Shannon Bradley will develop strategies to recruit a diverse workforce and ensure culturally sensitive care for patients.
Former HCA Healthcare executive Shannon Bradley has been named Keck Medicine USC's first chief diversity and inclusion officer, effective Sept. 26.
Previously, Bradley was the assistant vice president/division director of diversity, equity and inclusion for HCA's Gulf Coast Division in Houston, where she increased the diversity of the health system’s board members for Asian and Black members by 45% and 24% respectively.
At Keck, Bradley will develop strategies to recruit a diverse workforce and ensure culturally sensitive care for patients, and will lead diversity, equity and inclusion efforts already in progress at the health system and create and track metrics to measure these efforts, the health system says.
"With Bradley onboard, we are confident that Keck Medicine can progress even further on its journey to inclusion," says Smitha Ravipudi, MPH, CEO of USC Care Medical Group and chair of Keck Medicine's Diversity & Inclusion Steering Committee. "Together, we will create a lasting road map for change."
The House Subcommittee on Oversight raises concerns about the for-profit health system's billing practices and reports of chronic understaffing.
A House subcommittee wants federal watchdogs to investigate questionable emergency department admissions by HCA Healthcare hospitals that may have cost Medicare $1.8 billion.
"In light of reports that there may be misconduct and potentially the improper shifting of taxpayer dollars, I ask that HHS launch an investigation into the allegations leveled against HCA regarding its emergency department admissions practice, including its joint venture with EmCare," Pascrell says in his letter to Becerra. "As HCA is the largest health system in America, transparency and oversight are essential to ensuring that hospitals, like those in HCA's system, are honest stewards of taxpayer dollars."
HCA pressed for admissions policies
In a separate, four-page, footnoted letter this week to HCA CEO Samuel Hazen, Pascrell raised concerns about "alleged fraud and staffing issues at HCA facilities."
"As HCA is the largest health system in America, transparency and oversight are essential to ensuring that hospitals like those in your system are appropriate stewards of taxpayer dollars," Pascrell says in his letter to Hazen. "Recent reports of systematic unnecessary inpatient admissions intended to draw higher and more profitable reimbursement rates, in addition to severe understaffing issues, raise questions about HCA's corporate policies and practices."
Pascrell notes that HCA – the largest health system in the nation – "sets the pace for both for-profit and not-for-profit hospitals in the United States."
"HCA's profits in 2021 were almost $7 billion, up nearly 100% in one year. This is welcome news for your shareholders, since HCA repurchased $8.2 billion worth of its shares in 2021 and recently authorized an additional $8 billion of share repurchases, all during the COVID-19 pandemic. Yet this single-minded focus on profits might be bad news for patients, families, workers, Americans taxpayers, and the Medicare program."
Pascrell cites recent media reports that patients in HCA emergency departments are being admitted for inpatient stays "regardless of medical necessity."
"One recent report estimates that these unnecessary admissions by HCA may have charged $1.8 billion in excess amounts to the Medicare program from 2008-to-2019," Pascrell says.
"I am especially alarmed by these findings given HCA's history of healthcare fraud settlements with both federal and state authorities," Pascrell says, pointing to a $1.7 billion settlement in the early 2000s to resolved criminal counts and civil fraud allegations that occurred when now U.S. Sen. Rick Scott was CEO. It was at the time the largest health care fraud in U.S. history.
There have also been allegations that HCA sets corporate admission targets and threatens retaliation against staff if those targets are not met, Pascrell says.
The congressman also raised concerns that HCA was in cahoots with its contracted physician staffing firm EmCare, a subsidiary of the private-equity-owned Envision Healthcare, in setting and meeting admissions targets.
He asked Hazen to provide by Sept. 27 explanations of several HCA practices including:
Incentives for physicians practicing in HCA hospitals relating to the admission or referrals of inpatients, including value-based measures, job termination policies or loss of admitting privileges for all employed and contracted physicians.
