All Children's Hospital in St. Petersburg, FL is the first US hospital outside of the Baltimore/Washington DC area to join Johns Hopkins Medicine, the hospitals have announced.
The non-cash transaction formally integrating ACH into JHM took place eight months after the two organizations signed a letter of intent.
"This is a momentous occasion -- the beginning of a new chapter in the history of All Children's Hospital," says Gary Carnes, president/CEO of All Children's Health System. "The goal has always been to become a national leader--not only in clinical care, but also in teaching and research to benefit future generations of children in Florida and beyond. As part of Johns Hopkins Medicine, All Children's value as a key community asset will increase exponentially."
Ronald R. Peterson, president of The Johns Hopkins Hospital and Health System and executive vice president of JHM, said: "Integrating with such an outstanding pediatric medical center as All Children's Hospital offers benefits that will extend far beyond our respective campuses."
Under the terms of the integration agreement, ACH retains its name. Donations made to the Hospital's Foundation remain for the benefit of ACH. Leadership and day-to-day operation of the 259-bed freestanding pediatric hospital and outreach facilities in eight west Florida counties are not expected to change. ACH retains its voluntary medical staff and physician organizations, including those University of South Florida physicians practicing at ACH. The University and ACH will continue the USF Residency Program through 2014, with the possibility of extending beyond that under discussion.
Board governance structure ensures that local community leaders continue oversight of ACH as majority members of the board of trustees. The chairman of the board of ACH will be a member of Johns Hopkins Medicine and members of the ACH board will be offered opportunities to serve on JHM and JHHS committees.
ACH is the only pediatric hospital on Florida's West Coast and one of only two hospitals in the state totally devoted to children's care. ACH draws patients from throughout Florida, 50 states and 36 countries, with specialized staff, services and facilities, including heart transplantation, blood and marrow transplantation, pediatric trauma services and one of the largest neonatal intensive care programs in the southeast. The hospital is part of the billion-dollar All Children's Health System, with more than 2,800 employees on its main campus and 10 outreach centers in west central Florida.
Hospitals can reduce life-threatening bloodstream infections in children with peripherally inserted central venous catheters by removing the devices as early as possible, according to a Johns Hopkins Children's Center study in the journal Clinical Infectious Diseases.
The study, believed to be the largest of its kind in pediatric patients, analyzed predictors of catheter-related bloodstream infections among 1,800 children treated at Hopkins over six years. The children cumulatively underwent more than 2,590 catheter insertions, which resulted in a total of 116 infections.
One potent predictor of infection was length of use, the researchers found. Children whose devices remained in for three weeks or longer were 53% more likely to get a bloodstream infection, compared with those with shorter catheter times. Children who got the catheters to receive IV nutrition were more than twice as likely to get an infection as children who had the devices placed for other reasons, the study found.
The findings of the study underscore the need for a tailored approach to each patient while at the same time following standard infection prevention guidelines, the study's authors said. "Clinicians should evaluate each patient's condition daily and weigh the risk of leaving the device in against the risk of removing it by asking a simple question 'Does this child need a central line for another day?'" says senior author Aaron Milstone, M.D., M.H.S., an infectious disease specialist at Hopkins Children's.
No matter the length of PICC use, the first line of defense against bloodstream infections should always be simple precautions that include rigorous hand-washing before handling the line, regularly changing the dressing that covers the PICC line, and periodically changing the tubes and caps attached to it, the researchers said.
"Even when clinicians follow meticulously basic rules of catheter insertion and maintenance, the risk of infection is never zero," Milstone said. "Reducing the time a child has a PICC is one extra step to minimize that risk."
Researchers found an 80% higher risk of bloodstream infections among children in the ICU than in regular units. However, the study also showed that more than 30% of all infections occurred in children outside of the ICU. Twenty-two percent of infections occurred after patients left the hospital, the researchers found, a finding that points to the importance of educating both parents and home-based caregivers on ways to prevent infections at home.
