospital at The University of Pennsylvania, Presbyterian Hospital, and Pennsylvania Hospital. "That allows us to see and detect alerts for patients earlier than maybe the bedside nurse might see."
He explains that often bedside caregivers set patient alarms so that they only go off in an extreme emergency and are not ringing all day, as a distraction. The eICU's system is set to be alerted whenever there is a 20% or higher change in a vital sign and the eICU staff members can alert the bedside caregiver if it is necessary.
eICU setup
The UPHS eICU was started in 2005, and the VAP initiative began in 2006. The eICU contains three surveillance stations—two for each of the nurses monitoring patients and one for the doctor monitoring patients. There is a smaller setup for the data coordinator as well.
A surveillance station contains six computer screens, each displaying pertinent data, pictures, or video, mounted on a desktop. Additionally, a phone and any alarms necessary are attached. Currently, the eICU is staffed by two nurses from 11 a.m. to 11 p.m. and one nurse 11 p.m. to 11 a.m. Additionally, a physician monitors the eICU from 7 p.m. to 7 a.m. The data coordinator's shifts vary.
If the eICU staff members recommend a change to the ICU bedside caregivers in the morning, the eICU staff members look to see that the change has taken place by that night.
Successful results
Data from the original ICU show that in 2006 there were 17 cases of VAP. That number dropped to nine in 2007 because of the eICU surveillance. The program has been expanded to ICUs at all three UPHS hospitals and continues to reduce VAP numbers.
Integrating eICU technology with VAP prevention
DiMartino's team originally approached the bedside team at a specific ICU at Presbyterian Hospital to discuss using telemedicine to lower the rate of VAP. Although the idea was accepted overall, some staff members needed to warm up to the idea.
"There are always individuals who aren't really accepting of the eICU and what we do, people might think we're spying on them, another set of eyes," says DiMartino. "We're trying to show them how we can help them." Staff members really needed to be educated about what telemedicine actually is, as well as the eICU’s responsibilities.
The eICU surveillance team was trained to watch for the care techniques identified in the IHI's bundle of care for preventing VAP. This means head of bed elevation between 30 and 45 degrees, stress ulcer prophylaxis, and DVT prophylaxis. The bedside caregivers are responsible for measuring whether daily sedation holidays have been implemented and the patient's readiness to extubate.
To adequately estimate a patient's head of bead elevation, the data coordinators working at the eICU underwent a two-week training period that helped them become accustomed to identifying this.
"We have the ability to go in and visualize what's going on in the room, so we trained the data coordinators to figure out where the head of the bed is elevated based on visual cues behind the bed—if the bed is flat, or at 10, 20, 30, or 40 degrees elevated," says DiMartino.
Additionally, eICU staff members check each patient's documentation to ensure adequate prophylaxis has been ordered, and is being delivered. Is the patient taking an anticoagulant? Does that patient have compression boots, and are they being worn properly? The same goes for stress ulcer prophylaxis—has an acid blocker been prescribed and administered?
Crowded emergency rooms, ambulance diversions, and bed capacity issues in hospitals have created a crisis that politicians, administrators and patient advocacy groups are scrambling to address. For the most part, hospitals try to fix these problems by improving processes in or expanding the emergency department (ED), or by building new inpatient beds. In some cases, these are the right approaches. But in many others, the solution lies elsewhere.
Surprisingly, one of the main culprits causing both ED overcrowding and inpatient capacity issues is the operating room schedule. Although it seems counterintuitive, research shows that the elective surgery schedule is the primary source of the peaks and valleys in hospital census. In contrast, emergency admissions to the hospital, although randomly occurring, are often more predictable on a day-to-day basis than elective surgical admissions.
The variability in admissions caused by the elective surgical schedule causes capacity constraints for inpatient beds and the ED on days with heavy surgical volume. As the hospital fills with scheduled cases, the flow of emergent/urgent cases competes with the scheduled surgical cases for the few remaining inpatient beds, causing unpredictable nurse-patient ratios, slowed admissions from the ED, equipment conflicts and patient placement on inappropriate inpatient units during peak census. During the valleys, beds are empty, operating rooms (OR) run at low utilization rates, and staff is sent home.