Performance data for all employed and contracted physicians, including the volume or value of referrals or admissions and value-based measures.
Details of HCA internal reviews to ensure that care is medically necessary, and that Medicare is not being billed for unnecessary services, including the scope and frequency of reviews, the identity the HCA official overseeing the reviews, and any memorandum describing specific compliance failures.
To address reports of chronic understaffing at HCA hospitals, Pascrell asked Hazen to describe: how the number of physicians, nurses, and other staff needed to provide medically necessary care to patients is determined; any role that financial metrics or financial targets play in the setting of staffing levels; the extent to which the cost of employees' salaries, wages, and benefits factor into the determination of bonus compensation for corporate, regional, and hospital executives, and how that compares with the role of other cost centers considered in that determination; whether decisions about how many and which employees are assigned for shifts are made at the hospital department level, hospital level, regional level, or corporate level; and which measures of staffing are monitored by HCA corporate staff.
HCA Responds
HCA issued a statement saying it was "reviewing Congressman Pascrell's letter and will respond to his requests for information."
"The issues raised in the letter appear to be similar to ones we addressed previously and publicly," HCA says. "HCA Healthcare operates more than 180 hospitals in a variety of communities throughout the country. Our hospitals are staffed by physicians, clinicians and nurses who work tirelessly to ensure our patients receive medically necessary care in the appropriate clinical setting. We believe that our operational processes and procedures are working well and that we are meeting the healthcare needs of our patients and communities."
"We are proud of our response to the pandemic, during which we cared for more COVID-19 patients than any other health system," HCA says. "We were one of the only, if not the only, health system to return all of our portion of the federal CARES Act funding to the government, which was approximately $6 billion. We are grateful to our colleagues who show up in every way to serve the healthcare needs of our communities."
The health systems says it spent $250 million on programs to ensure that none of our employees would be furloughed or laid off due to the pandemic, that it was again named one of Ethisphere's Most Ethical Companies for the 11th time and was recognized on the 2021 LinkedIn Top Companies rankings
A former physician at the prestigious health system endangered patients when he unnecessarily replace batteries for implanted difibrillators.
New York-Presbyterian/Queens Hospital will pay more than $2.5 million after the prestigious health system self-reported that it billed Medicare for medically unnecessary replacements of batteries powering implanted defibrillators, the Department of Justice says.
According to federal regulators, a former physician -- who was not named in the DOJ’s media notice -- repeatedly replaced patients’ implantable cardioverter defibrillator batteries before they reached the elective replacement interval (ERI) that is determined by dedicated computer monitors.
“Such batteries were functioning normally. He therefore subjected his patients to unneeded and risky surgical procedures. New York-Presbyterian/Queens then submitted claims for payments to federal health care programs for these procedures,” DOJ says. “Physicians closely monitor the functioning of ICD batteries so that they replace the batteries when they are nearing the end of their lives, but no earlier. That way, physicians can balance the risks associated with a failing ICD battery against the risk of the procedure needed to replace that battery.”
When New York Presbyterian billed Medicare for the unneeded procedures it violated the False Claims Act, DOJ says.
After an internal investigation, New York-Presbyterian/Queens voluntarily self-disclosed the infractions to the Department of Health and Human Services, Office of Inspector General.
New York Presbyterian did not return HealthLeaders' request for comment. The health system was recently placed among the nation's Top 10 hospitals in 2022-23 by U.S. News & World Report.
OIG auditors were unable to determine if an additional $112 million in non-emergency medical transportation claims complied with state and federal requirements.
Federal auditors say New York City should refund $84.3 million to Medicaid after inspectors uncovered widespread noncompliance and sloppy documentation in claims for non-emergency medical transportation.
The audit examined 4,768,858 payments totaling $269,584,249 (federal share) for NEMT services in 2018 and 2019. Inspectors found that only 17 of the 100 payments picked in a random sampling complied with state and federal requirements. Forty-one samples did not comply and auditors could not determine compliance for the remaining 42 samples.
