Rochester, NY-based emergency physician Sandra M. Schneider, MD, assumes a one-year term as president of the American College of Emergency Physicians this week.
Schneider is a professor and chair emeritus of the department of emergency medicine at the University of Rochester and attending physician at Strong Memorial Hospital in Rochester. She has been a leader on the issue of reducing overcrowding in the nation's emergency departments and on implementing high-impact, low-cost solutions to address the problem of holding or "boarding" patients in the emergency department.
"Patient boarding and overcrowding in emergency departments are critical problems that deserve attention at the highest levels," Schneider said. "It is imperative that we reduce the number of patients we board in our emergency departments to ensure that all patients get the timely care they need and deserve."
Schneider served as the founding chair of the department of emergency medicine at the University of Rochester from 1993-2007. She established a residency training program there in emergency medicine and fellowship programs in pediatric emergency medicine, sports medicine, international emergency medicine and EMS.
Schneider was elected to the ACEP Board of Directors in 2004 and re-elected in 2007. She previously served on the board of directors of the American Association for Emergency Psychiatry and as president of the Society for Academic Emergency Medicine and the Association of Academic Chairs of Emergency Medicine.
Online ads for healthcare practitioners and technical workers fell by 26,200 listings to 516,300 in September, the third straight month of declines. However, vacancies continue to outnumber skilled healthcare job seekers by 2 to 1, a report shows.
The Conference Board's Help Wanted Online Data Series, which tracks more than 1,000 online job boards across the United States, said the drop in healthcare job ads was largely due to decreases in advertised vacancies for registered nurses, and physical and occupational therapists. Since January, online job listings for the healthcare sector have fallen by a total 51,100.
Healthcare support vacancy listings also dropped for the third straight month by 5,100 to 103,800, mainly due to the slide in physical and occupational therapist assistants. Unlike highly skilled healthcare professions, however, there were 2.8 unemployed for every advertised vacancy in healthcare support, The Conference Board reports.
The average wage advertised for healthcare practitioners and technical workers was $33.51 an hour, while the average wage for healthcare support occupations was $12.84 an hour, the report says.
The U.S. Bureau of Labor Statistics, which will release its employment statistics for September next week, has shown that the healthcare sector is one of the few areas in the economy that has seen monthly job growth throughout the recession, although that growth has slowed considerably since 2009.
June Shelp, vice president at The Conference Board, said online job postings across all sectors of the economy have increased by 1 million advertised vacancies since the end of the recession in June 2009. “Following the rapid HWOL rises in labor demand in the 4th quarter 2009 and 1st quarter 2010, labor demand has now settled into more modest growth, pointing to a moderate growth in employment through the end of 2010,” Shelp said.
The Conference Board reported high demand in computer and mathematical science, transportation and material moving, and architecture and engineering, while job listings fell for sales and related workers.
A final regulation from the Veterans Administration makes receiving healthcare and disability compensation for diseases it easier for veterans who served in the Gulf War, Iraq, and Afghanistan. The rule adds nine infectious disease "presumptives" associated with military service.
"This is part of historic changes in how VA considers Gulf War Veterans' illnesses," says Secretary of Veterans Affairs Eric K. Shinseki. "By setting up scientifically based presumptions of service connection, we give these deserving veterans a simple way to obtain the medical and compensation benefits they earned in service to our country."
The final regulation—published Wednesday in the Federal Register—establishes presumptions of service connection for nine specific infectious diseases associated with military service in Southwest Asia beginning on or after the start of the first Gulf War on Aug. 2, 1990, through the conflict in Iraq and on or after Sept. 19, 2001, in Afghanistan.
The regulation reflects an association between service in Southwest Asia or Afghanistan and nine diseases and includes information about the long-term health effects potentially associated with these diseases: Brucellosis, Campylobacter jejuni, Coxiella Burnetii (Q fever), Malaria, Mycobacterium tuberculosis, Nontyphoid Salmonella, Shigella, Visceral leishmaniasis and West Nile virus.
