The Florida Office of Insurance Regulation has ordered a British Virgin Islands-based health insurer and its affiliates to stop doing business in the state, after an investigation determined that the company was reportedly operating without a license.
The company, identified as American Assurance Underwriters Group, and affiliates Worldwide Expatriate Administrators LLC, and Worldwide Expatriate Advisors LLC, use offices in Florida and sell health insurance directly through a Web site to United States citizens and foreign nationals when they reside outside of the United States, Florida OIR said in a media release.
OIR investigators determined that the health insurance companies are underwritten by AAUG Insurance Company Ltd., which is a "captive insurance company" licensed by the British Virgin Islands that does not hold a certificate of authority from the State of Florida.
"We began investigating this company and its affiliates based on consumer inquires," said Florida Commissioner Kevin McCarty. "The office will not tolerate unlicensed companies unlawfully selling insurance products to consumers in Florida."
The companies have 21 days to challenge the office's action.
In October 2008, staff members at Riverside Methodist Hospital (RMH) in Columbus, OH, approached Sheryl Tripp, MSN, RN-BC, nurse manager for the gynecology/gynecology-oncology (gyn/gyn-onc) surgical unit, in hopes of changing the way nurses were issuing patient reports.
Tripp reviewed the current process on the gyn/gyn-onc surgical unit for patient reports, along with the unit's Press Ganey patient satisfaction scores, and decided it was time to implement a new process for patient reports and end-of-shift reports. Press Ganey scores help facilities measure patient satisfaction with their care and offers guidance to help provide a higher level of healthcare.
Tripp led an effort to implement a new reporting process, Transferring Accountability at the Bedside (TABS), that includes an interaction between nurses ending and beginning shifts. Both nurses visit the patient's bedside together, as opposed to each nurse reporting separately.
The new process has improved the unit's Press Ganey scores dramatically, Tripp says.
Time for a change
For as long as Tripp could remember, nurses on her unit used tape recorders to create patient reports. At the end of each shift, the nurse would go into the designated recording room to record patient reports. The nurse coming in for the next shift would listen to that report and attend to patients and daily tasks.
"This process is all right, but most of the time nurses would end up doing verbal reports because the tape recorder would fail, or they had problems understanding what the nurse was saying on the recording," says Tripp.
The unit's Press Ganey scores were hovering around 50% for nurse-to-patient communication and safety during the patient's stay. Tripp knew it was time to honor her nursing staff members' requests to help improve patient safety and nurse communication.
To start, Tripp ran a series of two-week trial methods on her unit that involved doing a few different types of reports: with the tape recorder, a written report, a verbal report, and a bedside report.
"We told the staff members each week the style of reporting we would do, and then asked them to report back to us with any feedback," says Tripp.
While the trial period was going on, Tripp would visit patients' rooms and talk with them about each of the reports, specifically the bedside reporting.
On RMH's gyn/gyn-onc surgical unit, semi-private and private rooms are available, and there are patients who share rooms. Tripp wanted to make sure patients did not have any problems with bedside reporting with respect to fear of violating the patient's privacy.
"During this trial period, a majority of the patients I talked with liked the bedside process, so I decided this was the right process to move forward with and focus on developing," Tripp says.
Education and implementation
Tripp, her clinical nurse manager, the women's health clinical nurse specialist, and a research nurse at RMH formed an evidence-based practice team to research information on bedside reporting.
While researching, the team chose three different articles that highlighted the pros and cons to bedside reporting. Nursing staff members received these articles as education and to prepare for the upcoming change in reporting.
As part of the TABS process, when the two nurses enter a patient's room, the nurse coming off shift introduces the nurse coming on shift to the patient. Then, the nurse now on shift checks the patient's armband and asks the patient's name and date of birth.
The new nurse on shift writes his or her own name, along with the patient's name on the white board located in each patient room.
"The nurse also makes sure there is an opportunity for the patient to ask questions," says Tripp. "This allows the patient to comment on treatment or clarify why they are on a particular medication."
In addition to having the two nurses work together and converse more with the patient, a report sheet is kept outside the patient's room.
