The Daily Briefing

News for Health Care Executives

How to structure a mini-campaign

January 05, 2012

A smaller goal is not the mini-campaign’s sole characteristic—it is narrowly scoped across all components of a traditional campaign.  The mini-campaign's downsized characteristics—timeframe, staff and ally involvement, and activity—enhance flexibility in today's volatile market by allowing for more frequent strategy adjustments and minimizing staff and ally burnout.

Learn the four components critical to executing a successful mini-campaign. Click to view the Philanthropy Leadership Council infographic in full size.

Cheney gets heart transplant —and sparks age debate

Some experts say younger patients should be favored over older patients

March 26, 2012

Former Vice President Dick Cheney on Saturday underwent a heart transplant, rekindling the debate over whether age should be a major factor in deciding which patients qualify for the operation.

Cheney, 71, underwent the heart transplant procedure at Virginia-based Inova Fairfax Hospital, where he currently is recovering in the ICU. According to MedPage Today, Cheney has suffered at least five myocardial infarctions and undergone several cardiac treatments, including a four-vessel coronary bypass graft, two angioplasties, and placement of an implantable cardioverter defibrillator. Cheney waited more than 20 months to receive the transplant.

Heart transplants in the U.S.
Physicians in 2011 performed 2,322 heart transplants, including 332 on patients older than age 65, according to Joel Newman, a spokesperson for the United Network for Organ Sharing. More than 3,100 U.S. residents are on a waiting list for a new heart and about 330 people die annually before one becomes available, Politico reports.

Most heart transplant recipients are between the ages of 50 and 64 because older patients are less likely to survive the transplant procedure and are more likely to die within 30 days after the operation than younger patients, NPR reports.

Should younger patients be favored?
Some experts argue that age should play a larger role when physicians decide whether to perform a heart transplant.

Noting that younger patients are more likely to live longer than older patients, Art Caplan, a bioethicist at the University of Pennsylvania, said, "I've been arguing for a long time that the system should pay more attention to age because you'll get a better return on the gift."

Meanwhile, Stanford transplant cardiologist Sharon Hunt noted that "[i]f more and more of the older population is on the list, they're going to crowd out the younger people." Hunt added, "It's going to be a huge problem, a tough societal issue that is going to get tougher."

However, Mary Norine Walsh, medical director of cardiac transplantation at Indianapolis-based St. Vincent Hospital, noted that physicians consider a patient's overall health—not just their age—when determining whether they qualify for a transplant. For example, Reuters reports that older patients are rigorously screened for potential comorbidities, including cancer, neurological abnormalities, and kidney and liver dysfunction.

"What we say in our circle is that it's not the age, it's the mileage," said Mariell Jessup, medical director of the University of Pennsylvania's heart and vascular center. "Issues other than age determine how well a patient will do." Jessup added, "A 70-year-old that has a heart transplant can expect an excellent probability to live five or 10 years or longer with a superb quality of life, as long as they don't have other medical problems" (AP/Politico, 3/25; Neale, MedPage Today, 3/24; Cortez/Langreth, Bloomberg, 3/26; Steenhuysen/Sherman, Reuters, 3/26; Stein, "Shots," NPR, 3/26; Szabo, USA Today, 3/25).


Berwick joins Washington think tank

Former CMS chief to be senior fellow at Center for American Progress

March 26, 2012

Former CMS chief Don Berwick will continue his public policy work as a senior fellow at the Center for American Progress (CAP), a liberal-leaning think tank based in Washington, D.C.

According to CAP, Berwick will focus on defending the Affordable Care Act, ensuring its implementation, and developing new ways to improve care quality and reduce costs.

Berwick will join other health policy heavyweights at CAP, including Zeke Emanuel, who served as a senior health adviser in the Obama White House, and former South Dakota Sen. Tom Daschle (D), Obama's first nominee for HHS secretary

Calling Berwick a "visionary leader of change and progress in our health care system," CAP President Neera Tanden said, "We are thrilled to have Don join CAP as a senior fellow, as he is a critical voice for our national deliberations on health care now and in the future."

Berwick looks ahead
In an interview with the Washington Post, Berwick discussed how the reform law has changed the U.S. health care system, what challenges it may face in the future, and whether he would accept another policy-making role.

"I think the Affordable Care Act has changed the mentality of the nation toward one where we realize we can provide better care," Berwick said in the interview. "It's not only the programs contemplated within the law that are changing and gaining momentum," he said, adding, "There's faster progress in the private sector."

According to Berwick, the establishment of insurance exchanges will be pivotal to the next phase of health reform implementation. "It's a bit of a horse race to see whether it will go well enough, and whether the federal and state exchanges will be ready on time," Berwick said.

