AHA Cautions Hospitals about POE Systems
Hospitals should consider a few notes of caution before investing heavily in a computerized physician order entry (POE) system with the idea that such a system will solve all medication error problems, the American Hospital Association (AHA) noted in a recent quality advisory. While recognizing the value of a POE system and the potential for reducing many errors, the organization cautioned, "they are not a panacea for patient safety concerns; indeed, any new system also carries with it the capability of introducing new sources of error."

The advisory urged hospitals to make their POE investment decisions by weighing potential benefits and limitations, "including the lack of formal evaluation of most commercial products," financial considerations and institutional characteristics that may have an effect on successful implementation of a POE system. The AHA has a resource guide to help hospitals make POE investment decisions, "The AHA Guide to Computerized Physician Order-Entry Systems," available at http://www.aha.org by clicking on "Improving Medication Safety."

BUSINESSES PUSH FOR SAFETY
The Leapfrog Group, Fortune 500 companies looking to reduce medical errors, recommended on November 15 that its members refer employees to hospitals that use computerized physician order entry systems; employ "intensivists" – physicians credentialed to serve in intensive care units; and perform a high volume of complex procedures.

While these ideas may hold promise, they're largely in an embryonic stage, said the American Hospital Association. For example, there isn't an off-the-shelf computerized physician order entry system for hospitals to buy; and the supply of intensivists is limited. As for steering patients to high-volume hospitals, patients make their decisions on where to get care based on several factors, including patient preference. A financial commitment from purchasers, however, would help providers implement these changes.

OIG 2001 Work Plan
The Department of Health and Human Services’ (HHS) Office of Inspector General (OIG) has released its FY 2001 work plan which details the various projects the agency has scheduled during fiscal year 2001 which began October 1. The projects will cover the HHS’ major entities, including the Health Care Financing Administration; Public Health Services agencies; and the Administration for Children, Families, and Aging; as well as interdepartmental issues, including state and local government use of federal funds.

Among the multitude of OIG projects are those related to one-day hospital stays, prospective payment system transfers, hospital discharges and subsequent re-admissions, home health compliance programs, consolidated billing requirements for skilled nursing, physicians at teaching hospitals, advanced beneficiary notices, and reimbursement for outpatient prescription drugs. Go to oig.hhs.gov/wrkpln/index.htm to download the report.

Triad’s Arkansas Hospitals May Double
Triad Hospitals Inc, which owns and operates two Arkansas hospitals, announced plans October 19 to buy Quorum Health Group. If the transaction is completed, Triad would own four Arkansas hospitals and have a hand in managing eight others. 

The $2.4 billion deal is conditioned on receipt of a private letter ruling from the Internal Revenue Service indicating it will not alter the tax-free nature of Triad’s 1999 spin-off from HCA. If the sale goes through, Triad would become the third-largest for-profit hospital corporation in the U.S., holding 53 hospitals and 14 ambulatory surgery centers.

Currently, Dallas-based Triad owns 31 hospitals. While most are located in Texas, two are Arkansas facilities – the Medical Center of South Arkansas in El Dorado and Medical Park Hospital in Hope. Quorum owns 22 hospitals and manages 210 others across the country.

In Arkansas, the company owns Northwest Health System in Springdale and Bates Medical Center in Bentonville. It also manages the Saline Memorial Hospital (Benton), Delta Memorial Hospital (Dumas), Helena Regional Medical Center, Rebsamen Medical Center, Inc. (Jacksonville), Chicot Memorial Hospital (Lake Village), Mena Medical Center, Howard Memorial Hospital (Nashville), and Siloam Springs Memorial Hospital. 

Quorum announced plans last August to merge with another company, sell, or recapitalize after it agreed to a $95.5 million settlement with the federal Department of Justice on two qui tam, or whistleblower, fraud and abuse lawsuits. The sale is expected to close during the first half of 2001.

Arkansas Medicaid Proposes Payment Policy
Arkansas Medicaid director Ray Hanley mailed a proposed official notice in late October indicating the program will pay hospitals for newborn bilateral physiological hearing exams beginning in February 2001. The proposed policy must go through the state’s Administrative Procedures process before being finalized. 

