Stroke patients admitted to the hospital on weekends are slightly more likely to die compared to stroke patients admitted on weekdays, regardless of the severity of the stroke, according to a Canadian study published by the American Academy of Neurology.
"We wanted to test whether the severity of strokes on weekends compared to weekdays would account for lower survival rates on the weekends," says Moira K. Kapral, MD, of the University of Toronto in Ontario. Kapral was with the Institute for Clinical Evaluative Sciences in Ontario when the research was done. "Our results suggest that stroke severity is not necessarily the reason for this discrepancy."
Researchers analyzed five years of data from the Canadian Stroke Network on 20,657 patients with acute stroke from 11 stroke centers in Ontario. Only the first stroke a person experienced was included in the study. The study was published in the Nov. 2 issue of Neurology, the medical journal of the AAN.
People with moderate to severe stroke were just as likely to be admitted to the hospital on weekends and weekdays, but those with mild stroke were less likely to be admitted on weekends in the study. Those who were seen on weekends were slightly older, more likely to be taken by ambulance and experienced a shorter time from the onset of stroke symptoms to hospital arrival on average, the study shows.
Seven days after a stroke, people seen on weekends had an 8.1% risk of dying compared to a 7% risk of dying for those seen on weekdays. The results stayed the same regardless of age, gender, stroke severity, other medical conditions and the use of blood clot-busting medications. "Stroke is not the only condition in which lower survival rates have been linked for people admitted to hospitals on the weekends. The reason for the differences in rates could be due to hospital staffing, limited access to specialists and procedures done outside of regular hours," Kapral says. "More research needs to be done on why the rates are different so that stroke victims can have the best possible chance of surviving."
The study found no differences in the quality of stroke care, including brain scans and admission time, between weekends and weekdays.
Online ads for healthcare practitioners and technical workers rose by 26,800 listings to 543,100 in October, posting the largest increase of any job sector for the month, and breaking three consecutive months of declines. Vacancies continue to outnumber skilled healthcare job seekers by more than 2 to 1, a report shows.
The Conference Board's Help Wanted Online Data Series, which tracks more than 1,000 online job boards across the United States, attributed the uptick to increases in advertised vacancies for registered nurses and occupational and physical therapists.
Healthcare support vacancy listings also reversed a three-month decline and saw an increase of 7,800 listings to 111,600, primarily reflecting an increase in demand for occupational and physical therapist assistants. However, there were 2.3 unemployed people for every advertised vacancy in healthcare support, The Conference Board reports.
The average wage advertised for healthcare practitioners and technical workers was $33.51 an hour, and the average wage for healthcare support occupations was $12.84 an hour, the report says.
The U.S. Bureau of Labor Statistics, which will release on Friday its employment statistics for October, has shown that the healthcare sector is one of the few areas in the economy that has seen monthly job growth throughout the recession, although that growth has slowed considerably since 2009.
In the overall economy, online advertised vacancies rose 113,700 in October to 4,409,800, following an increase of 59,900 in September, with 40 of 50 states reporting increases in online job postings, The Conference Board reports.
The nation’s supply/demand rate stood at 3.44 unemployed for every advertised vacancy in September (the last available unemployment data), down from a peak of 4.73 in October 2009. Nationally, there are 10.5 million more unemployed than advertised vacancies, The Conference Board reports.
"In this slow economic recovery, the October rise is welcome news that the trend in labor demand continues to move in a positive direction, albeit at a very moderate pace," said June Shelp, vice president at The Conference Board. "The October increase reflected a moderate rise in a range of occupations and geographically across the nation. The slow but steady upward trend of the last seven months points to modest growth in employment through the end of 2010."
Shelp said online job postings across all sectors of the economy have increased by 1 million advertised vacancies since the end of the recession in June 2009. "Following the rapid HWOL rises in labor demand in the 4th quarter 2009 and 1st quarter 2010, labor demand has now settled into more modest growth, pointing to a moderate growth in employment through the end of 2010," she said.
In addition to the high demand for healthcare practitioners and technical workers, The Conference Board also reported high demand for management workers, and computer and mathematical science.
