Changing News Archive - July, 2010

The law Congress adopted this spring to reshape the nation's health-care system will be especially beneficial to women, because they traditionally have relied on health care more than men, faced more insurance problems and had greater difficulty paying medical bills, according to a new analysis.

The Commonwealth Fund found that women will be helped in particular by central aspects of the legislation designed to improve and expand access to insurance. Commonwealth was a major supporter of the legislation. At a time when some Republicans and other conservatives continue to challenge the law, the study on women is part of a series of reports the foundation is planning to demonstrate the law's relevance to different groups of people.

Once the insurance expansion occurs, starting in 2014, about 15 million of the nearly 17 million U.S. women who currently are uninsured will be eligible for coverage with federal financial help, the report predicts. Slightly more than half of them will qualify to join Medicaid, and the rest will qualify for government subsidies to buy private coverage through new insurance "exchanges" that will be run by states.

ATLANTA – Physicians estimate the cost of defensive medicine to be between 26 and 34 percent of annual total healthcare costs, according to a new online survey. At an estimated $2.5 trillion in annual spending, this means $650-850 billion is spent each year on medically unnecessary care.

This is a sharp contrast to the current belief that three percent, or $60 billion, of overall healthcare spending is wasteful, according to Richard Jackson, chairman and chief executive officer of Jackson Healthcare, the Atlanta-based firm that conducted the study.

According to Jackson, the physician data for the survey was gathered from a series of online physician surveys conducted between October 2009 and May 2010.

Experts: Lack of incentives, financial interests hinder integrated, accountable care

NEW YORK – Healthcare and healthcare policy leaders say the lack of incentives and current financial interests of providers and other stakeholders are barriers to moving healthcare toward more integrated and accountable delivery models, according to a new survey.

The Commonwealth Fund/Modern Healthcare "Healthcare Opinion Leaders Survey" asked leaders for their views on barriers to delivery system innovation and strategies for fostering more accountability and coordination among providers.

"Across the board, leaders in healthcare say that our current perverse financial incentives are the chief barrier to implementing accountable and integrated systems of care that would improve quality and efficiency," said Karen Davis, president of The Commonwealth Fund. "The good news is that the Patient Protection and Affordable Care Act goes a long way toward overcoming these financial barriers and paving the way for a high-performance health system."

WASHINGTON – The Centers for Medicare and Medicaid Services will make available $2.25 billion in state grants to support community-based alternatives to institutional long-term care.

According to Monday's CMS announcement, the grants will extend the "Money Follows the Person Rebalancing Demonstration" (MFP) with funding from the Affordable Care Act.

"The Money Follows the Person Rebalancing Demonstration has been critical to our efforts to deliver on the promise of the Americans with Disabilities Act and expand access to community living services," said Health and Human Services Secretary Kathleen Sebelius.

Hospital leaders attending the American Hospital Association's Leadership Summit in San Diego Thursday got a stern lecture from Captain Chesley “Sully” Sullenberger, who told them adopt the mentality of the aviation industry. They must stop thinking of accidents “as inevitable and start thinking about them as unimaginable," he said. “We in aviation have learned a lot, and we’re anxious to share it with you.”

WASHINGTON – Today, the Obama Administration is announcing both new regulations to empower consumers to appeal decisions made by their health plans or insurance companies and the availability of resources that will be used to help give consumers more control of their health care decisions.  These provisions of the Affordable Care Act will help support and protect consumers and help end some of the worst insurance company abuses.

The new appeals regulations were issued by the Departments of Health and Human Services (HHS), Labor, and the Treasury.  Consumers in new health plans in every State will have the right to appeal decisions, including claims denials and rescissions, made by their health plans.  This includes the right to appeal decisions made by a health plan through the plan’s internal process and, for the first time, the right to appeal decisions made by a health plan to an outside, independent decision-maker, no matter what state a patient lives in or what type of health coverage they have.

WASHINGTON – Fifty-two senators have pressed the federal government to prevent a 2.9 percent Medicare cut to hospitals in the proposed fiscal year 2011 Inpatient Prospective Payment System (IPPS) regulation.

The proposed cut is part of a coding "offset" in the IPPS, designed to correct any overpayments hospitals may have received due to changes in Medicare billing codes.

The senators, led by Debbie Stabenow (D-Mich.) and Lisa Murkowski (R-Alaska), say the calculation for the coding offset in FY2011 is not based on enough information, including the severity or complexity of patients who are treated in the hospitals.

HIPAA privacy and security concerns with the government's EHR certification program are so great that hundreds of practitioners have called for the program's cancellation, the Department of Health & Human Services (HHS) announced in its final rule on meaningful use released Tuesday.

The final rule, issued through the Centers for Medicare & Medicaid Services (CMS), defines "meaningful use" for the first two years (2011 and 2012) of a long-term financial incentive plan through Medicare and Medicaid under the Health Information for Economic and Clinical Health (HITECH) Act, signed into law by President Barack Obama February 17, 2009.

