President Obama's road show on healthcare reform is coming to California on April 6. Gov. Arnold Schwarzenegger and Washington Gov. Chris Gregoire will co-moderate in Los Angeles for the event that will link participants from Oakland, San Diego, and Clovis (Fresno County) via satellite.
After participating in a recent White House healthcare summit, New Hampshire Sen. Jeanne Shaheen is returning to New Hampshire to hear more from those on the front lines of the issue. Shaheen will meet with healthcare advocates and providers to discuss rising healthcare costs and the need for comprehensive healthcare reform.
California health inspectors have fined Los Angeles County-USC Medical Center $560 for violating state workplace rules, a penalty assessed after investigators confirmed employee complaints that helicopter exhaust fumes were entering the hospital's ventilation system from the rooftop landing pad. The fine by the California Division of Occupational Safety and Health stemmed from a January inspection of the $1.02-billion facility, which opened its doors in November.
Soaring medical costs may drive up premiums paid by already beleaguered California employers for workers' compensation insurance, after rates plunged 65% over the last six years. Gov. Arnold Schwarzenegger, who forged major changes in the state workers' comp law in 2004 that slashed rates, has launched a bid to stop a potential 24.4% rate hike now being discussed.
While Washington has put health reform on the fast track, a group of Tennessee thought leaders wants to see a more gradual approach that uses Tennessee, and perhaps a few others, as laboratories to test ideas, improve access to care, and trim medical costs.
Under its proposal, The Rolling Hills Group recommends phasing in universal coverage over 10 years at a rough cost of $100 billion a year. The group includes representatives of private business, hospitals, and an ex-BlueCross BlueShield executive.
Individuals who lost their jobs in the last several months may be eligible for employer-sponsored health insurance coverage at greatly reduced rates. The federal government will pay 65% of COBRA continuation coverage premiums as part of the American Recovery and Reinvestment Act of 2009. The coverage will apply to individuals who lost or lose their jobs between Sept. 1, 2008 and Dec. 31, 2009 and are eligible for continuing coverage under COBRA.
With 663,000 more jobs disappearing from the American economy in March, the government's response to the downturn is being put to a strenuous test. Three months into the year, the unemployment rate has already soared to 8.5%, from 7.6%, the highest level in more than a quarter-century. The severity and breadth of the job losses in March prompted economists to conclude that an agonizing plunge in employment prospects was still unfolding.
The Obama administration's plan to spend $19 billion to hasten the adoption of electronic health records that can share data across networks will only give more impetus to the shift toward Internet-style computing. One good example of the trend is a joint project, between the Centers for Disease Control and Prevention and GE Healthcare. The project will deliver individually tailored public health alerts to electronic health records in doctors' offices. The goal, for example, is to have an alert pop up on a physician's screen that a certain patient, based on location, age, and perhaps occupation, might be at risk for an influenza outbreak that is nearing a certain community or for contracting a food-borne illness.
There is a common misconception among hospital administrators that burn centers are neither self-sustaining nor profitable. However, this is a world view at odds with my personal experience. If managed properly, plastic surgery-based burn centers can be new, highly profitable revenue sources that bring enhanced prestige to the hospitals with which they affiliate.
Hospital administrators and executives are often skeptical about the cost and sustainability of burn centers, and question how burn care will fit into the overall business structure of the organization. This hesitation to embrace burn care as a business solution rather than a cost center likely stems from a limited perspective on the true nature of burn care and an underestimation of the size and scope of the market.
True "burn care" is more than just the acute care and stabilization rendered by a general surgeon prior to transferring a patient to another facility for follow-up care. It constitutes a full range of services—from acute care and reconstruction to rehabilitation and psychological counseling. Fewer than 30% of the burn centers in this country are plastic surgery-based, even though this model has been proven effective. For example, the Grossman Burn Center in California has plastic and reconstructive surgeons, intensivists, internists, pediatricians, and a full range of service providers including dieticians, therapists, and counselors who treat the patient functionally, emotionally, and cosmetically.
Hospital administrators also need a better understanding of the "market" for burn care. While natural disasters and house fires make headlines, occupational burns are far more common and a perennial risk in just about every community. Auto mechanics, electricians, industrial plant workers, and machinists are among the professions that are at risk of burn injury. Additionally, almost one-third of the patients we see in our practice are children.
This underestimation of the demand for dedicated burn centers, coupled with misconceptions about their viability, has led to a severe lack of burn care resources throughout the country. Taking a regional approach to establishing new centers to treat underserved populations is one way the healthcare industry can address this shortage. Targeted population centers with easy access to interstate highways that serve rural and outlying areas, and that are in close proximity to high risk populations such as heavy industry and fire zones, are ideal places for hospitals to expand services and locate a dedicated burn center.
Establishing a burn center in an existing hospital is not the daunting proposition that many hospital executives perceive it to be, either—especially if they have the right partner. For little up-front investment, a hospital can covert existing ICU beds into a dedicated burn-care ward, without incurring the costs of a major build-out. A four- to eight-bed unit requires about 3,000 square feet, a continuous block of operating room time, and the right professional partner to recruit, train, and manage the on-site personnel.
Once up and running, better carve-out rates for burn care can usually be negotiated with insurers, as well. For instance, a dedicated burn center can yield as much as 200% of Medicare costs. Further, by capturing the full range of services required to affect a significant functional and cosmetic recovery, burn centers are actually accretive to revenues, not the cost center many providers perceive them to be.
With the healthcare conversation today being dominated by proposed public policy reforms that are aimed at improving the patient's access to care from an economic standpoint, we run the risk of paying too little attention to the need for better and greater numbers of healthcare delivery assets. The more the myths about the business of burn care and the markets served by burn centers are debunked, the greater the opportunities for providers will be.
Peter H. Grossman, MD, is a Board-certified plastic surgeon and president of Grossman Burn Centers. For more information, visitThe Grossman Burn Center.For information on how you can contribute to HealthLeaders Media online, please read our Editorial Guidelines.
Increasing market share in today's environment is not easy, as patient volumes are down and people are postponing elective surgeries and cutting back on doc visits. Sg2 analysists suggest capturing new market share to recoup any that has been lost. They also say it's important to go into the market aggressively and capture the volumes that still exist, and establish benchmark metrics that go beyond market share and regularly evaluate progress.
