The $2.6 billion acquisition of Boston Biomedical by Dainippon Sunitomo Pharmaceutical and the $2.5 billion acquisition of Inhibitex by Bristol-Myers Squibb were the largest mergers and acquisitions in the healthcare industry during the first quarter of 2012.
Despite those blockbuster deals, the dollar value of M&A activity in the first quarter of this year dropped by 47% to $28.9 billion compared to first quarter 2011 activity. However, the total number of deals increased by 9% to 274, according to Norwalk, CT-based Irving Levin Associates Inc.
The volume increase is good news because it demonstrates that strategic and financial buyers are in the market and willing to invest capital, explains Sanford Steever, editor of The Health Care M&A Report. He notes, however, that 2012 is an election year and that may slow activity.
The technology sector, including pharma and biotechs, accounted for 44% of the deals (121) and 70% of the dollar value ($20.3 billion) for the current first quarter. A dearth of blockbuster deals saw the dollar value of the services sector, which includes long term care and hospitals, fall by 63% to $8.5 billion.
Biotechnology ($10.5 billion), pharmaceuticals ($6 billion), medical devices ($3.2 billion), and long-term care ($1.7 billion) were the leading market segments in terms of dollar value. Biotechnology and pharmaceuticals captured 19% of the deal volume and 57% of the dollar value of first quarter M&As.
"The distinction between biotech and pharma is blurring," Steever told HealthLeaders Media. He says biotechs are looking for money to develop their products so they purchase mature pharma companies to tap into their revenue streams. In turn, pharma companies, faced with patent expirations on some of their best earners, are interested in the products being developed by biotechs.
Steever says medical devices continue to be an important part of the M&A market despite a 19% decrease in deal volume and a whopping 73% drop in dollar value. "It’s taking a breather but it’s still a very hot market for M&A."
Laboratories, MRIs, and dialysis ($395 million), hospitals ($129 million), and behavioral health ($94 million) were the bottom market segments in terms of dollar value. The 62% drop in the number of deals for labs, MRIs and dialysis that may reflect declining reimbursements. Dialysis clinics in particular are at the mercy of falling Medicaid reimbursements.
While the number of hospital mergers and acquisitions in the first quarter of 2012 kept pace with activity during the comparable period in 2011, a lack of big portfolio deals contributed to a 93% drop in their value to $129 million.
Healthcare reform continues to drive some M&A activity, especially for hospitals, physicians groups and managed care. Steever says the acquisition of critical access hospitals is on the rise. The small hospitals, usually around 25-beds, want to join larger systems to reduce their costs and improve their negotiating position with vendors and health plans.
He cautioned that increased Federal Trade Commission interest could make hospitals more wary of M&As. Hospitals continue to acquire physicians groups as part of their accountable care organization strategies.
Steever says managed care is looking to consolidate and diversify. The number of managed care deals increased from one in first quarter 2011 to six in first quarter 2012. The latest round of deals was valued at $488 million. Health plans are looking at Medicare Advantage and Medicaid companies. He adds that "insurers are more concerned about what the Supreme Court may do" so they are also buying into other sectors such as pharmacy benefit managers and e-health businesses to diversify revenues.
Earlier this week the General Accounting Office released a report critical of a Medicare Advantage bonus plan that rewards the performance of what the GAO views as just average plans. The cost adds up to around $8 billion over 10 years, with most expenditures occurring during the first three years.
While the GAO study seems fairly complete and certainly nonpartisan, I wish there had been some analysis of what taxpayers are getting for their $8 billion. As the GAO left it—calling for the immediate termination of the program—the report is fodder for every anti-healthcare reform-minded politician, blogger, pundit, columnist, and citizen journalist with access to a keyboard.
The Centers for Medicare & Medicaid Services' five-star star program has been around for about five years. Health plans weren’t initially crazy about the methodology (they still aren’t) and didn’t begin to take the program seriously until the 2010 Patient Protection and Affordable Care Act attached cash and other perks to the star system.
The Affordable Care Act set the minimum bonus standard at four stars on a one- to five-star scale, but six months later CMS announced that it would delay implementation of the ACA bonus plan until 2015. In the meantime, it announced an alternative plan (Medicare Advantage Quality Bonus Payment Demonstration) that extended the bonus option to three-star plans.
The bonus for three-star health plans is a sticking point. The GAO is not alone is contending that the demo is just a back-door way to restore to health plans some of the reduced Medicare payments included in ACA. The independent Medicare Payment Advisory Commission, which advises Congress on Medicare issues, has warned that demonstration projects "should not be used as a mechanism to increase payments."
