"If we have the same objective, we can find the common ground necessary to get there."
In our annual HealthLeaders 20, we profile individuals who are changing healthcare for the better. Some are longtime industry fixtures; others would clearly be considered outsiders. Some are revered; others would not win many popularity contests. All of them are playing a crucial role in making the healthcare industry better. This is Jim Douglas' story.
Anyone who watched the deeply partisan, mean-spirited wrangling in Washington, DC, this past year during the healthcare reform debate would not be faulted for believing that the American political system is dysfunctional.
To find a working, bipartisan, political system that focuses on practical results within budgetary constraints, leave the Beltway and look to the states. In striking contrast to Congress, Vermont provides a great example of what Republicans and Democrats can achieve in healthcare when they agree upon a common goal. And perhaps no one better embodies that bipartisan spirit in the Green Mountain State than long-serving Republican Gov. Jim Douglas.
A career politician who has held various roles in state politics for three decades, Douglas is serving the last of his eight years in office, having been elected and reelected four times as a fiscal conservative and social moderate Republican in a state with a national reputation as a quirky hotbed for progressive politics.
In 2003, shortly after taking office, Douglas launched the Blueprint for Health in Vermont, with an emphasis on preventing illness and complications, rather than responding to health emergencies. Working with Democratic majorities in both chambers, he signed a package of healthcare reforms in 2006 to expand access to coverage, improve quality, and contain costs.
"If we have the same objective, we can find the common ground necessary to get there," Douglas says of his work with Democrats. "We found ways to make the progress here in a bipartisan basis that we can all be proud of. There are always advocates who will want to do more or something different, and that is a dynamic of our system. But the commonality of the interests in serving the people of Vermont and working toward a healthier population has allowed us to find that common ground."
Vermont's healthcare successes have not gone unnoticed. For the past three years, Vermont has been ranked the nation's No. 1 healthiest state by the United Health Foundation, the American Public Health Association, and Partnership for Prevention. The state ranked among the Top 10 states in 11 of 22 measures, including second-highest level of funding for public health, and ninth-lowest percentage of people without health insurance.
In March, Douglas was awarded the 2010 Health Quality Award from the National Committee for Quality Assurance for his work to improve Vermont's healthcare system through a focus on chronic disease prevention and management resources. Douglas, who was chairman of the National Governors Association during the healthcare reform debates this year, says the nation's governors share similar experiences, regardless of party affiliation.
"We have to deliver. We don't have the luxury of talking about things and letting deadlines pass. We have to balance budgets. Governors have to live within their limited resources, make tough decisions on a daily basis," Douglas says. "I spoke with a colleague—who I won't identify—who served in both the U.S. Senate and as a governor and he said the difference was striking. He said the Senate was a debating society where you talk about things and don't have to make a practical decision, whereas an executive has to make things happen and happen on time."
In this most recent election season that ended last month, the partisan gridlock and charred-earth tactics that has crippled Washington for years crept into a number of hotly contested state campaigns. Douglas, who will retire from state government at the end of his term, says he hopes the days of the moderate, consensus-building politician are not numbered.
"The American people like moderation. I don't think Americans are extremists at one end of the spectrum or the other. They want someone who is practical, gets the job done, who makes the trains run on time. On balance, it is going to be people who are more centrist who ultimately accomplish that," he says. "I hope I am not a breed that is dying. I think that is where most Americans are. Ultimately, it's not ideology. It's putting food on the family table that guides decisions and priorities of the people in our country."
“We have been able to bring back in the last year-and-a-half over $4 billion lost to healthcare fraud.”
In our annual HealthLeaders 20, we profile individuals who are changing healthcare for the better. Some are longtime industry fixtures; others would clearly be considered outsiders. Some are revered; others would not win many popularity contests. All of them are playing a crucial role in making the healthcare industry better. This is Tony West's story.
The settlement this year with Nashville-based FORBA Holdings LLC was far from the biggest fraud case that the Department of Justice has prosecuted.
But for Tony West, assistant attorney general for DOJ's civil division, the satisfaction he got with that dental management company case represents a big reason he left a thriving private law practice to return to the Department of Justice as a political appointee when President Obama took office in 2009.
