Looking to prevent a significant labor and cost burden on America's hospitals, CEOs from 17 hospitals and health systems sent a letter to the Centers for Medicare & Medicaid Services this week, strongly objecting to some of the required date reporting included in the 2009 proposed Inpatient Prospective Payment System rule. The 17 CEOs represent more than 100 hospitals—all members of the Premier healthcare alliance.
Some of the measures that hospitals would be required to report under the 2009 IPPS rule are those collected by the Society for Thoracic Surgeons' database, says Charles Hart, MD, CEO of Regional Health in Rapid City, SD, and chair of Premier's Quality Improvement Committee. STS is a private, proprietary database that hospitals must pay to participate in. Many hospitals already collect this data, Hart says, but for those who don't, being required to do so will mean a significant cost increase and need for additional personnel.
"There's certainly routine agreement in the medical field that it's an excellent database," Hart says, but he and the 16 other CEOs who signed the letter fear that the STS database is the first of many that CMS could require hospitals to participate in. While the CEOs are in favor of more transparency and data reporting, Hart says, they asked CMS to come up with a way to automate reporting requirements and lessen the burden on healthcare organizations.
"We'd much rather spend our time looking at the data to see how we can improve instead of spending our time collecting this information," Hart says.
Premier also sent a separate letter to the National Quality Forum (NQF) opposing the use of any quality measures that depend on proprietary methodologies or tools as contrary to the public interest and evidence-based quality improvement.
"Private-sector innovation can contribute valuable methodologies that enhance quality measures, and that innovation should be encouraged," says Blair Childs, Premier healthcare alliance senior vice president of public affairs. "However, measures subject to public reporting, and those used as a basis of reimbursement, must be fully transparent to providers and the general public. Monopolistic suppliers of quality measures that are required in public programs are unacceptable."
Walgreens is seeking state approval to open medical clinics inside 16 of its Massachusetts stores, a sign of competition for CVS's MinuteClinics. Walgreens wants to open a Take Care clinic inside a store in Boston, potentially setting up a showdown with Boston Mayor Thomas M. Menino, who opposes the clinics. Menino has argued that retail clinics providing episodic care will fracture the medical system and ultimately hurt patients.
Hospital and nursing home building projects would have to be environmentally friendly to win state approval under sweeping regulations proposed by Massachusetts health authorities. If the measure is endorsed by the state Public Health Council this fall, Massachusetts would become the first state to tie approval of healthcare construction to green standards increasingly adopted by office builders. Three of the biggest hospital expansions in New England have already embraced green construction standards, such as incorporating foliage on roofs and floors that eliminate the need for noxious cleaning solvents.
U.S. health insurers are targeted for billions in cuts in legislation that lawmakers will begin debating. Payments to health insurers which contract with the government Medicare program would be trimmed under competing plans offered by the top Democrat and Republican on the Senate Finance Committee. Lawmakers must pass a legislative fix by June 30, or doctors who treat Medicare patients will face a nearly 11% pay cut.
A bill sponsored by Montana Sen. Max Baucus, Democratic head of the committee, would cut payments to private plans, as well as other health companies, by at least $12 billion. As part of the proposal, payments to health insurers such as Aetna, Inc. and Humana, Inc., which contract with the government Medicare program, would be trimmed under competing plans offered by the top Democrat and Republican on the Senate Finance Committee. Lawmakers continue to debate the proposed bill.
A short distance from a sprawling hospital complex closed since Hurricane Katrina, a primary care facility has reopened its doors in eastern New Orleans. The 5,000-square-foot office, with nine examination rooms, will offer primary care with minor cardiac services as well as OB/GYN exams and minor surgeries. Administrators later hope to provide additional specialized services, lab services and complete cardiac care, including ultrasounds and stress test equipment.
Legislation designed to help prosecutors determine whether to file charges against doctors, nurses or other healthcare professionals for their actions during or immediately after disasters has been approved by a Louisiana Senate committee. The bill establishes a three-member Emergency-Disaster Medicine Review Panel to examine disaster-related decisions by healthcare personnel, and a district attorney or state attorney general could choose to ask the board for an evaluation of a medical professional's conduct in a case before launching a prosecution. The findings of the panel would be advisory and not binding.
Nearly 40 Muslim doctors will begin providing free care to the growing number of underserved and uninsured people in Hernando County, FL. The doctors expect to have two or three general physicians staffing the office while specialists will rotate through the clinic on various days. The clinic is financed solely by physicians from Hernando's Muslim community.