When asked whether he would serve in government again, Berwick called his time at CMS "the highlight and privilege of my career." He said, "[t]o help the people in the agency work more effectively and engage in tough questions, I absolutely loved it. And I'm very sorry that I had to leave" (Zigmond, Modern Healthcare, 3/23 [subscription required]; Fox, National Journal, 3/23 [subscription required]; Pecquet, "Healthwatch," The Hill, 3/23; CQ HealthBeat, 3/23 [subscription required]; Kliff, Washington Post, 3/25).


Five ways health care's changed since 'Mad Men'

How we've gotten smarter about our health habits

March 25, 2012

From the Daily Briefing editors

AMC's award-winning TV drama "Mad Men" returns on Sunday night, and as our Advisory Board infographic captures below, health care's dramatically changed since the 1960s depicted on the show. Mortality rates from many diseases are down, the percentage of women in the health workforce is up, but the most striking difference is around our personal health habits.

We've plucked out four examples of characters on the show acting in unhealthy ways, as well as one egregious case of questionable medical ethics. For those who have watched the show, please browse and tell us what we missed.

(And as a last-ditch reminder: These examples all involve considerable spoilers. Consider yourself warned)

1. Smoking, drinking takes the edge off of pregnancy: Smoking is exceedingly commonplace in "Mad Men"; this video purports to chart every cigarette smoked in the first three seasons.

But there's no more striking moment than in Season 3, when viewers watch Betty Draper light up while pregnant with her third child. A visibly pregnant Betty also is seen quaffing cocktails, as parents in the 1960s were unaware of the risk of fetal-alcohol syndrome.

2. Roger Sterling won't let a few heart attacks keep him from a good steak: Ad man Sterling is smoking a cigarette when he suffers his second heart attack of Season 1.  ("Not again," he grimaces in mid-puff.) But those back-to-back AMIs don't stop Sterling from eating, smoking, and drinking in subsequent episodes as though his cardiovascular health isn't an issue.

3. 'Exercise' is nonexistent: The biggest workout on "Mad Men"—outside of the energy spent chasing extramarital affairs—may be the effort to cover up those affairs. Unlike corporate TV dramas set in the present, no major character on "Mad Men" is ever depicted going for a jog or visiting the gym; the show's creator famously told the show's actresses to stop exercising in order to look more realistic for the period.

4. Doctor-patient confidentiality apparently doesn't apply to therapy: Don Draper regularly gets a rundown of his wife Betty's therapy sessions—from Betty's doctor. (She's emotionally immature, the doctor says at one point.)

5. Parents are concerned by children's anticsbut not why you'd think: In an early episode, Betty scolds her daughter for running around, wearing a plastic bag. Is she worried about asphyxiation?

Hardly; Betty's worried that something's happened to her nice clothes.


Study links hospital work environments to nurse and patient satisfaction

International survey suggests inexpensive way to boost satisfaction scores

March 26, 2012

Hospitals could improve patient satisfaction, care quality, and nurse retention by improving their nurses' work environment, a new study in BMJ suggests.

For the study, University of Pennsylvania School of Nursing researchers surveyed 61,168 nurses and 131,318 patients at more than 1,000 hospitals in the United States and Europe. The surveys indicated that nurse burnout and job dissatisfaction were "common" in both parts of the world and that about 60% of hospital patients on average were satisfied with their care.

Based on their analysis of the survey findings, the researchers determined that hospitals with better nurse work environments—such as better nurse-to-patient ratios, nurse involvement in decision-making, and positive nurse-physician relations—were more likely to have high patient satisfaction scores. Overall, those hospitals' patients were more likely to recommend them to other patients.

The researchers also determined that better work environments were associated with a lower likelihood of nurse burnout. In addition, nurses with better environments were about half as likely to rate their hospital's care quality as poor or fair.

Strategies for improvement
The study suggests that workplace improvements may provide a relatively inexpensive method to boost care quality, patient satisfaction scores, and nurse retention. "Indeed, our research in the U.S. showed that investments in better nurse staffing improved patient outcomes only if hospitals also had a good work environment," the study noted.

Moreover, the researchers wrote, "Almost every country had one or more hospitals that nurses ranked as having good work environments, suggesting that this success could be replicated in additional hospitals" (Aiken et al., BMJ, 3/20 [subscription required]; Barber, Medscape Medical News, 3/22; Nurse.com, 3/22).


'Misguided' regs prompt pharmacists to trash scarce drugs

Survey: Regulations contributing to drug shortage crisis

March 26, 2012

Nearly 60% of surveyed hospital pharmacists said that government regulations have forced them to throw away scarce medications, despite the ongoing drug shortage, MSNBC's "Vitals" reports.

