Health Reform Pervades Economic Stimulus Bill

From the Wall Street Journal Health Blog:

You might mistake the economic stimulus package slated for a House vote today for a health-reform bill, if weren’t sprinkled with some goodies for other sectors of the economy.

Take a look at the changes to Medicaid policy, in particular, the New York Times reports. If it becomes law, the bill would temporarily allow unemployed workers to qualify for Medicaid regardless of their income or assets. Medicaid is typically for the poor.

The bill also increases federal funding for Medicaid and subsidizes laid-off workers who are paying for Cobra insurance coverage through their former employers, NYT says. Here’s how the paper quotes the Congressional Budget Office on the costs: $87 billion to increase the federal share of Medicaid; $29 billion to subsidize private insurance and $11 billion to fund Medicaid for unemployed workers who wouldn’t otherwise qualify.

Grassley pushes legislation to aid rural access

From Modern Healthcare:

Sen. Chuck Grassley (R-Iowa) has introduced legislation intended to improve Medicare payments to rural doctors, ambulance services and midsized hospitals. The Medicare Rural Health Access Improvement Act of 2009 would also seek to protect access for rural residents to home medical equipment and supplies, as well as continue to lend support to critical-access hospitals, according to a summary of the legislation from Grassley’s office.

In addition, the bill could provide relief to the so-called “tweener” hospitals, which are too large to be designated as critical-access hospitals—having 25 or fewer beds—but too small to be financially viable under the Medicare hospital prospective payment system. Grassley said in a news release that there is “no justification” for Medicare not to recognize the unique role of these facilities.

Most tweener hospitals are designated in the Medicare program as Medicare Dependent Hospitals or Sole Community Hospitals. Specifically, this bill’s provisions would provide temporary and permanent improvements so that payments to these hospitals would better reflect the cost of providing inpatient and outpatient services. Also, the bill would extend and increase rural ambulance payments by 5% for next year. And it would protect rural areas from being affected by the new Medicare competitive-bidding program for durable medical equipment, as rural and metropolitan statistical areas with populations of 600,000 or fewer would be exempt from the bidding process.

ER doctors sue state, say emergency room system near collapse

From the LA Times:

Emergency room doctors filed a lawsuit today against the state, saying that California’s overstressed emergency healthcare system is on the verge of collapse unless they receive additional funding.

California has seen 85 hospital closures in the last decade. An additional 55 facilities have shut down emergency rooms. The state now ranks last in the country in access to emergency care and is last in emergency rooms per capita with only seven per 1 million people. The national average is 20 emergency rooms per 1 million people.

“Patients are suffering every day,” said Irv Edwards, one of the doctors represented in the lawsuit and president of Emergent Medical Associates, which staffs 12 emergency rooms in Southern California. “There are emergency rooms throughout the state where people, we believe, have died. Some have died in the lobby before they were seen. Some have died shortly after being placed in a bed after having waited in the lobby for hours. Are people truly suffering consequences? Absolutely.”

Emergency room physicians say they have been particularly hard hit by the state’s fiscal problems. Unlike other doctors, who can choose not to accept Medi-Cal patients, emergency rooms cannot deny treatment. They provide care for these patients but are reimbursed at rates they say are half the cost of the treatment. California’s reimbursement rate ranks 43rd in the country, state officials said.

“As we go forward, these emergency room doctors, they can’t any longer take on the financial burden of the state’s obligation to its poor and to its elderly,” said attorney Raymond Boucher, who filed the lawsuit in Los Angeles County Superior Court today.  “This isn’t a joke. This isn’t just a power play. They are on life support.”

Emergency room doctors statewide believe they subsidized more than $100 million in services provided to Medi-Cal patients in 2007 alone, according to the lawsuit.

MRSA screening test

From the manufacturer’s website:

The MicroPhage MRSA screening test identifies methicillin-resistant S. aureus (MRSA) when you need rapid results in a simple-to-use, cost sensible format.

MicroPhage’s bacteriophage amplification technology will provide the performance of molecular results at a price that is more in line with chromagenic culture media. The easy-to-use platform allows for simple, unbatched test starts and rapid batched or unbatched results, perfect for an early morning delivery of hospital-wide results when Infection Control can best use them. The MicroPhage MRSA screening test is ideal for institutions concerned with screening for MRSA in their patients that may not have the capacity for molecular or traditional microbiology.

Concierge Emergency Department

From richard[WINTERS]md:

Some patients will want more service. Some will be willing to pay for that service.

This can occur safely as long as we ensure that:

• The sickest patients get a bed.
• Care should not be delayed for anyone.
• Although extra service may be purchased, care should be equal.