"On the basis of our sample results, we estimated that New York improperly claimed at least $84,329,893 in Federal Medicaid reimbursement for payments to NEMT providers that did not comply with certain Federal and State requirements," OIG says. "In addition, we estimated that New York claimed $112,028,279 in Federal Medicaid reimbursement for payments to NEMT providers that may not have complied with certain Federal and State requirements.
The auditors recommend that New York City refund $84,329,893 to the federal government for the noncompliant payments and further audit the $112,028,279 in questionable payments and refund any money that was inappropriately billed.
In a written response to the audit, New York Department of Health Acting Executive Deputy Commissioner Kristen M. Proud did not comment on the specific recommendations but asked auditors to withdraw the refund request and provide additional documentation for 28 sampled payments.
"Because of the enormous number of people transitioning transportation managers, and the state's moral obligation to ensure that there would be no interruptions in the delivery of medical services, the department directed the new transportation managers to accept the level of transportation previously established for each enrollee," Proud says in a letter to HHS Regional Inspector General Brenda Tierney.
"Neither State statute nor regulation defines a specific period of time for which the written order specifying the appropriate mode is valid," Proud writes. "Based on the foregoing information and the details below, the Department requests that the repayment request be withdrawn from the audit report.
The LA hospital identified 15 cancer disparities in the county and are designing interventions to address them.
Los Angeles County residents experience varying cancer risks and survival rates based on race/ethnicity, gender, sexual orientation, geographic location and socioeconomic status, according to a new study from Cedars-Sinai Cancer.
Investigators at the Los Angeles hospital identified 15 cancer disparities in the county and are now designing and initiating interventions to address them.
The study, published in Frontiers in Oncology, found that: Latinos have higher rates of some cancers, including liver cancer and late-stage melanoma than non-Latino whites. Rates of breast cancer among Korean women have grown more faster than among other groups. Black people have higher rates of prostate cancer, triple-negative breast cancer and pancreatic cancer. Filipinos have higher rates of thyroid cancer. Self-described LBGTQ+ people have higher rates of "well-known risk factors" for lung cancer and HPV-related cancers (i.e., smoking, low HPV vaccination). Low-income whites have an increasing rate of late-stage melanoma.
The study is part of a two-year initiative to define and identify Cedars-Sinai's patient mix and develop effective strategies to reduce cancer care disparities.
Investigators reviewed cancer data from national, statewide and county sources, and created a survey asking county residents about their cancer screening behaviors, medical history and healthcare access. So far, 3,200 people have completed the surveys.
"These surveys help us understand barriers that people in L.A. County face that prevent them from getting screened for cancer," said Zul Surani, director of Community Outreach and Engagement and Operations at the Cancer Research Center for Health Equity at Cedars-Sinai. "By creating relationships with churches, health clinics, nonprofits and other community organizations, we are learning how to help people overcome these barriers."
For example, investigators discovered that mammography rates among Korean women in L.A. are low and that not having health insurance and not feeling sick were top barriers to getting screened. Their analysis of cancer registry data revealed that L.A. County's Koreatown neighborhood has one of the densest concentrations of late-stage breast cancer in the county.
"The next step is to increase the inclusion of people who identify with racial and ethnic groups who are underrepresented in cancer clinical trials," said senior author of the study Robert W. Haile, DrPH, MPH, director of the Cancer Research Center for Health Equity and the Cedars-Sinai Chair in Population Health Sciences. "By making our study populations more diverse, we'll have a better understanding of the effectiveness of cancer treatments."
Brian Wedgeworth, 47, posed as a surgeon and operated the scam nationwide over five years, using at least 13 'Doctor' aliases.
A sham doctor in Florida who swindled $1.3 million from women he duped at online dating sites was sentenced to nine years in federal prison this month after pleading guilty to more than two dozen counts of mail fraud, wire fraud, aggravated identity theft and money laundering, the Department of Justice says.