I think that in their assessments the GAO and MedPac are missing some important points. First, the demo is temporary, with a brief three-year lifespan: 2012 through 2014. That means the three-star plans have only three years of bonus eligibility.
Second, the bonuses are on a sliding scale. No health plan is going to be content with a three-star rating if it can make some changes and become a four- or even five-star plan with a larger bonus, some great perks such as year-round enrollment, and major bragging rights.
The list of health plans with three- or three-and-a-half-star ratings reads like a who's who of health plans with Aetna, Humana and UnitedHealth Group all looking for ways to improve their scores.
During an earnings call last year, Humana officials said they planned "to invest heavily in improving our stars' processes, procedures, and infrastructure to position us for further improvements in star metrics."
United has reportedly set the goal of having all of its more than two million Medicare Advantage demo members in four-star or better plans by 2014. Aetna has established a dedicated business team to drive the improvement of its performance in the stars program. And, WellPoint officials have linked the acquisition of CareMore, a Medicare Advantage plan, with its efforts to achieve higher quality star ratings.
And finally, we're talking about a paradigm shift from payment-for-volume to payment-for-quality. That takes some adjustment. The demo just makes the change a little easier. Think of it as kickstarting the quality improvement process.
According to the GAO figures, $3 million will cover increased enrollment in the Medicare Advantage demo as beneficiaries switch from fee-for-service. I thought that was the point of the program—to move beneficiaries away from the volume-based care of FFS to quality-based care.
The GAO report also notes that much of the increased Medicare Advantage demo enrollment will occur in average-rated plans, which is where most of the membership is concentrated now. But that's probably because most of the large enrollment plans such as Humana and UnitedHealth are currently three-star plans. They have no intention of staying at that position, and will most likely take their enrollment with them as they improve their ratings.
The CMS star rating program is based on more than 40 different Medicare Part C and Part D quality measures. Information is compiled from member surveys, physicians, and CMS reports, as well as the results from regular Medicare monitoring activities.
It's not a static process. According to a consultant who works with Medicare Advantage demo clients, the star program gets tougher each year. Quality measures change as a majority of healthy plans achieve competencies, explains Nathan Goldstein, CEO of Gorman Health Group, a Medicare managed care consulting firm in Washington, DC. Health plans will need to work very hard just to maintain their star rating; moving up will require a concerted effort.
And no slacking will be allowed. Goldstein says CMS has made it clear that it will systematically eliminate poor performers (fewer than three stars) from the MA program.
CMS seems to have developed an effective carrot (bonus) and stick (termination) plan that has engaged the health plan industry. Calling for the program to end really seems like overkill.
A report released Monday by the Government Accountability Office says that a Medicare bonus program to reward high-performing health plans is expensive, poorly run, and should be cancelled.
The report notes that the Medicare Advantage (MA) Quality Bonus Payment Demonstration program will pay out $8.4 billion over 10 years with much of that money going to health plans that perform at only an average level.
The GAO contends that the demo, set up in November 2010, is simply a back-door way to restore to health plans some of the reduced Medicare payments included in the ACA.
In comments included in the report, the Centers for Medicaid & Medicare Services counters that the project supports the triple aim of healthcare?better care, better health, and lower cost. Without the demo, many plans wouldn't have an "immediate incentive to improve the quality of care delivered to Medicare Advantage enrollees," says CMS.
The five-star rating program, created to help monitor Medicare Advantage plan performance, has been around since 2007, but began to generate real interest among health plans when the bonus payments for four and five star health plans were added to the Patient Protection and Affordable Care Act in March 2010. The rating system is based on more than 40 quality measures, including preventive screenings and managing chronic conditions.
The Office of the Actuary at CMS estimated that the reforms in the Affordable Care Act would result in reduced payments to Medicare Advantage plans, which in turn could cause plans to offer less robust benefit packages.
To counter that outcome, CMS announced that instead of implementing the ACA bonus payments, it would implement a three-year demonstration project that would expand the bonus program to three-star health plans, accelerate bonuses for four and five-star plans, and increase the bonuses for 2012 and 2013.
Based on 2011 star ratings 84% of the 446 Medicare Advantage plans representing 90% of enrolled beneficiaries will qualify for some type of bonus. Keeping the original ACA bonus standards would mean only 24% would receive bonuses.
