Orlando Health, the University of Florida, and Shands HealthCare have formed a free-flowing collaborative to expand physician training, develop interoperable electronic medical records systems, and improve quality and access to healthcare for 2.5 million people across a 20-county region in Central Florida.
At a ceremony on Thursday, officials at the three institutions signed a memorandum of understanding that provides a foundation for several cooperative initiatives, which they called a natural result of years of close working relationships.
"The formal affiliation of Orlando Health with the University of Florida and Shands will build on our longstanding and valuable relationship and enhance our collective energies as regional and statewide clinical leaders," says David S. Guzick, MD, senior vice president for health affairs at UF and president of the UF & Shands Health System.
"As the healthcare needs of patients throughout Central and North Central Florida continue to grow, we will seek out ways to collaborate on comprehensive clinical programs for adults and children and fortify our role as educational leaders in delivering the highest-quality education for future physicians and other health providers," he adds.
The agreement calls for the three institutions to form joint clinical programs in pediatrics, neuroscience, oncology, women's health, transplantation, and cardiovascular medicine, which will include a regional comprehensive cardiac care program. The collaborative will increase undergraduate and graduate medical residency and fellowship training at Orlando Health, facilitate clinical trials through UF's clinical research program, and collaborate on quality care and safety initiatives.
UF College of Medicine Dean Michael L. Good, MD, said the collaborative is "built upon existing partnerships" with physicians in three "tremendously strong healthcare organizations."
"Many of our doctors already work together," Good said. "This agreement allows us to collaborate on much broader scale between groups of physicians and divisions and departments, working with one another around the triad of best care, best educational opportunities, and providing the best environment for advancing new knowledge and discovery."
Orlando Health CEO John Hillenmeyer called the collaborative "a work in progress" with some of the details not finalized.
"There is not a structure," he said. "Now that we have arrived at this it becomes management's responsibility, and we're required by our boards to figure out how we are going to manage this process. While we have ideas, if you ask for a specific staff that is doing A, B, C, or D today, it's not there. But those plans are being laid right now."
Hillenmeyer said the three institutions agreed on front-end guiding principals, and will sort out the details as the collaborative matures.
"Rather that try to figure it out on the front end and probably create barriers for getting things done, we'd rather say we've agreed to this and we are going to go about it," he said. "I can assure you we did not dream this up two weeks ago. This has been going on, parts of it, for several years. We just thought the time was right to go to both of our boards and to announce to the public that we are working together. As details on particular programs evolve, I'm sure there will be more activity."
Through the collaboration, Orlando Health physicians could receive faculty appointments, teach UF medical students or graduate medical trainees, or participate in UF-sponsored clinical trials.
The agreement could increase the use of Orlando Health as a training site for UF medical residents and fellows. The clinical faculty from UF's College of Medicine also could participate with Orlando Health medical staff on clinical services.
The alliance creates additional opportunities for the physician groups to work together to develop joint clinical protocols that will enhance quality and safety for patients.
More than 2.5 million Floridians across nearly 20 counties are served by the three health-care organizations.
With an eye towards healthcare reform mandates, the collaborative will develop compatible electronic medical information systems to ensure easy access to patient records. They hope to provide services ranging from primary care to the most complex, such as transplantation, and will share common values in education, research, and charitable care.
"We really do have an opportunity with this number of physicians and connected organizations to make some serious initiatives in delivery system reform, which is what healthcare reform is all about," Hillenmeyer says.
Seventy-three defendants—including alleged members of an Armenian-American crime syndicate called Mirzoyan-Terdjanian—have been indicted for crimes involving more than $163 million in fraudulent billing of Medicare and insurance companies across the nation, the U.S. Department of Justice says.
The announcement came Wednesday after indictments were unsealed in California, Georgia, New Mexico, New York and Ohio. Law enforcement officials in the national, multi-agency investigation reported 52 arrests on Wednesday, in what the DOJ says is the largest prosecution of a Medicare fraud scheme committed by one criminal enterprise.
The defendants are charged with highly-organized, multi-million dollar schemes to defraud Medicare and insurance companies by submitting fraudulent bills for medically unnecessary treatments, or treatments that were never performed, DOJ alleges.
