The healthcare services for those enrolled in Oklahoma's Medicaid program will likely be cut as officials roll back costs due to a deepening statewide budget shortfall, the program's chief executive said. During the past year, 825,000 Oklahomans received medical help through one of the healthcare programs administered by the state's Medicaid provider, the Oklahoma Health Care Authority. Oklahoma lawmakers have ordered 5% budget cuts for OHCA and other state agencies through June because the economic slowdown and low energy prices have forced a revenue shortfall.
U.S. Surgeon General Regina Benjamin said during a conference on health disparities in Atlanta that the nation must reverse the downward trend of minorities attending medical, dental and nursing schools. Benjamin said the recent downward trend in minority admissions follows years of gains in these areas. She cited a study that said minorities make up only 6% of U.S. physicians, and she lamented that the percentage was the same in 1910, the Atlanta Journal-Constitution reports.
Soleil Securities upgraded Tenet Healthcare to "buy" from "hold" with a price target of $6.25. Tenet has recently begun a strong recovery from seven years of bad credit stemming from Medicare fraud, the brokerage firm said. Soleil said that for the first time in a year all the hospital stocks outperformed consensus expectations on the EPS, revenue, and EBITDA lines.
A handful of letters released this week by medical groups illustrate how divided physicians are over healthcare overhaul legislation, the Wall Street Journal reports. The American Medical Association, for example, sent a letter to Senate Majority Leader Harry Reid saying it supports part, though not all, of the legislation. Nineteen surgical groups, including neurosurgeons, anesthesiologists and gynecologists, wrote to Reid this week saying they flatly oppose the Senate health bill, the Journal reports.
The Senate's slow-moving health bill is colliding with other legislative priorities on the economy, raising chances that Democrats won't meet their goal of pushing a healthcare overhaul through the chamber in December, the Wall Street Journal reports. Lawmakers hope to act this month to avert planned cuts in Medicare payments to doctors, scheduled to drop sharply in 2010. But action on the bill has slowed sharply, with the war in Afghanistan and the struggling economy moving to the forefront of lawmakers' concerns.
A report from the New Jersey Attorney General's office called for state agencies to create new rules that include barring doctors and their office staff from accepting food from drug companies and restrict the sale of "prescriber-identifiable" prescription data for commercial purposes. The rules would also require doctors who are renewing their licenses to disclose whether they accepted more than $200 worth of payments and/or gifts from industry during the preceding two years, and create a public database of the disclosures. Some of the recommendations could be enacted by the state's Board of Medical Examiners, while others would require the state to pass a new law.
Majority Leader Harry M. Reid has assumed full ownership of the healthcare overhaul that includes a 2,074-page bill that would cost $848 billion over 10 years and institute the most far-reaching changes to the system in generations, the Washington Post reports. Reid's goal is to the the bill backed by the 60 senators needed for final passage, something he hopes will come to pass as soon as late next week. Here, the Post offers his strategy to get it done.
Enrollment in entry-level baccalaureate nursing programs increased 3.5% in 2009, but nearly 40,000 qualified applicants were turned away, according to preliminary data released today by the American Association of Colleges of Nursing.
Even with a decade of enrollment increases, and the continued heavy demand for nurses, AACN's 29th Annual Survey of Institutions with Baccalaureate and Higher Degree Nursing Programs found that nursing schools are still hindered by a shortage of faculty, insufficient clinical education sites, and budget cuts.
"Despite considerable financial challenges and capacity constraints, nursing schools nationwide were successful in their efforts to maintain a robust pipeline of future nurses this year," said AACN President Fay Raines.
This year's 3.5% enrollment increase for entry-level baccalaureate programs is based on data supplied by the same 511 schools that reported in both 2008 and 2009. This is the ninth consecutive year of enrollment gains.
Though interest in nursing careers remains strong, the survey found that faculty and resource constraints meant that 39,423 qualified applicants were turned away from 550 entry-level baccalaureate nursing programs in 2009, a number comparable with data from the last five years, which ranged from 36,400 to 41,385 rejected applications. AACN expects this number to increase when final data on qualified applications turned away in 2009 is available in March 2010.
Based on data received from 318 schools of nursing, the primary barriers to accepting all qualified students at nursing colleges and universities continue to be a shortage of faculty (60.7%) and an insufficient number of clinical placement sites (61%). With cuts in state funding to schools of nursing last year, the number of schools reporting budget cuts/insufficient budget as a primary reason for turning students away more than doubled from 14.8% in 2008 to 31.1% in 2009.
It's not all bad news. Survey data also show a surge in enrollments in graduate nursing programs, which Raines said is a promising trend.
"Moving more nursing students into graduate programs is a top priority for the profession given the growing demand for more nurses to serve as teachers and researchers as well as specialty and primary care providers," Raines said. "As we move closer to healthcare reform, many more nurses with master's and doctoral degrees will be needed to provide essential healthcare services, including nurses to serve in the four Advanced Practice Registered Nurses roles," such as clinical nurse specialist, nurse anesthetist, nurse practitioner, and nurse midwife.
Preliminary data from AACN show that enrollment in master's and doctoral degree nursing programs increased significantly this year. Nursing schools with master's programs reported a 9.6% increase in enrollment (409 schools reporting) and a 10.5% increase in graduations (380 schools reporting).
