In spite of efforts to make Minnesota hospitals safer, the number of deaths and injuries from errors or accidents rose again last year, according to a report released by the Minnesota Department of Health. Minnesota Health Commissioner Sanne Magnan said that changing the attitudes among hospital staff has proved harder than adding new safety procedures. Hospital officials, however, and experts say there's a growing belief that Minnesota hospitals are safer today than they were five years ago, when they first started publicly disclosing mistakes.
University of Alabama Hospital wants UAB Highlands to operate with it as one institution, although they will keep their separate campuses, UAB Health System CEO Will Ferniany announced. Ferniany said the health system has to continue to improve in order to stave off economic challenges. He said he aims for the hospital to have a 3% operating margin by the end of 2010, which will allow it to have the resources it needs. Ferniany said he didn't know the exact margin right now, but figured it is lower than 3%.
Texas Sen. Jane Nelson has filed a bill focused on stemming a nursing shortage in Texas hospitals. Nelson's bill would prohibit mandatory overtime policies for nurses and extend whistle-blower protection to publicly employed nurses who report patient-care concerns involving public hospitals, state schools, or prisons. The bill would also elevate the clout of nursing commissions at every hospital, requiring them to report directly to hospital boards and giving them a say in the working environment of nurses in that hospital.
Two settlements involving UnitedHealthGroup this week will require the nation's largest health insurer to shell out $400 million, cease two databases run by its subsidiary Ingenix, and help fund a new independent database that will collect price information.
As part of the settlements, UnitedHealth Group will pay $50 million to develop and own a new independent database that will replace Ingenix's two databases, Prevailing Health Charges System and Medical Data Research. The money will also fund a new healthcare consumer Web site to provide market prices for patients. In addition, Hartford, CT-based health insurer Aetna has agreed to pay $20 million to help fund the new database.
Critics of Ingenix, which most insurers use to determine "prevailing" and "usual, customary and reasonable charges" for out-of-network physician services, have complained that a health insurer-owned company should not oversee the databases. With the agreement, a yet-to-be determined university will house the price information, which will also allow doctors and patients access to the data, in addition to health insurers.
"The Ingenix database has corrupted the system for paying out-of-network medical bills, resulting in patients and physicians being cheated by health insurers. A lack of transparency, accuracy, and integrity in the payment system has allowed insurers to place profits ahead of their promises to patients," says Nancy H. Nielsen, MD, president of the American Medical Association, which filed the lawsuit with two state medical societies in 2000 that challenged the validity of the Ingenix's databases. Nielsen asked health insurers to stop using Ingenix databases and create a new independent database immediately.
Nielsen says the new independent database will create a more transparent process because physicians will have access to the information that Ingenix deemed proprietary.
"What will happen is now patients will know. It will be transparent what the fee is and what the insurer has agreed to pay. It won't be this secret, rigged scheme to keep what the insurance company pays low," she says.
In the $350,000 settlement, which is being called the largest class action lawsuit settlement against a single U.S. health insurer, UnitedHealth Group agreed to resolve the 2000 lawsuit.
UnitedHealth Group officials, who did not acknowledge any wrongdoing in the settlements and stand behind the quality of information Ingenix's database, believe that the two settlements resolve the issues raised by the AMA and New York Attorney General Andrew M. Cuomo's office concerning the company's two physician charge databases.
Robert Laszewski, president of Health Policy and Strategy Associates, LLC, a policy and marketplace consulting firm in Alexandria, VA, however, says the winner in the two settlements is neither physicians nor consumers, but the health insurance industry. "When the day is done, I don't think it changes much for the consumer or for the physician, but it gets the insurance industry off the hook in terms of people being able to be critical of them or sue them for conflict of interest," says Laszewski.
The Department of Health and Human Services (HHS) announced on January 15 the final regulation to replace the ICD-9-CM code sets now used to report healthcare diagnoses and inpatient procedures with the more advanced ICD-10 code set currently used in other nations. The final regulation will implement the ICD-10 code set two years later than HHS initially proposed: October 1, 2013.
The new timeline comes as welcome news to the industry, which feared that the original proposed implementation date of 2011 wouldn't give organizations enough time to prepare for the change.
Gloryanne Bryant, BS, RHIA, RHIT, CCS, senior director of coding and health information management (HIM) compliance for Catholic Healthcare West (CHW) in San Francisco, says CHW's recommendation was that an implementation date should have "at least three complete years, and because the implementation date would come out in January, we would foresee that moving [implementation] ahead would make more sense for everybody. So I'm pleased with the dates in the Final Rule."
Dan Rode, MBA, CHPS, FHFMA, vice president of policy and government relations for The American Health Information Management Association (AHIMA) in Washington, DC, agrees. "It certainly gives people plenty of time to implement and do the testing. On the other hand, it's not a reason to think that we can sit by for a while until we get closer to 2013. The concerns that we've raised about what has to be done over the next few years are still in front of us."
"We've got an extra year, so let's use it wisely," he says.
The delay in implementation did cause some mixed feelings. Jennifer Avery, CCS, CPC-H, regulatory specialist with HCPro, Inc. in Marblehead, MA, admitted to some excitement over the proposed 2011 date. "I'm sad in a way," she says. "This gives us a little more time to prepare. At the same time, I can't see why prolonging it will make it any better."