According to the indictments, the defendants allegedly stole the identities of doctors and thousands of Medicare beneficiaries and operated at least 118 different phony clinics in 25 states that submitted bogus Medicare reimbursement claims.
"The international organized crime enterprise known as the Mirzoyan-Terdjanian, fleeced the healthcare system through a wide-range of money making criminal fraud schemes," says Kevin Perkins, FBI assistant director of the Criminal Investigative Division.
"The members and associates located throughout the United States and in Armenia, perpetrated a large-scale, nationwide Medicare scam that fraudulently billed Medicare for more than $100 million of unnecessary medical treatments using a series of phantom clinics," Perkins said. "We want to restore the confidence in the nation?s healthcare system and assure practitioners we will not stand by and let their identities be used for criminal gain."
Acting Deputy Attorney General Gary G. Grinder said the emergence of the Mirzoyan-Terdjanian operation "signals a dangerous expansion that poses a serious threat to consumers as these syndicates are willing to exploit almost any program, business or individual to earn an illegal profit."
Here is the breakdown for the defendants:
* Forty-four defendants were charged in two indictments unsealed Wednesday in New York with racketeering conspiracy and conspiracy to commit: healthcare fraud, bank fraud, money laundering, fraud in connection with identity theft, credit card fraud and immigration fraud.
* Seven defendants were charged in New Mexico with healthcare fraud, mail fraud, wire fraud, money laundering conspiracy, money laundering, forfeiture and aggravated identity theft.
* Six defendants were charged in Georgia with healthcare fraud, conspiracy to commit healthcare fraud, money laundering conspiracy and aggravated identity theft.
* Six defendants were charged in Ohio with healthcare fraud, mail fraud, conspiracy to commit mail fraud, wire fraud, conspiracy to commit money laundering and aggravated identity theft.
* Ten defendants were charged in two indictments in California with conspiracy to commit bank fraud, bank fraud, money laundering, conspiracy to launder monetary instruments, criminal forfeiture, aggravated identity theft, aiding and abetting, and causing an act to be done.
Federal prosecutors say Mirzoyan-Terdjanian is named for its leaders, Davit Mirzoyan and Robert Terdjanian. The gang is based in Los Angeles and New York, and its operations extend throughout the United States and internationally.
Among the defendants charged with racketeering is Armen Kazarian, who is alleged to be a "Vor," a term translated as "Thief-in-Law," which refers to a member of a select group of high-level criminals from Russia, Armenia, and other countries that had been part of the former Soviet Union. This is the first time a Vor has been charged with racketeering, and the first time since 1996 that a Vor has been arrested on a federal charge.
The Institute of Medicine elected 65 new members and four foreign associates to its prestigious ranks at its 40th annual meeting this week in Washington, DC.
"It is a great pleasure to welcome these distinguished and accomplished individuals to the Institute of Medicine," IOM President Harvey V. Fineberg said in a statement to media. "Each of these new members stands out as a professional whose research, knowledge, and skills have significantly advanced health and medicine and who has served as a model for others. The Institute of Medicine is greatly enriched by the addition of our newly elected colleagues."
A complete list of the new members and associates can be found at theIOM Web site.
New members are elected by current members through a process that recognizes people who have advanced the medical sciences, healthcare, and public health. IOM stipulates that at least one-quarter of its members be selected from outside the health professions, from such fields as the natural, social, and behavioral sciences; law; engineering; and the humanities. The new members raise the IOM's active membership to 1,649 and 96 foreign associates. With 72 members holding emeritus status, IOM's total membership is 1,817.
The members make a commitment to volunteer on IOM committees, boards, and other activities. Projects completed during the past year include studies on the cardiovascular effects of secondhand smoke, nutrition standards for the federal school meals programs, prevention and control of viral hepatitis, strategies to reduce hypertension and sodium intake, and a major summit on integrative medicine.