St. David's HealthCare on Monday finalized its $83.8 million purchase of Heart Hospital of Austin.
"St. David's HealthCare has completed the necessary steps required to move forward with its purchase of Heart Hospital of Austin," Jon M. Foster, president/CEO of St. David's, said in a media release. "Heart Hospital of Austin has demonstrated that it is one of the top providers of cardiovascular care in the state and nation, and we believe this is a logical extension of St. David's HealthCare's long-standing tradition of excellence in this field."
HHA's cardiac services and includes a 24-hour full-service emergency center. HHA President/CEO David Laird, called the acquisition by St. David's "a perfect fit for our organization."
St. David's purchased the 58-bed HHA from MedCath Corp.—the former manager and majority owner based in Charlotte, NC—for $83.8 million. HHA will maintain its current leadership, including Laird, but its staff of about 400 medical, technical and support workers will become employees of St. David's.
Six-hospital St. David's is one of the largest health systems in Texas, and is the fifth-largest private employer in Austin with more than 6,700 employees.
Healthcare information technology giant McKesson Corp. has announced it is scheduled buy US Oncology in a cash deal valued at more than $2.1 billion.
The transaction, which is expected to be finalized by the end of the year, includes the purchase of all outstanding shares of US Oncology, and the assumption of all of the company's outstanding debts.
McKesson, ranked 14th on the FORTUNE 500, said the acquisition of US Oncology will provide oncology customers access to:
Evidence-based medicine that improves clinical outcomes and enables value-based reimbursement;
Expanded clinical expertise and research, and personalized medicine offerings;
Integrated, efficiency-enabling HIT to improve outcomes measurements, reporting, and product and inventory management;
Practice-management consultation for independent specialists;
Distribution and supply-chain expertise.
"This strategic acquisition is a logical next step in our commitment to ensure the continued vitality of community oncology, while creating value for our shareholders," said John H. Hammergren, chairman/CEO of McKesson. "The combination of US Oncology and McKesson will enhance our ability to achieve these goals in one of the most important segments in healthcare. Community oncology practices need strategic support that offers not only technology and distribution solutions, but also value-added clinical and reimbursement management services that enable them to provide the highest-quality, most efficient care to their patients. With this acquisition, McKesson will offer a compelling suite of services and solutions to community oncologists and other partners in the rapidly evolving specialty business.?
The combined McKesson Specialty Care Solutions business will be led by Bruce Broussard, Chairman/CEO of US Oncology, and will be headquartered in The Woodlands, with operations in San Francisco and throughout the country. Broussard will report to Paul Julian, executive vice president and group president, McKesson Corp. McKesson will continue to operate the United Network of US Oncology, including US Oncology’s Comprehensive Strategic Alliance, US Oncology Research, and other services under the US Oncology brand name.
"With the healthcare marketplace moving rapidly toward reimbursement based on quality and cost-effectiveness, our physician customers need access to deep clinical, operational and information technology capabilities to create integrated networks that continually enhance the quality of care in a cost-efficient manner," Broussard said. "In joining McKesson, we are building the scale and expertise necessary to empower our customer base to shape the future of healthcare."
Serving about 3,000 physician customers, the unified company is expected to accelerate investments in integrated systems that improve processes and outcomes for the delivery of more efficient care.
"The addition of US Oncology’s physician-centric business model and clinical expertise to the McKesson portfolio advances our strategy and significantly strengthens our offering for community oncology and other partners in the specialty segment," Julian said. "McKesson and US Oncology's businesses are highly complementary, providing our collective customers access to more services and solutions that will enhance their ability to deliver advanced cancer care."
Cynthia Barraca Palomata, RN, died last week after she was attacked and struck in the head with a lamp by a prisoner she was treating at the Martinez Detention Facility in Contra Costa County, CA.
Palomata was a veteran nurse who'd worked in San Francisco-area hospitals for more than 20 years. She joined Contra Costa Health Services in 2005 and had worked in the Martinez Detention Facility since then.
"She was a well respected member of our nursing staff and our hearts go out to her
family during this incredibly difficult time," says William Walker, MD, director of Contra Costa Health Services. "Staff safety is the highest priority and we continue to work closely with the Sheriff's Office to evaluate safety procedures."
