Critical gaps exist between older Americans – particularly among minorities -- who receive potentially lifesaving preventive services and those who do not, according to a new federal report.
The report, Enhancing Use of Clinical Preventive Services Among Older Adults: Closing the Gap, calls for promoting preventive services for all adults age 65 and older. The prevention services include vaccinations against influenza and pneumococcal disease such as bloodstream infections, meningitis, and pneumonia, screenings for the early detection of breast cancer, colorectal cancer, diabetes, lipid disorders, and osteoporosis, and smoking cessation counseling.
About 10,000 Americans turn 65 every day and about 1 in 5 Americans will be 65 or older by 2030.
“Millions of Americans are not getting proven clinical preventive services that we know can prevent disease and improve quality of life,” said Lynda Anderson, director of the Healthy Aging Program at the Centers for Disease Control and Prevention, and a lead author of the study. “The report takes stock of current levels of recommended services by older adults, and it becomes obvious that many of these services are woefully underutilized.”
“We know prevention is critical to healthy living and independence,” said Kathy Greenlee, assistant secretary for aging with the Department of Health and Human Services. “It is important that we continue our efforts at the community level to reach all older Americans. We want to ensure that they are aware of the preventive benefits which are available to them, including those made possible by the Affordable Care Act.”
The report identifies racial and ethnic disparities for preventive services. For example, 49% of Asian/Pacific Islanders and 47% of Hispanics reported not being screened for colorectal cancer, in comparison to 34% of whites. More than 50% of Hispanics, 47% of blacks and Asian/Pacific Islanders, and 36% of whites report never receiving a pneumococcal vaccination.
The reasons for the disparities are complex and beyond the traditional healthcare arena of patient-provider relations. Older adults may not be aware of the screening services recommended for their age group, or they may not know that the services are covered by Medicare, the report said.
The report calls for increasing community access, making services available in community settings, such as providing influenza vaccinations at polling places on election days, and building awareness through media.
“If we can help patients age 65 and older get the recommended preventive screenings and regular immunizations, we could significantly reduce unnecessary illness,” said Edward Langston, MD, an American Medical Association board member.
The report was published by the CDC, and HHS’s Administration of Aging, Agency for Healthcare Research and Quality, and the Centers for Medicare and Medicaid Services.
To view the full report and for more information about CDC′s health aging activities, click here.
A federal judge has sent a South Florida physician to prison for his role in a $2.3 million Medicare scam, the U.S. Department of Justice has announced.
Jerry A. Spiegel, MD, of Boynton Beach, FL was sentenced to 41 months in prison followed by three years of supervised release. Spiegel, 78, was also stripped of his medical license and ordered to pay $880,958 in restitution, prosecutors said.
Spiegel, the former medical director of three Miami-Dade County HIV/AIDS-infusion clinics, was convicted last year of conspiring to commit healthcare fraud. Federal prosecutors said Spiegel signed patient prescriptions without examining patients or reviewing patient files. The HIV/AIDS-infusion medications that Spiegel prescribed were not medically necessary and were not administered to patients, prosecutors said.
During Spiegel's time as medical director, and based on the prescriptions he signed, the three clinics billed Medicare for more than $2.3 million in fraudulent claims. For example, from Sept. 3, 2008 to Dec. 31, 2008, R&M Services Center Corp., submitted $952,589 in fraudulent claims to Medicare, and received $425,385. From Aug. 29, 2008 to Jan. 23, 2009, Buena Vista Family Medical Center, Inc., submitted $769,094 in fraudulent claims to Medicare, and received $270,703. From Oct. 10, 2008 to Feb. 23, 2009, Solution Diagnostic Center, Inc. submitted $617,415 in fraudulent claims to Medicare, and received $184,870, prosecutors said.
Most states are "poorly prepared" to respond to a major radiation emergency like the nuclear disaster that Japan faces now, according to a report and survey of state health departments posted Monday by Disaster Medicine and Public Health Preparedness.
The report, entitled Nuclear Preparedness, notes that public health preparedness has improved since the Sept. 11, 2001 terrorist attacks on Washington, DC, and New York City, and that many of the 38 state health departments that responded to the survey reporting having some sort of written plans in place that provide for nuclear emergencies. However, most states complained of inadequate resources.
"Few reported having sufficient resources to do public health surveillance, radiation exposure assessment, laboratory functions and other capabilities," the study said. "The results of this assessment indicate that in many measures of public health capacity and capability, the nation remains poorly prepared to respond adequately to a major radiation emergency incident."