"We found through our investigation not only were they cheating Medicaid, the way they were cheating Medicaid was by performing unnecessary procedures and surgeries on kids," West said. "They were pulling healthy teeth. They were giving kids unnecessary root canals; some really horrific things. We went after that company. Not only did we settle for a large amount of money, $24 million, but we also obtained the company's cooperation in our ongoing investigation of individual dentists."
It's hard to put a finger on the cost of Medicare and Medicaid fraud. Daniel R. Levinson, Inspector General at the Department of Health & Human Services, estimated for Congress this year that 7.8% of Medicare fee for service claims paid in 2009—roughly $24.1 billion—did not meet program requirements, although he stressed that the improper payments did not necessarily involve fraud.
A program as big as Medicare is ripe for fraud, which can take many forms. It could be a bogus durable medical equipment shop that's actually a post office box in Miami or Detroit. It could be a hospital using indigents to bill Medicare for unneeded services. It could be a multinational pharmaceutical company illegally marketing its medications for off-label uses not recognized by the Food and Drug Administration.
Regardless of the exact dollar amount, West concedes that fraud is a huge problem for Medicare and Medicaid, both in terms of lost money, and the corrosive effect on public confidence.
"It's been very damaging. Some people view Medicare fraud as a victimless crime because you don’t see it in the same way you would see street crime. But it really does damage the integrity of our public healthcare programs, which so many Americans depend upon for their care," West says.
"We lose so much of our hard-earned taxpayer dollars because of fraud. We have been able to bring back in the last year-and-a-half over $4 billion lost to healthcare fraud. While there is more than that that is being lost to fraud, it does represent an increase because we have been so aggressive cracking down on it."
In May 2009, HHS and DOJ joined forces to create HEAT, the Healthcare Fraud Prevention and Enforcement Action Team, and West says it's working.
"Every year, we have seen an increase in our ability to bring back taxpayer dollars lost to fraud," he said. "The cases do have a deterrent effect. If you look at the criminal side, you've seen an increase in our healthcare strike forces that we have set up around the country. We have seen an increase in the number of criminal defendants that have been arrested and are going to trial and are being held accountable."
West acknowledges that the crackdown on Medicare and Medicaid fraud is also highly symbolic now, as the Obama Administration begins implementing the complex healthcare reforms.
"When you look at the Medicare/Medicaid system, you are talking about trillions of dollars. It is just immense. The millions of Americans that rely on those two programs and the lives they touch is very far reaching and wide ranging," he says. "The fact that we can not only do the job of administering those two programs that help so many Americans, but at the same time crack down on waste fraud and abuse where we see it, and really step up the number of individuals and companies that we hold accountable for healthcare fraud is a testament to the work we have been doing over the past two years."
"The simulator we can control. If it becomes too much, we can tone it down, make it literally a walk in the park if we need to."
In our annual HealthLeaders 20, we profile individuals who are changing healthcare for the better. Some are longtime industry fixtures; others would clearly be considered outsiders. Some are revered; others would not win many popularity contests. All of them are playing a crucial role in making the healthcare industry better. This is Robert Neil McLay's story.
Public opinion polls show that the war in Afghanistan and the fragile peace in Iraq have fallen far down the list of concerns for most Americans, replaced by the economy and jobs, the federal budget deficit and spending, healthcare, and even immigration.
But there remains a dedicated group of medical professionals within the military that has not forgotten the wars, and the horrific impact they can have on the bodies and minds of the people who fight; nor have they forgotten the moral obligation this nation has to help these wounded warriors.
While it's hard to feel comfortable about medical advances that owe their development to the violence of war, that should not detract from the valiant work of people like U.S. Navy Reserve Commander Robert Neil McLay, MD, PhD, a psychiatrist and the research director in the Mental Health Directorate at Naval Medical Center San Diego.
McLay's field of expertise involves post traumatic stress disorder and the effects of combat-induced stress on the brain. He is a pioneer in the use of computer-based virtual reality simulators for treating PTSD. His treatment regimens, which include traditional therapy and consultation, have enjoyed success rates of up to 75%, even for patients with a history of treatment resistance.
"We see all types. PTSD can happen to just about anyone," says McLay, who spent seven months in Iraq in 2008. "We see the full range of people who had difficulties before they went and the trauma just made them worse, to at the other end of the spectrum, some Special Forces supermen who had never had any problems in their lives, who had always been the absolute best at anything they had ever done, and are now struggling with the very idea that, 'Hey! Why did this bother me?'"
