All year, Congress has been trying to figure out what to do about the 21% cut in Medicare payments to doctors that's set to take effect on Jan. 1, 2010, the Wall Street Journal Health Blog reports. A legislative maneuver would block the cut, but only for two months. The short-term patch is tucked inside a big defense spending bill the House passed, the Health Blog reports.
Looking to wrap up a variety of end of session items Wednesday, the House of Representatives incorporated into its $636 billion defense spending bill a provision that will prevent a 21% cut in Medicare payments to physicians until March 1.
Last month, the House, voting mostly along party lines, approved a bill (HR 3961) that would have prevented a 21% cut in the Medicare physician payment rate scheduled at the beginning of January 2010. The bill, known as the Medicare Physician Payment Reform Act, calls for replacing the sustainable growth rate (SGR) formula, that was enacted more than a decade ago to help keep physician costs down. A similar bill was turned down in the Senate.
In previous years, Congress has stepped in annually to override the cuts called for with the SGR. However, major medical groups, noting that time was running out, said they would support a short postponement of the cuts so that Congress would have time to pass healthcare reform legislation.
In a Dec. 15 letter to Senate Majority Leader Harry Reid (D-NV), national medical groups, including the American Medical Association, and state medical societies said that "because Congress has repeatedly 'kicked the can' to postpone imminent payment cuts to future years," they are "facing impossibly severe cuts." At the same time, "the cost of repealing a formula whose faults have been known since its inception has continued to grow, from $49 billion in 2005 to over $200 billion today."
After Wednesday's vote, J. James Rohack, MD, president of American Medical Association, released a statement: "Ensuring continued access to physician care for America's seniors is critically important, which is why Congress must fix the broken Medicare physician payment formula once and for all. The AMA acknowledges today's vote in the House to temporarily suspend for two months the 21% Medicare physician payment cut that begins in three weeks, as this will allow physicians to continue to care for Medicare patients while waiting for the Senate to vote on a permanent solution."
He added that the House already passed HR 3961, which would replace the "broken Medicare physician payment formula with a system that better reflects the cost of providing 21st century medical care." The AMA urged the Senate to take similar action so the president could sign the law early next year.
Our Lady of Lourdes Health Care Services Inc. will pay the government $7.95 million to resolve allegations that two of its New Jersey hospitals defrauded Medicare, the Justice Department has announced.
The hospitals are Our Lady of Lourdes Medical Center in Camden and Lourdes Medical Center of Burlington County in Willingboro. Calls to the Camden-based health system seeking comment on the settlement were not immediately returned.
"As the settlement demonstrates, the Department of Justice is committed to pursuing those who defraud Medicare and drive up the costs of healthcare," said Assistant Attorney General Tony West, head of the Civil Division of the Department of Justice.
Lourdes Medical Center was a defendant in a civil suit filed in 2005 by whistleblower Tony Kite, a private healthcare consultant, who alleged that the hospital fraudulently inflated its charges to Medicare patients to collect enhanced reimbursement from Medicare under the program's outlier payments provision. Under the civil settlement announced Tuesday, Kite gets $356,000, plus interest, from the settlement.
In a separate investigation of Our Lady of Lourdes Medical Center, the government alleged that the hospital also wrongfully obtained excessive Medicare outlier payments.
Our Lady of Lourdes Health Care is part of the Catholic Health East system, which is based in Newtown Square, PA.
West said the settlement was the result of the coordinated efforts of DOJ's Civil Division, the U.S. Attorney's Office in New Jersey, HHS' Office of Inspector General, CMS, and the FBI.
The American Hospital Association has elected veteran Arkansas healthcare executive Raymond W. Montgomery II to its board of trustees for the term beginning Jan. 1.
Montgomery has been president/CEO of White County Medical Center in Searcy, AR, since 1992. He will serve as chairman of AHA's Regional Policy Board 7, which includes Arkansas, Louisiana, Oklahoma, and Texas, and participates in the AHA's policy development process. He served on the AHA Section for Small or Rural Hospitals Governing Council from 2001 to 2005, and was chairman in 2004. He was vice chairman of the Voluntary Hospitals of America, Oklahoma/Arkansas board of directors, and served on the Arkansas Hospital Association board of directors from 2001-2009 and as its chairman from 2007 to 2009.
Montgomery joins several other trustees elected to serve for the upcoming term. They are:
Rhonda M. Anderson, RN, pediatric administrator for Cardon Children's Medical Center in Mesa, AZ, and regional pediatric service line administrator for Banner Health's Arizona Region.
Craig A. Becker, president/CEO of the Tennessee Hospital Association and its subsidiaries, THA Solutions Group, Inc., and the Tennessee Hospital Education and Research Foundation, since August 1993.