Also this week, IOM announced that it has received a $2 million gift to establish the Leonard D. Schaeffer Fund and create an endowed executive officer position. IOM's current executive officer, Judy A. Salerno, will be the first to hold the position. The gift comes from Schaeffer, an IOM member and founding chairman/CEO WellPoint Inc., and his wife. The money will be used to support core expenses and program activities, such as the convening of studies, production of workshops, and communication of IOM?s findings and recommendations.
Federal inspectors identified $167,064 in "unallowable and unsupported costs" at the California Transplant Donor Network, including nearly $100,000 that was not adequate documented, and $19,000 that was spent on a CEO's retirement party.
The audit of 2007, released this month by the Department of Health & Human Services' Office of Inspector General, determined that at the June 2007 retirement party for long-serving CEO Phyllis Weber "CTDN catered for 300 guests, including CTDN’s employees and their spouses, the board of directors, the audit and finance committee, and transplant center officials. The estimated Medicare share of the unallowable costs related to kidney procurement was $9,620."
In addition, "CTDN reported $6,019 of overhead costs and administrative and general costs related to entertainment and alcohol, including $2,619 for transportation and lodging for dancers for a donor family gathering; $2,337 for alcoholic beverages purchased by CTDN personnel; $577 for a party held for individuals who were not CTDN employees; and $486 for ushers’ services at the donor family gathering. The estimated Medicare share of the unallowable costs related to kidney procurement was $3,053," OIG reported.
In a three-page response to OIG's audit, CTDN CEO Cindy Siljeslrom defended the $18,967 spent on the retirement party for Weber. "Based on the length of service and the role this executive played in founding this organization, CTDN believes the costs to be reasonable," Siljeslrom wrote. "However, given the unusual circumstances around the event, CTDN does not plan to sponsor such an event in the future."
OIG sorted the total $167,064 in misspent funds in 2007 into $65,912 of unallowable costs, and $101,152 unallowable costs.
CTDN was unable to provide adequate documentation for $99,168 of the reported $101,152 in unsupported costs, and OIS determined that no documentation existed to account for $1,984 of costs. OIG estimated that Medicare's share of the unsupported costs related to kidney procurement was $51,304.
The $65,912 of unallowable costs tallied by OIG included costs incurred for donations and gifts, the retirement party, entertainment, lobbying, and meals. Federal inspectors estimated that Medicare’s share of the unallowable costs related to kidney procurement was $33,431.
CTDN agreed with many of the OIG findings, but also defended some of the expenses as reasonably associated with fundraising, publicity, and raising public awareness, including events such as the Donor Family Gathering, which allows transplant recipients and their families to thank and share their stories with organ donors and their families.
"In order to participate in community events that provide a forum for community outreach and education CTDN is often asked to contribute to the cost of the event as funding for these types of activities is extremely limited," Siljeslrom wrote. "Volunteers are recruited as additional resources for the events. CTDN occasionally identifies a small way to thank those who volunteer to support this part of our mission. Hence the gifts to non employees."
CTND said it had documented the $99,188 identified by OIG as unsupported "and believes that all the costs are legitimate." However, CTND concurred that the documentation was inadequate.
Consolidations involving for-profit hospital companies acquiring struggling not-for-profit hospitals are a growing and "favorable" trend that will increase competition in local markets, increase efficiencies, and improve leverage with payers, Moody's Investors Services says.
"More consolidation is coming as weaker not-for-profit hospitals seek capital partners in larger for-profit or not-for-profit hospital systems," Moody's said. "Larger systems with greater economies of scale will benefit from healthcare reform because Medicare payments will favor more efficient, lower average cost health providers."
Moody's pointed to the recently completed $120 million acquisition by Tennessee-based for-profit Community Health Systems of the bankrupt not-for-profit Forum Health, a small hospital system in Youngstown, OH.
"Although small, this consolidation indicates that for-profits believe even bankrupt hospitals offer opportunities for future growth, a favorable development for holders of low-rated not-for-profit hospital bonds," Moody's said. "Proceeds from the purchase will (void) outstanding tax-exempt bonds creating an immediate exit strategy for bondholders."
Moody's said the expected sale of Boston-based non-for-profit Caritas Christi Healthcare System to New York-based private-equity firm Cerberus Capital Management—which last week won the approval of the Massachusetts Attorney General—will be closely watched by the for-profit hospital industry.
