By now—unless you've been prospecting for zinc in Siberia—you've probably read and heard about Steven Slater and his dramatic last day at work.
The JetBlue flight attendant literally pulled the chute on his career during a heated confrontation with a passenger who Slater says was acting rudely. After Slater used the jet's PA system to curse the passenger, he grabbed a couple of beers, popped open the emergency exit, waved goodbye, and swooshed down the inflatable slide into unemployment and jail. His meltdown became the stuff of legend and created a throng of admirers for a man who—for many—has become the living embodiment of a Johnny Paycheck song.
Some scolds have noted that Slater's actions were unprofessional and irresponsible. In fact, the blow back for Slater—always predictable in the media saturation cycle—has already started with investigators questioning passengers on the flight and the flight attendants about their versions of the events.
Was he irresponsible? Of course! That's why his stunt reverberates with so many working and middle class Americans who've had their fill of being responsible and playing by the rules their whole lives, and who still find themselves living one paycheck off the street. Is Slater's version of events the truth? I don't know. It almost doesn't matter. The specifics of the stunt are not as important as the symbolism.
This recession is taking its toll on the psyche of the American worker, and the frayed edges are showing. About 14.6 million people are unemployed, and there is no indication that their prospects are going to improve any time soon.
Many people who've been fortunate enough to keep their jobs have seen their life's savings diminish or disappear, or their home values plummet. Many haven't received a pay raise of any size in years. Some employers have stopped their match on already-battered 401(k) plans, and are using the recession as a worker retention strategy. Health insurance premiums continue to increase at a rate well above inflation, along with co-pays and deductibles, even as health insurance companies post record profits and shower their top executives with what some would argue is obscene compensation.
This is the environment in which many working and middle class Americans find themselves. And many of these same people are either employees at your healthcare workplace, or they're walking through your doors as patients.
There are obvious comparisons between the job demands on a flight attendant, and those made on a frontline healthcare professional. Both occupations bring a heavy burden of responsibility—often incommensurate with the pay—and require dealing with an increasingly resentful and irritated public, often at their worst in stressful environments. The flight attendant and the healthcare professional are often scapegoats for problems far beyond their control. The public doesn't want to hear why the plane is delayed, or why they've been waiting in pain and in fear for two hours in your ER without seeing a physician. They have a problem, and it's your fault!
We're already seeing more instances of rowdy patient behavior and outright violence in the hospital setting. Can we expect to see a sequel, perhaps "Revenge of the Nurse?" Will some fed up, angry healthcare professional "Pull a Slater" on his or her way out the door?
For the most part, the healthcare sector has been spared much recession-related misery because skilled healthcare professionals remain in demand in most parts of the country. That doesn?t mean that healthcare workers are happy, or that they're not stressed out, or that they don't carry deep frustrations about their jobs. Add a potentially volatile patient mix—and the ingredients are prepped for a major meltdown.
I cringe at phrases like "teachable moment," but that may apply with the Steven Slater affair. His stunt is something that everybody who has ever held a job can relate to, regardless of whether or not they support his actions. Can the flight attendant's farewell gesture be used to engage your employees about their own concerns, fears, and frustrations at work? What ventilation systems—if any—does your healthcare workplace provide for stressed-out employees who want to blow off steam in an appropriate way? Have you asked? Do you know?
As for Slater, there are some indications that he is remorseful, if not overwhelmed by the reaction to his stunt. The flight attendant's attorney told a throng of reporters last week that Slater—now suspended by JetBlue—hopes to get his job back. It's hard to imagine he'll return to the unfriendly skies, unless he buys a ticket. Actions have consequences, and he's already pulled the chute.
The University of Texas System Board of Regents has approved an $800 million project that includes the construction of the 424-bed University Hospital at UT Southwestern Medical Center in Dallas. The project now goes to the Texas Higher Education Coordinating Board for final approval.
The 12-story hospital is a key component of UT Southwestern's commitment to become one of the nation's top 10 academic medical centers. It will replace the aging University Hospital St. Paul, which opened in 1963.
"With the necessity of constructing this new replacement hospital came the ability to create a design that will enable us to provide patient-centric care as well as integrate our education, research, and clinical missions," said Daniel K. Podolsky, MD, president of UT Southwestern. "It incorporates forward looking approaches to patient care and embeds appropriate space to support clinical and translational research as well as education and training."
The $800 million total project also includes a dedicated thermal energy plant and facilities to support the hospital. Construction of the 1.3 million-square-foot project will start in March 2011 with completion anticipated in late 2014. University Hospital—St. Paul will remain fully operational until the new facility opens. The new hospital will be located on a 32-acre site on UT Southwestern's West Campus.
