A Dean Health System physician made an incision during a recent routine surgery, but it's a manager's cut during the procedure that is making waves.
Healthcare professionals are now questioning why the manager laid off a nurse during the surgical procedure.
Paul Pitas, director of corporate communications at the Madison, WI-based facility, confirmed the incident followed an announcement on April 8 that the health system would lay off 90 employees "immediately."
The facility released a statement in which Pitas declared "the absence of an RN goes against established patient care procedure" and that the act was "clearly . . . an error in judgment on the part of the manager conducting the layoff." Pitas declined to release the manager's name, who he stated has more than 30 years of nursing experience in the Wisconsin State Journal.
The timing of the layoff—during a surgery—is what has upset many nursing advocates.
"Layoffs may occur in these economic times, but there are correct methods for doing them," says Polly Gerber Zimmermann, RN, MS, MBA, CEN, FAEN, assistant professor at Harry S. Truman College in Chicago, and former ED nurse director. "The employee should be told at the end of the day, after care responsibilities have concluded. Healthcare workers are traditionally known for their caring approach; it is important that the same consideration is given to them in this type of situation."
Neither the name of the dismissed nurse nor the type of procedure he or she was assisting in were released. According to Pitas, the layoff didn't endanger the patient because other clinical staff, including a physician, were present during the remainder of the surgery.
But regardless of the surgery's severity, the nurse is there to advocate and care for the patient, while the operating physician focuses on the procedural aspect, says Zimmerman. "One nurse does not leave a procedure without being replaced," she says. "If the same nurse left on his or her own initiative, they could have been charged with patient abandonment."
Pitas stated in the Wisconsin State Journal that the nurse manager is "very upset" and "extremely remorseful" over the incident. He added that the layoffs created "extraordinary circumstances."
No one can deny that the pressures are mounting for healthcare leaders in today's economic climate, but Beth Kessler RN, BC, director of patient care services at Lehigh Valley Muhlenberg Hospital in Bethlehem, PA, questions whether the manager could have delayed the layoff until the procedure was completed or if it was just a bad decision on his or her part.
"I cannot judge the actions of the manager without knowing the circumstances that he or she faced," Kessler says. "We in the healthcare industry are not escaping the effects of the economy. But we, as a profession, must unite and recognize the need to be efficient while still providing safe patient care."
Strong outpatient volume and expense control helped the Sarasota County (FL) Public Hospital District improve its financial operating performance in the first six months of the district's fiscal year. The hospital system posted a $2.8 million operating loss for the six months ended March 31, compared to a $5.8 million operating loss in the same period one year earlier.
They are lands of great expanse, of tumbleweed, grand canyons and parks, and yes, national treasures.
But for health program funding and definition purposes, just what is a "Frontier"? How many people must live there to qualify, or sustain a program for funding, licensing, or support?
Should it be defined merely by the great distances between neighbors, the isolation of its people? How about the number of paramedics, the condition of its roads or the challenges of its topography, be it mountains, deserts or tundra? Should weather patterns, economy, or the availability of a licensed health practitioner be considered? What about areas that may not initially have expertise to provide healthcare service, but hopes to get it?
Starting this Friday in Albuquerque, federal officials are holding the first of three meetings to help resolve these questions, followed by meetings May 18 in Seattle and June 26 in Omaha. The task—to better distinguish what is merely "rural" from what is really "out there yonder"—is advocated in part by a patient, but persistent nonprofit group, the National Center for Frontier Communities.
The meetings are entitled "Potential Definitions of the Terms Frontier or Remote Areas."
"We're interested in (defining) frontier because we want to try to identify those areas that are really, really remote," says Steve Hirsch, public health analyst with the Office of Rural Health Policy in Rockville, MD, a division of the federal Health Resources and Services Administration. They have special needs, and may not be as easily or simply categorized, Hirsch acknowledged.
Initially, he says, federal officials are not looking to define frontier for funding purposes, but that is a logical consequence down the line.
"These are areas that lack access to healthcare services or population, and when we define these, we can think about what sort of healthcare services they can support," he says.
