Showing posts with label HOSPITALS. Show all posts
Showing posts with label HOSPITALS. Show all posts

Tuesday, April 1, 2014

Burnt Out Primary Care Docs Are Voting With Their Feet

This KHN story was produced in collaboration with wapo
Janis Finer, 57, a popular primary care physician in Tulsa, Okla., gave up her busy practice two years ago to care full time for hospitalized patients. The lure? Regular shifts, every other week off and a 10 percent increase in pay.
Illustration by Doug Chayka
Lawrence Gassner, a Phoenix internist, was seeing four patients an hour. Then he pared back his practice to those who agreed to pay a premium for unhurried visits and round the clock access to him.  "I always felt rushed," said the 56-year-old. "I always felt I was cutting my patients off."
Tim Devitt, a family physician in rural Wisconsin, took calls on nights and weekends, delivered babies and visited his patients in the hospital. The stress took a toll, though: He retired six years ago, at 62.
Physician stress has always been a fact of life.  But anecdotal reports and studies suggest a significant increase in the level of discontent-especially among primary care doctors who serve at the frontlines of medicine and play a critical role in coordinating patient care.
Just as millions of Americans are obtaining insurance coverage through the federal health law, doctors like Finer, Gassner and Devitt are voting with their feet. Tired of working longer and harder because of discounted insurance payments and frustrated by stagnating pay and increasing oversight, many are going to work for large groups or hospitals, curtailing their practices and in some cases, abandoning primary care or retiring early.
"I was thinking of leaving medicine; I didn't think I could maintain the pace," Gassner said about why he switched to a concierge-style practice with the help of consultant MDVIP.  "I went to bed many nights lying awake, worrying that I missed something."
The timing couldn't be worse. "The lack of an adequate primary care infrastructure in the U.S. is a huge obstacle to creating a high-performing health care system," said David Blumenthal, president of The Commonwealth Fund, a health care research foundation.
A 2012 Urban Institute study of 500 primary-care doctors found that 30 percent of those aged 35 to 49 planned to leave their practices within five years. The rate jumped to 52 percent for those over 50.
Stressed doctors, meanwhile, often mean anxious, dissatisfied patients. Many consumers report feeling shortchanged after waiting weeks or even months for an appointment, only to get a quick once-over and be told there isn't time to address all their complaints in one visit.
"Your actual one-on-one with the doctor is getting to be less and less," said Christine Miserandino, 36, of Valley Stream, N.Y., who sees many doctors to manage her lupus.
Unhappy Doctors, Unhappy Patients

