About The Journal of Healthcare Management
The Journal of Healthcare Management is a publication of the American College of Healthcare Executives (ACHE) featuring articles on current healthcare management topics and industry trends. The journal is published six times per year and presents scholarly studies and columns by healthcare executives, industry experts and clinicians.

Practical Advice for 2010
“Guide to CMS Compliance” focuses on recent and anticipated changes in CMS regulations and offers insight into trends for the upcoming year, including more surveys and greater regulatory scrutiny. Elzer presents recommendations for understanding CMS regulatory requirements and presents practical approaches to delivering compliant patient care and responding to poor surveys.

About Ruth Elzer
Ruth Elzer is an expert at keeping hospitals compliant. As the Practice Leader for Accreditation and Compliance Services at Compass Clinical Consulting, Ruth gives clients practical solutions that work across the board. Before specializing in accreditation and compliance, Ruth worked for St. Joseph Medical Center in Joliet, IL, and at The Joint Commission (TJC), where she managed the development of educational programs designed to help hospitals prepare for regulatory survey. Ruth is trained as a surveyor for not only The Joint Commission, but also CMS and EMTALA. A nationally recognized speaker, Ruth is a member of the American Organization of Nurse Executives (AONE) and ACHE.

The article can be downloaded free from Compass Clinical Consulting’s Accreditation Resource Center.

The American Academy of Family Physicians predicts that the shortage of family doctors will soar to 40,000 within the next decade. Worse yet, the overall shortage of doctors is expected to climb to nearly 160,000 by 2025, according to the Association of American Medical Colleges.

“I don’t see anything in the legislation that will greatly increase the primary care pipeline,” said Dr. Russell Robertson, chair of the Council on Graduate Medical Education.

The Journal of the Medical Library Association, Healthcare IT News reports on a study that indicates social networking tools are rapidly being added to the curricula in medical and nursing school. It should be noted that the study included a fairly small sampling and results may be non-projectable. We include this, however, because based on our experience (see last paragraphs of this posting), social media are gaining momentum.

Hopefully, this will be a trend because physicians, nurses and hospital administrators will gain by expanding their view of professional and patient discussions that should serve to improve care at lower cost.

The study cited:

• 53% of nursing schools and 45% of medical schools include Web 2.0 tools in their curricula.
• 58% of nursing schools plan to implement social networking tools in their curricula in the upcoming year, compared with 50% of medical schools.

Although a larger percentage of nursing schools report using or planning to use Web 2.0 tools in their curricula than medical schools, medical school respondents were more likely to report personal use of social networking tools than nursing school respondents.

Student, Practitioner Demand

A separate survey conducted in 2007 found that medical students and practitioners want more training to become better users of Web 2.0 tools.

Compass Clinical Consulting Using Social Media

Compass Clinical Consulting’s decision to reach out to the healthcare community through social media fits in with a growing trend of medical and nursing schools who are now teaching students how to be proficient in using social media.

Visit our website, our social media news room and our growing list of blogs and links to our Twitter, Facebook, LinkedIn, Flickr, YouTube, StumbleUpon, and other social media.

Over 300 hospitals are now following us on Twitter and in just three months nearly 20,000 pages have been viewed on our blogs.

The goal is to become an integral participant in the discussions that impact reducing the cost of delivering safe, quality healthcare.

Growth of freestanding EDs, of course, are a threat to the back door of all acute care hospitals. It is another whittling of the full-service hospital. Does this mean such hospitals face the same demise as did department stores of the past that are now replaced by boutique retailers?

Modern Physician explores the dispute surrounding private, freestanding emergency departments. Private companies can operate their freestanding EDs without regulatory oversight. Hospitals argue this advantage compromises quality of care, while the Joint Commission says private EDs provide efficient and quality care. At least one private ED company welcomes more regulation, and one state is considering legislation this year that would increase oversight of all freestanding EDs.

Check out the video on The Doctor’s Channel to see further discussion via video.

Not to be outdone, The Cleveland Clinic has lent its name and backup services to a string of CVS drugstore clinics in northeastern Ohio. And the Mayo Clinic is in the game, operating one Express Care clinic at a supermarket in Rochester, Minn., and a second one across town at a shopping mall.

This is one more wave of competition, slicing off segments of the healthcare business. For hospitals, it is an enticing way of extending their local brand names into high traffic centers. For primary care doctors, it is chipping away at their business. Soon it might be a rare sighting to see frozen corn at the supermarket as the owners look for ways to add more profitable offerings and simply view their stores as a medium for selling more and more non-food merchandise.

