Maybe it was the heated debate on “death panels,” or the inflamed rhetoric about “socialized medicine” and “rationed care,” or the arcane complexity of the sweeping reforms.
Whatever the reason, another online poll shows that most Americans are confused by the healthcare reform law. The Harris Interactive/HealthDay poll found that a majority of the 2,104 adults who took the online survey from July 15-19 could correctly identify only four of 18 reforms included in the new law.
About 58% of adults polled know that the reform package will prohibit insurers from denying coverage to people because they are already sick; 55% know the law permits children to stay on their parents' insurance plan until age 26; and 52% realize that people who don't have insurance will be subject to financial penalties. Half are aware that employers with more than 50 employees will have to offer their workers affordable insurance.
Among other findings: 63% of those polled either aren't sure or don't know if the new law will increase the number of people eligible for Medicaid, (it will); 79% don't know or aren't sure if drug companies will pay an annual fee, (they will); 73% don't know the law establishes a new tax on the sale of medical devices; 66% don't know or aren't sure if the legislation will result in insurance exchanges where people can shop for insurance, (it will); and about 82% think the bill will result in rationing of healthcare, or aren't sure if it will. (It won't).
"The problem for the Obama administration is healthcare reform is fiendishly complicated because the healthcare system is fiendishly complicated, and it is not politically feasible to tear up the system and build it again," says Humphrey Taylor, chairman of the Harris Poll. "Instead you have to build on the system that you have. When you try to build on a fiendishly complicated system, you have fiendishly complicated reforms."
Another cause of the confusion is the long and heated political debate that surrounded the bill before it was passed, Taylor says. "The level of ignorance and misinformation is sort of astounding," he says. "It seems people are still reacting to the rhetoric, not the substance of what is in the bill, because they don’t actually know what is or is not in the actual legislation."
The Harris findings jive with a National Council on Aging poll released Monday which shows that only 17% of 636 seniors surveyed knew the correct answers to more than half the factual questions posed about key aspects of new law, particularly as they relate to Medicare, and only 9% knew the correct answers to at least two-thirds of the questions.
CVS Caremark has signed a 12-year contract to provide pharmacy benefit management services for 9.7 million Aetna customers.
Under the deal, announced this week, Aetna will retain its PBM and manage clinical programs, protocols and oversight of its pharmacy benefits business. CVS Caremark will serve approximately 9.7 million Aetna PBM members and administer approximately $9.5 billion in annual drug spending.
CVS Caremark will also manage purchasing, inventory, and prescription fulfillment for Aetna's mail-order and specialty pharmacy operations. The contract will go into effect on Jan. 1, 2011. As part of the agreement, Aetna will transfer to CVS Caremark approximately 800 PBM employees who will work in support of the transferred functions. Aetna will retain approximately 1,000 PBM employees.
"We worked hard to construct a strategic solution that enhances our value proposition in the marketplace in a way that creates a durable competitive advantage for Aetna and long-term value for our shareholders," says Ronald A. Williams, Aetna chairman/CEO. "Through this strategic agreement, we retain our PBM and our ability to integrate medical care with clinical and pharmacy programs and actionable data. We will add CVS Caremark's best-in-class clinical capabilities and broad market reach, enabling us to deliver better drug discounts and improved pricing and service to our customers."
CVS Caremark says its PBM platform capabilities include:
Broad access across multiple channels;
Face-to-face counseling at retail pharmacies and MinuteClinic locations, online, by phone and through specialty and mail service pharmacy support;
A Pharmacy Advisor program, powered by CVS? Consumer Engagement Engine;
Procurement, fulfillment, contracting;
Physician engagement through e.prescribing, real-time physician support, and pharmacist support.
Aetna will maintain and manage its core pharmacy benefits business, including:
Medical and pharmacy policy, including formulary and benefit design and network configuration;
Clinical integration of pharmacy and medical benefits, including integrated care management and utilization management programs;
Clinical program development, protocols and oversight;
Sales and marketing activities;
Management of member appeals and grievances;
Rebate contracting and administration;
Ownership and management of its mail order and specialty pharmacies.