With the final rule, a veteran will only have to show service in Southwest Asia or Afghanistan and that he or she had one of the nine diseases within a certain time after service and has a current disability as a result of that disease, subject to certain time limits for seven of the diseases. Most of these diseases would be diagnosed within one year of return from service, though some conditions may become apparent later than that.
For non-presumptive conditions, a veteran is required to provide medical evidence to establish an actual connection between military service in Southwest Asia or Afghanistan and a specific disease. The decision to add these "presumptives" was made after reviewing a 2006 report from the National Academy of Sciences Institute of Medicine that looked at the long-term health effects of diseases affecting to Gulf War veterans. The VA included Afghanistan veterans because NAS found that the nine diseases are also prevalent in that country.
The 1998 Persian Gulf War Veterans Act requires the VA to review NAS reports that study possibly links between illnesses and exposure to toxic agents by veterans who served in the Persian Gulf War.
In a separate development, Shinseki, and former VA Secretary Anthony Principi, MD, told the Senate Veterans Affairs Committee this month that they still stand behind their decisions to add diabetes, prostate cancer, heart disease, Parkinson's disease, and leukemia to the those conditions that VA officials can "presume" to be caused by Agent Orange exposure among Vietnam War veterans. With associated cases and costs quickly rising, the Senate is panel is reviewing the landmark 1991 Agent Orange regulation that has set the tone in terms of how disability claims are handled in regard to the herbicide and defoliant widely used during the Vietnam War. By granting a "presumption," the VA creates a way to bypass the standard process for filing disability claims.
Nonprofit healthcare institutions in the United States raised $7.6 billion in fiscal 2009, a decline of $944 million from fiscal 2008, according to the Association for Healthcare Philanthropy's annual Report on Giving.
"Whether the recession ended in 2009 is for economists to debate, but its ripple effect certainly continued to curtail the ability of donors to give," said William C. McGinly, president/CEO of AHP. "It means fundraisers will have to work harder and smarter."
The largest declines were in cash donations, down $818 million from 2008, and secured pledges, which declined $97 million over the year. Amounts donated per dollar-spent to raise them also went down, from $3.51 in 2008 to $3.19 last year, a 9% decline.
"This downward trend is a very serious problem in the U.S." said Gregory Pope, chair of the AHP board and vice president of philanthropy for Saint Thomas Health Services Foundation in Nashville, TN. "It comes just as some in Congress want to make it difficult for taxpayers to earn deductions for their donations, and as healthcare reform puts new pressure on nonprofit hospitals to serve more patients."
More than four out of five contributors in the U.S. were individuals, and most of them had a direct relationship with the healthcare facility to which they gave, including patients, employees, physicians and board members. Other major donors were businesses and foundations, who together made about 12% of all donors, accounting for 28% of the funds raised.
There was little change over the year in the allocation of funds raised. U.S. nonprofit healthcare facilities devoted much of their donated money to construction and renovations (27.3%) and new equipment (18.4%). Eighteen percent of donated dollars went to fund charity care and community benefit programs, and 15% supported general operations. Donations were also used for endowments (6.5%), research and teaching (5.1%), hospice and long-term care (4%) and other purposes (5.6%).
The trade group representing the healthcare industry's group purchasing organizations says their efforts to improve transparency, accountability, and fair product discounting has been validated by a federal government report released this week.
The Government Accountability Office report interviewed GPOs, hospitals, and device vendors, and determined that hospitals increasingly rely on GPOs as the primary means to help keep the costs of medical products and services in check.
"With so many votes of confidence affirming the value of GPOs, and 98% of all hospitals reliant on GPO low-cost contract pricing, the market has spoken loudly and the facts are clear," said Curtis Rooney, president of the Health Industry Group Purchasing Association. "The GAO confirmed what the 8th Circuit Court of Appeals, U.S. Department of Justice, the Federal Trade Commission, and virtually all of the 5,000-plus American hospitals have already found—GPOs reduce costs for hospitals."
