Changing News Archive - September, 2009

WASHINGTON – The Department of Health and Human Services has awarded $40 million to help 41 states and the District of Columbia find and enroll uninsured children who are eligible for either Medicaid or the Children’s Health Insurance Program.

“With millions of Americans either out of work or otherwise struggling to make ends meet during this recession, there is an even greater urgency to bring steady, reliable healthcare to children in these families who may have lost their coverage,” said HHS Secretary Kathleen Sebelius.

LAGRANGE, GA – The West Georgia Health System and Perot Systems have signed a deal for revenue cycle management technology and services for the health system's facilities in western Georgia and eastern Alabama.

The agreement is designed to enable the LaGrange, Ga.-based system to use technology from Plano, Texas-based Perot Systems to lower its revenue cycle administrative costs and improve its billing and reimbursement processes.

TORONTO (Reuters) - Canada outperforms the United States in health outcomes but is well behind global leaders like Japan in overall health of its population, a Canadian report released on Monday showed.

The annual report card by the Conference Board of Canada ranked Canada 10th out of 16 developed countries, with a "B" grade. The United States was the worst performer, placing 16th and earning a "D" grade.

GENEVA (Reuters) - Early use of antivirals is effective in treating H1N1 flu and health authorities must be vigilant for signs of drug resistance, the World Health Organisation said on Friday.

Silver Spring, Md. -- Vice President Joe Biden and Health and Human Services (HHS) Secretary Kathleen Sebelius today hosted a town hall meeting with seniors in Silver Spring, Md., and released a new report, Health Insurance Reform and Medicare: Making Medicare Stronger for America’s Seniors. The report, authored by HHS, outlines how health insurance reform will help seniors and answers key questions about President Obama’s health insurance reform plan.

As directed by President Obama, the Secretary of the Department of Health and Human Services (HHS) will launch a new demonstration initiative that will help states and health care systems.

In opening the first day of what could turn into a lengthy hearing on the Senate Finance Committee's healthcare reform bill, committee Chairman Max Baucus (D-MT) said today, "The time has come to reform America's healthcare. The times demand nothing less."

To get the ball rolling, Baucus will introduce a revised Chairman's Mark later today. At least one of the changes will deal with physician payment. "At one point, I want to acknowledge up front that we did not do as much to correct the payment of doctors—especially as I would have liked under the incredibly misnamed sustainable growth rate (SGR)," he said. "The SGR needs to be fixed permanently. I look forward for further progress on this."

WASHINGTON – Community health center advocates and policy experts are applauding an announcement by the U.S. Health and Human Services Department to use $33 million in stimulus funds to train health professionals.

For health reform to be meaningful, access and coverage must be accompanied by support for the workforce profession, said Feygele Jacobs, executive vice president of RCHN Community Health Foundation.

“Workforce development must be appropriately distributed, funded and scoped,” she said

Six national organizations representing thousands of healthcare professionals nationwide have joined together to create the Hospital Care Collaborative (HCC) to examine pressing needs and outcomes related to hospitalized care.

As part of the launch of HCC, the group has established 13 guiding principles for delivering team-based care in the hospital. It represents the consensus of the HCC members.

President Obama directs HHS to announce within 30 days that the Department will make available demonstration grants to States, localities, and health systems for the development, implementation, and evaluation of alternatives to our current medical liability system, consistent with the goals and core commitments outlined by the Administration.

WASHINGTON -- Senate Finance Committee Chairman Max Baucus formally unveiled a 10-year $856 billion bill that would extend health insurance to tens of millions of Americans not now covered, moving an important step forward on President Barack Obama's top domestic priority.

The sweeping measure is designed to steer a more moderate course on health policy than other major bills moving through Capitol Hill, and doesn't propose to create a new government insurance plan to compete with private insurers, as proposed in rival House legislation and favored by many liberals. Instead, the Montana Democrat is proposing to expand coverage by creating a network of nonprofit health insurance cooperatives.

As the three major nurses' organizations in the country came together earlier this month to form the largest registered nurses union and professional association in the U.S., some resistance remains from Massachusetts nurses' unions.

So far only one of the three organizations has voted unanimously to endorse and join the proposed "super union." In a meeting held on September 10, delegates from the Oakland-based California Nurses Association (CNA) became the first organization to join the super union. The Oakland-based association represents 86,000 of the potential 150,000 nurses of National Nurse United (NNU).