HHS released a second final rule the same day, through the Office of the National Coordinator for Health Information Technology (ONC). It establishes an initial set of standards, implementation specifications, and certification for EHR technology for vendor products.

Today I’m joined by several key leaders and partners in the U.S. government’s fight against health care fraud: Department of Health and Human Services Secretary Kathleen Sebelius, Special Agent in Charge John Gillies of the FBI’s Miami Field Office, HHS Inspector General Daniel Levinson and the United States Attorney for the Southern District of Florida Willy Ferrer.

 We are here to announce the results of the largest federal health care fraud takedown in our nation’s history: 94 people in four cities have been charged for their alleged participation in schemes to submit more than $251 million in false Medicare claims.  Here in Miami, 24 defendants have been charged for their alleged involvement in fraud schemes totaling approximately $103 million.  Additional arrests have been made in Baton Rouge, Brooklyn and Detroit.

NEW YORK – A new report indicates that a combination of better-coordinated public- and private-sector care, stronger patient awareness of health risks and wellness and improved information systems to eliminate fraud and abuse could save $3.6 trillion over the next decade.

Such savings would represent a 50 percent reduction in wasteful spending in healthcare, according to the report, issued by New York-based Thomson Reuters.

Raymond Fabius, MD, Thomson Reuters' chief medical officer, said stakeholders in the healthcare system must do their part to achieve a major health culture shift in the United States.

The American Hospital Association is not pleased with final regulations on the meaningful use of health IT.

AHA officials said they are still reviewing the 864-page regulations, released Tuesday, and are pleased with the added flexibility and removal of some of the "unnecessary administrative burdens."

But that's where the positive comments end. Overall, AHA leaders said they remain concerned that the requirements may be out of reach for many hospitals. "Unfortunately, CMS continues to place some barriers in the way of achieving widespread IT adoption," they said in a statement.

Some doctors have been reluctant to communicate with patients via e–mail, in part because of reimbursement and medical liability concerns. But a new study in Health Affairs provides a compelling case for opening up the inbox to patients: It may improve the quality of care.

Researchers at Kaiser Permanente followed 35,423 patients with diabetes, hypertension, or both, over a two–month period. Those that used e–mail to communicate with their doctors saw a statistically significant improvement in measures from the Healthcare Effectiveness Data and Information Set, a group of performance measures used by the managed care industry.

WASHINGTON – States, territories and large metropolitan areas will receive $390.5 million in grants this month to help hospitals and other healthcare organizations strengthen their medical surge capability.

The Department of Health and Human Services’ Office of the Assistant Secretary for Preparedness and Response will provide the funds through the Hospital Preparedness Program.

According to officials, the grants “enhance community resilience by increasing the ability of hospitals and healthcare facilities to respond to the public health and medical impacts of any emergency, such as natural disasters, disease outbreaks or acts of terrorism.”

WASHINGTON – President Barack Obama's recess appointment of Harvard Medical School Professor Donald Berwick, MD, to lead the Centers for Medicare & Medicaid Services is drawing praise from healthcare Ieaders across the country who view him as a strong choice for leading the $800 billion agency with more than 90 million enrollees.

"What you have here is someone who is deeply committed to quality and deeply committed to applying whatever lever one can apply to help hospitals deliver safer care and higher quality care and that kind of orientation and aspiration and desire, I think, will be very important and perhaps even transformative for CMS," said John Glaser, vice president and CIO of Partners HealthCare in Boston.

Glaser called Berwick an "intellectual and also bully pulpit leader" who could help change the reimbursement formulas and help focus the healthcare system on "the performance of care rather than the occurrence of care."

Children's Hospital is preparing to launch a $228 million expansion that will add 124 new beds to its Aurora hospital. Upon projected completion by the end of 2012, the addition is expected to bring at least 500 new jobs to the hospital's workforce of 4,000.

Construction is expected to begin this week.

The American College of Physicians has promoted Steven Weinberger to executive vice president and CEO, effective July 19. Weinberger has served as the internal medicine group's deputy executive vice president since 2009. In his new roles, Weinberger will succeed John Tooker, who announced his intention to retire last October.

Weinberger has worked as the Philadelphia-based, 129,000-member organization's senior vice president for medical education and publishing since 2004.

Twin Cities nurses and hospitals turned their bitter labor standoff into a surprise settlement Thursday, concluding a suspense-filled day of secret talks and averting the strike.

The 3 p.m. announcement stunned many members of the Minnesota Nurses Association, who had been bracing for a strike Tuesday. Instead of striking, they'll be voting on the agreement that day. At 1 a.m. Wednesday, the two sides had grimly broken off negotiations and announced that there was "no reason to talk." But by 11 p.m., they had quietly returned to the bargaining table and hammered out a tentative agreement, which was formally endorsed by the union leadership Thursday.