Simulators create a variety of scenes with varying intensity. A routine patrol on a Fallujah street can be dialed up into a bloody firefight, if the patient is ready for it.
"The first time they tell that story is often the hardest part of therapy. The simulator we can control. If it becomes too much, we can tone it down, make it literally a walk in the park if we need to," McLay says. "But just coming forward and deciding to face your own demons, that can be tough for people. That is one reason why we introduced the simulator. It is to try to be able to put it slightly more in control between the doctor and the patient, and introduce people to it a little gradually."
Much of the thought behind the simulators comes from the older forms of exposure therapy that were developed decades ago, and which are based on the idea that fear naturally burns itself out.
"It is physiologically difficult to maintain an amped up state for long periods of time, which definitely happens in PTSD," McLay says. "If you actually really are under threat repeatedly, the system will stay ramped up. The brain stem?what keeps the physiology amped up?learns from the upper brain, the part that thinks. We learn to be afraid of what we avoid. Our brain stem learns that 'This really is a dangerous situation and I need to back away from it.' And when you are backing away from something that is inside your own head, we can't do that effectively."
The simulator allows patients to address their fears, to relive the source of anxiety and see that they no longer have to fear for their safety. "Your brain stem learns, 'Maybe I can be safe. If something reminds me about the trauma, I'm not going to be hurt this time around,'" McLay says.
Even with the simulator, and the new advances in therapy and medication, McLay says a big stumbling block remains the negative perceptions of mental illness, despite the military's efforts to remove the stigma. "We deal with some amazing people who have gone through some very difficult things, in some cases quite horrific things. The hardest step for most folks is coming forward and saying, 'I am going to talk about this,'" McLay says. "If you can get over that hurdle, it doesn?t mean the rest is easy but it does show the person has shown a certain amount of motivation and has overcome a huge hurdle just by coming in."
As much as he is an advocate for simulators, McLay also remains a healthy skeptic.
"It works but I'm not convinced it?s the best thing out there," he says. "I'm not absolutely convinced yet that the gizmo portion of it—the actual virtual reality—is the active component of treatment. It may be just meeting with the therapist as often as we are and providing the type of therapy that we are."
That's the question that McLay and his colleagues at NMCSD are now trying to answer. "Do you really need all these gizmos or can you do it with a still computer image without using the fancy simulators?" he says. "If you could, that might be good news. It would mean we were able to do this type of treatment in a lot more different clinics and with a lot more people."
"In the face of such a huge and overwhelming tragedy I saw people who really acted in a decent manner."
In our annual HealthLeaders 20, we profile individuals who are changing healthcare for the better. Some are longtime industry fixtures; others would clearly be considered outsiders. Some are revered; others would not win many popularity contests. All of them are playing a crucial role in making the healthcare industry better. This is John Brebbia's story.
For trauma surgeon John Brebbia, MD, volunteer work in Haiti after the Jan. 12 earthquake was inspired by the memory of a fallen colleague, as much as it was by the knowledge that the practical expertise and care he could provide was desperately needed in the stricken island nation.
"I had a good friend who really would do this kind of thing on a fairly regular basis. That included him joining the military to be a doctor in Iraq," Brebbia says of U.S. Army Maj. John P. Pryor, MD. "Unfortunately, John was killed by a mortar on Christmas Day 2008. I know that if he had still been alive he would have gone to Haiti. Since he was not alive, that space was not filled. I know he would have been on me to go, go, go, and as a tribute to him I went."
Brebbia, of Dover, DE, became one of the thousands of healthcare professionals who travelled to Haiti in the days immediately after the quake.
The United Nations estimates that between 250,000 and 300,000 people were killed by the 7.0 magnitude temblor, although no firm number has been established. Hundreds of thousands more suffered from traumatic injuries as well as illnesses resulting from the ensuing breakdown in public sanitation.
Brebbia was part of a 22-member team of healthcare professionals affiliated with Christiana Care and Bay Health Medical Center in Delaware that travelled to the flattened hillside city of Jacmel, 90 miles south of Port au Prince, eight days after the quake.