One of the leading population health management companies announced Monday it has filed a voluntary petition under Chapter 11 of the U.S. Bankruptcy Code. LifeMasters Supported SelfCare, Inc., based in South San Francisco, CA, alleges that the costs associated with participating in Centers for Medicare and Medicaid Services' demonstration projects is a reason for the decision.

"The Chapter 11 filing is the most efficient path for the company to restructure liabilities that are a result of demonstration projects previously performed under contracts with the Centers for Medicare and Medicaid Services, " said George D. Pillari, who was named president of LifeMasters Monday.

DENVER – Catholic Health Initiatives, a 20-hospital national nonprofit healthcare organization, is using Intelligent Optical Character Recognition (IOCR) technology to convert paper-based medical bills and payments into electronic accounting records.

The Denver-based organization is using technology designed by Pittsburgh-based PNC Healthcare to enhance its revenue cycle process. In a pilot project with CHI, PNC's IOCR solution demonstrated the capacity to significantly improve cash posting efficiencies.

In the future, patients will communicate with their doctors via e-mail, online chat room, Web portal, mobile device, remote monitoring technology (or some other method or medium that hasn't yet been invented), thus avoiding a long wait for a short appointment that might not have been necessary anyway.

Senate Finance Chairman Max Baucus announced Monday that he may unveil his long-awaited health-care bill as soon as Tuesday -- and he predicted that Republicans will find plenty to like about it.

The Montana Democrat and his fellow "Gang of Six" Finance Committee negotiators haggled Monday over top Republican concerns, including provisions that would limit medical malpractice cases, bar benefits from reaching illegal immigrants, and block federal funds from subsidizing abortions.

In reflecting on the events of September 11th, 2001, Secretary Sebelius calls for health professionals to consider enlisting in the Medical Reserve Corps, especially in light of this year's flu season.

In July 1868, as the United States was reconstructing and reuniting after being torn apart by civil war, the nation came together to enshrine in a constitutional amendment the right of employment for every physician in the country.

Ok, that may not have been the original intent, but some California physicians are using the 14th Amendment to argue that the state's Medical Practice Act, which bans hospitals from employing doctors, is unconstitutional.

"No State shall make or enforce any law which shall abridge the privileges or immunities of citizens of the United States," the amendment reads, and some are arguing that targeted restrictions on how physicians can earn a living do just that.

But even more interesting, to me at least, than the legal validity of the case is the context in which it is being debated.

Those in favor of the ban on employing physicians, including the California Medical Association, have claimed the ban allows physicians to maintain their independence. They fear that an employed physician's decisions would be influenced by the hospital's profit motives, degrading the sacred physician-patient relationship.

But now it is opponents who argue that employment is nearly the only way for physicians to maintain their independence, because the financial climate has become so severe that physicians are struggling to make a living as independent practitioners.

WASHINGTON (Reuters) - Democratic leaders promised swift action on a healthcare system overhaul on Thursday after a high-stakes speech by President Barack Obama that earned good public reviews but appeared to change few minds in Congress.

U.S. House of Representatives Speaker Nancy Pelosi told reporters she was confident that Obama by year's end would sign a healthcare reform bill, his top domestic priority.

WASHINGTON — President Obama’s speech on health care failed to bridge the gulf with Republicans, but Democrats said on Thursday that the president had largely succeeded in unifying his own party by making a cogent, persuasive pitch to the American public and by casting his plan to overhaul the health care system as a political and moral imperative.

A bill that may become the strongest legislation in the nation to prevent health plans from dropping coverage to members who become ill passed the California Senate yesterday and may soon be headed for the governor's desk.

The bill, called AB 2, is expected to receive Assembly approval in the next few days.

If it is signed by Gov. Arnold Schwarzenegger, as its sponsors anticipate, the legislation would set up an independent board, managed by two state agencies, which would have to approve any health plan's cancellation of an enrollee's plan. Only when insurers prove the applicant intentionally misrepresented his or her health on the questionnaire would cancellation be approved.

If an insurer tried to cancel a policy without getting approval, the state Department of Managed Health Care and the Department of Insurance would impose administrative penalties.

After a month of angry town hall meetings and dire predictions about the state of his top domestic priority, President Obama moved forcefully Wednesday night to take the initiative on health care -- and in the process rejuvenate his presidency and unite his fractious Democratic Party.

