A new study has found that the odds of surviving cancer depend on which country the patient lives in. Factors such as economic differences among countries, access to healthcare, and the availability of cancer treatments feed the disparities in survival, the report said. The study also confirms the disparity in cancer survival among blacks and whites in the United States, said the study's authors.
After President Bush sought to block a bill aimed at forestalling an 11% cut in payments to doctors taking care of Medicare patients, Congress quickly overrode his veto. The House voted 383 to 41 for the override, while the Senate voted 70 to 26. Both cases were far more than the two-thirds necessary to block the veto. At issue in this bill was how the government should respond to a planned reduction in Medicare doctors’ fees, mandated by a formula that requires the cuts if certain spending targets are not reached. Under the formula, a 10.6% cut in fees for doctors was supposed to go into effect, but Congress voted instead to reduce the reimbursement to insurance companies that serve Medicare beneficiaries under its managed-care program.
Massachusetts General Hospital and Concord, MA-based Emerson Hospital are collaborating on an advanced cardiac care clinic that will move some of MGH's expertise to the suburbs. The new center will include specialists in heart electrical systems, women's heart disease, and advanced heart failure. The MGH-Emerson Cardiovascular Center will be located in a medical specialty building about a mile from Emerson. The collaboration follows a trend of academic medical centers creating suburban outposts, giving them an expanded geographic reach and a flow of patient referrals. The suburban hospitals add advanced services without having to hire doctors, and get to piggyback on the better-known hospital's brand name.
Illinois-based hospital operator Evanston Northwestern Healthcare has acquired Rush North Shore Medical Center in Skokie, IL, and committed more than $160 million to the deal. As part of the deal, which still needs approval of regulators including the Federal Trade Commission, Evanston Northwestern will retire Rush North Shore's $54 million in debt and contribute $10 million to a community foundation. Evanston Northwestern will also commit $100 million in capital over the next several years that includes establishing an electronic medical record system at Rush North Shore.
Some former healthcare professionals are working for Iowa's largest health insurer in a new role that company leaders hope will help members avoid costly illnesses. Using a call center, Iowans have can have conversations about their ailments with nurses or specially trained "health coaches," who work for Healthways, a contractor of Wellmark Blue Cross and Blue Shield. Wellmark representatives say the company can use its high-tech capabilities to track patients in ways that independent doctors' offices can't. The call-center nurses routinely encourage patients to go in to their doctors for tests and checkups. The service helps the doctors keep patients well, instead of having patients come in just when they are in a crisis, the representatives say.
Two years after construction began, Louisville, KY-based Baptist Hospital East will hold a public open house to show off the first three floors of a 144-bed addition. The $130 million Park Tower addition also includes an outpatient surgery center with eight operating rooms that will open next month. That project will be followed in phases by private patient rooms and other care units still under construction.
The Missouri Court of Appeals has ordered a long-running antitrust case by 3,000 Kansas City-area doctors against several insurers to be submitted to arbitration. The Court of Appeals reversed a lower court ruling, agreeing with Blue Cross and Blue Shield of Kansas City and United Healthcare Services that the antitrust claims were covered by arbitration agreements. The case, which was filed in 2005, alleges that Blue Cross, United Healthcare and Coventry Health Care of Kansas violated antitrust laws by fixing prices and engaging in other monopolistic behavior.
One healthcare trend that I hear repeatedly is that we need to do more with less—less money, less physicians, and less access to care. I doubt this trend will abate any time soon. First of all, there's not going to be a sudden influx of specialists choosing to practice in rural America. But an even greater concern may be primary care. If you live in a small town and your family physician has announced plans to retire, good luck finding a replacement. The number of U.S. medical graduates going into family medicine fell by more than 50% from 1997 to 2005. The fact that family docs earn on average about $170,000 annually while specialists earn on average about $322,000 annually isn't helping matters. Certified registered nurse anesthetists are earning more (on average about $185,000) than family practitioners, as well, according to a recent report by Merritt, Hawkins, and Associates. So unless family docs start getting paid more, I doubt we'll see more med students signing up for primary care—and who can blame them?
There are programs to entice primary care docs and specialists into rural practice like loan repayment, providing med students more experience in rural healthcare, and recruiting people from rural areas into the healthcare field. While these efforts may help increase the supply of physicians to rural areas, odds are there will still be major gaps in the rural healthcare delivery system.
One way to bridge these gaps is through telemedicine programs, which scored a big win yesterday when Congress voted to override President Bush's veto of HR 6331. The legislation, which stopped a Medicare physician pay reduction, also provides nearly $2 billion to rural healthcare including a provision that makes skilled nursing facilities, hospital-based dialysis centers, and community mental health centers eligible to participate in Medicare's telemedicine program. This is great news for people living in remote regions with little or no access to specialty care like mental health services.
While this legislation helps address some of the gaps in the rural healthcare delivery system, the full potential of telemedicine to help rural practitioners provide the high quality care that their communities not only expect but demand has yet to be realized. Hospitals and physicians have been using telemedicine to offset work force shortages, provide additional services, or improve access to specialty care for people in their communities—mostly through real-time videoconferencing consultations. But scheduling these consultations can be difficult given the high demand placed on some specialties in rural areas. In many nonemergent situations, store-and-forward telemedicine would be a more efficient model. Under this scenario, providers would capture the patient data and send it to the consulting physician, who can then review it at a time that is convenient. The problem? Currently, Medicare only reimburses for store-and-forward telemedicine in Alaska and Hawaii. (I'm not referring to teleradiology-type services for which Medicare does reimburse providers. Rather, I'm referring to consultations with specialists like dermatologists or ophthalmologists, which are not covered.)