CVS Chairman/CEO Thomas M. Ryan says his company?s integrated, multichannel platform will improve outcomes and save money for Aetna customers. "Aetna's selection of CVS Caremark is a testament to our integrated pharmacy care model as well as our reputation for service excellence," Ryan says.
Vestar Capital Partners V, L.P., a private equity firm, will purchase healthcare ratings company HealthGrades, Inc. in a deal valued at $294 million, the two companies jointly announced Wednesday.
The purchase price—$8.20 per share for approximately 35.9 million shares—represents a 32% premium over HealthGrades' 30-day average closing stock price, and a premium of approximately 29% over the closing price of HealthGrades' common stock on Tuesday, the last trading day prior to today's announcement.
The agreement, unanimously approved by the board of directors at Golden, CO-based HealthGrades, calls for Vestar to make an all-cash tender offer no later than Aug. 10.
"We are pleased to announce an agreement of HealthGrades to be acquired by Vestar Capital Partners,? HealthGrades CEO/Chairman Kerry Hicks said. ?We believe the acquisition price of $8.20 per share, which represents a premium of approximately 32% over our 30-day average closing stock price, represents a strong return for our stockholders and is a great confirmation of all of the efforts of our management team and all of our employees."
HealthGrades executives, who own approximately 21% of HealthGrades' shares, have agreed to support the transaction and sell their shares to Vestar. After the tender offer, Vestar will acquire all of the remaining publicly-held shares of HealthGrades at $8.20 per share through a second-step merger.
The deal includes all shares of common stock outstanding, securities convertible into common stock, and shares of common stock issuable pursuant to a non-compete agreement with an executive officer.
The Agency for Healthcare Research and Quality's annual release of state-by-state quality data now has data on health insurance, including healthcare quality categorized by private insurance, Medicare, Medicaid and the uninsured, AHRQ announced Tuesday
“The addition of the insurance information to the State Snapshots adds one more dimension to the picture of health care quality and disparities in individual states and regions,” says AHRQ Director Carolyn M. Clancy, MD. “The 2009 State Snapshots continue to evolve into an invaluable resource for state officials and other stakeholders.”
The health insurance section allows users to compare payer-specific quality rates as well as differences among payers. For example, a state can compare the quality of care received by Medicaid or uninsured patients with that received by these same patients nationally. In addition, a state can assess whether its insurance-related disparities are larger or smaller compared with the nation as a whole, AHRQ says.
Snapshots provide state-specific healthcare quality information, including strengths, weaknesses, and opportunities for improvement. Overall, states get mixed reviews for the quality of care they provide. As in previous years, AHRQ's 2009 State Snapshots show that no state does well or poorly on all quality measures.
Maine, Maryland, Wyoming, South Carolina, and the District of Columbia showed the greatest improvement. The five states showing the smallest improvement were North Dakota, Texas, West Virginia, Nebraska, and Washington State. For each state, specific clinical conditions could be identified that account for different rates of improvement.
The 2009 State Snapshots summarizes healthcare quality in three dimensions: types of care (preventive, acute, and chronic care), settings of care (hospitals, ambulatory settings, nursing homes, and home healthcare) and clinical conditions (cancer, diabetes, heart disease, maternal and child health, and respiratory disease). There are also special focus areas on diabetes, asthma, Healthy People 2010 objectives, clinical preventive services, and disparities.
Snapshots also provide more ways to analyze the quality of healthcare for each state compared with all states, as well as with states in the same region. New and enhanced features include sections on asthma care, diabetes care, and healthcare disparities.
State-level information used to create the State Snapshots is based on data collected for the 2009 National Healthcare Quality Report.
The American Medical Association and the Medical Group Management Association jointly unveiled a toolkit today that’s designed to help physicians pick the most appropriate and cost-effective software to run their practices.