Palomata was attacked in the intake area of the jail by a burglary suspect who police said had no previous history of violent behavior and who allegedly picked up the lamp and struck the nurse "without provocation or warning," even though sheriff's deputies were in the area. The inmate faces murder charges.
Regular HealthLeaders Media readers know we've touch upon the subject of workplace violence numerous times. The topic doesn't get old for us, because the incidents of violence won't go away. Bureau of Labor Statistics data for 2008—the latest figures available—show 2,890 work-related assaults at hospitals. That doesn't tell the whole story, because the data reflect only assaults that are serious enough to inflict injury and force the victim to miss at least one day of work. Other BLS data show that for every 10,000 hospital workers, there were eight workplace assaults that resulted in missed work days. By comparison, in the overall private sector, there were only 1.7workplace assaults resulting in missed work for every 10,000 workers. Last year, more than half of the 3,465 respondents to an Emergency Nurses Association online survey said they've been spit on, hit, pushed, shoved, scratched, or kicked while on the job.
The public is becoming aware of the issue, and they're getting angry, thanks to high-profile media reports of attacks like the one that killed Palomata. The publicity is a good thing. People need to know about the extent of the problem.
In the wake of Palomata's murder, there have been calls to re-examine enhanced criminal penalties for assaults against healthcare workers. California enacted a law in 1993 requiring hospitals to have a security plan in place for general acute-care hospitals, but the law did not cover prisons and jails. There is now a call to amend the law to include correctional facilities.
The California Nurses Association has weighed in too, and it's completely appropriate that they do. CNA represents the nurses at the Contra Costa Health Services, which contracts to provide inmate healthcare services. The union says its members had repeatedly called for stronger security measures, but that the health system has indicated it is not responsible for security at the detention center, and has ignored requests for security upgrades in the main hospital to include 24-hour guards, metal detectors and other security devices in the ER and psychiatric unit.
"We can no longer tolerate inadequate security measures which threaten not only RNs and other staff, but also put families and other patients at risk," said Kay McVay, RN, CAN's president emeritus, and a long-time resident of Contra Costa County.
CNA is correct to raise these concerns. So far, it's not clear what—if anything—could have been done to prevent Palomata's murder. Perhaps it was an isolated, tragic instance. However, there are just too many of these "isolated" incidents going on across the nation, and hospitals must be compelled to evaluate their security measures to ensure a safe workplace for their frontline healthcare workers.
Many will note that Palomata was killed in a jail, not a hospital. That point is irrelevant for Palomata's family and colleagues, however, and it should be for the rest of us as well. There shouldn't be a tacit lowering of standards for safety and security for healthcare providers depending upon where they practice their profession. Any hospital or health system that provides healthcare beyond the campus should make every effort to ensure that their employees are as safe there as they would be in the C suite.
"Prevention is essential for creating a safe and therapeutic environment for patients and a safer workplace for healthcare workers, and to reduce the loss of experienced staff who leave because of assaults and threats of violence," McVay said.
Ascension Health has announced plans to open a professional service center in Indianapolis, creating up to 500 new jobs by 2013.
The Ascension Health Ministry Service Center will provide support services in human resources, supply chain, finance, and accounting for the Catholic nonprofit health system's 70 acute care hospitals and more than 400 related facilities in 20 states and the District of Columbia. Ascension Health is finalizing a lease on an office building in northwestern Indianapolis that will house the new center, with a total investment in the facility of nearly $11 million.
"Bringing our capabilities together in one place to serve the national health ministry in vital support areas will allow us develop new capacity and expertise, lower our costs and improve our ability to serve overall," said Ascension Health's President/CEO Anthony Tersigni in a statement.
"Over the years," he said, "the Health Ministries of Ascension Health have demonstrated a willingness to innovate in ways that allow us to devote more resources to our Mission and service to our communities. We are very excited about the potential of this resource for our ministry, those we serve and for the community."
Based in St. Louis with 113,000 associates around the country, Ascension Health is the nation's largest Catholic nonprofit health system, and is already is a major employer in Indiana. St. Vincent Health, a 20-hospital system in Indiana that has more than 13,000 associates and 2,500 physicians, is a part of Ascension Health.