"Children in intensive care have more severe disease and often require catheters, but it is critical that we remain vigilant about patients with perceived 'lower risk' outside of intensive care, and indeed those outside of the hospital, because they are not immune to infections," said lead investigator Sonali Advani.
Some accountable care organizations could fall into designated antitrust "safety zones" while other ACOs could be eligible for expedited antitrust reviews under proposed rules issued jointly Thursday by the Federal Trade Commission and Department of Justice.
The two agencies are asking for public comment on their joint proposed policy guidelines that are designed to ensure that ACOs can serve Medicare beneficiaries and patients with private health insurance without raising competitive concerns.
"The Administration has led an unprecedented, collaborative effort among all of the agencies responsible for developing guidance for ACOs," said FTC Chairman Jon Leibowitz. "This guidance will help ensure that ACOs meet their goals of improving quality and lowering costs while minimizing the regulatory burden on healthcare providers."
ACO collaborations among competitors could raise concerns about competitiveness, DOJ and FTC said. So they developed the proposed antitrust policy statement to coordinate competition analysis with CMS's review of ACO applications to ensure they do not lead to reduced competition and higher prices for consumers.
The policy statement describes:
The ACOs to which it will apply;
When the FTC and DOJ will apply particular antitrust analyses to those ACOs;
An antitrust safety zone for certain ACOs;
The CMS-mandated antitrust review process for certain other ACOs;
Options for ACOs to gain additional antitrust clarity if they fall outside the safety zone but below the CMS-mandated antitrust threshold.
The FTC and DOJ will evaluate applicants that meet CMS eligibility criteria based on the ACOs' share of services in each participant's primary service area. ACOs with high PSA shares may pose a higher risk of being anticompetitive, could restrict competing ACOs, and could allow an ACO to raise prices charged to commercial health plans above competitive levels, the two agencies said.
Depending on an ACO's range of PSA shares, CMS may mandate, or an ACO may choose to seek, an expedited antitrust review. An ACO will submit its request for an expedited 90-day review to both the FTC and DOJ, and the agencies will determine which of the two will review the request. In addition, the FTC and DOJ will establish a Joint ACO Working Group to discuss issues arising out of ACO reviews.
The two agencies have opened a public comment period on the proposed policy statement through May 31 on issues including:
Whether the proposed policy statement should be changed in any respect;
Whether other data sources exist that ACO applicants could use to determine relevant PSA shares for: 1) physician services rarely used by Medicare beneficiaries (e.g., pediatrics, obstetrics); and 2) inpatient hospital services located in states where all-payer hospital discharge data are unavailable; and
Whether providing the documents and information for an expedited antitrust review will present an undue burden on ACO applicants.
Comments can be submitted electronically here. The proposed policy statement can be found here.
HHS said it will hold open-door forums and listening sessions during the comment period to help the public understand what the Centers for Medicare & Medicaid Services is proposing to do with the voluntary ACOs, and to ensure that the public understands how to participate in the comment process.
“The Affordable Care Act is putting patients and their doctors in control of their healthcare,” said HHS Secretary Kathleen Sebelius in a statement. “For too long, it has been too difficult for healthcare providers to work together to coordinate and improve the care their patients receive. That has real consequences: patients have gaps in their care, receive duplicative care, or are at increased risk of suffering from medical mistakes. Accountable care organizations will improve coordination and communication among doctors and hospitals, improve the quality of the care their patients receive, and help lower costs.”
The Medicare Shared Savings Program initiated under the Affordable Care Act will reward ACOs that lower healthcare costs while meeting performance standards on quality of care and patients’ need. The Obama Administration has said that by linking payments to outcomes ACOs could save Medicare as much as $960 million over three years.
Online job ads for healthcare practitioners, technical workers, and support staff made slight gains in March, regaining some of the ground lost in February but well below the surge in job postings for the healthcare sector in January, according The Conference Board Help Wanted Onlinereport.
