The nation's unemployment rate fell slightly in November to 10%, and for the third straight month hospitals reported solid payroll additions, with 6,800 new jobs created, according to U.S. Bureau of Labor Statistics seasonally adjusted preliminary data that was released this morning.
The healthcare sector—from hospitals, to physicians' offices, to residential mental health homes, kidney dialysis centers, and blood and organ banks—reported 21,000 payroll additions in November, and 613,000 payroll additions since the start of the recession in December 2007. The home healthcare services sector reported 7,300 payroll additions in November, BLS preliminary data show.
The healthcare sector has created 249,700 new jobs in the first 11 months of 2009, an average of 22,700 new jobs each month, according to BLS' preliminary data. In the first 11 months of 2008, the healthcare sector grew 330,100 new jobs and averaged nearly 27,500 new jobs per month, data show.
Ambulatory healthcare services continue to be the major driver of healthcare sector job creation, with 12,600 payroll additions reported in November, and 152,600 payroll additions in the first 11 months of 2009, according to BLS preliminary data.
The gains made in the hospital, home healthcare, and ambulatory services sectors were offset somewhat by job losses in some other healthcare sectors. For example, the nursing care facilities sector reported 1,200 payroll cuts in November, and the outpatient care centers sector reported 3,300 payroll cuts. That same outpatient care center sector reported 3,500 payroll additions in October, BLS preliminary data show.
All BLS data for November and October is considered preliminary and could be considerably revised in the weeks ahead.
Hospitals' 6,800 payroll additions in November represent the third consecutive month of job growth. Hospitals added 9,000 jobs in October and 5,700 jobs in September, preliminary data show. Those 21,500 new payroll additions reported in the last three months represent more than half of the 41,700 hospital payroll additions reported in the first 11 months of 2009. In June, the hospital sector actually lost 200 jobs. Over all, there were more than 4.7 million hospital jobs at the end of November, preliminary BLS data show.
Despite the three-month hiring surge, the pace of job growth in the hospital sector in 2009 is well off that of recent years. Based on average monthly payroll additions, hospitals will create about 45,000 new jobs in 2009, compared with 136,700 new hospital jobs in 2008, 105,700 in 2007, and 81,400 in 2006, BLS data show.
The healthcare sector is still outperforming the overall economy. BLS preliminary data show that the nation's payroll employment was essentially unchanged last month, with 11,000 jobs lost, as nonfarm unemployment fell to 10% in November from 10.2% in October, which had been the highest unemployment rate since April 1983.
Some of the reduction came with lowered readjustments of preliminary data, which showed that job losses in September and October had not been as severe as initially reported, BLS reported. Revised data show that in the three months before November, payroll job losses averaged 135,000 a month.
In November, 15.4 million people were unemployed. Since the start of the recession in December 2007, 7.9 million people have lost their jobs, and the unemployment rate has increased by 5.1 %, BLS preliminary data show. In that same period, the healthcare sector has created 613,000 jobs, with hospitals accounting for 181,600 new jobs during the recession. BLS data show that there were more than 13.7 million healthcare sector jobs in November.
Seasonally adjusted data, which are used in this story, allow for better month-to-month comparisons that better reflect changes in economy, rather than seasonal employment patterns. Payroll growth also reflects the number of new jobs, not the number of new employees, because one person can have more than one job.
Unless they work in a medical facility with perfectly compliant employees, safety directors and infection preventionists (IP) are usually forced into the unenviable, but inevitable job of confronting a healthcare worker who is not adhering to safety and infection control regulations.
On most occasions, managers encounter an innocent mistake or a one-time offense that is easily correctable. On other occasions, persistent or especially hard-headed employees will demonstrate consistent non-compliance because of inconvenience or simply out of sheer stubbornness.
In either case, finding the right approach can often be challenging both in smaller private medical practices and in larger hospital systems. With Joint Commission standards focusing on topics, such as hand-hygiene improvement, it's imperative that managers have a documented disciplinary policy along with an effective approach for fixing non-compliance.
Two of the most common IC and safety violations are phlebotomists biting the tip of the index finger off gloves to feel for a vein, and physicians not wearing required personal protective equipment (PPE) during procedures, says Kathy Rooker, safety officer and owner of Columbus Healthcare & Safety Consultants in Canal Winchester, OH. Incision and draining procedures are the most common vehicles for ignoring PPE because physicians don't think they need the required gloves, mask, goggles, and impervious gown for such a simple procedure. However, Rooker has seen instances where pus has sprayed into the mouth or eyes of a doctor.
