The California Association of Health Plans announced that Howard Kahn, CEO of LA Care Health Plan, the nation's largest public health plan, will serve as the chair of the CAHP Board of Directors until the end of 2010. Kahn was elected by CAHP's membership for a term that officially began Jan. 1, though he assumed the chair's seat for the first time at CAHP's first Board of Directors meeting of 2009 on March 18.
Children's Healthcare of Atlanta and Emory University's Woodruff Health Sciences Center have appointed Paul W. Spearman, MD, chief research officer for Children's Healthcare of Atlanta and as vice chair of Research in the Department of Pediatrics, Emory School of Medicine. Spearman, who was selected following a nationwide search of candidates, has been division director of Pediatric Infectious Diseases at Emory since November 2005, when he joined Emory from Vanderbilt University's Department of Pediatrics.
Chris Van Gorder, president and CEO of Scripps Health, San Diego, has been elected chairman-elect of the American College of Healthcare Executives. He took office at the Council of Regents meeting during the ACHE's 52nd Congress on Healthcare Leadership in Chicago last month. As chairman-elect, he will serve the first part of a three-year term in ACHE's consecutive chairmanship offices: chairman-elect, chairman and immediate past chairman. Van Gorder previously served as an ACHE Governor since 2006. He has been president and CEO of Scripps Health since 2000.
Mike Wilson is retiring from Providence Sacred Heart Medical Center and Providence Holy Family Hospital after a 27-year career. Wilson, 58, president of Sacred Heart and Holy Family, will continue to advise Providence's local leadership for several months as they work through a recession that will cut services and jobs.
Healthcare revenue cycle management firm Passport Health Communications, Inc. has named Scott MacKenzie, previously with McKesson Corporation, to succeed Jim Lackey as CEO. Lackey will remain chairman of the board of directors. MacKenzie since 2005 was president of RelayHealth Pharmacy Solutions, now part of McKesson. Prior to joining McKesson, MacKenzie spent six years in various executive capacities with Cerner, most recently as vice president and general manager.
Cross Country Healthcare, Inc. has appointed Lori Schutte president of its Cejka Search subsidiary effective this month. Schutte has served as vice president of client services of Cejka Search since 2004. She succeeds Carol Westfall who previously announced her retirement in September 2008.
Kaiser Permanente should be commended for quickly firing or disciplining 23 employees for unauthorized viewing of the personal medical files of Nadya Suleman, aka, Octomom.
The privacy breach at Kaiser Permanente Bellflower Medical Center in Los Angeles County—where the eight children were born on Jan. 27—occurred in mid-March. Suleman was immediately notified. Kaiser confirmed the breach to the public after several media outlets raised the issue. The case is now under investigation by the California Department of Public Health for possible HIPAA violations.
Kaiser's quick, unequivocal response and willingness to take responsibility for its employees' lapses in judgment will serve the health system well in the long run. Kaiser has sent a message to its employees, patients, and the public that spying on the health records of patients will not be tolerated.
So far, nothing more sinister than simply curiosity appears to have motivated the breach, Kaiser spokesman Jim Anderson says. There is no indication that any information in the files was sold to the media, or used for other nefarious purposes like identity theft.
Kaiser uses an electronic record system that allows the health system to track access to medical files. That's how the snoopers were caught. Anderson says Kaiser already had a training program in place at Bellflower well before Suleman's admission that stresses to the hospital's 5,000 employees the importance of patient confidentiality and the consequences for those who violate that trust.
When Suleman was admitted, Bellflower officials knew her condition would garner a lot of media interest. So, the hospital reaffirmed to employees who would be in contact with Suleman the importance of patient confidentiality. The hospital also enhanced security around her electronic records.
Mark Leavitt, chair of the Certification Commission for Health Information Technology, says most records breaches at hospitals involve not external hackers, but nosy employees or other insiders peeking at files, especially if the patient is a celebrity. "Sometimes, there is no monetary motive, just curiosity. That's still not good," he says.
UCLA Medical Center was embarrassed to disclose last year that employees had sifted through the medical files of more than 30 celebrities, including singer Britney Spears, actress Farah Fawcett, and California First Lady Maria Shriver.
Patient confidentiality violations don't just affect the famous. A person with an embarrassing or socially stigmatized medical condition can can also fall prey to snoops.
It's easy to snicker at these news accounts. But the repercussions of these privacy violations can do more than simply embarrass a patient. They can also cause patients to delay care or not seek care for fear that their medical conditions might be made public.
Leavitt says the expanding use of electronic health records will help more hospitals and other providers catch snoopers. "Used properly, they are far more secure. When you have an electronic health record, you have the ability to monitor every access," he says. "With paper records you will never know if someone goes into the chart room and Xeroxes pages. You don't see people deciding they are going to make banking records more secure by writing them down on paper."