The keys to solving these problems are to eliminate the peaks and valleys in patient flow caused by the variable volume in scheduled surgical cases, and to develop the ability to predict and manage the emergent/urgent volume. By actively managing patient flow, hospital leadership can increase the effective capacity of the hospital, the OR and ED, improve patient outcomes, increase staff morale and retention, reduce costs, and improve quality of life for both patients and caregivers.
The Problem of Peaks and Valleys Looking at Block Scheduling
The OR schedule is the primary driver of the hospital's inpatient census. Examination of the block schedule will help identify the sources of the peaks and valleys in elective case volume throughout the week. Block scheduling for elective surgery is usually based on surgeon preference or requirements, history, convenience and utilization. Rarely is a block schedule designed to smooth case volume throughout the week or to optimize a patient's placement on an appropriate nursing unit post-surgically.
Most ORs have peak days in the surgery schedule, usually on Tuesday or Wednesday. Surgeons who perform complex cases with longer lengths of stay want to do them early in the week so patients can be discharged before the weekend, minimizing the need for cross coverage and rounding on the weekend.
As a result, inpatient bed capacity is filled early in the week, leaving fewer beds available for emergent/urgent patients. Not only does this tax the hospital's resources, but it also creates competition between the OR and the ED for available inpatient beds. When inpatient beds are full, the ED becomes overcrowded, extending wait times and potentially compromising quality of care and patient safety.
Peak days also require more expert OR staff and equipment. This can lead to resource conflicts and excessive use of flash sterilization. The peaks may result in longer turnover times, case delays and cancellations. Patients may be held up in the post-anesthesia care unit (PACU) waiting for beds or worse, held in the OR waiting for available PACU space. Boarding in the OR causes delays, cancellations, and excessive and unnecessary costs.
A hospital in this situation must make tough decisions. The elective surgery schedule must be delayed or cancelled, and/or the ED must divert ambulances. In some communities with few hospitals, diversion may not be an option. Then the surgery schedule suffers because canceling elective cases becomes the only alternative for relieving the bed crunch. Limiting or canceling cases too often may permanently damage referrals, managed care contracts, and the hospital's financial viability. To avoid canceling or delaying cases, the hospital might place patients in the first available bed—not necessarily in the right bed or unit—which can lead to extended stays and safety risks.
Steps to Actively Manage OR Volume Separating Flows of Patients
In order to reduce competition between the ED and the OR for inpatient beds, the flow of elective cases must be separated from that of urgent/emergent cases. This is best accomplished in the OR (or any procedural area) by determining the volume, arrival patterns and acuity of urgent/emergent volume, as well as the clinically appropriate timeframe for treatment. Using a queuing theory, data analysis, and an objective clinical classification system with waiting times associated with each type of case category provides the information necessary to determine how much capacity is required to accommodate this volume.
Once the capacity requirement for this volume is known, space and staffing resources must be allocated to meet the demand. Establishing separate staffed capacity for urgent/emergent cases ensures that these cases have quicker access to the OR and that elective case volume is not bumped or delayed in order to accommodate the urgent/emergent volume. The separated flows thus allow better access to the OR, fewer delays, and more predictability for both urgent/emergent and elective volume.
Smoothing Elective Surgical Volume
The next step to improving flow is to smooth the flow of elective admissions into the hospital. One way to accomplish smoothing is to provide consistent OR block time by surgical service throughout the week based on OR utilization, as well as the patients' appropriate inpatient destination units. This requires accurate data on surgeon and surgical service utilization of the OR, and accurate and clinically-based admission and discharge criteria for the destination units for surgical patients. Data should also include accurate case duration times, defined as patient-in-room to patient-out-of-room time. Utilization is defined as case duration plus turnover time divided by the allocated block time or primetime as defined by the hospital.