Areas are often excluded from "rural" program designation because they don't have the required number of providers or people, or perhaps just a few too many. These might qualify for funding under "frontier" status. There might be a telemedicine project, or grants for a van or helicopter service that can transport patients to the doctor or a hospital 150 miles away. Now, there's no shades of gray in the way such areas are defined, he says.
Carol Miller, former director of a community clinic in Tierra Amarilla, NM, is executive director of the National Center for Frontier Communities, as well as a former Health Resources and Services Administration official. She insists that government officials should not be too exact with whatever definition they eventually write. What she wants, she says, is "geographic democracy," so even people in frontier lands get the care they need.
Whatever definition comes out, it must be flexible because the area is extremely diverse, she says. Lands now loosely called frontier make up 56% of the land area of the U.S., but hold about 3% of the nation's population (fewer than 9 million people).
One way to deal with that diversity, advocated by her organization, is to use a weighted formula that gives "frontier" points to regions of the country based on three elements: population density, travel distance to whatever health service services might exist, and the time it takes to get there. A region with more than 12 people per square mile might lose points because it has more people, but if its distances or travel times are greater, it will gain points.
But such a proposal, Miller says "was not uniformly appreciated by federal policy makers," at least initially.
"It really gets down to one thing: how isolated are you?" she says. "I spend a lot of time explaining to people who may need emergency care one day: we hope to reach you with a paramedic within an hour, and get you to a hospital in another hour."
For city folks, it's easy to lose perspective, Miller said. Frontier areas are not just ultra rural. Urban areas are home to 80% of the U.S. population, but just 4% of America's geography.
Today's definitions of urban and rural have evolved, more or less by default, Hirsch says. First, it was agreed in general what areas would be called "urban." Everything else was classified as "rural," including that which was truly frontier.
Today, however, the term frontier is all too frequently lumped in with rural, which is 96% of the nation's real estate, but only 20% of its population. What is rural is usually much more urban than what is frontier. Rural and frontier, she said, are two different worlds.
"The frontier is not empty," Miller says. "These are places from which much of our national wealth is derived, from mining, agriculture, ranching, and many Native Lands. There is someone there, maybe a ranger station, a fire watcher or a national park that gets 12 million visitors a year driving through."
Miller explains the problem by describing the challenges of providing healthcare in Lordsburg, a 4,000 population town in New Mexico 50 miles from the Mexican border in Hidalgo County, an area with only 1.7 people per square mile and about as remote as anyone can be in the U.S.
A few years ago, Miller says, Charlie Alfero, CEO of HMS Health System, was trying to start a two-bed extended care service in his clinic so patients who don't need to go to the hospital 50 miles away in Silver City, or 150 miles away to El Paso, can get appropriate care closer to home. The project had been planned for years and was ready to go, or so he thought, Miller said.
But the day before his pilot project was to be approved as part of federal legislation, someone changed the rules, eliminating him from opening his service because his clinic was less than 75 miles away from the nearest hospital.
That was unfair, Miller said, because in an area this rural, many patients live in towns like Rodeo or Playas that are already at least 25 miles farther away.
"That structural barrier left out many other facilities that had worked for the legislation," she says.
Miller enumerates dozens of ways in which very rural areas are discriminated against. Bigger areas, for example, get more money per capita than smaller ones and tend to fund projects in pieces rather than taking a holistic approach to healthcare.
Frontier areas have extreme difficulties recruiting health professionals. They may be lumped in with multiple county groups, partners who may not always like to share.
Miller sums up the issue this way. "Do people throughout the entire country have access to a minimum amount of services, and if they don't, how do we create a system that allows them to get them?"
Quest Diagnostics Inc., and its subsidiary Nichols Institute Diagnostics (NID), entered into a global settlement with the U.S. government that includes a $40 million criminal fine and a $262 million fine to resolve False Claims Act allegations.
NID pleaded guilty to charges of felony misbranding of one of its products, a test called Nichols Advantage Chemiluminescence Intact Parathyroid Hormone Immunoassay. Laboratories use the test to measure parathyroid hormone (PTH) levels in patients. According to the U.S. Department of Justice (DOJ) press release, the tests provided elevated results that lead to unnecessary medical treatments for patient who were thought to have high levels of PTH.