There are no hard national data on physician burnout. But nearly half of more than 7,200 doctors responding to a survey published in 2012 by the Mayo Clinic reported at least one symptom of burnout that indicated a loss of enthusiasm about medicine or cynicism about it. That's up from 10 years ago, when one quarter of doctors reported burnout symptoms in another survey.
A RAND study for the American Medical Association last year found that nearly half of surveyed physicians called their jobs "extremely stressful" and more than one-quarter said they were either "burning out," experiencing burnout symptoms "that won't go away," or "completely burned out" and wondering if they "can go on."  Nonetheless, many described themselves as satisfied with their profession.
But should the happiness of physicians - a fairly privileged lot - be of concern to their patients? Experts answer with a resounding 'yes,' saying that unhappy doctors can make for unhappy patients.
Indeed, one of the drivers of physician dissatisfaction is their sense they are shortchanging patients: that they are too rushed, don't have enough time to listen and aren't always providing good care.
"Being a doctor is a bit like being a parent, where they say you're only as happy as your least happy child," said Martin Kanovsky, 61, an internist in Chevy Chase, Md., who reduced the number of patients he is seeing from 1,200 to 400 last December when he switched to an MDVIP concierge practice. "At the end of the day, if you have one patient who's unhappy, you're unhappy."
Research shows that patients of satisfied doctors are more likely to show up for their appointments and adhere to treatment for diabetes and high blood pressure. Another survey found dissatisfied physicians reporting more difficulty than other doctors in caring for patients.
And in another study, burned-out surgeons were more likely to report having made a major medical error, in the past three months. 
"What drives physician satisfaction is also what patients and payers want - delivering good care. And we're less and less able to do that," said Christine Sinsky, an internist in Dubuque, Iowa, who is working with the AMA to try to improve physician satisfaction. "You spend less time listening to patients, getting to know them, and thinking more deeply about their care." 
'I Knew I Had To Be Able To Sleep At Night'
That was the situation that confronted Janis Finer, who loved - but ultimately left -primary care to work with hospital patients.
Like many physicians, she did not want to be bothered with the business of medicine -dealing with insurers, hiring staff and making bank deposits -and sold her practice to a hospital.
But hospital administrators dictated the pace, telling her she needed to see 22 to 28 patients a day.  "At one point, we were scheduled to see patients every 11 minutes," Finer said.
She was supposed to suggest they schedule another visit if they had more than one or two medical complaints. But Finer worried they wouldn't come back.
"I knew I had to be able to sleep at night," she said. "I was trained to dot every 'i,' and cross every 't' and leave no stone unturned."
If a patient had anemia, for example, she could simply prescribe iron, but she wanted to find out what was causing it. 
But she found she was unable to do such things while seeing so many patients.
At the same time, her income lagged far behind that of her peers in specialties, a pay disparity that irked her more over time. Salaries of primary care physicians were around $220,000 in 2012, according to the 2013 Medical Group Management Association's compensation survey, while specialists were averaging close to $400,000, with cardiologists and orthopedic surgeons earning over half a million dollars.
Efforts to boost compensation for primary care doctors have been largely unsuccessful. Specialists' pay is based largely on procedures, but primary care doctors are usually paid per visit, and not reimbursed for managing their patients' care outside of visits, which can consume a lot of their time.
Richard J. Baron, president of the American Board of Internal Medicine, set out to document how much time a doctor spends managing care and discovered that on a typical day, he or she handles 18.5 phone calls; reads 16.8 e-mails; processes a dozen prescription refills (not counting those written during a visit); interprets 19.5 lab reports; reviews 11 imaging reports; and reads and follows up on 13.9 reports from specialists.
"This is not just busy work -- this is about meeting the patients' needs," Baron said.  "But … it doesn't generate revenue."
'I Used To Be A Doctor; Now I'm A Clerk'

Perhaps the single greatest source of frustration for many physicians is a tool that was supposed to make their lives easier: electronic medical records.
Many do not merely dislike electronic health records - they despise them. "We were surprised by the intensity of their reports," said Mark Friedberg, a physician and co-author of last year's RAND study.
In 2009, President Obama committed billions of dollars to help defray providers' costs of going digital. The goal was to boost coordination of care and to reduce errors and rampant duplication. Most primary care doctors got financial help from the federal government and also face potential penalties beginning next year if they don't use the new systems.
But many physicians say that instead of speeding things up, digital records have slowed them down. They say the designs often frustrate patients and providers -with the doctor's face often turned to the computer screen while the patient is talking.
Digital records often contain numerous, repetitive information fields but leave little room for the kind of personal, nuanced observation that was captured in an old-fashioned doctor's note. And restrictions on who is allowed to input the data have shifted many administrative tasks from medical assistants and nurses to physicians.
Using electronic medical records is often more time-consuming for primary-care physicians than for specialists, because they are often taking more comprehensive medical histories, tracking more tests and lab results and filling in more fields.
"Many physicians said to us, 'I used to be a doctor, now I'm a clerk,'" said Dr. Jay Crosson, a pediatrician and vice president of professional satisfaction for the AMA.
Worsening Shortage Forecast
Meanwhile, the promise of electronic health care records to reduce errors and duplication and facilitate communication has so far gone largely unfulfilled, as far as many doctors are concerned.
John Schumann, a primary care doctor who teaches at the University of Oklahoma's School of Community Medicine in Tulsa, sees patients at three different hospitals, with three different record systems. "They're all different and none of them talk to each other," he said. "That's the kind of thing that drives doctors' nuts."
To ease the burden, some physicians have started using scribes - laptop-carrying assistants who follow them in and out of the exam room.
Scribing is one of several proposals to provide greater support to physicians by giving more responsibility to nurses, health coaches and health educators. But adding personnel involves additional costs, which worries physicians trying to limit their overhead.
The trend line, meanwhile, is troubling. The Association of American Medical Colleges estimates the United States will be short 45,000 primary-care doctors in 2020, when 268,000 are projected to be practicing. That compares to a shortfall of 9,000 in 2010, with 254,800 practicing.
Even a recent uptick in medical students who are electing primary care is not enough to avert the projected shortage. Meanwhile, experienced doctors are joining large groups or becoming hospital employees, which some argue reduces clinical autonomy and discretion -such as deciding how much time to spend with patients -and which may potentially drive up health-care costs because hospitals may tack on additional fees to their bills.
"They want a place to shelter from the storm," Blumenthal said.


