Two thirds of physicians say they are using personal devices for mobile health solutions that aren't connected to their practice or hospital IT systems, but nearly a third said their hospital or practice leaders will not support the use of mobile health devices.
As for patients, 40% would be willing to pay for a remote monitoring device that sends health information to their doctors, according to a new online survey and report by PricewaterhouseCoopers' Health Research Institute.
The findings of the survey, published in a report titled Healthcare Unwired were presented this week by PricewaterhouseCoopers at the mHealth Initiative 2nd International mHealth Conference in San Diego. Physicians' interest in mobile technologies reflects the growing market for remote and mobile health applications and business opportunities for organizations using consumer technologies to support preventative, acute, and chronic care, PWC said.
Two thousand consumers and 1,000 physicians regarding their use and preferences for remote and mobile health services and devices.
Of the physicians questioned for the survey:
88% would like their patients to track and/or monitor their health at home, particularly their weight, blood sugar levels, and vital signs.
63% said they are using personal devices for mobile health solutions that aren't connected to their practice or hospital IT systems, and 30% said their hospital or practice leaders will not support the use of mobile health devices.
57% said they would use remote devices to monitor the patients outside of the hospital. Physicians, however, want to see filtered information or exceptions in their patient's health, not all the data all the time. Too much information could actually slow down care.
56% of physicians using mobile devices said they expedite decision making and nearly 40% said the use of mobile devices decreases time spent on administration.
40% of physicians said they could reduce the number of office visits by 11% to 30% by using mobile health technologies, which could address the shortage of physicians, reduce hospital readmission costs, and increase access for patients who delay care.
The greatest benefit of mobile health, physicians noted, would be faster real-time access to more accurate data.
"Remote and mobile technology is making it possible to move healthcare delivery outside the traditional settings of physician offices and hospitals to wherever patients are. It's bringing back the concept of doctors making house calls," said Daniel Garrett, leader of PricewaterhouseCoopers' health Information Technology (HIT) practice. "New consumer-oriented business models and technologies are emerging. Companies that will be well positioned competitively are those than can integrate mobile health into healthcare delivery and create value in the health system by helping doctors and their patients better manage health and wellness through mass personalization."
The report found that much of the momentum behind mobile health to date has been from companies outside traditional healthcare, such as technology and telecommunications companies looking to expand their footprint in the health industries. When asked who they would prefer to receive mobile health services from, however, consumers ranked their healthcare provider, hospital or health system as No. 1, followed by their health insurer.
"There are significant opportunities for physicians, hospitals, health insurers, pharmaceutical companies and medical device manufacturers to market and differentiate themselves using mobile health," Garrett said. "Yet many healthcare organizations are largely ignoring the opportunity to integrate mobile health into other IT efforts such as the implementation of electronic health records."
Physicians said accessing information where and when it is needed is one of their top challenges. One-third said they make decisions based on incomplete information for seven of 10 patients. They also complained that they don't have time to interact with patients as much as they would like, and 45% said that Internet visits would expand access.
One barrier to mobile health may be that in-person consultation is still the main basis of reimbursement in healthcare. Public payers and private health insurers have not pushed for adoption of mobile health, the report says.
That may be because the healthcare industry hasn't figured out how to pay for electronic transactions in the way other industries have, such as for music and video downloads.
This may be changing. Health plans are beginning to pay for remote monitoring devices to help reduce hospital readmissions. Some physicians are now getting limited reimbursement for phone consultations, email consults, telehealth, and texting.
Older adults have different risk factors when it comes to indoor and outdoor falls. This subtle variation is often ignored and should affect how fall prevention programs are structured, study says.
"Indoor and outdoor falls are both important, but people at high risk for indoor falls are different in many ways from those at high risk of outdoor falls," says Marian T. Hannan, lead author of the study by the Institute for Aging Research of Hebrew SeniorLife. "Failure to separate the two can mask important information on risk factors and may hamper the effectiveness of falls prevention programs."
The study, published in the Journal of the American Geriatrics Society, found that indoor falls are associated with an inactive lifestyle, disability, and poor health, while outdoor falls are associated with higher levels of activity and average or better-than-average health.
Older adults who fell outdoors were somewhat younger than those who fell indoors, more likely to be male and better educated, and had lifestyle characteristics indicative of better health. Those who fell indoors had more physical disabilities, took more medications, and had lower cognitive function than those who fell outdoors.