While smoothing the available block time across the week is a start, the real path to sustainable smoothing of the elective admissions begins with understanding how patients are placed in the downstream inpatient units. By identifying the clinically preferred destination unit by service or physician, as well as the average length of stay for these patients, the hospital is better able to allocate both block time and inpatient beds to ensure that patients are placed in the most appropriate bed the first time and every time.
This is best accomplished with simulation modeling so that a variety of block scenarios can be evaluated in order to determine which scenario provides for the best utilization of the OR, as well as the best patient placement on the preferred inpatient units. For example, if general surgery and urology share an inpatient unit and the average length of stay for both services is 1.5 days, the OR manager and physician leadership should be careful not to schedule these services on the same days in order to assure adequate bed availability for all patients who require that inpatient unit.
Assuring adequate inpatient bed availability
Once the variability in the elective surgical volume has been smoothed and the urgent/emergent cases optimally managed, the hospital can determine its true bed needs. Using simulation modeling and taking into account the strategic goals of the organization, the hospital can effectively allocate the number of beds needed for areas such as medicine, telemetry and surgical service. This further assures that patients are placed in the right bed with the nursing staff best trained to care for them, thereby reducing length of stay, risk of error and adverse events and improving overall patient, physician and staff satisfaction.
Collaboration and Trust Prove Critical
Actively managing surgical volume will, at times, require some surgeons to change operating days or times, as well as office or clinic days, in order to smooth the surgical volume across the week. In order to make this work, a high degree of physician and hospital collaboration and trust are crucial. To help build that trust, the following are necessary:
Collecting accurate data and conducting analyses in order to ensure transparent and objective decisions
Encouraging trails to cement the collaborative relationship, address issues and enable rapid-cycle improvements
Making hospital leadership fully aware and urging them to be supportive of this initiative
Choosing the right physician champion
Having physician and hospital leadership work together to ensure that issues are heard, goals are established and progress is made
This collaborative approach is the only method for implementing the smoothing strategy successfully. The gains in quality, patient safety, improved revenue, capacity and throughput are tangible and irrefutable.
Christy Dempsey, BSN, MBA, CNOR, is senior vice president for clinical operations at Patient Flow Press Ganey. She may be reached atcdempsey@patientflowtech.com.For information on how you can contribute to HealthLeaders Media online, please read our Editorial Guidelines.
Almost 10 years ago, the Institute of Medicine released one of its most talked-about reports ever—the pivotal "To Err Is Human: Building a Safer Health System"—which stated the alarming idea that at least 44,000 people and perhaps as many as 98,000 each year were dying in hospitals as a result of medical errors that could have been prevented.
At the time of its release, the report generated a firestorm of controversy: Was this figure a mistake? How could this be happening in our nation's hospitals? Congressional hearings, television show and magazine articles continually cited this figure—trying to make sense of it. And after a decade, we would have assumed that we had finally met this issue head-on.
Or have we? A new report released this week by Consumers Union says we may not have progressed as much as we thought. In fact, it says a review of the current scant evidence reveals that preventable medical harm accounts for approximately 100,000 deaths a year—accounting for one million deaths over the past decade.
Many hospitals are likely to be debating that finding. Since 1999, many have instituted organization-wide initiatives to improve patient safety. They have found ways to reduce hospital- acquired infections or prevent falls or ensure the right patient gets the right medication at the right time. Many have instituted programs such as hand washing or marking the correct body part for surgery that they know are making a difference in the way they deliver care.
But Lisa McGiffert, director of Consumers Union's Safe Patient Project and co-author of the report, "To Err is Human—To Delay Is Deadly," sees it differently when using a broader view.
"We know that there has been fragmented progress—different projects here and there to get hospital infection reporting," McGiffert said, "but they are very fragmented and they really aren't giving a complete picture of patient safety in the country, which is certainly not where the IOM committee envisioned we'd be 10 years later."
