Even as the health insurance lobby was publicly claiming to support healthcare reform last summer, the nation's largest insurers were reportedly funneling as much as $20 million through the U.S. Chamber of Commerce to fund attack TV ads to hobble the effort, National Journal reports this week.
That money came from Aetna, Cigna, Humana, Kaiser Foundation Health Plans, UnitedHealth Group, and Wellpoint, which are all members of the trade group America's Health Insurance Plans, according to two unnamed healthcare lobbyists sourced by the National Journal.
"The funds were solicited by AHIP and funneled to the U.S. Chamber of Commerce to help underwrite tens of millions of dollars of television ads by two business coalitions set up and subsidized by the chamber. Each insurer kicked in at least $1 million and some gave multimillion-dollar donations," the National Journal reported.
In a statement Wednesday, Robert Zirkelbach, press secretary for AHIP, said, "Reform needs to make healthcare more affordable, particularly for small businesses that struggle to provide coverage to their employees. We share the very serious concerns employers have raised about provisions that will increase health care costs, including new premium taxes that will hit small businesses hard. So when the employer community—our customers—asked us to contribute to their campaign, we readily agreed."
Chamber of Commerce officials did not immediately return calls from HealthLeaders Media seeking comment Wednesday. But in an e-mail message reported by the New York Times, Bruce Josten, executive vice president of government affairs for the chamber, wrote: "The chamber is fully engaged in the health care reform debate because it's critical to the future of our economy, and our members are the ones who pay for health care. We welcome any donors/funders to our efforts."
The report prompted an angry response from House Speaker Nancy Pelosi, D-CA. "These big insurance companies appear to have gotten caught secretly bankrolling the effort to kill health insurance reform for millions of Americans, despite their disingenuous claims of support for the legislation," Pelosi said in a media release. "This duplicity is not surprising coming from an industry that has used every method to try to kill health insurance reform that would save lives, save money, save jobs, and save Medicare."
Wendell Potter, a former communications director at CIGNA Corp., and now a leading critic of the healthcare industry, said he was not surprised, but still "outraged" by the National Journal report.
"It proves what I have been talking about since I switched from being a spokesman for the health insurance industry to being a vocal critic of it. The industry is laundering millions of dollars through third parties to influence the healthcare reform legislation and kill provisions that might hinder insurers' profits," said Potter, a senior health fellow at the Center for Media and Democracy.
St. Vincent Health System and HealthSouth Corp. have announced that they are expanding their joint venture, St. Vincent Rehabilitation Hospital, in Sherwood, AR.
The joint venture purchased a 23-bed St. Vincent Rehabilitation Hospital/Doctors, formerly operated by St. Vincent Infirmary Medical Center, which will now be operated under the joint venture and will be managed by HealthSouth, based in Birmingham, AL. The unit will be relocated to St. Vincent Infirmary Medical Center in Little Rock, AR, within the next two years.
"By combining the capabilities of St. Vincent Rehabilitation Hospital with those of the St. Vincent Doctors unit, we will be able to offer sophisticated inpatient rehabilitative care to both sides of the river," said Lee Frazier, CEO of St. Vincent's Rehabilitation Hospital/Doctors, in a media release.
St. Vincent Health System, based in Little Rock, is comprised of three hospitals, a network of primary care clinics, a home health agency, and numerous other ventures and entities. HealthSouth is the nation's largest provider of inpatient rehabilitative healthcare services, with operations in 26 states and Puerto Rico.
Investigators in Farmington Hills, MI, are examining the suspicious burning death of an elderly patient at Botsford Hospital, who was discovered aflame in his bed.
Walter Gajewski, 92, a patient in the hospital's psychiatric unit, died from his burning injuries shortly after the Jan. 6 incident, investigators say.
"Right now, the Wayne County Medical Examiner has ruled it a homicide only because we have not been able to prove otherwise," says Farmington Hills Police Lt. Mike Stasch. "The investigation continues and the method or manner of death can be changed later if we can prove that it was other than what they're saying it is right now."
Stasch says there are no suspects in the late-night incident, which occurred well after visiting hours. Investigators have not ruled out suicide. "Certainly that is something we are looking at," Stasch says.
Gajewski was found in flames by a nurse, says Botsford Public Relations Manager Nancy Dumas O'Neill. He was taken to the emergency department at the 330-bed teaching and community hospital, but was quickly transferred to the burn unit at Detroit Receiving Hospital, where he died on Friday.