Labor demand for healthcare practitioners and technical occupations grew by 3,700 in March to 603,800. Healthcare support positions posted 4,400 new listings to 143,500 in March, with the primary demand coming for physical therapist assistants, home health aides, nursing aides, and medical assistants, The Conference Board reports.
The board's Help Wanted Online Data Series tracks more than 1,000 online job boards across the United States.
In January, The Conference Board reported 78,500 new listings for healthcare practitioners and technicians, and 16,600 new ads for healthcare support jobs, as healthcare jobs led a strong first month of 2011. However, February saw online job ads for practitioners and technical occupations drop by 4,300 owing largely to decreases in advertised vacancies for registered nurses and occupational and physical therapists, while support positions posted a decrease of 4,200.
Even with March's tepid growth in job postings, there were three job listings for every healthcare technician and practitioner job seeker, with the average salary of $33.51 an hour. Conversely, there were two healthcare support workers for every online job listing, with pay averaging $12.84 an hour, The Conference Board reports.
In the overall economy, online advertised vacancies rose 208,800 in March to 4.4 million, which brought the gain in labor demand for the first quarter of 2011 to more than 600,000. The biggest areas of job listing growth were in office administrative (35,800 new online posts), sales (28,300), and food preparation and serving (20,900).
"Thus far in 2011, labor demand is looking strong," says June Shelp, vice president at The Conference Board. "In the first quarter of 2011, the monthly increase in advertised vacancies has averaged about 200,000/month. That's good news after the overall anemic growth in labor demand over the last 11 months of 2010. In March, almost half of the advertised vacancies were new ads that were not there the previous month (new ads up 98,200). This is a further positive sign that employers are continuing to look for workers."
Enhanced access and care coordination are among the cornerstone "value-driving elements" that must be implemented if patient-centered medical homes and accountable care organizations are to succeed.
That's one of several key findings in a sweeping report, Better to Best: Value-Driving Elements of the Patient Centered Medical Home and Accountable Care Organizations issued Wednesday by the Patient-Centered Primary Care Collaborative. The report was crafted in partnership with The Commonwealth Fund and the Dartmouth Institute for Health Policy and Clinical Practice.
Paul Grundy, MD, president of the Patient-Centered Primary Care Collaborative said the report is most noteworthy for the consensus found among major providers, payers, and consumer groups. "It's the first time there's been such a broad agreement on a set of principles," said Grundy, who is also IBM's Global Director of Healthcare Transformation.
"There's an understanding from providers about what they want to provide and a consensus among buyers that they want to buy what the providers are offering. It is a national consensus across the broadest possible range of players on a journey toward care that's comprehensive, integrated, coordinated and accessible, versus care that's episodic, disintegrated, uncoordinated, inaccessible," he said.
Better to Best provides an action plan for core areas of consensus that were first identified at a one-day collaborative that PCPCC sponsored on Sept. 8, 2010. The collaborative agreed that:
The goals of PCMHs and ACOs are better care, better health and lower costs.
Improvement must be considered for lower costs and value to the consumer.
Ongoing reportable measurements are needed to address these goals.
Payment systems need to change and several payment models should be tested.
Learning collaboratives and rapid learning environments are needed to establish an evaluation framework around these issues.
Each point of consensus includes recommendations and action items around policy, research and features to embed in federal demonstration projects. Some require development of new structures for measurement and evaluation, but others build upon existing efforts, such as aligning federal meaningful use standards with health IT requirements associated with medical home recognition and ACO regulations. The group will continue to work together in support of these shared goals.
"This report indicates that key stakeholders are in agreement on the need to promote patient-centered, coordinated care through changes in the way we pay for and deliver care, and development of medical homes and accountable care organizations are mutually reinforcing models for achieving these goals," said Commonwealth Fund President Karen Davis.
Of the four value-driving elements identified, two -- enhanced access and care coordination -- require urgent overhaul to maximize health outcomes at lower costs. The others, HIT and payment reform, are essential tools without which widespread implementation of new care delivery models will not succeed, the report said.