The DOJ asserts NID manufactured, marketed, and sold the test kits despite knowing they produced inaccurate and unreliable results. Along with the settlement, Quest also entered into a corporate integrity agreement (CIA) with the OIG.
The April 15 settlement comes nearly five years after whistleblower Thomas Cantor filed a qui tam suit. Cantor will receive a $45 million share of the settlement.
Cantor's determination was key in bringing this False Claims Act case to a settlement, says Norm Werner, FACHE, corporate compliance director for Continuum Health Partners in New York.
"This was years in the making," he says. "Cantor really persevered."
It all started when Cantor found a dramatic increase in parathyroidectomies after laboratories began using NID's test kits. Physicians performed the surgeries because the test kits lead them to believe they were necessary, Werner says.
With the government consistently cracking down on healthcare fraud and abuse, this large settlement is a significant victory, he says.
"This will definitely be a deterrent going forward," he says.
The CIA should also help in preventing future similar cases. "Now they have to be that much more compliant by having to adhere to the CIA," Werner says.
The United States is drowning in healthcare costs, which are projected to top a whopping $4 trillion by 2015. President Barack Obama's healthcare reform plan includes funding for workplace wellness programs.
When he signed the stimulus package, Obama said, "Wellness initiatives will keep millions of Americans from setting foot in the doctor's office for purely preventable diseases."
But most companies have reported low and stagnant participation rates in workplace wellness programs. With so much riding on prevention to help cure America's healthcare system, how can wellness programs fulfill the promise of lowering healthcare costs?
Here are eight tips to ensure a successful wellness program:
Assess—Conduct research to understand your participants: What motivates them, both from a rewards and recognition perspective? How do they want to be communicated with? What are the current realities of your health and productivity program?
Design—Develop a program that is both fair and fun, taking into consideration your unique member population as well as which goals are realistically achievable and measurable along the way.
Manage—Ensure one person or partner is managing all aspects of the program. Make sure the wellness movement starts at the top. Executive management needs to embrace wellness as a business imperative, not a "nice to have," and they need to live up to that mission.
Reward—Develop a continuous rewards and incentives program with personally meaningful, memorable, and motivating rewards. Many organizations are using incentives as a one-time "carrot," or a simple "do this, get that" approach. However, because the required behavior changes are new, challenging, and difficult to sustain, programs must include incentives and rewards throughout the year in order to drive long-term program engagement in healthy behaviors.
Communicate—Share ongoing reminders, feedback, and recognition using multiple media and taking into account member preferences. This is the single biggest reason wellness programs fail. There is not enough budget or emphasis given to the importance of communication either in content or frequency. Effective communication continues to reinforce attention on the wellness movement and it answers five key questions for employees:
What do you want them to do?
Why do you want them to do it?
How do you want them to do it?
What's in it for them?
How are they doing?
Segment—Know the demographics of your workforce. Demographics are a key data point that allow you to disseminate the appropriate communications and rewards. In addition, we suggest going a step further to take the pulse of your population and its readiness for change. Understand what they expect and prefer, as well as the types of tools, communications, and rewards that may actually engage them to adopt healthier behaviors.
Measure—Help members understand how they are doing individually and track the success of the overall program. This will help both members and program managers make the necessary tweaks to stay on track.
Spend—Spend money to save money on healthcare costs. Too often organizations try to cast too broad of a net, spreading their investment dollars too thin. The result: a disjointed and haphazard program with very little strength to drive change. Make the most of your investment dollars and focus them on a couple of objectives with the idea that you can always phase in more services and interventions after the wellness movement gains momentum.
Creating a wellness movement in an organization takes time, resources, and investment. The last thing that you want is for it to fail. Taking some of these tips to heart may help in mitigating the risk of failure.
Mindy McGrath is vice president of strategy for Maritz's healthcare sector. She has more than 15 years of experience within the healthcare industry, including the pharmaceutical and health plan markets. She has served in multiple roles for companies such as Bristol-Myers Squibb, PricewaterhouseCoopers, and Medimedia. She also authors the healthcare blog,Rewarding Health.
