The Daily Briefing

News for Health Care Executives

How accountable care affects your staffing strategy

March 18, 2012

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Accountable care staffing strategy

Undercover CEO helps feds nab corrupt governor

Illinois hospital executive wears wire for FBI

March 19, 2012

Eight years after she led a double life as an FBI informant, one hospital executive said she felt closure as former Illinois Gov. Rod Blagojevich reported to prison on Thursday to serve 14 years for corruption.

An undercover mission
Pamela Davis, president and CEO of Naperville-based Edward Hospital and Health Services, for eight months passed the FBI information about an alleged hospital shakedown that she collected while secretly wearing a wire. In a phone interview last week, Davis recalled delivering tapes to FBI agents at rendezvous sites—like department store makeup counters—and meeting with alleged schemers in restaurants. 

Davis first alerted the FBI after the Illinois Health Facilities Planning Board in 2003 said they would deny Edward Hospital's proposal for a new medical building unless they used a specific contractor or investment firm. "This was a very strong-armed attempt for me to work with individuals who had no experience in building hospitals," Davis said. "The more I told them no, the more they put personal pressure on me."

According to TribLocal Naperville, Edward Health Ventures Vice President and President Bill Kottmann also secretly wore an FBI listening device. "I did not worry about wearing a wire, I feel strongly that individuals have to stand up and be counted or government doesn't work well," Davis said. "I'm proud that my colleague and I played a key role in exposing this corruption."

Wearing a wire takes its toll
However, she said going undercover took a tremendous personal toll, noting that it led to high blood pressure and feelings of isolation and distrust toward others. "I had felt so wronged. I felt health care … had been so toyed with, that there was a part of me that felt vindicated, that maybe people would understand something terrible had been happening."

According to the FBI, Davis' cooperation was invaluable to the investigation, which ultimately gathered enough evidence to convict Blagojevich on 17 counts of corruption. Blagojevich—who also was accused of selling President Barack Obama's senate seat—on Thursday reported to a federal prison in Colorado to serve his 14-year sentence.

"I do hold Blagojevich personally responsible for dragging Edward Hospital and me through the sludge of his corrupt administration," Davis said. "I'm glad he's going to jail, but I'm sick about all the corruption that has occurred in this state."

Although Edward Hospital never received approval to build the new medical building, the state in February approved a $63.7 million expansion of its existing campus. "Things have settled down dramatically with (the health planning board)," Davis said. "I think the board is now reviewing projects and acting responsibly" (Johnson, AP/Quad-City Times, 3/14; Jenco, TribLocal Naperville, 3/14; Wurst, Naperville Sun, 3/15; Wall, Fox Chicago News, 3/15; Pyke, Daily Herald, 3/14).


Obama administration moves to clarify contraceptive coverage rules for self-insurers

New guidance outlines implementation proposals, calls for comments

March 19, 2012

The Obama administration on Friday issued draft proposals on how it would enforce federal contraceptive coverage rules for religious employers—including certain hospitals and universities—that offer self-insured group plans.

Federal officials in February said religious-affiliated organizations no longer were required to cover employees' birth control, instead announcing that it would require insurers to offer no-cost contraception directly to women.

In an Advanced Notice of Proposed Rulemaking, HHS, the Department of Labor, and the Department of the Treasury suggested three possible implementation strategies for the policy:

  • Requiring third-party administrators to cover the costs of contraception with revenues not connected with the religious organization;
  • Covering contraception costs by offering rebates to third-party administrators through the federal health reform law's reinsurance program; and
  • Having a separate insurance company offer contraceptive coverage to employees.

Stakeholders have 90 days to comment on the notice. The three departments intend to hold listening sessions to hear concerns and feedback prior to issuing final rules. According to the New York Times, administration officials expect to release the final rules for self-insured employers after the fall elections but before Aug. 1, 2013.

The administration on Friday also released a final rule governing student health insurance plans that affords students the same consumer protections as U.S. residents with individual market insurance (Pear, Times, 3/16; Feder, Politico, 3/16; Zigmond, Modern Healthcare, 3/16 [subscription required]; HHS release, 3/16).


Cigna plans to increase number of ACO patients by 10-fold in two years

CEO: Health law case won't derail market transformation

March 19, 2012

Cigna—the nation's fourth largest insurer—plans to enroll more than one million patients in accountable care organizations by 2014, according to David Cordani, the company's CEO.

Bloomberg/Businessweek reports that the insurer's ACOs currently cover roughly 100,000 people. The expansion is part of an effort to focus more on individual policyholder needs rather than on employers.

