Emergency physicians are more likely to honor the requests of women and racial minorities to see a doctor of their same gender, race, or religious background, a University of Michigan Health System-led study shows.
One-third of the 176 physicians surveyed at the American College of Emergency Physicians Scientific Assembly said patients perceive they get better care from racial, gender, or ethnic matching, even though there is no evidence to support that perception.
The U-M study—conducted with the University of Rochester, and University of Pennsylvania—showed Muslim patients were the most likely to have their request accommodated.
Women and minorities appear more likely to make a doctor request, and female physicians are more supportive of that request than are male physicians, according to the study published in the Journal of Emergency Medicine.
“Some patients prefer, and are more satisfied with, providers of the same gender, race, or faith,” says lead author and Robert Wood Johnson Clinical Scholar Aasim I. Padela, MD, an emergency physician at U-M. “This study is the first to look at the culture of accommodation in the emergency department.”
Black patients tend to rate black providers higher in quality and Hispanics are more satisfied with care received from Hispanic providers. Similarly a large percentage of Asians seek care from providers of a similar background.
Padela says the reasons patients make the request are more complex than doctors may think, and can include prior discrimination, feelings of a lack of cultural sensitivity, and language difficulties.
Physicians appear unaware of these patient experiences, which could affect physicians’ attitude toward honoring patient requests and strategies to improve workforce diversity, Padela says. Roughly 80% of the nation’s emergency physicians are white.
The study showed that greater physician diversity is one solution for addressing racial health disparities because physicians and patients who share common values and language are more likely to develop stable healthcare relationships.
“Within healthcare, and particularly within the emergency department, provider and patient matching is not entirely possible, nor in line with our value system,” Padela says. “A better approach is to enhance cultural sensitivity and compassionate care.”
After three years of decline, the nation’s stand-alone, not-for-profit hospitals stabilized balance sheets in 2009 and saw improvements in other key operating metrics. This results in pre-recession levels similar to 2006. This improving trend is expected to continue through 2010, despite the uncertainty surrounding the economy and healthcare reform, according to Standard & Poor’s.
“Since the 2008 median report and in response to the broader global economic challenges that began in late 2007, we have seen management teams at many hospitals sharpen their focus on tightening expenses and strengthening revenue cycle performance, which has yielded better operating margins in many cases,” S&P states. “At the same time, the investment and financial markets have shown signs of recovery this past year after much instability. We believe that along with more prudent management of capital investments and spending levels, this helped stabilize balance sheets for many rated stand-alone hospitals.”
S&P says the improvement is reflected in fewer credit rating downgrades in the first half of 2010, and nearly as many upgrades as downgrades.
“In our opinion, management teams spurred operational improvements by returning to the basics with a focus on strengthening market positions, improving processes, and reducing costs,” S&P says. With severe constraints on non-operating revenue, S&P said many hospitals exerted tighter control of expenses and held off on major capital projects to focus on operations and to retain cash balances.
“More specifically, these stricter expense policies included tighter staffing levels and focus on patient-throughput processes as well as salary and benefit freezes or cutbacks,” S&P says.
For the past decade, S&P said, stand-alone, not-for-profit hospitals have been a good credit risk thanks to strong non-operating income, growing liquidity, and solid operations. However, the recession has created a challenging environment.
“We are optimistic about the initial improvement reflected in the 2009 medians and fiscal 2010 year-to-date results. However, we are also mindful of ongoing economic and industry pressures such as weaker volumes, potential state Medicaid funding reductions, capital upkeep needs, and the still unknown impact from the passage of the Patient Protection and Affordable Care Act,” S&P says.
Providers are showing improved performance using expense-control measures, but there is still the question of: can these gains be sustained?
The financial performance of individual hospitals often was influenced by their respective fiscal years. For example, hospitals that ended their fiscal year on June 30, 2009, were more likely to report depressed non-operating earnings, while hospitals that ended the fiscal year on Dec. 31, 2009, were more likely to enjoy stronger earnings because of improving investment markets, and because the hospitals had recorded their biggest investment losses in the previous fiscal year.
Patients last year averaged a record of four hours and seven minutes spent in the nation’s emergency departments—a four minute increase over 2008 wait times, and a 31-minute increase since reports were made available in 2002, according to a new review from Press Ganey Associates, Inc.
Press Ganey’s 2010 Emergency Department Pulse Report: Patient Perspectives on American Health Care, is based on evaluations of more than 1.5 million patients treated at 1,893 hospitals in 2009.
Utah had the longest wait, with an average emergency department time of 8:17—nearly 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.
