Forces Shaping Health Delivery System

The healthcare consulting firm PricewaterhouseCoopers recently surveyed 400 healthcare executives about forces that will shape the nation's health delivery system over the next decade. Results showed that things such as empowered consumers, E-health, and genomics will be the most powerful drivers of change.

Unfortunately, the healthcare experts conclude in their report, HealthCast 2010, that most healthcare organizations aren't well equipped to meet the challenges posed by those forces. Forty-one percent of those surveyed believe hospitals and health systems won't be able to address needs of consumers, who, ten years from now, may be tabbed as "impatient patients." Just under half of the survey responders (48%) think insurers will be able to deal with consumers who are expected to demand speedy, customized healthcare services.

Among the things Pricewaterhouse-Coopers names that healthcare organizations should do to prepare for succeeding ten years from now are: become more consumer-friendly; focus on service and speed as major determinants of consumer satisfaction; develop new E-business lines of service; stress prevention rather than early detection and treatment, which is a more costly approach; and work toward global standards of medical treatment.

JCAHO Survey Changes for 2000 Explained

Nearly 600 surveyors attended the Joint Commission's Annual Surveyor Conference earlier this year and learned about changes to the survey process being implemented in 2000. Here are some of the changes that accredited organizations are experiencing this year.

When surveyors arrive on site, they present the organization with a report on its ORYX data. The Joint Commission recognizes and understands that it would be more desirable for organizations to have this information available prior to the survey. During the second quarter of 2000, the Joint Commission will be able to send these reports to the organization about 30 days prior to its survey.

The Performance Improvement Interview has been expanded and is now called the Performance Measurement and Improvement Interview. Half of the one-hour interview is devoted to looking at ORYX data. During the other half, the organization provides the surveyors with an overview of its performance improvement activities and describes a specific performance improvement project. Beginning in 2001, the use of ORYX data will be included during the on-site survey of home care organizations.

Some other changes in the 2000 survey process include the following:

• In support of a more data-driven accreditation process, surveyors will receive more complete information about organizations prior to survey including ORYX and sentinel event information.
• The Medical Record Review places greater emphasis on review of open versus closed medical records.

The survey agenda has been revised to allow surveyors the time necessary to customize the survey based on the needs of the organization. It includes a block of time that surveyors can use to conduct special interviews, visit additional patient care settings, and discuss special issues that arise on site.

Cancer Survey: We're Stronger Than We Think

Gilda's Club, a national nonprofit organization named for the late comedian Gilda Radner, recently conducted a survey of cancer victims. Among the findings:

• 33% of patients who've undergone chemotherapy call it "difficult" or "extremely difficult," compared with 56% of family members of patients.
• 23% of cancer patients say managing day-to-day tasks is "difficult" or "extremely difficult," compared with 42% of family members and 49% of those untouched by cancer.
• When asked, "What's important in living with cancer?" 84% said "appropriate medical care." Next came "emotional support within the family," cited by 75%. Just 29% cited "being able to work."
• Of those who used support groups, 89% found them helpful-mostly for the feeling of not being alone that one gets from knowing others in the same situation and the positive experiences that result from mutual sharing.

Research for the Cancer Support Survey, with financing by the Whirlpool Foundation, was conducted and analyzed by Mark Clements Research of New York City. Results are based on 1094 responses from a national population sample of 1850 men and women, 18 years or older.

HHS Issues New Poverty Guidelines

A family of four will be able to show about 2.1% more income this year and still qualify for certain federal health programs, the Department of Health and Human Services announced in mid-February. Under the year 2000 poverty guidelines published in the Federal Register, the new poverty level for a family of four in the contiguous 48 states will be $17,050, up from last year's level of $16,700. There are different rates based on the size of the family unit, with most increases running about 1.5% to 2.5%. Separate tables exist for Alaska and Hawaii. For details, see http://aspe.hhs.gov/poverty/poverty.htm.

New Reports Highlight National Anti-Fraud Efforts

The Health Care Fraud and Abuse Control Program resulted in judgments, settlements, and administrative impositions of $524 million last year-while spending $137 million between the Department of Health and Human Services (HHS) and the Department of Justice (DOJ)-according to a new program report. As a result of program activities, the federal government collected $490 million in 1999, resulting from cases of health care fraud and abuse, the report states. Of these recoveries, nearly $369 million was returned to the Medicare Trust Fund. And $4.7 million was recovered as the federal share of Medicaid restitution.