Each of the nation's 5,700 hospitals must cut $2.6 million a year on average in costs in the next 10 years to meet the demands of President Obama's proposed health care reform, a daunting task when half of those hospitals lose money.

Criticism came from almost every corner leading up to Obama's speech before Congress on Wednesday night, yet many hospital CEOs aren't complaining, at least not publicly. They say that the hospitals they run are rife with inefficiency and that they are optimistic that the $155 billion in savings is do-able with the help of business disciplines, such as the Toyota Production System, lean manufacturing and Six Sigma.

"Efficiency has not been the hallmark of health care delivery operations," says Alan Aviles, CEO of New York City Health and Hospitals Corp. (HHC), one of the largest hospital and health care systems in the country, with $5.4 billion in revenue.

In 2009, U.S. health-care reform moved rapidly to the front burner, and it will stay there. President Barack Obama and his advisors have made it clear that reducing health-care costs is a necessary prerequisite to achieving their broader economic goals.

The levers that the new administration plans to pull will address the obvious issues: treatment variability (standardized procedures tend to be more cost-effective), value-in-use analysis (evaluating costs and benefits), chronic disease management, enhanced information technology, and utilization rates. (Utilization rates measure the amount of health care delivered and received per capita. Preventive medicine and other means of reducing long-term utilization while maintaining overall public health thus represent a major cost-saving opportunity.) The reforms are all expected to involve both public and private initiatives, reassuring voters that “if you have insurance you like, you can keep it.”

A bipartisan group of six Finance Committee senators considers a new proposal that might be the last, best hope for an overhaul agreement.

The six were to meet Tuesday on  Sen. Max Baucus' proposal to create nonprofit insurance plans to compete with those offered by profit-making companies. The proposal by the committee chairman is noteworthy for the piece that's missing: a government-run alternative favored by liberal Democrats.

CHICAGO – Janie Johnson has no health insurance, so when she cut her toe while giving herself a pedicure, she limped to the emergency room at one of Chicago's safety net hospitals and waited her turn.

"I'm 44, but I probably look about 55 right now," Johnson joked in Stroger Hospital's emergency department where more than 100 patients sat waiting. Urgent cases, from chest pains to gunshot wounds, are rushed to doctors first. Johnson was glad to have somewhere to go for health care.

"I don't know what I would do" without the hospital, she said. "My health would probably get worse."

To all the knotty issues involved in health care overhaul, add one more: The proposals in Congress may threaten the funding and future of the nation's already-struggling safety net hospitals.

It's an irony hospital leaders are expressing quietly as Congress reconvenes this week to take up health care again. Hospital leaders support expanding insurance coverage to more Americans, but they worry financing the expansion will cause some teetering urban hospitals to deteriorate and close.

WASHINGTON (Reuters) - U.S. President Barack Obama's top aides said on Sunday he still wants a government insurance option in healthcare legislation but they left room for a compromise that could disappoint his liberal backers.

Ahead of a major Obama healthcare speech on Wednesday night, the advisers sought to portray a sense of momentum behind an overhaul of the $2.5 trillion U.S. healthcare system after a tumultuous summer of debate during which Obama lost ground and Republicans rallied opposition.

Obama, speaking to a joint session of Congress, will lay out specifics of what he supports to try to regain control of the healthcare issue and gain passage of a plan this year.

Analysts say how he handles the debate this autumn is a major test of his leadership and could define his presidency.

WASHINGTON – Medicare has announced that it will pay healthcare providers the same rate to administer the H1N1 flu vaccine as the seasonal flu vaccine, according to the Centers for Medicare & Medicaid Services.

The program will pay for both H1N1 and seasonal vaccination and for administering more than one dose of vaccine, if medically necessary for the beneficiary, according to an article in the CMS publication MLN Matters.

The 12 California hospitals receiving the latest fines for putting patients in "immediate jeopardy" of harm or death include three that failed to remove sponges or towels from surgical patients, one where a psych tech repeatedly slapped an unconscious patient in the face in the belief he was "faking it," and another where staff failed to properly use restraints, resulting in a patient's critical fall.

Poor training of medication use resulted in a heparin overdose that caused a brain hemorrhage in a patient at a sixth facility while at a seventh hospital, managers failed to properly staff the intensive care unit, and a patient whose condition was quickly deteriorating was not adequately treated.

