HealthLeaders contributor Ricardo Guggenheim, MD, discusses why health systems should pay for outpatient care for uninsured patients with chronic diseases. Not only can it help control costs, he says, but it also helps hospitals better manage the medical needs of patients in their community. +
With the controversial Recovery Audit Contractor program going nationwide by 2010, many hospitals are concerned that while the demonstration program recovered $371 million in overpayments to hospitals, more than 96% of the improper payments were overpayments collected from providers and only 4% were underpayments repaid to providers. Further, the research conducted by my guest Michelle O'Daniel, director of member relations with VHA's West Coast office, shows that 31 VHA member hospitals were required to return nearly $46 million to CMS as a result of the audits but that once appealed, approximately 90% of the RAC rulings were overturned. +
For developing countries, physician brain drain continues to be a serious public health concern. But now, some are complaining about the threat of brain drain from private health systems within these regions. +
Ronald Miles, MD, a cardiothoracic surgeon, discusses Aspirus Wausau (WI) Hospital's strategy to expand its target area by participating in a domestic medical travel network. +
Doctors aren't going into primary care anymore, despite a rapidly aging population, according to an article in the September 2008 Journal of the American Medical Association. The resulting problem is that even if healthcare coverage becomes universal, there will not be enough primary care physicians to go around, according to this opinion article in the Denver Post.
Kaiser Permanente has found an innovative solution to its shortage of dermatologists: the roving physician. The program involves arming a dermatologist at each Kaiser site in the Diablo, CA, service area with a cellular telephone to respond to the call of primary care doctors with patients that display suspect moles or non-obvious skin rashes. The roving dermatologists can provide same-day assessments and biopsies of skin lesions, saving patients the month-long wait it can otherwise take to get an appointment with a dermatologist.
In this article, BusinessWeek asks whether or not doctors are hypocrites as part of a debate over whether doctors are "glorified merchants" or benevolent professionals deserving greater respect. One side argues that today's doctors put their pocketbooks first and patients second. The other points to the years of training and long hours doctors put in to make the case that medicine is still an art and doctors are underappreciated.
Approximately 80% of medical records contain inaccurate information, posing serious health risks for patients. Many physician practices and health systems simply do not update medical records on a regular basis, thus leaving them incomplete. To ensure the safety of patients and eliminate potential liabilities for practices and hospitals, medical records cannot be overlooked.
Communication is key in ensuring that medical records are as accurate and up to date as possible. More organized recordkeeping is crucial in the fight for accuracy.
Physicians should be checking with patients at each office visit about health conditions that may have changed, changes in disease or disorder symptoms, and other physicians patients might be seeing, says Paula Griswold, executive director of the Massachusetts Coalition for the Prevention of Medical Errors.
"This is a good opportunity to open the lines of communication," she adds. Although the responsibility to keep records up to date lies primarily with healthcare providers, Griswold says patients should be held equally accountable.
"Practices should think about asking patients when they come in, while they're in the waiting area, if there have been any changes since their last visit," Griswold says, noting that there is not always ample time to discuss such matters during the actual visit with the doctor.
Physicians can use the appointment reminder call to ask patients to be ready to share any health-related changes with the doctor, such as new medications they are taking. Creating a medication form for patients to fill out can also help ensure that the information in the records is accurate and up to date.
Griswold says healthcare providers should additionally urge patients to carry with them a list of prescribed and over-the-counter medications they're taking and what disorders and symptoms each drug is treating. She does this for her father, making sure to update the list when anything changes.
Taking the time to check on changes, ask about concerns, and talk about how the patient is generally feeling is a good idea too. "People tend to be concerned with breaches to privacy and identity theft," Griswold says. "But you can have breaches to a patient's safety too with inaccurate records."
This article was adapted from one that originally ran in the October 2008 issue ofThe Doctor's Office, a HealthLeaders Media publication.
Physicians might soon find out that healthcare is not completely immune to tough economic times. It's often said that Healthcare is the most recession-proof industry—people get sick regardless of what's going on in the economy and can rely on publicly-funded safety net programs if worse comes to worst, after all.
But as the Congressional debate over bailing out Wall Street draws the news world's focus toward the financial sector, a couple of recent news items suggest physicians are already feeling the effects of a sluggish economy.
The first comes from the Wall Street Journal, which points to evidence that Americans are cutting back on healthcare spending as the credit crunch threatens to throw the economy into a major slump.
For instance, the number of prescriptions filled per year in the United States has declined for the first time in a decade. Physician office visits have also dropped since 2006, and 22% of consumers in a recent survey said economy-related woes were causing them to go to the doctor less often.
This is good news for a work force that is overworked and hit by shortages, right? Well, maybe not if you rely heavily on hip and knee replacements, mammograms, and other preventive or elective procedures. Knee replacements per 1,000 people fell 18.6% between March 2007 and 2008, pap smears fell 6%, and dispensed prescriptions for antidepressants dropped 29%, according to a survey conducted for the WSJ by research firm D2Hawkeye.