Recently, I spoke with Stewart Ferguson, PhD, the director of telehealth for the Alaska Native Tribal Health Consortium, who is no stranger to the store-and-forward telehealth model. He heads the Alaska Federal Health Care Access Network, which is now in its ninth year and provides healthcare to federal beneficiaries in remote areas via telemedicine. Ferguson says that AFHCAN has found significant value in store-and-forward telemedicine and believes that the private sector could benefit from this model, as well. "Most of our healthcare delivery is not something that has to be dealt with immediately, but can be dealt within a 24-hour window. [Store-and-forward telehealth] is a really efficient use of our healthcare resources, which has got to be the focus of any solution at this point," he says.
Is telemedicine helping you improve access to care in your community, or are you struggling to afford or implement the technology? I would like to hear about your successes and headaches, please drop me a line at cvaughan@healthleadersmedia.com.
Carrie Vaughan is editor of HealthLeaders Media Community and Rural Hospital Weekly. She can be reached at cvaughan@healthleadersmedia.com.
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The future for hospitals is not dependent on getting more dollars in the door to offset revenue restrictions but to focus on stopping dollars from going out the door. The Centers for Medicare & Medicaid Services' pain-for-gain revenue policies drive hospital leadership to pursue new revenue streams to relieve the pain, rather than reduce operational inefficiencies and preventable medical errors—each of which CMS continues to reward through cost reports and increasing DRGs, respectively.
On October 2008, CMS will tweak its traditional pain-for-gain policies in the inpatient prospective payment system and not reward reimbursement for select preventable medical errors. This contradicts prior CMS statements. On May 18, 2006, a CMS press release stated, "Reducing or eliminating payments for ‘never events' means more resources can be directed toward preventing these events rather than paying more when they occur." This is true for commercial insurers, not for Medicare, which usually pays less for healing than the cost of prevention. Even though CMS promotes Medicare benefits that cover a broad range of services to prevent diseases, it lacks a policy to do so for preventable medical errors. Hospitals should not be surprised that IPPS will not include the promised prevention funds that could be financed with a portion of projected savings unless CMS has an epiphany or a crisis of conscious.
Whether you chose to respond with new services or not, focusing on operational efficiencies, which are the rails quality travels on to achieve excellence in patient and financial outcomes, will keep dollars in the bank. It is what CMS wants you to pursue, but is clueless in how to manage the transition with less pain, so it remains committed to utilizing revenue pain-for-gain policies. You have to be committed to achieve excellence, pain or no pain. You can do this with little financial investment, but a major personal investment in using your leadership skills to inspire staff to execute the basics flawlessly.
My suggestion to leadership is simple to state but mentally hard to pursue. Start listening to your physicians, nurses, patients, and support staff —especially those you are actively avoiding. Rather than rounding with a "hi and good-day" approach, start engaging the staff throughout the hospital on a daily basis and become known as the barrier slayer. You are not there to go to meetings; you are there to facilitate the meetings of minds, ideas, and outcomes throughout the hospital. Implement a survey where all hospital services—from volunteers and housekeeping to the executive suites —are rated by other services in meeting their needs and identifying what barriers prevent them from achieving their goals. Be relentless in identifying all barriers every service feels or knows inhibit them from being efficient and quality driven. Learn to let the facts take shape and put feelings on hold before decisions are made. Create an environment where individual anxiety is to elevate excellence, not to compromise it. Inject comfort zones with large dosages of accountability. Inspire all leadership levels to be the force behind an efficiency evolution by adopting these tactics.
Remember that the No. 1 operational disease in hospitals is the communication breakdown that usually exists in the black hole of an information chasm under the oversight of complacent leadership. These characteristics do not inspire reflection, inquiry, and collaboration, which are critical to an efficiency evolution. Leadership, information, and communication are the three piers necessary to build the foundation for a culture of excellence in the shifting sands of the healthcare delivery system. If these piers are structurally weak, you limit the number of "pillars" your hospital can support, if any.
How will I know that you are in the midst of an efficiency evolution? When I enter your hospital and approach a housekeeper who has the emergency room looking exemplary and compliment him or her and then ask, "Do you know the CEO?" and I see a face light up with an affirmative response. I then look to the waiting area in the ER where patients look anxious but not angry, and I think, "This place is busy!" But my senses tell me this is not organized chaos because every staff member is moving with purpose, uninhibited by the sense of disorder that operationally inefficient ERs cultivate. And this affirmative response towards you and a sense of purpose by employees is repeated throughout my tour. Then I know this is a hospital in the continuous pursuit of excellence, because the people know that leadership believes in them and that they are the only means to make a hospital quality-driven, profitable, and great--no matter what pain CMS inflicts.
R. Daniel King is a retired healthcare consultant in Tyler, TX, with a background in operational, financial, and crisis-management for hospitals, medical practices, and skilled-nursing facilities.
Many marketers treat the 78 million baby boomers as if they were cut from the same cloth, but there are many sub-demographics of Americans born between 1946 and 1964. In order to market to them effectively, you've got to know the specifics.
