Concerns Raised About Effect Of Medicare’s Readmission Penalty

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English: Created by vectorizing Image:Medicare and Medicaid GDP Chart.png with Inkscape (Photo credit: Wikipedia)


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Topics: Delivery of Care, Health Costs, Hospitals, Marketplace, Medicare, States

Apr 01, 2013

The New York Times explores the new policy that penalizes hospitals if they have too many patients return within 30 days. Meanwhile, in Maryland, officials are weighing an ambitious plan to control hospital costs.

The New York Times: Hospitals Question Medicare Rules On Readmissions
While federal statistics show the effort is beginning to reduce costly and unnecessary readmissions, a growing chorus of critics is asking whether the government policy, which penalizes hospitals that have high readmission rates, is unfair. They are also questioning whether hospitals should be responsible for managing the personal lives of patients once they are released — or whether they should focus on other ways to improve care (Abelson, 3/29).

Kaiser Health News: Maryland’s Tough New Hospital Spending Proposal Seen As ‘Nationally Significant’
Maryland officials have proposed what analysts call the most ambitious initiative in the country to control soaring medical spending, a plan that would bring relief to employers and consumers footing the bill while bluntly challenging the state’s powerful hospital industry. The blueprint, which needs the Obama administration’s approval, would use Maryland’s unique rate-setting system to keep hospital spending from growing no faster than the overall economy — roughly half its recent rate of increase (Hancock, 4/1).

In other health industry news, federal officials release more details about hospital problems and a federal watchdog focuses on Medicare spending for equipment.

The Associated Press: Reports Of Hospital Mistakes Now Available Online
At St. Charles Medical Center in Bend, (Oregon) employees failed to notice that a cleaning machine was accidentally reprogrammed to leave out the disinfection cycle. Eighteen patients received colonoscopies with scopes that had been only rinsed with water and alcohol. … Hospitals make mistakes. When they are reported — by patients, employees or family members — state and federal officials investigate. Now, for the first time, the U.S. Centers for Medicare and Medicaid (CMS) has released those inspection reports for hospitals nationwide from the past two years. The release was in response to requests from the Association of Health Care Journalists, which has compiled them into a searchable database available to the public
(Peterson, 3/31).

Kaiser Health News: Capsules: IG Report Slaps Medicare For Not Recouping More Overpayment For Equipment
Medicare has made nearly $70 million in overpayments to suppliers of consumer medical equipment and more than half of that money is unlikely to be recovered, according to a new report from the Department of Health and Human Services Inspector General (Carey, 4/1).

This is part of Kaiser Health News’ Daily Report – a summary of health policy coverage from more than 300 news organizations. The full summary of the day’s news can be found here and you can sign up for e-mail subscriptions to the Daily Report here. In addition, our staff of reporters and correspondents file original stories each day, which you can find on our home page.

State Roundup: Federal Audit Calls For N.Y. Medicaid Program To Repay Funds

English: Newsroom of the New York Times

English: Newsroom of the New York Times (Photo credit: Wikipedia)

Topics: Delivery of Care, Health Costs, Hospitals, Medicaid, Mental Health, Politics, Women’s Health, States

Mar 26, 2013

News outlets report on health care developments in California, Colorado, Georgia, Massachusetts, New York, North Carolina and Texas.

Boston Globe: Report Hails Mass. Biotech Spending As Job Creator
Halfway through a decade of investment promised by Governor Deval Patrick’s 10-year, $1 billion life-sciences initiative, launched in 2008, the state has spent only about a third of the money targeted to promote the biotechnology and medical device industries in Massachusetts. But the authors of a report set to be released Tuesday by the Boston Foundation, a philanthropic group, say the effort has helped stimulate a key sector of the state’s economy, creating more than 8,000 jobs through capital grants, tax incentives, and business loans. They urge state government leaders to continue funding the initiative in the face of stepped-up competition from other life-sciences hubs, such as California, Maryland, and New Jersey (Weisman, 3/26).

The New York Times: U.S. Wants State To Pay After Audit Of Youth Care
In another critical assessment of New York’s multibillion-dollar Medicaid program, a federal audit says the state improperly claimed $27.5 million in reimbursements for services to mentally ill and emotionally disturbed children and teenagers (McKinley, 3/26).