Better to Best lays the groundwork for achieving the Triple Aim: Improve the health of the population; enhance the patient experience of care; and reduce, or at least control, the per capita cost of care, said co-author Elliott S. Fisher, MD, in a statement. Fisher is a leading proponent of the ACO concept. "If we remain true to the agreement made in September and formalized in this document, we have the opportunity to help create an accountable, patient-centered system that not only enhances quality of patient care but controls costs."
Inova Health System has reached a settlement with the U.S. Department of Justice. Under the agreement, Inova would pay aggrieved former patients at its Fairfax, VA hospital $120,000, another $25,000 in civil penalties, and bolster training to hospital staff on the requirements of the Americans With Disabilities Act and related laws.
The settlement resolves a federal complaint that the health system failed to provide sign language interpreters to a hearing impaired pregnant woman and other deaf people, the Department of Justice announced this week.
The consent decree, which must be approved by a federal judge, also requires Inova to adopt specific policies and procedures to ensure that auxiliary aids and services are promptly provided to patients or companions who are deaf or hard of hearing.
The DOJ lawsuit, filed this week with a consent decree in the U.S. District Court for the Eastern District of Virginia, alleged that because the hospital failed to provide sign language services, deaf patients were denied effective communication with hospital staff, the opportunity to participate in medical treatment decisions, and the full benefit of healthcare services provided by Inova Fairfax Hospital.
"This settlement shows that Inova and the government share the same goal – making sure that deaf and hard of hearing patients can communicate with their doctors, especially at critical moments in their medical care," said Neil H. MacBride, U.S. Attorney for the Eastern District of Virginia.
The ADA requires doctors, hospitals and other healthcare providers to provide equal access to patients and companions who are deaf or hard of hearing. When medical services involve important, lengthy or complex oral communications with patients or companions, hospitals are generally required to provide qualified sign language interpreters and other auxiliary aids, free of charge, to individuals who are deaf, are hard of hearing or have speech disabilities.
The appropriate auxiliary aid to be provided depends on a variety of factors, including the nature, length and importance of the communication; the communication skills and knowledge of the individual who is deaf or hard of hearing; and the individual's stated need for a particular type of auxiliary aid.
Inova issued the following statement about the settlement:
Inova Fairfax Hospital is pleased to have resolved a dispute with the Department of Justice and a deaf couple involving accessibility for deaf and hard of hearing patients and their companions. A consent decree negotiated three ways -- between the hospital, the Justice Department, and the deaf couple -- is intended to ensure that the hospital meets the needs of the deaf and hard of hearing community we serve through an improved system to deploy sign language interpreters and assistive technology.
Inova Fairfax Hospital has always been committed to satisfying its duties under the Americans with Disabilities Act, and to making efforts to secure needed interpretive services and other auxiliary aids for patients and their immediate companions in order to ensure clear and effective communication on important healthcare matters. The consent decree represents a favorable outcome for all concerned, taking Inova's commitment a step forward by putting Inova in a position of leadership in serving persons who are deaf or hard of hearing.
Inova looks forward to demonstrating that when a proper patient assessment coupled with appropriate care is undertaken, both the healthcare provider and recipient may anticipate a favorable experience.
Raising the Medicare eligibility age from 65 to 67 in 2014 would generate about $7.6 billion in net savings to the federal government, but it would add $5.6 billion in out-of-pocket costs for 65- and 66-year-olds, and $4.5 billion in employer retiree healthcare costs, according to a Kaiser Family Foundation study.
The study also estimates that raising the Medicare eligibility age would raise premiums by 3% for those who remain on Medicare and for those who get coverage through health reform's new insurance exchanges. The study assumes both full implementation of the Affordable Care Act and the higher eligibility age in 2014.
