MHA's Executive Briefing

Bennett seeking District 120 seat

Richard Bennett has announced his candidacy for House District 120 in the state Legislature.

Bennett, 50, is a lifelong resident of Long Beach and attended the University of Southern Mississippi.

For the full story from The Sun Herald, click here.

Communication, med rec among top compliance challenges in 2006

Communication among clinicians and medication storage and reconciliation were among the top compliance challenges in hospitals from January 2006 to July 2006, according to the February Joint Commission Perspectives. Specifically, the following were the most troublesome measures:

• National Patient Safety Goal #2: Improve communication among caregivers-59% noncompliance
• MM.2.20: Properly store medications-40%
• Goal # 8: Reconcile medications through the continuum of care-38%
• EC.5.20: Make sure the facility is safely designed and meets the Life Safety Code® (LSC)-28%
• UP 1: Meet the expectations of the Universal Protocol for Preventing Wrong Site, Wrong Procedure, Wrong Person SurgeryT-28%
• MM.3.20: Make sure medication orders are legible and transcribed accurately-26%
• PC.8.10: Assess pain in all patients-19%
• EC.1.10: Manage safety risks-18%
• Goal #3: Improve the safety of medications-18%
• IM.6.10: Guarantee that every patient treated has a complete and accurate medical record-17%
• PC.13.20: Plan the proper administration of moderate or deep sedation or anesthesia-15%

[ via Quality Improvement Monitor ]

Not-for-profits using more derivatives

The not-for-profit healthcare sector has increased its use of derivatives, or interest rate swap transactions, to raise capital and minimize risk, according to a new report by Standard & Poor’s.

The trend coincides with an increase in capital spending in response to changes in technology and patient-care delivery, S&P said. Funding for capital projects has come in large part from additional debt, operating cash flows or unrestricted cash reserves, but debt service is nevertheless a large expense for providers, who tend to have healthy income statements because of the essential services they provide.

Implemented to minimize cost and lessen interest-rate and cash-flow risks, derivatives are sometimes a key part of a hospital’s risk-management program, S&P said. Although they can be a hedge and lower borrowing costs, they do also pose risks, according to S&P.

[ via Cinda Becker, Modern Healthcare's Daily Dose ]

Senate budget resolution passes out of committee

The Senate Budget Committee voted 12-11 along party lines March 15 to approve a fiscal year 2008 budget resolution that includes up to $50 billion through fiscal year 2012 for reauthorization of the State Children’s Health Insurance Program. Of that, $15 billion would come from Medicare, although the resolution does not specify which Medicare programs would be cut.

To qualify for the funding, the reauthorization bill would need to maintain coverage for current SCHIP enrollees, strive to reach eligible uninsured children, support state efforts to cover more children and be budget neutral. The resolution could go to the Senate floor next week, when the House budget committee also is expected to begin consideration of its version of the budget resolution.

[ via AHA News Now ]

GAO recommends profiling physicians to identify inefficiencies

In an effort to improve the current Medicare physician payment system, the Government Accountability Office (GAO) has recommended that the Centers for Medicare & Medicaid Services (CMS) begin profiling physicians to identify those provide excessive care.

The recommendation comes after a GAO study found primary care physicians in every part of the country that provided more healthcare services than were required to patients. The GAO examined 10 healthcare purchasers with profiling systems to determine whether inefficient physicians could be identified. After identifying inefficient physicians, the purchasers provided incentives to improve efficiency, such as

• educating physicians to encourage more efficient care
• designating in physician directories those physicians who met efficiency and quality standards
• dividing physicians into tiers based on efficiency and giving enrollees financial incentives to see physicians in their particular tiers
• providing physicians bonuses or imposing penalties based on efficiency and quality standards
• excluding inefficient physicians from the network

The GAO found that Medicare's data-rich environment is conducive to identifying physicians who are likely to practice medicine inefficiently, and recommended this as a partial solution to Medicare's long-term fiscal instability.

Click here for more information about the GAO study.