Monday, March 10, 2014

Measuring patient engagement is a 'science,' not a 'dark art'

A new collaboration announced at HIMSS14 aims to rank all of the nation's hospitals on their patient engagement abilities, much like hospitals are now ranked for their health IT acumen or their beauty.

"The best hospitals realize the patient gets well outside the hospital," said Joanne Rohde, CEO of Axial Exchange. "They've been doing this long before Meaningful Use 1, 2 or 3 … and now it's time for the rest to catch up."
Axial Exchange, a Raleigh, N.C.-based developer of mobile engagement tools for hospitals and their patients, has been creating so-called Patient Engagement Indexes (PEIs) for specific states. At HIMSS14 last month in Orlando, the company announced a partnership with Becker's Hospital Review to expand that system to a national stage, with the rankings set to be released in May.

"Patient engagement is increasingly at the center of healthcare reform, and achieving excellence in clinical outcomes has been proven dependent upon enhanced patient involvement," said Lindsey Dunn, editor-in-chief of Becker's Hospital Review, in a press release. 

Speaking to mHealth News at HIMSS 14, Rohde said many hospitals rely on a patient portal that's nothing more than a "view into a back-office system designed by a vendor for regulatory obligations." Likewise, she said, hospitals often create websites that offer information they want to share with the public, rather than offering a link to information that patients want to see. If that's a mobile version – a huge advantage in this day of mobile consumers and health pricing transparency – the site is often clunky and underwhelming.

Rohde said hospitals need to realize that two-way communications with the patient outside the hospital – no matter where they are or what device they're using – is crucial to ensuring that patients are satisfied with the care they're getting. That translates into better Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores, which are used by the Centers for Medicare and Medicaid Services to determine reimbursement for Medicaid patients.

Established in 2013, the Axial Exchange PEI evaluates hospitals using publicly available data in three categories and gives each a score of 1 to 100. For example, while a hospital is expected to offer electronic access to patient health records, it would score extra points for offering resources for disease management support, including mobile tools.

The categories are defined as:

• Personal health resources (representing 50 percent of the score), based on an aggregate score for hospitals that provide any of the following: read-only Internet access to health information, mobile applications or interactive tools for managing ongoing health.

• Social engagement (25 percent of the score), based on a weighted score of hospital ratings on leading social media and consumer ratings sites.

• Patient satisfaction (25 percent of the score), measured by the HCAHPS survey, a standardized instrument for measuring patients' perspectives on hospital care that has been endorsed by the National Quality Forum.

Matt Mattox, Axial's vice president of products and marketing, said in a July 2013 interview with mHealth News that healthcare executives were mindful of the value of patient engagement, but were too busy implementing EMRs to devote the time, money and staff. Now they're feeling pressure and seeing the value.

"Patient engagement is strategic ground that the best health systems will claim in order to thrive in a profit-from-quality world. Mobile devices are quickly making an impact on how patients manage their health," he noted in a May 6, 2013 blog titled "How to Generate a 15X Return on Patient Engagement." "For a health system, not having a mobile engagement offering in 2013 may be similar to not having a corporate website in 2003. Whether healthcare systems and practices are motivated by higher margin patients, professional reputation, payment incentives – or all three – they have everything to gain from enabling superior patient engagement and everything to lose if they do not."
Rohde said healthcare executives have to understand that patient engagement can be measured.
"It's a science, not a dark art," she said. 'There's a real correlation between patient satisfaction and social media, and mHealth plays a big role in this."

Rohde is critical of hospitals and health systems who "make patient engagement the responsibility of the IT department," because that creates a separation between the patient and the clinician. She's also critical of Meaningful Use standards that compel hospitals to "just check things off a list."

She sees a national PEI as a means of shining the spotlight on innovative and successful patient engagement programs, while establishing benchmarks for hospitals and health systems looking to improve.
"At the end of the day, it's all about the patient," she said. And that may be the missing factor in many a health system's path to success.