The New York City Health and Hospitals Corporation has entered into a consent agreement with federal authorities to clean up the troubled psychiatric emergency department and psychiatric in-patient units in its Kings County Hospital Center in Brooklyn.
A federal investigation at KCHC that began 13 months ago reportedly uncovered systemic violations of civil rights laws protecting institutionalized people. According to the Department of Justice, the violations included:
Failure to protect patients from harm
Failure to treat psychiatric disabilities of patients
The use of drugs to sedate rather than treat patients
Failure to provide adequate and individualized discharge planning and follow-up services
Falsification of patient medical records
Failure to respond promptly to medical emergencies
Federal investigators said these violations and others contributed to the June 2008 death of Esmin Green, who collapsed in the psychiatric ED after waiting 23 hours to see a doctor. Green lay on the floor for more than one hour while hospital employees, including doctors and security staff, walked through the area, ignoring her condition, and made no effort to attend to her.
New York City Health and Hospitals Corporation President Alan D. Aviles said the health system has acknowledged problems at the hospital and wants to "begin implementing reforms that go beyond merely correcting deficient conditions alleged in the original lawsuit."
"All the parties have contributed to the creation of a comprehensive plan to fundamentally overhaul the psychiatric program at Kings County Hospital to create a true model of safe, compassionate, patient-centered behavioral health services that others in the city and the country will want to replicate," Aviles said in a media release.
The consent agreement calls for regular site visits at KCHC over the next five years by outside experts to assess compliance. U.S. District Judge Kiyo A. Matsumoto of New York was given oversight authority to monitor improvements at the hospital.
The agreement also resolves a suit filed in May 2007 by the New York Civil Liberties Union and the Mental Hygiene Legal Services that identified similar deficiencies in the hospital's psychiatric unit.
Believe it or not, there are some physicians out there who only want to practice medicine, the noble profession to which they've dedicated their entire lives.
For some reason, claims coding updates, haggling with insurance companies, monitoring the new walk-in clinic across the street, recruiting new partners to the practice, and developing relationships with referring physicians don't interest them.
Depending upon who's talking, these medicine-only physicians represent either a dying breed or a growing trend.
David R. Neiblum, MD, says these single-hat physicians are disappearing. "We're probably seeing it less so than in the past, where people used to go into practice and not worry about anything except seeing patients and doing clinical activities," says Neiblum, the managing partner at West Chester Gastrointestinal Group, an eight-physician practice in West Chester, PA.
"Now, if you are an owner or a partner in a practice, the business part of it becomes large depending upon your role in it," he says. "So much has changed in healthcare with reimbursement issues and having to worry about increased costs and decreased reimbursement. There is much more of a focus on what we are allowed to do, how to code properly, how to stay in compliance with Medicare regulations, and so on. There is so much more bureaucracy and governmental intrusion and rules that we have to be cognizant about, not just practicing and winging it. You see a patient and you have to know 'are you coding a three-level office visit or a four, and if you code a four can you prove you did that much work?' "
Kenneth T. Hertz, a senior consultant with Alexandria, LA–based MGMA Health Care Consulting Group, is in the other camp, claiming that younger doctors are more inclined to shirk their business duties.
"One of the things we are finding is that a lot of the young docs coming out of school want to go into practice and do one thing: practice," he says. "They don't want to deal with the business side. They don't want to deal with governance issues. They don't want to deal with any of those issues. So, what is happening in some of the practices we are working with, the senior docs are asking ‘what can we do to get the younger docs to get interested in the business side of the practice, the things that need to be done to keep the practice going?'"
To some extent, Hertz says the negligence starts in medical schools. "The business side is something that is simply not talked about in medical school," he says. "In medical school, you 'learn how to be a doctor.' The issues related to running a practice, to how do you code and document properly, to how do you deal with personnel issues, are not talked about."
Because physicians make money when they're practicing their highly skilled profession, it's understandable if they don't want to waste time on less-profitable distractions. But, Hertz says, physicians in private practice have to accept that they are businessmen as well as healing professionals, and that both the clinical and business sides of the practice come with important responsibilities.
"There is the notion of the more time you spend practicing, the more money you make, sure," he says. "But as a business owner, you have certain responsibilities. In that sense, running and owning a medical practice if you are in private practice is really no different than owning the UPS store."
Understand management vs. governance
Hertz says it's also important to make a distinction between the physicians' roles in the management and the governance of the practice.
"Running the practice is management. Physicians don't run the practice. They provide the governance for the practice," he says. "It is their responsibility to set the vision, set the direction, and set the policies. But they hire people to manage the practice."