The GAO report was instigated at the request of Congress, which had raised concerns about GPOs engaging in anticompetitive practices such as collecting excessively high administrative fees. For the report, the GAO interviewed the six largest healthcare GPOs, which made a combined $108.7 billion in hospital purchasing in 2007. The GPOs were not identified by name in the report.
According to the GPOs, the average contract administrative fees paid by vendors in 2008, weighted by purchasing volume, ranged from 1.22% to 2.25% of customer purchases. The GPOs in GAO's review reported that they have revised their codes of conduct and established the voluntary Healthcare Group Purchasing Industry Initiative association to promote best practices and public accountability.
Rooney said the GAO report "clearly demonstrates" GPOs commitment to transparency, even as they secure significant savings for the hospitals and healthcare systems they serve. "GAO and academic research have documented the significant cost savings and the wide range of valuable services that GPOs provide to hospitals, which is why virtually all American hospitals voluntarily contract with GPOs," he said.
The GAO study determined that:
90% of hospitals voluntarily contract with GPOs, and these hospitals use an average of two to four GPOs per hospital;
All GPOs evaluate technologies that could benefit patients, and can rapidly introduce these technologies in the marketplace;
GPOs respond to hospitals and long-term care providers by adding services to improve quality, safety and economy;
All GPOs offer a range of services to hospitals, including individualized contracting, product evaluation such as clinical evaluation and standardization, and assessment of new technologies;
GPOs distinguish themselves in a competitive marketplace by offering additional services designed to meet the needs of hospitals, including e-commerce and benchmarking services, patient safety services, clinical resource guides, and supply chain services to help manage in-house pharmacies;
GPOs provide many of these additional services at no cost to hospitals through collection of nominal administrative fees received from vendors under GPO contract;
3 of 5 device vendors interviewed indicated that they are now paying lower administrative fees, and that fees are more consistent and predictable as a result of transparency initiatives voluntarily undertaken by GPOs. The average weighted contract administrative fee for the GPOs interviewed ranged from 1.22% to 2.25%;
Multi-sourcing device contracts may be less cost-effective than anticipated, as some medical device suppliers have increased device prices in response;
All GPOs reported that their codes of conduct impacted their contracting practices, innovative product selection, administrative fees, conflict of interest policies, transparency and accountability of GPO practices;
Voluntary initiatives undertaken by GPOs include establishing and revising codes of conduct, creating ethics hotlines for employees, hiring compliance officers, and convening Best Practices Forums, where Congressional staff is invited to monitor progress.
Illinois' 200 hospitals and health systems are responsible for about 426,700 direct and indirect jobs and generate $75.1 billion for the state's economy, the Illinois Hospital Association reports.
An IHA study, Illinois Hospitals $75 Billion Impact on our Economy—the first report of its kind in Illinois that examines the statewide economic impact of hospitals—found that Illinois hospitals are among the top three employers in nearly half of the state's counties. Hospitals are essential to economic development because companies looking to relocate or expand want access to high-quality healthcare services.
"Illinois hospitals play a vital role in strengthening the economy of their local communities and the state, which is more essential now during the economic downturn," said IHA President Maryjane A. Wurth. "By providing jobs for a wide range of healthcare workers and spurring more economic activity by spending on goods, services and capital improvements, hospitals are a cornerstone of the local and state economy."
The report states that:
Illinois hospitals employ more than 250,000 people and expend $14.8 billion a year on payrolls, resulting in 426,700 direct and indirect jobs and an economic impact of $35.5 billion;
Illinois hospitals spend $16.5 billion on goods, services and capital improvements, resulting in $23.1 billion in other spending, for an impact of $39.6 billion;
Illinois hospitals generate a total statewide economic impact of $75.1 billion;
Each Illinois hospital job generates another 1.1 jobs in the state;
Every dollar spent by Illinois hospitals on goods, services and payroll generates another $1.40 in spending throughout the economy;
Healthcare/social assistance will be the second fastest growing sector in the Illinois economy in the next eight years;
Healthcare/social assistance will create more jobs than any other sector—nearly 150,000 by 2018; and
The healthcare sector is the sixth-highest contributor to state GDP at 6.8%.