"It is an unbelievable, overwhelming sight. You can see the pictures but you cannot even fathom it until you are standing there looking at it," Brebbia says. "Jacmel is built on a hillside. You stand at the foot of the hill and everything is in rubble and there are people living in the streets. More than one person, when they stood there and looked at it, cried because of what they saw."
Soon enough, however, the needs on the ground overtook the shock as the team scurried to provide care in the ruins. "There was one building we thought we were going to use the first day we got there. When we came back the next day to set it up, it had come down in one of the aftershocks," Brebbia says.
With all of the hospitals either flattened or wobbling and unsafe, Brebbia and his colleagues got tents, diesel fuel, and other critical supplies from members of the Canadian army—who also commandeered a generator from the office of a reluctant hospital administrator—and began work. "I would say we worked between 16 and 20 hours a day depending upon the day," Brebbia says, adding that he performed about 30 operations requiring anesthesia during his eight-day mission, and treated hundreds of other patients for wounds and ailments.
As expected, the surgeries for Brebbia often involved amputations of limbs crushed in the falling debris. "Probably the worst one I saw was a 3-year-old whose leg I had to take off. Her leg was totally crushed just above the ankle. I took it off just below the knee," he said. For many of the amputations, Brebbia used an old-fashioned gigli saw because the rescue team wasn't sure if they'd have access to electrical power. With the generator, Brebbia's team powered an autoclave plucked from the rubble of a hospital. "Initially we thought we were gong to have to use and throw away, but the Canadian Army really helped us," he says.
Even with the tremendous sense of mission for the work at hand, Brebbia says the trip was fraught with "huge frustrations."
"Things could have been done better. When we first arrived in Jacmel the mayor said none of us could work because he couldn't verify who we were. They didn't have a plan to verify who we were and they weren't going to let us work," Brebbia says.
Fortunately, a member of the Delaware rescue team was a Jacmel native who had been instrumental in planning the mission. "She got on the mayor pretty good to the point where he just said, 'I will take her word that you are all OK,'" Brebbia says. "Then we went to the hospital and the administrator didn't want us working in his hospital, which was a pile of rubble. There were tents outside. Well, not even tents. They were tarps over trees and patients under the tarps in the open air. The nurses were family members. If you didn't have a family member, you didn't have a nurse."
Fortunately, the Canadian army did a remarkable job maintaining order. "We would call them and say we need diesel fuel and 10 minutes later there is a 40 gallon drum of diesel fuel," he says.
The Canadians also handed out food, tents, and clothing on a massive scale to all parts of the city. "It prevented the people there from becoming unhappy, disgruntled, and dangerous," Brebbia says. "In Port au Prince we saw people killing each other for food. In Southern Haiti that didn't happen because of the way and the speed that the Canadians dispersed the aid was so great that people where having their basic needs met. We never felt threatened. We never felt unsafe."
Now back in Delaware, Brebbia thinks often of Haiti and the huge obstacles the nation still faces as it struggles to recover.
The time he spent there has changed him. "It's impossible not to," he says. And despite witnessing some decidedly dire images, he saw much good that stay with him. "Personally speaking, I saw hundreds of people whose lives were devastated—parents who lost little kids and who despite that were able to treat their neighbor better, or they took in kids who didn't have parents."
"In the face of such a huge and overwhelming tragedy I saw people who really acted in a decent manner. It does make you at least want to try to treat your neighbors better," he says. "Because if these people can do it in the face of that, why can't we do it every day?"
Private, not-for-profit WakeMed Health & Hospitals has asked to look at the public records of rival UNC Health Care and Rex Healthcare to determine if public money was used by either of the state-owned entities to duplicate and shift services to gain an unfair competitive edge.
"WakeMed made the request due to numerous recent transactions by UNC Health Care which have raised serious public-policy questions," said Bill Atkinson, MD, president/CEO of Raleigh-based WakeMed, after the health system's board unanimously voted Monday to make request the records.
"Specifically, the records request is to determine if UNC Health Care and Rex Healthcare are improperly using taxpayer dollars to compete with WakeMed and other healthcare institutions by investing in physician practices and other facilities," Atkinson said.
WakeMed alleges that UNC Health Care and Rex have taken "predatory actions" in Wake County that include recruiting doctors away from WakeMed.