Hertz says it's critical to spell out the business- and governance-side obligations to new physicians before they're hired.
"In the interview process, when a practice goes to recruit new docs, it is where they have conversations with them, and they discuss what is going to be involved in being part of the business," Hertz says. "'Dr. Smith, you are going to be expected to serve on the board and attend meetings and help market your practice.' If the candidate says 'I'm not interested in that,' you can decide to hire the doc and run into upset down the road or you make a decision that maybe this doc doesn't mesh with the practice."
But in this age of physician shortages, perhaps your practice can't be that choosy. So, be flexible, but also be clear.
"If we find Dr. Jones is absolutely perfect in every way except that he says 'I just want to be an employed doc, I don't want to be an owner, I don't want to do this, that, and the other thing,' it is incumbent on us to be creative and find a way to make it work if we think that Dr. Jones will add that much to the practice," Hertz says.
"Laying out expectations is appropriate. A lot of practices get into trouble when they don't. But by the same token, the idea that it's business as usual is not what today is," he says. "Today it's 'how can we approach it differently? What can we do to make the situation work for us and the candidate? Now is the time we have to be more creative in how we deal with these issues.'"
Consider compensating business responsibilities
Neiblum says the up-front discussions about business responsibilities during the interview process have helped West Chester Gastrointestinal Group avoid friction down the road. New doctors need to know that it's not all going to be Marcus Welby.
"Talk about the business end and how much they are expected to be involved," he says. "Certainly if they are not going to be actively involved, they still have to know about it and keep things in mind and know how to code properly and how to be in compliance with regulations. You can't escape it entirely. Even if you are not going to be a big decision-maker, you have to be aware of them."
Neiblum says West Chester Gastrointestinal Group compensates him for taking extra time to address business issues beyond his normal practice schedule.
"We have a good staff who do most of the things, and that is 90% of the battle, and I keep an eye on things globally, doing some things on my own but often delegating," he says.
He warns, however, that sometimes it's possible for practice partners to be too involved in business operations.
"We have a good structure, but maybe a little too much of the too-many-cooks-spoil-the-brew mentality," he says. "On some things, it's best where I would just make a decision and let's move on. Sometimes we sit down and say this is what we want to do and all of a sudden you start getting dissenting opinions and it becomes a big issue when before it wasn't. But besides that, the structure is pretty good."
For most of us, watching 2009 recede in the rearview mirror is a pleasant sight. Good riddance to a lousy year and a lousy decade!
But even within the worst economic climate since the Great Depression, 2009 was not such a bad year for job growth in the healthcare sector—which includes everything from hospitals to outpatient surgery centers to podiatrists' offices—when compared with the overall economy.
Yes, healthcare job growth was slower than in years past. Bureau of Labor Statistics preliminary data show the healthcare sector created 267,000 new jobs in 2009, including 22,000 payroll additions in December. That's a considerable drop from 2008, for example, when healthcare created 363,600 new jobs.
Before you grouse, let's get some perspective. That we are even talking about "job growth" in this economy should be a cause for celebration. Healthcare has created 631,000 jobs since the recession began in December 2007. In that time, the number of jobless people in the nation has risen from 7.7 million to 15.3 million, BLS figures show.
"One thing we've learned is that healthcare was not completely recession-proof over the last year and a half as we've seen a number of large-scale layoffs across the board," says David Cherner, managing partner of Health Workforce Solutions, LLC, a San Francisco-based research firm. "But, certainly, it is much stronger than any other segment of the economy."
The ambulatory services sector, for example, has shown itself to be remarkably resilient and consistent, having created 179,000 new jobs in 2009, 182,400 jobs in 2008, and 180,600 jobs in 2007.
Cherner says he was surprised to see that job growth at the nation's hospitals was essentially flat in December, with only 1,400 new jobs reported. That—at least temporarily—puts a halt to an encouraging uptick in hospital job growth over the last few months of 2009. The hospital sector added 37,600 jobs in 2009, the lowest level of growth in the decade. Hospitals created 137,100 jobs in 2008, and 105,700 jobs in 2007, BLS data show.
"What I found interesting was the increase was not larger, based upon some notable hiring announcements we've seen over the last few months in a number of large markets," Cherner says. "That tells me that the bulk of these jobs have yet to be filled and will be filled over the course of 2010."
"After several quarters of delayed expansions and in some cases layoffs, even of patient care staff, the last two quarters we saw slight improvement across the board, and in the last quarter we have seen some healthy improvement across many areas," he says.