The New York Times: Caregiver For Disabled People Sues New York State
A New York State-employed caregiver for people with developmental disabilities sued the state on Monday, accusing it of retaliating against him for whistle-blowing. The employee, Jeffrey Monsour, has brought to light a number of questionable practices by the state, as varied as routinely falsifying fire drills and turning a blind eye toward abuse of those in the state’s system of care for people with developmental disabilities. He was one of the people interviewed and featured in a 2011 series of articles by The New York Times examining problems of abuse and corruption within the system (Hakim, 3/25).

Georgia Health News: Senate Limits Abortion Coverage In State Health Plan
A bill that would allow the Georgia World Congress Center Authority to provide its own insurance plan added an amendment Monday that would restrict abortion coverage for state employees. The amended legislation passed on a 34-15 vote in the Republican-dominated Senate. It would bar coverage for abortion in the 650,000-plus-member State Health Benefit Plan. The only exception would be for situations in which the life of the mother is in danger or it’s needed “due to the mother’s medical necessity.” The bill still must be reconciled with the House version of the legislation, which does not address abortion (Miller, 3/26).

The Texas Tribune: Senate Approves Overhaul Of Long-Term Medicaid Care
The Texas Senate unanimously approved an overhaul of long-term and acute care Medicaid services on Monday in an effort to expand care to more Texans with disabilities while saving millions of state dollars. … SB 7 is expected to save $8.5 million in Medicaid costs in the 2014-15 biennium by expanding managed care services, establishing pilot programs to try to provide services at capitated costs and implementing measures to ensure more efficient monitoring of services (Aaronson, 3/25).

Health Policy Solutions: Colorado Third State To Ban Discrimination Against LGBT Patients
Colorado is the third state to prohibit discrimination in health coverage. California and Oregon have barred the practice along with the District of Columbia. The federal Affordable Care Act calls for equity in LGBT health care, but very few states have taken action thus far to codify these rights (Kerwin McCrimmon, 3/25).

San Jose Mercury News: Fremont’s Washington Hospital: Joint Replacement Patients, Doctors Excluded From New Facility
When Robert Cantley needed both knees replaced in August, he was expecting to recover from the surgery at Washington Hospital’s fancy, new $42.7 million Center for Joint Replacement. According to hospital marketing brochures, the center offered “A Higher Level of Care” in a 20,000-square-foot space featuring 25 private patient rooms, a “breathtaking physical therapy space” and a beautifully landscaped therapy garden. Instead, Cantley did his physical therapy sessions in a dimly lit hallway on the sixth floor of the main hospital in what he described as “a miserable set of circumstances.” What Cantley and many other patients at the public hospital didn’t know was that access to the new center, the only facility of its kind in the Bay Area, is restricted to just two orthopedic surgeons at the hospital — the only ones on the Washington staff who met 24 criteria set by the hospital (McGlone, 3/25).

North Carolina Health News: Medicaid Schools’ Tout High Numbers Of Primary Care Grads, But The Numbers Tell A Different Story
Medical schools in North Carolina are touting the high numbers of students they graduate who go on to primary care specialties. But those numbers aren’t the whole story. … In North Carolina, numbers released by the state’s four medical schools claim that from each, upwards of 42 percent of students will be headed into primary care. But Morris-Singer said matching for primary care doesn’t mean those doctors will practice in primary care (Hoban, 3/26).

California Healthline: California Rural Health Association Closes Shop
The California State Rural Health Association, a unifying voice for the state’s disparate rural health care providers for almost two decades, has laid off staff and closed its Sacramento office. The 16-member board of directors hopes to keep the trade association alive and active, “but it’s becoming more difficult in this environment,” said Dave Jones, president of the volunteer board (Lauer, 3/25).

Score Can Predict Risk For Hospital Readmission

English: Depiction of the House vote on H.R. 3...

English: Depiction of the House vote on H.R. 3590 (the Patient Protection and Affordable Care Act) on March 21, 2010, by congressional district. Democratic yea Democratic nay Republican nay No representative seated (Photo credit: Wikipedia)

Topics: Health Costs, Hospitals, Marketplace, Quality

Mar 26, 2013

A risk score for hospitalized patients can pinpoint those most at risk of having to be readmitted to the hospital for avoidable reasons.

