In the past two years, this column has focused much on workplace violence in the hospital—an issue that until recently received scant attention beyond the people who were immediately threatened.
Fortunately, awareness is growing. The mainstream media has picked up on the story, thanks to the efforts of groups like the Emergency Nurses Association (ENA), which has provided detailed accounts about the frequency of onsite violence against clinicians and other staff. ENA’s alarming 2007 survey in which 86% of respondents reported having experienced workplace violence is frequently cited by news outlets.
Now, when violence occurs in a hospital, media no longer report it simply as an isolated and unpredictable incident, but as part of a larger and disturbing trend of hospital violence that is taking place across the country. And, as more data is compiled about the extent of these attacks, the media will intensify its coverage because it resonates with the public.
This is all good. Acts of violence in places of healing are still occurring at an alarming rate, but most people who are in a position to address the issue no longer are in denial. That is an important first step. An informed and angry public will demand change, and that means that hospital leaders who ignore workplace security do so at their own peril.
If an employee, a patient, or a visitor in your hospital is attacked, be assured your local news media (probably unions, too) will examine previous incidences of violence at your hospital to look for patterns, and demand to know why you took no previous action to address an issue you should have known about. And, they’d be right in asking.
Recently, the Journal of Emergency Nursingreported on an innovative program at the University of Wisconsin Hospital and Clinics to address an uptick in violent incidents against staff, patients, and visitors at the Madison, WI-based health system’s emergency department. Working from Centers for Disease Control data which shows that emergency departments are the most frequent location for violence in healthcare, UWHC formed an interdisciplinary team of nurse leaders and front-line staff to address the issue.
They developed a safety program that uses a green-yellow-red color-coded alert system that shows the security status with lights in strategic places in the ED. For example, when ED staff encounter patients with behavioral problems, victims of violent crime, surge-capacity issues, gang activity, multivictim trauma, and other events that could lead to a higher of risk for violence, physicians, nurses and security staff briefly huddle to discuss changing the department's status from green (business as usual) to yellow (potential for disruptive behavior) to red (potential for loss of control of any part of the ED). When security status changes, a three-second alarm and change in light color alert staff to the new situation.
“The training may not prevent unexpected violent outbursts, but staff are better able to identify people at risk of individual violent behavior and know when to cue a potential change in security status,” said Tami Morin, ED clinical nurse manager at UWHC.
Bingo!
Front-line healthcare professionals like the folks at UWHC tend to be practical problem-solvers. They understand it’s probably not realistic to think that workplace violence in the hospital can be eradicated. However, raising staff awareness, and training staff in appropriate responses will give them the tools they need to react accordingly to protect themselves, their colleagues, patients, and visitors.
Appleton (MN) Area Health Services, a community-owned critical access hospital, has entered a volume purchasing agreement with Sanford Health, effective Jan. 1.
"Rural hospitals face many challenges, and this associate relationship with Sanford Health allows us to continue to provide quality healthcare for people in the community. It also increases potential for growth in services," said Jason Carlson, CEO of Appleton Area Health Services.
Sanford Health, based in Sioux Falls, SD, and Fargo, ND, has several relationship tiers with hospitals in the region, ranging from associate, managed, leased and owned status. The associate agreement with Sanford Health allows Appleton Area Health Services access to Sanford's volume purchasing power, saving money for the local hospital.
"This new relationship also expands education opportunities for staff and Appleton Area Health Services to gain and share 'best practices' knowledge with the entire Sanford Health system," Carlson said.
Appleton Area Health Services includes the 15-bed critical access hospital, a long-term care facility, congregate living facility, home health and a primary care clinic. It employs approximately 170 full and part-time people.
"Both of our organizations believe healthcare should be delivered as close to home as possible," said Sanford Health President Ed Weiland. "Sanford Health has a significant presence in Minnesota, and by working together we can create a virtual medical hub for the area with potential for sharing expertise, resources and providers.
