Operation Restore Trust Expanded

Saying that Operation Restore Trust (ORT) is "a model that works," Health and Human Services (HHS) Secretary Donna Shalala announced that ORT, which officially expired March 31, will be extended and expanded to target more states and more types of healthcare providers.

According to Shalala, besides home care agencies and hospices, the expanded ORT will focus on clinical labs, nursing homes, psychiatric hospitals, community health centers, and some rural health clinics. The new states ORT efforts will focus on include Arizona, Colorado, Georgia, Louisiana, Massachusetts, Missouri, New Jersey, Ohio, Pennsylvania, Tennessee, Virginia, and Washington. These states are in addition to the original five (California, Florida, New York, Texas, and Illinois).

Shalala also indicated that, over the longer term, "techniques developed by ORT will be applied in all 50 states and will be applied throughout Medicare and Medicaid program areas." These techniques include the following:

-- use of sophisticated statistical methods to identify providers for investigations and audits;

-- use of interdisciplinary teams to review individual facilities with unusually high Medicare reimbursement rates;

-- increased use of concentrated planning and conducting of investigations with the Department of Justice and other law enforcement agencies;

-- training and empowering state and local aging organizations and ombudsmen to detect and report fraud in nursing homes and in other settings; and

-- use of state survey officials who regularly monitor care in home health agencies and nursing homes to identify inappropriate and fraudulent billing.

Shalala credits ORT with 74 criminal convictions and 58 civil actions. Moreover, according to Shalala, ORT has identified almost $188 million owed to the federal government, "constituting a return of more than $23 for every $1 spent on the project."

Safeguard Electronic Health Records

The National Research Council has identified the need to strengthen security measures to safeguard electronic health records. The report says industry standards, regulatory action, and pressure from consumers all are needed to bolster the privacy and security of electronic patient records.

According to the report, the healthcare industry has concentrated its resources primarily on expanding the capabilities of automated information systems rather than protecting it from snoops. Sensitive information circulates routinely among non-caregivers who use it legitimately for claims payment, research, and oversight, adding to the potential for breaches of privacy and security. The committee's report urges healthcare organizations--including hospitals, doctors' offices, and insurance firms--to adopt the following technical and organizational practices for improving security, most of which can be implemented now:

-- Require a unique identifier or password for employees with a legitimate need to know. Sanctions should be in place to discipline those who share their passwords or who leave records open at unattended computers.

-- Encourage organizations to use additional access controls to restrict employees from obtaining information not necessary for their jobs, and routinely conduct electronic audits to track all accesses to clinical information.

-- Develop special software, encrypted passwords, or dedicated modem lines in systems that are vulnerable or set up for remote access.

Within a few years, healthcare organizations should be able to maintain logs of all internal accesses to clinical information, the committee said. In the longer term, organizations should pursue ways of tracing all patient-identifiable information that is passed around. The report also calls for the Department of Health and Human Services to develop industry standards for protecting computerized health records to comply with the Health Insurance Portability and Accountability Act of 1996.

Lead Wire Rules

The federal Food and Drug Administration (FDA) has announced a new safety standard for electrical wires that connect patients to medical devices such as breathing, heart, and brain wave monitors. The standard mandates manufacturers of cables and leads to protect the wires so caregivers can't mistakenly plug them into electrical outlets. The rule applies to hospitals, nursing homes, ambulances, ground transportation vehicles, doctors' offices, and clinics. Although accidents involving unprotected lead wires are rare, there were 24 reported incidents involving related major electrical shock to patients between 1988 and 1994. Five of the patients died from the accidents, which occurred either in hospitals or at home.

The FDA rule, published in the May 9, 1997 Federal Register, specifies ten medical devices which pose the greatest risk of accidental connections. Wires for these devices must meet the new standards within one year: breathing frequency monitors, apnea monitors, electrocardiographs, radio transmitters and receivers, heart monitors, electrocardiograph electrodes, transducer and electrode cables, magnetic tape recorders, arrhythmia detectors and alarms, electrocardiograph telephone transmitters, and receivers. Within three years, the FDA will not allow unprotected cables and lead wires to be used on any medical device.

Global Disease Study Findings

The Harvard School of Public Health has completed the landmark Global Burden of Disease study, the most extensive analysis ever undertaken of worldwide patterns of death and disability. The study documents the impact of over 100 diseases across the industrialized and non-industrialized world and projects their course over the next 30 years. One of the study's key innovations was its measurement not only of how any people are killed by a disease, but also of the often crippling disabilities that afflict the victims of these diseases.