“Although the overall national average wait time increased slightly, what we found encouraging is that 32 states had either reduced wait times or held increases in wait times to five minutes or less over the previous year,” says Deirdre Mylod, vice president, hospital services, Press Ganey. “Some states have done really well in keeping emergency department times in check, despite growing challenges of higher patient volumes and understaffing. But there’s still a long way to go to make visits to the emergency department much more efficient for patients.”
Despite longer waits, patient satisfaction with hospital emergency departments stayed about the same in 2009, continuing a five-year upward trend. Press Ganey says providing a patient with good emergency department experiences requires communication. Patients are willing to wait for care as long as they are kept informed about wait times. Patients who waited more than four hours, but received “good” or “very good” information about delays were just as satisfied as patients who spent less than one hour in the emergency department. Patient evaluation of communication about delays is identified as a key driver nationally of satisfaction.
“Patients would, of course, prefer a more efficient process,” says Mylod. “But good communication helps them understand the processes within the emergency department environment and shows them that staff has not forgotten them. Frequent, proactive communication improves both the quality of patient care and the manner in which patients perceive their care.”
Many hospitals are instituting procedures such as whiteboards in exam rooms to keep patients informed about treatments or delays. Also, welcome letters or pamphlets provided by the hospital help patients understand the process of triage, and prioritized treatment.
A long wait time might not be indicative of the emergency department’s performance. Instead, it could be a symptom of a larger patient flow issue in the hospital that keeps the patients in the emergency department when inpatient beds or testing equipment are not readily available.
Another factor impacting patient satisfaction with emergency departments is the time of day patients arrive. According to the report, patients who arrive between 7 am and 3 pm evaluate their care much more favorably than those who arrive after 3 pm. Patients who arrive in the emergency department on Monday and Tuesday rank lowest in terms of patient satisfaction, while Saturday and Sunday evaluations of care are the highest.
Among metro areas, patient satisfaction with ED care was highest last year in Madison, WI, which failed to make the top metro area list in 2008. Miami-Fort Lauderdale-Pompano Beach, FL, which was No. 1 in patient satisfaction in 2008, fell to sixth last year, but 2009 marked the third consecutive year it made the list.
All Children's Hospital & Health System in St. Petersburg, FL, has signed a letter of intent to join the Johns Hopkins Health System as a fully integrated member, the two systems said Tuesday.
The non-cash transaction between the two venerable not-for-profit health systems—the first of its kind for JHHS outside of the Baltimore region—is expected to be completed by the end of the year.
"The integration of All Children's into Johns Hopkins Medicine creates a synergy that allows both partners to continue our mission-centric work in children's healthcare," said Gary Carnes, president/CEO of All Children's. "We believe it increases All Children's value as a key community asset, extending benefits near and beyond to the families of children in need of top-notch clinical care by adding the benefits that the world-class teaching and research opportunities of Johns Hopkins Medicine will bring."
The proposed transaction hasn't been finalized, but the plan calls for ACH to retain its voluntary medical staff and physician organizations, including those University of South Florida physicians practicing at ACH. ACH will operate under the direction of the JHHS governance structure.
"All Children's is a very attractive organization because of its robust high quality clinical programs, its strong regional brand presence, and very high quality leadership team," said Edward D. Miller, MD, dean/CEO of Johns Hopkins Medicine. "The full integration of ACH into JHM offers a unique opportunity to both institutions. With this integration—and as part of its historic mission—JHM can leverage the intellectual and human capital within its pediatrics programs to expand the reach and impact of its current clinical, teaching and research programs."
All Children's Hospital, which opened a one-million-square-foot, 10-story tower and adjacent outpatient building in January, will retain its name and mission, and donations made to the Hospital's Foundation will remain for the benefit of All Children's. Leadership and day-to-day operation of the 259-bed freestanding pediatric hospital and outreach facilities in eight west Florida counties won't change. Local community leaders will continue to provide oversight of All Children's as majority members of the Hospital's Board of Trustees.
"Integration with Hopkins will position us to jointly shape the future of children's healthcare in partnership with an unparalleled leader in medical research and teaching," said Claudia Sokolowski, All Children's Health System board chair. "The potential economic impact for St. Petersburg, the Tampa Bay area and the state of Florida is significant and lasting. But the positive impact for children and their families will extend well beyond our geographic reach for generations to come."
JHHS' Maryland affiliates include The Johns Hopkins Hospital, Johns Hopkins Bayview Medical Center Inc., Suburban Hospital, and Howard County General Hospital Inc., and The Johns Hopkins University School of Medicine.