Sanford Health is the largest, rural, not-for-profit healthcare system in the nation, with a presence in 110 communities in eight states that includes 30 hospitals, 111 clinics, more than 800 physicians in 70 specialties, and more than 18,000 employees. Sanford Health is also developing clinics in Belize and Ireland.
Community Health Systems, Inc. has made public its unsolicited offer to acquire Tenet Healthcare Corp. for $6 per share in cash and stock—a deal valued at $7.3 billion that if finalized would create the nation's largest private hospital chain.
However, Tenet's board of directors unanimously rejected the offer as "inadequate," and added that "Community Health's stock appears to be over-valued and is not a desirable currency for Tenet shareholders."
"In making its determination, the Tenet Board considered that Community Health's opportunistic proposal would transfer the growth potential inherent in Tenet to Community Health without adequately compensating Tenet shareholders," Tenet President/CEO Trevor Fetter, and Chairman Edward A. Kangas said in their letter to CHS. "The Tenet Board believes that the interests of Tenet shareholders would be better served by benefiting from 100% of the upside inherent in Tenet rather than accepting Community Health's inadequate proposal. In addition, the Board has serious concerns about Community Health's ability to integrate and operate a business like Tenet."
CHS had offered to pay $6 per share, including $5 per share in cash and $1 per share in CHS common stock, which represents a premium of 40% over Tenet's closing stock price on Thursday. The value of the transaction would be approximately $7.3 billion, including $3.3 billion of equity and approximately $4 billion of net debt. The offer was made in a letter to Tenet's Board of Directors on Nov. 12, and rejected by Tenet on Dec. 6.
CHS Chairman, President, and CEO Wayne T. Smith said he decided to go public with the offer to ensure that Tenet shareholders were made aware of the proposal, and the board's rejection.
"This will allow Tenet shareholders to decide for themselves if they prefer the substantial premium and high degree of certainty offered in this transaction—or would rather continue to accept the significant risk, especially in light of recent operating performance, that Tenet can achieve greater present value for shareholders through execution of its strategic plan in the years ahead," Smith said in a letter Thursday to the Tenet board.
Franklin, TN-based CHS said the combined company would have approximately $22 billion in annual revenues and own or operate 176 hospitals in 30 states with a total of 32,830 licensed beds.
Global spending on healthcare will surge by $71 trillion—an increase of more than 50%—by 2020, with the greatest growth coming from emerging markets in Brazil, Russia, India, and China, according to a new report from PricewaterhouseCoopers.
Health spending in these countries is rising faster than gross domestic product, exposing gaps in budget deficits and prompting governments to look to public-private partnerships for better value, PwC said in its report, Build and Beyond: The (r)evolution of healthcare PPPs.
The report identifies as a growing trend the use of PPPs to finance and manage health infrastructure and delivery, which PwC said could create a multi-trillion global market opportunity for private companies and investors, implement a more efficient use of taxpayer dollars, and improve healthcare quality.
"The public finance of private innovation and efficiency is a win-win-win for governments, private industry and patients," said David Levy, MD, global health leader, PwC. "Public-private partnerships offer the opportunity to increase access and quality of care, bend the cost curve on health spending and create accountability for health systems among groups that previously haven't had appropriate incentives to work together."
Public health authorities around the world are increasingly contracting with private entities to manage healthcare services for defined populations or markets. These PPPs—which have been used for infrastructure finance—are evolving as way to slow the rising cost of healthcare and address larger problems in the health system.
PPPs enable public health authorities to maintain oversight of standards while injecting private sector fiscal discipline, innovation, and efficiencies that are driven by incentives to generate long-term savings and improve quality, PwC said.
The market for PPPs is expected to grow significantly over the next five years, because the model can save healthcare costs. For example, Spain's Alzira project, which includes hospital and primary care services, saved the government 25% of the cost of providing care, PwC said.
Competition for private capital has prompted governments in Europe, Asia, Africa and southeast Asia to establish PPP agencies to develop policy recommendations, streamline procurement and contract for services, PwC said.