Thursday, February 6, 2014

USDA awards millions for telemedicine

Monday, July 22, 2013

Hospitals May Soon Be Reaching For The Stars - Kaiser Health News

JUL 18, 2013
Star wars may be coming to a hospital near you.
Medicare is considering assigning stars or some other easily understood symbol to hospitals so patients can more easily compare the quality of care at various institutions. The ratings would appear on Medicare’s Hospital Compare website and be based on many of the 100 quality measures the agency already publishes.
The proposal comes as Medicare confronts a paradox: Although the number of ways to measure hospital performance is increasing, those factors are becoming harder for patients to digest. Hospital Compare publishes a wide variety of details about medical centers, including death rates, patient views about how well doctors communicated, infection rates for colon surgery and hysterectomies, emergency room efficiency and overuse of CT scans.
In its proposed rules for hospitals in the fiscal year starting Oct. 1, the Centers for Medicare & Medicaid Services asked for ideas about "how we may better display this information on the Hospital Compare Web site. One option we have considered is aggregating measures in a graphical display, such as star ratings."
Private groups such as Consumer Reports, the Leapfrog Group and US News and World Report already issue hospital guides that boil down the disparate Medicare scores -- along with their own proprietary formulas -- to come up with numeric scores, letter grades or rankings.
But even before it's formally proposed, the possibility of the government rating hospitals based on a star system is receiving less than heavenly reviews. In a letter to Medicare, the Association of American Medical Colleges said it "strongly opposes the use of a star rating system, which may make inappropriate distinctions for hospitals whose performance is not statistically different. A star rating system can also exaggerate minor performance differences on measures."
In a statement, Medicare defended the idea. "Visual cues can be an important way to help patients understand how their hospital measures up to others," it said, adding that the government is interested in hearing from people about "user-friendly, creative designs for a rating system to help patients get information so they can take an active role in their care."
Peter Slavin, president of Massachusetts General Hospital, said making medical care standards more comprehensible is a worthwhile pursuit, but a good hospital ranking system would need to be based on more sophisticated underlying data than what’s now available.
"The quality information we're now using in health care is pretty crude and needs to get a lot better," Slavin said.
Much of that data is derived from the bills hospitals submit to Medicare, which he said is "a lot like judging the quality of a restaurant from the checks they give to their customers."
Slavin questioned whether star ratings would be useful for patients seeking specific services, such as a lung transplant, which Medicare does not evaluate.
"At some point if you oversimplify things, you're not providing people with information that is all that meaningful or helpful," he said.
Robert Berenson, a health policy researcher at the Urban Institute in Washington, D.C., also wondered whether there is enough solid information about medical care quality available to make star-rating system effective.
"I recognize the appeal of making things easy for consumers by giving stars, but I don't think the data is robust enough and valid enough," Berenson said. "There are important gaps in what's measurable. What gets considered important is what we can measure, not the other way around."
But Tanya Alteras, deputy director of the advocacy group Consumer-Purchaser Disclosure Project, was more enthusiastic about a star system. "If it's tested with consumers and shown to be useful we are definitely in favor it," she said.
Medicare already uses a five-star system to rate the private Medicare Advantage health insurance plans. A quarter of U.S. seniors get their insurance from these private insurers, which Medicare helps pay for, instead of through traditional Medicare, which pays hospitals, doctors and other providers directly for medical services. Those stars carry extra gravity because Medicare gives financial bonuses to high-performing plans.
But applying such a system to hospital quality could be challenging. Private groups have come up with differing judgments on the same hospitals. For instance, hospitals given an "A" in patient safety by Leapfrog for patient safety can end up at the bottom of Consumer Reports’ rankings because of differences in their analyses.
And even Medicare's current evaluations of hospital care and services don't always lead to consistent overall conclusions. For instance, Medicare rates Beth Israel Deaconess Medical Center in Boston as above average nationally in keeping heart attack, heart failure and pneumonia patients from dying, but below average in readmissions and the frequency of collapsed lungs and accidental cuts and tears during treatments.
Beth Israel declined comment for this story.
Also, Medicare's current quality evaluations using statistical tests end up concluding most hospitals are indistinguishable from one another on major performance measures such as death rates. On Hospital Compare, 9 out of 10 hospitals' mortality rates are described as "average." That kind of narrow range doesn't lend itself to a star system, said Leapfrog executive director Leah Binder.
"If their plan is to give the same number of stars to all the hospitals, at best it will be boring," Binder said. "At worst it will be misleading."

