Hospitals Ill-Prepared for Computer Glitch

A nationwide survey by the Chicago law firm Gordon & Clickson reveals that hospitals across the country are ill-prepared to face the so-called "year 2000" problem that is due to upset the world's computer system when the clock strikes midnight on January 1, 2000.

The survey found that less than a third of 1,700 hospitals polled have a strategy to prepare their computers for the year 2000. Only 20% have begun to implement any changes and 18% say they have no plans to take pre-emptive actions.

For hospitals and health systems, the year 2000 problem will lead to miscalculations on any function they perform involving dates, resulting in costly systems crashes affecting everything from billings to materials management to clinical data. At most risk are integrated delivery networks with systems cobbled together from mainframes, workstations and PCs from various manufacturers.

HCFA Slow to Use Software for Medicare Fraud

The federal government, which has been investigating Medicare fraud and abuse across the U.S., could have saved more than $1 billion in the past two years by using computer software that finds billing problems.

According to a report by the General Accounting Office (GAO), the Health Care Financing Administration (HCFA) just recently began a pilot test of the software which is used by many hospitals, physicians and insurance companies. The federal agency is lagging far behind in utilizing advanced information technology that is used by private industry, the GAO report showed.

A number of ways have been used to cheat the Medicare program, the GAO report indicated, including:

-- Global service, or billing for a procedure and related services when they should fall under one code.

-- Unbundling, or billing for several codes when one code covers the entire procedure.

-- Duplicate procedures, or billing for the same procedure twice when it was done only once.

-- Upcoding, or billing for an illness that pays more than the diagnosed illness.

In its 1995 study, the GAO ran physician bills through four different software programs and discovered significant overbilling. However, less than 10 percent of providers in the sample had miscoded any claims. The GAO report noted that only a small number of providers are responsible for most of the abuse.

Last year, HCFA awarded GMIS, which produces antibilling abuse software, a two-year, $1.6 million contract to test the software in lowa. If the test project successfully identifies savings, it will be installed nationwide.

Arkansas Hospital DEA Investigations

The federal Drug Enforcement Agency (DEA) has named Mark Johnson as compliance officer and investigator with offices in Little Rock. Johnson has contacted the Arkansas Hospital Association to offer assistance to any hospital seeking guidance on complying with rules and regulations pertaining to the reporting of misplaced or stolen controlled substances. Johnson can be reached at 501-324-5981.

Legislators Approve Outpatient Regulations

The Administrative Rules and Regulations subcommittee of the Arkansas Legislative Council and the Arkansas Board of Health have approved an amendment to the 1988 Rules and Regulations for Hospitals and Related Institutions. The amendment states:

New/existing Outpatient Facilities which do not meet the criteria of the National Fire Protection Association (NFPA), Life Safety Code (LSC) Volume 101 Chapter 12 (new)/13 (existing), Section 12-1.3 (new hospitals and/or ambulatory surgery centers)/13-1.3 (existing hospitals and/or ambulatory surgery centers) will be allowed to be classified as a Business occupancy as defined in LSC 101, Chapter 26 (new)/27 (existing) with the following exceptions:

1. A fire alarm system with local (in-house) capability must be functional, and where power is generated by electricity, an alternate power (i.e. battery backup, emergency generator, etc.) source with automatic triggering must be present per NFPA requirements.

2. Lights, supported by an emergency power source (i.e. battery backup, emergency generator, etc.) must be provided for illumination in means of egress per NFPA requirements.

3. Fire extinguishers shall be provided and be easily accessible per NFPA requirements.

Controlled Substances Added

The Arkansas Department of Health has published the list of Controlled Substances for Arkansas. The list has been updated to include Carisoprodol, Nalbuphine, and Butorphanol. These drugs have been added to Schedule IV and became effective June 27, 1997. For a complete list of controlled substances, contact Joe Rogers, P.D., director, Division of Pharmacy Services & Drug Control, Arkansas Department of Health, 4815 W. Markham, Little Rock, AR 72205-3867, or call (501) 661-2000.

Campaign For Coverage

The American Hospital Association (AHA) has begun Campaign for Coverage ... A Community Health Challenge, a program designed to reduce by 10% the number of uninsured Americans by the end of 1998. Reg Ballantyne, AHA chairman, urged hospitals across the country to take part in the Community Action Initiative part of the campaign. He challenged CEOs to learn where coverage is needed in a community, and then to take the steps needed to get the job done.

Examples cited by Ballantyne in his own community of Phoenix, Arizona are:

-- Free primary medical care to more than 400 uninsured elementary school children.