ACH is part of the $1 billion All Children's Health System, with more than 2,800 employees on its main campus and 10 outreach centers located throughout west central Florida. The system, founded in 1926 as a hospital primarily for young polio victims, has a patient mix that is 70% Medicaid.
The National Association of Public Hospitals and Health Systems has appointed Bruce Siegel, MD, to the newly created position of CEO. He succeeds Christine Capito Burch, who is retiring after serving 20 years as executive director, NAPH announced Monday.
"This is an unprecedented time for our patients and the public hospitals that serve them each and every day. I am eager to work with these crucial safety net systems to ensure that they have the resources and the support to protect their communities," Siegel said in a statement. "Healthcare reform may have passed but our work is just beginning."
With the appointment, Siegel becomes the first African-American to lead a major hospital association in the United States. He is now director of the Center for Health Care Quality and a professor of health policy at the George Washington University School of Public Health and Health Services. Siegel was president/CEO of Tampa General Healthcare, and the New York City Health and Hospitals Corporation. He also served as commissioner of health for the state of New Jersey.
"Safety net hospitals and health systems must gear up for the implementation of health reform, while also responding to the increased need for safety net services during the current economic crisis," said NAPH President Larry S. Gage. "Bruce's experience leading two of the nation's most important safety net health systems, coupled with the major role he has played at George Washington University in studying the needs and concerns of vulnerable patient populations, provide an ideal background for this position."
Siegel has conducted studies on quality and equity for the Robert Wood Johnson Foundation, the Commonwealth Fund, the California Endowment, and the Agency for Healthcare Research and Quality. He is a member of the National Advisory Council for Healthcare Research and Quality and he has served as a director of the Accreditation Council for Graduate Medical Education.
""Bruce Siegel's deep understanding of health disparities will assist members in serving our diverse communities and in positioning public hospitals to be leaders in implementing health reform," said Lisa Harris, MD, who led the search process for NAPH. Founded in 1980, NAPH represents the nation's largest metropolitan safety net hospitals and health systems.
"Siegel earned an A.B. from Princeton University, a Doctor of Medicine from Cornell University Medical College, and a Master of Public Health from Johns Hopkins University School of Hygiene and Public Health.
Click here to read more about Siegel's appointment.
From all indications, the nation is emerging—however slowly—from the worst recession since the Great Depression. Although the brightening economic outlook will be welcomed, it also creates a new set of challenges as nonprofit hospitals and health system struggle to retain top-level executives.
Providing top talent with hefty pay hikes or bonuses at a time when 15 million people are out of work could prove to be a public relations disaster for a nonprofit hospital, especially if rank-and-file workers have received modest (if any) pay hikes.
On the other hand, the market for top healthcare talent is competitive. Nonprofits that don't provide executives with fair market compensation risk losing them, which is a far more expensive proposition.
Ron Seifert, executive compensation practice leader for Hay Group's healthcare practice, says that compensation increases in the last year were below historical trends, partly because many executives understood the market realities and "took one for the team." However, in the coming year, if the economic recovery continues, Seifert says, those same executives might not be so willing to wave the pom poms.
Seifert says most nonprofit hospital boards—well aware of the economic realities, political climate, and public perception—have done a good job exercising discretion with executive compensation packages over the last year.
The Hay Group's 2010 Healthcare Compensation Study, which looks at data from more than 120 integrated health systems, and 1,268 hospitals, found that pay hikes for healthcare employees decreased in 2010 to a rate of 2.5%, compared with a 4% increase in 2009.
For the C Suite, the newly released survey found that:
Turnover decreased at the executive level: CEO (5.2% in 2009-2010 from 14% in 2008-2009), the COO (4.1% from 11.6%), and the CFO (5% from 12.2%).
Executives faced a drop in salary increases: all executive groups experienced a decrease in both the most recent and next planned salary structure increases from the 2009 report. For instance, in 2010, the number of CEOs receiving at least a 6% increase in base salary has dropped to 22%—its lowest level in 10 years.
"People have been hunkered down," Seifert says. "They have been fully committed to seeing their organizations and healthcare through this very difficult time, but these are executives and they are not blind to opportunity. These hospitals need to be run by capable leaders and if you have high-performing individuals, the reality is you shouldn't mess around with their retention if they are that critical for you."
So, what will the next year bring? Seifert expects that more health systems will turn to long-term incentive plans as a retention tool for top executives. He notes that 24% of survey participants have a long-term incentive plan in place in 2010, up from 19% in 2009.
