Growing Deficit May Threaten Health Reform Law More Than Elections, Supreme Court Ruling

Written by Jaimie Oh | December 19, 2011

Cost-controlling initiatives under President Obama’s landmark healthcare reform law may face greater risk of “running aground” as the country’s deficit continues to grow, according to a Reuters report.

The healthcare reform law has drawn intense opposition from conservative leaders, and the question of its constitutionality will be the subject of the Supreme Court’s review this spring. In addition, the reform law could face a possible repeal, pending results from the upcoming presidential election. GOP candidates have made no secret on their intents to scrap the entire law if they are elected into office.

Despite these threats, former healthcare policymakers from both sides have expressed concern that the growing deficit — rather than a Supreme Court ruling or a GOP win in the presidential election — could pose the greatest risk to upcoming changes under the reform law, which includes wide-ranging initiatives to improve quality while controlling costs.

These initiatives, including bundled payments, are vulnerable to cuts since it has not yet been proven whether the efforts can cut costs over the long term. In addition, lawmakers may be forced to make additional cuts to federal healthcare programs, forcing healthcare providers to revert back to fee-for-service models and turn away Medicare or Medicaid patients.

“If the plan is what’s on the table now, which is cut, cut, cut — shift the burden to poor people and taxpayers, take away benefits, take away Medicaid coverage — things will get worse,” former CMS administrator Don Berwick, MD, said in the report.

NorthShore CEO: Supreme Court Decision Won’t Stop Healthcare Reform

By: Molly Gamble

Mark Neaman, CEO of Evanston, Ill.-based NorthShore University HealthSystem, thinks most provisions of the Patient Protection and Affordable Care Act will survive even if the U.S. Supreme Court rejects the individual health insurance mandate, according to a Highland Park Pioneer Press report.

While Mr. Neaman doesn’t think it will overturn the healthcare reform law, he still thinks the decision is an important one. “If you are not responsible for having health insurance, what does that mean for the rest of the people that do spend money to buy health insurance? It is an unlevel, or unfair, playing field,” Mr. Neaman said, according to the report. The Supreme Court is set to hear arguments in late March on the constitutionality of the mandate.

The CEO of the four-hospital system also said employers’ reaction to the employer mandate to provide coverage will have large implications since employers drive the financing of healthcare. “The Affordable Care Act says that if you have 50 or more employees, then you must do one of two things. You must offer health insurance at a high federal level, [or] you must subsidize it so it is ‘affordable,” Mr. Neaman said, according to the report. “It is play or pay.”

He also noted predictions that 30 percent of large employers and 50 percent of small employers who offer health insurance today will drop out. “If employers opt out, is the Affordable Care Act affordable?” Mr. Neaman said, according to the report.

Google Helps Emergency Room Docs to Predict Flu Trend

Google, the search-engine giant, may be able to help doctors anticipate when they’ll get a surge in the number of patients they see with flu symptoms.

That’s the new finding from a team of doctors, based in Baltimore, who relied on Google Flu Trends, a service that tracks the number of flu-related Internet searches by folks like you and me. In an article this month in the journal Clinical Infectious Diseases, those doctors, led by Dr. Richard Rothman, an emergency medicine physician at Johns Hopkins School of Medicine describe how data from Google Flu Trends stacked up against conventional systems to track the spread of flu

Hospital workers don’t report 86% of patient harm events

By: Alicia Caramenico

Hospital workers reported only about 14 percent of the patient-safety incidents experienced by Medicare beneficiaries discharged in October 2008, according to a new report from the Office of the Inspector General (OIG).

Hospital staff failed to report the remaining 86 percent of patient harm events, partly due to staff misunderstanding what constitutes patient harm. Hospital administrators labeled 61 percent of the unreported events as those that staff did not identify as reportable and 25 percent as events that staff normally reported but did not report in this case, according to the OIG.

According to the report, all of the 189 hospitals reviewed used incident reporting systems to identify patient safety incidents. Although they rely heavily on such systems to track and analyze problems, administrators admitted they supply incomplete data about how often problems occur, the OIG notes.

To help hospitals ensure patient safety, the OIG recommends the Agency for Healthcare Research and Quality (AHRQ) and the Centers for Medicare & Medicaid Services (CMS) join forces to enhance the efficiency of incident reporting systems.

AHRQ agreed that it will work with CMS to create a list of potentially reportable events, as well as offer technical assistance to help hospitals use the list, the report states. Similarly, CMS agreed to provide guidance to accreditors about their assessment of hospitals’ patient safety improvement efforts.