"The approval is significant: If Cerberus completes the purchase and does well with this investment, it will likely encourage other private equity firms to find hospital acquisition targets," Moody's said.
"In the short term, a merger or acquisition strategy may fund a weak, low-rated, not-for-profit hospital's immediate capital needs and address growing pension liabilities. Consolidations can also help bondholders increase the value of their holdings if it results in higher credit quality when the debt is assumed by a stronger system, or even get 100% immediate recovery in a distressed situation if debt is paid off at the merger."
The transition to for-profit status, however, will bring a loss of transparency.
"As for-profits make inroads into not-for-profit strongholds like Boston and Youngstown, the remaining not-for-profit hospitals will have a tougher time peering inside the walls of their former brethren as the new for-profit owners build a disclosure fortress around their latest acquisitions, upping the competitive climate," Moody's said.
We're three quarters through calendar 2010, so it's a good time to examine where we stand on job growth.
Federal data show that the overall healthcare sector remains one of the few bright spots for job growth in a weak economy. However, we're getting mixed news about job growth at hospitals.
Bureau of Labor Statistics data for September show that hospitals have added 28,200 jobs in the first nine months of 2010—a rate of job growth that is more than double that of 2009, although dwarfed by the 86,200 hospital jobs created in the first nine months of 2008.
BLS data also suggest that hospital mass layoffs affecting 50 or more employees could hit a new record for the year. There have been 102 mass layoffs resulting in 8,233 initial unemployment claims—government-speak for lost jobs—in the first eight months of 2010, a pace that would slightly surpass the record set in 2009, when hospitals reported 152 mass layoffs resulting in 11,787 lost jobs.
So, we've got overall hospital job growth that is:
Healthy when compared to the rest of the economy;
Improving when compared with last year, although slower than it has been for the better part of the last decade; and
Subject to frequent mass layoffs.
A little perspective is needed. BLS tells us that the nation's hospitals directly employ more than 4.7 million people. With all respect to the 8,233 hospital employees who've lost their jobs through no fault of their own—from a macro-economic perspective the layoffs are not a big number. That is especially true when we note that hospitals have created more than three jobs for every job eliminated so far this year.
Major negatives hospitals face include the usual suspects: lower government reimbursements, declining admissions, declining philanthropy for nonprofits, and more charity care owing to job losses in the larger economy. It is not surprising that individual hospitals are imposing short-term layoffs as they reallocate money for other budget concerns, and reprioritize services.
On the other hand, with respect to long-term demand, hospitals may also be primed for a major job growth spurt in the coming years. The federal government's healthcare reforms will expand health insurance coverage for another 30 million or more Americans. More importantly, however, is the impact of demographics. We are aging, and getting fatter and sicker by the year. Americans will require more healthcare well into the middle of the century.
For the overall healthcare sector, job growth is healthy thanks largely to ambulatory services, which accounted for 17,200 payroll additions in September, and 117,200 payroll additions in the first nine months of 2010.
The healthcare sector—everything from hospitals, to chiropractors' offices, blood and organ donor banks, to walk-in clinics—employed 13.8 million people in September, and has been one of the few areas of steady job growth during the recession and anemic recovery, creating an average of 21,000 jobs each month, and 186,200 jobs in the first nine months of 2010.
Here's an illuminating factoid: Healthcare is responsible for 23,900 of the 65,000 jobs created in the entire economy in September—more than one-in-three new jobs.
Do you want a second opinion?
David Cherner is the managing partner at Health Workforce Solutions, LLC, and publishes the quarterly HWS Labor Market Pulse Index, which monitors healthcare sector job growth in the nation's 30 largest markets. He predicts that healthcare sector job growth will weaken for the remainder of the year, but overall, he remains optimistic.
"Despite a drop-off in near-term demand for the quarter, we remain convinced that healthcare hiring has generally improved over the last year and we expect it to continue through the remainder of the year," Cherner said.
"There are a number of large expansions projects that will be coming on line over the next few quarters and much of the negativity reflected in this quarter's numbers come from job cuts previously announced."