“Selecting the right software to manage a practice has become increasingly challenging due to the rapidly-changing health care environment,” says AMA President Cecil B. Wilson, MD. “Physicians who submit claims and do other business functions electronically and those who plan to participate in the government’s EHR incentive program will need to upgrade or replace their current practice management software (PMS). The AMA is pleased to offer physicians guidance to make this transition smoother.”
The toolkit—Selecting a Practice Management System—is free to AMA and MGMA members on their associations’ Web sites. Physician practices can use this information to establish their organizational needs and take advantage of recent improvements in automation. AMA and MGMA said in a joint announcement.
“Now that many of the public and private health plans have committed to streamlining practice revenue cycle management, the last piece of the puzzle is to ensure that the PMS software can take full advantage of those opportunities. We anticipate that this new toolkit will be an essential reference for physicians and practice staff,” says MGMA President/CEO William F. Jessee, MD.
The new toolkit provides:
a five-step guide to PMS software selection,
a checklist of PMS software features and functionalities that physician practices can use to determine what their practice needs, and
a sample “request for proposal” that physician practices can use in their negotiations with PMS software vendors.
An online directory of PMS software vendors that includes self-reported PMS software features and functionalities will be added to the toolkit by the end of the year.
Health Management Associates, Inc. announced Tuesday that it will acquire the two-hospital, not-for-profit Wuesthoff Health System in Melbourne and Rockledge, FL for $145 million. The purchase is expected to be completed by Oct. 1.
Wuesthoff Health System includes the 291-bed Wuesthoff Medical Center-Rockledge, and the 115-bed Wuesthoff Medical Center-Melbourne, both of which are located in Brevard County, along the Atlantic Coast of Central Florida.
“For nearly 70 years, the Wuesthoff Health System has served the healthcare needs of Brevard County and its adjoining communities, and Health Management is pleased to have the opportunity to continue that tradition of service as we seek to enable America’s best local health care,” says Gary D. Newsome, president/CEO of HMA. “We look forward to the opportunity to work closely with the Wuesthoff physicians and associates to provide them with the processes, capital and expertise necessary to fulfill their local mission of delivering superior health care to the region.”
Wuesthoff Health System generates approximately $290 million of annual net revenue and is centrally located on Florida’s east coast. Wuesthoff Medical Center—Rockledge and Wuesthoff Medical Center—Melbourne, located less than 40 miles and 20 miles, respectively, from HMA’s Sebastian River Medical Center in Sebastian, will create a network of HMA services for cardiac, neurosurgical and other services, Newsome said.
When the acquisition is completed, HMA and its affiliates will operate 60 hospitals, with approximately 9,000 licensed beds, in non-urban areas throughout the nation.
According to Florida Today, the health system's financial report covering the period from Oct. 1, 2008, to Sept. 1, 2009, showed that the 115-bed hospital opened by Wuesthoff in Melbourne in 2002 has been a financial burden on the company.
The Melbourne hospital had $48.1 million in assets and $66 million in liabilities, and suffered an operating loss of nearly $800,000 for the year, according to the state records.
"Health Management presented us with a solid proposal, and after careful consideration, we believe this is the best option for the residents of Brevard County, because they share our commitment to quality, affordable, and accessible healthcare" said Emil Miller, president/CEO Wuesthoff.
"This transaction will enable our associates, physicians, and volunteers to continue delivering quality care with the resources Health Management has to offer," Miller continued. "We appreciate the compassionate care that our associates have provided our patients and their families throughout the years and feel confident the excellent staff that has been assembled will continue to be an invaluable asset."
The deal marks Naples, FL-based HMA's second affiliation with a not-for-profit hospital or health system in Florida in the last two months. On May 27, the hospital chain paid $21.4 million for a 60% controlling interest in Shands HealthCare and its three money-losing hospitals.
The second quarter of 2010 was not kind to hospitals.
April posted a record 18 mass layoffs of 50 employees or more in the hospital sector. And as I reported earlier this month, hospitals reported 2,200 payroll reductions in June, which followed 2,400 reductions in May. The last time that the nation's hospitals reported back-to-back months of payroll reductions was in 2000, when 2,200 jobs were lost between January and April, according to the Bureau of Labor Statistics.