-- Enrolling community members who qualify for Medicaid and other healthcare programs.

-- Free regular screenings, including breast cancer, skin cancer, prostate, cholesterol, blood pressure and glucose, as well as monthly immunizations for children.

-- Low-cost mammography and breast exam screening programs twice each year.

-- Well-woman health checks for those without insurance.

State hospital associations from all 50 states, the District of Columbia, and Puerto Rico have signed on to the effort, which was established by the AHA board of directors last year and formally announced by AHA president Dick Davidson during the January 1997 AHA Annual Meeting in Washington.

OIG Compliance Program

The federal Department of Health and Human Services' (HHS) Office of the Inspector General (OIG) is nearing completion of its model hospital compliance program. The OIG model plan, which has been under development since early this year, could be released by press time. Even with no model plan available, many healthcare providers have already implemented their own plans as a safeguard for helping them comply with Medicare rules. AHA legal counsel, Diane Mackey, during the Arkansas Hospital Administrators' Forum meeting in mid-summer, suggested that those plans, at a minimum, should include the following elements:

-- Writing standards of conduct for employees;

-- Developing and distributing written

policies that promote the lab's commitment to compliance and address areas of potential fraud such as billing, marketing, and claims processing;

-- Designating a chief compliance officer or an equivalent committee;

-- Educating and training all employees;

-- Auditing or implementing other techniques to monitor compliance or reduce problems;

-- Developing a code of improper/illegal activities and disciplining employees who violate internal compliance policies or laws;

-- Investigating and remediating personnel problems;

-- Making promotion of and adherence to compliance a factor in evaluating supervisors and managers;

-- Prohibiting the employment or retention of anyone sanctioned for healthcare offenses;

-- Maintaining a hot-line to receive complaints and adopting procedures to protect confidentiality; and

-- Adopting requirements for record creation and retention.

During her remarks, Ms. Mackey referred to a letter from HHS' Inspector General, June Gibbs Brown, which indicated that OIG's compliance reviews, as a rule, consider whether reasonable efforts have been made by management to avoid and detect compliance problems. That analysis is normally used in determining the level of sanctions to be imposed, if any are called for. According to Brown, a hospital which implements a compliance program gains no immunity from civil, criminal or administrative procedures, but it may be a relevant factor in negotiations with the OIG, presumably on sanctions.

"I love to hear a story, and everyone has one"

Rev. Rex Horne, Senior Pastor, Immanuel Baptist Church
Trustee, Baptist Health, Little Rock

Everyone has a story--everyone. I attended a board meeting recently that influenced me, not by business conducted, but by a conversation at lunch. I enjoy the men and women of this board and administration. Many of them I rarely see, except at these meetings.

While we were eating lunch, one of my friends told me of an experience many years ago. The event was tragic, an automobile accident that claimed this person's spouse and child. The pain of the experience is present, but the steadfast faith of my colleague is an inspiration. In summarizing the experience of long ago he said, "You are faced with two choices: going up or going down." He moved up, choosing the high road of faith in God and service to people.

On the same day, I received a call that a special friend had been involved in a terrible accident. The accident did not claim his life, but it could have. He faces months of healing and rehabilitation.

Everyone has a story. Not too far along in one's life the truth is revealed that bad things do happen to good people. The loss of a child, spouse, health, mobility, speech, sight, ability to care for oneself or any number of other things most of us take for granted can be crushing. Some give up, others become bitter. Some overcome and if they had not told you, you would not have suspected certain facets of their story.

Those who overcome share some common thoughts and lessons. Someone was willing to help in his or her trying hour. How often do I hear that a pastor, a friend, someone "showed up" and helped them in their crisis. The healing process allowed them to see that others, many others, have suffered as much or even greater. It is likely that the overcomers become people that are mindful of others and enjoy service that benefits neighbors, friends and even strangers.

The stories of that recent day had an impact on me. I know things can change quickly. They have in my own life. I walked to my car thanking God for the sunshine, life and friends who have enriched my experience. I hope to be a better person for I have encountered overcomers.

You never know what story the person next to you in a restaurant, on a plane or on a church pew holds. Neither do you nor I know the instant our story will be forever changed. One knows. He cares and will get us through. Thank God!

Hospital Market Basket Inflation

Many hospitals are currently involved in the budget process. Listed below are the national hospital market basket inflation rates as of March 31, 1997, as published by Rate Controls newsletter. The statistical results are based on national averages from various services and should be used for gross comparisons only. Primary financial planning at individual institutions should be based on local studies and conditions.

