After more than one year of bitter, partisan and often insipid fighting, the healthcare reform legislation that President Barack Obama signed last week is now the law of the land.
Get ready for the mother of all learning curves, as Congress—one of the nation's least trusted entities (along with bankers and journalists)—passes its handiwork to the nation's most trusted professionals–healthcare workers.
This is a daunting task. Simply by the nature of their work, and their personal contact with patients, doctors, nurses, and others, direct-care providers will be charged with explaining the intricacies of the most complex, comprehensive, and truly life-changing federal legislation since the creation of Medicare in 1965. Their patients will probably be confused, perhaps skeptical, or even frightened about how the new reforms will impact their care. This is completely understandable after more than one year of scare tactics and deliberate distortions about "death panels," killing grandma, and faceless Washington bureaucrats rationing care.
"The difference between the way the bill was fought legislatively and what is actually in the bill is enormous," says Frederick E. Turton, MD, an internist from Sarasota, FL, and chair of the Board of Regents of the American College of Physicians. "In fact, there are a lot of good things in this bill that make patient care immediately better, and the physician is going to have to carefully explain this to his or her patients on an issue-by-issue and occasion-by-occasion basis."
Patients might display their fear or confusion in the questions they ask. "Generally, the questions arise in a patient-doctor encounter when the patient says something like 'Please order this test before the government says I can't have it,"' Turton says. "In fact there is no rationing in this bill whatsoever. The most important part is that doctors and patients can see each other again because 94% of legal residents will have access to health insurance, and that is a big deal."
Turton concedes, though, that no matter how healthcare providers feel about these reforms, nobody really knows if they are going to work over the long run. "There are so many moving parts to this legislation and it kicks in over such an extended period of time that it is difficult--if not impossible--to say exactly how this is going to translate into practice," he says.
Understanding the reforms and how they impact patients will take time. "I believe a natural process would be a good way of describing it," Turton says. "The tenets of the bill will survive based on their merits. Secondary consequences will occur based on merits that we didn't understand. As time goes by we will understand this bill much more than we do now."
In the short term, however, Turton says the confusion over the new reforms will probably be worse than confusion he witnessed when Medicare Part D was implemented. "We really didn't understand that, and it took some while. In particular, with the donut hole, it took a lot of patients telling me 'please don't prescribe another medication because I am in the donut hole' for me to understand what that meant," Turton says. "And this bill is magnitudes of order bigger than Medicare Part D. It is going to take us much longer to figure out what the real consequences are."
What about those physicians, nurses and other direct-care providers who don't like the new reforms? How can they balance that discontent with their responsibilities to their patients? Turton isn't worried.
"They will do what they have always done, which is take care of their patients, and use the resources available to them in the best way they can to take care of their patients," he says. "Politics is one thing, but taking care of people is quite another."
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As the dust settles on the great healthcare reform debate, a new analysis shows that the clear winners are the armies of healthcare lobbyists from all sides of the debate who led a stampede on the Capitol and raked in record amounts of cash in 2009 to influence the legislation.
The analysis by the nonpartisan Center for Public Integrity, Washington Lobbying Giants Cash in on Health Reform Debate, estimates that about 1,750 businesses and organizations hired about 4,525 lobbyists—eight lobbyists for each member of Congress—and spent at least $1.2 billion to influence healthcare bills and other issues, according to a CPI analysis of disclosure documents that included "health reform" or similar wording.
CPI Executive Director Bill Buzenberg says $1.2 billion is a lot of money, but he's not surprised.
"If you will recall, 2009 was a recession year, but it was a banner year for lobbyists. The healthcare debate has gone on so long and it has been so complicated and there is so much at stake so it's not surprising that this much money and these numbers of lobbyists were involved," Buzenberg says. "It's like a very long and messy lawsuit is beneficial to the lawyers. The long, contentious, high-stakes healthcare reform bill was very beneficial to the lobbyists."
The exact dollar amount spent on healthcare reform is a bit fuzzy because lobbyists are not required to itemize how much money in a given contract is devoted to a specific area. However, CPI said that if only 10% of that spending went toward health reform, the amount would total $120 million—likely a record for a single year's spending on a particular issue.