The defendant Brian Brainard Wedgeworth, 47, formerly of Tallahassee and Center Point, Alabama, operated the catfishing scam over five years, using at least 13 "Doctor" aliases, including: Dr. Brian Anderson; Dr. Anthony Watkins; Dr. Brian Adams; Dr. Edward Chen; Dr. Brian Chris; Dr. Chris Williamson; Dr. Brian Christopher Williamson; Dr. Brian Edmonds; Dr. Brian Ammerson; Dr. Brian Lamar Wilson; Dr. Brian Wilson; Dr. Brian Mims; and Dr. Brian Lamar Sims, prosecutors say.
He pleaded guilty in May to 25 counts of wire fraud, mail fraud, aggravated identity theft, and money laundering, says Jason R. Coody, U.S. Attorney for the Northern District of Florida.
"Our citizens should not be preyed upon by fraudsters who steal through overtures of affection," Coody says. "(This) sentence should serve as a significant deterrent to criminals of like mind."
Court documents showed that between October 2016 and March 2021, Wedgeworth defrauded more than 30 women across the country who he met through online dating forums by falsely claiming he was a physician, wooing them, and inducing them to send him more than $1.3 million in money and jewelry.
Wedgeworth's sentence will be followed by three years of supervised release, and he will also be required to pay more than $1.1 million in restitution. The investigation was led by U.S. Postal Inspection Service and the Internal Revenue Service Criminal Investigations unit.
HHS announces additional $35 million to improve 988 Lifeline access in tribal communities.
Call volumes to the 988 Suicide and Crisis Lifeline grew by 45% in August, when compared with August 2021, while response times shortened by 72%, the Department of Health and Human Services reports.
The nation in July transitioned to 988, formerly known as the National Suicide Prevention Lifeline. In August 2022 – the first full month of performance data -- the 988 Lifeline answered 152,000 more contacts (calls, chats and texts) compared to August 2021 and significantly improved the average speed to answer across all contacts to 42 seconds, down from 2.5 minutes in August 2021, HHS data show.
HHS Secretary Xavier Becerra credited the improvements to the Biden administration's 18-fold increase in funding for 988 Lifeline – rising from $24 million to $432 million.
"Our nation's transition to 988 moves us closer to better serving the crisis care needs of people across America," Becerra says. "988 is more than a number, it's a message: we're there for you. The transition to 988 is just the beginning. We will continue working towards comprehensive, responsive crisis care services nationwide to save lives."
Becerra also announced that HHS -- through the Substance Abuse and Mental Health Services Administration (SAMHSA) – has created an additional $35 million grant opportunity to support 988 Lifeline in tribal communities.
The U.S. had one death by suicide every 11 minutes in 2020, according to the Centers for Disease Control and Prevention, and suicide was the second leading cause of death for young people aged 10-14 and 25-34 in that span.
From April 2020 to April 2021, more than 100,000 people died from drug overdoses.
Chronically Underfunded
Although it was created in 2005, the Lifeline initiative has been hamstrung by chronic underfunding.
The tribal communities grant is part of the $150 million allocated for the 988 Lifeline under the Bipartisan Safer Communities Act signed by President Joe Biden on June 25.
That funding builds upon the $432 million already provided by the Biden administration to support the 988 transition, which includes $105 million in grants to states and territories under the American Rescue Plan to improve response rates, increase capacity, and ensure calls are routed to local, regional, or state crisis call centers.
"We want everyone to know that there is hope. Whether you're experiencing thoughts of suicide, a mental health or substance use crisis, or any other kind of emotional distress, there is compassionate, accessible care and support," says Miriam E. Delphin-Rittmon, PhD, HHS' assistant secretary for mental health and substance use, who also leads SAMHSA. "With rising levels of anxiety, depression, and other mental illnesses – and the devastating number of overdose deaths – it is crucial that people have somewhere to turn when they’re in crisis."
Analysts' report offers dire predictions for healthcare cost growth.