The study examined 765 men and women, age 70 and older, randomly selected in the Boston area, all of whom underwent a baseline falls assessment, including a home visit and clinic examination. Over a nearly two-year period, 598 indoor falls and 524 outdoor falls were reported, and study participants were interviewed to determine the causes.
Hannan said the study shows that falls are not necessarily a marker of poor health. Almost half of all falls occurred outdoors, and people who fell outdoors had the same or better health than those who did not fall at all. Hannan said epidemiological studies of risk factors for falls in older people may be hampered when falls are combined, with important associations between risk factors and indoor and outdoor falls potentially being missed.
Intervention programs need to be tailored differently for people more likely to fall outdoors than those who tend to fall indoors. "Most fall prevention programs emphasize the prevention of indoor falls, particularly through strength, balance and gait training; use of assistive devices; treatment of medical conditions; reduction in the use of certain medications; improvement in vision; and the elimination of home hazards," Hannan said in the study.
Many of these programs do not take into account the causes of outdoor falls, she said. Falls interventions for community-dwelling seniors should consider their health status, activity level, and other characteristics. Most seniors who fall outdoors do so on sidewalks, streets or curbs, or in parking lots.
"Healthy, active older people should be aware of their surroundings, especially when walking outdoors," said Hannan, an associate professor of medicine at Harvard Medical School. "More attention needs to be paid to the elimination of outdoor environmental hazards involving sidewalks, curbs and streets, such as repairing uneven surfaces, removing debris, installing ramps at intersections, and painting curbs."
According to the Centers for Disease Control and Prevention, nearly 40% of seniors who live in the community fall each year, with many suffering moderate to severe injuries, including hip fractures and traumatic brain injuries. At least half of these falls occur outdoors.
The study was funded by the National Institutes of Health.
The Internal Revenue Service has released a draft form for small businesses and tax-exempt organizations to calculate healthcare tax credits in preparation for filing income tax returns next year.
The tax credit was included in the Affordable Care Act signed by President Obama in March and is effective this year. The credit is designed to encourage small employers to offer health insurance coverage for the first time or maintain coverage they already have.
IRS also announced how eligible tax-exempt organizations—which do not generally file income tax returns—will claim the credit during the 2011 filing season. IRS has posted a draft of Form 8941 on IRS.gov. Small businesses will include the credit as part of the general business credit on its income tax return.
Tax-exempt organizations will claim the small business healthcare tax credit on a revised Form 990-T. The Form 990-T is now used by tax-exempt organizations to report and pay the tax on unrelated business income. Form 990-T will be revised for the 2011 filing season to enable eligible tax-exempt organizations—even those that owe no tax on unrelated business income—to claim the small business healthcare tax credit, IRS said.
The final version of Form 8941 and its instructions will be available later this year.
In 2010, the credit is available to small employers that contribute an amount equivalent to at least half the cost of single coverage towards buying health insurance for their employees. The credit is specifically targeted to help small businesses and tax-exempt organizations that primarily employ moderate- and lower-income workers, IRS said.
For tax years 2010 to 2013, the maximum credit is 35% of premiums paid by eligible small business employers and 25% of premiums paid by eligible tax-exempt organizations. In 2014, the maximum tax credit will go to 50% of premiums paid by eligible small business employers and 35% of premiums paid by eligible, tax-exempt organizations for two years. The maximum credit goes to smaller employers—with 10 or fewer fulltime employees—paying annual average wages of $25,000 or less, IRS said.
The credit is phased out for employers with 25 fulltime employees or more or that pay average annual wages of $50,000 or more. Because the eligibility rules are based in part on the number of FTEs, and not simply the number of employees, businesses that use part-time help may qualify even if they employ more than 25 individuals, IRS said.
Ordinarily, the names of hospital CEOs grace the society pages of their local newspapers—not the police blotter. Seldom are these community titans the subject of investigations by state attorneys general into questionable workplace conduct.
So, it was off-putting if not curious to see this past week a spate of unusual behaviors from a handful of hospital executives and former executives, all of whom allegedly appeared to have exercised poor judgment—or worse.
Obviously, the seriousness of these incidents varies greatly. Using skid row transients to rip off the government is a far more egregious lapse than is a questionable personal relationship with a subordinate. And, we have to presume the innocence for those executives who've been charged but not convicted. However, at face value, these incidents reflect bad judgments by people who should have known better.