Just one more sign that healthcare is changing faster than you can say PRESTO.

The intervention was associated with 29% fewer hospitalizations (95% CI 10% to 44%) and 24% fewer ER visits (95% CI 3% to 40%) compared with usual discharge planning for homeless patients.

In the United States, Google Trends has identified a remarkably close relationship between the number of people searching for flu-related topics and the number of people who actually have flu symptoms.

While not every person searching for “flu” is actually sick, a pattern apparently emerges when selected flu-related search queries from each state and region are added together.

For the United States, Google compared its query counts with data the U.S. Centers for Disease Control and Prevention (CDC). Some search queries tend to be popular exactly when flu season is happening. By counting how often these search queries occur, Google Trends has shown how much flu is circulating in various regions of the United States. Their results have been published in Nature.

Google is now running a similar project on Swine Flu (H1N1) to spot outbreak concentrations by state within Mexico. You can see the results in a graph on their website.

University of Cincinnati Medical School "Match Day"

I fully understand the goal of providing healthcare to all Americans who need it. I also clearly understand that the cost of  our healthcare system is one of the fast growing of all segments in our economy. And I see many politicians and lobbyists seeking to write or influence the coming healthcare reform activity now meandering through Washington.

What I don’t understand is how our policymakers make decisions without consideration of cause and effect.

We have a limited number of physicians, nurses and hospitals. Most are operating in the red. Some of the red ink can be avoided not so much by mandatory reform from Washington but by more efficient and effective process management by the leaders running our nation’s hospitals. These are complex organizations staffed with professionals who have agendas that do not always work for the good of the organization. That’s an area of reform that can bring about positive impact on our national cost of healthcare without the help of a single politician.

It does not address universal access which can happen most likely only with the support of some aspect of national healthcare reform. But it does run head into the notion that healthcare cost must be brought down. Most of the pay-go solutions to fund this are not going to be popular. Cutting back on healthcare services to those covered by Medicare or Medicaid (like withholding medication for macular degeneration until a patient is totally blind in one eye and then providing this medication to save the remaining eye) are brutal … who has the right to be so arbitrary?

And then there’s the issue of supply to meet demand. If universal access doubles the number of Americans seeking healthcare to a supply base that is fixed to meet the needs of the insured, who is going to provide care to all these new patients? With supply-demand issues, typically as supply is unable to meet demand, prices go up; not down.

So in our infinite wisdom, we also pass laws that limit the number of physicians coming through medical schools and academic (teaching) hospitals which exacerbates supply.

Medicare resident caps have been in place for more than 10 years while the nation is now facing a potential physician shortage. The caps have a chilling effect on the ability of teaching hospitals and medical schools to increase the nation’s physician workforce and meet the needs of local communities.

Given these times of increasing financial uncertainty for teaching hospitals, it is important that the Medicare program maintain its commitment made in 1965 to support the additional costs associated with the educating future physicians and beginning a move now to assure adequate numbers of providers as healthcare becomes the law.

If we are going to have healthcare reform, let’s hope the politicians consider carefully what they are doing. A failure to do this right will increase costs even faster than they are now. Politicians talk now about the expenditures in the current legislation (nearly $700 billion on some accounts and a trillion on some other accounts) as “spend now to save in the future.” Maybe instead, we have to accept the fact that healthcare will continue to be a costly and increasingly expanding segment of our national economy.

Perhaps, even broader, maybe we need a national referendum to give citizens of the U. S. a voice in what kind of healthcare system we want.

As background, over the holidays, then President-elect Obama called on Americans to hold community discussions on health care. Over 9,000 Americans signed up to host in all 50 states – over 30,000 Americans attended a discussion near them. The groups submitted reports to the President’s health care team listing their concerns about the system and their suggestions for reform. The responses from around the country were summarized and analyzed in the report. And today, seven Americans who participated in these discussions are joining us at the White House today.  There are a lot of “stakeholders” here at the Forum, but I have a sense that having those people here who engaged just as a way of standing up with their community keeps everybody grounded by realizing that every oridinary person is a “stakeholder” in this discussion.

Before the group heads to breakout discussion sessions on the subject, the President says he believes this time around the effort to reform the health care system is different: “this time the call for reform is coming from the bottom up.”  The summit discussions produced their fair share of good ideas. Many spoke, here are a few excerpts from various sources including the White House Blog:

A few forthright speakers cut through some of the more gratuitous remarks. Senator Jay Rockefeller, for example, warned that anyone who believes healthcare reform won’t cost us anything is delusional: reform will cost money. Rockefeller then went on to talk about the power of lobbyists, pointing out that their money and muscle remain formidable. This doesn’t mean that healthcare reform is not doable, but it does suggest that meaningful reform will require both time and dollars.

