Carilion Labs, a for-profit affiliate of Roanoke, VA-based Carilion Clinics, will merge with Spectrum Laboratory Network to form one of the nation's largest regional hospital lab companies, the two companies announced today.
The merger, which is expected to close by the end of February, will create a new company serving 37 hospitals and 14,000 physicians in eight states, with more than 2,600 employees and annual revenues above $300 million, the two companies said in a joint media release.
David Weavil, a laboratory industry veteran executive, will be CEO of the new company—the name of which has yet to be announced. The new company will be headquartered in Roanoke, and Greensboro, NC, where Spectrum is located.
Carilion Clinic will own 33% of the new company. Carilion President/CEO Edward G. Murphy, MD, and two other Carilion appointees will sit on the board.
"A new company that combines the strengths and shared values of Carilion and Spectrum with a focus on hospital laboratory services will significantly improve services to our customers and their patients, and provides a strong platform for further expansion within the region and across the nation," Murphy said.
Novant Health, a minority owner in Carilion Labs, will remain an equity owner in the new company and will hold a seat on the board.
The pending merger, subject to FTC approval, follows the recent purchase of Spectrum by Welsh, Carson, Anderson and Stowe, a private equity firm.
Florida Gov. Charlie Crist has immediately suspended state licensure requirements for traveling U.S. nurses, who have valid licenses in their home states or territories, and who want to work in Florida. The suspension is slated for 90 days.
The governor said in an executive order this week that the move was needed to cover a temporary nursing shortage that was created because many Florida nurses are in Haiti to help the recovery effort from the Jan. 12 earthquake.
Willa Fuller, executive director Florida Nurses Association, says her organization supports the governor's order.
"From my understanding, some of the nurses down in south Florida are Haitian and wish to go home to help, but that would affect the staffing at their hospitals," Fuller says. "This would allow nurses at other states who have licenses that are pretty much equal to ours could come here and work and cover them in the hospital so those nurses could take short trips to Haiti. We certainly support anyone who wants to help."
The American College of Radiology, The Joint Commission, and the Intersocietal Accreditation Commission have been designated as accrediting organizations for medical imaging facilities, CMS said in a Federal Registry notification published today.
The designation gives the three organizations the authority to accredit providers of advanced medical imaging mandated by the Medicare Improvements for Patients and Providers Act of 2008, which requires that providers of CT, MRI, PET, and nuclear medicine exams, who bill Medicare for the technical component under the fee schedule, be accredited by Jan. 1, 2012.
"While advanced diagnostic imaging procedures can be useful in identifying health problems that might otherwise require surgery, the rapid growth in their use raises important questions of quality and safety," said CMS' Barry Straube, MD, CMO, and director of the Office of Standards and Quality in a media release. "The three organizations that will be accrediting suppliers have the expertise and authority to set a standard of excellence industry-wide."
The three accrediting organizations had to demonstrate that they were experienced in advanced diagnostic imaging, and that their accreditation requirements met or exceeded the standards set out in MIPPA, including requirements for:
Qualifications of non-physicians performing the imaging
Qualifications and responsibilities or medical directors and supervising physicians
Procedures to ensure the safety of the individuals furnishing the imaging procedure and of the patients
Procedures to ensure the reliability, clarity, and accuracy of the technical quality of the diagnostic images
Procedures to assist the patient to obtain his/her imaging records on request
Procedures to notify CMS of changes to the imaging modalities subsequent to the accrediting organization's decision
The accrediting organizations were also required to develop a plan for reducing the burden and cost of accreditation to small and rural suppliers, and to provide CMS with detailed information about their survey processes.
MIPPA specifically excludes from the accreditation requirements: X-rays, ultrasound, and fluoroscopy procedures. The law also excludes diagnostic and screening mammography, which are regulated by the FDA under the Mammography Quality Standards Act.
CMS plans a provider education outreach program to ensure that suppliers understand the requirements and are able to comply with them prior to the Jan. 1, 2012, deadline.
Two former hospital executives in Los Angeles have agreed to pay the State of California and the federal government $10 million to settle civil claims that they recruited and treated homeless people for unnecessary medical procedures and then billed the government, according to the Department of Justice.
Robert Bourseau and Rudra Sabaratnam, MD, the former owners of City of Angels Medical Center, have already pleaded guilty to separate criminal Anti-Kickback Statute charges stemming from the case, in which City of Angels reportedly paid "recruiters" employed at homeless shelters in the skid row area to deliver their homeless clients by ambulance to the hospital for unneeded medical treatment.
City of Angels billed Medicare and Medi-Cal for treatment allegedly rendered to the homeless patients, much of which was not medically necessary, said the Department of Justice. The two men are awaiting sentencing.
One other former senior executive of City of Angels and two of the medical center's recruiters have also pleaded guilty to similar charges in connection with the alleged scheme.