In addition to incident reporting systems, hospitals could implement a program that encourages clinicians to report risky incidents before an adverse event happens. The “Good Catch Award” program at John Hopkins led to 27 potentially life-saving changes in only 24 months, according to a September 2011 article in Anesthesiology News

Looming Doctor Pay Cuts

Written by Embra King

On January first of next year the Medicare physician pay reduction plan is set to be implemented, unless of Congress steps in and provides relief from these pay cuts as they have been doing since 2003. The projected percentage of doctor pay cuts has fallen since earlier this year, however doctor organizations say the now estimated 27.4 percent cut will still be devastating to physicians and patients alike. These pay reductions would add to a system that is already under funded.

“Many physicians are already struggling with inadequate Medicare payment rates and the ongoing threat of future cuts from this broken physician payment formula,” Dr. Carmel the president of American Medical Association said. “Payments for Medicare physician services have fallen so far below increases in medical practice costs that there is a 20% gap between Medicare payment updates and the cost of caring for seniors.”

With these looming pay cuts, beneficiaries would suffer because they would not be able to see their doctor of choice, while physicians may consider leaving the insurance program or closing their doors altogether.

Since 2003, Congress has been providing temporary support against the budget cuts. We are in need of a long-term solution; our systemcan’t rely on temporary relief each year. President Obama has pledged that his current budget proposal will include funding for a fix to the SGR problem, protection for Medicare beneficiaries’ access to doctors, and a call for Congress to stop cuts to doctor’s pay.

You’ve Got Care

How technology is helping to bridge the gap between physicians and caregivers

Currently in the United States, more than 29% of Americans are acting as caregivers for someone else. A majority of these caregivers also hold a full-time job, while they spend an estimated twenty hours a week providing patient care. With all this time spent looking after another, caregivers are turning to technological advances to easy their workload. They hope that by making information sharing and staying organized it will give them more time to relax and take some stress off their shoulders.

Together, the caregiver and physician play an important role in taking care of those who can no longer look after themselves. It is crucial that communication between these two parties be made as simple and streamlined as possible. With new emerging technologies that can be delivered between physicians, or straight to a caregiver’s phone or email, the future is looking up for those who look after others.

The use of technology can help assure that the patient is making it to all scheduled appointments with the one or many physicians that are in charge of them. It will help make patient records easier to obtain by the myriad of doctors involved in a patient’s care, information such as health history, test results and medication lists. Electronic records that can be accessed online, makes viewing information and sharing records between physicians much easier.

Helping to remind the patient to take their medicine everyday can be tricky, especially when the caregiver does not live in the same house as they do. There are now tools on the market that can help with this problem, sending out audio reminders to the patient when it is time to take their medication. If it isn’t taken, the caregiver is sent an alert letting them know and they can respond accordingly.

In a study published in January by the National Alliance for Caregiving and United Healthcare, it was found that a majority of caregivers desire monitoring devices that collect data, such as vital signs and blood pressure, which would then be sent to physicians and caregivers. This they say would help keep them informed of their loved ones health without them needing to be present all the time. The problem with this however is coming up with a cost effective way to provide the service. The cost of providing such a service is currently very costly to doctors, who would have to hire new staff members just to review his patient’s monitors, looking out for out for any irregularities or caution signs.

While caring for another who is no longer independent is a very tough job, there is no denying that technology is helping to make their jobs a little easier. Over time, technological advances will help bring the patient better personal care and lower the number of office visits they will need to make. At the same time this will help make the lives of those who care for them that much easier.

Weak Economy Curbs U.S. Health Spending

by Julie Rovner

No, it’s not quite going down. But health care spending in 2010 rose at the second-slowest rate in the last half-century.

The Centers for Medicare and Medicaid Services reports that total health spending in the U.S. increased by 3.9 percent in 2010, just a notch above the slowest rate since the government started keeping track — 3.8 percent in 2009.

Overall, the U.S. spent $2.6 trillion on health care in 2010, or $8,402 per person. That’s 17.9 percent of the nation’s gross domestic product.

But despite claims from Republicans that the federal health overhaul, signed into law in March 2010, is already causing health spending to surge, these numbers don’t bear that out, says lead author Anne Martin.

“Although some provisions of the Affordable Care Act were in effect in 2010, their impact on health spending was minimal,” Martin told reporters on a conference call.

What, then, accounts for two straight years of historically slow growth in health spending? Mostly the poor economy.

“A substantial loss of private health insurance, and lower median household income, contributed to extraordinarily low growth in the use and intensity of health care goods and services in 2010 as individuals remained cautious about their spending,” Martin said.

Yet many voters seem to be under the impression that the health law is raising, not lowering, health care spending.

So what accounts for that?

“If I had to answer it truthfully, mostly the answer is politicians lie the blue from the sky to serve their purpose,” said Princeton health economist Uwe Reinhardt. “It would be hard to imagine how the Affordable Care Act could have driven up health spending in the last year, simply because it really doesn’t start until the year 2014.”