Hospital Market Basket Inflation Index

Infant Mortality Rate Declines

The U.S. infant mortality rate, the rate that babies die before their first birthday, is at an historic low of less than eight deaths per 1,000 live births in 1995--6% lower than 1994 and 18% lower than 1990. There also has been a 30% decline in the death rate from sudden infant death syndrome in the U.S. between 1992 and 1995. Despite these gains:

-- 20% of U.S. women fail to get prenatal care in the first three months of pregnancy, the most crucial time in the development of a fetus.

-- Approximately 16% of women continue to smoke while they are pregnant.

-- Nearly 19% of women drink alcohol while they are pregnant.

-- An estimated 5.5% of women have used an illegal drug at least once during their pregnancy.

-- A nationwide public service advertising campaign, "Don't Put Your Baby's Health on the Line," will inform parents about the new toll-free information service. The campaign includes television, print, and billboard advertisements aimed at getting women into early prenatal care.

JCAHO: New Policies and Agreements

-- Hospitals accredited by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) that have recently merged with or acquired another hospital will have to notify the JCAHO. According to Glen Krasker, director of the Joint Commission's hospital accreditation program, no established protocol exists for either mergers or acquisitions. However, he says the JCAHO views them as distinctly different situations.

In a merger, where Hospital A and Hospital B become Hospital C, the emerging new entity is not considered to be accredited by the Joint Commission. Hospital A and B continue to be independently accredited, but if they want to be recognized as a merged, new entity, they need to apply for a survey.

In an acquisition, where Hospital B becomes part of Hospital A, the Joint Commission would consider whether it needs to conduct an "extension survey," one of limited scope and duration to determine whether continued compliance with the standards is being maintained under changed circumstances. An extension survey will be determined by a 25% capacity increase after the acquisition or if the hospital adds a new service.

Krasker said that no matter what type of major change an accredited hospital makes, the hospital should notify the JCAHO within 30 days of making the change.

-- The JCAHO recently agreed to modify the requirements of its new ORYX program to address concerns raised by small hospitals. ORYX is the Joint Commission's initiative to integrate the use of outcomes and other performance measures into the accreditation process.

The modifications permit hospitals with average daily census of 30 or less to report its selected measurement system indicator data points on a quarterly, rather than monthly, basis. Hospitals with smaller populations-- an average daily census of less than 10 but an ambulatory care population of more than 150 visits per month--will also be permitted to select two ambulatory care measures in lieu of any inpatient measures. Hospitals with an average daily census of less than 10 and an ambulatory care population of less than 150 visits per month are temporarily excused from the ORYX requirements. Regardless of size, accredited hospitals must select a pre-approved measurement system before January 1, 1998. Call the ORYX information line with questions at (630) 792-5085.

-- The JCAHO has expanded its cooperative agreement with the Commission on Office Laboratory Accreditation (COLA). It will recognize and accept the accreditation process, findings and decisions of COLA for laboratories affiliated with hospitals and ambulatory care settings accredited by the JCAHO.

-- HCFA has announced that home health agencies accredited by the JCAHO that have been "deemed" as meeting Medicare certification requirements will no longer automatically face unannounced, annual surveys. Instead, the federal government will permit some accredited home health agencies in good standing to be surveyed every 36 months. Survey intervals, which may be one, two or three years, will be determined using HCFA criteria. HCFA will retain the authority to conduct random validation surveys and complaint investigations.

Hospitalist: Specialty Physician

The Wall Street Journal (WSJ) reported recently on the growing numbers of a new type of specialty physician, the "hospitalist." WSJ says a hospitalist is "a sort of designated hitter who stands in for a patient's regular family physician or internist while the patient is in the hospital." The article reports the number of hospitalists practicing in the U.S. is estimated to be 1,200 to 1,500.

Growth among hospitalist physicians has been fueled by managed care organizations' (MCOs) efforts to reduce the duration of hospital stays by their enrollees. Medical groups are using the new breed of doctors to help operate more efficiently, and hospitals are beginning to employ hospitalists to oversee patients admitted by primary care physicians.

The trend is proving to save money for MCOs and hospitals, and advocates say it improves patient care and satisfaction because patients don't have to wait for their own physician to see them during hospital rounds.

Critics argue that the hospitalist physicians lack familiarity with patients' medical and personal background, factors which give personal physicians an advantage in providing patient care. They also say the hospitalist adds another strange face to the string of nurses, technicians, and specialists patients already see during a hospital stay.