Hospitals and healthcare are subject to many of the forces that have battered the rest of the economy. But, as job creation machines, healthcare and hospitals are showing themselves to be resilient too. There will be fits and starts. There will be months when job growth slows, or even retreats. There will be more layoffs. Overall, the long-term forecast is good.
The Department of Health and Human Services says it will issue $727 million to 143 community health centers across the country for construction, expansion, and renovation projects through funds available from the Affordable Care Act.
Community health centers serve nearly 19 million patients, about 40% of whom have no health insurance. The 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.
"There is no question that the economic downturn has made it harder for some Americans to get healthcare and important preventive services. Community Health Centers provide quality healthcare services to Americans across the country but are a life line for those who have lost coverage or are between jobs," HHS Secretary Kathleen Sebelius says.
"The newly constructed or expanded community health centers will provide care to an additional 745,000 patients and much needed employment opportunities in both rural and urban underserved communities," she said.
The Capital Development program grants, administered by the Health Resources and Services Administration, builds on the more than $2 billion investment in community health centers in the American Recovery and Reinvestment Act.
"Many of these community health centers need more modern space to meet the increasing patient demand for services," says HRSA Administrator Mary K. Wakefield, RN. "These funds will help community health centers build new facilities and modernize their current sites in their continuing effort to provide the best care possible to more and more people in need."
Over the next five years, the Affordable Care Act will provide $11 billion for the operation, expansion and construction of community health centers across the country to serve nearly double the number of patients receiving care, regardless of their insurance status or ability to pay.
A state by state list of Recovery Act investments in community health centers is available here.
Despite a projected record level hospital layoffs by the end of 2010, the sector reported 2,900 payroll additions in September, and 28,200 payroll additions so far this year, a rate of job creation that is more than double that for the same period in 2009, preliminary data released Friday by the Bureau of Labor Statistics shows.
Hospitals added 7,000 jobs in August—the largest single month of job growth for the sector in 2010—shed 1,400 jobs in July, added 5,700 jobs in June, and shed 1,900 jobs in May, after creating 15,900 jobs in the first four months of the year.
BLS data from August and September is considered preliminary and may be considerably revised in the coming months.
Hospitals have reported 28,200 payroll additions in the first nine months of 2010, compared with 12,100 payroll additions in the first nine months of 2009. The sector reported 86,200 payroll additions in the first nine months of 2008. Hospitals last reported sustained payroll reductions in 2000, when 2,200 jobs were lost between January and April, BLS data and preliminary data show.
The job growth comes even as hospitals mass layoffs of 50 or more employees are projecting to hit a new record for the year. BLS data show that there have been 102 mass layoffs resulting in 8,233 initial unemployment claims in the first eight months of 2010. The 2010 layoffs are on a pace to slightly surpass the record set in 2009, when hospitals reported 152 mass layoffs resulting in 11,787 initial unemployment claims.
The overall economy lost 95,000 jobs in September, as the nation's jobless rate held at 9.6%. The decline in payroll employment reflected the loss of 159,000 temporary jobs from the U.S. Census Bureau, while private sector payrolls increased by 64,000, BLS preliminary data show.
Job growth in the healthcare sector continues to be powered by ambulatory services, which accounted for 17,200 payroll additions in September, and 117,200 payroll additions in the first nine months of 2010. Nursing and residential care facilities reported 3,800 payroll additions, and physicians' offices reported 3,400 payroll additions, BLS preliminary data show.
The healthcare sector—everything from hospitals, to chiropractors' offices, blood and organ donor banks, to walk-in clinics—employed 13.8 million people in September, and has been one of the few areas of steady job growth during the recession and sputtering recovery, creating an average of 21,000 jobs each month, and 186,200 jobs in the first nine months of 2010. Healthcare created 215,300 jobs in 2009, and 719,900 jobs since the recession began in December 2007, BLS data and preliminary data show.
In the larger economy, 14.8 million people were unemployed in the United States in September, and 6.1 million of them were long-term unemployed who had been without a job for at least 27 weeks. However, the number of long-term unemployed has decreased by 640,000 since May, BLS preliminary data show.