Cherner says many of the cutbacks and project delays during 2009 were a response to the economic unease about deteriorating financial conditions.
"But as a result of the belt tightening, we are also seeing many institutions reporting better-than-expected results over the last couple of quarters," he says. "Anecdotally, I've heard from a number of hospitals that they may have overreacted in terms of staff reductions and they are now trying to put stuff back on track."
Cherner's take on all of this strikes me as a fair assessment of the prospects for hospital job growth in 2010. It only makes sense that hospitals would cut back on labor costs in the face of tanking investment portfolios, adverse patient mixes, and other attacks on the bottom line.
But, it also appears that many hospitals have taken the last few months to assess their financial situations, as many investment markets have rebounded, and reassess their strategic visions.
All of this is occurring as Congress cobbles together reforms that could make health insurance available to another 30 million people, and as our nation's population—now at 308 million—gets older, fatter, and sicker.
Predictions are just that. But there is one thing you can bank on in healthcare, even when everything else is in flux. The demand will always be there.
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Lawson Software announced this week that it will acquire Healthvision Solutions, Inc., through the acquisition of privately held Quovadx Holdings, Inc., its parent holding company. The all-cash transaction of $160 million is subject to regulatory approvals and expected to close this month.
Healthvision is a Dallas-based company whose Cloverleaf integration technology connects software applications and technologies to facilitate data flow at large healthcare organizations.
Lawson said in a media release that the Healthvision acquisition allows it to connect multiple source systems and provide healthcare providers with quick access to clinical, financial, and operational information reliably and securely, regardless of the source system. Lawson said it can now help hospitals and healthcare organizations protect their existing technology investments, while adapting to future compliance and interoperability requirements driven by healthcare IT reform.
"Most healthcare organizations have added or acquired multiple IT systems throughout their lives and want to get the most out of these assets. Taking on this integration task themselves requires building, monitoring, and maintaining their own interfaces. That's expensive, time-consuming, and difficult and results in large organizations maintaining thousands of interfaces," said Jim Catalino, senior vice president and general manager of Lawson Healthcare.
"Smaller healthcare organizations usually don't have the money or IT resources to even do this task so their systems can't talk to one another. Big or small, these IT costs and disparate systems add to the big issues healthcare faces in terms of efficiency, affordability, and patient care. Healthvision eliminates the need for homegrown interfaces and the cost of those interfaces and allows healthcare CIOs to allocate IT resources to more strategic needs," said Catalino.
Healthvision has 800 customers, including 200 joint customers with Lawson, and its products are used in more than 3,000 healthcare facilities around the world. Healthvision product lines also include a Health Information Exchange platform that links an entire healthcare network consisting of hospitals, clinics, laboratories, pharmacies, and other stakeholders like payers, partners, and vendors, according to the company.
Based in St. Paul, MN, Lawson provides software and services to 4,500 customers in equipment service management and rental, fashion, food & beverage, healthcare, manufacturing & distribution, public sector, service industries, and strategic human capital management across 40 countries.
Primary care physicians could increase Americans' willingness to become organ donors by educating their patients on the process during routine office visits and discussions about end-of-life care, according to a study in the January issue of the Journal of the National Medical Association.
"With more than 100,000 Americans waiting for organ transplants, it is crucial that we find new ways to increase donation. New efforts should focus on improving communication on the subject between healthcare providers and their patients," said J. Daryl Thornton, MD, lead author of the study.
Thornton conducted the research as a scholar with the Harold Amos Medical Faculty Development Program, a national program of the Robert Wood Johnson Foundation. Thornton is medical director of the Medical ICU at MetroHealth Medical Center in Cleveland and an assistant professor at Case Western Reserve University. He is also a researcher at the Center for Reducing Health Disparities at MetroHealth and CWRU.
Most often, the decision about organ donation is made by individuals coping with the death of a family member. Obtaining consent for organ donation under these circumstances is complicated, sensitive, and often unsuccessful. Most individuals who are organ donors make the decision during a visit to their local departments of motor vehicles, where workers are often not fully trained to address questions about the topic, the study found.
Shifting the location for requesting consent to a routine patient care setting may have an important impact on the number of organ donors, according to the study. About 65% of physicians surveyed agreed that organ donation discussions were within the scope of their medical practice, but only 4% reported having discussed the subject with their patients.
This is in spite of the fact that 30% of physicians reported talking about end-of-life care with their patients. The authors believe the study is the first to report on the paucity of organ donation discussions among primary care physicians and their patients.