Why do normally responsible people in positions of high visibility and responsibility engage in career- and institution-threatening misadventures? There is no one reason. Often, however, leaders who fall spectacularly from positions of power don't work in a culture of accountability. They didn't have someone close at hand who felt comfortable forcibly pointing out the flawed behavior and the consequences to their careers and the institutions they lead.
You see this all the time with Congress, the most unaccountable organization on earth. Under the usual formula, the Congressman acquires power and enjoys perks that include kowtows, back slaps, and ring kissing from lobbyists, hacks, colleagues, and even the media—all of whom want something. So, the pol cuts himself off from reality and surrounds himself with courtiers who laugh at his witless jokes, and nod reverently when he says something ludicrous. Before long, his better judgment is gone, and he files a bill to outlaw feather dusters, or to designate the Saguaro Cactus as the state tree of Vermont.
The public expects buffoonery from politicians but not from healthcare professionals. Doctors, nurses, technicians, hospital executives are all generally held to higher standards in the communities they serve. And the vast majorities of these professionals deserve and protect that higher status with exemplary personal and professional conduct. That's why headlines about executives gone wild garner so much attention.
So, what prompted these leaders to act recklessly? Does it reflect flaws in the culture of accountability in their hospitals? Do some healthcare CEOs and other top executives surround themselves with people who tell them only what they want to hear? In the investigation of Beth Israel Deaconess CEO Paul Levy, for example, the Massachusetts attorney general suggested that board members were too deferential to his considerable talents to pursue questions about his personal relationship with a subordinate.
Once again, we come to the teachable moment. These executives gone wild provide an excellent comparison to examine senior executive accountability at your hospital. Can your subordinates raise concerns about questionable behavior from their bosses including you—without fear of retaliation?
A top-to-bottom culture of transparency and personal and professional accountability should be fostered, encouraged, and led by example from the top. It's a great way to stay out of the headlines.
The nation's hospitals reported 8,600 payroll additions in August, the largest single month of job growth for the sector in 2010, which so far has seen erratic employment growth, preliminary data released today by the Bureau of Labor Statistics show.
The hospital sector shed 1,400 jobs in July, added 5,700 jobs in June, and shed 1,400 jobs in May, after creating 7,800 jobs in the first four months of the year.
BLS data from July and August is considered preliminary and may be considerably revised in the coming months.
Hospitals have reported 27,400 payroll additions in the first eight months of 2010, compared with 6,700 payroll additions in the first eight months of 2009, according to BLS data and revised preliminary data.
Hospitals last reported sustained payroll reductions in 2000, when 2,200 jobs were lost between January and April, BLS data show.
Overall, the economy lost 54,000 jobs in August, as the nation's jobless rate rose slightly to 9.6%. The decline in payroll employment reflected the loss of 114,000 temporary jobs from the U.S. Census Bureau, while private sector payrolls increased by 67,000, BLS preliminary data show.
Job growth in the healthcare sector continues to be powered by ambulatory services, which accounted for 16,900 payroll additions in August, and 99,400 payroll additions in the first eight months of 2010. Nursing and residential care facilities reported 2,700 payroll additions, and physicians' offices reported 5,300 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 13.7 million people in August, and has been one of the few areas of job growth during the recession and sputtering recovery, creating 28,200 new jobs in August, and 158,500 jobs in the first eight months of 2010. Healthcare created 215,300 jobs in 2009, and 692,200 jobs since the recession began in December 2007, BLS data and preliminary data show.
In the larger economy, 14.9 million people were unemployed in the United States in June, and 6.2 million of them were long-term unemployed who'd been without a job for at least 27 weeks, BLS reports.
A domestic dispute may have been the motive behind a Friday morning shooting at Baton Rouge General Medical Center Mid City hospital that left two visitors wounded, one with life-threatening injuries, and police searching for the gunman.
The incident occurred at around 12:35 a.m. on Friday morning. The East Baton Rouge Police Department was searching Friday for the alleged attacker, identified as Darrell Garner, 36, who is wanted on two counts of attempted first?degree murder.
"We are deeply saddened that domestic situations have spilled over into a community hospital setting," said Bill Holman, president/CEO of BRGMC. "Hospitals should be a place for healing and wellness."