[ via Physician Practice Advisor ]

Dingell, Clinton announce SCHIP bill

House Energy and Commerce Chairman John Dingell (D-MI) and Sen. Hillary Rodham Clinton (D-NY) on March 13 announced legislation that would give states federal funding incentives to expand their State Children’s Health Insurance Program and allow employers and families to buy into the program. The Children’s Health First Act would allow states to expand SCHIP coverage to families up to 400% of the federal poverty level, which amounts to $70,000 for a family of three.

Federal funding would be based on the state’s prior year spending, adjusted for medical inflation and child population growth. “It’s time for Congress to act to protect the most vulnerable among us - our children,” Dingell said.

[ via AHA News Now ]

The Changing Role of the Physician

Very little of consequence happens in the delivery of health care without the involvement of physicians. The role of the physician is changing, however, and has been for some time.

No longer in total control of evaluation, treatment and patient, the physician is becoming less of a director and more of a coordinator and health coach. These changes have significant implications for the efficient and effective delivery of health care.

For the full story from Richard D. Wittrup in Hospitals & Health Networks, click here.

MedPAC discusses a new approach to the wage index

The Medicare Payment Advisory Commission (MedPAC) on March 9 discussed a draft recommendation that would make changes to how the wage index is calculated. The draft recommendation would direct the Centers for Medicare & Medicaid Services to compute the hospital wage index using wage data collected by the Bureau of Labor Statistics from all employers instead of the current process of collecting wages from hospitals.

The index methodology also would be modified by using Census wage data to calculate county-level wage index values and would reduce differences between neighboring counties to no more than 10%. Congress has instructed MedPAC to make recommendations on the area wage index by June 30 for consideration by CMS in the fiscal year 2009 inpatient prospective payment system proposed rule.

Earlier this month, the American Hospital Association sent a letter to MedPAC raising questions about its proposal, including the use of BLS versus hospital-specific data. Danielle Lloyd, AHA senior associate director of policy, noted during the public comment period that AHA has convened a working group comprised of state, regional and metropolitan association executives to examine area wage index reform, and that the group believes three of the biggest problems with the current system are its volatility, unrealistic labor market definitions and the "cliffs" that can occur when neighboring hospitals have dramatically different wage indices.

Lloyd asked MedPAC to provide further analysis and information on the aspects of the proposal that address these issues. The commission is scheduled to vote on its draft recommendation in April.

[ via AHA News Now ]

National Practitioner Data Bank to launch ‘proactive disclosure’ prototype

Health care organizations that use the National Practitioner Data Bank to monitor practitioner credentials can enroll practitioners in a new Proactive Disclosure Service prototype, the Health Resources and Services Administration announced March 7. The service, effective April 30 for a limited number of organizations, will notify them within one business day when the database receives a report on any of their enrolled practitioners.

Authorized database users can choose to enroll all their practitioners in the PDS, or enroll some practitioners and continue to periodically query on others using the regular query methods. The annual subscription fee during the 18-24 month prototype period is $3.25 per practitioner, while the query fee for periodic queries remains $4.75 per name.

[ via AHA News Now ]

Martinez introduces bill to delay CMS’ proposed Medicaid cuts

Sen. Mel Martinez (R-FL) on March 7 introduced legislation that would delay implementation of the Centers for Medicare & Medicaid Services proposed administrative cuts to Medicaid. The measure (S. 787) would place a two-year moratorium on CMS’ implementation of the proposed rule to allow further study to determine the extent of any negative impact on states, particularly those with Medicaid or State Children’s Health Insurance Programs.

“CMS is trying to enact a rule that will financially crush our hospitals,” Martinez said. “This proposal will ensure Florida’s hospitals can continue providing services to the most vulnerable families seeking care.”

CMS estimates its proposed rule would reduce federal Medicaid funding by $3.8 billion over five years. Martinez said Florida hospitals stand to lose $4.6 billion in state and federal Medicaid funds.

[ via AHA News Now ]