For the survey, the Institute of Safe Medication Practices (ISMP) polled 715 hospital pharmacy directors, managers, and clinicians.

According to the findings, roughly 61% of respondents said they "feel compelled" to throw away injectable drugs, citing fears of industry or government sanctions. According to MSNBC's "Vitals," current regulations—including those enforced by CMS—require pharmacists to follow drugmakers' written instructions for storage, stability, and expiration dates, although information may be outdated.

The survey found that about 80% of respondents said that the rules "often" or "always" result in unnecessary medication waste. Meanwhile, 97% of surveyed pharmacists said they believed regulations contribute to the drug shortage.More than 100 different drugs have been discarded, including Velcade, a cancer treatment now in short supply that costs between $1,500 and $2,500 per 3.5-milligram vial.

According to MSNBC, although CMS did not respond to requests for comment about the survey, CMS chief medical officer Patrick Conway has said the agency would work with ISMP to resolve the package instruction issue (Aleccia, "Vitals," MSNBC, 3/22).


Auditing the auditors: Why Medicaid contractors failed to ID overpayments

81% of Medicaid pre-screened audits unable or unlikely to ID overpayments

March 26, 2012

The HHS Office of Inspector General says that Medicaid Integrity Contractors (MICs) relied on ineffective audits and faulty data in 2010, preventing MICs from recouping millions of dollars in overpaid claims.

According to the report, 370 audits that were conducted between Jan. 1 and June, 30, 2010, highlighted about $80 million in suspected overpayments, but just 11% of the audits identified overpayments totaling $6.9 million.

Meanwhile, 42% of the audits showed no overpayments and 39% were still being conducted as of June 2011 and were not expected to reveal any overpayments, the report said.

OIG recommended that CMS, Audit MICs, Review MICs and the states collaborate to ensure that the audits target the right providers and eliminate duplicative efforts that might delay the audit process. CMS in its response said it has altered the audit targets selection process (OIG report, 3/19; Daly, Modern Healthcare, 3/20 [subscription required]).


Weekly review

Key articles from March 19-March 23

March 26, 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.

HealthGrades names 'America's Best Hospitals' (March 21)
HealthGrades on Tuesday released its sixth annual list of "America's 50 Best Hospitals," which recognizes U.S. hospitals performing in the top 5% across 26 common procedures for the most consecutive years.

Undercover CEO helps feds nab corrupt governor (March 19)
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.

Ryan budget would 'drastically reshape' Medicare (March 20)
House Budget Committee Chair Paul Ryan (R-Wis.) on Tuesday unveiled his fiscal year 2013 budget proposal, which would establish a "premium support model" for Medicare.

Advisory Board congratulates members named as 'America's Best Hospitals' (March 21)
HealthGrades on Tuesday released its first-ever list of "America’s 100 Best Hospitals," adding 50 organizations to its annual list of 50 top-performers. The Advisory Board congratulates the 91 member hospitals named to the list.

'Holy grail' of cardiac care? Simple blood test may forecast MIs (March 22)
A simple blood test may be able to predict a myocardial infarction (MI) about one week before it occurs, a small study in Science Translational Medicine found.

What managers can learn from Steve Jobs (March 23)
Writing in the Harvard Business Review, Steve Jobs biographer Walter Isaacson outlines the Apple visionary's employee engagement strategies and tackles questions about his rough management style.


Health reform on trial: Day 1 of Supreme Court hearings

Anti-injunction act up for debate

March 26, 2012

The Supreme Court on Monday heard the first 90 minutes of oral argument in the multi-state lawsuit around the Affordable Care Act's constitutionality.

Today's arguments centered on both a legal and linguistic dispute:

    Does the penalty for failing to get insurance amount to a tax?

Understanding today's arguments
Under the ACA, taxpayers must report their health insurance status in their 2014 tax returns; taxpayers that fail to obtain health insurance face a penalty.

At issue in today's hearings was whether that penalty is actually a tax. If so, the Anti-Injunction Act prohibits courts from hearing challenges to a tax before it's been collected—which wouldn't happen until 2015.

However, both opponents of the ACA and the White House have urged the Supreme Court to hear the case, although one lower court did seize on the Anti-Injunction Act and conclude the legal challenge was premature.

Argument to throw out case
Robert Long, appointed by the justices to argue that the lawsuit was brought prematurely, made the case that the penalty essentially functions like a tax.

However, Long faced "a rapid fire half-hour of questioning," the Wall Street Journal reports, with eight of nine justices challenging Long with two dozen questions—nearly one per minute. The justices generally appeared unsympathetic to Long's argument that the Supreme Court lacks jurisdiction.