The IOM goal was to have findings substantiated—to get to the level where providers across the country could say "where we've reduced preventable medical harm by X percent," she said. But that has not happened. No central repository exists to show changes nationwide. "So not only do we not know if we're any better off. We have every indication that we are worse off."
So rather than push the Consumers Union report aside, maybe healthcare organizations should be taking a closer look at what it is recommending. For instance, it suggests:
Creating accountability through transparency. The IOM recommended creation of two national reporting systems to help reduce errors—a mandatory and public reporting system for encouraging accountability, and a voluntary and confidential reporting system to help healthcare providers learn from their mistakes.
Since 1999, progress has been made mostly on voluntary, confidential systems that do not create any external pressures for change. Twenty four states do not have any medical error reporting requirements in place; those states that do require error reporting do not disclose facility-specific information to the public about mistakes. The report suggested a facility-specific reporting of medical harm that is "mandatory, validated and public."
Measuring the problem. The IOM, noting in 1999 that there was no unifying effort to improve healthcare, called for the creation of a Center for Patient Safety within the federal Agency for Healthcare Research and Quality (AHRQ) to coordinate and monitor improvements. However, 10 years later, no national entity exists to comprehensively track patient safety—hindering the ability to tell if improvements have been made.
While AHRQ is attempting to do this, its efforts have been hampered by the lack of reliable medical error reporting. In its May 2009 report, the AHRQ noted that patient safety actually declined by almost 1% a year in the six years after the IOM report was issued in 1999. Ironically, AHRQ still points to the IOM's 1999 report as the best estimate of the magnitude of medical errors, according to the Consumers Union report.
Raising standards for competency in patient safety. The IOM recommended a bigger focus on patient safety by regulators, accreditors, and purchasers. It also called for periodic examinations of doctors and nurses to assess their competence and knowledge of safety practices.
During the past decade, many ideas in patient safety standards have come from the private sector. While these efforts are noteworthy, the results have been fragmented—making it difficult to promote and measure national improvement.
The report noted that the Joint Commission has attempted to use the accreditation process to ensure competency and adoption of its National Patient Safety Goals at hospitals. However, the Commission does not publicly disclose individual hospitals' progress in adopting these goals; its efforts to monitor patient safety sometimes have been criticized.
In the last 10 years, most of the patient safety work done by providers has been on the "confidential side for learning." said McGiffert. "Maybe they've learned something but we sure don't know what the results are."
As the debate over healthcare heats up in Washington, Congress should make sure that improving—and monitoring—patient safety is a central part of any reform legislation it adopts, she adds. Keeping in mind these important issues, hospitals and healthcare organizations—even those that have made big strides is addressing patient safety issues—should see what the Consumers Union report says about transparency and raising standards.
"That is what the public wants to see. You can tell us all you want—that you're doing better," McGiffert said. "But show us the evidence. That's what this report is about."
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In addition, HHS promises more enforcement through the Health Information Technology for Clinical and Economic Health (HITECH) Act, so hospitals must get prepared.
How does the healthcare industry quell the curiosity of staff members who are peeking into patient records?
Some industry leaders say give them what they want–full access to medical records–and see if they take it. In other words, bait them, then catch them in the act.
Monitoring staff members and tracking their access to medical records will only get you so far. Some facilities use fictitious medical records that IT monitors to determine whether anyone is accessing them.
"This is frosting on the security cupcake," says Gary Nichols, CISM, chief information security officer (CISO) at Blue Cross Blue Shield of Arizona. "You put something so sweet out there that they can't resist."
Nichols does not use these so-called "honeypots," but he's hearing an awful lot about them across the industry.
"It has spectacular results," he said. "If you have 500 users who have access to a system, and you are aware of patient information system access requirements, you know something is wrong when people start searching for and accessing records for Barack Obama."
Not everyone will use the information, says John R. Christiansen, founder of Christiansen IT Law in Seattle.
"I tend to doubt it's being done in smaller hospitals at all," Christiansen says. "It does require a certain sophistication and commitment of resources, and it isn't clear to me that the costs are necessarily worth the benefits compared to other commitments of compliance resources."