"To continue to retain and create jobs, attract businesses to their communities, and provide access to high-quality healthcare, Illinois' hospitals must have funding support to keep them fiscally healthy," Wurth said. "We urge state and federal lawmakers to take steps to continue to invest in the state's healthcare system so hospitals can remain strong and viable employers in their communities."
The American College of Physicians has offered ethical guidelines for using incentives to promote personal responsibility for health. If you're running a wellness program at your organization, this is must reading.
While the position paper specifically examines a Medicaid pilot project in West Virginia, much of it can be applied to private sector wellness programs.
At play here is the inherent friction between personal responsibility, incentivizing healthy behaviors, and punishing people who don't or can't reach goals such as quitting smoking or weight loss. We know that many of the chronic and expensive ailments that plague this country—diabetes, arthritis, and respiratory and cardiovascular diseases, to name a few—are largely the result of self-inflicted poor health choices around bad diet, tobacco use, and sedentary lifestyle. Why shouldn't the individual be held accountable for his or her poor health decisions? Why should the rest of society be forced to pay for the poor health decisions of others? If the individual isn't responsible for his or her health, who is? These are legitimate questions.
On the other hand, the poor, the old, the undereducated, and minorities are often disproportionately affected by these bad health choices. Are we going to create a caste system that rewards the healthy and punishes the unhealthy? Won't that create a downward spiral of disincentives and discouragement that will only worsen health issues—and the cost—for this unhealthy segment of society? Those are legitimate questions, too.
ACP quite clearly opposes "negative incentives" that penalize patients who don't meet goals by withholding or cutting benefits, or by increasing health insurance premiums. Instead, ACP says incentive programs must:
be equitable and not penalize individuals by withholding benefits.
support a patient's right to refuse treatment without punitive consequences.
be transparent and provide a clear explanation of the benefits and operational details.
support the patient-physician relationship and the physician's ethical and professional obligations to care for patients.
be designed to allocate benefits equitably.
facilitate patient-centered care.
"Incentive programs should not discriminate against a class or category of people," said Virginia Hood, a co-author of the paper. "Age, gender, race, ethnicity, and socioeconomic status should be carefully considered in designing, implementing, and interpreting results of social and behavioral interventions."
ACP found that West Virginia's Mountain Health Choices Medicaid program—one of the first programs to use incentives—puts an emphasis on the patient's role in promoting good health. Mountain Health's evidence-based strategies increase access to prevention and treatment; support patient participation in decision-making; consider variables affecting comprehension and learning; and respect cultural, religious, and socioeconomic conditions. (It should be noted that The West Virginia University Institute for Health Policy Research in August 2009, offered a less generous assessment of Mountain Health.)
Regardless of the triumphs or shortcomings of Mountain Health, ACP's guidelines make sense for the larger wellness movement. There is no denying that we Americans are overweight and aging badly, and the costs associated with our graying, bloating population are staggering. We have to take responsibility for our own health. If we don't, who will? That's the appeal of wellness programs. We just have to make sure they appeal to everyone.
Broward Health President and CEO Frank Nask is undertaking due diligence on a proposal to transition the giant four-hospital health system from its current not-for-profit public health system status into a community 501(c)(3) not-for-profit corporation.
The board of commissioners of the Fort Lauderdale, Florida-based North Broward Hospital District—one of the 10 largest public health systems in the nation—this month authorized Nask to initiate the transition, which would create a nonprofit corporation led by area business leaders. Under the plan, the corporation comprised of local business and civic leaders would lease the health system from the district and operate its four hospitals, health centers and other facilities. Broward Health's more than 8,000 employees would work for the new corporation, and the system would retain its chartered mission as a safety net hospital for indigents.
Nask says the advantages of transitioning to 501(c)(3) status include the ability expand geographical boundaries, and enter into joint ventures with for-profit healthcare businesses, such as partnerships with physicians' groups, which now are prohibited by Florida law.