Despite the reductions, David Cherner, managing partner of Health Workforce Solutions, LLC, says he remains “bullish” on hospital hiring, and believes hospitals in several markets across the country are poised to add staff—possibly by the end of this year or the first quarter of 2011.
“Overall, the demand for healthcare labor continues to strengthen, notwithstanding the fact that there were all of these massive layoffs,” Cherner says. “There are still a lot of challenges in terms of hospitals and healthcare employers getting ready for decreased reimbursements—and having to do with a lot less. But at the same time, you can only cut patient care services so much. In order to deliver quality care, you need people.”
HWS’s Labor Market Pulse Index (LMPI) quarterly barometer of the nation’s 30 largest healthcare markets shows that key indicators were up in 20 of the nation’s 30-largest healthcare labor markets in Q2. LMPI’s basket of indicators includes temporary health workforce shortages and surpluses, facility and bed closures, announced layoffs and expansions, and local economic trends. In Q1 of 2010, only 11 markets were showing improvement.
LMPI found that near-term demand for healthcare workers is growing fastest in Orlando, San Francisco Bay and Detroit in the second quarter, while the Las Vegas, New York City, and Houston markets ranked at the bottom of the 30 markets tracked. “There are select parts of the country that are still weak,” Cherner says. “But on the whole, the healthcare labor market as measured by our composite index, continues to strengthen.”
Cherner says much of the growth is fueled by expansion plans and large-scale hiring announcements, most notably at the University of Michigan Health System, Ann Arbor; the Henry Ford Health System, Detroit; the University of California San Francisco Mission Bay Hospital; and the University of California-San Diego Medical Center.
“We are seeing folks cut as much as they could over the last couple of years. They can’t cut anymore. At the same time you have all these expansion projects that we have been chronicling over the past year or two that continue, and some of them are coming on line later this year and early next year. You are going to need folks to staff those facilities,” he says.
“Our bet is that in the next two to three quarters you are going to start seeing an increase in hiring. My sense is that there is a lot coming on at the end of this year, and the first quarter of next year. There will be a lot of staffing ahead,” he says.
“We expect that this collaborative affiliation with Miami Children’s Hospital will take the already great level of pediatric emergency room care at Palms West Hospital to an even higher level,” said Bland Eng, CEO of Palms West Hospital. “Palms West is looking forward to working with one of the most respected names in pediatric healthcare to provide enhanced pediatric emergency care.”
The 289-bed, not-for-profit Miami Children's Hospital is South Florida’s only licensed specialty hospital exclusively for children, with more than 650 attending physicians and more than 130 pediatric subspecialists.
“Miami Children’s Hospital has grown to become a regional healthcare system for the children of South Florida. Through this new collaboration with our esteemed associates at Palms West Hospital, we look forward to offering enhanced convenience for the families of Palm Beach County,” said Narendra Kini, MD, president/CEO of Miami Children’s Hospital. “This affiliation is part of our commitment to being ‘where the children are.’”
A report detailing record-long waits at the nation's emergency departments comes as no surprise to emergency physicians, who say waits will lengthen as health coverage expands, emergency departments close, and hospitals fail to improve admitting processes.
Angela Gardner, MD, president of the American College of Emergency Physicians, says the four-hours-and-seven-minutes average wait at the nation's EDs—detailed in Press Ganey's 2010 Emergency Department Pulse Report: Patient Perspectives on American Health Care— threatens patient safety.
"Nobody can possibly call a national average of more than four hours in the emergency department something to cheer about," Gardner says. "Last year the GAO reported that even patients who need to be seen in 1 to 14 minutes are waiting an average of 37 minutes for care. Emergency physicians have become masters of improvisation and troubleshooting under extreme conditions, but the fundamental problems in our emergency departments remain unsolved."
The Press Ganey report is based on evaluations of more than 1.5 million patients treated at 1,893 hospitals in 2009. The 2009 average wait was a four minute increase over 2008 wait times, and a 31-minute increase since reports were made available in 2002.