When East Baton Rouge police officers arrived at the hospital, they placed it in lockdown for four hours, and searched the entire campus. No employees or patients were injured during the shooting, and normal shift operations have since resumed.
"We thank the East Baton Rouge Police Department for their very fast and strong response to the situation and for dedicating so many officers to the response," Holman said. "We also thank our employees for responding appropriately in this emergency to ensure the safety of patients, and for their actions to provide care for those involved. It is our hope that the police will quickly apprehend the individual responsible for this and we thank the community for the outpouring of support."
The Massachusetts Attorney General's Office has chastised the executive leadership and the board of directors at Beth Israel Deaconess Medical Center in Boston for years of inaction before addressing CEO Paul Levy's inappropriate personal relationship with an employee.
Investigators determined that while no laws had been broken, the reputation of the prestigious Harvard-affiliated teaching hospital had suffered a blow.
The 11-page report issued Wednesday by the AG's Non-Profit Organizations/Public Charities Division was requested by the BIDMC board, and focused on whether charitable funds were used inappropriately as a result of Levy's indiscretions, and whether the board acted appropriately in its handing of the matter.
In May, Levy was fined $50,000 and publicly reprimanded by the board after the anonymous complaint was made public.
Investigators found that no misuse of charitable funds related to the matter, and said the employee—a former chief of staff at Beth Israel Needham who was not named in the report—was qualified for the jobs she held, and received compensation that was consistent with the position and her experience.
However, investigators said Levy's personal relationship with the employee, who left in November 2009, created the perception among other employees that her employment, her qualifications for the jobs created for her, and her six-figure compensation package were influenced favorably by that relationship.
Levy hired the employee when he joined BIDMC in 2002 and their relationship continued throughout her tenure, despite warnings dating back to 2003 from some board members and executives that the relationship was raising concerns. No action was taken, however, before the employee resigned in November, 2009. Investigators said BIDMC leadership waited too long to act.
"Had (Levy) been called on his failure to act, or had his failure to act been reported to the entire board, this acknowledged 'lapse of judgment' might never have occurred. For senior managers who reported to Levy, demanding a response was likely difficult. For board members, it was their job," Assistant Attorney General Jed M. Nosal concluded in the report.
Nosal said that respect for Levy and his accomplishments may have created a level of deference from the board that colored their better judgment. "Oversight of management is a primary duty and responsibility of a governing body and this unfortunate and preventable situation should serve as a stark reminder to all boards of the importance of diligent and independent management oversight," Nosal said.
The AG's report is sure to reignite debate over whether Levy—who until the complaint was made public, was an outspoken proponent of hospital transparency—should remain on the job. Hours after the AG's report was made public, the Massachusetts director of the National Organization for Women and the executive vice president of the Service Employees International Union 1199—which represents some BIDMC workers—said in a joint statement that they were "shocked by the facts in the report that demonstrate a clear pattern of governance failures by both the CEO and the board chairs."
"Many CEOs and board chairs in the private sector have been rightfully fired for much less. Taxpayers have a right to expect at least equal standards for public charities and for the executives of hospitals that receive millions in subsidies, and which is a key institution of the public trust," said SEIU's Veronica Turner, and NOW's Christina Knowles.
The two women said they would hold "emergency meetings on Thursday to determine what next steps we should take to ensure accountability for the many troubling facts and disturbing questions raised by this report."
The SEIU has been in conflict with BIDMC since before the Levy complaint and has been actively attempting to unionize in Boston teaching hospitals.
LifePoint Hospitals, Inc. has purchased Sumner Regional Health Systems in Nashville for $145 million and will change the name to HighPoint Health System.
The Brentwood, TN-based private hospital chain has committed $60 million in capital investments in the system's four hospitals over the next decade and will provide charity care to residents in surrounding areas and inmates of Sumner County, LifePoint said in a media release.
"Sumner Regional Health Systems is an excellent addition to LifePoint's family of hospitals. The employees and medical staff share LifePoint's mission of making communities healthier," LifePoint CEO/President William F. Carpenter III says. "We look forward to working with them to enhance the scope of services available and to find new and even better ways to provide quality healthcare close to home for the residents of these communities."