The study found that 45% of the states surveyed had no comprehensive response plans for a nuclear disaster. "Without a comprehensive plan, states in which a radiation emergency occurs are likely to mount inefficient, ineffective, inappropriate, or tardy responses that could result in (preventable) loss of life," the report said. "With nearly half of the responding states not having a response plan, a large portion of the U.S. population is at increased risk should a radiological event occur within the country's borders."
Emergency preparedness guidance related to radiation release incidents -- both intentional and unintentional -- has come from a collaborative of state, county, municipal and federal organizations called the National Alliance for Radiation Readiness. As part of the NARR activities, the Council of State and Territorial Epidemiologists reassessed the status of radiation preparedness planning and response capabilities at the state health department level in 2010 through a survey.
The 38 state health departments responded to the survey include 26 states with nuclear power plants.
Even before President Obama's healthcare reforms came into play, we were seeing the role of human resources growing (or expanding) within hospital operations. The view that HR is an orphan at board and senior management meetings has been mostly – but not completely -- rendered obsolete because senior managers have come to understand the usefulness and savings associated with effective recruiting and retention in an era of chronic workforce shortages.
The Patient Protection and Affordable Care Act adds to HR's stature because of the provision that factors patient satisfaction into Medicare reimbursements. And most anyone with any experience in hospital management will tell you that patient satisfaction is impossible without employee engagement, and effective employee engagement is difficult without strong HR leadership.
For HR leaders who want to play a strategic role in hospital planning, a mere knowledge of their own areas of expertise is no longer sufficient, says Stephanie Drake, executive director of the American Society for Healthcare Human Resources Administration. With that in mind, ASHHRA has created the eLearning Network, a series of Web-based professional development courses built around five competencies. These courses will not only provide training in traditional HR areas like "people strategies" and "personnel leadership," but will also offer a broader perspective of hospital operations with a course on healthcare business knowledge.
"Many HR departments are simply handed a budget and told to stay between these guidelines. Now they are becoming more of a business partner with hospital operations," Drake says. "We are trying to facilitate their knowledge around what they should be communicating to their CEOs. Some HR professionals may not have a business background, but they need to speak appropriately at the board table, understand their audience, because many of them are asked to be more involved with the budget."
Drake says the eLearning Network, launched Feb. 14, had been under consideration for about five years as an alternative to more rigidly scheduled and expensive Webinars or conferences. "Since about 2008 when the economy took a nose dive we saw that many of our members still needed education and still needed an avenue to be on top of best practices," Drake says. "They had less time with a variety of communication vehicles. We decided to start eLearning purely because our members were looking for it. It allows them to learn at their own pace and their own time frame."
Depending on the class, eLearning costs ASHHRA members anywhere from nothing (for the course that examines the impact of healthcare reform) to $199 to complete one of the five competencies. Each of the seven to nine courses within a competency takes about 20 minutes to 40 minutes to complete. "If you took every lunch hour per day I would think you could easily get through it in a year," Drake says. "But we are always adding new courses. There might be something like managing disruptive behaviors because it's become an issue in your facility. It's up to the learner. It's truly what they look for and what they would want."
Drake says eLearning will always be a work in progress, adapting to whatever training members need. "It will change as our members' needs change. As health reform guides the way we do business. That will change," she says. "There will always be a class in there about on-boarding, for example, and we won't necessarily change the basics for on-boarding, but there may be some best practices that we want to add to the class. We will always need to update the classes."
ASHHRA is on to something here. In this era of tighter budgets, HR administrators still need professional development – perhaps even more so. This series of courses seems to be a practical and affordable way to address that need. If you've taken these courses, let me know what you think.
Two New York City healthcare executives, a gynecologist, and a healthcare consultant are among eight people charged with bribery, conspiracy, fraud, and related offenses for their alleged roles in an influence peddling scheme involving three state legislators, federal prosecutors said.
The U.S. Attorneys' Office in New York last week unsealed the complaint against Democratic State Sen. Carl Kruger, who is alleged to have taken more than $1 million in bribes from several co-defendants named in the indictment, including David Rosen, the CEO of MediSys Health Network, Robert Aquino, the former CEO of Parkway Hospital in Queens, NY, and Solomon Kalish, a healthcare consultant.
Rosen is also charged with paying more than $390,000 in bribes to former New York State Assemblyman Anthony Seminerio, and $177,000 in bribes to New York State Assemblyman William Boyland, prosecutors said.
Michael Turano, MD, a Manhattan-based gynecologist and a family friend of Kruger, is charged with laundering Kruger's bribes through two shell companies.
Manhattan U.S. Attorney Preet Bharara said the federal case details "an unholy alliance of politicians, lobbyists, and businessmen."