Higher-than-projected inflation is fueling healthcare cost growth and could add another $370 billion to national healthcare expenditures within five years, according to a report from McKinsey & Company.
That additional spending could balloon to $600 billion by 2027 when factoring in a possible recession and the lingering disruptions caused by the COVID-19 pandemic.
Before COVID-19 shuttered the global economy, Centers for Medicare & Medicaid Services' Office of the Actuary projected that national healthcare expenditures would grow at a rate of 5.5% through 2027.
However, the McKinsey analysis shows that the additional costs associated with the pandemic would push up the rate of NHE growth to 6.8%, about 2.5 percentage points above forecasted GDP growth.
"These are not in the Office of the Actuary's projections yet, but if you take their baseline, what they would have said is $370 billion more of cost," says Shubham Singhal, a senior partner at McKinsey.
In turn, that additional cost would be foisted on employers, who Singhal says will pass the cost to employees.
"We did a survey recently asking employers if they were to see price acceleration, what would they do?" Singhal says. "Anything that is 4% or higher, almost all of them said they're going to pass it on to their employees."
Singhal says a separate McKinsey poll of healthcare executives predicted 9% cost growth.
"That's a pretty big differential," he says. "If we get all the cost growths we've talked about employers are not going to be willing to just absorb those."
The report also predicts that:
COVID-19 healthcare labor shortages will continue to rise post pandemic, with shortages of 200,000 to 450,000 registered nurses and 50,000 to 80,000 physicians by 2027;
Through 2027 an estimated 100 million COVID-19 cases per year will add $222 billion in national healthcare expenditures.
The report says the healthcare sector can address the cost growth through care delivery transformation, improved productivity, technology enablement, and organizational growth and transformation.
AHA examines the causes behind 136 small hospital closures since 2010.
Low reimbursement, staffing shortages, low patient volumes, regulatory barriers, and COVID-19 disruptions all played a role in the shuttering of 136 rural hospitals between 2010 and 2021, including a record 19 closures in 2020, the American Hospital Association reports.
Those problems appear to be worsening as rural hospitals contend with rising costs for labor, drugs, supplies and equipment, threatening care access for rural Americans, AHA says.
"While many hospitals and health systems are facing unprecedented challenges, those faced in rural America are unique," AHA President and CEO Rick Pollack says."We must ensure that hospitals have the support and flexibility they need to continue to be providers of critical services and access points for patients and communities."
"One of the things that COVID-19 did for us, as devastating as it was, it shone a light on the importance of local healthcare, especially hospitals," Fadale says. "The organizations that stepped up and filled the gap were hospitals, and especially rural hospitals."
"If we weren't there, the likelihood of those patients getting the life-saving care they needed at the time they needed it would have been very slim," he says. "Every one of those hospitals that closed was providing for a community that has needs. When that hospital closes, all the support around them, primary care, diagnostics, imaging, all that go away."
"We have not seen an adjustment of payment from state and private payers to reflect the added financial burden to care for the patients we are serving," Yaroch says. "We also are seeing a higher level of care required by our aging population that often have multiple comorbid conditions."
Rural hospitals comprise 35% of all hospitals in the U.S. and include Medicare-designated critical access hospitals, frontier hospitals, and sole community hospitals.
In addition, rural hospitals are often the biggest employers and economic drivers in their service areas, supporting one-in-12 rural jobs across the nation, and contributing $220 billion in economic activity in their communities in 2020, AHA says.
Yaroch says that, because of the increased care costs and slimmer operating margins, "we are not able to invest in the infrastructure, capital needs, or innovative technology," Yaroch says.
"It also impacts the dollars we can put back into the community. It has a global impact that goes beyond our four walls and into our communities," she says.
The AHA report recommended "a number of pathways" to stabilize rural hospital finances, including flexible care models, lowered regulatory hurdles, partnerships, and state Medicaid expansion.
