Friday, July 26, 2013

Exeter John Lewis trains NHS on customer care

John Lewis and NHSJohn Lewis said it could learn from the NHS about running a large organisation
NHS doctors in Devon are getting training from John Lewis store managers to help them improve customer service and staff morale.
The retailer will share its secrets of the trade with the Northern, Eastern and Western Devon Clinical Commissioning Group (CCG).
The CCG, which includes GPs and other health workers, is responsible for buying health services in the area.
John Lewis said the two organisations' concerns were "very similar".
The CCG took over responsibility for commissioning £1.1bn of healthcare services from primary care trusts in April.
The government hopes the change will make the NHS more efficient.
'Fantastic opportunity'

Start Quote

They clearly have some tricks up their sleeves that would be good to share with our health services”
Dawn EckhartHealthwatch Devon
Jenny Winslade, the CCG's chief nurse, said it was a "fantastic opportunity" to partner John Lewis.
"When we buy services we focus on the needs of patients," she said.
"Customers have a great experience at John Lewis so the opportunity to partner with them is absolutely brilliant.
"It should have a great effect on how we commission health care."
There is no fee involved in the training, which is meant to be a "partnership", she said.
Kate Connock, store manager at John Lewis Exeter, said it had been a "great insight" for the firm into how a "huge organisation handles its challenges".
Ms Connock said: "It may look as if we have little in common.
"But whether private or public, our concerns and opportunities are very similar.
"These are two great organisations with a long heritage and history, but made successful by its people for its customers, so there is lots of synergy in the way we work with our teams."
Dawn Eckhart, of health watchdog Healthwatch Devon, said: "John Lewis is well respected for a good customer experience so they clearly have some tricks up their sleeves that would be good to share with our health services."

Medicare and Medicaid Programs; Quarterly Listing of Program Issuances—April Through June 2013


Centers for Medicare & Medicaid Services [CMS–9080–N]

Medicare and Medicaid Programs; Quarterly Listing of Program Issuances—April Through June 2013
AGENCY: Centers for Medicare & Medicaid Services (CMS), HHS.

ACTION: Notice.

SUMMARY: This quarterly notice lists CMS manual instructions, substantive and interpretive regulations, and other Federal Register notices that were published from April through June 2013, relating to the Medicare and Medicaid programs and other programs administered by CMS.

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Hospitals Testify on Medicare RACs to Senate Finance Committee

Hospital representatives from Billings (Mont.) Clinic and Intermountain Healthcare in Salt Lake City testified before the Senate Committee on Finance yesterday, urging Congress to take action on Medicare Recovery Auditors, or RACs.
Sens. Max Baucus (D-Mont.) and Orrin Hatch (R-Utah) established the hearing to "simplify the way [RACs] interact with providers," which should "increase efficiency and may also reduce some unnecessary burden on doctors and hospitals," according to a statement.
J.J. Carmody, director of reimbursement at Billings Clinic, and Suzie Draper, vice president of business ethics and compliance at Intermountain, said Medicare RACs have become burdensome at their respective organizations. Ms. Carmody said since her hospital's regional RAC began auditing in May 2010, Billings Clinic has had to submit 6,000 records involving more than $45 million, or 14 percent of its overall Medicare payments.
Ms. Draper added that Medicare RACs have also not been completely accurate in their audits. Intermountain's RAC audited roughly $120 million in Medicare payments, but only $16,000 has been returned to the program due to Intermountain's successful appeal efforts.
Robert Rolf, vice president of CGI, the Region B Medicare RAC, also testified. He argued that CGI and other RACs have "worked diligently to implement the program in an open and transparent fashion" and that the current system has worked to recover overpayments while not incenting RACs to "over-audit."
The hearing came as Congress weighs the Medicare Audit Improvement Act, a bipartisan measure that would reform how RACs could request medical records from providers and penalize RACs for making auditing errors.