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With so little known about the specifics of a possible public insurance option, it's difficult to have a serious debate about the plan—and its potential effect on healthcare.
One only has to look at recent industry dialogue to see that we're all confused about what will happen to the various healthcare players if it becomes reality. And Washington hasn't been particularly helpful in opening up the topic for serious debate. Nancy-Ann DeParle, White House health reform director, shed little light on the plan in her Kaiser Family Foundation media briefing. DeParle's definition of a public insurance plan is one sponsored by the government with low or nonexistent administrative costs compared to private plans.
But beyond that definition, the White House health reform director does not go into any detail except to say that a public option could follow the same rules as private insurers or it may have its own regulations. The public plan could pay physicians at the Medicare rates or it could pay at the private payer level.
In other words, we're getting the Washington spin.
This lack of information is causing much consternation in healthcare. In particular, health insurance plans want to know how they should prepare to compete with a public plan.
The way I see it, a public insurance option could begin to take shape if policymakers answered two key questions:
What does the government hope to accomplish by creating a public insurance option? Does it want to provide competition for private insurers, which could ultimately reduce costs? Or, is it a safety net to protect Americans from being uninsured?
This gets to the reason behind a public insurance plan and what will influence its benefit design. It also explores whether the public plan will offer expanded programs found in private insurance, such as vision and dental, or become a lower cost option that provides basic coverage and protects Americans from exorbitant healthcare costs while offering preventive services.
Will the public option pay doctors at Medicare rates or closer to private insurer levels?
Paying at a rate similar to Medicare will lead to lower premiums than private insurance, which will woo many currently insured under private plans to the public option. But it could also cause a battle with physicians because it will mean lower reimbursements. I'm sure many doctors are wondering whether the lower administrative costs associated with public insurance can realistically offset the lower reimbursements.
On the flip side, if a public plan pays similar to private payers, it will have to feature premiums similar to private insurance, which would erect cost barriers for the poor and uninsured. Higher reimbursement rates coupled with lower administrative costs is the recipe physicians would love, and would create an acceptable option for private insurers, but would also price out many Americans.
Having the answers to these questions would lead to a better understanding of a public insurance plan. But don't expect anything out of Washington for awhile.
Comprehensive healthcare reform bills are not expected until June at the earliest, and Health and Human Services secretary nominee Kathleen Sebelius is still not through the Senate confirmation process. Once Sebelius is in place at HHS, the secretary should make sure that her office works with Congress to present more specifics about the public insurance option so the industry can have an informed debate—and prepare for the future.
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Trisha Torrey has every right to be angry with the medical profession. After doctors removed a golf-ball sized lump on her torso, she waited two weeks for test results before she was told she had a rare form of cancer and another two weeks before she could get an oncology appointment. Without chemotherapy, the doctors said, she would die in six months. Even with treatment, they said, her prognosis was poor.
Torrey says her oncologist was an "arrogant SOB." who refused to consider that the test results might be wrong, dismissed her questions about symptoms that didn't fit with what she'd read about the disease online, told her that seeking out a second opinion would be fruitless because surely no one would know any more than he, and failed to follow up on an important test that ultimately proved she did not have cancer after all.
That was five years ago. Since then she's made it her mission to educate patients on navigating the healthcare system, communicating with doctors and other caregivers, and making the most of those eight-minute doctor appointments. She blogs, twitters, writes columns, is an expert on About.com, and hosts a radio show on healthcare.
Torrey, who was a marketer for 20 years, also speaks to healthcare marketers about how they can improve service at their organizations.
It starts with educating patients and managing their expectations.
"Nobody ever teaches us to be patients," Torrey says. "Doctors go through years and years of training, but no one ever teaches patients to be patients."
For example, many patients don't think about the fact that physicians are running a business—that they have to keep the lights on and pay their staff. Many don't understand the pressures of declining reimbursements and increasing costs.
Twenty years ago, a doctor could spend 20 minutes with a patient. That's no longer realistic. But if you tell the patient that the doctor has only eight minutes, the patient knows to maximize that time, she says. If the patient is old-school and you don't manage his or her expectations, he or she will be upset.
On the other hand, Torrey notes, if you tell patients they're getting eight minutes and they actually get 10? Now you've exceeded their expectations.