"I just try to tell them the consequences are if they don't wear it and is it really worth them taking the risk?" Rooker says. "I hear, 'Oh, I'm going to look ridiculous,' and I say, 'Yeah but you'll be alive.'"
Although all OSHA regulations are important from a general safety perspective, IPs should consider the risks involved with non-compliance, rather than how flagrant the foul is, says Steve MacArthur, a safety consultant at the Greely Company in Marblehead, MA.
"For instance, at the moment handwashing and wearing appropriate PPE have shifted as a function of their risk 'potential' into the realm of probability," MacArthur says. "Now there is a very real threat as opposed to what might nominally be described as theoretical threat, so the tolerance levels for non-compliance, either accidental or purposeful, are much less because inappropriate protection can impact any number of people."
Taking a tactical approach
It's rarely effective to yell and scream at a healthcare worker, or call out a physician in front of his or her peers or in front of a patient, says Rooker. Instead, it is more beneficial to either take the physician aside and explain the error, or meet with him or her individually to explain the requirement.
"I would sit down with them one-on-one, and I will usually bring with me statistics on hepatitis B, hepatitis C, and HIV and say, 'Look at the statistics. Look what could happen to you by not using a safety needle if this person were infected,'" Rooker says. "And that's a real eye-opener sometimes."
However, the conversation should not be one-sided. IPs should address the issue from the employee's perspective because there may be legitimate reasons for non-compliance, says MacArthur.
"Most people know what they are supposed to do, but if convenience gets in the way, compliance can take a window seat pretty quickly," MacArthur says. "But maybe, just maybe, there's a kernel, grain, atom of useful information there. Maybe the PPE is really not accessible enough or maybe you need to look at a different product or a different technique."
Initiating disciplinary action
There is always the possibility that a one-on-one consultation is not enough to elicit consistent compliance, or that a blatant offender will continue to ignore safety protocols. In these cases, employers will turn to their established disciplinary matrix.
Most facilities already have this in place, but with any luck, managers rarely have to initiate the process. Most corrective action procedures begin with one or two verbal warnings, then a written warning, suspension, and finally termination.
In most facilities, disciplinary action should be handled by the employee's supervisor, not necessarily the IP or safety officer. The IP may be involved with consultation, but he or she should not be the "police officer" for the entire staff.
"Safety should be a baseline competency for anyone working in the organization," MacArthur says. "It should be evaluated just like any other competency, clinical or otherwise."
A federal court judge on Thursday granted preliminary approval of a $350 million settlement that involves the American Medical Association, UnitedHealth Group, and UnitedHealth's subsidiary, Ingenix.
The case deals with Ingenix's database that many insurers used to determine "prevailing" and "usual, customary and reasonable charges" for out-of-network physician services. New York Attorney General Andrew Cuomo investigated the Ingenix database and earlier this year Ingenix and parent UnitedHealth agreed to a settlement with the New York Attorney General's office to resolve what investigators called "an industry-wide investigation into a scheme to defraud consumers by manipulating reimbursement rates."
The deal also required UnitedHealth to close two databases run by Ingenix, and to help fund a new independent database to collect price information.
A number of other health insurers that used Ingenix to find out-of-network costs also agreed to pay to help create the new independent database that will be run by a nonprofit company, FAIR Health, which will work with Syracuse University and a group of other state universities.
The Ingenix issue dates back to March 2000 when the AMA, Missouri Medical Society, and New York State Medical Society filed a suit that alleged UnitedHealth Group "colluded with others to underpay physicians for out-of-network medical services," according to the AMA.
The suit sought relief for physicians who were "seriously harmed by the insurer's long-term use of the flawed database," noted the AMA.
The AMA is pleased with the U.S. District Court for the Southern District of New York's preliminary approval and the court is expected to set a final approval hearing in the courtroom of U.S. District Judge Hon. D.J. McKenna.
"The court's approval is an important step in finalizing a settlement that recognizes UnitedHealth's flawed payment scheme resulted in significant damages to physicians who provided out-of-network care to patients enrolled with UnitedHealth," said AMA Immediate Past President Nancy H. Nielsen, MD.