"Performing unnecessary medical procedures just to take money from taxpayers' pockets is bad enough, but to prey on homeless people struggling to survive day to day is particularly reprehensible," said Tony West, DOJ's assistant attorney general for the civil division, in a media release. "We won't tolerate illegal conduct and we will continue to hold companies, institutions and individuals accountable for health care fraud."
DOJ said it has used the False Claims Act to recover approximately $2.2 billion since January 2009 in cases involving fraud against federal healthcare programs. DOJ's total recoveries in False Claims Act cases since January 2009 have topped $3 billion, according to the department.
Language in the House healthcare reform bill that would strip an antitrust exemption for medical professional liability insurers could increase premiums, the American Academy of Actuaries (AAA) said.
"The end result of the enactment of H.R. 3962, relative to medical professional liability insurance, is likely to be reduced availability with fewer willing insurers, less vigorous competition among those that do write the coverage, and higher costs to the consumer," Kevin Bingham, chairperson of AAA's Medical Professional Liability Subcommittee, told congressional leaders in his Jan. 21 letter.
If Congress repeals the exemption, AAA wants lawmakers to restore language from an earlier version of the bill that would permit information gathering and rate setting activities, which are currently allowed under the McCarran-Ferguson Act. He said aggregated data "provides credible information, supports competition, and guides companies, self-insurers and regulators in reducing the likelihood of insolvencies."
Bingham said that a single company's data is often not sufficiently credible to determine basic loss costs and determine reasonable premiums. He attributed this to the "low-frequency, high-severity, long-tailed" nature of medical professional liability claims, which makes the estimation of losses and premiums more uncertain than in other insurance lines.
"The bill does not specify what loss data may be collected. Additionally, it is unclear about what actuarial activities are allowable," Bingham wrote. "If such limitations on data-gathering apply, it will result in a reduced level of reliability of determinations, with less data available to state regulators charged with evaluating rates."
Cleveland Clinic should be commended for expanding its free employee wellness and health programs to more than 35,000 dependents.
This simple, common sense move is exactly the far-sighted, cost-effective, proactive action needed to address many of the preventable chronic illnesses that otherwise drive healthcare costs beyond control.
The fact that a high-profile healthcare institution like Cleveland Clinic is aggressively expanding wellness benefits is another sign that wellness programs work.
Since Jan. 1, Cleveland Clinic dependents who participate in its corporate employee health plan have had access to weight loss support services, memberships to fitness facilities, and smoking cessation treatment and medication, all at no cost to the employees.
Cleveland Clinic CEO Toby Cosgrove, MD, said the expansion is the latest step in the employee wellness campaign launched in the summer of 2008. Since then, more than 10,000 employees enrolled and participated in smoking cessation, weight management, and fitness programs. Collectively, Cleveland Clinic says 5,000 weight management program participants have lost more than 88,000 pounds–an average of 17 pounds per employee.
"Our nearly 40,000 employees and their families represent a crucial part of our community, both locally and around the world," Cosgrove said. "By giving them access to wellness and prevention programs at no cost, we can make a significant impact on the health and wellness of our community."
Cleveland Clinic banned tobacco use from its campus on July 4, 2005. In September, 2007, the hospital said it would no longer hire smokers. It has since banned trans fats from its cafeteria, and inpatient menus.
The clinic opened a Wellness Institute nearly three years ago to promote healthy lifestyle choices among employees. Chief Wellness Officer Michael F. Roizen, MD, said that extending the wellness benefits to employees' families will decrease chances that they will become one of the 30 million Americans affected by chronic illness. "Lifestyle choices that include smoking, poor nutrition and lack of physical activity are key contributors to the increased rate of chronic disease affecting our families and neighborhoods," he said.
Expanding free wellness programs to include dependents is a smart move for several reasons. From the employee productivity side, healthier families mean fewer sick days for employees, and fewer employees missing work to provide dependent care, and obviously, lower healthcare costs.
For recruiting, this will do nothing but enhance Cleveland Clinic's status. Taking proactive and progressive actions to improve the quality of life for employees is a powerful draw, and sends a strong message that management cares about the employees. Quality people want to belong to vanguard institutions.
Most importantly, it makes wellness not just an employee benefit, but a family benefit. This changes not just the behaviors at work, but the more-crucial behaviors at home. Now, mother, father and even the children can go together to the health club, or they can join Weight Watchers or smoking cessation programs, and support each other at home to meet – and maintain – health goals.
We will only reduce our nation's healthcare costs when we as individuals take personal control of our own health. Cleveland Clinic and other businesses that recognize the importance of promoting wellness for the entire family are providing the tools to do it.
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Nine in 10 hospitals use social media to some degree, but most of them say they're having little luck attracting new patients with it, and only one in three has a formal social media plan in place, a new study by Greystone.Net shows.