According to Justice Ruth Bader Ginsburg, the penalty "cannot be a revenue-raising measure, because if it's successful, there won't be any revenue raised." 

Argument to hear case
U.S. Solicitor General Donald Verrilli, who represented the federal government, argued that the case "presents issues of great moment," and the Anti-Injunction Act, does not preclude the court’s consideration of those issues.

However, Verrilli also met with criticism from several justices. According to Justice Samuel Alito, the government on Monday is arguing that the insurance mandate's penalty is not a tax—but will change its argument on Tuesday, and present a case that the penalties essentially function like a tax, in order to uphold the ACA's constitutionality. Phillip Klein of the Washington Examiner notes that the White House "has to thread a difficult needle" this week, in making that dual argument.

Attorney Greg Katsas, representing the National Federation for Independent Business and the 26 states challenging the ACA, also argued that the court should hear the case. Katsas said that the Anti-Injunction Act does not apply because the legal challenge to ACA centers on the requirement that taxpayers must purchase health insurance, not on the penalty.

However, Chief Justice John Roberts was skeptical that the ACA's mandate and penalty could be separated, asking "Why would you have a requirement that is completely toothless?"

Next steps
According to the Wall Street Journal, the justices generally "appeared ready to get to the core of this case now," rather than wait until 2014.

Tomorrow's hearings center on a pivotal question: whether the government has the right to impose a mandate to purchase health insurance (Hanrahan/Radnofsky et al., "Washington Wire," Wall Street Journal, 3/26; Klein, "Beltway Confidential," Washington Examiner, 3/26; Sherman, AP/Yahoo! News, 3/26).


Maximize your bargaining position in upcoming payer negotiations

March 26, 2012

Join us for a complimentary webconference to learn how you can employ accurate and complete data to your advantage in contract negotiations, leveling the playing field and ensuring maximum return.

Learn more.


Daily roundup: March 26, 2012

Bite-sized hospital and health industry news

March 26, 2012

  • Maryland: Maryland Health Insurance Plan on Monday launched a new advertising campaign to increase enrollment in the federal and state insurance program created under the federal health reform law. The campaign will target five counties with a total of 376,000 uninsured residents ages 19 to 64 who are ineligible for Medicare or Medicaid (Gantz, Baltimore Business Journal, 3/19). 
  • Massachusetts: The Greater Boston Interfaith Organization and the Associated Industries of Massachusetts last week took separate actions urging lawmakers to limit the rate of health care spending to two points below the state's gross domestic product because health care spending has grown at double the rate of the rest of the state's economy. At its current rate Massachusetts health care spending will reach $89 billion by 2015, according to Kaiser Health News (Bebinger, WBUR/NPR/Kaiser Health News, 3/16).
  • Massachusetts: The state Public Health council has approved a merger between Burlington-based Lahey Clinic and Beverly-based Northeast Health System. The new Lahey Health System will begin operating on May 1 (Lee, Modern Healthcare, 3/23 [subscription required]).
  • Pennsylvania: Five Philadelphia hospice nurses have been accused of participating in an alleged multi-year fraud scheme. According to the Department of Justice, the company's director of professional services allegedly authorized fraudulent medical claims for inappropriate patients totaling $9.3 million. The FBI has arrested the five nurses, a news release said (Evans, Modern Healthcare, 3/23 [subscription required]).


Study: Online counseling could help decrease cancer-related fatigue

Web-based counseling could help cancer survivors manage daily fatigue, according to a study published in the Journal of Clinical Oncology.

For the study, Korean researchers assessed 273 participants who had been treated for cancer within the past two years. Half of the participants were randomly assigned to use a Web-based educational program, and the other half were put on a waiting list.

The online program provided users with personalized instruction on conserving energy, exercise, nutrition, sleeping habits, and stress management.

After 12 weeks, participants using the Web-based program reported experiencing less fatigue and a higher quality of life than those not using the online program.

The study also found that:

  • 56% of participants using the online program who began the study with moderate to severe fatigue reported a "clinically meaningful" improvement—indicating noticeable changes in everyday life—compared with 45% of participants on the waiting list who began the study with moderate to severe fatigue; and 
  • 42% of all participants using the online program reported improvement in their "worst fatigue," compared with 33% of participants on the waiting list.

Lead researcher Young Ho Yun of Seoul National University College of Medicine said the findings suggest that Web-based programs could provide cancer survivors with an easier way to cope with lingering symptoms.

Yun said, "The program can allow users to obtain information from the Web pages at their own pace and to review material as needed, averting the information overload that sometimes occurs during face-to-face counseling" (Norton, Reuters, 3/21).