Michael Rock, MD, CMO at Mayo Rochester Hospitals/Mayo Foundation in Rochester, MN.
Thomas F. Zenty III, CEO of University Hospitals in Cleveland since 2003.
Steven Goldstein, president/CEO for Strong Memorial Hospital of the University of Rochester in Rochester, NY.
Russell W. Johnson, CEO of San Luis Valley Regional Medical Center in Alamosa, CO.
Among seven leading social networking sites ranked by college students in the Anderson Analytics 2009-2010 GenX2Z American College Student Survey, Facebook was viewed as "cool" by 82% of males and 90% of females. All other social networking sites were deemed "lame" by significant percentages of both male and female collegiate users. Facebook also overtook Google as the number one most popular website among both genders of the college students surveyed.
Several ads from Danbury (CT) Hospital's "A Higher Level of Care" campaign feature people with portions of their body seen through X-ray film. In addition to making for intriguing images, these ads are also a metaphor for the campaign goal: convincing consumers to look past their preconceptions and see Danbury as a center for high-level care.
Marketers at Danbury worked with SPM Marketing & Communications to create the campaign, which won a platinum award at this year's HealthLeaders Media Marketing Awards in the branding category. Danbury leadership decided an image campaign was crucial after its 2008 brand monitoring study showed that most locals viewed the organization as a community hospital that they would only go to for run-of-the-mill ailments.
"When it came to more specialized care, even specialized care they did very well, they were losing market share and suffered from diminished consumer preference to local and New York competitors," wrote SPM on the award entry form. "They were influenced by a somewhat unfavorable perception of the town of Danbury itself and consumer biases regarding of the limitations of a ‘community hospital.'"
The effort included print, TV, radio, outdoor, and a microsite, focusing on driving volume to colon surgery, bariatric surgery, orthopedics, and cardiology service lines.
"The print and outdoor ads are a perfect combination of simple and attention-grabbing," wrote one judge. "The TV and radio ads are strong, clear, and to the point."
The campaign's success was measured by call center volume, event and screening attendance, Web hits and visits, and qualitative and quantitative consumer research. Research found that ad recall is up 13% from the previous year in all markets, with unaided ad recall up 20% in the primary market.
"Danbury saw results in each of the several areas they measured and then some," wrote another judge. "The fact that unaided ad recall increased by 20% is very impressive."
The trend toward patient engagement has been building slowly for a long time, now. (Very slowly: Remember when it was called consumerism?) No, we're not yet at the stage where consumers are using price and quality data to make decisions about where to go for care, but they are getting better at taking charge of their health: researching their health conditions online, bringing what they've found along with lists of questions to their annual physicals to share with their docs, and beginning to demand more convenient communications and scheduling options, such as e-mail and online.
I interviewed them together and their relationship is remarkable—it is much more evolved than the stereotypical paternalistic physician and passive patient. They are more like partners–sharing information with each other and spreading their passion for patient engagement to others as well.
I think that as the general public hears more about patients and doctors like deBronkart and Sands, the more people will want to have that kind of relationship with their own physicians.
"We're spreading the word," deBronkart says. "And sooner or later everybody will be headed to our party."
Getting docs on board
I love that. But if every patient in the U.S. woke up tomorrow morning and decided they were going to become an engaged patient, they would probably find a big stumbling block: There are still plenty of physicians who are skeptical, stuck in their doctor-knows-best ways, or just don't think they have the time to practice this kind of healthcare. I wrote about that a bit in my article for HealthLeaders magazine about the patient of the future, noting that doctors don't get paid for phone or e-mail consultations, nor do they want to risk missing a diagnosis because they chatted online instead of face-to-face with a patient. Physicians have five to 10 minutes to see a patient, listen to his or her complaints, make a clinical decision and move on to the next appointment—there's hardly enough time to engage on a personal level or listen to a patient's summary of all the cool information he or she found on WebMd.
"We still hear about people whose doctor tells them, 'Look, who has the medical degree here?'" deBronkart says in that article. But the best way to improve medicine is to make it more collaborative, he adds. "It may be that this new form of relationship is not nearly as burdensome as people might reasonably anticipate . . . The reality is that there is an enormous flood of new information being published. It's just more than anyone can keep up with."
Another thing that might start to bring docs around: Studies that show patient engagement can improve clinical care.
A new study on shared-decision making, where the patient and physician share information and decide on a course of treatment together, found that patients who were more involved in their care were less likely to undergo risky treatments. Other studies have also suggested that the perception of risk is increased under conditions that emphasize choice.