"Right now our constitution prohibits us from joint venturing with for-profit entities like physicians," Nask says. "In the world of healthcare when you can do that in a surgery center or radiation therapy it's a big advantage. There are some opportunities out there that we are missing out on."
"The other issue is that there is a joint venture opportunity under the Accountable Care Organization model under Medicare reform, which physicians are always interested in because they like partnering with facilities," he says.
Broward Health collects about $170 million in local property taxes annually, and the health system was projected to report about $3.7 billion in total gross patient revenues, and more than $1 billion in total operating expenses in fiscal 2010.
If the North Broward Hospital District board approves the change, possibly by the end of December, Nask says the new entity could take control by July 1, 2011, the start of the fiscal year, to account for changes in reporting and accounting procedures. "If we flipped in the middle of the year, unless we did an audit, it would wreak havoc with our auditors," he says.
Nask says the health system will hold four "public workshops" over the next month to explain the issue and gauge support.
The change in organizational status is permitted under a Florida law passed in 1982 that was designed to permit the leasing of public hospitals to not-for-profit groups to allow greater flexibility to compete with for-profit hospitals.
The proposal has drawn considerable criticism. Although the due diligence process has been underway for more than one year, critics say they weren't aware of it until the board's announcement on Sept. 10.
William R. Scherer, a former general counsel at the health system for 17 years, called the proposal "a half-baked idea" that he believes is motivated by politics. "My experience at the district has been that every time there is a governor's race there is a great deal of angst about what is going to happen and what the governor's position is going to be and who the new board members are going to be," he says.
Scherer says Broward Health has "floated" the idea of changing its organizational status at least four times, and the move has always fizzled. It's not just a change in tax status, he says, it's a fundamental change in the way the health system operates, adding that Nask and the board don't appreciate the ramifications and complexities of the task.
"They jeopardize their tax revenues. They jeopardize their sovereign immunity. They jeopardize their bonding," he says. "They have hundreds of millions of dollars of bonds. How are they going to redo those? How are they going to transfer assets that are the collateral for those bonds? What are they going to do with the pension plans? How are they going to deal with the thousands of contracts they have? Are they going to rewrite all of those contracts?"
Nask says he doesn't think the switch would be difficult.
"I think it's effortless. We just flip the switch. The core board would be in place, so then it would be a matter of continuing to populate the board with other community leaders," he says. That board, he stressed, would be "populated by local community leaders. We are not bringing in people form out of the area who have no vested interest in how this healthcare system works in the community."
Also, the change in status will allow the 501(c)(3) the option of conducting closed meetings away from public scrutiny. "That is not one of the issues that is driving us. We are being driven by market challenges," Nask says. "Whatever best works for the market challenges I think we are OK with. I'm not all that concerned about who comes to the board meetings."
The bidding process and negotiations with vendors also would become more private, which Nask says could be a good development. "With all due respect to the RFP public bidding process, that means that when somebody bids on something their prices are public information to all of their other vendors," he says. "While it seems like the best way to get the best price, I'm not sure we are getting the best price."
Scherer disagrees, and says that transparency is vital to retain public trust and accountability. "I was there for 17 years. I don?t know of any important business measure that open government hurt," he says.
The Federal Communications Commission has unanimously endorsed a proposal to free up for unlicensed use the so-called TV white spaces—vacant airwaves between TV channels—that supporters predict will improve the availability of new technologies such as "super Wi-Fi" for underserved areas, including rural healthcare providers.
It's the first significant block of spectrum made available for unlicensed use in more than 20 years.
"This new unlicensed spectrum will be a powerful platform for innovation. And as we've seen time and again, when we unleash American ingenuity, great things happen," said FCC Chairman Julius Genachowski, after Thursday's 5-0 vote.
"We know from experience that unlicensed spectrum can trigger unexpected but hugely beneficial innovation. For example, years ago, there was a band of low-quality spectrum that was lying fallow. Nobody could figure out what to do with this so-called 'junk band,' so the FCC decided to free it up as unlicensed spectrum. The result was a wave of new technologies—baby monitors, cordless phones, and eventually a real game changer: Wi-Fi. Today, Wi-Fi is a multi-billion industry and an essential part of the mobile ecosystem," he said.
