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.
Radiologists and anesthesiologists remain among the best paid physicians, but internists received large pay increases in the past year, according to the 2010 LocumTenens.com Physician's Salary Survey.
The survey, conducted this spring, received responses from 1,703 physicians and Certified Registered Nurse Anesthetist (CRNAs).
It found that internists' salaries in 2010 averaged $191,864, a 6.6% increase over the $179,958 average salary in 2009. However, internists' annual salaries remain well below that of subspecialists like radiologists, who reported an average salary of $398,571 in 2010, up 5.1% from the 379,140 average reported in 2009.
The survey also found that anesthesiologists reported an average salary of $362,450 in 2010, up 2% from the $355,264 reported in 2009; psychiatrists' salaries averaged $202,975, up from $201,683 in 2009; surgeons' average salaries fell from $287,520 in 2009, to $284,642 in 2010. Since 2007, surgeons' average salaries have fallen $7,462, or 2.5%, from $292,104 to $284,642, according to the LocumTenens survey.
Certified registered nurse anesthetists also saw their average salaries fall from $178,068 in 2007, to $169,043 in 2009, to $166,833 in 2010, an overall drop in the last four years of $11,235, or 6.3%.
The Alpharetta, GA-based physician recruiting firm also provides salary breakdowns by region, years in practice, and gender. Survey respondents are physicians who practice on a locum tenens basis as well as those with permanent salaries. Respondent demographics included in the reports include region of practice, board certification, and time frame for making next job change.
In a separate survey released last week, the American Medical Group Association found that 76% of all specialties saw an increasein compensation, with the overall weighted average increase of approximately 3.4%. The primary care specialties' (excluding hospitalists) average compensation increase was about 3.8%. Other medical specialties had on average a 2.4% increase, and surgical specialties had a 3.8% average increase.
The Locum Tenens findings are also in line with those issued in mid-July by Dallas-based physician recruiters Merritt Hawkins, which noted that recruiting was down in 2009-10 for the first time in the 17-year history of the survey, even though there is nothing to suggest that demand has abated.
The average return on investments for 85 nonprofit healthcare organizations reviewed by the Commonfund Institute improved to 18.8% in Fiscal Year 2009. It was the best year for investments in nearly a decade.
The Commonfund Benchmarks Study of Healthcare Organizations results for FY2009 represent a dramatic improvement over average losses of -21.2% reported for FY2008.
The 2009 return was the highest in the eight years the study has been conducted, and came in the year following the poorest return of the eight studies. The 85 participating organizations represented $76.8 billion in investable assets and $26.8 billion in defined benefit plan assets as of Dec. 31, 2009.
Investable assets include endowment and foundation funds, funded depreciation, working capital and other separately treated assets.
For the previous three years, nonprofits in the study reported average annual returns on their investable assets of -0.2%, while for the past five years participants reported average annual returns of 3.5%.
The average 2009 return for study participants' defined benefit pension plans was 21.5%, compared with last year's return of -26.3%. Returns on defined benefits plan assets averaged -.8% for the previous three years and 3.9% for the previous five years.
"FY2009's results represented welcome and much-needed relief after the dismal FY2008," said John S. Griswold, executive director of the Wilton, CT-based Commonfund Institute. "Still, the fact remains that the average return of 18.8% was not enough to move trailing three-year returns into positive territory and the average 3.5% return for the five-year period is well short of covering healthcare organizations' spending and investment and costs, plus the added impact of inflation."
Based on asset class, international equities provided the strongest return, an average of 37.3% for study participants. Returns for other asset classes were: domestic equities, 31.2%; fixed income, 11.7%; alternative strategies, 17%; and short-term securities/cash, 1%.
The negative returns came from subcategories of the alternative strategies allocation. Private equity real estate fell -25.8%; venture capital, fell -10.5%; and private equity fell -7.2%.
Other alternative strategies allocations were very strong, however, as commodities and managed futures produced a 32% return, energy and natural resources returned 28.2%, and distressed debt returned 20.8%.
"If we go back to the study for FY2007¬ before the losses of FY2008 ¬trailing returns for three- and five-year periods were 9% and 11.1%, respectively. Returns at levels such as these are essential for the long-term health of the nonprofit healthcare community," Griswold said.
For the fifth consecutive year, participating nonprofit healthcare organizations reported higher average debt levels in 2009. Overall, debt rose to an average of $903 million from $681 million in FY08. The largest increase in dollars came from organizations with assets of more than $1 billion, where debt increased to an average of $2.6 billion from $2.2 billion a year ago. Forty-five percent of responding organizations confirmed that they had increased debt in FY09.
At the same time, 41% reported decreasing debt in FY09. Only 14% said they made no change in debt levels this year. When compared to other areas of the nonprofit sector, nonprofit healthcare organizations realized lower returns.
In addition, 173 independent and community foundations in the Commonfund study posted an average return of 20.9% for FY2009, and 66 charities in the study saw an average return of 21.5%.
Aurora Health Care said it will open Wisconsin's first entirely green hospital in Grafton on Nov. 1.
The 106-bed, 520,000-square-foot Aurora Medical Center in Grafton cost $184 million, and will provide integrated care for thousands of residents in Ozaukee County, north of Milwaukee, Aurora said in a media release.
The hospital is nearly 80% complete, including most of the exterior. At the end of summer medical equipment to support surgeries, diagnostics and rehabilitation will arrive, with installation expected to take three months to complete. After that, the equipment will undergo testing and certification, Aurora said.
Aurora Medical Center in Grafton is being built to Leadership in Energy & Environmental Design (LEED) standards, which provides third-party verification that a building was constructed using environmentally friendly processes.
The original plans in 2007 called for Aurora Medical Center in Grafton to have 89 beds. Another 18 beds were added in the final design to account for anticipated increases in patient volume from physicians who have joined Aurora and Aurora Advanced Healthcare. The adjustment also reflects the projected rise in orthopedic surgeries based on demographic data.
The non-profit hospital will offer specialty services including cardiac, cancer, and neurological care, a 24-hour emergency department, an orthopedic center, a neonatal ICU, and advanced technology for diagnoses and treatments.
Milwaukee-based Aurora Health Care operates 13 nonprofit hospitals and 140 clinics in eastern Wisconsin. The medical center will bring more than 600 jobs to the area.