Under Cigna's ACO model, the company embeds nurse practitioners and health coaches in physician offices to help them track medication adherence and follow-up care. Cigna also monitors its claims information for signals that a patient may be relapsing, Bloomberg/Businessweek reports.

According to Cordani, Cigna "philosophically believe[s]" that ACOs are an integral strategy to reduce systemic health care costs. He noted that even if the Supreme Court strikes down the reform law, the market will continue to transform the U.S. health care delivery system.

"There are a lot of products designed now around incenting health, incenting behavioral change and lifestyle changes and where physicians and hospitals engage in a much more comprehensive fashion," Cordani said. "With or without the health care law, the economic forces are driving change" (Nussbaum/Wayne, Bloomberg/Businessweek, 3/15).


Dangerous drug combo? Algorithm uncovers 'sneaky side effects'

Researchers find thousands of unknown interactions

March 19, 2012

A computer algorithm has helped researchers comb through FDA's adverse event database and pinpoint thousands of previously unknown drug side effects and interactions, according to a new study.

About the algorithm
For the study—which was published in Science Translational MedicineStanford University researchers developed an algorithm that mined information from FDA's database of patient- and physician-reported adverse events.

According to the researchers, adverse event reports often contain bias because people taking the drugs could have multiple medical conditions. For example, adverse event reports might incorrectly link cholesterol-lowering drugs with myocardial infarction (MI) because the population taking cholesterol medication—typically older patients—tend to be more prone to MI.

To eliminate such bias, the algorithm matched data from each drug-exposed patient to a nonexposed patient with the same illness. The method helped researchers create a database of 1,332 medications that listed potential side effects of the drugs. Researchers found an average of 329 previously unknown side effects for each drug.

Database on drug pairs
The researchers also used the algorithm to create a database of potential interactions between pairs of drugs.

Using the database of drug pairs, researchers found that people who were taking a class of antidepressants known as selective serotonin reuptake inhibitors—or SSRIs—were significantly more likely to develop a dangerous heart condition called prolonged QT if they also were taking a class of high blood pressure medications called thiazides.

Researchers then searched through electronic health records from Stanford University Hospital to confirm the interaction between SSRIs and thiazides. They found that patients were one-and-a-half times more likely to have prolonged QT if they were taking both drugs than if they were taking either drug by itself.

Possible uses for FDA
Russ Altman—the study's lead author, a bioengineer at Stanford University and an adviser on FDA's Science Board—said he plans to present the results of the study to FDA. He said FDA could use the algorithm in conjunction with its existing drug-surveillance programs to eliminate bias when searching for potential adverse events.

However, Altman acknowledged that it might be challenging for FDA to address all of the new data generated by the algorithm. He said, "We've just released a database with 10,000 or more adverse events. I do not expect the FDA to uncritically take these results and add them to every drug label" (Ledford, Nature, 3/14; "80 Beats," Discover Magazine, 3/15).


When ICU beds are scarce, physicians shift mindset to end-of-life care

Despite pivot, patients may not die sooner

March 19, 2012

Physicians are more likely to administer end-of-life care than life-saving care when a hospital's ICU is operating at full capacity, according to a provocative study in the Archives of Internal Medicine.

For the study, University of Calgary researchers analyzed data for nearly 3,500 hospitalized patients with sudden clinical deterioration.

The results showed that 12% of patients were admitted to the ICU within two hours when no beds were available, compared with 21% when at least three beds were vacant. In addition, the study found that the goal of care shifted to medical or comfort care from resuscitation 15% of the time when the ICU was at full capacity, compared with 9% when more than two beds were free.

Although there was no variation in mortality rates, Scott Halpern, a critical care expert at the University of Pennsylvania who wrote a commentary accompanying the study, noted that the results could be misleading because patients who received comfort care often were discharged from the hospital.

"We don't know whether this study documents rationing or the elimination of waste," Halpern said. "Work needs to be done to better understand how commonly ICU beds are not available, and how often that affects patients who could benefit from ICU admission" (Joelving, Reuters, 3/15).


HHS releases final rule on Medicaid expansion

March 16, 2012

HHS on Friday released the final rule for the Medicaid expansion mandated by the federal health reform law.

The overhaul expands Medicaid to individuals ages 19 to 64 who have an income up to 133% of the federal poverty level ($14,856 for an individual and $30,656 for a family of four). The changes will become effective in 2014, when the state-based health insurance exchanges begin operating.

HHS first proposed policies governing the expansion in August 2011. Responding to feedback from states and various stakeholders, the agency in the final rules included additional protections for consumers and additional options and flexibilities for states, according to a CMS release.

The final rules also make it easier for eligible residents to enroll in Medicaid and the Children's Health Insurance Program by reducing red tape and coordinating enrollment with insurance exchanges.