MedPage Today: Score Predicts Preventable Readmissions
A risk prediction score for hospitalized patients can find those most at risk of returning for avoidable reasons, researchers found. The HOSPITAL score — based on hemoglobin and sodium levels at discharge, whether the admission was elective, and similar factors — identified 18% of patients as at high risk for a potentially avoidable readmission within 30 days with a “fair” level of accuracy (Phend, 3/25).

Also in the news, a progress report on efforts to reset hospital and doctor pay –

Kaiser Health News: Slow Progress On Efforts To Pay Docs, Hospitals For ‘Value,’ Not Volume
For decades, reformers have sought to change how doctors and hospitals are paid to reward quality and efficiency – efforts that accelerated as a result of the health care overhaul. But surprisingly little progress has been made to date, a consortium of large employers reported today (Mitchell, 3/26).

Hospitals Get New Grades On Safety

By Jordan Rau

November 28th, 2012, 5:55 AM

Updated at 9:35 a.m.

The Leapfrog Group is out with its second round of hospital safety ratings, and what a difference a few months has made.

Photo by Phil Jern via Flickr

In the results released Wednesday, 103 hospitals that Leapfrog had given a “C” or lower in its first round of ratings in June got an “A” in the updated Hospital Safety Score, based on more recent data and a slightly tweaked methodology. These included New York-Presbyterian Hospital, the Hospital of the University of Pennsylvania and Geisinger Medical Center.

Two hospitals awarded an “A” in the first round, Leonard J. Chabert Medical Center in Houma, La., and Lawrence General Hospital in Lawrence, Mass., both slipped to a “D.”

Altogether, 8 percent of the 2,619 hospitals that Leapfrog rated changed by two or more grades, like an “A” to a “C,” according to Leapfrog, a patient safety nonprofit based in Washington, D.C. Thirty-four percent changed one grade, like a “C” to a “B,” and 58 percent kept the same grade, Leapfrog said.

Leapfrog’s effort to provide a single letter grade based on 26 different measures of safety is part of a burgeoning effort to help consumers evaluate medical providers. Consumer Reports this year also started boiling down hospital metrics into its signature circular symbols, known as “Harvey Balls.”

In its first effort, Leapfrog gave a break to hospitals with poor showings, giving them a “Grade Pending.” This time, Leapfrog pulled out its red pen, giving 25 hospitals an “F,” including the Ronald Reagan UCLA Medical Center in Los Angeles. Another 122 hospitals got a “D.”  Leapfrog gave 790 hospitals an “A,” and 678  received a “B.” Leapfrog gave 1,004 hospitals a “C.”

Leapfrog calculated its grades using publicly-available data, including the frequency of blood line infections, falls in the hospital, bedsores and the consistency that hospitals follow recommended methods of care, such as discontinuing an antibiotic within 24 hours of surgery.

Leapfrog’s effort has earned grumbles from hospitals, which note that much of the data is old, with some of it dating to events from as far back as July 2009.  Hospitals also have complained Leapfrog incorporates its own survey in its evaluations, although the organization says that doesn’t disadvantage hospitals that don’t fill them out.

Dr. Shannon Phillips, patient safety officer at The Cleveland Clinic—which saw its grade slip from a “C” to a “D”—said the Clinic “has seen measurable improvement month after month,” so Leapfrog’s evaluation is now outdated.

Phillips said the grades are of no help to hospitals since they are already aware of the underlying measures, which Medicare calculates and publishes. “It’s repackaging of data the public and we already have,” she said.

Leah Binder, Leapfrog’s chief executive officer, said the ratings will help companies and other health care purchasers as they try to educate their employees to select services with the highest value. “When a person or employee looks at comparative pricing information, they assume the highest price is the highest quality,” she said. Leapfrog’s grade is “something that can be incorporated pretty easily into pricing transparency,” she said.

The individual hospital scores can be looked up on Leapfrog’s web site. A breakdown of how hospitals in each state did as tabulated by Kaiser Health News is below.  Maryland hospitals are not listed, because Medicare does not collect the same data from that state’s hospitals due to a unique arrangement with the federal government.