In fact, Reinhardt says that President Obama “could turn this on the Republicans and claim that his health care bill has controlled health care spending. That wouldn’t, in my view, be true, either. But he can do it. I hope he will, just to teach the other side a lesson.”

The White House is close to doing just that. In a blog post accompanying the study, Obama’s deputy chief of staff, Nancy-Ann DeParle, says the new numbers “show why the Affordable Care Act is so important. And we’re confident the law will continue to help hold down cost growth in the years ahead.”

And this slowdown in spending, of course, is relative; the 3.9 percent rise is more than double 2010’s overall inflation rate of 1.6 percent.

Using Stem Cells to Help Reverse Heart Damage

By Embra King

For as long as medicine has been practiced and the human heart examined, the medical world believed that heart damage was permanent and there was nothing to be done about it. On Monday however, two different groups released reports that will change how we treat heart conditions. Dr. Robert Bolli’s group and a teamfrom Cedars-Sinai have both produced separate reports that, in at least a small group of test subjects, stem cell therapy has been able reverse heart damage with no serious side effects.

The results when compared to patients not treated with a clean stem cell transfer have been remarkable. The amount of blood pumped through the heart with each beat in Bolli’s patients increased by an average 8% increase in blood flow in only a four-month span. That percentage was as high as 12% in patients that were followed for a year. With this increase in blood flow Bolli’s patients are able to partake in physical activities that they could no longer do after the heart damage The previous method of trying to surgically open up the patient’s artery has yielded little to no effect.

In the Cedars-Sinai study, researchers found a 30 to 47% reduction in scar tissue in patients who received healthy stem cell transfers. It also increased the production of healthy new tissue, up to 600 million new heart cells.

The most rewarding aspect from the two studies is that of the thirty-three patients between the two studies, none of those receiving stem cells suffered from a major health setback.

What researchers have found are that the heart naturally produces stem cells that can repair the heart, just not in near enough quantities to fix damage done from heart attacks or heart disease. So what researchers have done is to extract these good cells and make millions of copies in a lab for the transfer to an unhealthy heart.

While testing is still young, and the need to do research on a larger scale will be needed before this process is approved as a standard practice, doctor and researchers remain positive. This advancement has the possibility of being the most important advancements in the study of cardiology. Dr. Bolli is for one very optimistic about recent discoveries, “We would possibly be curing heart failure. It would be a revolution.”

5 Top-Paid Medical Specialties

Written by Rachel Fields

Here are 13 statistics about compensation of the five highest-paid medical specialties, according to MGMA’sPhysician Compensation and Production Survey: 2010 Report Based on 2009 Data.

1. Orthopedic surgery — spine

Orthopedic surgeons specializing in spine made an average of $710,055 in compensation in 2009.
Orthopedic surgeons (spine) working in a multi-specialty group practice made more than those working in a single-specialty group practice, at $622,568 compared to $605,139.
Orthopedic surgeons (spine) working in metropolitan areas of 50,000-250,000 residents made more than any other demographic classification, at $717,710.

2. Surgery — neurological

Neurological surgeons made an average of $675,825 in compensation in 2009.
Neurological surgeons working in a single-specialty group practice made more than those working in a multi-specialty group practice, at $601,117 compared to $599,933.
Neurological surgeons working in metropolitan areas of 50,000-250,000 residents made more than any other demographic classification, at $782,332.

3. Dermatology — mohs surgery

Dermatologists specializing in mohs surgery made an average of $674,454 in compensation in 2009.
Dermatologists (mohs surgery) employed by a hospital made more than those not employed by a hospital, at $644,642 compared to $570,955.

4. Orthopedic surgery — sports medicine

Orthopedic surgeons specializing in sports medicine made an average of $653,642 in compensation in 2009.
Orthopedic surgeons (sports medicine) working in a single-specialty group practice made more than those working in a multi-specialty group practice, at $599,948 compared to $580,378.
Orthopedic surgeons (sports medicine) working in metropolitan areas of more than 1,000,000 residents made more than any other demographic classification, at $617,913.

5. Ophthalmology — retina

Ophthalmologists specializing in retina made an average of $619,114 in compensation in 2009.
Ophthalmologists (retina) working in a multi-specialty group practice made more than those working in a single-specialty group practice, at $594,696 compared to $570,319.

Money Matters: How the Hospital Revenue Cycle Impacts Patient Satisfaction

Hospital leaders are increasingly prioritizing patient satisfaction, understanding that the experience of the patient impacts hospital finances, reputation and physician satisfaction. But one of the most crucial parts of the patient experience — the revenue cycle — is still neglected in favor of pushing customer satisfaction during the clinical encounter. Scott Morgan, chief strategy officer for Avadyne Health, discusses how the revenue cycle impacts patient experience — and what hospitals can do to improve their satisfaction ratings through interactions about money.

How revenue cycle affects the patient experience