Like many of the readers of this column, I am preparing for next week's America's Health Insurance Plans (AHIP) conference in the land of cable cars, fog, and Barry Bonds supporters—San Francisco.
The flight has been booked, the hotel room reserved, the Giants tickets purchased, and the trips to Alcatraz and the Charles M. Schulz Museum planned.
All that's left is to think about the conference—which I'll have plenty of time to do during my six-plus-hour flight from Boston. Before attending a conference, I take a step back and think about the industry and trends. There is no better place to come bearing questions than a national conference with hundreds of industry leaders. (Check back next week to the health plans page and find out what I'm learning. I will be blogging from the conference.)
Here are some of the questions I plan to ask during my time in the city by the bay:
Are health plans situated in a way that they will always be the bad guys or is there a way for health plans to gain the support of providers and members? As I have written before, health plans have become a convenient whipping boy for politicians. I wonder if there is any way to change that. Step one would be improving reimbursements and creating greater transparency with physicians, but what else is needed? I hope health plan leaders have some ideas.
How will the Microsoft and Google personal health records impact the future of healthcare? Is a personal health record really going to spark a patient to become more engaged in his or her health? Colleague Molly Rowe recently offered a list of questions for Google. In addition to Molly's questions, I wonder if personal health records are just the latest in a line of ways that health leaders think will engage patients, but simply don't create the desired spark. The problem is: How do you get a person to do something when he doesn't see the benefit? I'm sure attendees will get an earful on that topic.
Given the growth of the individual health insurance market, how can health plans create a system that reduces costs while providing coverage to everyone who is eligible? Are rescission policies the only way to perform that balancing act? California has been ground zero in the rescission fight. The California situation shows that health plans need to get out in front of controversies like rescissions. The health insurance industry must become more forward-thinking and review its programs. If there are more effective ways to offer services, improve outcomes, and reduce costs, health plans need to get ahead of the curve—before the states create laws that don't benefit the industry.
Is health management cost effective or just the flavor of the month? Leaders in the disease management realm are pointing to health management (the combination of disease management and wellness) as a way to save money. Studies have shown ROIs of 3:1 and 5:1. But for every health management supporter there are those who say there simply isn't an adequate gauge of ROI for health management. I'm curious to see what industry leaders think of health management and whether there are ways to accurately find an ROI.
Will not paying for "never events" improve quality and impact health plans' bottom line? Health plans have followed Centers for Medicare & Medicaid's lead on not reimbursing for "never events," such as operating on the wrong side. Cynics see health plans' move as a way to merely cut costs and has nothing to do with improving quality. One way to change naysayers' opinions is for health plans to take that money they saved from "never events" policies and put it into research to find ways for hospitals and doctors to avoid those situations.
Is Massachusetts healthcare reform, with its collaboration with private health insurers, the best way to offer coverage to the uninsured? Other states are looking to move slower than Massachusetts. Instead of mandating coverage, they have implemented cost-saving measures and quality improvements. The belief is that lowering costs will allow uninsured people to get health insurance. There are other states, most recently Florida, that have legislated mandate-lite health insurance policies, which allow individuals to buy lower cost insurance that doesn't include state-mandated programs, such as maternity, geriatrics, and gynecology. But the controversial nature of mandate-lite policies is also evident in the Sunshine State. A week after approving the mandate-lite legislation the state added autism to its mandated coverage list. In one sense, the state looked at mandate-lite policies as a way to decrease costs, but on the other hand an added mandate puts more costs on health plans. As this dilemma shows, healthcare reform is not easy.
Next week's sessions should prove insightful and will hopefully answer some of my questions—though I'm sure the conference will raise a few dozen others.
I look forward to meeting with industry leaders at next week's conference. Make sure you say hello if you see me.
How will you know me? I'll be the one asking a lot of questions.
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Opinions on bathrooms, hospital rankings, and new-fangled phones
Want to take a guess which of my recent columns got the most response from readers? That's right, the one on dirty hospital bathrooms. It might not seem like a very important topic—after all, hospitals are in the business of saving lives, not cleaning toilets. But it struck a nerve with readers who agreed that this little detail says a whole lot about your organization. I absolutely love hearing what readers have to say—so please keep those comments and e-mails coming.