Many of these elective procedures are extremely profitable, and doctors may start to really lose revenue if the economy turns for the worse. Ultimately, the consumer cutbacks will increase strain on the system, as patients who forgo testing and preventive care end up clogging hospital emergency rooms with more serious conditions.
But what about that publicly-funded safety net? It's going to take a hit as well. A new report suggests many states may begin cutting Medicaid payments to physicians as early as next year in order to reign in rising costs. According to the authors of the Kaiser Family Foundation Survey, Medicaid enrollment rates are climbing—by 2.1% in 2008—in part because of patients losing their jobs and employer-based coverage.
Every 1% increase in the national unemployment rate translates to one million more enrollees in Medicaid and the State Children's Health Insurance Program (SCHIP) and $1.4 billion in state Medicaid costs, according to the study's authors.
And without additional tax revenue, states may have no choice but to cut reimbursement. At the federal level, prospects of Medicare or Medicaid increases become slimmer as Congress considers spending $700 billion of taxpayer money to fix the current financial mess.
It's a good thing that legislators already voted in July to eliminate this year's 10% reduction in Medicare physician payments, because if it was coming up for a vote now or later in the year, I'm not so sure it would pass.
I'm not trying to be alarmist. Many of these problems—the stagnant reimbursement and rising costs—are not new to the industry. But a bad economy could exacerbate the financial problems physicians have been facing for years and delay much-needed reform.
Elyas Bakhtiari is a managing editor with HealthLeaders Media. He can be reached at ebakhtiari@healthleadersmedia.com.
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JCAHO. Until The Joint Commission changed its name early last year, that acronym was enough to strike fear in the hearts of hospital employees at all levels. When a JCAHO surveyor arrives, everyone from executives to front line managers scrambles to make sure that supplies are stored in the right places and medications are delivered properly. Survey time at a hospital is serious business.
Now another acronym has made its way to the accreditation scene, and it remains to be seen if this one will have the sheer power that JCAHO held for so long. The Centers for Medicare and Medicaid Services announced last week that it has granted DNV Healthcare, Inc. deeming authority for U.S. hospitals. DNV is the first organization to receive deeming status in more than 30 years.
JCAHO hasn't been the only deeming authority over the past 30 years, but it may seem that way. In fact, I'm sure there are a lot of healthcare workers out there would be hard-pressed to tell you the names of the other accreditation organizations out there. The Joint Commission is the accreditation authority, and any hospital that wishes to be seen as one that provides quality care works to meet its standards.
So why after 30 years has CMS decided to grant another organization deeming authority? Surely it has something to do with CMS' increased focus on quality and patient safety. By creating a growing list of "never events," and an emphasis on transparency, CMS has made it clear that it wants hospitals to not only improve on certain key outcomes, but also make the quality of hospitals something that consumers take into consideration when they're selecting a hospital. DNV's accreditation process combines CMS Conditions of Participation with ISO-9001, a collection of standards for quality management systems. DNV's process is called the National Integrated Accreditation for Healthcare organizations and was designed to streamline the accreditation process, identifying ways to make continual improvements.
It sounds good, but will hospitals really abandon The Joint Commission for another agency? I think it's possible. The Joint Commission's accreditation process isn't perfect—just ask anyone on the hospital staff who is involved with accreditation. They'll tell you that the JC's standards change too frequently, and that JC staff members, though good at pointing out needed improvements, often aren't helpful to hospitals that are implementing changes or process improvements.
DNV, too, will have its challenges. It won't be an easy road convincing hospitals to move away from what they've always known—The Joint Commission—and work through a new and different accreditation process. But there's hope for them already. Before CMS' announcement last week, 27 hospitals had already received accreditation from DNV in addition to that of the Joint Commission.
Will DNV ever strike fear in the hearts of hospital executives as JCAHO once did? That remains to be seen. But with an increased focus on quality and patient safety from both CMS and accreditation agencies, you can bet that your hospital's accreditation process will get tougher each year.
Maureen Larkin is quality editor with HealthLeaders magazine. She can be reached at mlarkin@healthleadersmedia.com.
Note: You can sign up to receive HealthLeaders Media QualityLeaders, a free weekly e-newsletter that reports on the top quality issues facing healthcare leaders.
An increase in cases of the bacteria "super bug" known as C. diff in recent years is being attributed in part to the overuse of antibiotics. Hospitals have taken measures to curb the increase, but C. diff is said to afflict as many as 500,000 Americans each year, and cause more than 15,000 deaths.
An outbreak of Legionnaires disease at Saint Peter's University Hospital in New Brunswick, NJ, has claimed the life of a second patient. This patient was one of six to contract the disease, which has been linked to the hospital's water supply. According to the Centers for Disease Control and Prevention, Legionnaires disease is fatal in about 30% of cases.