TriMedx, an Ascension Health subsidiary and healthcare equipment services company, also is headquartered in Indianapolis. In Evansville, St. Mary's Health System is a member of Ascension Health that employs 3,765, and the national system also operates an information services division in that city.
"The establishment of this new center is a key part of a larger transformational process under way within Ascension Health to standardize and synchronize systems, processes and data," said Robert Henkel, Ascension Health's president, healthcare operations/COO. "We're giving our Health Ministries new insights into their operations and enabling the sharing of best practices across our national health ministry. All of that contributes to better controlling healthcare costs."
Hiring for the center will begin in a few months, and the facility is expected to be operational in mid 2011.
The Indiana Economic Development Corporation offered Ascension Health up to $5 million in performance-based tax credits and up to $90,000 in training grants based on the company's job creation plans. Develop Indy and the City of Indianapolis offered Ascension Health infrastructure support and a training grant worth up to $300,000. Develop Indy will also support property tax abatement for Ascension Health before the Metropolitan Development Commission. Indy Partnership served as a project liaison, providing research and site selection support.
The quarterly costs to hospitals for growth in wages, salaries, and total compensation has steadily declined over the past decade and now is roughly the same as the wage, salary, and total compensation growth for all workers in the overall economy, U.S. Bureau of Labor Statistics data shows.
In the fourth quarter of 2001, BLS data shows that the cost increases to hospitals for wages and salary growth were 5.7% higher than they were in the fourth quarter of 2000. The cost of wages and salaries for all workers in the larger economy was 3.7% higher in the fourth quarter of 2001, than it was in the fourth quarter of 2000.
Since the fourth quarter of 2001, however, hospitals and the larger economy have seen the cost of growth in wages, salary and total compensation decline steadily. In the first three quarters of 2010, hospital wage and salary costs grew about 1.6%, when compared with the first three quarters in 2009, while wages and salary costs for all workers increased about 1.5% for the same period.
BLS does not provide a further breakdown of hospital wage and salary earners, who presumably could range from CEOs to environmental staff. Nor does BLS provide a monetary average or value to the cost growth data.
The growth in total compensation for hospital workers and all workers—which includes wages, salaries, health insurance, pension plans, 401(k) matches, and other perks—has followed a similar downward trend since the fourth quarter of 2001, according to BLS data.
Total compensation for employees cost hospitals 6% more in the fourth quarter of 2001 than it did in the fourth quarter of 2000, while total compensation costs for all workers in the larger economy was 4.2% higher in 2001, according to the BLS.
During the first three quarters of 2010, however, the growth of hospitals' total compensation costs for employees had slowed to 2.1% when compared with the first three quarters of 2009, and about 1.8% for all workers for the same three quarters.
The University of Michigan Health System and Physicians' Organization of Western Michigan have formed a new statewide group to help independent physicians improve access to resources, opportunities and support during the implementation of healthcare reform.
The new group—Physician Organization of Michigan—will recruit members from across the state when it becomes operational in January.
"We're very pleased to be able to expand and strengthen our abilities to support the independent practice of medicine through this relationship," says Randall Clark, MD, president of POM, an independent practice association which has 570 physician shareholders in western Michigan.
According to Ora Hirsch Pescovitz, MD, U-M executive vice president for medical affairs and CEO of UMHS, POM's aims to help independent physician members:
Improve and measure quality of the care
Monitor patients' health more effectively
Reduce or contain the growth of healthcare costs
Help physicians gain access to shared technology systems
Help patients receive primary care in their communities
Facilitate access to specialty care.
Access continuing medical education for physicians
"This concept of the right care, at the right place, and at the right time fits perfectly with our health system's goal of serving the entire state, by being available for any Michigander who needs the advanced care that U-M physicians provide," Hirsch Pescovitz, says.
UMHS includes a 1,600-member multispecialty physician group, with faculty from the U-M Medical School who practice at U-M hospitals and health centers, and at partner locations across the state. POM is the latest in a series of UMHS partnerships, which also includes the Pennant Health Alliance, a recently announced partnership among four western Michigan hospitals and UMHS.