"Every single time we arrest a state senator or assemblyman, it should be a jarring wake-up call. Instead, it seems that no matter how many times the alarm goes off, Albany just hits the snooze button," Bharara said. "Maybe this time they will get the message."
The indictment alleges that from at least 2006 through March 2011, Kruger received a stream of bribes totaling at least $1 million from several sources, including Rosen, Aquino, and Kalish.
Kruger allegedly funneled the bribes to the bank accounts of two shell companies -- Olympian Strategic Development Corp., and Bassett Brokerage – that were created by Turano. Turano allegedly used the money to pay the lease on a Bentley, pay his credit card bills, and pay off the mortgage on the multi-million dollar home, prosecutors said.
Kalish, the owner of consulting firm Adex Management Inc., allegedly funneled $197,000 to Olympian, which prosecutors claim was used to buy favors from Kruger. In the summer of 2008, for example, Aquino, then the CEO at Parkway Hospital, paid Adex $60,000 –- half of which Kalish put in the Olympian account -– so that Kruger would lobby the state to help Parkway acquire the Caritas Hospitals.
At the same time, Rosen also allegedly attempted to bribe Kruger to help MediSys acquire the Caritas Hospitals. They were ultimately acquired by Cerberus Capital Management. Rosen allegedly had the health system's Brookdale Hospital hire a third-party hospice care provider, knowing that Kruger had a stake in it.
In addition, prosecutors allege that between 1999 and 2008, Rosen used MediSys or affiliates to funnel $390,000 to Seminerio through a sham consulting company. In exchange, Seminerio lobbied the state for the discharge of a $19 million loan in 2006, co-sponsored a bill to provide a secured financing option to MediSys in 2006, and pressed state agencies on behalf of Medisys in connection with the Caritas Hospitals acquisition. Seminerio has already pled guilty to fraud and was sentenced to six years in prison.
Rosen also allegedly hired Boyland for what prosecutors said was a "no-show consulting job" that paid the lawmaker $35,000 a year between 2003 and 2008. In exchange for the approximately $177,000, Boyland allegedly pushed for the State Assembly to award millions of dollars to Brookdale Hospital.
Emory Healthcare and Saint Joseph's Hospital of Atlanta have created a joint operating company that will give Emory the controlling stake, but allow the Catholic hospital to keep its religious affiliation and avoid an outright sale.
The financial details of the JOC were not disclosed when the deal was announced Friday. However, the partnership -- expected to be finalized by year's end -- will create the largest health system in Georgia, with campuses in DeKalb County, Johns Creek, Midtown Atlanta and Sandy Springs.
The two systems stressed that the JOC is a partnership -- not an acquisition -- that was first discussed but dismissed last October. However, the arrangement would give Emory Healthcare a 51/49 majority stake of Saint Joseph's and allow the joint healthcare system to expand services. Saint Joseph's said it will be involved in the governance of the JOC, with "super majority voting rights on certain issues critical to Saint Joseph's mission and values."
Executives at Emory Healthcare and Saint Joseph's -- Atlanta's oldest hospital -- said they see the partnership as "a strategic and transformative opportunity to marry the clinical and cultural strengths of the two organizations," the two systems said in a joint announcement.
"At our cores, both Emory Healthcare and Saint Joseph's Hospital share compatible values and a common purpose: to provide outstanding health care to North Georgia and the state," said John Fox, president/CEO of Emory Healthcare. "Combining the excellence of our physicians, skill and experience of our clinical staffs, and promise of our research capabilities only strengthens what we offer patients."
Heather Dexter, COO of the 410-bed St. Joseph's Hospital, told the Atlanta Journal-Constitution earlier this month that any decision to look for a buyer or a partner would be driven by inescapable changes in the healthcare sector that make it more difficult for independent hospitals. "We can't continue to be a stand-alone hospital in Atlanta, which is quickly changing into a market that will be dominated by three or four large players," Dexter told the newspaper. "We are making this deal in order to continue serving this community for the next 130 years." And while Saint Joseph's is profitable, the hospital increasingly has had to use investment funds to cover operations.
The deal is subject to state and federal review, and review by the Catholic Archbishop of Atlanta. It is anticipated to be completed by the end of the year, and Saint Joseph's Hospital will likely continue as a Catholic facility sponsored by the Sisters of Mercy.
"Similar values and mission statements outline our shared commitment to delivering compassionate, innovative care with integrity and excellence," said Paul Johnson, CEO of Saint Joseph's. "While complementing each other well, each organization brings unique features to the JOC that will enable us to better care for our community, while positioning us to meet the growing challenges of healthcare and industry reform."