In doctoral nursing programs, overall enrollment is up by 20.5% (154 schools reporting), and graduations increased by 1.9% (92 schools reporting) from 2008 to 2009. Doctor of Nursing Practice programs account for the largest share of growth in this student population with a 40.9% increase in enrollments reported this year (85 schools reporting). In 2009, the number of students enrolled in research-focused doctoral programs increased by 4.1%, according to preliminary estimates.
Since it was first convened by the U.S. Public Health Service in 1984, the U.S. Preventive Services Task Force (USPSTF) has pretty much performed its duties—conducting "impartial assessments of the scientific evidence for the effectiveness of a broad range of clinical preventive services, including screening, counseling, and preventive medications"—outside of the public limelight.
Who really ever heard of the task force outside of the medical community?
Two weeks ago, that all changed with the release of breast cancer screening guidelines—and the ensuing confusion about what they actually meant.
At a Dec. 2 hearing on Capitol Hill, the top two officials with the task force, which is now a part of the Agency for Healthcare Research and Quality, came to the realization that it's not just sufficient to come up with guidelines, but to communicate those guidelines very clearly to the public at large.
It could be argued that the timing of the release of the breast cancer screening guidelines occurred at the wrong time—just days after the House healthcare reform bill (HR 3962) was passed—and a new discussion, right or wrong, was emerging over the 24/7 news cycles about the possibility of how the government could ration healthcare.
"We voted on these recommendations long before the last presidential election. The timing of the release of the findings last month was determined not by us—but by the publication schedule of the medical research journal, which peer-reviewed our work," testified Bruce Calonge, MD, MPH, the task force chair and chief medical officer with the Colorado Department of Public Health and Environment in Denver.
But in the land of sound bytes, the top line of the new screening guidelines caught attention: "The USPSTF recommends against routine screening mammography in women aged 40 to 49 years."
Then the statement went on to say: "The decision to start regular, biennial screening mammography before the age of 50 years should be an individual one and take patient context into account, including the patient's values regarding specific benefits and harms."
The task force also graded the recommendation with the grade of "C"—meaning the task force graded the strength of the evidence as "no recommendation for or against" (as opposed to "A" for strongly recommends or "B" recommends.) Then many—including legislators on Capitol Hill—began to worry if that could mean insurers might drop coverage.
To refocus the argument and address the concerns, representatives of the task force found themselves in front of the House Energy and Commerce Health Subcommittee to say their earlier recommendations were "poorly worded"—leading the public to think they were suggesting screenings were unneeded for patients in their 40s.
To clarify, Diana Petitti, MD, MPH, the USPSTF vice chair, acknowledged that the initial communication was not very good. "The task force acknowledges that the language used to describe its 'C grade' recommendations about breast cancer screening for women 40 to 49 did not say what the task force meant to say. The task force communication was poor."
She also noted the harms and benefits that the panel weighed in making its evaluations—which sometimes might not seem that clear-cut. While benefits "are easy to communicate," the harms are somewhat harder to understand—such as false positives.
"No matter how the concept of screening is explained, a positive mammogram means cancer until cancer is proven not to exist. For some women who have a positive test, the time between a positive test and an answer is mercifully short. For other women, follow-up includes additional tests . . . and anxiety and psychological distress."
It's with these findings, she said, that "mammography starting at 40 should not be automatic." Instead, the task force recommends that "women in their 40s [should] decide on an age to begin screening that is based on conversation with their doctor as an individual."
Now that’s something to communicate to everybody.
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The struggling economy has left many hospitals with thin wallets, and government auditors are gunning for what's left.
There are big dollars at stake. The Government Accountability Office recently released a report that estimated the following overpayment amounts in 2008:
Medicaid, $18 billion. Medicaid hasn't been policed as strictly as Medicare. As a result, overpayments and sometimes even fraud have flourished, according to Michael Taylor, MD, senior medical director of government and regulatory affairs at Executive Health Resources, who spoke at the recent HCPro "Medicare Compliance Forum" held in Atlanta. "But those days are over, and CMS will be examining it as closely as the other programs," he said.
Medicare fee for service, more than $10.4 billion.
Medicare Advantage, $6.8 billion. The estimated Medicare Advantage overpayments have led some members of Congress to propose extending the RAC program to the Medicare Advantage program. "Imagine what that would look like," said Taylor. "Once the Medicare Advantage payers start to see the RAC program expanded, they'll then start to learn from the RACs. And they start to use the same techniques themselves.
"We've all heard the saying, ‘A billion here a billion there, soon it adds up to real money.' That's what we're seeing here," Taylor explains.
Hence the arrival of the many auditors—from RACs to ZPICs—looking for Medicare and Medicaid overpayments or fraud. They're looking for billions.
Thus, we enter a new era of smart, aggressive enforcement.
Unfortunately, dealing with the enforcement is a tall order for hospitals caught in a tough economic environment, with decreasing reimbursement and increasing regulatory demands. But manage, they must. Because the bottom line is patient care, Taylor said.
"Hospitals that fail to deal with this, that fail to … ensure compliance and ensure revenue integrity, that fail to appeal when appropriate and prevail when they should—those hospitals are going to suffer. And as a result patient access to care will suffer," Taylor says. "It's not just about the payment. It's about the care you can provide."
Editor's note: For more information, listen to sessions from the "Medicare Compliance Forum: A Strategic Approach to RACs, Observation Status, and the Role of Physician Advisors," available via HCMarketplace.com. Recordings from the Observation and Physician Advisor tracks are also available.