Among the estimated five million affected 65- and 66-year-olds, about three in four would pay an average of $2,400 more for their healthcare in 2014 than they would have paid if covered under Medicare, the study said. Nearly one in four are expected to have lower out-of-pocket spending, mainly due to the ACA's coverage expansions through Medicaid and the premium tax credits available to low- and middle-income Americans.
"Raising Medicare's age of eligibility would obviously reduce Medicare spending, but would also shift costs onto seniors and employers, and increase costs elsewhere on the federal ledger," said Kaiser Family Foundation Vice President Tricia Neuman. "This analysis drives home the tough policy choices that lie ahead when Washington gets serious about reducing the federal deficit."
In the absence of the health reform law, raising Medicare eligibility age would create more uninsured, according to other studies, as many older Americans would have difficulty finding affordable coverage in the individual market.
Under health reform, virtually all 65- and 66-year-olds would be expected to obtain alternative sources of coverage. According to the study, 42% are projected to obtain coverage through employer-sponsored plans, 38% through plans offered via health insurance exchanges, and 20% through the expansion of Medicaid for low-income adults.
Raising Medicare eligibility to age 67 in 2014 would result in $31.1 billion in gross Medicare savings in 2014 because Medicare would no longer be covering 65- and 66-year-olds, the study said. The gross savings would be partially offset by increases in federal spending for individuals who would be covered by Medicaid ($8.9 billion) and for individuals receiving premium tax credits in the exchanges ($7.5 billion). The gross savings also would be offset by a $7 billion reduction in Medicare premium receipts from 65- and 66-year-olds who would no longer be enrolled in the program.
In addition, the study said healthcare costs for employers would increase by an estimated $4.5 billion in 2014 as employer plans become the primary payer for 65- and 66-year-olds who would no longer be eligible for Medicare, rather than provide supplemental coverage that wraps around Medicare.
The study also found that:
Premiums for people younger than 65 purchasing coverage through health reform's insurance exchanges would rise by 3% as a result of adding 65- and 66-year-olds to the exchanges.
Medicare Part B premiums would rise by an estimated 3%, as the youngest seniors are removed from the Medicare risk pool, resulting in higher per-beneficiary costs for those remaining.
Costs to states would increase by an estimated $700 million overall. This reflects higher state Medicaid costs associated with 65- and 66-year-olds who would otherwise be dual eligibles and also from higher costs associated with higher Medicare premiums for remaining dual eligible beneficiaries for whom Medicaid pays the Medicare premiums. Those higher costs are offset in part by some affected beneficiaries qualifying for full federal funding under health reform's Medicaid expansion.
A Miami physician has been sentenced to two years in prison for his role in a multimillion dollar Medicare scam involving several home health agencies, the Department of Justice has announced.
Fred Dweck, MD, was also sentenced to three years of supervised release following his prison term, and ordered – along with his co-conspirators – to pay $22 million in restitution to the Centers for Medicare & Medicaid Services, DOJ said in a statement.
Dweck was the physician at Courtesy Medical Group, a Miami medical clinic that was owned by co-defendants, Auturo Fonseca and Yudel Cayro. Dweck pleaded guilty and admitted that he wrote hundreds of prescriptions and signed hundreds of care plans and medical certifications for Medicare beneficiaries to receive unneeded home health services, including twice or three-times daily skilled nursing visits for insulin injections.
Dweck, an employee of the clinics, admitted that the beneficiaries could care for themselves and did not need the expensive home health services. He also admitted to prescribing unnecessary physical therapy services for many of the same beneficiaries.
Federal prosecutors said Courtesy Medical Group would solicit and take bribes and kickbacks from patient recruiters and other home health agencies in return for Dweck's signature on bogus prescriptions. The prescriptions would be used by dozens of Miami-area home health agencies to fraudulently bill Medicare for millions of dollars in unnecessary services.