Another observation came during the discussion of fraud. Former health and human services secretary Donna Shalala spoke up: “If we want credibility with the public, we need to put some people in jail.” Indeed. Over the past 20 years, the FBI has raided a number of huge hospital chains. Indictments have been handed down, charging executives and physicians with defrauding Medicare and even performing unnecessary surgeries on innocent patients. Huge fines have been paid. But it is rare that anyone is incarcerated. In fact, executives like Richard Scott – former CEO of Columbia/HCA – often wind up back in the healthcare business.

Iowa senator Charles Gressley, the ranking Republican on the Senate finance committee, raised whether the reform plan should include a public-sector insurance program (some call it “Medicare for all”) as an alternative to private insurance? “A lot of us feel that the public-sector option would create unfair competition” for private insurers, Grassley explained before telling Obama.

The president answered Grassley and he didn’t give much ground: “The thinking on the public option has been that it gives consumers more choices and it helps keep the private sector honest, because there’s some competition out there.” Obama continued: “I recognize the fear that if a public option is run through Washington and there are incentives to try to tamp down costs”, then “private insurance plans might end up feeling overwhelmed. We’ll make sure it’s addressed.”

Many comments on various related blogs put the onus on insurance companies for skimming profit from the system without adding commensurate value. Such commenters tended to see a larger role for government — including a single payer system to replace our current private insurance system. So the debate will rage on for months, but one thing seems sure … President Obama sees opportunity at the end of the tunnel and is betting a lot of his popularity on being able to steer this issue.

The President concludes his first address to the forum guests, telling everyone to get to work: “this time there is no debate about whether all Americans should have quality, affordable health care – the only question is how?”

The White House Forum on Health Reform ended in a dialogue with President Obama that turned out to be the most revealing part of the afternoon. In that final hour, you began to hear the anger of the opposition – and you caught a glimpse of which principles the president himself considers most important.

A Detailed Analysis of the Obama Healthcare Reform Budget

According to “Healthcare Policy and Marketplace Review” – President Obama hasn’t made anywhere near the hard decisions that need to be made. In 2019, for example, when his proposals are all in, his budget would shave only about 3.5% off our Medicare and Medicaid bill, and half of his health care funding comes not from spending cuts but from new taxes. See the full article.

“Who is Richard Scott and Why Is He Saying these Things About Healthcare Reform?”

“Healthcare Beat” reports on the return of Richard Scott talking about Obama’s plans. Strange to hear again from Scott, since he once set out on a deliberate plan to run academic and non-profit hospitals out of existence in a “only the strong shall survive” strategy behind the collapse of Columbia/HCA Healthcare Corp. In July of 1997, the FBI swooped down on HCA hospitals in five states. Within weeks, three executives were indicted on charges of Medicare fraud, and the board had ousted Scott. He has now launched “Conservatives for Patients Rights” and is going on TV, radio and the Web in the same week President Barack Obama hosts a health care summit at the White House. See the full article.

Hospital CEOs Face Grassley’s Lasers

HealthLeaders Blog “Lead Time” reports that every hospital C-Suite dreads the day they get one of Senator Chuck Grassley’s  11-page letters asking them to detail everything from community benefit to justifying the job description of the executive vice president for strategic affiliations. An IRS Report last month that found hospital CEO compensation averages $500,000 a year, with an elite set of leaders in the millions, has fueled Grassley and other CEO hunters on the hill. Read the full article.      Download copy of letter-from-senator-grassley.

Source:  WebMD Health

Many children don’t have health insurance, even if their parents do, according to a new study published in The  Journal of the American Medical Association. This phenomenon — uninsured children with at least one insured parent — is particularly prevalent in low-income and middle-income families.

Jennifer DeVoe, MD, DPhil, from Oregon Health and Science University, and colleagues looked at records of 39,588 children and teenagers and found that 3.3% fell into the category of being uninsured (for part or all of the year) with at least one insured parent.

The data came from the Medical Expenditure Panel Survey, which is nationally representative. Researchers pooled data from 2002 to 2005.

The characteristics most commonly associated with uninsured children with an insured parent: low-income and middle-income households, parents with less than a high school education, Hispanic ethnicity, single-parent households, geographic residence in the south or west, and having a parent with private insurance coverage.

Children with parents who had public health coverage were 36% less likely to be uninsured than children whose parents had private insurance.