Number of Hospitals Receiving Each Grade for Patient Safety
State A B C D F
AK 1 2 1 2
AL 12 13 25 4 1
AR 3 5 22
AZ 11 10 14 5
CA 92 56 80 14 4
CO 13 11 15
CT 6 9 13
DC 1 4 2
DE 3 2 1
FL 61 38 49 8
GA 11 27 32 4 1
HI 1 4 4 1
IA 10 8 11 1
ID 1 2 5 1 1
IL 51 31 28 3 5
IN 15 31 16 1
KS 3 11 14 5
KY 12 20 21 1
LA 8 13 29 3 1
MA 50 4 5 1
ME 16 3 1
MI 37 25 22 1
MN 20 14 12 1
MO 18 11 30 3 1
MS 8 8 18
MT 3 4 3
NC 20 29 26 2
ND 3 1 1 1
NE 3 3 11
NH 2 5 6
NJ 23 22 24 1
NM 1 5 7 1
NV 2 5 12 1
NY 33 38 70 16
OH 35 23 45 8
OK 3 12 22 3
OR 4 10 14 2 1
PA 37 29 59 1
RI 2 4 3
SC 14 11 19 1 2
SD 2 1 5 1
TN 25 18 21 3
TX 52 44 91 16 5
UT 3 4 11 1
VA 30 16 21 2 1
VT 3 1 2
WA 13 15 14 1
WI 10 12 24
WV 2 5 17 2
WY 1 3 4
Grand Total 790 678 1004 122 25
Source: Leapfrog Group

Research centers and laboratories at the Unive...

Research centers and laboratories at the University of California, Berkeley (Photo credit: Wikipedia)

Research Roundup: Medicare Spending Grows During Recessions; Docs Discriminate Against Obese People; Too Much Hospital Smoking

Topics: Health Costs, Health Disparities, Hospitals, Medicare, Public Health

Nov 09, 2012

Each week, KHN reporter Alvin Tran compiles a selection of recently released health policy studies and briefs.

Health Affairs: State Unemployment In Recessions During 1991-2009 Was Linked To Faster Growth In Medicare Spending –  Although overall health care spending fell during the 2007-2009 recession, Medicare spending growth increased. Using 1991-2009 data, researchers found that “Higher unemployment rates across states and over time [1991-2009] were associated not only with faster Medicare spending growth, but also with more Medicare spending per capita – more hospital spending and more hospital use by free-for-service Medicare beneficiaries.”  They conclude that “One of many possible explanations may be that health care providers have greater capacity, inclination, and financial incentive to treat Medicare patients during recessions as a result of slackening demand from the non-Medicare population (McInerney and Mellor, 11/2012).

PLOS ONE: Implicit And Explicit Anti-Fat Bias Among A Large Sample Of Medical Doctors By BMI, Race/Ethnicity And Gender – Findings from previous research suggests that weight discrimination exists among Americans. Many patients have also reported that they have been mistreated by health care providers. In this study, researchers aimed to determine if some medical doctors (MDs) possess any bias based on their patients’ weight. “We found that MDs’ implicit and explicit attitudes about weight follow the same general pattern seen in the very large public samples that hold strong implicit and explicit anti-fat bias,” the authors write, and conclude that “implicit and explicit anti-fat bias is as pervasive among MDs as it is among most people in society” (Sabin, Marini and Nosek, 11/2012).

JAMA: Association Of Race And Sex With Risk Of Incident Acute Coronary Heart Disease Events – Guided by previous findings that showed disparities in the incidence of heart disease (CHD) among white and black individuals, researchers aimed to determine if the disparities continued. They found that black men and women in the US were more likely to die from CHD than whites. They conclude that the “excess risk factor burden among black men and women continues to be a major public health challenge, along with their high risk for death as the presentation of CHD. Increase emphasizes on optimizing well-established risk factors among blacks could potentially reduce these disparities.” Reuters quoted the lead author as saying the result is “distressingly similar” to racial differences seen in data from the 1990s, despite public health efforts to address them (Safford et al., 11/7).

