In the emergency room at Long Beach Memorial Medical Center, the triage was simple: Those complaining of flu symptoms were masked and separated from the rest of the ER patients until they could be further evaluated. Those who were visibly ill were immediately isolated pending tests. Those determined to be the "worried well" were reassured and sent home. One thing officials there and elsewhere have learned is the need to educate potential patients to be as calm and collected as the hospital staff has been.
No comprehensive national data are available to know how often "wrong-site" surgeries occur. In Georgia they occur on average more than once a month, data indicate. Yet despite protocols required by the Joint Commission and years of initiatives by medical groups, the problem persists. Regulators at the Georgia Department of Human Resources have received 102 reports of wrong-site surgeries since 2003, when reporting the incidents became mandatory. Since July 1, the state has received 20 reports. It received 15 in fiscal year 2008.
St. Joseph Regional Medical Center of South Bend, IN, has announced a pay freeze for employees as it prepares to open a new $355 million facility later this year. St. Joseph representatives said that it also was making an 8% reduction in executive pay and cutting the hours of some departments. No layoffs were announced. Officials said it has faced a growing number of uninsured patients and that Medicare and Medicaid payments have not kept pace with expenses.
Despite Massachusetts' 2006 health insurance overhaul, healthcare costs are devouring more than 10% of thousands of residents' income, according to a new study from Families USA, a nonprofit organization that lobbies for affordable care. The study found that more than 1 million Massachusetts residents are in families that will spend more than 10% of their pretax income on healthcare this year, even though the vast majority of them have health insurance.
Sen. Arlen Specter said his switch to the Democratic Party doesn't mean he will automatically vote for legislation to overhaul healthcare. Specter, who left the Republican Party, has bolstered Democrats' hopes of passing legislation to overhaul healthcare. His switch moves Democrats closer the 60 votes needed to stop a Republican filibuster.
A television commercial for the Akron Children's Hospital in Ohio presents Austin, who is 14 and bald from chemotherapy. The commercial is emblematic of a new approach to advertising by hospitals—an industry that, despite the recession, is not slashing ad spending. The campaign, by the Marcus Thomas agency in Cleveland and running on about 20 cable channels and network stations in Ohio, is entirely unscripted. Other spots feature more patients and their young siblings, who talk about how their families are coping.
CMS late Friday afternoon announced historically low net increases of well below 1% in its 2010 payment rates for Medicare inpatient services by both acute-care and long-term care hospitals, and signaled that even larger reductions may be coming in the next two years.
CMS is proposing to update acute-care hospital rates by 2.1% for inflation less an adjustment of 1.9%, and 2.4% for inflation minus a 1.8% adjustment for long-term care hospitals, in both cases to remove the effect of increases in aggregate payments due to changes in hospital coding practices that CMS says do not reflect increases in the severity of illness in patients.
“We understand hospitals will be concerned about lower than historical update amounts,” says Charlene Frizzera, CMS acting administrator. “However, we are proposing an adjustment that minimizes the effects on FY 2010 payments while still meeting the requirements of the law, which may mean larger reductions in the next two years. We are asking for comments from the public to help us ensure that these proposals are the best ways to meet the requirements of the law.”
CMS says the projected 2.1% update for inflation for inpatient acute-care payment rates is lower than the updates applied in recent years and reflects the slowing rate of inflation in the economy. Because long-term care hospitals generally use a different mix of resources than acute care hospitals, their inflation update of 2.4% is determined using a different market basket than the market basket used for acute care hospitals.
Critics were not mollified by that explanation. Blair Childs, senior vice president of public affairs at Premier health alliance, says he is “extremely disappointed” by CMS’s net payment cut of 0.5%, on average” and noted that hospital payments are already 7% below costs.
“As the economy and credit markets decline, non-profit hospitals are struggling, and now is not the time to further reduce hospital payments,” Childs says. The proposed rule would apply to approximately 3,500 acute-care hospitals paid under the Inpatient Prospective Payment System, and 400 long-term care hospitals paid under the Long-Term Care Hospital Prospective Payment System, beginning with discharges occurring on or after Oct. 1, 2009.
Medicare on Oct. 1, 2008 adopted a new classification system for general acute- and long-term care hospitals to better recognize severity of illness and the cost of treating Medicare patients. CMS says hospitals changed their documentation and coding of patient diagnoses under the new system in a manner that leads to an increase in aggregate payments without corresponding growth in actual patient severity.