Nearly 30 years old, ICD-9-CM will run out of possible code combinations within a year. The present code set includes 17,000 codes, while ICD-10-CM includes more than 155,000 possible code combinations. This greater number of combinations allows ICD-10-CM to expand and keep up with new diagnoses and inpatient procedures. According to a statement on the AHIMA Web site, the United States is virtually the last industrialized country to adopt ICD-10-CM.
A second final rule issued concurrently with the ICD-10 final rule states the pending adoption of the X12 data standard, Version 5010, which includes updated standards for claims, remittance advice, eligibility inquiries, referral authorizations, and other administrative transactions that will take effect January 1, 2012. The current X12 standard, Version 4010/4010A1, cannot accommodate the use of ICD-10 code sets, making this change crucial. The second final rule also references Version D.0 for pharmacy transactions and NCPDP Version 3.0, a standard for the Medicaid pharmacy subrogation transaction.
Small health plans have an additional year to adopt 5010 and must be compliant with Version 3.0 by January 1, 2013.
This story first appeared as a breaking news item from HCPro, Inc.
Two European nations with public-private healthcare systems that provide near-universal coverage could serve as inspiration for U.S. policymakers debating healthcare reforms, according to a study released today by the Commonwealth Fund.
The healthcare policies of those two countries, Switzerland and the Netherlands, have created systems in which a mere 1% of their populations are uninsured because of an individual mandate that requires everyone to purchase health insurance. In contrast, 15% of the U.S. population is uninsured, according to Robert E. Leu, PhD, executive director of the department of economics at the University of Bern, Switzerland, and four colleagues, who wrote the study. (The individual mandate mirrors the system in Massachusetts, which requires health insurance and offers a program that connects citizens with health insurers taking part in the program.)
"The Swiss and Dutch health systems provide real-world prototypes for a regulated competitive model with multiple insurance plans, which many believe is the most likely route to universal coverage in the United States. Both countries' systems are in transition, with ongoing reforms focused on improving cost and quality performance. Tracking and understanding their experiences—both challenges and successes—offers potential insights for U.S. policymakers," wrote the authors of The Swiss and Dutch Health Insurance Systems: Universal Coverage and Regulated Competitive Insurance Markets.
Both European systems feature cost-containment measures, which result in lower administrative costs. The Swish and Dutch health systems spend 5% of healthcare costs on administrative costs, compared to an average of 7% for private U.S. insurers, the authors reported.
The systems also feature patient choice, broad access to care, low rates of care disparities, and premium assistance to those who can't afford it they added.
Karen Davis, president of the Commonwealth Fund, which supports independent research on health policy reform and creating a high-performance health system, said the two European nations should serve as "idea labs" for U.S. health reforms.
"There are examples of universal, comprehensive, high-quality, efficient healthcare systems that can show us the path to high performance," said Davis.
U.S. policymakers could learn from Switzerland and the Netherlands in four ways, according to the study:
The universal mandate requires every individual to purchase basic health insurance.
National standards require private insurers to offer a certain baseline services and protections.
Tight regulations of basic health insurance markets include requirements for open enrollment and community rating, which lead to lower overhead costs.
Risk equalization systems help reduce incentives for insurers to seek healthier enrollees.
As a result, the two European nations spend a lower percentage of their gross domestic product on healthcare than the U.S. and benefit from better health outcomes, including life expectancy, than Americans, according to the study.
The study's authors acknowledged that the Dutch system is still "a work in progress" because it was implemented only three years ago. The Swiss program, on the other hand, has been around since 1996. The authors wrote that some of the Swiss program's "shortcomings" are in the areas of risk adjustment and provider contract, which have been difficult to address, partly "because of split responsibilities for healthcare under Switzerland's federal system of government."
"This may have important implications in considering the right balance of federal and state responsibilities in health reform in the United States," the authors wrote.
Animal rights group PETA has criticized St. Louis Children’s Hospital for using sedated cats to teach medical professionals how to perform an advanced life-saving technique on infants. PETA has asked the U.S. Department of Agriculture to investigate possible violations of the Animal Welfare Act because the group claims the cats suffer during the procedures and the hospital has failed to consider training tools that do not involve animals. Cats are used to mimic the airways of infants during intubation. St. Louis Children’s Hospital offers the instruction to doctors, nurses, and emergency workers as part of its Pediatric Advanced Life Support course.
A $112 million expansion of Shawnee Mission (KS) Medical Center will open to patients at the end of January. The six-floor, 265,000-square-foot wing gives added space to the emergency, intensive care, and cardiac departments, officials said. The critical-care services expansion, which is connected to the existing hospital, also will provide an updated, patient-friendly space, Samuel H. Turner Sr., the hospital's president and chief executive officer, said.
Healthcare advocates have implored Maryland Gov. Martin O'Malley to continue a planned expansion of the Medicaid program even as he is expected to severely cut the state's budget to fill a huge budget shortfall. O'Malley indicated he may not be able to fully fund the healthcare expansion in the budget he submits to the General Assembly, though he noted that a federal stimulus package in the coming weeks could change his plans. Many states, faced with deficits brought on by the national recession, are considering Medicaid cuts to balance budgets.
Anthem, Kentucky's largest health insurer, and University of Louisville physicians have agreed on a new contract day before their old one was to expire. The agreement means Anthem members won't have to pay higher co-payments to keep seeing U of L specialists, or have to switch doctors to get maximum benefits from Anthem.
