President Obama pronounced yesterday "a historic day, a watershed event," because doctors, hospitals, drug makers and insurance companies voluntarily offered $2 trillion in cost reductions over 10 years. But if history is a guide, their commitments may not produce the promised savings, according to this analysis from the New York Times. Their proposals are vague, and none of the savings are guaranteed, the analysis states. Without such a guarantee, budget rules would normally prevent Congress from using the savings to pay for new initiatives to cover the uninsured.
Engineers at Washington University in St. Louis have created a USB-based ultrasound probe that can connect to a smartphone and create a low-cost ultrasound imaging platform. Once connected to a smartphone, the probe acts like any other ultrasound device, serving as an imaging tool for screenings and biopsies. In the developing world, where there is a shortage of trained medical personnel, the system can help field workers transmit data to specialists in a centralized location, said William D. Richard, one of the project's lead researchers.
A Centers for Disease Control and Prevention study published in February noted a slight decline in the proportion of women having annual mammograms in just about every state. The drop is so small, that researchers hesitate to call it a trend; they call it a "declining tendency." But the downward trend, however slight, has breast cancer experts worried.
Citing "the lack of robust and coherent enforcement policy" for reviewing health plan mergers, the American Hospital Association today called on the federal government to "launch a critical examination of competition and enforcement policy" to see if the mergers violate antitrust laws.
"Providers are the backbone of our healthcare delivery system. Protecting them from current and future abuses of market power by health plans has to be a mainstay of any successful healthcare reform effort," writes AHA Executive Vice President Rick Pollack in a letter "hand delivered" today to Christine Varney, assistant attorney general for antitrust at the U.S. Department of Justice.
"It is essential that the Antitrust Division contribute to that success by taking an active and aggressive role in understanding how health plan market power and consolidation harm hospitals and other providers as well as in challenging conventional thinking and actions about how to approach those problems," Pollack writes in the letter.
Citing an American Medical Association report that 95% of the health insurance market in the United States is "highly concentrated," Pollack says the number of insurers has fallen by 20% since 2000. "These changes were supposed to make the industry more efficient, but instead premiums have skyrocketed, increasing over 87% over the past six years," he says.
Pollack's letter was released today at about the same time that leaders from the AHA, America's Health Insurance Plans, and other leading healthcare trade groups were meeting with President Barack Obama to announce a coordinated effort to trim $2 trillion in healthcare expenses over the next decade.
"The groups who are here today represent different constituencies with different sets of interests," Obama said at the White House event. "They've not always seen eye to eye with each other or with our government on what needs to be done to reform healthcare in this country."
HealthLeaders' calls to AHIP were not immediately returned.
In a separate development, Varney today vowed to step up Justice Department enforcement of antitrust laws after eight years of what she characterized as "overly lenient" enforcement under the Bush Administration, which she said in a speech today "lost sight of an ultimate goal of antitrust laws — the protection of consumer welfare."
"The failing of this approach is that it effectively straitjackets antitrust enforcers and courts from redressing monopolistic abuses, thereby allowing all but the most bold and predatory conduct to go unpunished and undeterred," Varney told the Center for American Progress. "We must change course and take a new tack."
In his letter to Varney, Pollack wants the Antitrust Division to study recent health plan mergers to determine their impact on their market areas, and hold public hearings about the lack of competition among health plans in most markets and the impacts on consumers, providers, and Obama's healthcare reform initiatives.
Pollack says the government should consider the idea that "proposed mergers by plans with preexisting market power should be viewed as presumptively unlawful."
The AHA letter also wants the government to consider whether:
Medicare/Medicaid with low reimbursements should be included in the market when determining the competitive effects of a plan merger on hospitals.
Government reimbursement programs are an adequate substitute for health plan competition, because of constraints on hospitals' ability to switch to new patients.
Several small health plans can be a countervailing force to mergers involving larger health plans.
Low provider payments can hinder the adoption of federally mandated healthcare IT.
Price discrimination by large plans against some hospitals creates competitive harm.
Dominant health plans can wreak competitive harm in ways other than reducing prices below competitive levels, such as adversely affecting the development or adoption of quality protocols or technology tailored to meet the needs of hospitals and the patients they serve.
The mergers of health plans with service areas that technically do not overlap because of license or other agreements still pose a risk of competitive harm and, therefore, should be challenged.
Limited divestitures are ever likely to be an effective antidote for anticompetitive health plan mergers.
California doctors will now have to post a sign or tell patients about the agency they can complain to if they're not happy with care after the Medical Board of California unanimously approved the mandate on Friday.
If unchanged after a series of regulatory hearings this summer, the requirement will take effect as early as this fall, says board spokeswoman Candis Cohen.
Physicians who have waiting rooms will have to post the following notice in 48-point type in their office waiting rooms or in an area "visible to patients on the premises where the licensee provides the licensed services:"
NOTICE
Medical doctors are licensed
and regulated by the
Medical Board of California
(800) 633-2322
www.mbc.ca.gov
Physicians who don't have waiting rooms, such as anesthesiologists or radiologists, would have to include the notice in a written statement that is signed and dated by the patient or the patient's representative stating that the patient understands the physician is licensed and regulated by the medical board.
The statement must be retained in patient medical records.
The physician also may opt to include the notice in a statement on letterhead, discharge instructions or other document given to a patent or the patient's representative, where the notice is placed immediately above the signature line for the patient in at least 14-point type.
Board officials say they need such a rule because too many patients are unaware about the existence of the board, which can investigate their complaints and may launch disciplinary actions against doctors with malpractice or other performance issues. Otherwise the patient may have no other recourse except going to an attorney.