On its fourth day of floor debate, the Senate finally began to vote on amendments to the healthcare reform bill on Thursday.
Getting the first nod in a 69-31 vote was the amendment proposed by Sen. Barbara Mikulski (D-MD) on Monday that would promote and expand preventive healthcare for women. Insurers would now cover a range of women's health screenings and would encourage no copays for those services.
The amendment, which calls for coverage of screening procedures, such as mammographies and Pap smears, would also cover cervical cancer, postpartum depression, heart disease and diabetes. The amendment received some bipartisan support with three Republicans—Sen. Olympia Snowe (ME), Sen. Susan Collins (ME), and David Vitter (LA)—voting for it.
After that vote, the senators moved to a competing amendment that had been offered by Sen. Lisa Murkowski (R-AK), which would prohibit government panels from determining which specific women's procedures would be covered. Her amendment just failed 59 41.(Amendments need at least 60 votes to pass.)
Meanwhile, the amendment proposed Monday by Sen. John McCain (R-AZ) to remove nearly $500 billion in Medicare cuts from the Senate bill was turned down in a 58 42 vote. Had the proposal passed, the Senate bill would have had to be returned back to the Senate Finance Committee.
Other amendments proposed (but no votes had been scheduled yet through Thursday) are:
A bipartisan proposal from Sen. Byron Dorgan (D-ND) and Sen. Olympia Snowe (R-ME) and seven other senators that would permit Americans to purchase lower cost prescription medications from other countries, such as Canada. This amendment is likely to spur challenges from the pharmaceutical industry.
An amendment offered by Senate Judiciary Committee Chairman Patrick Leahy (D VT) that would repeal the health insurance industry's antitrust exemptions—similar to the provisions found in the House bill.
Sen. Sheldon Whitehouse (D-RI) filed an amendment supporting the idea that surpluses generated by the Senate bill be reserved for Social Security, and that savings from the long-term insurance program be reserved for that program.
The Office of Inspector General announced Thursday that it saved $20.97 billion for fiscal year 2009 and highlighted six of the cases that led to those recoveries or savings.
"We continue to make significant progress in our fight against fraud, waste, and abuse in [Health and Human Services] programs, particularly Medicaid and Medicare," said Inspector General Daniel R. Levinson. "We're doing this by leveraging our audit, legal, evaluation, and investigative tools, as well as employing the latest in data analysis technology."
The $20.97 billion includes $16.48 billion in implemented recommendations for how to put funds to better use, $4 billion in "investigative receivables," and $492 million in audit receivables. Successful cases concluded during the latest six-month period ending Sept. 30 are outlined in a 101-page semi-annual report.
Among the successful cases are:
1. Medicare Fraud Strike Force. Operations by this team lead to sentencing of seven Miami-area residents in a Medicare infusion fraud scheme. They were ordered to pay $19.8 million in restitution and were sentenced to prison terms between 37 and 97 months.
The individuals admitted in their guilty pleas to "manipulating patients' blood samples to generate false medical records, ordering and administering medications to treat conditions that were falsely documented with fraudulent test results, and billing Medicare for services that were medically unnecessary or never provided," according to OIG.
The strike force's investigations, the OIG said, resulted in the filing of charges against 138 individuals or entities, which led to 44 convictions and $40.7 million in investigative receivables.
2. State and local pandemic influenza preparedness. This case involved two reviews.
In the first, the OIG found that although the majority of localities had started planning to distribute and dispense vaccines and antiviral drugs, more needed to be done. "In their preparedness plans, selected localities had not addressed most of the vaccine and antiviral drug distribution and dispensing preparedness items," the OIG found.
"Further, although all of the selected localities conducted exercises related to vaccine and antiviral distribution and dispensing, most did not create after-action reports and improvement plans."
In the second, although states and localities are preparing for an influenza surge, they needed to do more. Fewer than half of the selected localities had started to recruit medical volunteers required, and none of the states had implemented electronic systems to manage volunteers. Only three of the five states that OIG reviewed had electronic systems to track beds and equipment. And most localities had not identified triage, admission, and patient care guidelines for a pandemic.
3. Pfizer settlement. Pfizer entered a $1 billion settlement under the False Claims Act in connection with its anti-inflammatory drug, Bextra's marketing and promotion practices, according to OIG.