A sample of the study's findings includes:

-- Heart disease and stroke are now the leading causes of death worldwide, accounting for 21% of the 50 million deaths in 1990. Although these diseases are traditionally associated with affluent lifestyles in developed nations, more than half of the victims of cardiovascular disease are from the developing world.

-- Depression, although rarely given the same attention as infectious or chronic diseases, was the world's leading cause of disability in 1990. In all, psychiatric illnesses accounted for five of the ten leading causes of disability.

-- After malnutrition, tobacco use is the single biggest risk factor for death worldwide. By 2020, tobacco is expected to kill more people each year than any single disease, including AIDS.

A summary of the Global Burden of Disease study appears on the School's World Wide Web site at http://www.hsph.harvard.edu/Organizations/bdu. Printed summaries are available through the Office of the Dean by calling 617-432-1025.

FMLA Hotline Clarifies Employer, Employee Rights

Many nonprofits face tough questions from staffers about their rights to paid or unpaid leave under the Family and Medical Leave Act. In fact, the family leave act has proven to be one of the most confusing laws for nonprofits to implement.

According to the Department of Labor, more than 6,000 complaints have been filed since the law took effect, with 95 percent of those involving complaints against employers for alleged failure to comply with the FMLA. About 67 million employees in the for-profit, nonprofit and public service sectors are covered and eligible for family medical leave, which permits paid or unpaid leave to care for a seriously ill family member.

To help ease implementation for employers and to answer employee questions, the Department of Labor recently set up a toll-free number where you can get a brief explanation of the law and request more detailed information through the mail. The number is 1-800-959-FMLA (1 -800-959-3652).

The Department of Labor also posts additional information about the FMLA and its implementation on its Web site at http://www.dol.gov/esa/fmla.htm. There are two sample forms available online to assist employers in handling leave and medical certification requests.

Arkansas Program Awarded Grant

The Arkansas Medicaid ConnectCare program, which encourages patients to obtain routine healthcare services from their primary care physician rather than in hospital emergency rooms, has been awarded a $20,000 grant from the Ford Foundation. The program was also named one of 25 finalists for the 1997 Innovations in American Government Awards. The finalists, selected from a pool of 1,540 applicants, will compete for a total grant of $100,000 to be awarded each of ten winners in October. The awards are administered by Harvard University's Kennedy School of Government in partnership with the Center for Excellence in Government.

ConnectCare, established in 1994, has succeeded in getting primary care physicians in Arkansas to accept more Medicaid patients and in educating patients to see their physician when routine services are needed. As a result, according to Medicaid officials, hospital emergency room utilization by Medicaid recipients has fallen 10% below the usage by the overall population. Medicaid director Ray Hanley credited ConnectCare with saving Arkansas millions of dollars; making life easier for people applying for Medicaid; and vastly simplifying the Medicaid billing process.

AHA Ceases Publication of News Digest

As a measure to reduce annual operating expenses and reallocate limited resources, the Arkansas Hospital Association ceased publication of its monthly News Digest following the June 1997, issue.

The move consolidated three AHA publications, the News Digest, Arkansas Hospitals, and the weekly Notebook, into two. Some features of the News Digest will be incorporated into the other publications.

To keep our membership informed about hospital and other healthcare issues, all AHA members, both institutional and personal, will receive Arkansas Hospitals, beginning with this issue.

Arkansas Hospitals Quiz
(answers below)

1. What former hospital executive has been named director of the Arkansas Department of Human Services?

2. What new law allows employees to change jobs, while receiving continuous health insurance without regard to many pre-existing conditions?

3. True or False: The fabled "year 2000" computer problem will not affect hospitals.

4. The Campaign for Coverage is designed to reduce by ____ the number of uninsured Americans by the end of 1998.

5. Approximately 250 Arkansas high school students participated in MASH, (A) a popular TV show (B) Medical Application of Science for Health.

6. True or False: Medicare managed care is on the rise in Arkansas, as well as other states.

7. What Arkansas hospital was evacuated for five days because of deadly fumes from a chemical plant explosion?

8. True or False: Operation Restore Trust has been expanded to target more states because of its effectiveness in identifying healthcare fraud.

9. Who is the new Drug Enforcement Agency investigator assigned to Arkansas?

10. True or False: Strokes do not affect Arkansans, and are not worth studying.

Answers: 1. Lee Frazier 2.the Health Insurance Portability and Accountability Act 3.False 4. 10% 5. B 6. True 7. Helena Regional Medical Center 8. True 9. Mark Johnson 10. False