CMS says the proposed documentation and coding adjustments help ensure that estimated aggregate payments to hospitals under the new classification systems would not increase solely as a result of the changes to the classification system and hospital coding practices. CMS says it “has the authority to make a much greater downward adjustment to payment rates to address these changes in hospital coding practices, but believes it would be prudent to phase-in the adjustment carefully over time.”
The Federal Trade Commission (FTC) pushed back its compliance date Thursday on the "Red Flags Rule" from May 1 until August 1, giving healthcare facilities considered to be "creditors" three extra months to implement an identity theft prevention program.
But that does not mean healthcare entities should delay implementing a program–especially when you're dealing with the FTC, an organization known for harsh punishment and corrective measures.
"Don't forget, this is a much different agency than [Office for Civil Rights] and CMS, the enforcement agencies for HIPAA, and if they do show up, the consequences will likely be severe," says Kate Borten, CISSP, CISM, president of The Marblehead Group in Marblehead, MA.
The Red Flags Rule aims to keep the FTC away. It forces any organization considered to be a "creditor" to implement programs to identify, detect, and respond to patterns, practices, or specific activities that could indicate identity theft.
That regulation falls under the Fair and Accurate Credit Transactions Act of 2003 (FACTA), which defines "creditors" as agencies that regularly extend or renew credit–or arranges for others to do so–and includes all entities that regularly permit deferred payments for goods or services.
Originally, the compliance date for Red Flags was November 1, 2008, but the FTC delayed it until May 1, and now August 1.
Major financial institutions like banks and non-state regulated credit unions did not get a break from the original November 1 compliance date.
"I think the FTC was trying to give people enough time to here about it, embrace it, and move forward with it," says Suzanne Miller, PhD, senior partner at Compliance and Audit Group, Orlando, FL, a consulting firm. "But, do I think that by allowing them until August 1 will cause more to get on board? No. We are in a financial crisis here, and people don't care. If there aren't police or a big stick, people don't care."
So what should your healthcare organization do? For starters, your front end patient access team needs to be in the loop, since they take credit information. Your billing and accounting team and anyone who gets their hands on a patient's bill and credit information should also be involved. Not to mention your compliance and HIPAA officers.
Experts told Healthleaders Media to conduct an organizational audit, develop the identity theft program with approval from your board of directors, monitor the program, and train everyone.
Tanya Forsheit, co-head of the Privacy and Data Security Practice Group at law firm Proskauer Rose LLP in Los Angeles, says healthcare entities should determine whether they are covered, start work on a program to detect and respond to identify theft signs, and develop a written program and consult with counsel to determine what makes sense in that regard. They should also review regular practices for how to deal with patient identification, how to respond to law enforcement requests, and how to deal with medical records that might be at risk of identify theft.
"It may be that they already do a number of things that are in line with compliance and then it's just a question of putting something in writing to memorialize the program and making sure people in the practice or the hospital are trained and understand what this means," says Forsheit.
And realize there is a major financial risk associated with non-compliance–not to mention financial and potentially physical harm to your patients. Identity theft could compromise patient care.
"Look at the state laws," Miller says. "Massachusetts has one coming out that will bring you to your knees if you don't do it. If healthcare providers would understand what their risk is…because today they don't think there is a financial risk to non-compliance. If they realized that all of this really goes together, and if they have a breach of any kind that could be attributed to identity theft or fraud, then the penalties and the fines could put them out of business."
John Commins of Healthleaders Media contributed to this report.
A group of hospitals and healthcare systems took closer steps to becoming greener by joining this week with the U.S. Department of Energy in officially launching the Health Energy Alliance (HEA), a public/private partnership, in Washington.
The partnership is expected to boost the promotion of improved energy efficiency and renewable technologies in hospital design, construction, retrofit, operations, and maintenance.
Under the new alliance, hospitals and healthcare organizations will have access to the resources and technical expertise from the Energy Department and its national laboratories. The goal is to develop and use creative solutions "to cut costs, lower energy usage, and reduce pollution," according to Richard Moorer, the Energy Department's associate undersecretary for energy.
Under the HEA, hospital leaders are being brought together to provide insights into how to improve energy conservation while maintaining quality care for patients, said AHA's President and CEO Rich Umbdenstock in a statement. The HEA was created to "spur energy efficiency and lower costs" in the healthcare sector by quickening the adoption of high-performance technologies—while promoting healthcare delivery.