Of the organizations with LTI plans, performance units are the most commonly used vehicle, with 95% offering such a plan.
Beyond specific tools, Seifert says he anticipates "continued temperance in decision making" and a more focused approach to designing compensation packages.
"We will likely see an uptick, but it's more a demand for talent—not opening the floodgates," he says. "If you want to keep people retained, it's going to be selective, but you are going to need to do something. Boards are going to struggle more with pay decision-making going forward. and it is not going to be across-the-board type of budgeting. It's more likely to be focused on individuals. Going forward, the reality is they will have to think carefully if they want to retain key leaders."
Ninety-four people in five cities—including more than seven physicians—have been charged in alleged schemes to submit $251 million in Medicare false claims, U.S. Attorney General Eric Holder announced Friday.
The joint Medicare Fraud Strike Force operation involved 360 law enforcement officials from the FBI, HHS-Office of Inspector General, and other state and local agencies, who made 36 arrests in Miami; Baton Rouge, LA; Brooklyn, NY; Detroit; and Houston. More arrests are expected today and through the weekend as other warrants are executed.
"With today's arrests, we're putting would-be criminals on notice: Healthcare fraud is no longer a safe bet," Holder said in a media release. "The federal government is working aggressively—and collaboratively—to pursue healthcare criminals around the country and to bring these offenders to justice."
Charges unsealed today against the 94 defendants who are accused of various fraud-related offenses, include conspiracy to defraud Medicare, criminal false claims, violations of the anti-kickback laws, and money laundering.
The charges are based on a variety of fraud schemes involving physical therapy and occupational therapy, home healthcare, HIV infusion, and durable medical equipment.
The defendants charged today allegedly submitted false claims to Medicare for treatments that were medically unnecessary and oftentimes, never provided. In many cases, complaints allege that Medicare beneficiaries accepted cash kickbacks in return for allowing providers to submit forms saying they had received the non-existent or unneeded treatments that were collectively valued at more than $251 million.
In Miami, 24 people were charged for allegedly participating in schemes that led to $103 million in false billings. The defendants include owners of companies, doctors, nurses, and patient recruiters, as well as a medical biller who is alleged to have billed approximately $49 million for fraudulent services.
In Baton Rouge, 31 people were charged in schemes involving fraudulent claims for DME totaling approximately $32 million. The defendants include the owners of nine different purported medical services companies, four doctors, 14 patient recruiters and others.
In Brooklyn, 22 people were charged with filing fraudulent claims totaling $78 million. These schemes involved false billing for physical and occupational therapy and DME. The defendants include the owners, patient recruiters and employees at three different medical clinics and a medical equipment company, and three doctors. Six defendants are Medicare beneficiaries, who allegedly sought treatment from numerous providers, causing the submission of multiple claims to Medicare.
In Detroit, 11 people at five medical services companies were charged in schemes to submit fraudulent $35 million in bogus claims for home health services, nerve conduction tests and injection and infusion therapy sessions.
Four defendants were charged in Houston for their alleged roles in a $3 million scheme to submit fraudulent claims for DME.
In addition to the arrests, law enforcement agents are executing search warrants for ongoing healthcare fraud investigations.
Since its inception in March 2007, the Strike Force has obtained indictments of more than 810 people and organizations that collectively have billed Medicare for more than $1.85 billion.
Superior Health Partners trustees have finalized the formal affiliation agreement that went into effect on July 1 between Marquette General Hospital and Bell Hospital in Michigan's Upper Peninsula. Elected board officers are outlining initial priorities for the accountable care organization, the health system announced today.
"With the legal documents signed, our new board officers in place and our strategic plan outlined, we can move forward with plans to create an accountable care organization which relies on close hospital partnerships, collaborative alignment with physicians, robust information technology infrastructure and operational expense management," says SHP Board Chairman Tim Larson, who is also Marquette General Health System board chairman.
The legal documents forming the affiliation were signed at the SHP Board's first official meeting, which was held at Bell Hospital. The new board also adopted formal strategic plan priorities.
Elected SHP Board officers include: Larson; Vice Chairman Robert DellAngelo, MD; and Secretary/Treasurer Ron Katers. Gary Muller, MGHS president/CEO since 2007, was named SHP president/CEO.
"It's the goal of SHP to build an accountable care organization that can serve the entire Upper Peninsula," Muller says. "The partnership between Marquette General and Bell, and the potential for other hospitals to join SHP, puts our region way ahead of the curve both from a statewide and national perspective. It is impossible to over-emphasize the importance of our planning on improving regional healthcare quality and access, as well as strengthening the incredible healthcare economic engine healthcare represents in the U.P."