"The report sheet is used as a guideline for the nurses to communicate with one another, especially if a float nurse comes to the unit," says Tripp.
After a month of using the new TABS process, Tripp and her team sent out surveys to the nursing staff members along with the patients on the unit to solicit opinions about the new bedside reporting.
Overall, the new process of reporting was well received, and many nurses liked the process better than they had expected to like it.
"Nurses reported that they were now clocking out on time, as opposed to leaving a half an hour after their shift has ended," says Tripp.
Patients were also happy with the bedside reporting. "Some patients told me that they were considering having family members spend the night with them because they were scared," says Tripp. "But with the new bedside reporting, the patients said they felt safe because they were aware of what was going on and who was taking care of them."
Great success
In addition to receiving good reviews from the nursing staff members and the patients on the gyn/gyn-onc surgical unit, the TABS process vastly improved the Press Ganey scores.
The three areas on which RMH focuses are:
How well nurses keep patients informed
How well staff worked together to care for patients
Whether or not staff includes patients in decision making
Prior to implementation, Tripp's unit scores were hovering around 26%, 50%, and 60% satisfaction for each of the three focuses. Just three weeks after implementing reporting at the bedside, each focus area reached 99% satisfaction.
The Senate passed the second of three key procedural votes on the healthcare reform bill by a 60-39 vote along party lines on Tuesday morning.
An earlier vote to approve the nearly 400-page amendment package that was introduced this weekend by Senate Majority Leader Harry Reid (D-NV) also passed 60-39, though only a simple majority was required.
A third procedural vote is expected Wednesday afternoon to limit debate on the healthcare bill. A final vote is anticipated at 8 a.m. on Christmas Eve.
Senate floor debate is continuing throughout today, with breaks at noon for the parties' caucuses. Reid started out the morning calling for the senators, under pressure after meeting for 23 straight days, to avoid personnel attacks when speaking on the floor.
The Senate cleared the second of three key procedural hurdles on President Obama's healthcare legislation early Tuesday with another party-line vote, continuing the effort to pass the bill before Christmas. All 60 members of the Democratic caucus supported the measure to finalize amendments to the healthcare package, while 39 Republicans opposed it. A third procedural vote is expected Wednesday, with final passage of the bill likely to come late on Christmas Eve.
This year has been an eventful one for healthcare as the nation's attention has focused on the problems with the current system and possible ways to improve quality of care, lower costs, and insure more Americans. In addition to healthcare reform, health leaders have faced a difficult economy and greater government scrutiny. All of these issues are represented in our top 10 articles of 2009.
When Senate Majority Leader Harry Reid (D-NV) finally released his manager's amendment on Saturday, noticeably missing was the state opt-in public insurance option that had been included in the original Senate healthcare reform bill last month.
The public option became a hot issue when it became apparent that several Democratic and independent senators—who are needed for the 60 votes to advance the bill—would oppose the bill if the option remained.
Though not part of the Senate plan, a public option is still found in the House reform bill that was passed Nov. 7. The question is: Will it remain after the conference committee?
House Speaker Nancy Pelosi (D-CA) was adamant throughout the summer and fall that the legislation should contain a "robust" public option. However, speaking earlier this month at her weekly press conference, she declined to agree or challenge the Senate proposal to remove the option, which she had not seen at the time.
The House believes "that the public option was the best way to keep insurance companies honest… and also to increase competition. If you have a better way, put it on the table," she said. But she declined to elaborate further on keeping the option intact in the reform legislation: "What I have said is—as I always say to my members—give the Senate room."
But several senators have expressed their displeasure that the president did not make a stronger push for the public option. One of those senators, Russ Feingold (D-WI), said in a statement on Sunday that "the lack of support from the administration made keeping the public option in the bill an uphill struggle."
"Removing the public option from the Senate bill is the wrong move, and eliminates $25 billion in savings," he said. "I will be urging members of the House and Senate who draft the final bill to make sure this essential provision is included."