POM members can become a "Colleague in Care," which gives them full access to a clinically integrated network of physicians with EHR, business and marketing support, and systems to track quality. In return, each Colleague in Care agrees to meet standards for ongoing education, care quality tracking and reporting, and other metrics.
"The vision is that POM will offer independent physicians and medical groups access to information technology and administrative and clinical services they need to meet the challenges of a rapidly changing environment without the need for employment by a large system," says David Spahlinger, MD, executive director of the U-M group practice and senior associate dean for clinical affairs at the U-M Medical School.
The Christ Hospital, which agreed in May to pay $108 million to resolve a whistleblower lawsuit alleging illegal kickbacks, signed a corporate integrity agreement with the federal government this week that allows the Cincinnati hospital to continue to participate in Medicare and other federal healthcare programs.
Daniel R. Levinson, Inspector General at the Department of Health and Human Services, said in a statement that the agreement resolves an investigation dating back more than one decade.
"This administrative case was resolved after the Office of Inspector General met directly with TCH's board of trustees. OIG has maintained throughout negotiations with TCH that independent monitoring was needed to oversee the hospital's compliance with Federal healthcare program requirements," Levinson said in a media release. "Once TCH's board of trustees met with OIG, we were able to successfully negotiate a CIA (corporate integrity agreement) and close the door on this multi-year investigation."
TCH was told in May that OIG was considering excluding the hospital because it rewarded cardiologists for referring patients to TCH in violation of the anti-kickback statute. TCH and The Health Alliance for Greater Cincinnati paid $108 million to resolve False Claims Act liability for the conduct.
Under the five-year corporate integrity agreement, TCH must implement compliance measures, hire an outside reviewer of its financial relationships with physicians, and be monitored by OIG. The agreement requires the trustees to annually review the hospital's compliance program and certify its effectiveness.
When the settlement was announced in May, TCH declined to enter a corporate integrity agreement. This week, however, TCH issued a statement saying it "views the CIA as further evidence of the hospital’s continued commitment to conduct its business in accordance with the highest ethical standards and in compliance with the requirements for participation in the federal healthcare programs."
The government alleged that The Christ Hospital, a 555-bed acute care hospital in Mount Auburn, OH, limited work at the Heart Station—an outpatient cardiology testing unit that provides non-invasive heart procedures—to cardiologists who referred patients to the hospital.
Cardiologists whose referrals contributed at least 2% of the hospital's yearly gross revenues were rewarded with a corresponding percentage of time at the Heart Station, where they could bill for the patients they treated at the unit and for any follow-up procedures that these patients required, prosecutors alleged.
The Department of Health and Human Services said it will make available up to $335 million in Expanded Services grants for community health centers to boost access to preventive and primary healthcare.
The Affordable Care Act grant program is the second of two major initiatives announced this month totaling more than $1 billion for community health centers. On Oct. 11, HHS said it would provide $727 million to 143 community health centers across the country for construction, expansion, and renovation projects.
The funds are specifically intended to increase access to preventive and primary health care, including dental health and behavioral health. Patients are increasingly turning to primary care providers for mental health services, even as the ranks of primary care physicians are stretched thin.
Community health centers serve nearly 19 million patients each year—about 40% of whom have no health insurance. Health centers deliver preventive and primary care services at more than 7,900 service delivery sites around the country to patients regardless of their ability to pay. Charges for services are set according to income, HHS said.
The Affordable Care Act provides $11 billion in funding over the next five years for the operation, expansion, and construction of health centers throughout the nation. Of the $11 billion, $9.5 billion will create new health centers in medically underserved areas and expanding preventive and primary healthcare services at existing health centers. An additional $1.5 billion will support major construction and renovation projects at health centers nationwide.
The expansions of sites and services are expected to help community health centers serve nearly double the number of patients they serve now, regardless of their insurance status or ability to pay.
Last month HHS announced grants totaling $320 million to fortify the primary care workforce. Of that sum, $167.3 million is for expanding primary care residency programs.
Health centers requesting grants must show how they will be used to expand medical capacity and services to underserved populations. Grant applications are due Jan. 6.