Keeping the ACA bonus plan is exactly what the report authors recommend. "The Secretary of Health and Human Services should cancel the MA Quality Bonus Payment Demonstration and allow the MA quality bonus payment system established by PPACA to take effect."
The report was prepared at the behest of Congress. In addition to cost, the GAO report cites these concerns about the demonstration project:
It's not required to be budget neutral.
The program design precludes a credible evaluation of its effectiveness.
The bonuses and increased enrollment benefit average performing plans (3 and 3.5 star plans)
In response, CMS says it "does not concur" with the GAO recommendation to cancel the demonstration, which is scheduled to end in 2014. CMS contends that demo is intended to kick-start the process and "will lead to faster and larger quality improvements, as well as increased efficiency compared to the ACA."
It notes that the design features "are consistent with the overall goal of improving quality" in the Medicare Advantage program and do not "preclude a credible evaluation."
In an e-mail exchange, a CMS spokesperson added that the demonstration project has helped CMS improve its star-rating system "to place much greater emphasis on clinical outcomes and beneficiary experience measures. We are holding plans to higher standards of quality." He said Medicare Advantage plan payments today, including the costs of the demonstration, "are lower than what they would have been prior to the Affordable Care Act by $200 billion."
Nathan Goldstein, CEO of Gorman Health Group, a Medicare managed care consulting firm in Washington, DC, told HealthLeaders Media that the GAO report misses the carrot-and-stick aspect of the MA bonuses. "It's not all sunshine and roses. Sure, an average plan may get some bonus payments, but CMS has made it clear that a plan that remains at three stars or below for three years can be terminated from the program."
He also notes that some of the largest health plans in America, such as UnitedHealth Group and Humana, are among the three-star plans. "They will make the investment to get improve their star ratings."
In a statement, an industry group, America's Health Insurance Plans, says the GAO report "provides an incomplete picture of the demonstration project, which AHIP contends "establishes an appropriate transition to the new MA payment system." It cites a study in the January 2012 edition of Health Affairs that foundthat beneficiaries with diabetes in an MA special-needs plan had "7% more primary care physician office visits; 9% lower hospital admission rates; 19% fewer hospital days; and 28% fewer hospital readmissions compared to patients in FFS Medicare."
The GAO is not alone in its criticism of the demo project. The independent Medicare Payment Advisory Commission states in its March 2012 report to Congress that the demo will result in an estimated $2.8 billion in program costs for 2012 versus $200 million in bonus payments under the ACA. "Limited Medicare dollars should go to truly high-performing plans." MedPac reiterates its position that "demonstrations should not be used as a mechanism to increase payments."
Twenty-one states posted decreases in central line-associated bloodstream infections (CLABSI) in 2010, according to a report from the Centers for Disease Control and Prevention. This translates to a 32% national reduction, which suggests that the national goal of reducing CLABSI by 50% by 2013 is within reach.
California, Massachusetts, Oregon, and Virginia are among the states posting CLABSI decreases. Only Arizona and Delaware reported increases between 2009 and 2010, while 20 states reported no change, including Indiana, New Hampshire, and Vermont. Seven states, including Alaska and Idaho, didn’t file a report.
Data was reported from January through December 2010; the referent period is January 2006 through December 2008. In all, 22 states and the District of Columbia require the use of the National Healthcare Safety Network, CDC’s healthcare infection monitoring system, for HAI reporting mandates.
A Landmark Report
This is the first time the CDC has released a state level standardized infection ratio for CLABSI from all 50 states, as well as Puerto Rico and the District of Columbia. The data were submitted by more than 2,400 healthcare facilities to the NHSN.
According to the National and State Healthcare-Associated Infections Standardized Infection Ratio Report, 13,812 CLABSIs were reported compared to 20,184 predicted in 2010. This translates into a standard infection rate (SIR) of 0.684. When stratified by patient care groupings, SIRs were lowest among non-neonatal critical care locations (0.654), followed by NICUs (0.695) and wards (0.728).
The report also includes a national snapshot of the CLABSI infection risk linked to 10 common surgical procedures, including hip and knee arthroplasty, colon surgery, rectal surgery, coronary artery bypass graft, and abdominal hysterectomy. Only coronary artery bypass graft and rectal surgery showed a decrease in infections between 2009 and 2010. The others remained unchanged.
CAUTI Rates Dip 3%
In addition to CLABSI data, the report includes first-time national data reported for catheter-associated urinary tract infections (CAUTIs) showing that for all patient areas (excluding NICUs) 9,995 CAUTIs were reported compared to 10,656 predicted for an SIR of 0.938.