Gardner said hospitals aren't doing a good job of admitting patients through the ED, which creates a backlog. "Hospitals need to stop boarding admitted patients in the emergency department and get them to the appropriate inpatient floor quickly," Gardner says. "That is what's best for the admitted patients but it's also what's best for the patients suffering in the waiting room."
ACEP has called for hospitals to implement the full-capacity protocol, which Gardner says hospitals have been reluctant to embrace.
Gardner says the problems of long ED waits will worsen with the implementation of federal healthcare reform laws, which will expand health insurance coverage to more than 30 million people.
"Policymakers and the public should also have no illusions that the recently passed healthcare legislation is going to decrease ER use," she says. "Massachusetts, which enacted healthcare reform in 2006, has seen an increase in emergency department visits, with no decrease in patient acuity. It proves that healthcare coverage is no guarantee of healthcare access."
Exacerbating the problem even more, Gardner says, is the number of EDs that have closed in recent years. "More patients plus fewer ERs equals longer wait times," she says. Early one-quarter of hospitals report periods of ambulance diversion because they are over capacity. A longer ride to the hospital is not good medicine."
Utah had the longest wait, with an average emergency department time of 8:17—early an hour and a half longer than the state's average time spent last year. Iowa had the shortest average time spent at just under three hours (2:55), followed by South Dakota (2:59), North Dakota (3:07), Nebraska (3:08) and Minnesota (3:11). More than half the states were able to improve wait times or keep increases to a minimum. Nevada made the biggest improvement in 2009, reducing average wait time by 66 minutes since 2008.
"This report is yet another wake-up call that healthcare reform has yet to address the acute care needs of 123 million emergency patients a year," Gardner said. "They may report being satisfied with the care they are receiving in the ER, but emergency physicians are dissatisfied with an average time in the emergency department that is nearly equal to a coast to coast airplane ride."
An updated Massachusetts Hospital Association in-house study released this week shows that member hospitals in the Bay State trimmed $3.1 billion in operating expenses in the past two fiscal years.
This week's report, an update of MHA's April Hospital Costs in Context: A Transparent View of the Cost of Care report, details expenses of Massachusetts hospitals for fiscal year 2009 through the second quarter of FY 2010, and shows hospital cost trends have moderated substantially and in some cases reversed in response to the financial crisis and recession.
"The most current data shows that the trend in hospital expense growth reported earlier this year has abated," said Lynn Nicholas, president/CEO of MHA. "As a result of hospital cost management efforts, expense increases fell 65% from 2008 to 2009—from 8.6% to just 3%."
"All told, we're estimating hospital expense reductions worth some $3.1 billion in Fiscal Years 2009 and 2010. Expense growth has dropped back to very moderate levels, and this welcome change should be acknowledged by state policy makers and insurers," Nicholas said.
At the same time, payments to hospitals for the last two fiscal years were reduced more than $2.4 billion than they would have been had the FY 2004 – FY 2008 operational expenses trend continued, the study said.
Savings were found in the elimination of clinical and administrative positions, programs and services; cuts in compensation and benefits; changes in purchasing strategies, implementation of quality and process engineering techniques, and reduced non-essential spending, the report said.
"As the FY 2009 figures show, Massachusetts hospitals have responded to the call for cost reduction by health plans, government, and employers," Nicholas said. "Some of these changes were sparked by the economic downturn, but all the changes were driven by hospital initiative, and hospitals will strive to sustain this progress as part of our contribution to lasting reform and bending the cost curve. With real healthcare reform, the future will not replicate the past."
Nicholas said Massachusetts hospitals are committed to identifying greater cost efficiencies while maintaining quality of care, but that it needs to be implemented alongside "fundamental system reform, including fair and adequate payment to cover the cost of providing care, and adequate access to capital for health information technology and to modernize outdated facilities."
"Without these critical elements, hospitals will have to accelerate the closing of services and some hospitals may not survive. That means more than lost jobs and a drag on the economy; it means more limited access to healthcare, and that is not good for anyone," she said.