"In the absence of good technology and processes, however, when an (electronic medical records) error happens, it has a greater impact because you can have thousands of breaches instead of one," Leavitt says. "It's a matter of more encryption, strong audit trails, and stronger organizational safeguards."
The federal government is expanding HIPAA laws to cover just about everyone who handles a medical record. With that expansion of the law, and likely enhancement of fines and other penalties, will come a renewed emphasis on securing those records.
The Suleman case provides an excellent opportunity for hospitals, physician groups, and other healthcare providers to remind staff about the importance of patient confidentiality. This really is an ancient and fundamental principle of medicine. It must be honored. If it is not, then patient trust in the provider rightly comes into doubt. After all, if healthcare providers can't be trusted to ensure something as fundamental as a patient's privacy, how can they be entrusted with a patient's health?
John Commins is the human resources and community and rural hospitals editor with HealthLeaders Media. He can be reached at jcommins@healthleadersmedia.com.
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It's unlikely that most people take the time to read all the way through any kind of commercial contract. All that fine print and paragraph after paragraph of legal jargon seems to be written by and for lawyers.
A federal healthcare contract isn't much different. However, once you receive an award from a government agency, it is important that your organization reads and is familiar with the entire contract, including provisions incorporated by reference. Many of the clauses included "by reference" are "boilerplate" and completely irrelevant to the work to be performed, but by law, must be included. On the other hand, some of the clauses incorporated "by reference," as well as others included in full are indeed important, and warrant careful attention.
Once you begin to perform under the contract, one important rule is to accept direction only from an "authorized" official. The key point here is to know the difference between an authorized and "unauthorized" individual.
In a healthcare contract, while the inclination may be to assume that medical or clinical staff of the government are authorized to provide direction to a contractor, they are frequently not the ones officially vested with the authority to execute a contract or implement changes. Typically, only the contracting officer (CO) and specifically identified designee (often the Contracting Officer's Technical Representative, or COTR) are authorized to give instructions or changes to a contractor.
If you proceed with services at the direction of a government employee who isn't authorized to give such direction, you may find it difficult to be paid for those services. A related rule of thumb is that you shouldn't volunteer to perform extra work in the hope that you'll work out payment later with the government. Make sure that you have written direction from an authorized government official before performing.
What if an authorized government agent directs you to perform work that you believe isn't part of your contract? Organizations that are relatively new to federal contracting are often caught off guard by such requests and assume that because they've been asked to do something, they must comply.
To the uninitiated, the "intimidation factor" can be a powerful deterrent to challenge the directions of an official agency representative. Many inexperienced contractors do not realize that there are a variety of informal and formal ways to resolve questions about whether a requirement is "in scope" (e.g., within the scope of work formally approved as part of their contract), or "out-of-scope" (e.g., not something that was originally part of the scope of work).
Beware of the intimidation factor. Just because you get a request—or even a demand—to perform something, it doesn't mean you must comply without recourse. One of the clauses frequently cited "by reference" in most federal healthcare contracts is the Disputes Clause (FAR 52.212-4(d)), which provides an important mechanism for resolving such issues.
Unless the government has materially breached the contract, the best strategy is to keep performing those services that are not in question, while attempting to resolve other issues with contracting staff informally. If informal avenues are not successful, you have the right to file a claim or other request for relief afterward.
The government ultimately retains the right to terminate a contractor "for default," however, from a practical standpoint, terminations for default are relatively rare, as frequently the parties are able to resolve differences to their mutual satisfaction. Another important difference between federal and commercial contracts is the government's right to unilaterally terminate a contract for their "convenience." This right allows the government to end a contract without being subject to a breach-of-contract suit as could easily occur in the private sector between two parties if one decided to simply walk away from an existing agreement.
While it may initially appear that the government has the upper hand in federal healthcare contracts, federal procurement law provides important rights to the contractor as well. A contractor has the right to submit a claim if the government orders work outside the scope of the contract; a contractor's performance will be excused if performance is impossible or impracticable through no fault of the contractor; and a contractor may assert its right to an excusable delay if it cannot perform on schedule and it is not negligent or otherwise at fault. Finally, the law recognizes that the government has a "duty to cooperate" with a contractor, and cannot "hinder" the contractor's performance. Again, any government failure to uphold this duty may be actionable.
By now, you realize the importance of record keeping when doing work on a government contract. It's best to communicate with the government in writing, or at least keep detailed notes of phone conversations and meetings. In addition, the contract itself will instruct you on what types of records you must keep, and for how long. It's a good practice to have and follow a written record-keeping policy, and to keep a log of any contract documents you destroy, including the date of destruction. Good record keeping will simplify government audits, and will help if you or the government assert a claim concerning contract performance and administration.
In next month's article, we will discuss "set-asides" (e.g., contracts that are set aside for certain socioeconomic categories of businesses) for healthcare services within the federal marketplace.