"Today, too many uninsured Americans turn to the emergency room for care and can't pay their bills," said CMS Acting Administrator Marilyn Tavenner. "Insuring more Americans will decrease the hidden tax states and consumers with insurance pay to cover the cost of caring for the uninsured" (CMS release, 3/16; Daly, Modern Healthcare, 3/16 [subscription required]).


Weekly review

Key articles from March 12-March 16

March 19, 2012

Missed a day of the Daily Briefing? Here's a quick round-up of top stories and research highlights from last week’s issues.

U.S. News releases medical school rankings (March 13)
U.S. News & World Report last week released its annual Best Medical Schools list based on select indicators for research and primary care, as well as the list of top medical schools for eight specialties like family medicine, rural health, and women's health.

ACHE: The states with the highest hospital CEO turnover (March 14)
A recent American College of Healthcare Executives report analyzed hospital CEO turnover nationwide, outlining which states see the most movement across the top executive spot.

Plaintiff in health law case goes bankrupt with unpaid medical bills (March 12)
The plaintiff in the multistate lawsuit against the health reform law who filed for bankruptcy owed thousands in medical bills, the Los Angeles Times reports.

Why imaging programs can’t afford to do business as usual (March 14)
Under new payment models, imaging must contribute to health systems’ efforts to control the overall cost of care, which will be tricky. Here are four lessons to position for tomorrow without failing today.

Joint Commission, NQF announce 2011 patient safety and quality awards (March 15)
The Joint Commission and the National Quality Forum last week named one hospital and one health system as 2011 recipients of the John M. Eisenberg Patient Safety and Quality Awards.

NYT: Why new patient satisfaction metrics miss the mark (March 16)
Using patient satisfaction scores to assess hospital care quality is "worrisomely off the mark," oncology nurse Theresa Brown writes this week in the New York Times.


Daily roundup: March 19, 2012

Bite-sized hospital and health industry news

March 19, 2012

  • California: The National Cancer Institute has designated the University of California-Davis Cancer Center as one of 40 "comprehensive" cancer centers in the United States. To receive the designation, the center needed to meet certain standards for cancer treatment, research, and funding. UC-Davis said total research funding for the center has grown from $45 million in 2001 to about $107 million by the end of 2011. In addition, a $37 million expansion project is expected to nearly double the size of the center by September (Garza, Sacramento Bee, 3/14).
  • Mississippi: The state is "well on its way" to establishing a health insurance exchange by 2014, despite its involvement in the multistate lawsuit against the federal health reform law. According to Kaiser Health News, former Gov. Haley Barbour (R) initiated efforts to establish an exchange before the health reform law was enacted in 2010. Meanwhile, state Insurance Commissioner Mike Chaney (R) said that the exchange will be designed and administrated solely by the state. In January, the Center for Mississippi Health Policy released a study that found that an exchange could help reduce the state's uninsured rate from 20% to 7% (Hess, KHN, 3/14).
  • New York: New York City Council Speaker Christine Quinn has announced a deal that will create a school and preserve a historic building on the former site of St. Vincent's Hospital, which shuttered in 2010. The plan also says a freestanding ED will replace the hospital (Hartocollis, New York Times, 3/14).
  • Ohio: Gov. John Kasich (R) has proposed legislation that would factor hospital quality into future Medicaid payments. Under the legislation, quality components would be developed in association with the Ohio Hospital Association (OHA) and other industry stakeholders. "With Medicare and private insurers moving toward value-based purchasing, it makes sense for the state to provide hospitals with the opportunity to receive Medicaid incentives for high quality as well," said OHA President and CEO Mike Abrams (AHA News, 3/14).

 


Even with CMS delays, ICD-10 preparations still matter

March 19, 2012

Join Ed Hock from our ICD-10 team, and Josh Gray of the Financial Leadership Council, to discuss how to leverage the ICD-10 delay to your advantage.

Learn more.


CDC: Food-borne illnesses linked to imported foods on the rise

The incidence of food-borne illnesses linked to imported foods, particularly fish and spices, is on the rise, according to a recent CDC report.

According to the report, 39 outbreaks and 2,348 illnesses were linked to food that had been imported from 15 countries. Nearly half of those outbreaks were linked to food products that originated from areas that did not have a history of outbreaks, and 17 of them occurred between 2009 and 2010.

Hannah Gould, a CDC epidemiologist and the report's lead author, noted that it is too early to determine if the data represent a trend. A food safety law was enacted last year that granted FDA additional authority to monitor the nation's food supply (Weise, USA Today, 3/14; Bristol, CQ HealthBeat, 3/14 [subscription required]; Hsu, Los Angeles Times, 3/14).