Hospitals May Soon Be Reaching For The Stars - Kaiser Health News

Tuesday, June 18, 2013

From HFMA: ICD-10 Vets Offer Guidance

The clock is ticking louder for the ICD-10 go-live date in October 2014. As it does, health systems are beginning to fret about the likely financial impact on operations. Speakers at the Healthcare Financial Management Association conference in Orlando described the journey to ICD-10 as both arduous and full of uncertainties.


Sutter Health, a $9.1 billion health system with 24 acute care hospitals across northern California, began its transition program in 2013, noted HFMA panelist Danielle Reno, ICD-10 program director. Sutter’s 14 transition teams--which report up to a senior level executive sponsor--represent the breadth of the challenge, which impacts information systems, revenue cycle, contract management and multiple other areas. Sutter is about three-quarters of the way through its financial analysis of ICD-10’s likely impact--a key consideration in determining where to focus clinical documentation improvement and coding training resources, Reno said.
Using claims grouping and cross-walking tools from CMS, Sutter determined that about 8 percent of its claims mapped to Medicare DRGs would shift to another DRG under ICD-10. Medicare offers a cross-walk tool known as GEMs, or general equivalency mappings. Using the cross-walk, health systems can identify which cluster of codes in ICD-10 would correspond to a counterpart in ICD-9. Reno noted that the GEMs tool, while a good starting point, still requires a great deal of manual review due to the one-to-many relationship between versions 9 and 10--which includes tens of thousands of new codes.
Sutter is also conducting “table top testing” of ICD-10 with two commercial payers. Rather than submitting test data through its billing system, the process involves sending raw ICD-10 data on a spread sheet, which the payer can parse and analyze for errors and omissions. The effort requires pulling coders from their normal duties however and Reno cautioned that as health systems go through the exercise, they may discover a correspondent drop in cash flow as it could take longer to get real claims out the door. Sutter budgeted for additional coding support during the initiative, she noted.
Panelist Brett Kelsey, chief revenue officer at Lucille Packard Children’s Hospital, serves as executive sponsor of the pediatric facility’s ICD-10 transition team. Part of Stanford Health System in California, Lucille Packard has mostly completed its information systems and financial impact analysis. It’s now renegotiating payer contracts in areas most likely to be heavily affected by ICD-10.
But Kelsey and other panelists sounded one common theme: there is a great deal of uncertainty inherent to the transition to ICD-10. Packard, for example, is looking for a vendor partner to assist with cross-walking data from ICD-9 to ICD-10, noted Kelsey. And as Reno pointed out, even after training, coders may not agree on which particular ICD-10 code to apply to a given case--even if physician documentation is thorough.

http://www.healthdatamanagement.com/news/icd-10-codes-coding-hospital-physician-payer-revenue-46279-1.html

Monday, June 17, 2013

Medicare fraud and for-profit hospitals:

Medicare fraud and for-profit hospitals:

Medicare fraud and for-profit hospitals:

A story that never ends


Sunday, CBS’ Sixty Minutes took a close look at Health Management Associates (HMA), a for-profit hospital chain that, according to its employees, has “relentlessly pressured its doctors to admit more and more patients – regardless of medical need-in order to raise revenues.”healthinsurance.org contributor
“We talked to more than 100 current and former employees and we heard a similar story over and over,” CBS correspondent Steve Kroft reported. Emergency room physicians were told “that if they didn’t start admitting more patients to the hospital, they would lose their jobs.” The orders came from the top:
With 71 hospitals in 15 states, HMA is the fourth-largest for-profit chain in the country. Last year, it raked in revenues of nearly $5.8 billion; half of that came from Medicare and Medicaid. In other words, taxpayers were footing the bill for a large share of those unnecessary hospitalizations.
Patients also paid. As one doctor observed: “If you are put into the hospital for reasons other than a good, justifiable medical reason, it puts you at significant risk for hospital-acquired infections and what we would refer to as ‘medical misadventure’” (i.e. preventable medical errors).