"This is what is hard. This is what they spent on lobbying in 2009, and these were the companies that were involved in healthcare," Buzenberg says. "But we can't say that it was all directed to healthcare. I think when we use the 10% figure that is pretty conservative, and we believe it was higher than that."
In fact, Buzenberg says, the total amount spent attempting to influence the healthcare reforms could be considerably higher, because the CPI study does not include lobbying expenses in the first quarter of 2010, nor does it include outside expenditures for advertising and other public influence campaigns.
The biggest winners, based on number of lobbying clients, from healthcare reform include:
Patton Boggs LLP – $7.6 million
Alston & Bird LLP – $4.6 million
Foley Hoag LLP – $4 million
Podesta Group Inc. – $5.1 million
Capital Tax Partners LLP – $3.8 million
Holland & Knight LLP – $2.8 million
Dutko Worldwide LLC – $3.7 million
The clients who hired these firms ranged from industry associations like the American Hospital Association, America's Health Insurance Plans, the American Medical Association, and AARP, to small nonprofit advocacy groups. Some hired more than one of the top firms to lobby for their interests.
Pharmaceutical Research and Manufacturers of America hired Capital Tax Partners, Dutko, Mehlman, and 22 other outside firms, in addition to the group's own in-house lobbyists. Wal-Mart Stores Inc. hired Patton Boggs, Podesta Group, Mehlman, and Bryan Cave, according to CPI.
Some of the more notable lobbyist-insiders include Thomas Scully, a CMS administrator under President George W. Bush; and Colette Desmarais, a former health policy aide to Sen. Chuck Grassley, R-IA, CPI added.
All lobbying for all topics—from missile defense to trans-fats—topped out at $3.47 billion last year, which was a record. "That was $20 million a day in 2009," Buzenberg says.
Beaumont Hospitals in Michigan this week opened a Women's Urology Center offering treatment, research, and advanced minimally invasive procedures for women's urological conditions, such as incontinence, pelvic pain, and sexual dysfunction, the hospital announced. It is the first center in the Midwest dedicated and designed exclusively for women's urological care and sexual health, said Beaumont.
"We have created a special, private, and comfortable place for women to go where people who care will listen, evaluate their problem, and provide treatment that will make a difference in their lives," said Kenneth Peters, MD, chairman of urology at Beaumont, Royal Oak.
The 4,200-square-foot, $1.6 million eco-friendly center at Beaumont Hospital, Royal Oak was funded by a $5 million gift from Susan E. Cooper of Birmingham, a long-time member of the boards of directors of Beaumont Hospitals and the Beaumont Foundation.
The money funded construction, equipment, and furnishings; the remainder will fund ongoing research to advance women's urology.
Conditions evaluated and treated at the center include urinary frequency or urgency, urinary incontinence, interstitial cystitis, or painful bladder syndrome, unexplained pelvic pain, sexual problems or pain associated with sex, and post-cancer treatment.
Higher-volume hospitals saw lower mortality for acute myocardial infarction, heart failure, and pneumonia, according to a new study in the New England Journal of Medicine.
The study, led by Joseph S. Ross, MD, with the Mount Sinai School of Medicine in New York, analyzed data from Medicare claims for all fee-for-service patients, who were hospitalized between 2004 and 2006 in acute care hospitals for the three ailments.
"Hospital volume may be a sensible surrogate for quality in deciding where to obtain surgical and interventional care, but may not be similarly sensible for acute medical care. Understanding the relationship between hospital volume and mortality for medical conditions is critical for clinicians and policymakers, since they are under increasing pressure to identify strategies to improve the quality of care," the study said. "In addition, because three of the most common and costly reasons for hospital admission among Medicare beneficiaries are acute myocardial infarction, heart failure, and pneumonia, identifying factors associated with better quality of care has great significance."
The study examined 734,972 hospitalizations for acute myocardial infarction in 4,128 hospitals, 1,324,287 for heart failure in 4,679 hospitals, and 1,418,252 for pneumonia in 4,673 hospitals. An increased hospital volume was associated with reduced 30-day mortality for all conditions. For each condition, the association between volume and outcome was attenuated as the hospital's volume increased.
The study estimated the change in the odds of death within 30 days associated with an increase of 100 patients in the annual hospital volume. Analyses were adjusted for patients' risk factors and hospital characteristics.