Genachowski described the TV white spaces spectrum as "far more robust" than the airwaves released for unlicensed use in 1985, with the ability to travel longer distances and through walls.
Hocking Valley Community Hospital, a 25-bed critical access hospital in rural Logan, OH, is the first hospital in the nation to access TV white spaces through a demonstration project funded by Google and Spectrum Bridge Inc., a Lake Mary, FL-based wireless software and services provider.
HVCH's President/CEO LeeAnn Lucas-Helber says the hospital located 50 miles southeast of Columbus has already seen improved Internet access with white space, which was installed at the end of August.
"This is a rural hospital. We are in a very lovely setting with a lot of foliage. This is the type of technology that is able to get through challenging topographies. It's a neat technology that could be greatly utilized in rural settings," Lucas-Helber says.
"A lot of places where you go, whether they are healthcare facilities or retail outlet, they are Wi-Fi hotspots. We didn't have that before," she said. "We were beginning to get to a point where if you had a family member here in the hospital, or maybe you needed to be connected to work or communicating with your family via some type of electronic device, we couldn't provide that for the families before. Now we can."
Under the demonstration project, radios using commercially available Wi-Fi technology were deployed around HVCH to increase broadband access for wireless data transfer from first responder vehicles, indoor broadband access for enhanced connectivity in the hospital, and outdoor video security surveillance.
Joe Hamilla, COO at Spectrum Bridge, says that "because of its exceptional range and propagation characteristics, a TV white space network is ideal for rural and underserved areas. Doctors can transfer medical records to a hospital or receive medical records from a hospital at broadband speeds."
He said TV white space also allows ambulances and EMTs to send and receive critical data from hospitals and clinics for on-scene treatment or procedures, and medical data can be transmitted from the home to the doctor or hospital for patient monitoring and emergency notification.
Lucas-Helber says white space could also complement the move toward electronic health records and other aspects of telemedicine, particularly when white space spectrums have the capacity to carry secure patient data. "It's a great opportunity to complement and off load some of the network traffic that we have in our facility. Some might be more appropriate for white space network, while others might be more appropriate for a different type of network. I can see them working nicely together," she says.
Hamilla says that while TV white space itself is not secure for sending sensitive medical data, wireless network providers can install high levels of security for the data transmitted throughout the network.
Lucas-Helber says she's not sure when the demonstration project will expire. When it does, she's not sure how much it will cost to maintain access to white spaces. However, she says cost will play a big role in whether or not HVCH continues to access TV white space when the demonstration project expires.
"Would I have been able to pursue Wi-Fi as a high priority given the other competing needs at the hospital? We wouldn't have been able to do that without any kind of outside help," she says. "It would be great if they would make it reasonable for folks."
Hamilla says that when TV white space becomes widely adopted the pricing on equipment and subscriber devices will be on a par with the costs of Wi-Fi.
The Department of Veterans Affairs has announced a multi-year initiative called Veterans Relationship Management to improve veterans' access to healthcare and benefits information using technology.
"VRM will transform veterans' interactions with VA by using innovative 21st century technologies," said VA Secretary Eric K. Shinseki. "Veterans will have a better experience when they contact VA for assistance, and our employees will be able to quickly convey accurate, up-to-date information through call centers and the Internet."
By the end of the year, VRM will improve telephone services to enable veterans to reach a call center agent faster. Recording and review of calls will ensure the quality of services provided to veterans. VRM enhancements will be rolled out in six-month increments.
The VRM Internet site will give veterans greater and easier access to information. VA collaborated with the Department of Defense to provide a single sign-on capability for both active service members and veterans. Single sign-on will establish an individual's identity and allow that person to complete transactions without having to re-enter information.
Self-service access through the Internet site is already available in some benefit areas, including military personnel records, VA home loan eligibility certificates, and status information on compensation and pension claims.