"It is impossible to ignore the effect that social media is having on the Internet in general, and on hospitals and health systems specifically," said Mike Schneider, executive vice president of Greystone.Net. "Organizations that have a formal plan to manage their social media interactions are more likely to be successful, and we expect more and more hospital Web departments to embrace this strategy moving forward."
The research, conducted over two months using Greystone.Net's research panel of more than 100 hospital marketers, also showed that budgeting for social media, including hiring social media employees, is still relatively rare among hospitals. However, many respondents told Greystone.Net that that is likely to change in the near future.
Other key research findings include:
Monitoring social media is handled by relatively few people within a hospital's Web department—70% report they have three or fewer people monitoring.
Twitter, YouTube, and Facebook are the most popular social media for hospitals, and also the most effective in terms of driving traffic to the Web site.
Despite the fact that 92% of respondents originally got involved with social media to attract new patients, only 12.5% said they had had some success.
Hospitals are struggling to find success with other goals of social media, with only small numbers reporting that they have been successful improving community relations (16.7%), customer service (8.7%), employee engagement (8.7%), and crisis management (4.5%).
The staff at a Lorton, VA family physician practice thought they were dealing with a malfunctioning heating duct when they heard what sounded like a small explosion in a vacant examination room Monday night.
"We didn't know what it was. We left the room as it was and went home. We thought we would deal with it in the morning," says Kathy Ciampi, RN, with Williamsburg Square Family Practice. "We just had the heating system tweaked, and I thought something probably blew up in the system. We'll call the repairman in the morning."
As it happens, the explosion was caused by a grapefruit-sized meteorite that punched through the shingled dormer roof, insulation, and ceiling tiles on the one-story building, and came to rest in three large pieces on the concrete floor.
"It looked like it was fired out of something. It did a lot of devastation to the room. Everything was scattered everywhere," Ciampi says. "It was about 300 grams, the size of a grapefruit, a light gray concrete color on the inside, but the outside was dark and streaked and shiny. Our office manager's husband is a geologist. She described it to him. He drove an hour to get here and said 'you've got a meteorite.' We didn't believe him."
Ciampi thought the mysterious object more likely fell off an airplane or a helicopter from nearby Ft. Belvoir.
"We're doctors and nurses. Nobody's thinking meteorite. So we went on the Internet to look up meteorite, got a magnet to see if it was magnetized. It was magnetized," she says. "In the meantime, we called the Fairfax County police because we weren't sure if it came out of an airplane. The policeman was rolling his eyes when we told him. 'Yeah sure it's a meteorite.' And when it magnetized, his eyes got really big and then all the TV stations started calling."
The extraterrestrial rock was donated to the Smithsonian Institution, which has named it Meteorite Lorton.
"We have had a lot of people coming out of the woodwork. It's been a circus here," Ciampi says. "Yesterday was very difficult for the doctors because we had people with cameras in the waiting rooms, and we were trying to maintain patient privacy. They hung in there, but we had a tough day."
The happy ending for Ciampi is that nobody was hurt by the one-in-a-billion shot.
"We were very fortunate nobody was in the room. Our two physicians were about eight to 10 feet away. One doctor had a patient scheduled for that room who had cancelled."
After the last few days of media attention, Ciampi says everyone at the two-physician practice is ready for a return to normal. "We are just a doctors' office," she says. "We need to take care of our patients."
Grassley said that his 11-question survey is a response to complaints he's heard from providers about administrative complications, formatting and usability issues, errors, and interoperability roadblocks.
"Given the taxpayer investment and the investment of the healthcare system overall in the information technology industry, the more Congress and others overseeing implementation of this program dig into the problems and work to get them sorted out now, the better," Grassley said in a media release.
The ranking member of the Senate Finance Committee said providers have cited instances where software produced incorrect medication dosages because it miscalculated body weights by interchanging kilograms and pounds. Grassley said providers have also complained that their concerns and questions about software snafus are being "ignored or dismissed" by vendors and hospital administrators.
"Some sources recount difficulties in approaching the HIT vendor with problems and the lack of venue to discuss these issues either with the vendor or peer organizations," Grassley said. "Often this is attributed to alleged ‘gag orders' or non-disclosure clauses in the HIT contract that prohibit healthcare providers and their facilities from sharing information outside of their facilities regarding product defects and other HIT product-related concerns."
Grassley said some HIT products do not have to meet reporting requirements for adverse events under the FDA's Manufacturer and User Facility Experience database. "Thus, problems with these products may go without remedy thereby inhibiting the ability of the healthcare professional to provide quality care and potentially impacting patient safety," he said. "Furthermore, contractual restrictions on the sharing of experiences and information related to specific vendor products limit a healthcare facility's ability to make informed decisions about HIT adoption and implementation."