Muller said key to initial SHP success will be physician recruitment. "By enhancing physician recruitment efforts, the number of services and specialties available will be greatly increased, and patients will have access to more services in the Upper Peninsula," he says. "That, in turn, means more jobs for U.P. residents. There is an old saying the U.P. that our region's best export is our youth. Healthcare is creating the types of jobs that we hope will eventually render that old saying obsolete."
The strategic affiliation creates a healthcare network with more than 3,000 employees under its combined MGH-Bell umbrella. MGH, in Marquette, is a 315-bed regional referral center. Bell Hospital, in Ishpeming, MI, is a 25-bed critical access hospital.
Hospitals would have to cut direct costs by an average of $1,082 per case—14%—to sustain operating margins if average inpatient reimbursements from commercial insurers were paid at today's Medicare rates, according to a new study by the healthcare information company, Sg2.
"This changing environment requires a radical shift in behavior. The onus firmly resides with the provider," Sg2 Chairman/CEO Michael Sachs says. "The healthcare leader of the future must recognize incremental and long-term cost saving strategies today, while still delivering cost-effective, quality care."
With MedPAC projections of overall Medicare margins to be -5.9% in 2010 and performance-based penalties looming, Sachs says the threat of commercial insurance reimbursement rates approaching Medicare levels in some markets adds tremendous financial pressure to health providers.
"In order to survive and thrive, it is imperative for all organizations—regardless of size—to create a clinically integrated framework and understand financial implications of the growing Medicare population and performance-based incentives," Sachs says. "Now is the time to implement a disease-centered approach that not only uncovers financial opportunities, but addresses clinical performance across both inpatient and outpatient settings."
Sachs says demographic and economic forces are driving the pressure to reduce costs. The Medicare population will nearly double by 2030 as the 78 million Baby Boomers begin turning 65 in 2011.
Additionally, a slow economy makes health insurance coverage expensive for employers, and places pressure on commercial payers to reduce premium costs. Consequently, payers are forced to reduce reimbursements to providers— rates that could eventually approach Medicare levels in some regions, Sachs says.
The good news is that there is a lot of fat in the system that can be cut.
Sachs notes that Centers for Medicare & Medicaid Services estimates that 40% of total Medicare spending is waste in the form of provider error, unnecessary care, avoidable admissions and lack of care coordination.
To identify waste, Sachs says providers can use a disease-centered clinical approach that will identify the top Medicare severity diagnosis-related groups with the highest cost-reduction opportunities. He says hospitals can also improve clinical integration by assessing their performance across inpatient and outpatient settings.
Sg2's analysis is based in part on comparative data gleaned from the National Inpatient Sample. The analysis indicates that hospitals' cost reductions vary by market, provider type, case mix, payer mix, relative payment levels, and size. For example, large community hospitals would require a cost reduction averaging 17% to maintain overall operating margins at today's Medicare reimbursement rates. The average cost for small-to-medium-sized community hospitals would be $849 per case, and for academic medical centers it would be $1,168 per case.
Miami-based Florida International University's newly opened Herbert Wertheim College of Medicine has signed an affiliation agreement with Cleveland Clinic Florida.
John Rock, MD, founding dean of Wertheim, says the agreement with Cleveland Clinic Florida introduces another respected partner to the affiliations FIU already has, and will provide a valuable dimension to the college's unique approach to medical education.
"We are very excited to be affiliated with such a respected institution that has an excellent national reputation," Rock says. "Cleveland Clinic is world renowned for providing quality healthcare at an affordable cost and we are proud to partner with them to train the next generation of doctors."
The affiliation will allow FIU medical students in their senior year to receive clinical training from physicians in various specialties.
"Cleveland Clinic was founded on the principle that research and education are at the cornerstone of patient care," says Bernie Fernandez, MD, CEO of Cleveland Clinic Florida. "This partnership with FIU allows us to meet South Florida's healthcare and patient needs by investing in the next generation of physicians."
Herbert Wertheim College of Medicine, South Florida's only public medical college, began classes for its inaugural class of 40 medical students last fall. The college emphasizes a patient-centered care curriculum and stresses cultural competence as a key to providing quality care for South Florida's diverse demographics. When at full capacity, the medical college will have 480 students.
FIU's other clinical partners include Baptist Health South Florida, Jackson Health Systems, Mount Sinai Medical Center, Miami Children's Hospital, Mercy Hospital, and Leon Medical Centers, Broward Health, and Memorial Healthcare System.