For acute myocardial infarction, once the annual volume reached 610 patients (95% confidence interval [CI], 539 to 679), an increase in the hospital volume by 100 patients was no longer significantly associated with reduced odds of death. The volume threshold was 500 patients (95% CI, 433 to 566) for heart failure, and 210 patients (95% CI, 142 to 284) for pneumonia.
Sisters of Mercy Health System this morning announced the elimination of 226 positions across the four-state region it serves as part of a system-wide restructuring.
The layoffs affect 89 leadership positions and 137 "co-worker roles," which represent less than 1% of Mercy's 36,000 employees, said the Chesterfield, MO-based health system, in a media release.
"While these changes are not uncommon today, they nonetheless are difficult," said Lynn Britton, Mercy president and CEO. "We appreciate the community's consideration and concern for our co-workers as these changes are announced and we put our new organizational structure in place."
Mercy said the restructuring will more closely connect operations throughout the health system's four-state area and streamlines leadership, with many employees taking on new responsibilities.
"Most co-workers whose positions have been eliminated will be given the opportunity to leave Mercy immediately so that they can begin to plan their transition," the health system said. "In certain situations, co-workers may be asked to remain with Mercy for a short period of time to complete or transition their current work to others."
The redundant workers will also be offered outplacement services and severance packages.
New Bureau of Labor Statistics data for January and February show that hospital mass layoffs impacting 50 or more jobs are maintaining the pace set in 2009, a year that ended with a record 152 mass layoffs affecting more than 13,000 hospital jobs.
An informal HealthLeaders Media Internet search has found at least 10 instances of mass layoffs involving 50 or more jobs so far in March, including today's Mercy layoffs. BLS won't publish March layoff data until the end of April.
Despite the layoffs, the healthcare sector remains one of the few job growth areas of the economy. Hospitals created 33,400 new jobs in 2009, while the overall healthcare sector has created 631,000 jobs since the recession began in December 2007. In that same period, the number of jobless people in the nation has risen from 7.7 million to 15.3 million, BLS figures showed.
Mercy, the eighth largest Catholic healthcare system in the nation, provides healthcare services in Arkansas, Kansas, Missouri, and Oklahoma. The system includes 26 acute-care hospitals with more than 4,000 licensed beds, three heart hospitals, a rehabilitation hospital, physician practices, and a health plan.
It's already hard enough to find a primary care physician, and the new health reforms that provide 32 million Americans with health insurance aren't going to make it easier.
Leaders of two primary care physicians' organizations say new practice techniques, technologies, efficiencies, and an emphasis on wellness and prevention will help mitigate many access issues in the coming years.
"We have been talking about the shortage of primary care physicians for a long time, and the healthcare reforms do not magically turn that around or fix it," says Lori Heim, MD, president of the American Academy of Family Physicians. "Remember that this bill is being implemented over several years, so part of that process is going to be looking at what are the different delivery models that we can use, how can we increase our efficiencies."
Besides, Heim says, many of the 32 million people who are expected to get coverage under the healthcare reform bill that President Obama signed into law on Tuesday were already being seen by primary care physicians.
"We know from a survey of our members that at least nine patients a week are already getting charity care on a sliding scale. Now at least the doctors and the hospitals will get paid for charity care that they are already providing," Heim says.
A health reform provision will create and expand community health centers, which will also alleviate some of the burden for primary care physicians, as will the expansion and development of the patient-centered medical home model.
"We are going to have to be smarter about how we delivery care, and utilizing our team," Heim says.
She adds that patient-centered medical homes that use nurse educators, medical assistants, and asynchronous care through Web portals or telephone consultations can reduce a lot of the face-to-face time with physicians.
However, Heim says the reforms do not go far enough because they still emphasize patient volumes over outcomes.
Willarda V. Edwards, MD, an internist and president of the 35,000-member National Medical Association, says health reform has many pluses for primary care, including increased reimbursements for government-sponsored healthcare.
"We will get better reimbursements for many of us who have been the safety net for those patients who get Medicaid," Edwards says. "We can do more for prevention and hiring physician extenders who can help us provide better care for those patients, and make us better qualified for HIT in our offices so we can provide quality of care and better follow up."
Edwards says physicians must also encourage the newly insured to play a proactive role in their own wellness and prevention, which in turn will reduce demands on primary care.