Although the financial terms have not been made public, the two systems said their respective governing boards have reviewed the deal and have determined that each party has contributed adequate and fair consideration for its interest in the new company.
A member of Catholic Health East, Saint Joseph's Health System is based in Atlanta, with subsidiaries that provide indigent care services, an employed physician group, a 25-bed critical access hospital in Greensboro, GA, and research facilities.
The federal government has proposed new rules outlining what states may do to get a State Innovation Waiver under the Affordable Care Act.
Departments of Health and Human Services Secretary Kathleen Sebelius said the new guidelines “demonstrate the flexibility available to states as they continue to move forward on fixing our broken health insurance marketplace.”
Under ACA, State Innovation Waivers are available in 2017. However, the Obama administration said it supports legislation that would make waivers available to states beginning in 2014, so long as they:
Provide coverage that is as comprehensive as the coverage offered through Health Insurance Exchanges.
Make coverage as affordable as it would have been through the exchanges.
Provide coverage to as many residents as otherwise would have been covered under ACA.
Do not increase the federal deficit.
The enhanced flexibility for waivers comes as Republicans in Congress ramp up attacks on the more than 1,000 waivers issued under the ACA. The Hill newspaper reported Friday that the waivers have become a political liability for the Obama administration. Approval of waiver requests has jumped from 222 to almost 730 in December, and another 300 have been approved since then. The Department of Health and Human Services says waiver requests have slowed during the past two months, but that hasn't quelled the GOP outcry.
The Obama administration has said that states have significant flexibility in implementing ACA , from how they design exchanges to cracking down on insurance company abuses. States also have new resources to improve and lower costs in their Medicaid programs. For example, if states choose to operate their own exchange, they are eligible for grants to help design them and determine the rules, including whether to allow all companies to offer insurance in the exchange or to select only plans that improve the quality and affordability of the choices.
States could also provide tax credits that link small business tax credits to the tax credits for moderate-income families. Or they could change the benefit levels or add new benefit levels for health plans offered in the exchanges, HHS said in a media release.
The proposed regulation describes the content of the waiver application and how such proposals may be disclosed to the public, monitored, and evaluated. The Obama administration said it wants suggestions for improving this process from states, patients, providers, and the public.
Aetna and Roanoke, VA-based not-for-profit Carilion Clinic said this week they are collaborating to build an accountable care organization in southwest Virginia that will feature co-branded insurance plans for individuals and businesses.
Carilion CEO Edward G. Murphy, MD, told HealthLeaders Media Thursday that the collaboration was the logical next step for the health system because "we realized there was only so far you could go being a provider alone and deliver the kind of value that you want for the community."
"It became increasingly apparent to us that you needed a fundamentally different relationship with payersand be a partner in this regard," he says. "You have to think about what you and they bring to the table as being complementary and not adversarial and trying to jointly provide services and value to patients in common."
The Aetna-Carilion collaboration is expected to include co-branded commercial healthcare plans for businesses and individuals later this year, and new payment models that encourage providers to share accountability to improve patients' health, including rewards for meeting quality targets and shared costs savings, Aetna and Carilion said in a joint statement.
Carilion Clinic will continue to offer Medicare Advantage products and will buy administrative services through Hartford, CT-based Aetna to lower administrative costs. Aetna will become the administrator of Carilion's health benefits plan for its employees.
"Carilion Clinic would be the ACO, but the ACO needs a contracting vehicle and an insurance payment vehicle and that would be Aetna," Murphy says. "You will see co-branded insurance products with Aetna so we can bring insurance product to commercial market here that would carry Aetna's name and Carilion's name."
Murphy says Aetna would likely "begin taking over the back room management" for Medicare Advantage next month, and begin an open enrollment on July 1 for Carilion's 17,000 or so employees and dependents. Phase in for the commercial market and Medicaid are targeted for completion by the end of the year.
Charles Saunders, MD, president of Strategic Diversification at Aetna, said in a statement that the "collaboration is designed to bring new models of healthcare delivery, advanced technology and payment reform to the market that creates improvements in both quality and affordability of care. By bringing the best capabilities of each organization and aligning incentives across all stakeholders, we can create real value."
ACOs are a high priority for healthcare leaders. Seventy-four percent of hospital chief executives surveyed for the HealthLeaders Media Industry Survey 2011said they either already have the components in place to be considered an accountable care organization or that they will within the next five years.