For CAUTIs, the SIR was slightly higher for among critical care locations (0.967) compared to ward locations (0.903). This translates into a reduction in CAUTIs of about 3% (ICUs) to 10% (ward locations) since 2009. The findings are based on reports from 1,086 healthcare facilities in 47 states.
Surgical Site Infection Rates Down 8%
National surgical site infection (SSI) data is also reported. SIR is limited to SSIs classified as deep incisional or organ/space infection detected during admission or readmission to the same hospital where the procedure was performed.
Some 4,737 SSIs were reported from more than 529,000 procedures. More than 5,170 were predicted for an SIR of 0.916. This translates into n 8% reduction in the incidence of these SSIs. The findings are based on reports from 1,385 healthcare facilities in 45 states.
In a press release announcing the report's release, Thomas R. Frieden, MD, CDC director called for a "a comprehensive approach for tackling infections in the nation's healthcare facilities, as patients can seek care from a variety of locations and move between healthcare facilities."
Coincidently, HHS posted on line on Thursday for public comment an updated National Action Plan. The request for public comments will be published next week in the Federal Register.
In August 2011 the Department of Health and Human Services awarded a total of $9 million across all 50 states to boost HAI prevention efforts. The awards ranged from $23,239 for Wyoming to $782,173 for Michigan.
The funds are to help states coordinate their HAI activities, implement multi-facility and multi-disciplinary prevention efforts, improve monitoring of antimicrobial use and enhance HAI reporting.
Crystal Run Healthcare learned last week that it is among 27 healthcare organizations selected to participate as an accountable care organization in the federal Medicare Shared Savings Program.
The 250-physician medical group, based in Middletown, NY, doesn't match the ACO profile first presented by the Centers for Medicare & Medicaid. Back in April 2011 it was expected that hospitals would take the lead on ACOs, and physicians would be the carrot to pull in the patients for the hospitals.
A funny thing happened, though. Physician practices took a look at the ACO arrangement, connected the dots, and began to wonder why they needed the hospitals. A primary care network controls the flow of patients to hospital-based specialists as well as to the ancillary services offered by the hospitals. So why not form their own physician-based ACO unencumbered by an exclusive relationship with one hospital?
That's exactly how Crystal Run Healthcare plans to operate its MSSP ACO, explains Scott Hines, MD, co–chief clinical transformation officer at Crystal Run.
By not having a particular hospital as part of its ACO, the physicians at Crystal Run are free to send their patients to whichever hospital that provides the best quality at the lowest cost for a particular ailment or procedure. "It frees us up, at least in some way, to control the cost of the hospital," says Hines.
"Competition is good. We can tell hospitals that we are willing to increase our business there if they are able to prove to us that they are high-quality facilities that also have lower rates than their competitors."
The physician group contracts with 4 hospitals in Orange and Sullivan counties, which are located about an hour northwest of New York City. It also contracts with an academic medical center in Westchester County as well as one in New York City.
Crystal Run has for years been working on two parts of the popular "triple aim" for healthcare: better care and better health. The physician group's 15 sites are linked by a single electronic medical record system, and it has invested in patient care managers for more than 10 years. That hasn't been a reimbursable expense under fee-for-service arrangements, but Hines expects that with the ACO the group will begin to reap the financial benefits of having an established care management model in place.
Hines says cost, the third leg of the triple aim, hasn't been addressed because "frankly we haven't had to until now." He explains that there hasn't been a lot of Medicare Advantage or risk-based contracting in the group's service area compared to other parts of the county, but that's beginning to change.
Crystal Run will participate in track one of the MSSP. There is the potential for reduced revenues and reduced bonuses if the group doesn't meet patient quality and outcome goals.
According to our survey of healthcare leaders, many remain uncertain about the value of ACOs to their organization, many are operationally unprepared for ACOs, and financial risk remains a potential stumbling block for ACOs.
Hines says Crystal Run views the Medicare ACO as an extension of its existing business model. The investments in EMR and care management are the groundwork for an ACO-type of coordinated care. "We're not going to change very much in order to be successful in MSSP. May be just may some tweaks."
In a couple of areas Crystal Run will need work to reduce costs, such as making sure that best-practice guidelines are being followed in the treatment of chronic diseases and that unnecessary tests aren't ordered. The physician group has already piloted a program to analyze the wide variations in the total cost of care within its own practice for illnesses such as diabetes, asthma, and hypertension. The conclusion: Costs are reduced when physicians follow best practices. The group is developing a process to make sure physicians are up to date on all care guidelines.