North Shore-LIJ Health System member North Shore University Hospital will buy the bankrupt Saint Vincent’s Catholic Medical Center Certified Home Health Agency for $17 million, the Great Neck, NY-based health system announced this week.
The deal, which awaits approval from a federal bankruptcy judge, provides an eight-county Certified Home Health Aides (CHHA) license for North Shore University Hospital, which includes the five boroughs of New York City, Nassau, Suffolk, and Westchester counties. North Shore-LIJ Home Care now is licensed for Long Island and Queens.
The purchase includes $17 million in cash and assumption of some CHHA obligations. North Shore University Hospital will retain CHHA workers who meet its hiring standards and will work with the unions to transition the work force.
“The ability to provide post acute services such as home care, in counties where we have hospitals is strategically important as we continue to bundle and integrate chronic disease across the continuum of care,” said Michael Dowling, president/CEO of North Shore-LIJ Health System. “Many patients do best in their home environment. With this new acquisition we’re expanding our ability to reach the number of patients who can receive clinical services in the comfort of their own homes.”
When the deal is finalized, CHHA will be part of the North Shore-LIJ Health System’s Home Care Network, which conducts more than 800,000 home health visits annually for short-term health issues such as recovery from surgery, to longer-term chronic care management of conditions such as congestive heart failure, stroke, diabetes and other illnesses.
“When you look at providing service to a community—you look at how to best meet a need with quality care,” says Mark Solazzo, executive vice president/COO for North Shore-LIJ Health System. “We know that providing quality home healthcare is essential in our area. We believe this purchase makes sense for us and for the community from both a quality and access to care perspective.”
The 15-hospital North Shore-LIJ Health System is the nation's second-largest, non-profit, secular healthcare system, with a service area that extends into Long Island, Queens, Manhattan, and Staten Island, encompassing more than 7 million people.
Falls top suicides and automobile crashes as the leading cause of injury related death in Wisconsin—particularly among the elderly—and generate nearly $800 million in hospital costs each year in Wisconsin, according to a state-sponsored report.
87% of fall-related deaths, and 70% of falls requiring inpatient hospitalization involve people aged 65 or older.
About 70% of the costs for fall-related hospitalizations and emergency department visits are paid by Medicare and Medicaid.
Of the $798 million in hospital charges stemming on falls in 2008, emergency department visits accounted for $160 million, and inpatient hospitalizations accounted for $638 million.
55.2% of falls resulting in death occur in the home, and that 40% of those admitted to a nursing home had a fall in the month before admission.
"The first step in the prevention of falls is to understand the problem, which is in part achieved through surveillance efforts such as this document," says Wisconsin Secretary of Health Services Karen E. Timberlake, in a letter introducing the 32-page study. "This report shows the extent of the problem that falling creates for our citizens, both through loss of independence and costs to the healthcare system."
Timberlake says her agency is providing copies of the report to state legislators and healthcare policy makers to raise awareness of the problem and help them devise programs to reduce falls.
The study attributes 918 deaths in Wisconsin in 2008 to falls. Wisconsin's Top 5 causes for injury-related deaths in 2008 were the following:
Suicides: 737 lives
Automobile crashes: 581 lives
Poisonings: 481 lives
Homicides: 151 lives
Even though most falls occur in the home, 51.5% of the deaths occur in a hospital. Most who suffer a severe fall receive some treatment before dying. For example, of those who were hospitalized for a fall in 2008 and died in the hospital, the average length of stay was 6.5 days, resulting in more than $26 million in charges.
For ages 65 years and older, 25% of deaths occurred in a nursing home, and 15% of deaths occurred in a facility based hospice. As the population ages, the study found that a larger share of falls occur in nursing homes and assisted living facilities, the study found.
The report does not account for time between fall and death, and does not indicate whether the individual who died was transferred between facilities before death.
WellCare Health Plans. Inc. announced Monday that it will pay about $194 million to settle a class-action securities law suit that arose from a 2007 fraud investigation.
The Tampa-based insurer said Monday's class-action settlement resolves all litigation stemming from the four-year-old investigation and—combined with other state and federal lawsuits and fines—bumps the total settlement costs in the last 15 months to about $427.5 million.
Under the agreement, which awaits approval by a U.S. District Court judge in Middle Florida, WellCare will make cash payments of $52.5 million within 30 days of approval, and $35 million by July 31, 2011. WellCare will give the plaintiffs tradable unsecured bonds at a face value of $112.5 million, with a fixed coupon of 6%, and a principal maturity date of Dec. 31, 2016.