A couple of quick tips to get started:
Gain executive sponsorship. "Using a honeypot implicitly communicates we don't trust our staff, even though we know that insider snooping is by far the most common cause of privacy or security breaches," Christiansen says. You need to have executive sponsorship willing to back you in the event that the use of honeypots results in controversy.
Get HR buy-in. HR must be looped in to ensure that it will take appropriate action if you catch someone accessing records inappropriately, Christiansen says, adding that "legal counsel should vet the whole program to make sure legal risks are avoided."
Less is more. The fewer people involved, the better your plan will work. One healthcare company that Nichols has spoken with uses a honeypot with only 15 people involved in establishing and monitoring it.
Conduct a risk assessment of your systems and equipment. Then create records for five media-centric personalities, making them as real as possible. Don't be too obvious. For instance, Madonna would probably not end up in a central Montana facility. "You also want to be careful that you don't establish them in a way that might affect actuarial research," Nichols says. "Create the records, but do it in a way that leaves a secure way to remove them as well."
Beware of entrapment. Honeypots are analogous to entrapment; they're bait that wouldn’t work if someone wasn't predisposed to snooping, Christiansen says, because, as W.C. Fields said, "You can’t cheat an honest man." Organizations should be certain that staff members know about policies that prohibit snooping and that system configuration prevents accidental access, says Christiansen.
Ultimately, do we want to operate in a healthcare industry where set-up is the only way to catch inappropriate snooping of patient records? No. But because of recent violations, the message is clear: Some just do not respect HIPAA privacy laws enough.
"We are still trying to change the norms in the industry," Christiansen says. "Paradoxically, maybe once we have shifted the balance so that the norm is a robust respect for the privacy and security of personal information, we can deal more leniently with offenders."
Work restrictions intended to limit residents' fatigue and stress, and as a result reduce medical errors, have associated labor costs of nearly $1.6 billion per year, according to a new study in the New England Journal of Medicine. That figure includes costs associated with handing off excess work from resting residents to substitute providers.
The researchers based their assumptions on Institute of Medicine recommendations to improve adherence to the ACGME's 80-hour work week, encourage naps during extended shifts, and limit shifts without naps to 16 hours. They also tried to measure costs associated with preventable adverse events and the total societal costs of the restrictions.
Their ultimate conclusion was that the effectiveness of the IOM's recommendations is unknown. "If highly effective, they could prevent patient harm at reduced or no cost from the societal perspective. However, net costs to teaching hospitals would remain high," they wrote.
But are those the only costs tied to work restrictions?
It has taken me a while to wrap my head around the controversy of the 80-hour resident workweek. I confess, in my mostly Monday-Friday, mostly 40-50-hour work world, 80 hours seems like an admirable and exhausting commitment. When I first began learning about resident work restrictions I assumed that it was a no-brainer. Of course residents are going to become fatigued and make more errors if they're working 120 hours a week on little sleep.
I still think resident exhaustion is worth addressing, but some recent conversations with physicians and administrators have opened my eyes to some of the long-term negative impacts of the 80-hour workweek.
The work restrictions seem to be gradually and not-so-subtly changing physician culture. Physicians have traditionally been known for basing the amount of hours they work on the amount of work that needs to be done. Many doctors take pride in not leaving the hospital until all their patients are cared for.
As residents get accustomed to limited shift work in their training, however, they are increasingly looking for similar scheduling arrangements in their post-residency careers. Physicians, particularly those early in their careers, are shying away from private practice in favor of employment arrangements with set schedules. They are favoring specialties like dermatology that are known for both high compensation and a controllable lifestyle.
"One of my concerns is that a lot of the doctors in training are now going to this have mindset that I only have to work so many hours and I'm gone, it's somebody else's problem," says John Jeter, MD, CEO of Hays Medical Center, a 153-staffed-bed community hospital in Kansas. "That's not how it works. You can't abandon patients and partners."