Crystal Run is also developing a care team program to help prevent unnecessary hospital readmissions. Hines says it will have applications not only for the ACO but for any risk-based contract. The program is an extension of the physician group's existing discharge team that works with hospitals in coordinating patient discharges.
Hine says he is unconcerned by the political maelstrom surrounding the Patient Protection and Affordable Care Act. "The MSSP is only about 30 pages of the law. I think CMS will continue to pursue this. Really, the payment method hasn't changed but now we'll tally things up at the end of the year and see where we stand."
The trustee for Saint Catherine Medical Center does not believe that "a Chapter 11 reorganization is possible" due to debt and undercapitalization and has requested that the medical center be placed in Chapter 7 bankruptcy instead. That means assets will be liquidated to pay off debts.
Motion to convert Ch.11 case to Ch.7
A hearing on the request is scheduled for Wednesday, April 18.
The move comes just a week after attorneys for the Ashland, PA facility filed emergency Chapter 11 bankruptcy papers on behalf of the 67-bed medical center.
Attorney William G. Schwab serves as trustee. On Monday he filed the Chapter 7 papers in the US Bankruptcy Court for the Middle District of Pennsylvania. According to the trustee report filed with the Chapter 7 request, Saint Catherine Hospital of Pennsylvania LLC (dba Saint Catherine Medical Center) has $45,000 on hand and debt in excess of $5.8 million.
According to the trustee report, the medical center:
Rents its facility on a month-to-month basis but hasn’t paid the rent in three years
Is in default on the leases for numerous pieces of medical equipment
Owes at least $1.1 million in trust fund taxes
Owes at least $30,000 for past due 401(k) payments
Saint Catherine Hospital Trustee Report
In addition, Schwab reports that he has been notified by attorneys representing the American Federation of State, County and Municipal Employees, District Council 89, AFL-CIO that "many of the employees have not received wages for five weeks, and payroll has not been made, and there will also be WARN Act claims." The Worker Adjustment and Retraining Notification Act (WARN) requires most employers with 100 or more employees to provide at least 60 days notice of plant closings and mass layoffs.
Chance for Sale Bleak
The report notes that the trustee contacted four large regional hospital groups to gauge interest in a possible purchase of the medical center, but "because of the area of surrounding hospital systems, (the medical center’s) demographics and insurance mix, none have been interested in looking at the financials."
The report concludes that "the trustee does not believe that this corporation is capable of being reorganized." If the request to convert to Chapter 7 bankruptcy is granted, Schwab asks for "limited operating ability for the trustee to take care of billing, medical records, return leased
equipment, and to sell those assets as possible through a specialized auctioneer."
This latest action follows a tumultuous couple of weeks for the medical center. In March an unannounced survey visit by the state Department of Health uncovered serious deficiencies and violations that placed patient health and safety in immediate jeopardy.
As a result the DOH imposed a ban on new admissions, as well as surgical services, emergency and outpatient procedures at the 67-bed hospital. In an April 3 letter the medical center was notified by the Philadelphia office of the Centers for Medicare & Medicaid Services that because of the deficiencies the medical center faced termination of its Medicare agreement.
Efforts to reach the trustee or the attorneys handling the bankruptcy for Saint Catherine Medical Center were not successful.
According to a Pennsylvania Department of Health spokesperson Saint Catherine officials "have volunteered to surrender the license and send it back" to the DOH. "To date, we have not yet received the license."
This article appears in the April 2012 issue of HealthLeaders magazine.
Accountable care organizations, heralded as the cornerstone of healthcare reform, remain something of an enigma in the healthcare industry. While ACOs hold the promise of retooling the industry into a leaner, meaner cost-cutting, care-improving machine, there's still plenty of doubt that ACOs are the way to go, according to results from the 2012 HealthLeaders Media Accountable Care Organization Survey.
While 11% of respondents say they are already part of an ACO, for the rest that are not, just 39% of healthcare leaders say their organization plans to become part of an ACO. Rob Slattery is surprised by what he considers to be a low level of interest. He suggests that for the majority that is not interested in developing an ACO the focus may still be on the more defined Medicare Shared Savings Program and not so much on developing a commercial ACO. "They may have looked at the Medicare program and decided that they don't want to assume that type of risk."