“Putting heads on beds” – an old story

The piece was shocking. But it is not a new story. It is an old story. To be more precise, it is a never-ending story. In Money-Driven Medicine: The Real Reason HealthCare Costs So Much, I profiled several for-profit hospital companies that did just what Health Management Associates has done: “put heads on beds” even though the patient didn’t need to be hospitalized.
At Tenet, in Redding, California, patients weren’t just hospitalized, they underwent heart surgery. An investigation would reveal that in many cases, they “had no serious cardiac problems whatsoever.”
An FBI affidavit estimated that in one-quarter of all cases, Tenet’s two “rainmaker” heart surgeons were slicing open patients who should never have been on an operating table. Other doctors tried to alert the hospital’s administration. They were ignored.
Some of those patients did not survive. Others were crippled. All suffered psychological trauma.

HCA: Florida Governor Rick Scott’s back story

In 1997, Health Corporation of America (HCA) made headlines when FBI agents swarmed HCA offices in five states, and found evidence that at HCA, executive salaries hinged on meeting financial targets such as “growth in admissions and surgery cases.”
The FBI also discovered that HCA had been keeping two sets of books – one to show to Medicare, a second that contained the real numbers. Ultimately, the investigation would reveal that the hospital chain had been bilking Medicare while simultaneously paying kickbacks to physicians who steered patients to its hospitals.
Just as at HMA, whistleblowers said that the directives came from the top. Rick Scott, who would later become governor of Florida, was the CEO of HCA.
In 2000, HCA finally settled with the government, pleading guilty to no fewer than 14 felonies – the biggest case of Medicare fraud ever. The company paid $1.7 billion in fines.
No one went to jail – probably because the Frist family (as in Senate Majority Leader Bill Frist) had founded the hospital and hired Scott to run it. (Some would say he was hired to do their dirty work.)
HCA settled with the government shortly before the Senator’s brother, Dr. Tommy Frist, (who served as HCA’s chairman) was scheduled to be deposed by the government’s attorneys.
Rick Scott was never indicted, and waltzed away with $10 million in severance. In 2009, when he led a committee to kill health reform, I told his story on HealthBeat, and wrote about him again when he became Florida’s governor.

For-profit hospital chains: the pattern

Tenet, HCA and HMA are just three examples of corrupt for-profit hospitals. After defrauding Medicare and hurting patients for years, these chains are caught, and pay a huge fine. No one goes to prison. Frequently they change the name of the chain, paint the front door, hire executives who are cronies of the former management team, and start all over again.
Update: Sure enough, HMA CEO Gary Newsome has announced that he will be retiring July 1. Newsome, 55, said in a news release that he is stepping down after being “called by the First Presidency of the Church of Jesus Christ of Latter-day Saints to serve as the president of its Uruguay-Montevideo mission.” (It appears that he’s getting out of Dodge.)
Newsome, who has been at the helm of the company since September 2008, took home $8.3 million in total compensation last year.
Meanwhile, the word on Wall Street is that HMA is now a takeover target. Bloomberg reports that, according to financial analysts, Community Health Systems (CHS), a sister for profit hospital chain is the most likely suitor.
HMA and CHS have quite a lot in common: CHS has disclosed that it, too, has received requests for information from numerous law-enforcement agencies regarding its admissions policies, some of which are based at least in part on whistle-blower allegations. Unfazed by charges of wrong-doing, shareholders have sent HMA’s share price soaring, up 25% in a week. ( Typically, takeover rumors spur buying.)

Why do they do it?

The hospital industry is a tough business, and it’s not easy to make the fat profits Wall Street expects. This is why the whole idea of trying to make hospitals “for-profit” is a truly terrible idea. Too often, shareholders’ interests trump patients’ interests.
More importantly, the hospital business is a labor-intensive, capital-intensive business. It just about impossible to reap the returns investors demand – unless you become creative.

Non-profits follow the for-profits

This is not to say that for-profits have a monopoly on fraud. A few years ago, a whistle-blowing doctor at a non-profit Catholic hospital contacted me. The administration at his hospital was pressuring doctors to admit ER patients. The hospital ultimately closed down his practice, transferring his patients to other doctors at the hospital. But he didn’t back down.
Unfortunately, no one at the hospital would talk to me. And none of the doctors’ colleagues would talk on the record – though they had all heard the CEO tell staff they were going to have to hike admissions from the ER.
His partner did talk to me and corroborated the story, but wouldn’t talk on the record. It is so sad; people are so afraid.
I was seriously disappointed. This had all the elements of a great story: The Catholic Church! Nuns! Blood! Money! A guy who is willing to stand up!
I will always remember this physician. He was in his early 60s, and devastated when they closed his practice and he lost so many long-time, patients. Many of them were older, and he told me he kept a notepad by his bed, in case, during the night, he thought of something that he should check on regarding one of his patients.
After he lost his practice, his girlfriend left him.