More than 9 million children in the United States lack health insurance. That number doubles if you include, as this study does, children who have gaps in coverage during the year. Gaps in coverage result in poorer health long-term, the authors write.

“When entire families have access to health insurance, children and adolescents not only benefit from more consistent insurance coverage but also have improved access to a regular source of care and higher rates of preventive services,” the authors write.

The authors estimate that more than 1 million children had no coverage for the entire year, and 3 million children had some lack of coverage despite having one parent with full coverage. The authors assert that many adults may be able to afford employer-sponsored health insurance for themselves but not for their children. Because the cost of insurance relative to income is projected to rise, this could be an even larger problem in the future.

The authors write, “The question of whether the employer-based model is sustainable may need to be revisited. In this study, the private system did not do a good job of providing coverage for entire families.”

“Corporate or executive blogs can help in profiling of your company as an expert and using the knowledge of the collective,” says Guy Powell, President and Founder of Altanta-based agency DemandROMI. “Blogs and social networks can also serve as a business development tool as they provide a number of capabilities including backchannel information on particular prospective clients, advice, key informational contacts, prospective partners, etc.”
According to a November 2007 report from Nielsen Online, the major blogging sites have shown significant traffic spikes over the past year, with Blogger growing 58% to 34 million unique vistors in October 2007. WordPress jumped 444% to 11 million unique, followed by Typepad, which climbed 20% to over 10 million.

Research has also shown that the influence of blogs and other social media is increasing, particularly among technology buyers. A 2007 study from Universal McCann and Knowledge Storm found that IT buyers trust social media more than traditional content sources, with 80% of business and IT professionals saying they read blogs and 53% indicating blog content impacts their work-related purchase decisions.

In another sign that blogs have arrived as a staple in the overall marketing mix, an association was recently formed to address the topic. The Blog Council (http://blogcouncil.org/members.php), an organization made up of top global brands, was officially launched this month with a goal of sharing corporate blogging strategies and developing standards-based best practices. Founding members include Cisco Systems, Dell, Microsoft Corp. and Wells Fargo. The council will also address issues such as managing employee blogs and engaging and responding to bloggers who write about individual companies.

Using the Bureau of Labor Statistics American Time Use Survey, Krueger calculated that Americans age 15 and older collectively spent 847 million hours waiting for medical services to be provided in 2007.  He went on to conclude that if we value all people’s time at the average hourly wage of production and nonsupervisory workers ($17.43 in 2007), Americans spent the equivalent of $240 billion on health care in 2007.

Put another way, omitting patients’ time caused national health care expenditures to be undercounted by 11 percent in 2007.

That’s a lot of bills to be delivered to health care providers.

Obviously, no provider is going to be paying out any of these invoices anytime soon.

But it does point out a critical flaw in the customer experience that providers are missing. Making patients wait does not make them patient; it makes them mad. They value their time just as much as professionals in the system value their time.

Waiting time seen from an internal point of view has a real cost associated with it. If an OR rents out at $500 a minute then a turnaround of 20 minutes adds $10,000 to the cost of operations. If the team is sloppy, that can easily double to $20,000. The cumulative cost of wait time is a huge cost — in the millions of dollars.

When hospital teams are slow in turning around an operating room between surgeries, surgeons are unhappy, anesthesiologists are unhappy, OR nurses are unhappy, staff is unhappy, patients and their families are unhappy. In this modern world where satisfaction is an important factor in how hospitals are evaluated, wait time equals unhappy customers.

Reducing waiting time in surgical services should be on the target list of every COO, CMO and CNO.  The clock is ticking.

“They borrow leftover prescription drugs from their friends, attempt to self-diagnose ailments online, stretch their diabetes and asthma medicines for as long as possible and set their own broken bones.”

A doctor was quoted: “We often see young people who have taken the wrong antibiotics borrowed from friends. We see urinary tract infections taking meds better suited for ear infections or pneumonia — the problem is, they haven’t really treated their illness and they’re breeding resistance.”

It is understandable when you see young adults trying to start a career making less a month than the health insurance would cost. It is understandable when a 2-day stay in the hospital costs a young adult more than a year’s college tuition.

It is understandable, but that does not make the problem go away. Where lies responsibility?  Hospitals already donate an average of 9% of their revenue to community health — much of it to provide care to the uninsured. Soon it’s like getting blood from a turnip.

Health care reform is in bad need for a fix. While we are bailing out car manufacturers and banks and launching heroic measures to bring our economy out of a near-depression, we wait for answers on healthcare.

In the meantime, young adults remain a population in peril.