Hospitals that were sent the query include: Banner Health, Brigham & Women's Hospital Case Western Reserve University Hospital Health System, Catholic Healthcare West, Geisinger Medical Center, Kaiser Permanente System, Mayo Clinics, and the University of Pittsburgh Medical Center. Grassley has asked the hospitals to complete and return his survey by Feb. 16.
Last fall, Grassley wrote a similar letter to 10 major HIT vendors relaying those issues and concerns. His office is still examining those responses.
Louis Wenzlow, director of HIT at the Rural Wisconsin Health Cooperative, says Grassley's new letter underscores the myriad challenges involved in implementing HIT on such a massive scale.
"What makes the incentive program a potential disaster isn't the fact that providers will face these challenges, but the fact that they are not being given the time or the flexibility to implement [electronic health records] systems in a way that will mitigate these challenges and meet the quality and efficiency goals of the incentive program," Wenzlow says.
"Rural providers, who are much farther behind non-rural providers in their EHR adoption efforts, will be particularly hard pressed to meet the implementation deadlines," Wenzlow says. "The result will be that hospitals that already have EHRs will be getting the vast majority of the incentives; and hospitals without EHRs—those most in need of funding—will be largely excluded from the incentive program."
Charles E. Christian, CIO at Good Samaritan Hospital in Vincennes, IN, says some problems should be expected considering the size of the undertaking.
"Software is software. Even Microsoft has problems getting the code written, and these are not simplistic systems," says Christian, who sits on the steering committee of the College of Healthcare Information Management Executives.
Christian says hospitals must be careful not to rush to meet the meaningful use deadline. They need to get the technology in place properly and take the necessary time to make sure the systems are working correctly.
Christian says it's imperative that providers understand the abilities and limitations of the systems they're buying. "A lot of the systems being purchased these days are flexible enough to let you bend and twist them in ways that meet your work flows and work practices. But if you aren't careful and don't test them appropriately you could create self-inflicted wounds that could have unintentional outcomes," he says.
Whatever new systems are installed must be tested vigorously.
"Sometimes, the protective measures we take drive people crazy," Christian says. "But I'd rather make sure it fails in the testing environment than when I put that in live productive use and have the potential to harm the patient."
It's needed now more than ever, as the CDC reports that 34% of adults, and 17% of kids are obese. If we want to reduce healthcare costs by any significant measure, getting people to take responsibility for their health is the single most important component.
However, when we create the incentives for healthier living that are at the heart of wellness programs, we must also understand that not everybody will be able to take full advantage of those incentives.
We have to account for people who can't afford the snazzy health club, or they work a second job, or they don't live in a nice part of town with leafy green parks and safe streets that provide for enjoyable walks, or they've got a chronic illness like arthritis that makes movement painful and difficult.
The House and Senate healthcare reform bills each contain incentives to expand workplace wellness programs. The bill that passes must ensure that the motivation for people to maintain their health does not come in the form of shame, veiled threats, or economic hardship.
A recent essay in the the New England Journal of Medicine frames those concerns succintly. The essay warns that some of the "carrots" in wellness incentives are just orange-colored sticks designed to punish and weed out employees who aren't improving personal health metrics, like weight loss, or reducing blood pressure and cholesterol levels.
"Attainment incentives provide welcome rewards for employees who manage to comply but may be unfair for those who struggle, particularly if they fail," write the essay's authors, Harald Schmidt, Kristin Voigt, and Daniel Wikler, with the Harvard School of Public Health, and the Harvard University Program in Ethics and Health.
"The law demands the provision of alternative standards for those who cannot or should not participate because of medical conditions, but those categories are narrowly defined. For all others, the implicit assumption is that they can achieve targets if they try. This assumption is hard to reconcile with what we know about lifestyle change."
The Harvard researchers correctly note that this is also about money and class. Many workers on the lower end of the socio-economic ladder — the ones who could most benefit from reduced healthcare costs — are also more likely to be overweight, or to suffer from other chronic health problems that wellness programs are supposed to address.
Will these also be the people who are more likely to be punished with higher premiums if they don't meet their metrics?
We're touching upon a key friction point in the wellness movement. If people make conscientious and disciplined decision to take better care of themselves, exercise, watch what they eat, why shouldn't they be rewarded with lower healthcare costs? On the other hand, if we reward people for improving health metrics, are we then discriminating against coworkers who don't?
The wellness movement could be the perfect tonic for a graying, fat nation. But it's based on individual initiative, responsibility, and reward. Without incentives, the wellness movement could resemble a warm-and-fuzzy soccer tournament where even the last-place team gets a trophy.
On the other hand, if the incentives are too rigid, the people who would most likely benefit will also be penalized if they don't succeed. Their poor health will remain an growing expense that everyone else will share. That's not a good cost containment strategy.
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