Dweck admitted that from August 2006 to December 2009 he referred approximately 858 patients through Courtesy Medical Group and other Miami-area clinics for the unnecessary services, resulting in more than $37 million in fraudulent billings to Medicare. Of that, more than $22 million was paid by the Medicare to the home health agencies. More than $16 million of the bogus billings stemmed from prescriptions issued by Dweck through Courtesy Medical Group, of which nearly $10 million was paid by Medicare.
The case was brought by the Medicare Fraud Strike Force. Since its inception in March 2007, strike force operations in nine cities have charged more than 1000 defendants who collectively have falsely billed Medicare for more than $2.3 billion, DOJ says.
State Medicaid programs spent at least $329 million more in 2009 on 20 popular brand-name drugs than they would have if they'd used lower-cost generic equivalents, according to a study from the American Enterprise Institute.
The study – Overspending on Multi-source Drugs in Medicaid -- also projects that as much as $433 million in potential Medicaid savings could be lost in the two years when 10 "blockbuster brand drugs" lose their patent protections, unless states and the federal government press for the use of generic equivalents.
The study from the conservative think tank examined Medicaid spending in 45 states for 20 popular prescription drugs in 2009 and found that the federal-state program "wasted" an average of $95 per prescription by failing to use therapeutically equivalent generics. That amounted to about $1.5 billion in total costs, about 22% higher than the cost of generic equivalents. The federal share of total Medicaid spending is generally about 57%.
The study's author, Alex Brill, said states and the federal government need to take action now to encourage or mandate the use of generic drugs before the federal healthcare reforms expand the Medicaid rolls by 16 million by 2019. "The subsequent increase in the size of the Medicaid drug program will result in greater waste if new policies are not implemented," Brill said.
Most of the overspending (85%) was concentrated in eight brand name drugs, including: the antipsychotic Risperdal ($60 million); anticonvulsants Lamictal ($58 million), Depakote ($40 million), Keppra ($34.6 million), and Topamax ($29.1 million); antidepressant Wellbutrin ($23.5 million); analgesic Duragesic ($22.7 million); and antiemetic Zofran ($10.3 million.) Total "waste" for these drugs was roughly $279 million, the study said.
On the state level, the greatest unnecessary spending was in California ($102 million), Texas ($31 million), Georgia ($25 million), and Ohio ($21 million). Per Medicaid enrollee, however, the most wasteful states were Vermont and Iowa ($31 per enrollee in each state), Maine ($18 per enrollee), and New Hampshire ($17 per enrollee).
Brill cites research from the National Association of Chain Drug Stores that the average generic prescription price among private payers in 2009 was $39.73 while brand drugs averaged $155.45, a generic discount of nearly 75%. "Clearly, potential savings from using generic versions of brand drugs is significant in a program that spent $20 billion on prescription medications in 2009," Brill said.
Patent protections are expected to expire for at least 10 popular prescription drugs over the next two years, Brill said, including: Actos, Combivir, Concerta, Lexapro, Lipitor, Plavix, Seroquel, Singulair, Xopenex, and Zyprexa. "Assuming that substitution rates are either 70% or 80% and … that generics are half the price of brands, I estimate that Medicaid will waste an annual $289 million–$433 million on these 10 drugs in the four quarters beginning after the end of the first generics' 180-day exclusivity period," Brill said.
More needs to be done to press for the use of generic alternatives, Brill said. Only 16 states require pharmacists to dispense the lowest-cost multi-source drugs to Medicaid patients. Forty-one states have generic substitution laws for Medicaid, when available, in their Medicaid programs, but many of those same states also have exceptions and carve outs. "One example in many states are 'dispense-as-written' exceptions, which allow physicians to override generic substitution when they deem a brand drug to be medically necessary," Brill said.
Other money-saving strategies that states could use include preferred drug lists, lower co-payments for Medicaid enrollees who use generic drugs, and monthly limits on the number of brand-name prescriptions an enrollee can fill. "To reduce or eliminate waste in Medicaid drug programs, policymakers will need to consider wider implementation of these policies or others like them," Brill said.