"Pfizer and Pharmacia & Upjohn agreed to pay a total of $2.3 billion, the case the largest healthcare fraud settlement in history, to resolve both the civil and criminal liability arising from the illegal promotion of certain pharmaceutical products."
4. Medicaid personal care claims in New York. The OIG estimated New York improperly claimed $275.3 million in federal Medicaid reimbursement for personal care claims by providers during calendar years 2004 through 2006. The state did not adequately monitor the city's personal care services program.
5. Barriers to the U.S. Food and Drug Administration to food emergency response.
The OIG conducted two reviews. In the first, it found that in a food emergency, the FDA would likely have difficulty tracing food products through the food supply chain. "We were able to trace only five of the 40 products reviewed through each stage of the food supply chain.
"For 31 of the 40 products, we could identify the facilities that likely handled the products, and for the remaining four products, we could not identify the facilities," the OIG said. Also, 59% of the facilities did not meet FDA's requirements to maintain records about their sources, recipients, and transporters, and 25% weren't aware of them.
In the second, the OIG discovered that the FDA "did not have statutory authority to require pet food manufacturers or importers to initiate recalls of contaminated food or to assess penalties for recall violations." Further, it said, "existing regulations were issued as nonbinding recall guidance. We found that FDA's lack of authority, coupled with its sometimes lax adherence to its recall guidance and internal procedures, limited FDA's ability to ensure that contaminated pet food was promptly removed from retailers' shelves."
6. Nursing home executive agreed to permanent exclusion. "The president and chairman of the board of Pleasant Care Corporation, Emmanuel Bernabe, agreed to be permanently excluded from federal healthcare programs after an OIG investigation found substandard care at nursing homes formerly operated by Pleasant Care. OIG alleged that Bernabe, through his management and oversight of Pleasant Care, caused services to be furnished to Pleasant Care residents that substantially departed from professional standards of care.
"For example, Pleasant Care failed to maintain adequate staffing levels, properly administer medication, provide adequate hydration and nutrition, and prevent accidents," according to OIG.
The Senate voted to reject a GOP proposal to strip the healthcare overhaul package of nearly $500 billion in Medicare cuts, its most important source of financing. On a vote of 58 to 42, the Senate defeated an amendment by Sen. John McCain (R-AZ) that would have sent the bill back to committee with orders to remove the spending cuts. The healthcare bill would slow Medicare spending by about 5% over the next decade, and Republicans said that would decimate the program in order to finance insurance subsidies for younger people. The Senate also approved an amendment that would guarantee access to mammograms for women younger than 50.
The Senate voted to require health insurance companies to provide free mammograms and other preventive services to women. The 61-to-39 vote on health benefits for women would, in effect, override new recommendations from a federal advisory panel that said routine mammograms should begin at age 50, rather than 40, the New York Times reports. Senator Barbara A. Mikulski (D-MD) proposed the coverage requirement as an amendment to the health legislation, and said it could save millions of lives.
California HMO Kaiser Permanente has agreed to pay $3.75 million to resolve allegations that several of its California units submitted false bills to the federal government for treatment of Medicare and Medi-Cal patients, officials announced. The U.S. attorney's office in San Francisco contended that from 1996 through 2002, Kaiser units in California submitted bills that falsely claimed treatment had been provided by teaching physicians. In fact, the government said, the care had been provided by unsupervised residents, the Los Angeles Times reports.
After posting an $18 million deficit through the first nine months of the fiscal year, Massachusetts-based Partners HealthCare reported a $45 million gain for the 2009 fiscal year. The state's largest healthcare system had been in danger of recording the first annual loss in its 15-year history, but instead said it had operating income of $164 million for the 12 months ending Sept. 30. That was partly offset by nonoperating losses of $119 million, largely from the hospital group's $4.6 billion investment portfolio, the Boston Globe reports.
A National Labor Relations Board decision has given a major victory to a breakaway union vying with the giant Service Employees International Union to represent tens of thousands of California healthcare workers. The board has called for elections to determine who has the right to represent some 2,300 Kaiser healthcare workers employed at various sites in Southern California. An SEIU affiliate currently represents the workers, but the breakaway group filed a petition in February challenging the SEIU. The balloting will give employees a chance to choose between the two unions.