This is particularly troubling at a time when severe physician shortages are being projected. There are also concerns that residents working fewer hours aren't getting the training they need and the length of residencies may have to be extended, slowing the development of much-needed new doctors, Jeter says.
So what's the solution? Work residents to exhaustion and risk preventable errors? Continue with the restrictions and lose physician productivity?
"There has got to be some in-between where there are still many opportunities to learn what needs to be learned without it being an unhealthy environment," says Jeter. "I'm not sure we've found the balance."
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The recession appears to have—at least temporarily—slowed physician turnover. But the factors that make retention such a challenge haven't disappeared, and hospitals and practices continue to seek ways to keep physicians they've recruited.
So it's not surprising that the 2008 Physician Retention Survey from AMGA and Cejka Search finds that groups are renewing their focus on retention. It identifies current trends and provides some insights into best practices, from actively courting spouses to implementing formal retention programs.
As in previous surveys, fit and family were top reasons for turnover: Fifty percent cited "poor cultural fit with the practice" and 32% indicated "relocation to be closer to family" as the reasons for leaving practices voluntarily.
When all family priorities regarding separation are factored in, family-related concerns are just as important as cultural fit.
The survey suggests that compensation is a secondary consideration. "Seeking higher compensation" was the third most frequently cited reason for voluntary departure. Compensation may be a reason for a physician candidate to rule out a practice during recruitment, but long-term retention depends more on other factors—in particular, fit and family—at least as long as the compensation is reasonable, says David Cornett, regional vice president at St. Louis–based Cejka Search.
Accordingly, the ability to assess the cultural fit and family needs of candidates appears to be an important factor in retention plans, the survey finds. Ideally, this begins by including the spouse or partner early in the recruiting process.
Most respondents (71%) indicated they began communicating with the spouse or significant other before or during the first in-person interview. Only 2% said they waited until after signing to reach out, whereas 10% had no interaction with the candidate's spouse or significant other.
Ignoring the spouse or partner is not a good plan, says Cornett, noting that "80% of the decision to relocate is ultimately up to the spouse. Spouse interests, concerns, questions should always be addressed up front as part of the interviewing process. The more resources an organization devotes to making the spouse feel comfortable and valued, the better the results will be."
This article was adapted from one that originally appeared in the May 2009 issue ofPhysician Compensation & Recruitment, a HealthLeaders Media publication.
This article from the New England Journal of Medicine explores how physicians can advance the healthcare reform process. "The first step is to acknowledge that delivery-system reform offers a potential win–win situation for providers. Physicians should support and help to develop integrated systems of care," the authors write.
"Providers should first attempt to contact the RAC through the customer service line. If that does not answer the provider's questions and/or concerns, then the provider can contact CMS," according to the FAQ. (Contact CMS regarding RAC questions or concerns at CMS RAC@cms.hhs.gov.)
Interestingly, the FAQ concerning RAC contact information does not specifically contain Web site address information, which many providers may find most useful—especially as the permanent program implementation moves forward and the RACs begin posting lists of issues for which RACs will audit. While not all of the RAC Web sites have been approved or announced by CMS at this time, the following sites are currently correct for the RACs:
Region A: Diversified Collection Services, Inc., www.dcsrac.com
Take advantage of the RAC education available as much as possible in the coming days. Chances are CMS and the RACs will have important announcements to make as they near the time when the RACs begin reviewing claims in locations in the first set of states.
Early estimates had targeted May as the time when this process would begin, though this may have been an ambitious date—CMS has indicated the RACs must post the list of issues they'll be reviewing prior to reviewing any claims, and none of the RAC Web sites contain this information at this point. But watch your RAC's Web site carefully for this information.
May is not yet over, and CMS and the RACs may still be trying to meet their original goal to begin reviewing claims this month.
Attorney General Eric Holder and Health and Human Services Secretary Kathleen Sebelius announced this week the government's latest tool in the fight against healthcare fraud and abuse—The Health Care Fraud Prevention and Enforcement Action Team (HEAT).