Shortcomings in the Department of Defense's failed 13-year, $2 billion transition to electronic medical records were largely due to poor planning and execution, and a failure to appreciate the "significant complexity" of the program, the Government Accountability Office said.
DOD's EHR project—the Armed Forces Health Longitudinal Technology Application (AHLTA)—was expected to give the military's healthcare providers realtime access to health information for the 9.6 million active duty service members, their dependents, and other beneficiaries worldwide. However, the system hasn't met expectations.
GAO was asked by DOD to examine AHLTA's shortcomings as the military prepares to acquire a replacement system called EHR Way Ahead, for which the federal government has budgeted $302 million in fiscal 2011.
GAO found that AHLTA had met some benchmarks for outpatient care and dental care documentation, but that DOD had been forced to scale back other capabilities. "In addition, users continued to experience significant problems with the performance (speed, usability, and availability) of the portions of the system that have been deployed," GAO reported.
DOD has begun to improve system performance and enhance functionality and plans to continue to stabilize the AHLTA system through 2015, as a "bridge" to EHR Way Ahead. "However, it has not carried out a planned independent evaluation to ensure it has made these improvements. Until it ensures that these weaknesses are addressed, DOD risks undermining the success of further efforts to acquire EHR capabilities," GAO reported.
Weaknesses in acquisition management and planning processes contributed to AHLTA's persistent underperformance. GAO identified four problem areas:
A project management plan was not established to guide DOD's execution of the system acquisition.
A systems engineering plan did not exist to guide the "significant complexity" of the technical development.
Requirements were incomplete and did not reflect user and operational needs.
There was no plan to improve users' satisfaction.
EHR Way Ahead is expected to address performance problems, provide unaddressed capabilities such as comprehensive medical documentation, capture and share medical data electronically within DOD, and improve existing information sharing with the Department of Veterans Affairs.
DOD said it is acting on all of the GAO recommendations.
Houston-based Christus Health Systems will pay the federal government nearly $971,000 to settle whistleblower allegations that several of its hospitals in Texas and Louisiana fraudulently billed Medicare for ineligible costs and expenses and failed to disclose overpayments.
The settlement by Christus, which operates more than 40 hospitals and facilities in eight states, resolves a whistleblower's lawsuit that alleged fraudulent Medicare billings as far back as 1988 while others occurred as recently as 2001. The lawsuit had been under seal until this month, when a federal district court judge in Los Angeles unsealed the case.
The hospitals involved in the settlement include St. Mary's Galveston Hospital in Galveston, Texas; St. Michael's Health System in Texarkana, Texas; Christus Hospital—St. Elizabeth in Beaumont, TX; Christus Hospital—St. Mary in Port Arthur, TX; Christus Schumpert Health System in Shreveport, LA; Christus St. Frances Cabrini Hospital in Alexandria, LA; and Christus St. John Hospital in Nassau Bay, TX.
Christus Health paid the settlement without admitting any wrongdoing.
The whistleblower lawsuit was filed in 1998 by Mark Razin, a former employee of Healthcare Financial Advisors, a California-based consulting firm that helped hospitals prepare cost reports that were submitted to Medicare/Medicaid. The lawsuit alleged that HFA helped hospitals seek reimbursement for unallowable costs and helped conceal known overpayments from the government, federal prosecutors said.
HFA also allegedly helped hospitals reopen previously filed cost reports to seek reimbursement for costs that it had inadvertently failed to claim in its original cost reports, while simultaneously concealing from Medicare overpayments the hospitals knew they had received on account of the original cost reports, federal prosecutors said.
The settlement with Christus is the latest and last in a series of settlements with nine hospital defendants in the whistleblower suit that have cumulatively paid approximately $61 million to the federal government, including: a 2007 settlement in which the Loma Linda Behavioral Medicine Center in Redlands, CA, paid more than $2 million; and the 2006 settlement in which Jackson Memorial Hospital in Miami, FL, paid $14.25 million.
The settlement was negotiated by the United States Attorney's Office in Los Angeles.