According to physicians, the reasons for the low number of organ donation discussions include: the lack of formal training in organ donation, with only 17% of physicians receiving such training; and the lack of staff to address organ donation issues with patients, as reported by 64% of physicians. A small percentage of doctors reported having donor information available in their medical offices (11%), with even fewer having donor cards available (5%).
Primary care physicians, who had received organ donation education or who regularly discussed end-of-life issues with their patients, were more likely to talk about organ donation issues, the study found.
For this nationally representative study, 831 family and internal medicine physicians were surveyed. Hispanic and African-American primary care physicians were oversampled to determine how frequently they discussed donation with their patients and what factors encouraged or inhibited such discussions.
Race and ethnicity of primary care physicians may play an important role in improving organ donation, particularly among minorities. African-American and Hispanic physicians are likely to care for patients of similar race and ethnicities, according to the study.
As of Jan. 6, there were 105,307 people waiting for organ transplants, according to the United Network for Organ Sharing. People of color are disproportionately in need of donated organs, making up more than 50% of those waiting for a donation. African Americans, who comprise only 15% of the population, represent more than 25% of those on organ donation lists, and are more likely to die while waiting for an organ transplant.
"Increasing organ donation among people of all ethnicities should be a national healthcare priority. By increasing the number of organ donors, we can extend both the length and quality of life for those who need transplants," Thornton said.
The healthcare sector created 267,000 new jobs in 2009, including 22,000 payroll additions in December, new Bureau of Labor Statistics preliminary data released this morning show.
The overall economy shed 85,000 jobs in December as the nation's unemployment rate remained unchanged at 10%, according to BLS preliminary data.
Of the 22,000 new jobs in the healthcare sector in December, the biggest job growth came from physicians' offices, with 9,000 payroll additions, and home health services, with 8,000 payroll additions. Physician offices added 55,000 jobs in 2009.
The healthcare sector—which includes everything from hospitals to outpatient surgery centers to podiatrists' offices—has added 631,000 jobs since the recession began in December 2007. In that same time frame, the number of jobless people in the nation has risen from 7.7 million to 15.3 million, BLS figures showed.
Other healthcare highlights include:
Ambulatory healthcare services continue to push job expansion in this sector, with 179,000 jobs added in 2009, and 23,000 in December alone.
Outpatient care centers increased jobs by 13,000 in 2009.
Home healthcare services increased 74,000 jobs in 2009, with 8,000 added in December.
The BLS information is considered preliminary and may be revised.
The National Association of Insurance Commissioners told Congress this week it supports health insurance exchanges but wants them to be established and administered at the state level.
In a letter this week to House Speaker Nancy Pelosi, D-CA, and Senate Majority Leader Harry Reid, D-NV, NAIC said it backs the goals of healthcare reform to curb rising costs and improve quality of care. The association offered a qualified endorsement of provisions in the House and Senate bills that would:
Extend guaranteed issue protections to the non-group health insurance market
Eliminate pre-existing condition exclusions and annual and lifetime limits
End the practice of rating policies based upon gender and health
"The NAIC supports these measures, if they are paired with an effective individual mandate to mitigate the risk of adverse selection," said NAIC President and West Virginia Insurance Commissioner Jane L. Cline in the letter. "We also support the creation of state-based health insurance exchanges to streamline the process of purchasing coverage and make meaningful comparisons of health insurance plans much easier."
However, NAIC said consumers will benefit most from reform that ensures continued consumer protection and oversight of health insurance policies at the state level. NAIC wants Congress to:
Oppose the creation of a new federal Health Choices Commissioner and Health Choices Administration. Instead, regulators recommend health insurance exchanges be established and administered at the state level.
Ensure that all group policies be subject to the bill's reforms at the end of a five-year grace period and ensure that any risk adjustment be applied to both grandfathered and newly-issued policies.
Impose stronger penalties under the individual mandate provisions.
Avoid provisions that could separate the regulation of premiums from the regulation of solvency.
Allow the federal government to quickly shut down fraudulent multiple employer welfare arrangements that falsely claim to be exempt from state regulation.
Ensure that the effective dates of provisions in the new law are coordinated with implementation of the individual mandate and subsidies in order to mitigate the risk of adverse selection.
Insist that nationally-sold plans be subject to all statutes and regulations that apply to other plans being sold to the same population and that they remain subject to the oversight of state insurance regulators.
The NAIC also urged Congress to address healthcare costs, warning that unless spending is brought under control, all of these reforms will shift the financial burden from one group to another without reducing overall cost.