Slattery is president and CEO of Integrated Solutions Health Network, which includes 2,000 physicians, 14 community hospitals, five skilled nursing facilities, and four ambulatory surgical centers, among other healthcare business lines. ISHN is developing an ACO as part of Mountain States Health Alliance, a 13-hospital system based in Johnson City, TN.
The survey shows that the organizations interested in ACOs are setting a fast track to have them operational. Some 11% were up and running in 2011 and another 57% are expected to come on board by 2014.
This article appears in the April 2012 issue of HealthLeaders magazine.
Accountable care organizations, heralded as the cornerstone of healthcare reform, remain something of an enigma in the healthcare industry. While ACOs hold the promise of retooling the industry into a leaner, meaner cost-cutting, care-improving machine, there's still plenty of doubt that ACOs are the way to go, according to results from the 2012 HealthLeaders Media Accountable Care Organization Survey.
While 11% of respondents say they are already part of an ACO, for the rest that are not, just 39% of healthcare leaders say their organization plans to become part of an ACO. Rob Slattery is surprised by what he considers to be a low level of interest. He suggests that for the majority that is not interested in developing an ACO the focus may still be on the more defined Medicare Shared Savings Program and not so much on developing a commercial ACO. "They may have looked at the Medicare program and decided that they don't want to assume that type of risk."
Slattery is president and CEO of Integrated Solutions Health Network, which includes 2,000 physicians, 14 community hospitals, five skilled nursing facilities, and four ambulatory surgical centers, among other healthcare business lines. ISHN is developing an ACO as part of Mountain States Health Alliance, a 13-hospital system based in Johnson City, TN.
The survey shows that the organizations interested in ACOs are setting a fast track to have them operational. Some 11% were up and running in 2011 and another 57% are expected to come on board by 2014.
Slattery says patient accountability is a political land mine because "we've created a social system that supports the behavior that's counterproductive to health and wellness. Look at obesity." In that environment, he says it's very difficult to develop benefits and programs that can successfully incentivize appropriate behaviors and move patients to be more accountable to any care plans prescribed by their physicians.
There is general agreement among the survey respondents that organizations with ACOs will be better off in terms of cost control, patient outcomes, and patient engagement. However, respondents generally see no perceived advantage for ACOs in terms of patient loyalty or physician satisfaction.
Slattery expects that over time ACOs will provide advantages across the board as organizations adjust their models to balance the needs of their payers, providers, and patients. "Our focus is the triple aim. It will provide us with the equilibrium to out maneuver and out innovate our competition and to really enjoy the advantages of an ACO."
There still isn't a clear picture of how healthcare leaders expect ACOs to play a role in healthcare reform. There seems to be plenty of concern within the industry that ACOs are as much of a minefield as they are an opportunity to redefine healthcare deliver.
This article appears in the April 2012 issue of HealthLeaders magazine.
Hospitals and other healthcare facilities looking to hire more doctors, nurses and other healthcare professionals may want to add Facebook, LinkedIn, and even Twitter to their recruitment efforts.
A survey from AMN Healthcare, a San Diego-based recruitment firm, finds that people employed in healthcare have increased their use of social media to look for jobs, apply for new positions and network with colleagues.
Just a few years ago job seekers might have relied on informal get-togethers to glean information about potential job openings. While personal networking is still important, social media makes “the cocktail party very large and very private,” Ralph Henderson, president of healthcare staffing at AMN, told HealthLeaders Media.
According to the survey, healthcare professionals spent more time on social media sites and/or mobile devices in 2011 compared to 2010, and reported receiving more job interviews, job offers, and new positions through the use of mobile job alerts.
Some 31% of the 2,790 survey respondents used social media in their job search versus 21% in the 2010 survey. Of those 11% received a job interview compared with 6% in 2010; 9% received a job offer compared with 5% in 2010, and 6% secured a job through social media versus 3% in 2010.
Advancements in social media, such as mobile job alerts, have helped increase usage and success, explains Henderson. “The tools and opportunities available through LinkedIn, Facebook or Twitter are very different now from just a few years ago.”
He adds that social media is a great way for hospitals and other healthcare facilities to appeal to the passive job seeker such as the healthcare professional who is happy in their job but would make an employment move if the right position presented itself.
Among the key 2011 survey findings:
Nearly 50% of all respondents report that they use social media for professional networking versus 37% in 2010.
Allied professionals (36%) and nurses (33%) are the most frequent users of social media for job searches followed by pharmacists (29%) and physicians (23%).
Some 41% of responding physicians have used mobile devices or tablets like iPads to search for employment or healthcare-related content
Three out of four respondents named Facebook as their favorite site for job seeking opportunities.