Posted June 13, 2013
- See more at: http://www.healthinsurance.org/blog/2013/06/13/medicare-fraud-and-for-profit-hospitals/#sthash.J6pNCZCi.dpuf

Sunday, June 16, 2013

Panel Tells Congress Medicare Is Unfairly Penalizing Hospitals Serving The Poor - Kaiser Health News

Panel Tells Congress Medicare Is Unfairly Penalizing Hospitals Serving The Poor - Kaiser Health News

Panel Tells Congress Medicare Is Unfairly Penalizing Hospitals Serving The Poor

JUN 14, 2013
This KHN story was produced in collaboration with wapo
The financial penalties that Medicare imposes on hospitals with high rates of patient readmissions are too harsh for hospitals serving the poor and should be changed, according to a congressional advisory agency.
Since last fall, Medicare has been reducing its payments to 2,213 hospitals under a provision in the health care law that aims to improve quality at the nation's hospitals. The penalties kick in when patients with heart failure, heart attack or pneumonia are readmitted at higher than expected rates within 30 days.
While the Medicare policy seems to be having an effect - facilities are scurrying to keep better tabs on their high-risk patients after discharge - some hospital officials and other experts say the penalties are unfair because hospitals that treat the poorest patients are getting hit harder than others.
"The idea is right, but the implementation has been greatly flawed by penalizing hospitals that take care of the most vulnerable patients," said Dr. Atul Grover, chief public policy officer at the Association of American Medical Colleges.
Low-income patients, doctors and researchers say, are more likely to have trouble following hospital instructions for taking care of themselves after discharge. They don't always have easy access to doctors to monitor their recuperations and sometimes can't afford needed medications.
The maximum penalties, now set at 1 percent of Medicare payments, are scheduled to double to 2 percent starting in October and 3 percent in the fall of 2014.
In the District of Columbia, Howard University Hospital, which treats the largest share of low-income patients, is being penalized the most of any area hospital; since last October, its Medicare payments have been reduced by 0.95 percent. Sibley Memorial Hospital, which treats the smallest share of poor patients, was the only District hospital to avoid a penalty, data show.
In Virginia, Mary Washington Hospital in Fredericksburg and Culpeper Regional Hospital were penalized 1 percent. Maryland hospitals are exempted from the federal program because the state has a unique reimbursement system.
Medicare has disagreed that the readmissions penalty program needs revisions. But thereport to Congress from the Medicare Payment Advisory Commission, or MedPAC, agreed with critics that there are "shortcomings" that "can work at cross purposes to the policy's intent." The criticisms carry extra weight because MedPAC helped devise the readmission penalties, calling for them back in 2008.
MedPAC found that hospitals where fewer than 3 percent of Medicare patients were low income received an average penalty of 0.21 percent. Hospitals where more than 18 percent of Medicare patients were low income had an average penalty more than twice that, 0.45 percent.
"Income is still an important … variable in explaining variation in readmissions," the commission said. It recommended that in future years, when determining penalties, Medicare compare a hospital's readmission rates to those of hospitals with comparable numbers of poor patients. Penalties can be a drain on safety net hospitals, many of which operate on slim profits or at a loss.
The Centers for Medicare & Medicaid Services did not comment on the MedPAC recommendations. In the past, officials have noted that after years of holding steady, the national hospital readmission rate last year dipped below 18 percent.
But MedPAC warned that if the penalty formula remains unchanged many hospitals will continue to get penalized in future years even if they reduce readmissions because they will be judged on how they compare to the entire industry. MedPAC proposed that Medicare set target readmission rates for hospitals each year and exempt from penalties those that succeed.
"These are all steps in the right direction," said Dr. Ashish Jha, a Harvard School of Public Health researcher who first documented the unevenness of the penalties. “MedPAC is thinking smartly about this and they're looking at the evidence coming and making changes to the metrics."
Changing the program, however, might not be easy. Medicare officials have said that many details were spelled out in the 2010 law, making them difficult to change in light of deep partisan divisions in Congress.
This article was produced by Kaiser Health News with support from The SCAN Foundation.