The AHA is also calling on Congress to extend the financial support provided under the Medicare-dependent Hospital and enhanced Low-volume Adjustment programs. Both programs expire on Sept. 30, 2022 unless Congress acts.
However, 'high risk' providers billed the program for $127.7 million for telehealth services in the first year of the pandemic.
First the good news.
Only 1,714 of the 742,000 providers who billed Medicare and Medicare Advantage for telehealth services for about 28 million beneficiaries during the first year of the pandemic "posed a high risk" to the program integrity, a federal audit shows.
Now the not-so-good news.
These high-risk providers represent only 0.2% of the audit sample, but they billed for about 500,000 beneficiaries and collected $127.7 million in Medicare fee-for-service payments for care provided between March 2020 and February 2021, according to an audit by the Department of Health and Human Services, Office of the Inspector General.
The first year of the coronavirus pandemic saw massive infusions of federal money and relaxed oversight by HHS of telemedicine services, as more than 28 million Medicare beneficiaries —about 2 in 5 — used telehealth in that first year of the pandemic, about 88 times more than in the previous year.
Using Medicare claims and Medicare Advantage encounters data for the 12-month period, auditors flagged providers for violating one or more of seven measures developed by OIG investigators to identify high-risk billings for fraud, waste, or abuse. OIG says it "set very high thresholds to identify providers whose billing poses a high risk to Medicare."
Each of the 1,714 flagged providers hit on at least 1 of 7 measures and warrant further scrutiny. The report called for "targeted oversight of telehealth (to) help ensure the benefits of telehealth are realized while minimizing risk in an effective and efficient manner."
Auditors also recommend five steps HHS could take to improve program integrity:
Strengthen monitoring and targeted oversight of telehealth services,
Provide additional education to providers on appropriate billing for telehealth services,
Improve the transparency of "incident to" services when clinical staff primarily delivered the telehealth service,
Identify telehealth companies that bill Medicare,
Follow up on the providers identified in this report.
"Although these high-risk providers represent a small proportion of all providers who billed for a telehealth service, these findings demonstrate the importance of strong, targeted oversight of telehealth services," OIG says.
CMS agreed with the recommendation to monitor flagged providers but "did not explicitly indicate whether it concurred with the other four recommendations," OIG says.
Oversight Challenges
Auditors say it's likely that there is additional leakage that their audit did not detect.
“Because this data brief focuses on specific measures with very high thresholds, it does not capture all concerning billing related to telehealth services that may be occurring in Medicare," the report says.
"Additionally, this report does not confirm that any particular provider is engaging in fraudulent or abusive practices. Any determination of fraud or an overpayment would require additional investigation."
The audit also acknowledged "challenges" for oversight of Medicare "incident to" billing because it allows clinical staff services under a practitioner to be billed under the supervising practitioner's identification number.
“It is critical for program integrity efforts to identify the individual who delivered the telehealth service that is billed to Medicare," OIG says. "To address these limitations in the data, we developed measures for this report that aim to minimize the effect of "incident to" billing on the results of the claims analysis."
ATA Responds
The American Telemedicine Association and affiliate ATA Action called the report "another clear statement outlining the resounding success of telehealth during the COVID-19 pandemic."
"Their report found that only a 'very small proportion of providers' billed Medicare inappropriately, indicating that the measures put in place to safeguard against fraud, waste, and abuse related to telehealth worked well to maintain program integrity," says Kyle Zebley, senior vice president, public policy at ATA and executive director of ATA Action. "We are incredibly proud of how telehealth was able to respond during the pandemic and extremely pleased at another very positive report from OIG."
Zebley noted that the 28 million Medicare beneficiaries who used telehealth in the first year of the pandemic "represents a dramatic increase from previous years."
"As we focus on finding ways to solve for health disparities in our country, this report sheds important light on populations that were most likely to use telehealth, including beneficiaries in urban areas, Hispanic beneficiaries, younger beneficiaries and female beneficiaries," Zebley says.
