California healthcare regulators have fined four San Diego-area hospitals $25,000 each for preventable mistakes that led to the death of one patient. Five more reports of similar incidents at San Diego-area hospitals are under review and could lead to additional fines, according to a spokesman for the state Department of Public Health. The reports are part of a statewide review of reported incidents. Forty California hospitals have been fined since July 2007.
At Banner Page Hospital in northern Arizona, traditional Navajo healing is merging with modern medicine. The hospital's Native American Cultural Committee is working toward an inclusive medical community by tackling the cultural sensitivities of the Navajo people, many of whom are wary of modern medicine. The 25-bed, Page, AZ-based facility serves a population of about 20,000 drawn from a 50-mile radius. About 50% of patients come from the nearby Navajo reservation.
It has been a year since the closure of emergency and inpatient services at Martin Luther King Jr.-Harbor Hospital in Los Angeles, and L.A. county officials have acknowledged that they remain far from fulfilling their promise of restoring it to full operation. The University of California has so far been unable to overcome significant obstacles to accepting management of the South Los Angeles facility. The financing, governance and role of labor unions remain unresolved, and officials on both sides said they did not expect to know until the end of the year if a deal could be struck.
One in three Texas foster children has been diagnosed with mental illness and prescribed mind-altering drugs, including some that the federal government has not approved for juveniles, state records show. Many of these drugs are prescribed by doctors who have a financial stake in pharmaceutical companies' success, according to an investigation. Dozens of physicians who treat children in state custody supplement their salaries with tens of thousands of dollars in consulting and speakers' fees, and they use drug company grants to fund research projects.
Horizon Blue Cross Blue Shield, New Jersey's largest health insurer, has filed to become a publicly held for-profit company. The move could bring the state a $1 billion windfall for healthcare, but it comes with concerns about how the change could impact consumers. Horizon representatives said converting to a for-profit company would help raise capital and allow competition with other insurers. The value of the insurer on the open market, which is estimated to be at least $1 billion, would go to a charitable foundation that, under current state law, would aim to provide healthcare for the needy. Horizon covers 3.6 million people, roughly four out of every 10 New Jerseyans.
The Food and Drug Administration may soon recommend doctors be required to undergo special education in order to prescribe powerful narcotics. Typically, state medical boards impose licensing requirements on doctors. A few states now provide doctors with education about the treatment of pain patients. But nationally, state medical boards have shown little interest in mandating added training in the use of potent pain medications or in screening patients for those prone to drug abuse. Pain experts say they support increased education for doctors, but some fear that mandatory training may harm limit the number of doctors prescribing such drugs and ultimately harm patients.
Maryland-based health management company WellNet Healthcare is launching Point to Point Healthcare this month. WellNet's clients nationwide will be among the first to test-drive the new system that lets employees create a personal network uniting their insurance claims manager with multiple doctors and pharmacies to better coordinate treatments. An online concierge helps workers find new specialists, and a message system reminds them to pick up prescriptions.
South Carolina-based Companion Global Healthcare expanded its international network this week by adding three new international hospitals. Inking the two separate deals—with International Hospital Corp., of Dallas, and India's Wockhardt Hospitals Group—allows Companion's American clients a wider choice for elective surgery and other medical procedures at Joint Commission International-accredited hospitals.
The addition of Hospital CIMA San José in Costa Rica, and two Wockhardt hospitals in Mumbai and Bangalore is yet another step in the maturation of the medical travel industry. Now Companion's individual and employer-sponsored clients, as well as more than one million members of Blue Cross Blue Shield and BlueChoice HealthPlan of South Carolina, can access care at these facilities at preferred network rates.
"International patients have experienced at Wockhardt Hospitals excellent clinical outcomes in an environment of personalized care, which is highly affordable," says Vishal Bali, CEO of Wockhardt Hospitals Group. "Companion Global Healthcare has empanelled our JCI-accredited facilities for elective care of its insured members after an extensive quality survey. This truly is an example of how globalization of healthcare is providing both insured and uninsured people the choice of affordable centers of excellence across the globe as their treatment destinations."
CIMA's CEO, Carole Veloso, points out that the full-service hospital employs English-speaking clinical staff, and Costa Rica is a relatively short flight from the U.S.
Since its start-up in 2007, Companion Global Healthcare continues to develop its hospital network, which now stands at 10 hospitals. Companion President David Boucher says that when the entire network is completed, Companion will probably have about 20 international hospitals. The firm is trying to be both deliberate and diverse as it includes hospitals that meet the various needs of potential medical travelers. With this in mind, Boucher is trying to add hospitals that are high in value and quality.
Gary Wood, Ph.D., International Hospital Corp.'s chairman and CEO, says the agreement with Companion bolsters his system's reputation of delivering high-quality patient care. "For the past 12 years, we have provided a U.S. standard of care to hundreds of thousands of patients in Brazil, Costa Rica, and Mexico, and helped build the private acute care hospital industry in Latin America," he says.