Assuming it is eventually approved, effective for Medicaid claims received on and after February 1, 2001, the Medicaid program will remit to the birthing hospital a $96 payment for each newborn screening exam, in addition to the hospital’s normal per diem to cover inpatient care for the newborn. The payment amount is the same as the amount paid to providers that furnish the hearing screen as an outpatient service.

Hospitals may bill Medicaid only on a claim for the inpatient birthing admission, using revenue code 471 to identify the screening exam. Claims for newborn birthing admissions will be denied if the code is not on the claim, unless the hospital is identified by the state Health Department as one that averages fewer than 51 live births per year and the hospital has declined to participate in the screening program in spite of its low delivery number.

Stop Smoking Strategies for Teens (and Adults)
Ninety-percent of smokers pick up the tobacco habit in high school – contributing to the deaths of 400,000 people a year. How do you get a teen’s attention about the hazards of smoking? Online!

The first thing you can do is to type "anti-smoking" into any search engine and you will find numerous sites. Here are a few to try:

You might consider "asking" your teen to access these sites before doing anything else on the Web – and sit down and discuss the information together. You might save a life.

Arkansas Administrators Forum/AHEF’s New Officers
Doug Weeks, senior vice president and administrator of Baptist Health Medical Center in Little Rock, was elected president of the Arkansas Hospital Administrators Forum during the group’s annual breakfast meeting October 12 in Hot Springs. Also elected were Tim Hill, CEO of North Arkansas Regional Medical Center in Harrison, president-elect; and Ed Lacy, administrator, Baptist Health Medical Center Heber Springs, secretary-treasurer.

The Arkansas Health Executives Forum also elected new officers during its October 11 annual meeting. Those elected were: president -- Greg Hart, FACHE, Director of Professional Affairs, Arkansas Blue Cross Blue Shield, Little Rock; president-elect -- David Chumley, FACHE, executive director, American Red Cross Blood Services, Little Rock; and secretary-treasurer -- Christy Hockaday, director of administrative services, Conway Regional Medical Center.

HBO2 Overpayments Cited
A medical review of hyperbaric oxygen therapy (HBO2) by the U.S. Office of Inspector General (OIG) determined that $19.1 million of approximately $49.9 million allowed charges for outpatient hospitals and physicians was paid for inappropriate or excessive treatment. An additional $11.1 million was paid for treatments with questioned quality.

According to the OIG, the erroneous reimbursements result from confusion or abuse of the current coverage policy, medical opinions that do not align with guidelines of the Health Care Financing Administration (HCFA) and inadequate documentation. A failure by Medicare contractors to implement appropriate edits and medical review standards further contributes to inappropriate payments. 

In an effort to resolve these problems, the OIG recommended that HCFA review its national coverage for HBO2 and improve policy guidance and oversight, such as practice guidelines, physician attendance policy, and contractor edits. HCFA generally concurred with the OIG recommendations. A copy is available online at www.hhs.gov/oig/oei/whatsnew.html.

Medicare Premium, Co-Pay Increases
The calendar year (CY) 2001 Medicare Part B premiums will increase by $4.50 to $50.00, an increase of almost 10%, according to a Department of Health and Human Services press release. The Part B premium was not increased at all in 2000 and was increased only $1.70 in 1999. The increase next year is attributable to an increase in health costs and legislative changes that increase Part B spending. 

The Part A premium, for individuals who are not entitled to automatic Part A coverage because they have fewer than 30 quarters of coverage, will be decreased by $1, to $300 per month, while Part A premiums for those who have between 30 and 40 quarters of coverage also will be reduced by $1, to $165 per month.

The CY 2001 Part A inpatient hospital deductible will increase by $16, to $792, an increase of only 2%. This low increase is due to reduced hospital payments and other Part A legislative changes. The Part A co-insurance amounts, which are based on percentages of the inpatient hospital deductible, will be $198 per day for hospital stays of from 60 to 90 days, and $396 per day for stays of longer than 90 days. The skilled nursing facility co-insurance will increase by $2, to $99 per day.