If WellCare is sold within the next three years at a share price of $30 or more, the insurer will make an additional $25 million payment. WellCare said the settlement has been accrued in the second quarter of 2010 at approximately $194 million.
On June 24, WellCare agreed to pay $137.5 million to settle fraud allegations with the U.S. Attorney's Office in Tampa, the U.S. Department of Justice, and the state of Connecticut.
"Upon final approval of these two matters, WellCare will have addressed the financial aspects of the legal proceedings that began in late 2007," said WellCare Executive Chairman Chuck Berg said in a media release. "These resolutions will enable us to focus on our mission of serving some of the country's most vulnerable populations and to invest in our priority areas: healthcare quality and access, compliance, infrastructure and growth."
The insurer reported losses of $128.9 million, or $3.05 a share, for the second quarter of 2010, which it attributed to the settlement costs.
On May 19, 2009, WellCare paid a $10 million civil fine to the Securities and Exchange Commission to settle an investigation related to earnings statements irregularities. On May 5, 2009 the insurer paid $80 million to Florida and federal prosecutors to resolve fraud allegations stemming from its contracts with Florida Medicaid and Florida Health Kids Corp.
"We believe we will be able to meet our known near-term monetary obligations, including the terms of this settlement agreement, and maintain sufficient liquidity to operate our business," said WellCare CFO Tom Tran.
WellCare has been the subject of widespread speculation and litigation for the past four years, after federal investigators raided the insurer's Tampa headquarters, carted off boxes of documents, and grilled executives.
In 2007, WellCare stockholders filed federal and state lawsuits against former Chairman/President/CEO Todd Farha, former CFO Paul Behrens, former General Counsel Thad Bereday, and other current and former WellCare directors. On July 7, a federal court gave permission for WellCare to sue the former executives.
In late June, a federal judge unsealed a whistleblower complaint that accused WellCare of egregious conduct, including dumping hundreds of sick newborns and terminally ill patients from the membership rolls to bolster profits. Florida Attorney General Bill McCollum told Health News Florida in July that former executives at WellCare are the subject of state and federal criminal investigations.
Also Monday, WellCare announced a "strategic and organizational restructuring" that will result in layoffs for fewer than 100 employees, and the elimination of a "significant number" of open positions.
"Changes of this nature are difficult, and we are sensitive to the potential impacts to our associates, members, government customers, and business partners," said WellCare CEO Alec Cunningham. "Nevertheless, we believe these steps will strengthen our position for future opportunities and new requirements in government-sponsored healthcare programs."
WellCare provides Medicare and Medicaid managed care services for approximately 2.2 million people nationwide.
Where are you with healthcare diversity? Is your hospital or provider workplace hiring healthcare professionals who are representative of your patient demographic? Could a person who doesn't speak English, or who might have other cultural, physical, or emotional barriers, receive quality care at your facility?
And what about cultural competence in the healthcare setting? The subject crops up more these days because more healthcare professionals realize that terms such as "diversity" and "cultural competence" are not merely buzzwords but actionable strategies designed to improve outcomes.
As the nation becomes more diverse, so must the healthcare workforce. It's not a matter of political correctness. It's a matter of quality care. If you cannot communicate with a patient, put them at ease, and gain their confidence, your ability to help them is severely diminished.
A lot of this is common sense.
A recent report from in the Annals of Emergency Medicine, for example,found that professional on-site interpreters in the ED greatly improved patient?and physician?satisfaction, and likely has a positive impact on outcomes.
"The results were the same for physicians and nurses, which could be important for reducing staff burnout and errors. The improved quality of care can also reduce the likelihood that a patient will return to the ER for the same health problem," Bagchi said.
Of course!
Giving anxious patients and their families the means to communicate with hospital staff and to be updated on conditions, wait times, and course of treatment can only be a positive—especially with longer waiting times in crowded ERs.
Nobody expects that every hospital in the nation should have readily available translators for every language on the planet. But if your hospital's patient mix contains a significant minority population that you know has limited English abilities, it makes sense to either hire translators or medical professionals who can communicate with that population.
Is your hospital doing this or moving in this direction? Or, have the slow economy and the scarcity of healthcare professionals deprioritized diversity? Finding qualified staff of any race, creed, ethnicity, or culture—regardless of the patient mix—is already tough enough for many healthcare providers, and that's assuming they have the budget to add staff in the first place.
There are some indications that—whatever the reason—healthcare providers are not prioritizing diversity. For example, a recent report from the American Hospital Association's Institute for Diversity in Health Management found that only 37% of organizations earmarked specific funds for diversity and cultural competency—on average, about $424,000 annually per organization. Most of that money went towards recruiting minority staff.