In remarks related to the records request, Dr. Bill Roper, CEO of UNC Health Care said Monday, "our guiding philosophy has been to partner with the best physicians in a community, and to help ensure that we get patients to the right care at the right time. In particular, this means that if the needed care can be provided locally, it should be provided locally, by our partner physicians. Certainly we want to be available at UNC for Wake County patients, as we are to all of the people of North Carolina, for tertiary or quaternary medical care. But we have no intention of siphoning patients.
"We believe that leaders of our state—including the General Assembly, the governor and the leadership of the university system and UNC Health Care—need to carefully consider whether public money should be used to compete with a strong system like WakeMed, which plays a critical role in providing vital healthcare services to Wake County and the entire state," WakeMed's Atkinson said. "While competition is healthy, these recent actions are not enhancing access or adding new physicians to meet demand, but are instead shifting and duplicating existing services, which is not good for the community."
Atkinson said the moves by UNC and Rex appear to be financed with public money at a time when the state of North Carolina is looking at drastic steps to balance the budget, including teacher layoffs, closing of state parks, eliminating 2,000 positions from the University of North Carolina System, and cutting healthcare.
WakeMed's records request to UNC Health Care asks for "all records constituting or reflecting correspondence or communications, other than correspondence or communications relating to identifiable patients" between UNC Health Care, Rex Healthcare, certain officials at UNC Health Care and subsidiary organizations with members of WakeMed's medical staff.
WakeMed also requested "audited financial statements" and other records related to UNC Health Care, Rex Healthcare, Rex Physicians LLC, and Triangle Physician Network, including 990 IRS forms from the named organizations.
WakeMed said it hopes the records will determine the legal status of Rex Healthcare, which is described as a private institution owned by UNC. WakeMed claims that Rex does not provide its fair share of indigent and charity care.
WakeMed, an 870-bed health system, said it has historically provided more than 80% of all charity care in Wake County, yet receives no state or county funding other than limited payments from Medicare and Medicaid.
More than a third of the prescription drugs paid for by Medicaid in 2008 were not on a list of approved drugs in National Drug Code Directory and may have accounted for $6.2 billion of the $24 billion that Medicaid spent on prescription drugs that year, according to an audit by the Department of Health and Human Services' Office of Inspector General.
In all, Medicaid paid for prescription drugs associated with 27,143 NDC listings, for which only 62%— 16,945—had an approved application number listed with the NDC Directory, the OIG has found.
The Food and Drug Administration maintains the NDC Directory, which contains the name, a numeric drug identifier, and the approved application number for each listed drug. Drugs must be FDA approved to qualify for Medicaid payments. In 2008, Congress raised concerns that Medicaid pays for drugs that do not meet this criterion and lawmakers asked OIG examine the FDA approval status of drugs paid for by Medicaid. Previous OIG reports found problems with the accuracy and completeness of FDA's NDC Directory, OIG reports.
Federal auditors examined 2008 Medicaid utilization data for prescription drugs, approval and listing data from FDA, and a targeted manual review to determine the FDA approval status of drugs paid for by Medicaid. The OIG audit found that there was no approved application number in FDA's NDC Directory for thousands of drugs paid for by Medicaid.
"Twelve percent of NDCs under review were listed in the NDC Directory but did not have an approved application number, and an additional 26% were not listed in the NDC Directory at all. As a result, Medicaid could potentially pay for drugs that are not approved by FDA. Without accurate approval and listing information, it is impossible to determine whether these drugs were paid for appropriately," OIG reported.
OIG recommended that the FDA conduct frequent reviews of the NDC Directory to ensure its accuracy and thoroughness, and work with the Centers for Medicare & Medicaid Services and Congress to create legislative or regulatory changes that force drug makers to list all approved products with FDA before they're eligible for Medicaid payments.
In its formal response to the audit, FDA said it generally agreed with the OIG's recommendations, and had already begun implementing several initiatives to evaluate and enhance the quality of drug listing data.
There are few things in our professional lives that provide a greater risk of peril with so few rewards than the annual office holiday party. To many workers, these contrived and tortuously staged attempts at mandatory good cheer are as welcomed as a holiday fruit cake.
Bah! I say get rid of them.
The justifications for the holiday party usually include a sincere expression of appreciation for employees' hard work throughout the year, or providing an opportunity for employees who rarely have contact with one another to meet in a "casual" environment. A closer look reveals flawed thinking. If the office holiday party is your way of telling employees you appreciate their hard work or your strategy for employee bonding, you've probably already failed.
