About one in four hospital executives in the tri-state area of Arkansas, Tennessee, and Mississippi would choose not to go into healthcare if they could start their careers over, a new survey indicates. The survey, developed by The MHA Group, an Irving, Texas based organization of affiliated healthcare staffing firms, was mailed to over 350 hospital executives in the tri-state area by the Arkansas, Tennessee, and Mississippi hospital associations.

Strategic Concerns

Hospital executives face a number of concerns that might cause them to rethink their decision to enter healthcare, according to James Merritt, president of The MHA Group. Close to 90% of executives cited declining Medicare/Medicaid reimbursement as one of the top three strategic priorities facing their hospitals in 1999.

Other top concerns included reducing costs/increasing efficiency, Y2K issues, and compliance with government regulations. While responding to increased managed care was cited as a top priority in 1998 by 29% of executives surveyed, only 18% saw managed care as a top priority for 1999. "Managed care is no longer at the top of most hospital executives' worry list," says Merritt. "They are more concerned with the budget crunch caused by changing government reimbursement." To meet these challenges, hospital executives spend the majority of their time on hospital-based activities involving human resources, information processing, medical records and other hospital departments. About two-thirds of executives spend the majority of their time on such activities. However, 45% of executives spend at least one-fifth of their time on such community-based activities as business group meetings, speeches, networking, and public relations events.

Primary Care Still Top Recruiting Target

The great majority of executives (98%) feel that their medical staffs are somewhat or very cooperative with hospital administration, the survey indicates. Conflicts between hospital administrators and physicians that do occur generally concern physician recruitment practices, competition with physicians, or hospital equipment and facilities.

"An increasing number of hospitals now find themselves competing with physicians who own surgery or diagnostic centers," Merritt states. "Physician recruitment also is a sore spot. Many physicians feel threatened when a hospital plans to bring additional physician services to the area."

Almost 50% of executives indicated their hospitals are currently recruiting primary care physicians, suggesting that "generalist" doctors remain the healthcare providers in greatest demand. About 40% of executives stated their hospitals are recruiting specialist physicians, with 33% recruiting nurses, 29% recruiting allied healthcare professionals, and 14% recruiting executive management. Forty percent or more of executives surveyed believe recruitment in these areas has grown easier in the last two-three years. About 30% to 40% of executives indicate that recruitment has become more difficult.

A Few Regrets

The fact that one-quarter of healthcare executives would choose a field other than healthcare if they could start their careers over is not surprising, according to Merritt. "Hospital administrators are in a pressure cooker," Merritt says. "Patients demand quality, yet reimbursement keeps declining. Meanwhile, government scrutiny of hospitals is at an all-time high. No wonder some executives are questioning their choice of a career." For a free copy of the survey, call The MHA Group at 800-876-0500, or access www.mhagroup.com.

Home Health Cuts Too Much

New data from the Health Care Financing Administration's (HCFA) Office of the Actuary confirms what home care representatives have been saying for some time - Medicare home health outlays dropped sharply between federal fiscal years (FY) 1997 and 1998. While the drop is good news for Medicare spending, it may signal an approaching crisis in access to home health services for eligible beneficiaries. HCFA's data indicate that home health outlays for FY 1998 were $14.8 billion, down 16.9% from actual FY 1997 spending of $17.8 billion. This stands in stark contrast to HCFA's May 1998 budget review, which had predicted $17.3 billion in home health outlays for FY 1998.

Medicare home health spending estimates have been a hotly debated issue in recent years. Several years of rapid growth in spending, coupled with alleged fraud and abuse among home health providers, led HCFA to propose ways to alter the payment method for home health care. Those changes were incorporated into the BBA and may now be responsible for cutting too much. The newly released data was also the basis of a HCFA report issued in February projecting total five-year Medicare expenditures for home health at $86.7 billion. That is a dramatic difference from the pre-Balanced Budget Act (BBA) estimate of $127 billion, or even a post-BBA estimate of $110.9 billion. The disparity between those estimates, and between the estimates and actual experience, highlights the degree of inaccuracy of data used to justify the BBA changes two years ago. It also shows how difficult it is for the Congressional Budget Office and HCFA to accurately predict the level of home health outlays. The data seem to confirm the home health industry's concerns that recently enacted Medicare home health cuts, and others on the horizon, go far deeper than originally intended.

Gets OIG's Attention

The Health and Human Services Office of Inspector General (OIG) and the Department of Justice are intensifying their investigations of how hospitals charge Medicare for pneumonia cases. The OIG lists upcoding as a primary enforcement goal for fiscal 1999. Inspector General June Gibbs Brown said her office has begun tackling upcoding-what it calls "DRG creep"-by focusing on pneumonia codes DRG 79 and 89. DRG 89 is used for simple pneumonia, while DRG 79 is used for pneumonia caused by bacteria that doesn't fall under a specific code. DRG 79 can pay thousands of dollars more per case than DRG 89.

According to the American Hospital Association (AHA), the Inspector General's office is currently investigating DRG 79/89 coding at more than 100 hospi tals, and to date has issued over 110 sub poenas targeting possible systemic mis coding. The subpoenas require hospitals to provide the government with documentation for specific records, any training material or written guidance provided to coders, audit results, computer programs, and work papers. According to the AHA's Health Care Compliance Service, to avoid upcoding problems, hospital's should:

• abide by official coding guidelines to ensure accurate and consistent coding;
• keep coding staff up to date on clinical topics and regulatory changes;
• use coding software to screen coding and DRG assignments;
• monitor inpatient diagnosis coding and DRG assignments for unusual trends and compare them with national standards;
• evaluate inpatient coding on a daily basis to detect and correct discrepancies prior to billing; and,
• develop a protocol for reporting and returning discovered overpayments from the government, as well as for determining when self-disclosure of potential miscoding is appropriate.