HCA Faces False Claims Suit Over 'Fraudulent' Billing

By Dan Prochilo

 A whistleblower suit unsealed Friday alleges a Florida hospital owned by Hospital Corp. of America Holdings Inc. falsified records to dupe Medicare and Medicaid into covering unsafe, sometimes fatal, procedures that were ineligible for reimbursement because they violated federal rules.
Northside Hospital in St. Petersburg fraudulently claimed that procedures performed by
unsupervised medical interns and resident physicians had in fact been overseen by its
medical staff and submitted other bogus claims to illegitimately extract payment from federal
health care programs, the qui tam suit alleges.
"The lack of teaching physician supervision over medical students and residents has caused
a severe detrimental effect upon the quality of care received by patients at Northside
Hospital and certain avoidable injuries," according to the complaint, which was filed May 30
but wasn't unsealed until Friday.
Rife with horrific anecdotes about patients who lost limbs and died allegedly as a result of
improper medical care, the suit was brought by Brenda Farnsworth, the vice president of
Quality and Risk Management for the hospital since August 2011.
Farnsworth, who has been on forced administrative leave since February 2012, accused
Northside Hospital, HCA subsidiary Parallon Business Solutions LLC and Nashville-based HCA
— which runs 162 hospitals and 113 surgery centers in the U.S. and U.K. — of violating the
federal False Claims Act.
The suit said the bogus claims the hospital sent to the federal government for some its
medical procedures masked that they had been performed belatedly and unsafely. Had the
incidents been accurately reported, they would never have been covered by Medicare and
Medicaid, which provide benefits to about 50 percent of the hospital's patients, the
complaint said.
Among the noncompensable claims that the hospital made was a bill for the treatment of a
44-year-old patient admitted in late May 2011 from the Pinellas County Jail with
gastrointestinal bleeding, the suit said. Despite vomiting a liter and a half of blood, the
patient was not seen by a doctor for nearly four hours, when an unsupervised resident
responded to an emergency call from nurses, the suit said.
The patient died with no teaching physician present, yet the hospital fraudulently billed
Medicaid as if two doctors had been supervising the resident’s vain resuscitation efforts, the
suit said.
In one November 2011 case, an unsupervised resident allegedly ignored a doctor's order to remove a catheter line that been inserted directly into the bone marrow of a 27-year-old woman, leaving it there for five hours longer than it should have been.
The patient "lost a large portion of her leg and was hospitalized for over two months," the
suit said. Once again, the hospital falsely claimed in its bills to Medicare that a supervising
doctor had been present for procedures handled by the resident.
Florida law requires that adverse incidents in a hospital be reported to the state Agency for
Health Care Administration within 15 days, but Farnsworth said she was reprimanded by her
employer for reporting the mishap, the suit said.
Farnsworth additionally alleged that Northside personnel forced or advised patients to go to
other facilities once their federal benefits were depleted, then falsely indicated in their
medical records that they had left against medical advice so the hospital still could bill the
government for the services it had provided.
The hospital allegedly permitted suspended doctors to perform procedures on patients and
put down the names of physicians who still had medical privileges on the claims submitted to
Medicare and Medicaid, "even though these services were ineligible for ... reimbursement
without a valid physician's order," according to the suit.
Farnsworth also said the hospital's farming out of its medical record department to a
subsidiary of HCA in early 2010 and later, to Parallon, violated rules of the Centers for
Medicare and Medicaid Services requiring medical record personnel to be hospital employees.
Farnsworth said she was abruptly placed on administrative leave and escorted from the
hospital days after submitting a complaint to HCA that Northside Hospital was violating
"several laws, rules and regulations" and for reporting medical-record deficiencies to
government officials.
According to the suit, the pretext for the penalty was "insubordination," but "the real reason
... was because she had direct knowledge of various types of fraudulent conduct occurring
at Northside Hospital and the defendants did not want her to cooperate in [an] upcoming
CMS survey," the suit said.
Representatives for HCA and Northside Hospital could not be immediately reached for
comment Friday.
Farnsworth is represented by J. Meredith Wester, Richard Candelora, and Krista Pendino of
Mechanik Nuccio Hearne & Wester, P.A.
Counsel information for HCA and the other defendants was unavailable.

The case is United States of America et al v. Hospital Corporation of America et al, case
number 8:12-cv-00734 before the U.S. District Court for the Middle District of Florida.