"It's incumbent upon the individual to take advantage of what is being presented to them," Edwards says. "We don't want people to think ‘OK I've got health insurance. Now I should be healthier.' No. it doesn't work like that. There are self-activities that people have to do, compliance and participation that is required of each individual and we need to emphasize that as well."
It's not clear if reform will have a big enough impact on primary care to make it a more popular field with graduating medical students, many of whom graduate deeply indebted.
Farheen Qurashi, legislative director for the American Medical Student Association, and a medical student at the University of Missouri – Kansas City, calls the reforms "a good step but it is a first step."
"To incentivize primary care and to really shift the physician shortage and the way we deliver healthcare is going to take many years and many more investments in primary care, shifting healthcare delivery, and creating more and larger medical school classes," Qurashi says. "Really, it will require a change in our medical culture and this bill is just opening the door. We aren't done yet."
Qurashi says medical students are well schooled in the salary disparities between primary care and subspecialties like radiology and ophthalmology.
"Primary care physicians not only have lower reimbursements than other specialties, but also have a more difficult time balancing family and work and have a higher work load because of the shortage the country faces," Qurashi says. "A lot of those things go into the decisions that students make, and those are the kinds of medical culture things we need to look at changing before we can change the skewed primary care/subspecialty field distribution."
Heim says that even if there were a sudden tremendous interest in primary care from medical students, it'd still be too little, too late.
"I don't think we are going to be able to say that every single person who has insurance will have a primary care physician. We've gotten too far behind the curve," Heim says. "What I am saying is it is not 32 million people walking in the door today and it is not a catastrophe today. I am confident that we have time to begin to do a lot of the stuff that we have already been working on, and growing our workforce, and changing how we deliver care."
Radiation oncologist Todd J. Scarbrough, MD, and Melbourne (FL) Internal Medicine Associates (MIMA) P.A. will pay the federal government $12 million to settle whistleblower allegations that they submitted false claims to Medicare and TRICARE, the Justice Department said.
MIMA operates clinics in Brevard County, FL, and Scarbrough was the medical director and practicing radiation oncologist at one of them, the MIMA Cancer Center in Melbourne.
In the complaint filed last October, federal prosecutors said the cancer center and Scarbrough improperly billed for radiation oncology services and submitted false claims to Medicare and TRICARE.
DOJ said its investigation revealed that the MIMA Cancer Center inflated claims through various schemes designed to cloak the fraud. In particular, MIMA Cancer Center billed for services not supervised, duplicate and unnecessary services, services not rendered, and upcoded services. DOJ said MIMA executives knew about the scam, but failed to stop it.
"Healthcare providers must be held accountable for their billing practices," said A. Brian Albritton, U.S. attorney for the Middle District of Florida. "Those who submit false claims will be sought out and in the end they will pay dearly for their fraudulent claims."
MIMA issued a statement acknowledging the settlement, but said it was not necessarily an admission of guilt. "Please keep in mind that we settled this matter rather than sustain lengthy, costly, complex litigation. The government and MIMA have agreed to a cash settlement and procedural clarifications. The understanding is that we still have deep disagreements about allegations made by the government. For our part, MIMA is relieved to have this resolved so we can now move on," the statement said.
The settlement resolves a False Claims Act whistleblower lawsuit filed by Fred Fangman, former director of radiation oncology at MIMA Cancer Center, who will receive $2.64 million of the settlement.
The Justice Department’s total recoveries in False Claims Act cases since January 2009 have topped $3 billion, said DOJ.
Attorneys general in 13 states didn't wait for President Obama's signature to dry on the healthcare reform bill today before they filed a joint lawsuit challenging the constitutionality of the new laws.
"A few minutes before 12 o'clock the president today signed into law a healthcare bill that in our judgment and the judgment of 12 other attorney generals is unconstitutional and invades the sovereignty of the states," Florida Attorney General Bill McCollum said at a midday press conference in Tallahassee.
"Each of us involved in the lawsuit that we filed at 12:02 p.m. today in the Northern District of Florida believes the freedoms of Americans are being impaired by this bill," said McCollum, a Republican who is running for governor.