"We found that highlighting the perception of having a choice increases patients' worry about the risks of adverse events and decreases their willingness to accept treatment," said Yale University School of Medicine's Liana Fraenkel, MD, co-author of the study, which was published in the journal Arthritis Care & Research. "Having knowledgeable and highly engaged patients making informed decisions is a requirement for ensuring high-quality healthcare."
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Health insurance leaders will place their stockings over the fireplace on Christmas Eve. They will put out milk and cookies for Santa Claus. All that will be left is the big morning when these executives head downstairs, gaze at the gifts Santa left, and rip open their presents.
But what exactly does a health insurance leader want this year—besides the early gift they received Tuesday? Here are four gifts they would like to see under their Christmas trees:
An olive branch from physicians. Despite some inroads, such as quality contracts, doctor-health insurer relations remain icy at best.
Physicians view insurers as money-grubbing, procedure-declining, patient-interfering companies that provide no benefit. Insurers, meanwhile, think of physicians as procedure-happy, cash-cow doctors who are a major reason health costs are skyrocketing.
If these two sides could only find some common ground and work together, Americans would have better healthcare. Better data exchange between insurers and physicians would lead to better outcomes. Doctors would know when their patients visited the ER or another physician immediately and insurers would get clinical data that could help them catch at-risk patients before they develop a chronic illness. Physicians would get paid and know when claims are denied—and why—immediately.
Progress has been made, but there isn't an olive branch under insurers' Christmas tree this year.
Healthier Americans. This is at the top of health insurers' lists each year, but much like the girl who excitedly puts a pony on her list, this isn't going to happen.
That's not to say that it's not a lofty goal. In fact, imagine the impact on healthcare costs if Americans ate better, smoked less, and exercised more.
Instead, we supersize everything—starting with our food. As I wrote in August, all the talk about health reform is pointless if Americans don't take better care of themselves. If we continue to gorge ourselves and stay away from the gym, don't expect much to change in healthcare.
An individual mandate. Health insurers would love to find a neatly-wrapped individual mandate under the tree—and they're even willing to accept everyone in their plans, regardless of health status, if they get this gift.
The problem is there are just too many elves who don't want this happen.
The individual mandate has fluctuated from DOA in 2008 to a distinct possibility earlier this year. I would say the current odds of an individual mandate in the final health reform bill is somewhere between the chances of an underfed Santa Claus and a White Christmas in Miami.
A best-selling, Oprah-recommended book called "Why Health Insurers Are Important." During the healthcare debate, public insurance proponents and many Democrats have bashed health insurers as an expensive, unnecessary third wheel in healthcare.
Alas, there will be no best-selling, pro-health insurance book that will catch the nation by storm. Instead, health insurers will need to continue to promote their positive work and try to raise their voices above the din of health insurance critics.
That will be difficult—and likely will not happen. It's up to individual insurers to promote their offerings to members in order to gain loyalty. At that point, insurers can take some comfort in at least knowing their members are happy with their offerings.
Those are four items on the top of health insurers' lists, so needless to say it's going to be a disappointing Christmas morning when they see none of these presents under the tree.
What will they get instead? A watered-down health reform package that will not include anything that they despise like the public plan or anything that will rejuvenate the private insurance industry. In other words, insurers will get the health reform equivalent of a sweater rather than a pony or—much worse—an inedible fruitcake.
Medical travel facilitator Companion Global Healthcare Inc. has brought two HIMAHEALTH network hospitals in Puerto Rico into its network of off-shore hospitals that treat American patients at prices lower than those at mainland facilities.
CGH said it will offer medical travel assistance and reduced pricing for individual clients and employer group members at either HIMA San Pablo Bayamon or HIMA San Pablo Caguas.
Service lines at the hospitals include cardiovascular surgery, orthopedic surgery, neurology, and oncology. Both hospitals are Joint Commission accredited, and their medical staffs include U.S. board-certified physicians. Puerto Rico is the only island in the Caribbean with Joint Commission-accredited hospitals.
"HIMAHEALTH hospitals are equipped with the latest technology, and their prices will enable our clients to obtain the care they need at an affordable cost," said David Boucher, president of CGH. "Since Puerto Rico is a short flight from many U.S. cities, HIMAHEALTH hospitals offer an added level of convenience for many of our clients."
CGH's international network now includes 26 hospitals around the world, all of which are Joint Commission accredited, with rates that are as much as 90% less than at hospitals in the United States.
"We are excited about the affiliation between HIMAHEALTH and Companion Global Healthcare," said Armando Rodriguez, a HIMA San Pablo executive vice president. "U.S. patients already travel for medical care to places as far away as India and Singapore; it makes sense for them to travel a shorter distance for treatment."