With what appears to be an intended pun, Sebelius said, "Today, we are turning up the heat on perpetrators who steal from the taxpayers and threaten the future of Medicare and Medicaid."
The HEAT team will consist of senior Department of Justice and HHS employees. Their task will be to strengthen existing fraud prevention tools and investigate new ways to root out and prevent fraud, which, according to Office of Inspector General Chief Counsel Lewis Morris, accounts for about 3%—or more than $60 billion—of the government's annual healthcare investment.
The team will build on demonstration projects created by the HHS Inspector General and the Centers for Medicare & Medicaid Services that focus on the vulnerable durable medical equipment (DME) industry. This includes:
Increasing site visits to potential suppliers to prevent imposters from posing as legitimate DME providers
Increasing training for providers on Medicare compliance, and offering providers the resources and the knowledge they need to help identify and prevent fraud
Improving data sharing between CMS and law enforcement to identify patterns that lead to fraud
Strengthening program integrity activities to monitor and ensure Medicare Parts C (Medicare Advantage plans) and D (prescription drug programs) compliance and enforcement
Holder and Sebelius also announced the expansion of the Medicare Fraud Strike Forces. Since their inception in 2007, the Medicare Fraud Strike Forces have recovered more than $240 million in fraud and abuse cases in South Florida and Los Angeles. The targets for the latest expansion are Detroit and Houston.
The creation of the HEAT team, the expansion of the Medicare Fraud Strike Forces, and the creation of a new healthcare fraud hotline (www.hhs.gov/stopmedicarefraud or 1-800-HHS-TIPS) continue President Barack Obama's push for greater healthcare fraud enforcement. Obama has made strengthening the integrity of the Medicare and Medicaid programs a priority for 2010, allotting $311 million of the $3.4 trillion budget on healthcare fraud and abuse prevention.
Also on Wednesday, Sen. Arlen Specter (D-PA), as the new chair of the Senate Judiciary's Crime and Drugs Subcommittee, presided over a hearing on whether tougher criminal sanctions should be used to serve as a deterrent to healthcare fraud.
"A greater investment in enforcement will pay sizeable dividends," said Lanny Breuer, an assistant attorney general in Justice's criminal division, who testified before the panel.
He noted that in South Florida, the Justice Department's prosecutions in fraud cases have had a "clear deterrent effect": In South Florida, for instance, the work of the Medicare Fraud Strike Force has led to a $1.75 billion reduction in DME claim submissions and $334 DME claims paid by Medicare in the past 12 months.
Current antifraud efforts have represented about a $4 return to the Medicare Trust Fund for every $1 dollar spent, Breuer said.
One of the big lessons that Justice Department officials have learned is "that quick apprehension and punishment of these criminals is critical."
Some of the more high-profile cases handled were conviction of a Miami physician in an $11 million HIV infusion fraud scheme and conviction of 13 DME company owners involved in a $6.4 million plan where false claims were submitted for DME supplies, including aerosol medications and oxygen concentrators.
Breuer told the panel that the resources available for fraud detection and control in the healthcare industry "are not only inadequate but at the wrong scale. We don't know how much we are losing in these programs."
On questioning from Sen. Jeff Sessions (R-AL), Breuer told the panel that the Justice Department was not looking for cases, for example, where hospitals or physicians may have miscoded Medicare claims.
"We're not targeting those who make mistakes," Breuer said. "We're looking for extraordinary aberrations in the numbers."
Janice Simmons contributed to this report.
Ben Amirault is an Editorial Assistant for the revenue cycle division of HCPro, Inc. He manages the Compliance Monitor e-newsletter and has developed a number of online learning modules. He can be reached at bamirault@hcpro.com.
A health technology trade association has asked the Obama administration to require that any electronic health-record equipment receiving stimulus funding be certified by a group the association helped to start and run, documents show. The Healthcare Information and Management Systems Society, which represents 350 technology vendors and 20,000 members, was a key force behind the decision to include $36.5 billion in the stimulus package to create a nationwide network for medical records.