Scott Honiberg is president and Jeff Weinstein is counsel at Potomac Health Associates, Inc. They can be reached at S.Honiberg@PHAInc.com or J.weinstein@PHAInc.com , respectively.For information on how you can contribute to HealthLeaders Media online, please read our Editorial Guidelines.
That's not the question, at least according to an admittedly unscientific survey of CEOs and CFOs I've talked with over the past few weeks—ever since President Obama made so-called "bundled" payments a centerpiece of his work-in-progress healthcare reform effort. Why this tortured reference to Shakespeare's Hamlet?
Well, because the question has largely been answered. At least many of your peers think so. If you haven't heard about bundling by now, you'd better spend some time investigating what it might mean for your organization. I try not to tend toward hyperbole in these columns, and I hope I haven't here, but based on what I'm hearing, bundling could transform the healthcare system into something you might not recognize over the next decade or so, should government and commercial payers succeed in their attempts to get it adopted.
If a hot-off-the-press study from the New England Journal of Medicine is to be believed, bundling would be not only a positive step forward to improving the cost and quality of healthcare in this country, but also it would be the best, biggest bang for the healthcare buck. Bundling means that instead of the government or commercial payers paying simply for procedures that hospitals perform on patients, as in the current regime, part of hospitals' payment would be based on how well the patient does in follow-up care. In other words, if a hospital treats a patient for a condition that requires re-hospitalization within a specified time period (the current thinking is about 30 days) then the hospital would eat the cost of treating the patient the second time. That scenario is overly simplified, but gets to the gist of what the president is proposing as one of the pillars of his healthcare reform agenda.
What I'm surprised about is that you don't hear a lot of public grumbling from hospital leaders on this proposal. As I mentioned, many of you have resigned yourselves that some kind of bundling system is inevitable. What it might mean in practical terms is new contractual relationships with a variety of hospital business associates who will help coordinate post-acute care, from rehab centers to disease management companies. Why? Because in many ways, a return to a modified integrated delivery system will be difficult if not impossible for the majority of hospitals.
The tricky part in such a contractual arrangement will be figuring who's responsible for what if a patient does have to be readmitted for the same medical condition before the 30-day period is up. The devil is in the details. Do you have the wherewithal to protect your income if the patient still needs readmission even though your hospital has done everything correctly?
I see a future where a lot of this might be determined contractually, but certainly there will be many instances where the contract might be unclear about who's responsible for eating the treatment costs and how much each party should take the hit for poor quality or for plain old bad luck. I could see many cases sent to independent arbitrators, who might or might not have the knowledge necessary to determine who's at fault. It's a minefield.
So maybe I'm asking the wrong question in my headline above. When it comes to bundling, perhaps it's not "to be or not to be," but "to me or not to me."
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While the quest to reform healthcare and promote affordable medical care steadily moves forward on Capitol Hill, a gap remains on how healthy Americans actually are—and how healthy they could be in the future. By failing to take proven steps to promote better health throughout communities—including discouraging smoking and promoting healthy foods and physical activity—children today face having sicker, shorter lives than their parents, according to recommendations released Thursday by a panel of healthcare experts.
A new definition of health reform is needed that addresses people's daily lives, said Mark McClellan, MD, PhD, co-chair of the Commission to Build a Healthier America that was launched by the Robert Wood Johnson Foundation just over a year ago. "The evidence is clear that how we live, learn, work and play has a much greater influence over how well and how long we live than our healthcare."
"It's time to take a wider view of what we need to do to improve our health," added McClellan, the former administrator of the Centers for Medicare and Medicaid Services and the Food and Drug Administration, who is now director of the Engelberg Center for Healthcare Reform at the Brookings Institution, Washington.
The commission called for individuals to take more responsibility for their health choices. But, it also recognized that many individuals face obstacles in making healthy choices outside the healthcare system. For instance, the lack of grocery stores in various lower-income communities may hinder attempts to include more fresh fruits and vegetables in daily diets.
To help break through these barriers, the commission called for initiatives that promote a "national culture of health"—especially among children. They include:
Banning junk food from schools.
Getting children to be physically active at least an hour every day.
Designing public programs that support the needs of hungry families for nutritious foods.
Eliminating smoking and promoting a smoke-free nation.
Giving children, especially those from low-income families, a healthy start by ensuring that they have high-quality education and child care.
Commission member Gail Warden, MD, president emeritus of the Henry Ford Health System in Detroit, suggested that emphasis needs to be placed on creating sophisticated school-based health programs in which "all aspects of the mental and physical needs of individual students are taken into consideration."
These programs should "put great emphasis on wellness and prevention" and "educate [children and parents] about their own personal responsibilities about their health," he said. A recent example of these programs involve getting childhood immmunizations that have received high compliance rates nationwide.
The full report, "Beyond Healthcare: New Directions for a Healthier America," which includes examples of community programs successfully addressing various health issues, is available at the Commission's website (www.commissiononhealth.org).