Another report released by the Health Care Financing Administration (HCFA) on its Medicare Integrity Program (MIP), found that the MIP prevented $5.3 billion from being "inappropriately paid to providers" in the last half of 1998 and the first half of 1999, according to a statement by the White House. According to the MIP's semiannual report, postpayment activities-including provider audits-recovered $1.4 billion, and prepayment activities denied $2.6 billion in submitted claims.

Other program accomplishments include the following: 2,976 individuals and entities were excluded from participating in federal healthcare programs; the government collected $1.725 million in civil monetary penalties associated with the Patient Anti-Dumping Statute; at the end of 1999, the Office of Inspector General was monitoring more than 425 corporate integrity agreements; and a Medicare beneficiary outreach campaign has increased the number of calls to the OIG hotline to 300,000 in 1999 from 76,000 in 1998.

Expect Increased FBI Involvement in Health Care Fraud Cases

As the Federal Bureau of Investigation (FBI) increases the number of agents responsible for health care fraud enforcement, Joseph Ways, chief of the bureau's Health Care Fraud Unit, expects the number of investigations and prosecutions to continue its dramatic rise. The FBI's caseload has increased substantially since 1992, when it was involved in 591 cases. At the close of 1999, the FBI's caseload stood at 3,027, according to a recent report by the Department of Health and Human Services (DHHS). "We haven't reached our full allotment [of funds through HIPAA] so to speak," Ways said. "Each year we're going to be adding more bodies, and with the more bodies we add, the more cases we're going to have." The FBI received $66 million from the HIPAA in fiscal year 1999. A large part of these funds went toward increasing the number of FBI agents who work on health care fraud cases. At the end of last year there were nearly 500 of these FBI agents, according to the DHHS report.

Arkansas Nursing Program On Internet

The University of Arkansas for Medical Sciences (UAMS) in Little Rock is offering Internet-based teaching courses in an attempt to help overcome the state's shortage of registered nurses. The online classes, which can lead to a Bachelor of Science degree in nursing, began in January. Funding came from a $900,000 federal grant that was awarded in the fall of 1999.

The university's nursing school actually sponsored three trial Web-based courses in the fall 1999 semester. Three new full-scale courses were initiated in January. An average of 18 students are enrolled in each class. Half of those are from rural areas of Arkansas, where some hospitals report that 30% of their nursing positions are vacant, according to a 1999 study conducted by a state nurse educators' task force.

Nursing students can take the courses using their own computers, at local libraries that have computers available, or at any of UAMS' seven Area Health Education Centers. The cost for the classes is $99 per semester hour, which compares with a typical $250 per hour for classroom courses. More information can be found at the Web site, www.nursing.uams.edu.

Cost Reports Cost Beverly $175M

Fort Smith-based Beverly Enterprises, the nation's largest nursing home chain, pleaded guilty February 3 of defrauding the Medicare program as part of a $175 million settlement of federal investigations into its Medicare billing practices. Under the agreement, Beverly Enterprises-California Inc.-an operating unit of the corporation-pleaded guilty to mail fraud and false statement charges. The unit will pay a $5 million criminal fine.

The larger Beverly corporation will pay a $170 million civil penalty over the next eight years and must sell ten nursing homes located in California, Kansas, Washington, Georgia, and South Carolina. The $175 million settlement is the largest nursing-home fraud settlement recorded in the U.S., but is far less than the $460 million the government claimed Beverly received through filing false Medicare cost reports. The agreement has been expected for several months.

OSHA Requires Safer Devices

The Occupational Safety and Health Administration (OSHA) has released a 263-page directive that requires all healthcare providers to use devices designed with safety in mind. The directive was released without warning November 5 and was effective immediately. OSHA officials said the directive is meant to combat the spread of bloodborne diseases, including AIDS and hepatitis, on the job. Agency reports show that between 590,000 and 800,000 healthcare workers are injured by needles and other types of sharps instruments annually.

Products named in the directive range from IV systems without needles to shielded syringes. Both are indicated as first-line defense measures against needlestick injuries. The rule would apply when states have weaker requirements, or nothing in place to address the problem.

The safety products generally are more expensive than the devices they replace, and additional training costs should add to overall compliance expenses for hospitals. In addition, hospitals may have trouble finding adequate supplies of the newly-required devices in the short run due to past limited production.