Sen. Kent Conrad (D-ND), speaking Sunday on Fox Sunday News, implied that very little wiggle room was found in the current Senate bill: "I think any bill is going to have to be very close to what the Senate has passed because we're still going to have to get 60 votes," Conrad said. "And anybody who's watched this process can see how challenging it has been to get 60 votes."
But Sen. Tom Harkin (D-IA), chair of the Senate Health, Education, Labor and Pensions committee, said on Tuesday that the issue most likely will be "revisited,"—such as legislation outside of the reform bill.
In his statement supporting the Senate's first procedural vote on the reform bill on Monday, President Barrack Obama seemed to prefer speaking about "affordable options," as opposed to public options.
"With today's developments, it now appears that the American people will have the vote they deserve on genuine reform that offers security to those who have health insurance and affordable options to those who do not," Obama sais. "There's still much work left to be done, but not a lot of time left to do it."
There were no patients waiting for emergency care at Oregon's Sacred Heart Medical Center RiverBend in Springfield yesterday around 6 p.m., but there were five in line at its sister hospital, University District in nearby Eugene.
Patients could assess their chances of being seen quickly at either ED simply by going to Sacred Heart's Web site. ED wait times are updated every five minutes through infrared badges pinned to patients in line, electronically tracking their flow.
Advertising your hospital's ED wait times and the number of patients in line is an emerging marketing strategy around the country as facilities search for ways to grab market share from their competitors and make sure their patients have the best possible experience.
Last year, Joy Cresci, Sacred Heart's emergency trauma assistant administrator, recalls that the system endured "a lot more volume in our emergency department than we anticipated by a significant amount," creating perception problems in the community "We were having long patient waits in the lobby; patients were unhappy."
For Sacred Heart, the posting is an effort to appease patients and ramp up competition against McKenzie Willamette Medical Center, which is a competing hospital, Cresci says.
But officials for the American College of Emergency Physicians are not so sure the idea is medically sound.
"I would say this is a gimmick more than anything else," says Sandra Schneider, MD, ACEP president-elect, and an emergency physician at Strong Memorial Hospital in Rochester, NY.
"I like the idea that some EDs are out there trying to be better, but at the same time I worry people might delay coming in to be seen. Sometimes a fairly minor symptom, like jaw pain or a bit of chest discomfort, can actually be a serious sign or condition that we need to jump on right away.
"And with this system, my concern is that people will wait in line at home rather than wait in line in an ED where a trained nurse has screened them," Schneider says.
Another facility posting ED wait times is Methodist Stone Oak Hospital in San Antonio, where the wait around 6 p.m. was only five minutes. And at Scottsdale Healthcare facilities in Arizona, a viewer could expect to wait 142 minutes for care at the Osborn emergency facility, but no waits at Thompson Peak ER, the Shea Main ER or the Shea Kids ER.
Still a variation on the theme of posting your hospital's ED wait times is a strategy that allows patients to buy, for $24.99, the ability to register online for a place at the head of the emergency room wait line at participating hospitals. The concept, called InQuickER—"Skip the ER Waiting Room"—was developed three years ago as a customer service program.
The patient prints out a confirmation number with instructions for what time to be at the hospital so they don't have to wait.
"We have a disclaimer. I am not experiencing a life-threatening emergency," says InQuickER CEO Tyler Kiley. Also, a charge nurse evaluates the nature of the symptoms or complaints the patient lists on the online registration form, to make sure that the patient's complaints aren't truly emergent, or require an ambulance.
Kiley says InQuickER has calculated return on investment for participating hospitals of between 200% and 2000% because patients who buy into the service won't go somewhere else.
InQuickER has experimented with various price points "and discovered that for $24.99, people absolutely love the service. They say 'This is the best $24.99 I ever spent.' And we're coming up on 3,000 patients who have used this across all of our sites."
ACEP is concerned that some seriously ill patient may attempt a much longer drive to a more distant hospital with a shorter advertised wait time, or one offering advance registration, yet not make it there fast enough.
"Patients don't understand how emergency rooms work, and expect to be taken in order they came, one, two three ...They don't understand that we always take the sickest patients first," Schneider says.
Nevertheless, it is the way some hospitals hope to woo patients, a strategy Schneider thinks is ill-advised.