I suspect that most hospitals would like to diversify staff but are probably limited by the economy and the market. At some point in the next few years, however, as the nation's healthcare system stumbles towards outcomes-based medicine, healthcare diversity will be reprioritized.
One in five Americans did not seek medical care for a recent illness or injury, with four out of 10 citing cost as the primary factor, according to a Deloitte Center for Health Solutions online survey of more than 4,000 adults.
The survey also showed a declining number of consumers reporting to have visited a physician or healthcare professional in the past year; 79% of respondents sought medical attention in 2010 as compared with 85% who did so in 2009.
"As the burden of care continues to be shifted to the individual, and more Americans lose their jobs and their health insurance, we expect this trend will continue," said Paul Keckley, executive director, Deloitte Center for Health Solutions. "It will be interesting to see what happens in 2014 when the individual mandates requiring Americans to purchase health insurance kick in. Will we see a significant spike in visits to the doctor as more Americans join the ranks of the insured?"
The survey of 4,008 adults, conducted between Dec. 28, 2009, and Jan. 5, 2010, also detailed alternative options that healthcare consumers are exploring, and found that:
15% of consumers reported visiting a retail clinic and 34% said they would do so if it cost 50% or less than the cost of a doctor's appointment.
More consumers are seeking alternative or natural remedies before seeing a physician (17% chose this option in 2010 compared with 12% in 2009).
More consumers are supplementing their current regimes with alternative remedies (20% pursue this route in 2010 compared to 16% in 2009).
Consumers are also receptive to medical tourism, but only 7% sought healthcare services outside their local community in the last 12 months.
“As consumers increasingly begin to ‘shop’ for their care, they are seeking new options—price and convenience are key drivers. Some consumers are heading to retail clinics for their flu shot instead of the doctor’s office,” Keckley said.
Some healthcare organizations have reported a decline in the use of healthcare services in their most recent quarterly earnings reports, including: declines in admissions at some hospitals, decreases in visits to the doctor, less volume for some prescriptions, and, (in some cases) a reduction in medical tests ordered.
“While some healthcare organizations are seeing a dip in utilization, this is not the case across the board,” said Russ Rudish, vice chairman and Deloitte healthcare provider practice leader.
“In fact, some hospitals and healthcare providers have also reported increased demand for healthcare services. A lot depends on geography and patient population. Overall, the healthcare provider industry is cautiously optimistic that once deductibles are hit and health insurance kicks in, the volume of activity for medical services may return.”
Medicare's financial stability was "substantially improved" by the passage this spring of the Patient Protection and Affordable Care Act, which will extend the solvency of the program for another 12 years to 2029, according to the 2010 Medicare Trustees Report released Thursday.
Despite the extended solvency, the trustees warned that Medicare is still not adequately financed over the next 10 years. "HI (Hospital Insurance Trust Fund) expenditures have exceeded income annually since 2008 and are projected to continue doing so under current law through 2013. However, the savings from the healthcare reform law is expected to generate surpluses from 2014 through 2022," the report states.
"Beginning in 2014, trust fund surpluses are estimated to occur throughout the short-range projection period and for several years thereafter. The shortfalls projected for the next four years can be met by redeeming trust fund assets, which at the beginning of 2010 were $304 billion, but the asset balance would fall below the Trustees' recommended minimum level starting in 2012 under the intermediate assumptions," the report states.
In 2009, 46.3 million people were covered by Medicare: 38.7 million aged 65 and older, and 7.6 million disabled. About 24% of beneficiaries enrolled in Part C private health plans that contract with Medicare to provide Part A and Part B health services. Total benefits paid in 2009 were $502 billion. Income was $508 billion, expenditures were $509 billion, and assets held in special issue U.S. Treasury securities were $381 billion, the report stated.
Projected costs are slightly lower overall than in last year's report, reflecting lower-than-expected costs in 2008-2009, which were partially offset by higher benefits from phasing out the coverage gap.
The report says the largest projected savings under the healthcare reform law comes from lower annual increases in the prices Medicare pays for services by hospitals, skilled nursing facilities, home health agencies, and most other providers. Payment increases will be reduced by the increase in "multifactor" productivity for the economy overall, which is about 1.1% per year.
Other provisions reduce Medicare costs through lower payments to private Medicare Advantage health plans. The tax hike of .9% of earnings above $200,000 for single taxpayers or $250,000 for married couples also directly benefits the Medicare Trust Fund.