Archives Of Internal Medicine: Prevalence And Predictions Of Smoking By Inpatients During A Hospital Stay – The authors write: “Accredited U.S. hospitals prohibit smoking inside hospital buildings,” though some allow smoking outdoors. Researchers surveyed more than 5,000 patients from Massachusetts General Hospital during and 2 weeks after their hospitalization to assess the proportion of smoking. Between 2007 to 2010, “18.4% reporting having smoked during their hospital stay … Patients were more likely to report having smoked while hospitalized if they were young, had more severe cigarette cravings, did not report planning to quit, had longer hospital stays, and were not admitted to a cardiac unit.” The researchers write that “a clear policy prohibiting patients from leaving the hospital to smoke may be necessary to prevent smoking by inpatients” (Regan, Viana, Reyen and Rigotti, 11/5).

Here is a selection of news coverage of other recent research:

Inside Health Policy: Avalere Health: CMS Likely To Grant Flexibility On Medicaid Expansion
With the elections over, the consulting firm Avalere Health predicts that CMS will grant states the flexibility to expand Medicaid to people earning up to 100 percent — rather than 138 percent — of the federal poverty level, and that most states will end up at that threshold. … States are under no strict deadline to decide whether to take up the reform law’s voluntary Medicaid expansion (Lotven, 11/7).

USA Today: Diabetes: Effect Of Weight Loss Thrown Into Question
A recent study showed that obese people with diabetes who lost a modest amount of weight didn’t lower their risk of having a heart attack or stroke, but the weight loss did help improve many other health factors. … “[W]e did show the benefits of weight loss for improving depression, quality of life, sleep apnea, incontinence, fitness, physical function and blood sugar control,” says Rena Wing, a professor of psychiatry and human behavior at Brown University and chairman of the Look AHEAD (Action for Health in Diabetes) study. The research was financed by the National Institutes of Health (Hellmich, 11/7).

Reuters: Hospital Guidelines Not Linked To Readmissions: Study
Procedural guidelines designed to ensure patients get quality care while in the hospital are also thought to reduce the chances a patient will need to be readmitted down the line, but a new study suggests there’s little connection between the two…. Overall, they found that hospitals with the best scores for following guidelines did not have “meaningfully” lower readmissions than hospitals with the worst scores. “Even when the associations were statistically significant, the differences in the readmission rates of high and low-performing hospitals were small,” the team writes in the Journal of General Internal Medicine (Seaman, 11/8).

Reuters: Values Exercise Improves Doctor-Patient Communication
A short waiting room exercise encouraging African American patients to reflect on their personal values helped improve communication between the patients and their white doctors, in a new study. However, those patients didn’t rate their trust in their doctor or satisfaction with the appointment any higher, compared to those who didn’t do the “values affirmation” exercise (Pittman, 11/7).

Reuters: Human Enhancements At Work Pose Ethical Dilemmas
Retinal implants to help pilots see at night, stimulant drugs to keep surgeons alert and steady handed, cognitive enhancers to focus the minds of executives for a big speech or presentation. Medical and scientific advances are bringing human enhancements into work but with them, according to a report by British experts, come not only the potential to help society and boost productivity, but also a range of ethical dilemmas (Kelland, 11/7).


Hospital (Photo credit: Ralf Heß)

This is part of Kaiser Health News’ Daily Report – a summary of health policy coverage from more than 300 news organizations. The full summary of the day’s news can be found here and you can sign up for e-mail subscriptions to the Daily Report here. In addition, our staff of reporters and correspondents file original stories each day, which you can find on our home page.

Hurricane Sandy’s Nursing Home Nightmare

English: Times Square

English: Times Square (Photo credit: Wikipedia)

Topics: Public Health, Hospitals, Aging

Nov 10, 2012

News organizations continued to report on how Hurricane Sandy affected N.J. and N.Y. medical facilities.

The New York Times: Nursing Home Is Faulted Over Care After Storm
Amid the worst hurricane to hit New York City in nearly 80 years, the home, the Promenade Rehabilitation and Health Care Center, failed to provide the most basic care to its patients, according to interviews with five employees, federal, city and hospital officials, and shelter directors. … Cold, thirst, fear: The situation grew so dire that the next evening, as the vestiges of the storm blew across the peninsula, ambulances arrived, evacuated the nearly 200 patients over several hours and deposited them in emergency shelters in the city. … Some family members are still desperately searching for their loved ones, with no help from Promenade (Powell and Fink, 11/9).