"A better thing to work on is to find out what's jamming up your emergency department in the first place, get your patients on the floor, get them feeling better rather than working to post your times. I would save my money, and let the emergency department take care of emergencies."
At Sacred Heart, Cresci acknowledges that initially, doctors in the emergency department "weren't all that hot on the idea. They were worried it would set false expectations, and some people would complain that, 'Hey, I saw on your Web site there was nobody waiting, and now there's five people.'"
She adds that typically, emergency room doctors don't want to tell people how long a wait there might be, "because you could have five ambulances come in all at once. So we do have a disclaimer, and we do update the site every five minutes.
Healthcare is a huge profession, with millions of medical professionals serving hundreds of millions of people in every state, 24/7. So it should not be surprising if a few weird stories pop up now and again.
In an effort to tap into a rich vein, we at HealthLeaders Media have cobbled together a list of some of the weirdest stories in the healthcare realm for 2009. We've steered away from the healthcare reform, and anything inside Congress, because they're already weird enough.
All the stories are odd. Some stories are funny. Some most definitely are not. Some, in fact, are tragic. And this list is by no means comprehensive. We feel it safe to say that no list of oddities in healthcare could be comprehensive. We're also not going to rank them, because we can't figure out criteria, other than weird, and that is highly subjective.
Off-duty Jacksonville (FL) Sheriff's Office Deputy Joy Smith was hurt in September when her hand was trapped between her police-issued Glock handgun and the powerful magnet inside an MRI machine. Smith was able to free herself, but the gun remained stuck for hours while the machine was powered down, which takes 24 hours. Jacksonville Beach police said Smith's hand was injured and she had difficulty bending her thumb, but it was not known if she sought medical treatment.
A decade ago, Gariner Beasley was kicked off the LAPD and sent to prison after he raped women while on-duty and threatened them with arrest and jail if they did not submit. Ordinarily, that might create a problem for some potential employers, but County-USC Medical Center in Los Angeles hired Beasley. Reportedly fully aware of Beasley's criminal past, the hospital hired him as an X-ray technologist after he got out of prison, even though the job would leave him working alone and unsupervised with female patients. He was subsequently fired when the LA Times wrote about it. "We had real pinheads working for us," Supervisor Gloria Molina told the newspaper, referring to managers who cleared the hires.
It's sad and ironic when someone dies unattended in an ER waiting room, so close to the life-saving care, and yet forced to wait because of overcrowding. A security camera was rolling when Joaquin Rivera, 63, brought his hand to his chest and died in the busy emergency room at Aria Health's Frankford campus in Philadelphia, about 11 minutes after complaining to ER personnel of pains in his left side. Rivera's death did not go completely unnoticed, however. The security tape shows that 39 minutes after his passing, another person in the ER stole his watch. Hospital workers walked by him several times, but did not notice that he appeared to be dead until 50 minutes after he'd stopped moving.
A woman says she was ignored for so long at a Las Vegas hospital that she went home and gave birth to a premature baby that later died. Nevada State Board of Nursing administrator Debra Scott wouldn't provide specifics about the complaint stemming from 25-year-old Roshunda Abney's attempt to get treatment Nov. 30 at University Medical Center, the region's only public hospital. Witnesses who were in the waiting room have corroborated accounts by Abney and her fiance, Raffinee Dewberry. They reportedly told authorities that a nursing aide told them to mind their own business or they wouldn't see a physician themselves.
For the staff at St. Helena Hospital, Clearlake, CA, the routine surgery to remove a lower colon went like clockwork. Unfortunately, a report by the California Department of Public Health determined that staff failed to remove all parts of a stapling instrument used in the procedure. That shortcoming might have gone unnoticed except that, several days later, "Patient 1 had a bowel movement and noticed a clanking noise in the commode. A metallic structure found in the commode was determined to be the upper part of the stapling apparatus. The structure was subsequently forwarded to the manufacturer for evaluation of a possible defect," the report said. At the risk of being accused of picking on California, here's a list of several potentially dangerous things that hospital personnel did in the Golden State.