The three-market HighPoint Health System employs more than 1,300 people and serves 11 counties in northern middle Tennessee. Hospitals include the 155-bed Sumner Regional Medical Center in Gallatin, one of the largest non-government employers in Sumner County, which provides cancer treatment, cardiac care, same day surgery, orthopedics, diagnostics, women's health, home healthcare and rehabilitation services; Riverview Regional Medical Center North and South, an 88-bed medical center with campuses in Carthage; and Trousdale Medical Center, a 25-bed critical access hospital in Hartsville. All facilities are accredited by The Joint Commission.
With the acquisitions,LifePoint now operates 52 hospitals in 17 states.
The merger of healthcare information technology providers Allscripts-Misys Healthcare Solutions, Inc. and Eclipsys Corp. has been finalized, now officially called Allscripts Healthcare Solutions, Inc.
The merger creates one of the nation's largest exclusively HIT providers, with more than 5,500 employees and combined 2009 pro forma revenues of approximately $1.2 billion. Atlanta-based Eclipsys has 2,800 employees, more than 6,000 healthcare clients, and annual revenues of $515.8 in 2008. The new Allscripts will have a client base of 180,000 physicians, 1,500 hospitals and 10,000 nursing homes, homecare agencies and other post-acute organizations—the largest network in healthcare.
"Our vision is to create a connected community of health to put the right information in the hands of all stakeholders at the right time, empowering them to deliver world-class outcomes, for both their patients and their organizations," said Allscripts CEO Glen Tullman.
"No company has a larger footprint in healthcare, crossing the entire spectrum of provider organizations from hospitals to physicians to nursing homes, home care agencies and other post-acute providers," Tullman said.
He said the new company can address the lack of connectivity that is plaguing the U.S. healthcare system, which makes it difficult for providers in hospitals, physician offices, nursing homes and other care settings to access and share patient care information.
He cited a Harvard School of Public Health survey published last month that showed that only about 12% of US hospitals had a basic electronic health record in place in 2009, and that physician practices and post-acute settings aren't doing much better.
By connecting physicians, nurses and other healthcare providers to real-time information provided by its own and third-party systems, Tullman said, Allscripts can deliver a single patient record at any time to providers across care settings.
Phil Pead, chairman of Allscripts and the former CEO of Eclipsys, said the merger creates an attractive product as the healthcare industry prepares for the $30 billion in federal funding for HIT implementation. "There is a level of excitement from both the market and from our clients that we are now positioned to make the connected community of health a reality for providers and patients," Pead said.
The new company will also offer:
A portfolio of systems for hospitals including Sunrise Acute Care, used by hospitals with more than 200 beds; the Helios line of connectivity systems; the Enterprise Performance Management system; and the Allscripts Care Management and discharge management systems.
Physician practices software of all sizes, including Electronic Health Record, ePrescribing, Practice Management and Revenue Cycle.
Post-acute care systems for skilled nursing facilities, homecare agencies and other extended care organizations for electronic patient referrals from hospitals.
A platform that uses Microsoft.NET and other technologies to integrate hospital and physician practice data.
An "open architecture" approach that simplifies connections to third-party applications across care setting, providing a single patient record.
Thomson Reuters has acquired healthcare benefits auditor and expense management consultants Healthcare Data Management, Inc., effective immediately. Financial terms were not disclosed.
King of Prussia, PA-based HDM will immediately become part of the Healthcare & Science business of Thomson Reuters, headquartered in Ann Arbor, MI. Thomson Reuters said in a media release that the acquisition will enhance its ability to remove healthcare waste, make cost and quality more transparent, and support compliance needs for payers. The acquisition is also expected to strengthen Thomson Reuters' audit and payment integrity capabilities, including medical, prescription drug, provider, eligibility, and plan design.
"Healthcare Data Management brings unmatched expertise in health benefits auditing and expense management reporting solutions," said Jon Newpol, executive vice president at the Healthcare & Science business of Thomson Reuters. "Together, we're poised to meet the increased demand for auditing and compliance due to the Sarbanes-Oxley Act, the healthcare reform law, and an overall focus on eliminating waste from the healthcare system."
Newpol said HDM's BenefitsAudit and BenefitsWatch business lines will allow Thomson Reuters to expand services for employer and government markets. "As a result, our new Audit & Compliance offering will support both retrospective and ongoing assessments of claims data," he said.
HDM was one of the first companies to build model employee health benefit plans and use data to monitor plan performance. The company also provides consultations for self-insured health benefit plans that are managed by plan administrators and pharmacy benefit managers.