"The keys to the success of PPPs as they move beyond building infrastructure to long-term delivery of clinical services will be in contracts that clearly establish performance goals around quality and health outcomes," said Kelly Barnes, U.S. Health Industries Leader, PwC.
In 2010, a number of record-setting PPPs formed across three continents to finance hospital infrastructure, including a new 700-bed Karolinska Solna University Hospital in Stockholm, Sweden, the largest hospital PPP in the world. Other deals were made in Canada, Mexico, Africa and Spain.
While the deals are dominated by infrastructure projects, they are also expanding the market for private capital and expertise in health services. As the scope of the partnership projects in healthcare grows, so does the size of the potential market for private companies, PwC said.
PwC estimates that:
By 2020, spending on health infrastructure among the Organization for Economic Cooperation and Development countries, and Brazil, Russia, India, and China, will increase to $397 billion annually, up from $263 billion today. However, the larger market for health PPPs will be in non-infrastructure spending, estimated to be more than $7.5 trillion annually, up from $5 trillion in 2010.
Between 2010 and 2020, OECD and BRIC nations will spend cumulatively $3.6 trillion on health infrastructure and $68.1 trillion on non-infrastructure health spending.
Health spending in the United States accounts for half of all health spending among OECD nations. However, the biggest growth will be outside of the U.S. According to PwC projections, the countries that are expected to have the highest health spending growth between 2010 and 2020 are China, where spending is expected to increase by 166%, and India, which will see a 140% increase.
Among OECD countries, health spending as a percent of GDP will increase to 14.4% by 2020, up from 9.9% in 2010. Among BRIC nations, health spending as a percent of GDP is expected to increase to 6.2% in 2020, up from 5.4% in 2010 as their economies grow and they build out their health systems. In actual spending, this amounts to a 117% increase in spending over the decade, with China leading the way.
The U.S. House on Thursday afternoon voted 409-2 to delay by one year the nearly $20 billion in Medicare reimbursements cuts to physicians that were due to take effect Jan. 1.
The overwhelming and bipartisan vote came one day after the measure garnered unanimous consent in the Senate. President Obama said he supports the delay. He also called for a permanent solution to the "doc fix," a perennial Congressional sideshow.
"This agreement is an important step forward to stabilize Medicare, but our work is far from finished," Obama said. "For too long, we have confronted this reoccurring problem with temporary fixes and stop-gap measures. It's time for a permanent solution that seniors and their doctors can depend on and I look forward to working with Congress to address this matter once and for all in the coming year."
The Sustainable Growth Rate formula for Medicare funding dictates the cuts, which have repeatedly been temporarily delayed – including five times this year -- since Congress passed the measure a decade ago. In the latest round of cuts, physicians were facing a 25% reduction in Medicare reimbursements on Jan. 1. Delaying the cuts is expected to cost about $19.2 billion.
The American Medical Association praised the lame duck Congress for its bipartisan support of the measure.
"Stopping the steep 25% Medicare cut for one year was vital to preserve seniors' access to physician care in 2011," said AMA President Cecil B. Wilson, MD. "Many physicians made clear that this year's roller coaster ride, caused by five delays of this year's cut, forced them to make difficult practice changes like limiting the number of Medicare patients they could treat."
Wilson echoed the president's call for a permanent SGR solution. "The AMA will be working closely with Congressional leadership in the new year to develop a long-term solution to this perennial Medicare problem for seniors and their physicians. This one-year delay comes right as the oldest baby boomers reach age 65, adding urgency to the need for a long-term solution before this demographic tsunami swamps the Medicare program," he said.
The bill, the Medicare and Medicaid Extenders Act of 2010, also includes extensions of other expiring healthcare provisions, including protections for rural hospitals and doctors, Transitional Medical Assistance and the Special Diabetes Program.
Senate leaders patted each other on the back Wednesday after approving the extension, which demonstrated a rare show of cooperation on Capitol Hill.