About 53% of the survey respondents work in hospitals. Nurses account for 31% of the respondents, allied professionals (26%), physicians (23%) and pharmacists (9%).
One surprising statistic about the respondents: 60% were more than 40 years old. That means social media appeals to mid-level healthcare professionals as well as younger works just beginning their careers.
Beleaguered Saint Catherine Medical Center, which filed for Chapter 11 bankruptcy earlier this week, owes 76 vendors an estimated $2.3 million according to a document released by the Philadelphia office of the Centers for Medicare & Medicaid Services.
draft of corrective action plan for SCMC
The document also notes that syringes and saline solutions are in short supply and that preventive maintenance is behind schedule for critical pieces of medical equipment such as an EKG, ventilators, and a defibrillator.
The debts, supply shortages, and equipment problems were discovered during a complaint survey conducted at the Ashland, PA facility on March 27 on behalf of CMS by the Pennsylvania Department of Health. According to state and federal officials the deficiencies and violations placed patient health and safety in immediate jeopardy.
As a result, the state placed a ban on new admissions to Saint Catherine, as well as surgical services, emergency, and outpatient procedures at the 67-bed hospital. Although the medical center is still licensed, there are no patients at the facility.
In an April 3 letter to Merlyn Knapp, the medical center's CEO, CMS officials said the medical center's Medicare agreement "will be terminated by April 19 if the immediate jeopardy has not been removed."
The CMS document released to HealthLeaders Media includes the findings of the original survey as well as Saint Catherine's corrective action plan (CAP) to address the deficiencies.
Typically, CAPs address each deficiency and provide a timeframe for resolution. In its April 3 letter CMS specifies that "to forestall termination of your facility's Medicare provider agreement, it must be determined that the hospital has removed the immediate jeopardy prior to April 19."
The completion date stated in the CAP for resolving each deficiency, however, is May 10.
According to a CMS official "the plan of correction would not constitute a credible allegation of compliance for federal purposes for the simple reason that the correction date is 16 days after the (Medicare) termination date."
Figures from the Pennsylvania Health Care Cost Containment Council indicate that in 2010 Medicare accounted for 49% of Saint Catherine's $22 million in net patient revenue.
The deficiencies indentified in the 51-page survey fall into five broad categories: radiologic services, physical environment, surgical services, compliance with laws, and governing body. Extensive shortages of medical supplies are noted, including a lack of syringes and needles in the intensive care unit and the lack of catheter kits used in the ER to measure blood flow pressure in the heart.
In addition a review of the medical supply room revealed no surgical gloves available, no medicated soap, no disposable bed pans, no paper or durapore tape, only 1 safety glide 22 gauge syringe (101 were supposed to be in stock), and 22 bags of one-half normal saline (64 were supposed to be in stock).
The medical supply shortages were directly related to vendors refusing to provide supplies until the medical center settles its debts. The blood supply vendor requires cash on delivery for any orders. An operating room orthopedic equipment supply vendor placed the facility on hold until its almost $20,000 outstanding balance is paid in full.
Delays in preventive maintenance and equipment repairs are also related to vendor debts. The facility's preventive maintenance vendor placed the medical center on hold until an $18,118 is settled. The diagnostic scope service vendor has taken a similar step over an almost $6,000 debt.
Day in and day out operations of the investor-owned, acute-care facility are also affected by the outstanding debt situation as vendors for coal heating, water company, electricity, phone service, the computer system, carpet cleaning, elevator inspection and repair, answering service, office equipment, and food supply take steps to recoup money owed to them.
Other deficiencies and violations identified in the survey include:
Failure to transfer emergency room patients to other facilities in a timely manner
Failure to ensure that the x-ray equipment is properly calibrated
Failure to dispose of expired medications
The continued use of expired lab testing supplies
Excessive humidity levels in operating rooms
Failure to conduct preventive maintenance on operating room anesthesia machines
Failure to prepare and for the board to accept an annual operating budget for 2012
Consistent delays in the payment of employee federal tax withholdings, and Social Security and Medicare payroll deductions as required by law.
Continuing to deduct from employee paychecks the payments for long-term disability insurance although the policy was terminated in August 2011 due to nonpayment.
Suspending payments to the employees' 401K vendor without notifying employees.
The survey identifies several instances when the deficiencies or violations may have directly compromised patient care:
The ER staff was unable to monitor the heart rate or blood oxygen levels of an 18-day old infant because there were no pediatric/infant electrodes or a pulse oximetry machine available in the ER.