Carilion's ACO features an integrated electronic medical record to support information sharing and a network of primary care physicians, specialists, hospitals and outpatient facilities.Aetna members using Carilion can access Aetna's online resources including pricing and quality, and wellness tools
"Aetna is exploring new ways to work with healthcare providers, and we've found that these discussions are positively received as we collectively seek to improve the healthcare system," said Thomas Grote, president of Aetna's Maryland, Virginia and Washington, D.C., markets. "Our arrangement with Carilion will provide a foundation to grow these new models of care."
Murphy says Carilion physicians and facilities will continue to participate in existing health plan provider networks and will accept members from Aetna and other private plans.
He says the relationship with Aetna should not hinder business with other health plans. "Certainly we will continue to contract with other insurance companies, and we need to, but our relationship with Aetna will allow us to provider broader array of services at lower costs," he says.
He says the collaborative won't stifle access for other insurers. "This was not an exclusive contract. We talked with other insurers about doing this but we got to the finish line with Aetna," he says. "It's another layer of competition that brings new products to the market that are in everybody's interest."
"If we were to tell all the other insurance companies that now we only deal exclusively with our own insurance product and that we would not be willing to continue having a contract with United or BlueCross that might be a different story," he says. "But we are not going to allow these contracts to get between us and our patients. Patient choice prevails and we are here to take care of our patients.
As many as 100 million Americans may be misclassified as having abnormal blood pressure, and it may time to reassess what constitutes "normal" blood pressure, the authors of a new study assert.
The study published in the current edition of the Journal of General Internal Medicine found that those people are not actually more likely to die prematurely than those with "normal" blood pressure, which is now considered below 120/80.
Lead researcher Brent Taylor, MD, from the Veterans Affairs Health Care System in Minneapolis and the University of Minnesota, and his colleagues, found that for people younger than 50, diastolic blood pressure is the more important predictor of mortality. For people over 50, systolic blood pressure is the stronger predictor.
"Our findings highlight that the choice of approach used to define normal blood pressure will impact literally millions of Americans," Taylor said. "If we cannot reliably see an effect on mortality in a large group of individuals followed for nearly 20 years, should we define the condition as abnormal? We believe considering this kind of approach represents a critical step in ensuring that diagnoses are given only to those with a meaningful elevation in risk, and targeted towards individuals most likely to benefit."
The study examined the independent contribution of diastolic blood pressure and systolic blood pressure on mortality, as well as how these relationships might affect the number of Americans currently labeled as having abnormal blood pressure.
Researchers looked at data for 13,792 people from the National Health and Nutrition Examination Survey, which enrolled participants in 1971-76 and followed them up for two decades. They studied DBP, SBP and long-term survival data specifically.
To assess the underlying distribution of untreated blood pressure in American adults by age, Taylor and team also looked at data for 6,672 adults from the first National Health Examination Survey carried out between 1959 and 1962.
They found that in people aged over 50, those with SBPs above 140, independent of DBP, were significantly more likely to die prematurely. In those aged 50 or less, DBPs above 100 were linked to significant increases in premature death. The authors' analysis offers alternative cut-off points for the definition of "normal."
HCA Inc. late Wednesday sold 126.2 million shares at $30 a share in an initial public offering that raised $3.79 billion – nearly $200 million more than projected by analysts for the third IPO in the history of the Nashville-based hospital chain.
HCA sold 87 million shares, and shareholders sold 38.4 million shares, HCA said. In addition, underwriters have been granted a 30-day option to buy an additional 18.9 million shares from shareholders. The shares are expected to begin trading on the New York Stock Exchange Thursday morning under the ticker symbol "HCA" and the offering is expected to close on March 15, HCA said in a statement.
HCA will use the IPO net proceeds to temporarily reduce its asset-based revolving credit facility and its senior secured revolving credit facility. The hospital chain said it will not get any of the proceeds from the sale of shares of common stock by the shareholders.
HCA has been privately held since November 2006 in a $33 billion leveraged buyout that required about $27 billion in debt to finance the deal.
HCA is the nation's largest for-profit hospital chain, with 154 hospitals and 96 freestanding surgery centersin 20 states and the United Kingdom. HCA reported more than $30 billion in revenues for the 12 months in fiscal 2010.
Standard & Poor's Rating Services said Wednesday that HCA's rating outlook is not expected to be altered by the IPO. "Still, financial sponsors of the largest U.S. hospital company, who have received dividends totaling over $4 billion since its $33 billion buyout in 2006, will continue to dictate a financial risk policy that we believe will be highly leveraged," S&P said. "That means that, in our opinion, debt to EBITDA may average around five times as shareholder-oriented investment and dividend activity consumes much of its cash flow from operations, which was $3 billion in 2010.