In California, many other professions are required to post signs, such as building contractors, pest control operators, barbers, cosmetologists, and auto repair shops.
The day before the vote, the board's education committee heard objections from representatives of the California Medical Association, who said that requiring such notices does not create an atmosphere of mutual trust for the physician-patient relationship.
CMA officials told the committee that the rule would place an "additional burden on physicians," says CMA spokeswoman Amber Beck. She adds that the CMA supports "giving information to patients that is useful for them to make decisions on their healthcare needs."
James Hay, MD, the CMA's liaison to the Medical Board of California, says, "This proposed rule does not seem to me to be a worthwhile thing to foster that doctor-patient relationship." If the Medical Board is supposed to educate the public, but hasn't done it, "that's the medical board's problem," he says.
California is not the only state with a posting requirement for doctors. Texas, Kansas, Georgia, and Idaho are among other states that have similar sign rules.
If patients knew who to complain to, disciplinary actions may be more promptly taken against physicians, the board argues.
Now, when the agency hears of a physician's alleged misconduct, investigators first look for court filings. "They routinely come across people who have sued doctors for malpractice but who have not filed a complaint with the Medical Board," says Julianne D'Angelo Fellmeth, who was hired as the board's Enforcement Monitor. Occasionally, the court has issued large awards against physicians after long courtroom proceedings before the medical board receives notice about the case.
A physician's failure to provide proper notice of the board's authority could come with penalties or fines, says Fellmeth, an attorney with the Center for Public Interest Law at the University of San Diego.
"Consumers have the right to know that if they do not feel that their physician is acting professionally, that the overseeing licensing agency should be informed of their concerns," says board member Mary Lynn Moran, MD. She said similar sign requirements are even required of cab drivers.
If you haven't already read it, there is a moving interview in The Los Angeles Times with actress Farrah Fawcett about her 2½ year battle with cancer.
Fawcett, 62, the one-time Charlie's Angels star and pin-up poster goddess of 1970s America, told the newspaper that her efforts to fight anal cancer were made more difficult when her personal medical records were illegally accessed by at least one employee at UCLA Medical Center. That employee then sold the information for $4,600 to the National Enquirer.
"It seems that there are areas that should be off-limits," Fawcett told the Times. " It's much easier to go through something and deal with it without being under a microscope. It was stressful. I was terrified of getting the chemo. It's not pleasant. And the radiation is not pleasant."
Because of the continuing unwanted publicity about her health, Fawcett had to take her attention away from fighting a deadly disease and devise—on her own—a sting operation to catch the snooping employee. In May 2007, when she learned that her cancer had returned, she told no one. Still, the news came out in the Enquirer within " maybe four days." When Fawcett asked UCLA Medical Center for the name of the snooping employee, she says a hospital official refused to provide it, saying they had a responsibility to " protect our employees." " And I said, 'More than your patients?' . . ." Fawcett told The Times.
Eventually, the snooping employee was identified. She pleaded guilty in December to a felony charge of violating federal medical privacy laws for commercial purposes. She died in March, of cancer, before she could be sentenced.
Fawcett hopes the Enquirer will also be charged with a crime for " buying stolen goods" in the form of confidential medical records. Fawcett also blames UCLA Medical Center for the lapses and suggested the only thing they cared about was getting her to donate money for a foundation to be named after her.
This is a unique case involving an internationally known celebrity. But there are lessons that every hospital can take from this security breach.
First, it illustrates very plainly how damaging a privacy violation can be to the health of the patient. Farrah Fawcett, nor any patient, should have to divert attention from fighting a disease and instead devise a trap for a snooping employee. All patients are vulnerable, even more so those battling cancer and other life-threatening diseases. No one should have to deal with the additional stress of protecting their medical records.
Second, if for whatever reason a patient raises questions about the security of their medical records, address those concerns immediately. Your hospital might not treat a lot of movie stars, but privacy violations affect everybody everywhere for any number of reasons.
Third, Fawcett's story justifies the new enhanced enforcement and security for HIPAA violations. As I've said before, if your hospital can't get patient privacy right, how can you be trusted with anything else?
Thirty years ago, Farrah Fawcett's smiling face was the pin-up fixture that adorned the walls of millions of teenage boys. Now might be a good time to print out that LA Times interview and pin that up on the employee bulletin board.
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Although the downturn has proven tough for workers, those who are still employed say they're gaining more from the experience than just managing to keep their jobs. Seventy-seven percent of professionals interviewed cited at least one positive effect the recession has had on their jobs, including the ability to tackle new projects, assume additional responsibility, and take on more challenging work.
A new survey conducted by Menlo Park, CA-based recruiters OfficeTeam finds that 28% of managers believe that meetings are a waste of time, and 45% believe employees would be more productive if meetings were banned one day a week.
As hospitals cut back on temporary nurses, Boca Raton, FL-based Medical Staffing Network flipped to a loss in the first quarter as its revenue fell 32%, compared to the same quarter last year. The company lost $3.7 million on revenue of $98.6 million in the first quarter. In the same period of 2008, it earned $800,000 on revenue of $145.2 million.
Joseph S. Rogers has been named senior vice president/COO for Broward Health. Rogers joined Broward Health in 2006 as senior vice president of business development and managed care. Before joining Broward Health, Rogers spent 18 years in healthcare in Miami-Dade County. Rogers started his career with Jackson Memorial Hospital/Public Health Trust in 1988 as an assistant administrator in the planning department. He served as associate executive director of the JMH Health Plan and executive director of managed care prior to his appointment as senior vice president for the health system. The six-hospital Broward Health system is one of the 10 largest public health systems in the nation.