A ER patient requiring advanced cardiac life support waited two hours for a transfer to another hospital
The fire alarm system vendor cancelled the service for nonpayment. For four months Saint Catherine didn't have central station fire alarm monitoring however staff was never informed that they would need to call the fire department to report a fire at the hospital.
Medical center officials addressed the steps they plan to take to correct the problems, including:
Present a monthly progress report to the board
Correct all state and federal deposits in arrears by May 10
Develop an annual operating budget
Set up payment plans with each vendor until outstanding balances are met or alternatives in place.
Monitor patient transfer times with a goal of less than one hour for a transfer
Schedule preventive maintenance and repair; remove any equipment not meeting the schedule from daily use
Institute a daily monitor for all blood bank reagents
Repair the ventilation system and air handlers in the surgical services department
Holli Senior, a spokesperson for the DOH, told HealthLeaders Media in an e-mail exchange that before Saint Catherine can reopen "it must address all of the deficiencies cited on the 2567 (survey)."
According to the Office of General Counsel at CMS, Saint Catherine's Chapter 11 filing will not "have any effect on CMS's termination action."
Saint Catherine officials have not responded to repeated requests for comment.
For 10 years researchers at Metropolitan Life Insurance Company (MetLife) have conducted an annual survey about employee benefits. While much of the survey focuses on benefits in general, the 80-page report is chock full of information that employers probably don't realize, but should consider as they talk to health plans and employees about their healthcare benefit programs.
The survey results confirm that health benefits are "number one on the minds of employees," says Ronald S. Leopold, MD, vice president and national medical director of MetLife U.S. Business. He adds that as the economy improves, employers are turning the corner in terms of how they view benefits. They’re moving from thinking that employees should be happy just to have a job, to seeing benefits as an important tool for attracting and retaining employees.
Leopold says employee attitudes are also shifting. During the bad economy, employees were focused primarily on salary. Now, he says, they are taking a look at their entire compensation package and benefits are coming into sharper view.
The survey results also reveal that when it comes to benefits, employees maintain a level of distrust toward their employer. Leopold says employers need to work harder to avoid miscommunications about benefits. He points to the finding that 33% of employees think employers plan to reduce benefits while only 10% of employers report that they plan to make that move. To avoid that disconnect "employers need to deliver a clear message to employees about the status of benefits."
Among the key findings of the 2011 survey:
Younger employees are interested in benefits. Despite all the talk about so-called "young invincibles" being benefit and health insurance skeptics, Gen X and Gen Y employees are looking more seriously at benefits and their interest will "redefine what benefits will mean in the coming decade." They are especially concerned about having protection from the costs of a serious illness that might not be covered by health insurance.
Employers don't offer the right benefits. Employees think employers are out of step when it comes to recognizing benefits employees want. Non-medical benefits or so-called voluntary benefit offerings such as long-term care, dental, and vision benefits are important to employees, but only 41% of employers say that voluntary benefits are part of their benefit packages.
Employees are willing to pay for benefits. Ten years ago employees expected benefits, but were less aware of the real cost of those benefits. In today’s economic climate employees are willing to pay more of the costs themselves. Gen Xs and Ys express an especially strong interest in being able to choose from a selection of voluntary benefits that they are willing to pay for on their own.
Employees are bracing for benefit cuts. Although 77% of employers report that they intend to maintain their current level of healthcare benefits, employees just don’t buy it. They are worried that a weak economy could cause employers to reduce benefits. However, only 12% of employers say they plan to reduce healthcare coverage benefits while 11% plan to increase those benefits. Still, 30% expect to shift more of those costs to employees.
There's a generational view. Employers are beginning to build a generational perspective, aligning benefits for Gen Xers and Yers as well as baby boomers, into their benefits programs but employees think they can do more.
Benefits correlate with job satisfaction. Survey results have noted this strong relationship since 2004. According to the survey the correlation drives a universal set of business objectives such as employee attraction, retention and productivity. But before employers get too excited, they should note the next key finding.
There's a loyalty gap. Only 42% of employees have a strong sense of loyalty to their employer. That's a seven year low for the MetLife report. Meanwhile, employer loyalty is at a seven year high with 59% of employers reporting a strong sense of loyalty to employees.
MetLife’s 2011 annual survey (PDF) comprised 1,519 interviews with benefits decision-makers; the employee sample comprised 1,412 interviews with full-time employees over age 21.