"You don't even have to change the experience to make it positive," Torrey says.
Of course, your docs probably don't have the time (or, in some cases, the inclination) to educate their patients. That's where you can step in, offering classes or online information about being a good patient—in turn making physicians' lives a lot easier. That's good for both patient satisfaction and physician relations.
When she first started on her quest, healthcare professionals were standoffish and defensive, Torrey says. Now, she says, "They are realizing how much of a friend I can be."
Note: You can sign up to receive HealthLeaders Media Marketing, a free weekly e-newsletter that will guide you through the complex and constantly-changing field of healthcare marketing.
The marketing team at Baton Rouge (LA) General Medical Center (BRGMC) wanted to do something different for its annual breast cancer awareness campaign. But they had to do it on a shoestring: The organization wasn't the market leader in oncology service lines and had a smaller marketing budget than the competition, the hospital wrote in its submission essay for the HealthLeaders Media Marketing Awards.
"We are constantly focused on maximizing our creativity and doing a lot with a little," they wrote.
Because national breast cancer awareness month coincided with the 2007 elections in Louisiana and because the region has a rich history of political satire, the hospital devised a unique political campaign of its own: a mock online election featuring five well-known community members who agreed that the winner of the mock election would wear pink on Election Day.
Jokes about voting early and often and some of the funniest press releases our judges have ever read set the lighthearted and memorable tone for the campaign. Yard signs, campaign buttons, cardboard cutouts of the candidates wearing pink boas, and other creative collateral showed the thought and effort that went into this campaign. The team carefully vetted its candidates, choosing men who are well-known in the community, have a personal connection to cancer and a passion for early detection, and would embrace the campaign's spirit.
"Obviously, a lot of great strategic thinking went into this campaign, and it showed," said one judge. "Outstanding!"
The goal of the campaign was to raise awareness of breast cancer, of course, but also to increase name recognition and market share for BRGMC. During the four-week campaign, the microsite got 1.2 million hits and banner ads received 1.1 million impressions and 5,600 click-throughs. In all, 24,000 people cast votes, sent 150 e-mails to the candidates, and ordered 200 breast health shower cards. What's more, the campaign ultimately won BRGMC a platinum award among large hospitals in the community relations category at the marketing awards.
"Objectives were more than clear, and the results speak for themselves. This was truly an ambitious and successful initiative," one judge said. "You absolutely hit the target of raising awareness and engaged the entire community," said another.
This Campaign Spotlight was excerpted from Hospital Campaigns That Work, featuring the winners of the 2008 HealthLeaders Media Marketing Awards.
Marianne Aiello is an editor with HealthLeaders Media. Send her Campaign Spotlight ideas at maiello@healthleadersmedia.com. If you are a marketer submitting a campaign on behalf of your facility or client, please ensure you have permission before doing so.
This morning's scheduled Congressional hearing on medical helicopter services is the latest in a string of discussions this year centered on the safety of EMS flights and the well-being of patient passengers.
The meeting by the House of Representatives' Subcommittee on Aviation appears to be mostly a fact-finding mission about medical helicopter safety in recent years rather than push for more regulations, says Rex Alexander, a director for the National EMS Pilots Association and the regional operations manager for Omniflight Helicopters in Fort Wayne, IN.
"Personally, I don't see anything happening [at the hearing]," Alexander says, adding he is most interested in whether lawmakers on the subcommittee make recommendations for improvements.
Meanwhile, on Monday, the Flight Safety Foundation—a nonprofit group that aims to improve aviation safety—released a 64-page report outlining 26 major risks in the structure and oversight of the medical flight industry. The document also highlights possible steps to offset these risks, with the caveat that it is up to various parties involved in medical flight services to help make changes.
"This is a great opportunity to educate hospital executives if they [lead] a sending or receiving hospital" involved with air transport of patients, says Kimberley Tucker, CEO of Aerosafe Risk Management, which has U.S. offices in Washington, DC. Aerosafe prepared the new report on behalf of the medical flight industry. Regarding today's congressional hearing, Turner says she'd like to see lawmakers examine the opportunities for the medical flight industry and other industries, such as healthcare.