"It's about forcing people to buy health insurance when there is no provision in the constitution that allows for anybody to be forced to do something when there is no commerce, no action, you're just sitting there. It's a living tax," he said.
"The lawsuit we filed today will challenge the constitutionality. Ultimately, it will arrive at the U.S. Supreme Court and I am confident that the court is going to declare the new healthcare reform law unconstitutional," he added.
Joining the suit were attorneys general from South Carolina, Nebraska, Texas, Utah, Alabama, Colorado, Michigan, Pennsylvania, Washington, Idaho, and South Dakota, all Republicans; and Louisiana's Buddy Caldwell, a Democrat.
Comments from other attorneys general were along the same vein. Texas Attorney General Greg Abbott said in a media release that the healthcare reforms "no matter how important or well-intentioned—can't be allowed to trample the protections and rights guaranteed by our Constitution."
Nebraska Attorney General Jon Bruning said of the healthcare law: "For the first time, the federal government is forcing Nebraskans to purchase a good or service. Today's court filing is the first step toward reining in Congress' unprecedented expansion of power."
Tom Arnold, secretary of Florida's Agency for Health Care Administration, attended the Tallahassee press conference and said the costs to the state's Medicaid program associated with the "full implementation" of the national healthcare reforms will be an additional $1.1 billion. "In addition to that, should the reconciliation package pass, there will be an additional almost $300 million in raising Medicaid fees to the Medicare level. And there would be administrative costs that would be anywhere from $100 million to $200 million," Arnold said.
McCollum said the reforms would "literally cost the state of Florida ultimately billions of dollars, at a time when the state is trying to fill a $3 billion budget shortfall. Forcing the state to assume that burden is way beyond the means of our state to do when we are considering the kinds of problems we have today," McCollum said.
There were 11 mass layoffs impacting 50 or more jobs at the nation's nongovernmental hospitals in February, the Bureau of Labor Statistics announced today.
February's mass layoffs, coupled with the 13 mass layoffs at hospitals in January, are on a pace with the first two months of 2009, a year that ended with a record 152 mass layoffs affecting more than 13,000 hospital jobs.
In the overall healthcare and social assistance category, there were 31 mass layoffs resulting in 2,118 initial claims for unemployment insurance, BLS said.
An informal HealthLeaders Media Internet search has found at least nine instances of mass layoffs involving 50 or more jobs so far in March. BLS won't publish March layoff data until the end of April.
Despite the layoffs, the healthcare sector remains one of the few job growth areas of the economy. Hospitals created 33,400 new jobs in 2009, while the overall healthcare sector has created 631,000 jobs since the recession began in December 2007. In that same period, the number of jobless people in the nation has risen from 7.7 million to 15.3 million, BLS figures showed.
In February, in the overall economy, employers took 1,570 mass layoff actions in February that resulted in the separation of 155,718 workers, seasonally adjusted, as measured by new filings for unemployment insurance benefits during the month, BLS data show.
The number of mass layoff events across all industries in February fell by 191 from the prior month, and the number of associated initial claims decreased by 26,543. Both events and initial claims have decreased in five of the last six months.
TeamHealth Holdings, Inc., has acquired Roanoke, VA-based Southwest Emergency Physicians and will assume the management and staffing of the emergency department at Lewis Gale Medical Center in Salem, VA, which cares for approximately 42,000 patients annually, TeamHealth said in a media release.
The financial terms of the deal were not disclosed.
"TeamHealth is excited to partner with the exceptional physicians that comprise SWEP, most of whom have been serving this emergency department more than 10 years," said TeamHealth President John R. Staley, MD. "We share their commitment to supporting the hospital's goals and creating a physician-led culture that enhances physicians' ability to deliver high-quality emergency care to the Salem community."
SWEP President Robert Dowling, MD, said his physicians' group "sought to partner with an organization that has the necessary clinical and operational infrastructure to support the growing practice, provide the tools necessary to help the physicians achieve the high performance goals set by the hospital, and maintain a physician-led culture that puts patient care first."
Knoxville, TN-based TeamHealth offers seven service lines, including emergency medicine, hospital medicine, anesthesia, teleradiology, and pediatric staffing in 13 regional sites, using more than 5,900 clinicians. TeamHealth has operations in 530 civilian and military hospitals, clinics, and physician groups in 48 states.