Listen to what your bathrooms are saying
Your article [How to Clean up Your Image in Just Three Easy Steps, April 23, 2008] was right on target with what we learn through healthcare mystery shopping and what we try to stress in customer service training. We teach healthcare staff to always consider this statement: “If everything speaks, what is your environment saying about your quality?"
The average consumer isn't necessarily fluent in her local hospital's quality indicators, but most have heard about the risks of hospital-acquired infections. And although consumers don't comprehend microbiology, they do understand visible filth.
Consumers judge us on what they know and see. They aren't invited into the operating room to observe stringent sterile procedures, but they are welcome to use the restrooms. If the restrooms are disgusting, you may begin to doubt the cleanliness in general. Everything about the patient and visitor experience should reinforce their confidence in the organization. Your example of the hospital bathroom is exactly what healthcare organizations need to hear.
If everything speaks, what are you saying?
Kristin Baird
President
Baird Consulting Inc.
Put down that Kool-Aid
My observation is that hospitals are such insular places that they tend to lose sight of the basics. They drink too much of their own Kool-Aid and lose sight of some of the more basic concepts to patient care—like clean bathrooms. As a result, they all try and distinguish themselves around the same stuff—medical staff, technology, building, etc. In the end they all appear the same. Little do they realize that the small things are what delight patients the most. And it's what they remember and talk about. Just because your medical staff is Harvard educated doesn't mean that I don't appreciate a clean bathroom. Please!
Kevin Lieb
Director, Provider Programs
J.D. Power and Associates, Healthcare Division
Experience by the book
It all gets back to what Fred Lee says in his book "If Disney Ran Your Hospital." It's all about the experience. When professionals in the field talk quality it is metrics and data. When the public talks quality it is about the total experience.
Anthony Cirillo
President
Fast Forward Marketing Consulting
So, what've you been reading lately?
How often do you hear stories like this? All the time! One of my favorites is from an experience study we did a few years ago, where an auditor found a copy of Freedom magazine in a waiting room with a headline in very large type reading, “John Kerry tells gun owners to STICK IT!"
I would imagine most people of with Democratic Party leanings found that offensive. But no matter what political affiliation, magazines featuring such raw language would not be considered conducive to the comfortable, quiet atmosphere patients expect at a heart center.
Perhaps it's regrettable that patients pay more attention to these experiences than they do the skill of a surgeon or the seamlessness of a process, but they do. And no matter how many new ratings Websites or quality rankings are launched, I suspect they always will.
Chris Bevolo
President
GeigerBevolo Inc.
One regular reader took umbrage with my assertion that Consumer Reports, the latest organization to enter into the online healthcare ranking biz, might hold more sway with readers than its competitors, including the government.
Consider the Source
It's interesting that Consumer Reports would be thought of as a highly credible and reliable source for hospital ratings [Online Ranking Sites Still Lacking, June 4, 2008]. True, it has a recognizable brand. And yes, it is not supported through advertising.
However, ‘free of advertising' doesn't necessarily mean consumers will attribute more credibility to a general magazine's findings. While Consumer Reports has long held claim to being the objective automobile ranking king, several other services (such as Edmunds.com and CarMax) have recently begun to chip away at that mantle. That's because consumers perceive these alternative sources to have more credibility in the automotive field.
And as much as it loves to throw brickbats at the government, the public still views governmental sources as more unbiased than other sources when it comes to their health. Will hospital ratings (or for that matter law firms or real estate businesses) ever work the way ratings for cars, appliances, garden hoses, and cell phones do? Hard to say.
But in the meantime, just as it's always been with services that are highly personal and carry a great deal of risk, it's "buyer beware."
Patrick T. Buckley
President and CEO
PB Healthcare Business Solutions
Finally, my column on customized or vanity phone numbers [A Custom Call to Action, May 7, 2008] sparked an interesting online debate about whether or not they're a good idea. I have to admit, it never occurred to me that it might be difficult for people with keyboards instead of number pads on their cell phones to dial, as one reader put it, “cute" phone numbers.
Those who responded online had some helpful hints about how to make this kind of customized marketing work, such as combining customized phone numbers with customized URLs and including a numeric translation in all ad copy.
(Read from the last comment up to follow the conversation chronologically.)
Gienna Shaw is an editor with HealthLeaders magazine. She can be reached at gshaw@healthleadersmedia.com.
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