Projected costs for Part B are also lower because of the health reform law, the report states. Part B spending now approximates 1.5% of Gross Domestic Product. Last year's Trustees report projected that would increase to 4.5% by the end of the 75-year projection period. However, now, under current law, it is projected to reach only 2.5% of GDP by the end of the trustees' 75-year projection period.
Part B is in financial balance because beneficiary premiums and general revenue financing are reset each year to match the expected costs for the next year.
However, the trustees said that actual Part B costs are likely to exceed current projections because Congress will continue to override Medicare payments cuts to physicians. Under the "sustainable growth rate" formula, physician payment rates would have to be reduced by about 23% on Dec. 1, 2010, a further 6.5% on Jan. 1, 2011, and 2.9% on Jan. 1, 2012.
The Medicare Part D prescription drug program is also balanced because of annual updating of enrollee premiums and federal payment rates.
The Medicare trust fund has not met the Trustees' formal test of short-range financial adequacy since 2003. In addition, the HI long-range actuarial deficit has been reduced to .66% of taxable payroll, which is one-sixth of its projected amount prior to the new health reform law, the report stated.
The Medicare Trustees are: Treasury Secretary and Managing Trustee Timothy F. Geithner; Health and Human Services Secretary Kathleen Sebelius; Labor Secretary Hilda L. Solis; and Social Security Commissioner Michael J. Astrue. Two public representatives to the board who are appointed by the president are vacant and the president's nominees await Senate confirmation. CMS Administrator Donald M. Berwick, MD, is the secretary of the board.
Press Ganey Associates, Inc. announced today that it has acquired the Quality Indicator Project division from the Maryland Hospital Association. Financial terms of the purchase were not disclosed.
Launched in 1984, QI Project was one of the first clinical performance measurement programs to use advanced data collection to help hospitals identify and improve quality measures.
Press Ganey CEO Richard B. Siegrist Jr., says the QI acquisition will bring to more than 500 the total number of U.S. hospitals that use Press Ganey to meet clinical reporting requirements.
"The experienced staff and robust tools of the Quality Indicator Project enhance our proficiency in this increasingly important area for hospitals," Siegrist says. "This new solution coupled with our current products will give our clients a timely and accurate picture of their clinical performance and will allow them to identify changes and improvements right away."
QI Project is housed in a Web-based data center which provides real-time data at different levels. Clients have a single vantage point for managing the performance measurement and assessment process, from data collection and management, to transmission and analysis.
"Press Ganey can make the investment QI Project and IQIP need to maintain and expand not just market share, but scope of work. The new owner will also be able to tap into the power of its wide and refined distribution network to achieve that goal," says Carmela Coyle, MHA President & CEO.
"Their vision of using performance measurement to improve quality aligns perfectly with that of QI Project and IQIP," she adds. "Press Ganey sees both as a perfect fit of people and culture, with a solid underlying strength and a similar approach to helping customers that, given adequate capitalization and full resources, can truly realize its potential in a growing market."
In addition to the immediate actionable data, QI clients have access to training and support staff to interpret data and design improvement plans.
"This fits well with Press Ganey's strategy of streamlining and integrating performance data with analysis and improvement tools to help clients drive alignment across their organizations," Siegrist says.
UnitedHealth Group's IT subsidiary Ingenix says it is acquiring compliance and medical management consultants Executive Health Resources, with undisclosed financial terms to be finalized by the year's end.
Ingenix, based in Eden Prairie, MN, says the acquisition will improve its ability to help hospitals manage medical necessity compliance with the CMS at a time when patient volumes for government-sponsored plans are expected to grow.
"The expertise and evidence-based clinical insights that Executive Health Resources and its outstanding team provide, combined with Ingenix's unmatched health information and analytics capabilities, will help our clients thrive in the evolving regulatory environment for health care," says Ingenix CEO Andy Slavitt.
Federal and state laws require hospitals to perform compliance reviews for medical services provided to patients covered by Medicare/Medicaid to ensure that the care is medically necessary and delivered in the proper setting. Congress expanded federal auditing oversight in 2006 to all 50 U.S. states to reduce federal payment discrepancies with hospitals.
"The regulatory landscape is complex and ever-changing, and compliance has become a crucial aspect of a hospital's operational integrity," says Robert Corrato, MD, president/CEO of Newtown Square, PA-based Executive Health Resources. "As we continue to support our clients in this rapidly growing market with solutions that simplify the compliance process, Ingenix's impressive data assets and sophisticated technologies will help us to more quickly deliver critical, technology-enabled intelligence for our clients."
Executive Health Resources advises more than 1,100 hospital and health systems nationwide, including for-profit and non-profit systems, academic medical centers, community hospitals, and specialty centers.