Reuters: US Northeast Digs Out From Snow, Gas Rationing Expands
A week after Sandy, Doctors Without Borders established temporary emergency clinics in the hard-hit Rockaways – a barrier island in Queens facing the Atlantic Ocean – to tend to residents of high-rises, which still lacked power and heat and were left isolated by the storm. “I don’t think any of us expected to see this level of lacking access to health care,” said Lucy Doyle, who specializes in internal medicine at New York’s Bellevue Hospital (Trotta and Respaut, 11/9).

The Jersey Journal/ Hoboken University Medical Center Will Reopen Full 6 a.m. Monday
Hoboken University Medical Center will reopen fully on Monday morning, 13 days after massive flooding from Hurricane Sandy forced the medical facility to shut its doors. The hospital opened up its emergency room as an urgent-care center a few days after the Oct. 29 storm, but otherwise has been entirely shut to the public (McDonald, 11/10).

The Economist: Making It Through The Storm
Each new disaster tends to surprise firms that thought they had good plans in place. Hospitals in New York that had moved their back-up generators above ground nonetheless lost power during Sandy because they had failed to put fuel and pumps where floods could not reach. Running disaster-readiness drills regularly, it turns out, is a common-sense idea practised all too rarely (11/10).

The New York Times: A Flooded Mess That Was a Medical Gem
NYU Langone, with its combination of clinical, research and academic facilities, may have been the New York City hospital that was most devastated by Hurricane Sandy. What’s next is a spectacularly expensive cleanup. Dr. Robert I. Grossman, dean and chief executive of NYU Langone, looking pale and weary — as if he were, indeed, struggling to hold back the FUD — estimated that the storm could cost the hospital $700 million to $1 billion. His estimate included cleanup, rebuilding, lost revenue, interrupted research projects and the cost of paying employees not to work (Hartocollis, 11/9).

This is part of Kaiser Health News‘ Daily Report – a summary of health policy coverage from more than 300 news organizations. The full summary of the day’s news can be found here and you can sign up for e-mail subscriptions to the Daily Report here. In addition, our staff of reporters and correspondents file original stories each day, which you can find on our home page.

Trinity Health, Catholic Health East Announce Plans To Merge

Trinity Health (Novi, Michigan)

Trinity Health (Novi, Michigan) (Photo credit: Wikipedia)

By Jenny Gold

October 17th, 2012, 1:42 PM

Big news today in the land of hospital mergers and acquisitions.

undefinedThe boards of two leading Catholic health systems, Trinity Health and Catholic Health East, have announced plans to join forces in 2013.

The consolidated Catholic health system would include 82 hospitals and 89 continuing care facilities, home health and hospice programs. The two health systems together have nearly 2.8 million visits each year across 21 states. They employ more than 87,000 employees, including 4,100 doctors.

The merger is aimed, in part, at preparing for a new system of care that is moving away from fee-for-service medicine and toward a focus on population-based health, where providers are offered financial incentives to keep patients healthy and lower costs through better-coordinated care.

“By bringing Catholic Health East and Trinity Health together, we will enhance our ability to create innovative models of care and advance clinical quality across the continuum,” said Judith Persichilli, president and CEO, Catholic Health East in a press release.

Hospital systems across the country are facing growing financial pressure to consolidate or expand by merging with or acquiring other providers. But expanding Catholic health systems has proved difficult in other parts of the county.  Several proposed mergers between Catholic and secular hospitals, for example, have collapsed in part because of concerns about the Catholic Church’s opposition to abortions, in-vitro fertilizations and sterilizations.

In January, Catholic Healthcare West, which primarily operates in California, Arizona and Nevada, decided to end its governing board’s affiliation with the Catholic Church and changed its name to Dignity Health to make it easier to merge with secular hospitals.

Today’s announcement represents another option: Maintain the religious character of the system by merging with another Catholic system.

“A unified ministry allows us to better leverage our talents and size, and to use our resources more effectively in furtherance of our mission,” said Dennis Fitzpatrick, chairperson of Catholic Health East’s board of directors. “Together, we will have a greater ability to influence and transform health care at the national level.”

Top 10 Catholic Health Care Systems

Top 10 Catholic Health Care Systems (Photo credit: Wikipedia)

The two systems will pursue the merger over the next few months with the goal of reaching a definitive agreement by next spring. If the merger is completed, the combined system would have annual operating revenues of about $13.3 billion and assets of about $19.3 billion.