"This bipartisan agreement gives peace of mind to seniors and military families in Nevada and across the nation," said Senate Majority Leader Harry Reid (D-NV). "We ensured that our seniors and veterans can continue seeing their doctors and getting the treatment they need."
Senate Minority Leader Mitch McConnell (R-KY) said he was "encouraged that we were able to work together in a bipartisan way and protect access to care for America's 45 million Medicare beneficiaries in a fiscally responsible manner."
Reid's office said the legislation would be paid for by modifying the policy regarding overpayments of the healthcare affordability tax credit. This policy does not change the tax credits for which people are eligible based on their income. Instead, the proposal would change the way people pay back overpayments when they have received more credit than they are eligible for because, for example, they earned more money than expected in a given year.
Under current law there is a flat cap of $250 for individuals and $400 for families on the amount of the healthcare affordability tax credit people are required to pay back when they received an overpayment. This payback cap is the same for people earning 160% of the federal poverty level and 360% of the federal poverty level. Under this proposal for correcting overpayments, the cap on the payback amount would be on a sliding scale based on the income of the recipient of the tax credit, making the policy fairer to both recipients and all taxpayers, Reid's office said.
The American Medical Association is praising the U.S. Senate's bipartisan vote Wednesday to delay by one year 25% Medicare reimbursement cuts to physicians, and is urging the House to follow suit before the Jan. 1 deadline.
"This one-year delay comes right as the oldest baby boomers reach age 65, adding urgency to the need for a long-term solution before this demographic tsunami swamps the Medicare program," said AMA President Cecil B. Wilson, MD.
The House has yet to take up the measure, and it's not clear how much support it will garner in the lame duck session.
"Stopping the cut for one year will inject some much needed stability into the system for seniors and physician practices who have spent this year in limbo because of five short-term delays," Wilson said. "We urge the House to quickly pass this critical legislation before the January 1 deadline when the 25% Medicare cut is set to begin."
Wilson said the AMA will work with Congress in the coming year to find a permanent solution to the so-called "doc fix." The Sustainable Growth Rate formula for Medicare funding dictates the cuts, but the cuts have repeatedly been delayed since Congress passed the measure a decade ago.
Delaying the cuts one more time would ensure that Medicare and Tricare, for active-duty service members, National Guard and Reserve members, retirees and their families, will pay physicians who participate in those programs at current levels.
The bill, the Medicare and Medicaid Extenders Act of 2010, also includes extensions of other expiring healthcare provisions, including protections for rural hospitals and doctors, Transitional Medical Assistance and the Special Diabetes Program.
Senate leaders patted each other on the back after approving the extension, which demonstrated a rare show of bipartisanship on Capitol Hill.
"This bipartisan agreement gives peace of mind to seniors and military families in Nevada and across the nation," said Senate Majority Leader Harry Reid (D-NV). "We ensured that our seniors and veterans can continue seeing their doctors and getting the treatment they need."
Senate Minority Leader Mitch McConnell (R-KY) said he was "encouraged that we were able to work together in a bipartisan way and protect access to care for America's 45 million Medicare beneficiaries in a fiscally responsible manner."
Reid's office said the legislation would be paid for by modifying the policy regarding overpayments of the healthcare affordability tax credit. This policy does not change the tax credits for which people are eligible based on their income. Instead, the proposal would change the way people pay back overpayments when they have received more credit than they are eligible for because, for example, they earned more money than expected in a given year.
Under current law there is a flat cap of $250 for individuals and $400 for families on the amount of the healthcare affordability tax credit people are required to pay back when they received an overpayment. This payback cap is the same for people earning 160% of the federal poverty level and 360% of the federal poverty level. Under this proposal for correcting overpayments, the cap on the payback amount would be on a sliding scale based on the income of the recipient of the tax credit, making the policy fairer to both recipients and all taxpayers, Reid's office said.
Kos Pharmaceuticals, a subsidiary of Abbott Laboratories, will pay more than $41 million to resolve criminal and civil False Claims Act violations related to illegal kickbacks and off-label marketing for the cholesterol drugs Advicor and Niaspan, the U.S. Justice Department announced.