GENEVA (Reuters) - H1N1 flu has killed at least 2,837 people but is not causing more severe illness than previously and the virus has not mutated, the World Health Organization (WHO) said on Friday.

"There is no sense that the virus has mutated or changed in any sense," WHO spokesman Gregory Hartl told a news briefing.

BATON ROUGE, LA – A new study shows how Louisiana's hospitals are responsible for providing economic stability to its communities.

The study, by the Louisiana Hospital Association, indicates hospitals account for 1.9 percent of all healthcare establishments in Louisiana, yet they provide 38 percent of total healthcare employment. Hospitals also account for 43 percent of the total payroll of the healthcare sector.

When it comes to reporting a physician to the National Practitioner Data Bank (NPDB), hospitals can sometimes find themselves between a rock and a hard place. Hospitals are obligated under the Health Care Quality Improvement Act to report physicians whose privileges have been denied or revoked under certain circumstances, but in doing so, they run the risk of being sued by those same physicians.

WASHINGTON (Reuters) - President Barack Obama will seek to boost flagging support for healthcare reform next week with a rare speech to Congress after a rocky summer raised questions both about his leadership and legislative program.

Obama, who has staked significant political capital on a broad plan to overhaul the $2.5 trillion healthcare industry, will make his speech to a joint session of the U.S. Senate and House of Representatives on September 9, an administration official said.

Disruptive, offensive behavior on the part of providers is still such a significant and frequent problem in health settings, it jeopardizes patient safety, and can affect quality of care, despite Joint Commission guidance that took effect Jan. 1 to prevent such breakdowns.

Of more than 1,500 providers responding to an e-mail questionnaire, three-fourths said they had been the target of unprofessional, intimidating or inappropriate behavior within the last 24 months. Two-thirds said they considered leaving their job because of it and 41% said they actually did.

Medicare physician fee schedule payments may be "excessive" for a variety of medical services because efficiencies that occur when two or more services are furnished together are not reflected in the fee schedule, according to the Government Accountability Office (GAO) in a study examining Medicare physician payments and fees. GAO's review found that expanding Medicare's practice in this area could reduce payments by an estimated half billion dollars a year.

Medicare essentially could end up paying twice for those overlapping services, which do not involved surgery or imaging, GAO said. For instance, when two medical services are furnished together, a physician may only review a patient's medical record once, but fees paid would reflect that Medicare paid twice for that activity with both services.

Catholic Health Initiatives and Trinity Health announced today they have signed a letter of intent to combine their four Eastern Oregon-Western Idaho hospitals into a single local system. The agreement calls for transferring the three CHI facilities to Trinity Health, thus creating a new regional healthcare system to be operated by Trinity Health.

Three of the hospitals – Mercy Medical Center, Nampa, Idaho; Holy Rosary Medical Center, Ontario, Ore.; and Saint Elizabeth Health Services, Baker City, Ore. – are part of Catholic Health Initiatives (CHI) of Denver, Colo. The fourth hospital is Saint Alphonsus Regional Medical Center (SARMC) of Boise, a part of Trinity Health of Novi, Mich.

Gwinnett Medical Center’s bid to perform open-heart surgery has set up a tooth-and-nail fight with Emory and Piedmont hospitals, which already perform the life-saving procedures.

Gwinnett Medical would be the first to offer open-heart surgery in that county. The conflict centers on Gwinnett’s arguments for access to care vs. the other hospitals’ assertion that another heart center will flood the metro market, driving up costs and driving down the quality of care.

Both sides maintain their position represents the best interests of health care for metro Atlanta. The great majority of the eight metro hospitals that already offer open-heart surgery are located in Atlanta, but pressure has grown in recent years to bring the service into suburban counties.

WASHINGTON (Reuters) - U.S. lawmakers returning next week to work on major healthcare legislation need to focus on insurance market reforms, consumer rebates and other measures that will curb soaring costs over time, economic and health experts said on Tuesday.

The group of academics outlined dozens of changes in their report, from restructuring payments under the Medicare insurance program for the elderly and disabled to providing doctors incentive payments for helping avoid costly treatments or complications.

All of the proposals, some of which are already included in various congressional plans, together will help provide better care for patients while lowering costs over time, said Dr. Mark McClellan, a former economic official under President Bill Clinton and health official under President George W. Bush.