Let's be honest, for many companies, the annual office holiday party is just another business function, wearing a party dress and sipping eggnog. Attendance usually is not mandatory, but miss it at your peril! And it's a little arrogant for supervisors to presume that employees want to spend time socializing with them.
I came across this soul-crushing list of office party "Dos & Don'ts" from Quintessential Careers, an HR consulting firm whose other titles include Surviving the Office Holiday Party. QC reminds us: "You can take advantage of the office party to have some fun and advance your career or misbehave and cripple your career."
Quintessential's tips include:
Do remember that although office parties are intended as social events to reward employees and raise morale, they remain strictly business events.
Do act as though your behavior is being observed every minute (because it probably is).
Don't pass up the invitation to an office party; not attending could hurt your reputation. And when you attend, do spend at least 30 minutes at the party for appearances. But don't overstay your welcome by partying until the wee hours.
Do conduct yourself professionally at all times. Don't use the office party as an excuse to blow off steam. It's still a company function, so proper etiquette and decorum matter.
Don't bring the party lampshade, gag gifts for the boss, or any other crazy stuff you might do at a personal holiday party.
Do enjoy yourself at the party. Employers spend the big bucks to reward their employees, so be sure to enjoy the one holiday gifts you may be getting from the company.
That's right drones. "Enjoy" yourself! Not too much, though. Someone is watching, and one wrong move could cost you your career!
Let me be clear: I'm not criticizing Quintessential Careers. Sadly, they are exactly right. Their recommendations make sense, and that is exactly the problem. What they're describing isn't a party. It's a wake. I'd rather stay home and do my taxes.
I last had a good time at an office party back in college, when I attended the annual gala for the buildings and grounds crew, the guys who plow snow, mow lawns, and buffalo heavy furniture for minimum wage. After a few too many, one of guys committed about 25 or so office party "don'ts," which culminated in a threat to "put the knuckles" to his immediate supervisor and an attempt to throw an empty beer keg at a coworker's car. Now that's an office party!
You might not want to take it to that extreme, but if your holiday party comes with a tacit list of do's and don'ts that is longer than the healthcare reform bill, maybe you should look for another way to express your appreciation.
Here's a suggestion: pay employees for the two or so hours that they'd otherwise have spent at the party, divvy up and give them the money you'd budgeted for the party, tell them to spend the time and the money with whomever and on whatever they want, and wish them Happy Holidays.
Advocate Good Samaritan Hospital in Downers Grove, IL, has won the U.S. Commerce Department's prestigious 2010 Malcolm Baldrige National Quality Award, the nation's highest honor for performance excellence through innovation, improvement, and leadership.
And, for the first time, Studer Group, a healthcare consulting firm in Gulf Breeze, FL, was one of three small businesses selected for the 2010 honor, which also was awarded to seven organizations for only the second time in its 23-year history.
The 2010 Baldrige Award recipients are:
Advocate Good Samaritan Hospital, Downers Grove, IL (healthcare)
Studer Group, Gulf Breeze, FL (small business)
Freese and Nichols Inc., Fort Worth, TX (small business)
K&N Management, Austin, TX (small business)
MEDRAD, Warrendale, PA. (manufacturing)
Nestle Purina PetCare Co., St. Louis, MO (manufacturing)
Montgomery County Public Schools, Rockville, MD (education)
"Today we honor the country's most innovative organizations and the people who make them great," said Commerce Secretary Gary Locke. "This year's recipients of the Malcolm Baldrige National Quality Award embody the ingenuity and creativity that characterizes the American spirit and drives America forward. Innovation is at the heart of U.S. job creation, competitiveness and global strength, and the accomplishments of these outstanding leaders are an inspiration to us all."
"This award is unique in that it honors the collective effort of an entire organization that has systematically strived to achieve excellence in all aspects of its work. Today's honorees demonstrate how teamwork and a shared vision can lead not only to organizational success but also to nationwide advancements in innovation and economic competitiveness," Locke said.