Delaware-based Kos will pay more than $38 million to settle civil allegations under the False Claims Act. The civil settlement resolves allegations that Kos paid doctors, other medical professionals, physician groups, and MCOs illegal kickbacks in money, free travel, grants, honoraria, and other valuables and services, in violation of the Anti-Kickback Statute to get them to prescribe or recommend Niaspan and Advicor.
Wednesday?s announcement marks the second time in as many days that Abbott has been named in a multimillion dollar False Claims Act settlement related to Medicare/Medicaid fraud.
On Tuesday, federal prosecutors said Abbott and two other drug makers would pay a combined $421 million to settle whistleblower allegations that they inflated prices for drugs paid for by Medicare and Medicaid. Abbott agreed to pay $126.5 million to resolve the claims against it in two whistleblower cases challenging its pricing of intravenous dextrose solutions, sodium chloride solutions, sterile water, vancomycin, and the oral antibiotic drug erythromycin.
Abbott released a statement Wednesday saying "the actions occurred prior to Abbott's acquisition of Kos in 2006 and Abbott has not been accused of any wrongdoing."
In the Kos investigation, federal prosecutors claim the drug maker promoted the sale of Advicor as a first-line therapy for management of mixed dyslipidemias—a disruption of the lipids in the blood. The off-label use was not approved by the Food and Drug Administration, and it was not a medically-accepted indication for Medicare/Medicaid programs. The federal share of the civil settlement is $33.7 million and the state Medicaid share is $4.4 million.
"Pharmaceutical companies that pay kickbacks to medical professionals take from the taxpayers and undermine the integrity of choices that doctors make for their patients," said Tony West, assistant attorney general for the Civil Division of the Department of Justice. "We will work with our federal partners to ensure that important health care decisions are based on sound medicine, not illegal payments."
Kos has agreed to a deferred prosecution agreement related to one count of conspiracy to violate the Anti-Kickback Statute. The criminal information states that Kos conspired to violate the statute by agreeing to pay physicians kickbacks in exchange for prescribing for Kos drugs. Prosecutors claim that two doctors agreed to promote Kos products, including Advicor, to treat high cholesterol in exchange for money.
Between January 2002 and June 2006, one of the doctors wrote 4,130 prescriptions for Kos products. According to the court documents, some of those prescriptions were paid by Medicare and Medicaid. From 2002 to 2004, Kos paid the two doctors or a third party intermediary in the form of "sponsorship" of continuing medical education classes conducted by the doctors and purported speakers? fees. Kos has agreed to pay a $3.36 million criminal fine as a condition of the deferred prosecution agreement.
Federal prosecutors said they agreed to the deferred prosecution agreement because Kos conducted an internal investigation of misconduct, reported the findings to prosecutors, and has cooperated with the investigation.
The civil settlement resolves two whistleblower lawsuits brought forward by former Kos employees, who will split payments totaling more than $6.4 million from the federal share of the civil recovery.
Drug makers Abbott Laboratories, B. Braun Medical, and Roxane Laboratories will pay $421 million to settle whistleblower allegations that they inflated prices for drugs paid for by Medicare and Medicaid, a violation of the False Claims Act, the U.S. Justice Department announced Tuesday.
DOJ said the three drug makers created artificially inflated "spreads" – the differences between the inflated government payments and the actual price paid by healthcare providers -- for drugs to market, promote and sell the drugs to existing and potential customers.
Because Medicare and Medicaid overpayments were involved, DOJ said, the drug makers caused the government to pay millions of claims for far greater amounts than it would have if the drug makers had reported truthful prices.
"Some pharmaceutical manufacturers have asserted that a culture within the industry gave them license to manipulate the system to suit their interests. This is not the case," said Carmen M. Ortiz, U.S. Attorney for Massachusetts, which led the prosecution. "When manufacturers report drug pricing information that they know will be relied upon by government healthcare programs, they are obliged to report honest prices. It is unlawful to do otherwise."