Members of the initial HEA Steering Committee include representatives from Catholic Healthcare West, Department of Veterans Affairs, Gundersen Lutheran Health System; Hospital Corporation of America, Kaiser Permanente, New York-Presbyterian Hospital, Providence Health & Services; TECO/Texas Medical Center; University of Pittsburgh Medical Center, American Society for Healthcare Engineering (ASHE), American Society of Heating, Refrigerating and Air-Conditioning Engineers (ASHRAE), Global Health and Safety Initiative (GHSI), and Illuminating Engineering Society of North America (IES).
The HEA is part of the initiative started last summer called EnergySmart Hospitals.
The goals of EnergySmart Hospitals are:
Promote 20% improved efficiency in existing buildings and 30% in new construction over current standards
Increase efficient and renewable energy applications in hospitals
Reduce energy use and operating costs
Create healthier healing and work environments
Maximize successful hospital upgrades and design strategies
Ensure reliable backup power during disasters
Improve environmental performance.
At the EnergySmart hospital Web site, the DOE notes that U.S. hospitals spend more than $5 billion annually on energy, which is equal to 1% to 3% total of their budgets and equivalent to 15% of profits. The DOE estimates that every dollar a nonprofit hospital saves on energy is equivalent to generating new revenue of $20.
The EnergySmart Hospital Web site also informs hospitals and healthcare organizations on how they can use lighting, heating and air conditioning, water efficiency, and energy management to save money. Also, tips are provided as well on how to improve design and construction of hospitals, for instance, by maximizing tree shade, promoting use of natural light, and checking the availability of geothermal energy.
Any hospital leader knows to be on the lookout for stress, especially in times when community panic may translate to one's own employees and their families.
That's why hospital systems should take precautions as the public's escalating worries over so-called swine flu cause hospital work overloads to tax staff patience.
"People can get short with each other, not collaborate as well, come in with complaints, loss of appetite, sleep disturbances, and there may be spikes in absenteeism, all of which can be associated with stress," says Daniel Hughes, a psychologist and director of employee assistance program at Mt. Sinai Medical Center in Manhattan.
While he doesn't know of any obvious cases of employee stress since the outbreak, he's keeping a lookout for it.
Marina London, a licensed clinical social worker who worked in a New York hospital as an employee assistance professional, says, "In my experience, being in the trenches, is that caregivers, are among the worst prepared on the planet at dealing with stress. They're great at taking care of everybody else. But not great on the uptake of thinking what happens if we're sick."
London worked as a counselor with employees of companies in buildings surrounding Ground Zero in New York City after 9/11. London also is spokeswoman for the Employee Assistance Professional Association and naturally advocates that all hospitals have trained teams of counselors and psychologists prepared to work with staff when crises arise that can affect the employees doing their jobs. She realizes that's not possible, but managers need to know the hospital's effectiveness can decline because of unrecognized employee stress.
"There is no formula that says after crisis incident #15, someone will start having problems, or after month six helping victims of Hurricane Katrina, but hospitals need to allow their employees the opportunity to talk with someone who is also a professional. It's common sense," she says.
Within the Scripps Health hospital system in San Diego County, where some of the first cases of this new strain of influenza were treated, administrators encourage managers to get out from behind their desks, walk around and talk with people working on the front lines.
"We want them to ask ‘Is everything okay? What are you seeing,'" says Paul Randolph, a psychologist who directs the employee assistance program. "It sounds obvious but the truth is, in a hectic pace of a healthcare setting, management responsibilities can keep managers from seeing what's happening with the staff on the front lines."
That was a lesson learned during two wildfires that took lives, destroyed hundreds of homes in 2003 and 2007, and required many Scripps employees to evacuate their families from homes in threatened neighborhoods. Many staff members lost their homes.
In some cases, staff members had no idea what was happening to their families while they were at work, and were prevented from re-entering their communities. At times, phone communication was limited as well.
So far, he says, Scripps has not seen any signs of staff stress from the influenza outbreak, which would be understandable in an area so close to the Mexican border, a region that has the bulk of the swine flu (H1N1 influenza) cases diagnosed so far in the state. Rumors about the extent of the spread of the epidemic have been inflamed by the media.
"We want to know, what are the gaps in understanding about what you're hearing in the news, and how that is impacting your daily work practice? This goes a long way to put people at ease. We always give reassurance and information to our staff about what the situation is," Randolph says.