The winners were picked from 83 applicants, all of whom were evaluated by an independent board of examiners in seven areas: leadership; strategic planning; customer focus; measurement, analysis and knowledge management; workforce focus; process management; and results. The evaluations for each recipient included about 1,000 hours of review and an on-site visit by examiners to clarify questions and verify information in the applications.
The award is named after Malcolm Baldrige, the 26th Secretary of Commerce, and was established by Congress in 1987 to foster competitiveness and performance of U.S. businesses. Originally, three types of organizations were eligible: manufacturers, service companies and small businesses. Congress expanded the program in 1999 to include education and healthcare, and again in 2007 to include nonprofit organizations. Since 1988, 86 organizations have won Baldrige Awards.
The Baldrige Performance Excellence Program is managed by the Commerce Department's National Institute of Standards and Technology in conjunction with the private sector.
St. Joseph's Heartland Health of St. Joseph, MO won the 2009 Baldrige award, in part because of process improvement implementation techniques that helped it reduce waste, costs, and errors.
MEDRAD, a medical device maker, also won the Baldrige Award for manufacturing in 2003.
Walter Janke, MD, his wife Lalita, owners of Vero Beach, FL-based Medical Resources LLC, will pay $22.6 million to resolve allegations that they filed false diagnostic codes to inflate Medicare reimbursements, the Justice Department has announced.
The Jankes were the owners of America's Health Choice Medical Plans Inc., a Medicare Advantage Organization, for Medicare beneficiaries. The Jankes also owned Medical Resources, AHC's primary care provider. AHC and MR are now defunct.
The agreement resolves a lawsuit brought by DOJ alleging that the Jankes and MR violated the False Claims Act by causing AHC to falsely increase the severity of diagnoses to get higher Medicare payments.
A federal district court judge in Miami also froze approximately $20 million of the Janke's assets believed to have been generated by the unlawful scheme. The assets and money from the dissolution of AHC are being held in receivership by the Florida Department of Financial Services, and will be used to pay the settlement.
"Patients seeking healthcare should be able to rely on the diagnoses they are given," said Tony West, Assistant Attorney General for the Justice Department's Civil Division. "We will aggressively pursue those who falsify medical diagnoses in order to receive taxpayer funds to which they are not entitled."
More than one in 10 family physicians may close their offices if Medicare slashes payments next year, according to an online survey of American Academy of Family Physicians members who have an ownership stake in their medical practices.
The survey asked family physicians in September about the impact of a pending 23% Medicare pay cut that was scheduled to take effect December 1, but which was subsequently delayed until January 1 by Congress. Nearly 13% of survey's 516 responding physicians said they would consider no longer seeing patients if Congress failed to override the mandatory pay cuts that will deepen to 25% in the coming months.
"This survey demonstrates the serious threat to Americans' access to healthcare that is posed by the current formula for paying physicians to care for the elderly and disabled," said Roland Goertz, MD, president of the American Academy of Family Physicians. "You can imagine how many more physicians will be forced to close their doors if a 25% or even bigger pay cut goes into effect next year. If you ran a business and knew that up to 30% of your customers were going to reduce your payment by 25% or more, what would your business do?"
AAFP membership data show that Medicare patients comprise as much as 30% of family physicians' patient population. More than one in four patients in rural family physician practices areas depends on Medicare for coverage.
The 2010 survey found that among family physicians who maintain their practices, 62% said they may be forced to stop accepting new Medicare patients, and 73% said they would have to limit the number of Medicare appointments because of the reimbursement cuts.
Goertz said that the impact of the cuts will likely be felt most by elderly and disabled Americans who depend on Medicare, and for military families enrolled in TRICARE. He said to an Oct. 13 AARP survey that showed 81% of AARP members who receive Medicare and 86% of members not yet eligible for Medicare are concerned about the impact of the Medicare physician pay cut on their access to a doctor.
Family physicians are the primary source of medical care for 60% of people age 65 and older who report having an individual health professional as their usual source of care. Elderly and disabled Americans in rural and underserved areas, where family physicians often are the only healthcare professionals in town, would be particularly hard-hit, Goertz said.
"We have reached a point where all patients—children, their parents and their grandparents—face the real prospect of losing their doctors," said Goertz. "Medicare—the program designed to ensure that our elderly have access to health care—could force the very doctors who care for them out of business. And if that happens, all patients in that community—regardless of their insurance coverage—would lose access to needed healthcare."