Feds call on Florida to take $50M and expand Medicaid | MedCity News

July 25, 2013 1:49 pm by  | 

Federal officials on Wednesday renewed calls for Florida lawmakers to accept an estimated $50 billion over the next 10 years to expand Medicaid, the joint state and federal health insurance program for the poor, to cover an additional one million Floridians who would otherwise remain uninsured even after Jan. 1 when healthcare reform begins in earnest.
Saying it's not too late for Florida to accept federal funds available for Medicaid expansion, officials with the U.S. Department of Health and Human Services held a conference call with reporters to reiterate the economic and social benefits of expanding the healthcare safety net for the state's poorest residents.
Under the proposal, the federal government would agree to pay 100 percent of the cost of expanding Medicaid in Florida, or an estimated $5 billion a year, from 2014 through 2016, and at least 90 percent thereafter.
Paul Dioguardi, director of intergovernmental and external affairs for HHS, said that Florida could expect to add about 120,000 private sector jobs to the economy and save the state an estimated $430 million in healthcare costs by accepting the funds.

Though Florida Gov. Rick Scott and other Republican lawmakers have been consistent in their statements that no special session will be called to reconsider Medicaid expansion, Dioguardi said he was encouraged by "the level of bipartisan support that we have seen from this'' in Florida, as well breakthroughs in states where lawmakers relented on their earlier opposition to it, including Arizona, Arkansas and Iowa."States can improve health, protect families from financial ruin, ensure doctors and hospitals get paid for the care they deliver, and boost the economy,'' he said. "We're still hopeful that Florida will take advantage of this generous offer.''
Medicaid expansion took center stage during this year's legislative session.
The Senate supported a bi-partisan plan to take the federal money and let Floridians obtain insurance through a state-subsidized system. House Republicans insisted on an alternate plan to use $300 million in state money to buy basic coverage for 130,000 low-income residents.
In the end, the two chambers were unable to make a deal -- and passed on billions of dollars in federal funds.
When the session ended in May, Democrats called on Scott to convene a special session on the issue. But with House Republicans unwilling to budge, the governor expressed little interest.
On Wednesday, a spokeswoman for Scott said the governor's opinion hadn't changed.
"We will not be calling a special session in Medicaid," Jackie Schutz said. The governor's office declined to comment on the HHS press conference.
Sen. Joe Negron, a Stuart Republican and chair of the Senate committee on the Patient Protection and Affordable Care Act, said there was a "zero percent chance'' of straight Medicaid expansion in Florida.
Negron also doubted a special session would be productive.
"It wasn't possible back in April or May, and nothing has changed,'' he said.
There is no deadline for Florida to accept the federal dollars, and state lawmakers could choose to opt out at any time. But the longer Florida lawmakers wait to accept the funds, the more they will lose when the clock starts ticking on Jan. 1.
If Florida lawmakers choose not to accept the federal funds for Medicaid expansion, Dioguardi said, that money would be used for other government programs, including expansion of Medicaid in other states. The money will not be used to pay down the federal deficit.
Dioguardi also pointed to an estimated 1.2 million people in Florida who would be left with no coverage at all because of assumptions in the healthcare law that states would expand Medicaid.
For instance, a family of four with an annual household income between $4,721 and $23,300 -- or 20 to 90 percent of the Federal Poverty Level for 2013 -- would be "left in the dark with no support,'' Dioguardi said.
"So would all childless adults,'' he added, "young people starting out, and older couples not eligible for Medicare.''
For a family of four, the federal poverty level is $23,550 a year.
In Florida, an adult has to earn 19 percent or less of the federal poverty level and have a dependent child in order to qualify for Medicaid.
Approximately 3.4 million people -- or 18.4 percent of the state's population -- were enrolled in Florida's Medicaid program in 2009, the most recent year for which information is available.
Of the approximately $14.9 billion spent on Florida's Medicaid beneficiaries in 2009, about $10.1 billion or 67.5 percent was paid for in federal dollars, and the remaining $4.8 billion or 32.5 percent was paid for by the state. ___