Based on the likelihood of problems occurring and the severity of related consequences, the three highest-ranking concerns in the report include the following:
A lack of a national framework to govern medical flight services, which leads to relaxed accountability, challenges to gaining agreements on best practices, and reliance on flight operators to make decisions regarding patient transport
An inadequate medical reimbursement model, which delays upgrades in equipment and technology
Little clarity about the roles of federal, state, and local agencies involved in medical flight oversight, which results in conflicting rules that may confuse flight operators
Currently, laws, codes, and regulations governing patient flights vary from state to state. Nine fatal medical flight accidents have occurred since December 2007, killing 35 people, according to the National Transportation Safety Board (NTSB). The NTSB lists enhanced safety of air ambulance services as one of its most wanted transportation safety improvements for aviation.
The NTSB has been pushing the Federal Aviation Administration (FAA) to enforce more aggressive medical flight regulations. The NTSB held hearings in early February to question the parties involved in some of the 2008 medical flight crashes and discuss recommendations from various stakeholders.
From its perspective, while the FAA is willing to lend its expertise to hospital and business challenges related to medical flights, the agency's regulatory responsibilities are limited to aviation, says spokesperson Les Dorr.
Representatives from The Joint Commission helped review a draft of the Flight Safety Foundation report earlier this year, and in doing so fleshed out patient safety and risk management practices within the document, Turner says.
"Acknowledging the problem and identifying risks are critical first steps toward finding solutions to accidents that have plagued helicopter emergency medical services," Jerod Loeb, PhD, executive vice president of the Division of Quality Measurement and Research at The Joint Commission, said in a press release issued by the Flight Safety Foundation.
The report's developers have set an August 31, 2009, timeline for a risk reduction plan to be formally released to the medical flight services industry. Until then, stakeholders—including hospitals—have an open invitation to create and submit solutions, Turner says.
For more information about these submissions, contact Katherine Robinson, communications and senior planner at Aerosafe.
In what has been felt throughout many healthcare organizations in recent months has been confirmed in a new survey: approximately 20% of Americans say they have delayed or postponed medical care—particularly physician visits—because of related costs, according to a new survey of 12,000 people nationwide from Thomson Reuters' Center for Healthcare Improvement.
"What is clear is that there is a substantial increase in stress on consumers on paying both for insurance and healthcare. Many said cost was the main reason," said study coauthor Gary Pickens, PhD, in an interview. The survey found that 21% of adults across the country expected to have difficulty paying for health insurance or services in the next three months.
Pickens noted that the recession has impacted the reasons why households may or may not have healthcare insurance between 2009 and 2006 (when an earlier survey was conducted). Although the same percentage of household reported making changes related to their healthcare coverage, the types of strategies were different--with an emphasis on cost-cutting in 2009. In 2006, the reasons were more likely to be related to not being eligible for insurance or waiting on insurance.
In 2006, lack of time for care was the reason most often cited by households for postponing care (cited by 26% of those surveyed), while cost was mentioned next (by 20%). But by 2009, cost (cited by about 24%) emerged at the top. "It's clear that at this point now that cost is the dominant reason," Pickens said.
For healthcare leaders, the picture does not appear to be changing much in the next three months—particularly when consumers' expectations are reviewed, Pickens noted. In particular, 28% of those surveyed said they were very likely to postpone or cancel elective surgical procedures, 13 percent would delay or cancel routine physician visits, 15% would delay or cancel therapy visits, and 17% would delay or cancel physician visits for minor illness or surgery. The visit least likely to be cancelled was healthcare treatment for a child.
Pickens and his colleagues also found the rate of households with employer-sponsored insurance declined to 54.6 percent in 2009 from 59 percent in early 2008. At the same time, those covered by Medicaid rose to 14.5 percent in 2009 from 11.9 percent in 2008.
Those households with higher incomes were far less likely to report troubles paying for health insurance: The lowest income household (with annual income less than $25,000) were five times more likely to report difficulties when compared with those in the highest income levels (above $100,000 annually). Those households with unemployed members reported difficulty paying for services (60%) than any other group—including retirees or those employed part-time.