For a fee families or individuals could become members of the Concierge Emergency Department. What do they get for the fee?

• A private room.
• Couches and chairs for family.
• Private telephone and wireless or wired internet connections.
• Flat screen television with movies and video games.
• Food and drinks.
• The hospital’s nursing and ancillary service stars.
• Member events and dinners where they get to meet the board, executives and physicians.
• Answers to outpatient questions and appointments with hospital-based preferred physicians.

Many of the tactics used by concierge primary care physicians, hotels, and frequent flier clubs may be adopted by hospitals and hospital based physicians. The fee could be paid annually or at a higher level at the time of service.

This is a source of cash flow for hospitals. It may save some hospitals.

Computers reduce odds of in-hospital deaths: study

From Modern Healthcare:

When computers replace paper, patient mortality rates drop 15% during hospitalization, among other metrics, according to a study of 41 Texas hospitals by Baltimore-based Johns Hopkins School of Medicine researchers published in the Archives of Internal Medicine.

The researchers divided hospital clinical information technology systems into four categories: medical notes and records, test results, order entry and clinical decision support. Physicians from the 41 hospitals ranked them in each of the four categories and researchers examined the relationship between those rankings and the rates of inpatient death, complications, costs and length of stay for 167,233 patients—all older than age 50—who were admitted to the participating hospitals in 2005 and 2006.

In addition to lower overall mortality rates, hospitals with higher scores for computerized order-entry systems posted 55% lower odds of death for patients undergoing surgery for coronary artery bypass grafts and 9% lower odds of death for patients with myocardial infarction.

Higher scores for computerized order entry were associated with lower average costs per admission and 16% lower odds of developing complications across all reasons for admission. The New York-based Commonwealth Fund funded the study.

Allscripts CEO Urges One-Two Punch on Electronic Medical Records

From the Wall Street Journal Health Blog:

Glen Tullman, chief executive of the health IT outfit Allscripts-Misys Healthcare and an advisor to the Obama campaign on health information technology issues, argues that that any legislation should first help doctors buy and install electronic medical records, then give them financial incentives to actually use them in a way that could reduce waste and improve care. “That one-two punch would dramatically change the adoption rate for physicians,” he said in an interview with The Health Blog.

The House bill does provide such bonuses for doctors who use the records to coordinate care and in other “meaningful” ways, while draft legislation introduced in the Senate provides upfront funding. “Congress is on the right track,” he says. “Now we have to put those bills together and make them a reality.”

ED Physicians, Inpatient Duties

From Today’s Hospitalist:

Q: An emergency department (ED) doctor sees a patient in the ED and admits that patient to inpatient status. The same physician then sees the patient on the floor, acting as a hospitalist for the same ED group. How should we bill this?

A: When ED doctors serve as the admitting physician, they can bill only the admission. If they are treating a patient in the hospital who they didn’t admit, they should bill for a subsequent hospital visit. The ED visit would be bundled into either hospital service if provided by a doctor in the same group who is part of the same specialty.

New study challenges effectiveness of rapid response teams

From Today’s Hospitalist:

New research has found that rapid response teams (RRTs) for adult patients may not lead to significantly fewer cardiopulmonary arrests or deaths.

The study looked at the effects of a rapid response team in a single hospital in Kansas City, Mo. While researchers found fewer cardiac arrests in the hospital after a team was put in place, the difference was not statistically significant. The number of overall hospital deaths also did not decline after an RRT was implemented.

The study was published in the Dec. 3, 2008, Journal of the American Medical Association. The use of RRTs has been heavily promoted by organizations like the Institute of Healthcare Improvement, which made the adoption of an RRT one of the six “planks” in its 100,000 Lives campaign.

Tougher times for hospitals

From Today’s Hospitalist:

Results from a new survey detail the types of new financial pressures on the nation’s hospitals and those facilities’ new cost-cutting initiatives. In November 2008, the American Hospital Association issued results from a third quarter survey with a sample of more than 730 hospitals. The following are some of those findings:

• Nearly 40% of respondents noted a drop in the number of overall admissions.
• More than 30% of survey respondents reported a moderate to significant decline in patients seeking elective procedures.
• The proportion of patients needing uncompensated care rose 8% over the same period in 2007.
• Total profit margins for hospitals for the third quarter were -1.6% vs. +6.1% in the same quarter the previous year.
• The number of respondents making or considering cutbacks was 60% for administrative cuts, 53% for staffing cuts and 27% for reducing services.
• Hospitals’ interest payments rose 15% compared to the same quarter in 2007. Among respondents, 45% planned to delay purchasing clinical technology; and
• 39% intended to put off investing in information technology.