Feds call on Florida to take $50M and expand Medicaid 

Dr. Atiq Durrani: Federal agents arrest local spine surgeon

Posted: 07/25/2013
EVENDALE, Ohio - A well-known Cincinnati spine surgeon could face up to 25 years in prison after being charged with billing millions of dollars to Medicare and private healthcare programs for unnecessary surgeries.
Federal agents arrested Dr. Atiq Durrani at his home at 5 a.m. Thursday and removed boxes of records from his private practice at the Center for Advanced Spine Technologies, Inc. on Reading Road. Durrani has another office in Florence.
Besides the federal charges, Durrani faces more than 160 lawsuits from surgery patients. Some claim Durrani botched their procedures and left them worse off than before.
Attorney Eric Deters, who said he represents 160 patients, referred to Durrani as “the butcher of Pakistan.”
“He destroyed a lot of lives,” Deters said. “... He deserves to be prosecuted. He deserves to be stopped.
“Just to show you how egregious he is, I have somebody who has - we lost count, two, three, four – pedicle screws in her aorta … We’ve had people who had six, seven surgeries unnecessarily.”
Durrani was released on his own recognizance after appearing before U.S. Magistrate Judge Stephanie Bowman in Cincinnati Thursday afternoon.
Bowman ordered Durrani to send a letter to his patients informing them of the charges against him. His defense attorney, Bruce Whitman, told the judge that would be "a death sentence to his practice" and called it  "an unconstitutional impingement on his rights."
Durrani, a native of Pakistan, was ordered to surrender his passport and was forbidden to travel beyond the southwestern district of Ohio and the eastern district of Kentucky.
Whitman requested that Durrani be allowed to travel to Pakistan to visit his terminally ill father. Bowman said he should request that at another time.
According to the U.S. Attorney's complaint, Durrani billed Medicare for three times as many interior lumbar fusion surgeries than the next most active medical practitioner.
In the three years from February 1, 2010, through January 31, 2013, the government said Dr. Durrani was the attending physician in cases where Medicare was billed $11 million for that procedure.
The complaint alleges $7.5 million of that was Part A reimbursements for hospitals with 95 percent of that amount going to West Chester Hospital of UC Health.  
Another $3.5 million was reimbursed in Medicare Part B payments going to physicians, and government lawyers claim Dr. Durrani received $1.5 million of that amount.
The complaint charges Durrani with one count of health care fraud and one count of making false statements in health care matters. Health care fraud is punishable by up to 20 years in prison. The crime of making false statements in health care matters is punishable by up to five years in prison.
Whitman spoke briefly as he and Durrani walked from courtroom, saying he would defend Durrani vigorously against the charges.
"Dr. Durrani has gotten bond. He's free to leave. We're going to defend the case in court. That's all there is to it," Whitman said. 
Michael Lyon, Durrani's attorney in the lawsuits, said Durrani feels he has done nothing wrong.
"He's been practicing in this town since 1999, he's never paid a penny on a medical malpractice case ever, nor has he ever had a serious complaint by any hospital, risk manager or employee," Lyon said.
Deters said other local spine surgeons are now treating his clients and have told him they’re willing to testify that Durrani’s surgeries were unnecessary.
He said he hired experts to review Durrani’s work.
"They're looking at that radiology film and saying to our clients and these patients, ‘You did not need that surgery based upon these radiology films,’ " Deters said.
One of Deters’ clients, Dana Setters of Trenton, said Durrani operated on her twice and she can’t straighten her head, do household chores or even lift her 2-year-old daughter.
“I've had a C-1/C-2 fusion in my neck and I've had a lumbar surgery.  My neck surgery was a failure and it was done incorrectly, which is why my head leans to the right,” Setters said.  “My lower back was also done incorrectly and I've got pain down both of my legs from it and probably will have from here on out.
“I can't drive. I can't play with my little girl or lift her up … I can't sleep correctly.  I can't do any of the household things that a woman should be able to do. I have to rely on my husband and my mother and my mother in law to help me.  So, it's affected everything that I normally have to do in my life.”
Setters said the two surgeries cost a total of $135,000. She said she cried when she heard about the charges against Durrani.

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