The settlements resolve allegations brought by whistleblower suits filed by a Florida home infusion company, Ven-A-Care of the Florida Keys Inc. As part of these settlements, the Ven-A-Care whistleblowers could receive about $88.4 million.
Roxane is paying $280 million to resolve claims against it and affiliates Roxane Laboratories Inc., Boehringer Ingelheim Corp. and Boehringer Ingelheim Pharmaceuticals Inc. for the following drugs: Azathioprine, Diclofenac Sodium, Furosemide, Hydromorphone, Ipratropium Bromide, Oramorph SR, Roxanol, Roxicodone and Sodium Polystyrene Sulfonate.
Roxane denied any wrongdoing and said it agreed to the settlement to end "expensive and disruptive litigation with the Department of Justice."
"The company at all times complied with laws, regulations and customary industry practices. Our generic medicines lower the overall cost of the US healthcare system – a shared goal of healthcare reform," Roxane said in a statement. "The expense of protracted litigation adds to the cost of producing Roxane medicines and therefore impacts the competitiveness of our business."
Abbott is paying $126.5 million to resolve the claims against it in two whistleblower cases challenging its pricing of intravenous dextrose solutions, sodium chloride solutions, sterile water, vancomycin, and the oral antibiotic drug erythromycin.
Abbott also denied any wrongdoing. "We continue to believe that we have complied with all laws and regulations and have entered into this agreement to eliminate the uncertainty associated with continued litigation," said Adelle Infanct, manager of external communications for Abbott.
B. Braun Medical Inc., a U.S. subsidiary of German pharmaceutical company, B. Braun Melsungen AG, has agreed to pay $14.7 million to resolve allegations that inflated drug prices for 49 of its drugs, including water-based solutions used for intravenous infusion of other drugs and for fluid replacement, including dextrose solutions, sodium chloride solutions, sterile water and lactated ringers solution, intravenous nutritional solutions and other intravenous drugs.
Tony West, assistant attorney general for the Justice Department's Civil Division, said the federal government has recovered more than $1.8 billion from drug makers using similar drug pricing schemes. "By offering their customers one price and then falsely reporting a greatly inflated price to the lists the government uses when determining how much to pay for the drugs, we believe pharmaceutical companies created an incentive for the purchase of their drugs, since buyers could obtain government payment at the inflated price and pocket the difference," West said. "Taxpayer-funded kickback schemes like this not only cost federal healthcare programs millions of dollars, they threaten to undermine the integrity of the choices healthcare providers make for their patients."
Aetna said Tuesday it will buy healthcare information exchange technology company Medicity for $500 million.
Headquartered in Salt Lake City, UT, Medicity specializes in securing health information systems and identifying quality and efficiency issues in care delivery. Aetna said it will finance the deal with "available resources," and that the deal will be neutral to Hartford, CT-based health insurer's financial results in 2011.
Medicity will operate as a separate business within Aetna, under its existing leadership.
"This acquisition will enable Aetna to offer a set of convenient, easy-to-access technology solutions for physicians, hospitals and other healthcare providers. That, in turn, can help improve the quality and efficiency of patient care," said Mark T. Bertolini, Aetna CEO/president. "Strategically, we believe this acquisition will enhance Aetna's capabilities and accelerate our growth in the health information technology and health information exchange space."
Medicity said its HIT products and services are used by more than 760 hospitals, 125,000 physicians and 250,000 end users.
"We are excited about joining Aetna, with the shared vision for improving the healthcare experience for all stakeholders," said James K. Lassetter, MD, Medicity chairman/CEO. "The combination of Medicity's connected healthcare platform for providers with the clinical decision support capabilities of Aetna's ActiveHealth Management subsidiary can help physicians make better decisions in real-time as they collaborate and coordinate care."
Tony West left a thriving private law practice to return to the Department of Justice as a political appointee when President Obama took office in 2009. Over the last year and half, the department has recovered more than $4 billion lost to healthcare fraud. [Sponsored by Emdeon]