The deals Companion is making today could pay dividends in the near future as U.S. employers and insurers consider creating medical travel options that share cost savings with individual members. In a recently released study, the Deloitte Center for Health Solutions predicts explosive growth that could reach 6 million outbound medical travelers by 2010.
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You are the new CFO. You've just been appointed at a hospital with significant revenue concerns, and you are eager to jump in and stabilize the institution. Your predecessor, try as he did, could not get the P&L statement to cooperate. Where can you search for some potentially overlooked revenue?
Consider the emergency department.
The ED is often wrongly considered an unavoidable drain on hospital revenue and resources. Factors such as increasing volumes of indigent and uninsured patients, difficult managed care contracts and pervasive caregiver shortages can leave hospital administrators feeling frustrated—and understandably so. However, the ED can be a great place to start a revenue cleanup because of its influence throughout the hospital. The ED accesses a great number of hospital resources, including radiology, pharmacy, lab and central supply, and it interacts closely with almost all of a hospital's outpatient services. Due to its far-reaching influence, improvements in the ED can spread to other departments.
As with any revenue enhancement project, lasting change can require a concerted effort. Before you commit, take a quick scan of your ED using the following five actions. All hospitals are different, and no hard-and-fast rules are guaranteed to improve ED financial performance. However, these tools can give you a general idea of the opportunity in your ED before you commit to the project.
Examine the frequency of your ED billing levels If your ED bills on a five-level system and the majority of patient visits are billed at levels one, two, and three, your billing is probably "left of center." You may have unclear definitions of your levels, or your coding staff may not understand how to apply the coding criteria. Accurately capturing payment for higher acuity patients is an essential component of ED financial success. In addition, coding and billing data may be your only method to evaluate your ED patient acuity patterns, which can be valuable information. Higher acuity may require higher resources, particularly during night shifts when volume decreases but acuity increases.
Determine if levels are appropriately tiered Do they accurately reflect patient care from lowest acuity to highest? In general, patients with the lowest acuity receive no diagnostic tests or treatments other than simple bandages and ointments. Mid-level visits often consist of one or two diagnostic studies, injection of medication and simple nursing support. High-level visits may involve longer, more resource-intensive stays for complicated procedures—these patients may be admitted or require follow-up. If your ED coding reflects a different pattern, take a closer look.
Find out if nurses and coders participated in criteria development Ask around. Medicare allows individual hospitals to design their own ED evaluation and management criteria. If clinicians weren't involved in this process, a disconnect may exist between caregiver documentation and the coding process. If nurses are unclear what documentation is necessary, services rendered may not match services billed. Coders need to understand how various nursing services reflect resources that can only be captured in the coding of the appropriate ED level.
Investigate billing for the clinical decision unit/observation unit (if you have one) Observation is a time-intensive process, and if clinical staff members don't understand the amount and type of documentation that needs to be recorded, billing and compliance can be compromised. In fact, coding observation services requires such detailed documentation that you may wish to utilize a dedicated form. Documentation needs to include the time the patient was admitted to observation care, progress notes throughout, the time the patient was discharged from observation care, discharge notes, and other items. Correct payment also depends on whether the patient was first seen in the ED or clinic or received critical care, regardless of where they were first seen. Services such as EKG interpretations and breathing treatments can be billed separately but are sometimes overlooked. Unless you have a designated form for capturing all of these services, your nurses and physicians may find it difficult to meet the documentation requirements.
Ensure every service performed in the ED is listed on the chargemaster Services should be listed even if Medicare does not reimburse the service. Other payers might reimburse and, in fact, Medicare requires that certain services be listed regardless of payment. Ask nurses and ED physicians to take a close look. As a general rule, if you have fewer than 300 E/M levels, surgical, and diagnostic procedures on your ED chargemaster, you may be missing some valuable services.
Addressing ED coding, billing, and compliance often requires a concerted effort, but the returns can be significant. In addition, revenue and compliance goals can be achieved in a timely manner when pieces fall into place. Educating clinical staff jump-starts documentation improvements, and chargemaster cleanup can identify lost revenue in short order. Then, as CFO, you can take comfort that lasting change is within reach.
Caral Edelberg is a senior vice president with TeamHealth, a provider of hospital-based clinical outsourcing and administrative services. She can be reached at Caral_Edelberg@teamhealth.com .
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California officials have nixed Anaheim Memorial Medical Center's $57-million purchase by Pacific Health Corp., which faces allegations that it defrauded Medicare and Medi-Cal. This was the third time that an agreement to sell Anaheim Memorial has unraveled. The Attorney General's office cited several factors in the decision, including "pending criminal investigations" and a civil complaint filed by Los Angeles City Atty. Rocky Delgadillo accusing three hospitals of recruiting homeless people for costly and unjustified treatment.