Pregnant mother Eutisha Revee Rennix, 25, died after two FDNY EMTs allegedly ignored pleas to help her when she went into cardiac arrest at her job in a Brooklyn bread and bagel shop, where they were taking a break. "They are useless. They are heartless," Cynthia Rennix, Eutisha's mother, told The New York Daily News. Co-workers said they begged two EMTs in the store to help, but they allegedly said, "Call 911" before walking out with their food. The two EMTs were placed on modified duty and are barred from providing patient care. A spokesman for the EMT union said the situation with its resulting accusation was an "odd event."
Plastic surgeon Loren J. Borud, MD, five other doctors, and two nurses at Beth Israel Deaconess Medical Center in Boston were sued after Borud allegedly fell asleep during a liposuction surgery injuring the patient. Borud told concerned colleagues before the surgery that he'd been up all night working on a book. "How common is it that nurses and other personnel don't speak up? I can't think of any [hospital] in the world where this isn't an issue," said Allan Frankel, MD, founder of a patient safety consulting company based in Washington, D.C.
Jim Bujalski of Denver said he was "surprised" when his bill for one night in the hospital was more than $58,000. Medicare and supplemental insurance covered most of the costs, but there was still a bill of $730 for "self-administered drugs" that Bujalski takes regularly at home. St. Anthony's Central Hospital charged him about $497 for two tablets of Plavix, a drug Buljalski he usually buys for $8. A Crestor tablet cost $65 in the hospital, at home he pays about $3 for it. The charges represent about a 3,500% mark-up. "I thought there's got to be some mistake here," Buljalski told a local TV station. St. Anthony's reportedly offered Buljalski a 40% discount that brought his bill down to $438. "I don't understand how they can come anywhere close to justifying that," Buljalski told the TV station.
The FBI arrested a Dallas man in July who allegedly hacked into a healthcare building's IT system and was prepared to take over the heating, ventilation, and air-conditioning system. The suspect, who worked as an overnight security officer for the site, allegedly had bigger plans of using the compromised computers to instigate a massive attack on other computers elsewhere. Police say Jesse William McGraw, who allegedly used the online aliases "GhostExodus" and "PhantomExodizzmo," is allegedly part of a hacker group called the Electronik Tribulation Army.
Virginia officials last spring warned more than a half-million people whose Social Security numbers may have been contained in the Prescription Monitoring Program database that was hacked into by a criminal demanding a $10 million ransom. The hacker left a ransom note in April at the Web site that read: "I have your [stuff]! In *my* possession, right now, are 8,257,378 patient records and a total of 35,548,087 prescriptions. Also, I made an encrypted backup and deleted the original. Unfortunately for Virginia, their backups seem to have gone missing, too. Uhoh :( For $10 million, I will gladly send along the password."
With a healthcare overhaul inching closer to reality, Democrats looking to next year's midterm elections plan to market the bill as a way to help voters who are focused more on unemployment and the economy. The chances of passing healthcare legislation rose significantly Monday, with a Senate vote that put it on track to clear the chamber by Christmas. A sour public mood may make matters tough for Democrats, whose comfortable congressional majority will be at risk. Party leaders hope to minimize concerns that many of the health bill's provisions would not take effect until 2014. That is when, for example, a new health insurance marketplace would open, with the goal of making it easier for consumers to find policies. Democratic leaders in the House and Senate are compiling lists of "immediate benefits" that would spring from passage of the bill, which still must emerge from the Senate and be reconciled with a version approved by the House.
If you listen to hospital lobbyists in Washington, the industry teeters on the brink of financial ruin, depending on how healthcare reform plays out. But the rhetoric does not match the balance sheets of some of Chicago's largest hospital operators. Many are spending unprecedented amounts on new buildings and seeing some of their best improvements in cash since the dot-com boom of a decade ago. Critics say large hospital operators that are amassing cash are doing so at the expense of patients, charging higher prices when that money could be used to lower costs or subsidize hospitals in a hole. The hospitals maintain they need to have ample cash to invest in the latest medical technology, attract top medical care providers, and maintain a reserve to cushion themselves from rocky economic conditions.
