HCFA Terminating Mental Health Centers

The Health Care Financing Administration (HCFA) has devised an action plan to combat rising costs related to Medicare partial hospitalization services. Under the first step of the plan, the agency will be terminating a total of 80 providers of the intensive outpatient psychiatric treatment services over the next few months. Medicare spending on partial hospitalization services, which was originally created to avoid inpatient psychiatric hospital admissions for beneficiaries with acute mental illnesses, jumped from $60 million in 1993 to $370 million in 1997.

HCFA decided to implement the plan after making site visits to 700 of 1,150 community mental health centers (CMHC) in nine southern states, including Arkansas. These providers account for 85% of Medicare's spending on CMHC services. During the review, HCFA found many patients were being "warehoused," playing bingo or watching television, but not receiving services Congress intended when it added the Medicare coverage in 1990.

About 1,150 community mental health centers and 1,000 hospital outpatient departments participate in the Medicare program, providing intensive psychiatric treatment on an outpatient basis to roughly 20,000 beneficiaries in each setting. They are required to provide a set of "core" services to seniors and qualifying children who are severely mentally ill patients; 24-hour emergency care; day treatment or other partial hospitalization services; and screenings to determine whether to admit patients to state mental health facilities.

Hometown Health Improvement Project

The Arkansas Department of Health (ADH) is piloting a new program called the Hometown Health Improvement Project, a community-driven project to improve the health and quality of life in Arkansas communities. Boone County in northwest Arkansas was chosen to pilot the project.

According to the ADH, the project offers an opportunity to bring together community members, public and private organizations, and businesses to identify and address issues in a collaborative manner. It is hoped that the project will: reduce healthcare costs; improve the health and quality of life in the community; decrease the number of days workers are absent due to illness; reduce the number of days school children are absent; help sell a community as a healthy place to live; reduce preventable illnesses and injuries; use available healthcare resources more efficiently; better coordinate community health services; address specific health problems identified by the community; and improve problems related to social issues such as teenage drinking and child abuse.

For more information about the project, contact the Arkansas Department of Health Planning Office at 501-661-2238.

Study Says Hospitalists Effective, Growing in Popularity

Two new studies indicate the use of hospitalists--primary care doctors who manage inpatient care for hospitals or physicians group--indicate interest in the profession is growing. A study published in the Journal of the American Medical Association indicates that the use of teaching physicians who specialize in hospital care may lead to shorter, less costly hospital stays without sacrificing quality or teaching opportunities. According to the study, which was conducted by University of California, San Francisco researchers, hospitalist physicians are more involved in care management than are faculty physicians in the typical teaching hospital.

Robert M. Wachter, M.D., who led the yearlong study of 1,623 patients at UCSF Medical Center from July 1995 to June 1996, believes a hospitalist model of a teaching hospital allows more direct supervision of patient care by physicians more experienced in an attending role. Wachter says typical faculty physicians are more involved with serving as advisors to medical residents. The study showed that patients under the care of a hospitalist had average stays 14% less than patients whose physicians were more typical faculty physicians, and their total hospitalization costs were 9% less.

A second study by the Medical Group Management Association shows that hospitalists have a median annual pay of $139,000. That's slightly less than the average pay for internists, according to the report. Sue Cejka, president of the consulting firm that funded the survey, said hospitalist careers are gaining in popularity due to the predictable hours and interesting work. She said the fact that pay levels are on par with other speciality physicians is an added benefit.

Changes Pending in Restraint Use

A Connecticut newspaper series on alleged misuse of physical restraints is prompting new legislation, a planned Capitol Hill hearing, and increased attention by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO). A Hartford Courant investigation revealed at least 142 deaths (and suggested a much higher actual number) in the past decade connected to the use of physical restraints or seclusion in psychiatric hospitals, mental retardation facilities, and group homes. The series can be viewed on the newspaper's web site at www.courant.com.

The JCAHO was expected to issue a Sentinel Event Alert to warn healthcare facilities of the dangers of improperly used restraints, and to suggest ways of avoiding problems. "The Joint Commission considers any death of a patient in restraint to be serious, and when we learn of one, we immediately follow up under our sentinel event policy," said a JCAHO spokesman.

U.S. Senator Joseph I. Lieberman (D-CT) wants to conduct congressional hearings on the issue, and he plans to ask the General Accounting Office to report to Congress on the number of restraint-related deaths across the country.

In late October, the National Alliance for the Mentally Ill (NAMI) called for an immediate federal investigation into the magnitude of the problem. "The real tragedy of this report is that steps have not been taken to prevent future deaths," NAMI executive director Laurie Flynn said in a news release. The group is making a number of recommendations that may be incorporated by legislators.

Transplant Survival Rates Improve

According to a new study in the Journal of the American Medical Association (JAMA), most U.S. transplant centers meet or exceed their expected survival rates. And, survival rates for all transplants of almost all organs are improving over time, mainly due to newer anti-rejection drugs. Heart transplant survival rates have remained steady.

Researchers analyzed 97,587 solid organ transplants performed at 742 centers from January 1988 through April 1994. They found that the major risk of dying after transplantation occurs in the first year, mainly because of the surgery itself, an organ that was preserved too long, and early infections and rejection episodes. Patients who live a year following transplantation show an optimistic outlook for long-term survival, say researchers.

In a second JAMA study, researchers from Case Western Reserve University in Cleveland found that blacks, women and the poor were less likely to get on waiting lists for kidney transplants than whites, men or higher-income patients. In the first study to examine the steps leading up to getting on the waiting list, scientists studied 7,125 long-term dialysis patients. Medicare pays for kidney transplants, but incidental out-of-pocket costs might keep the poor from seeking transplants, and religious concerns may dissuade blacks. It is unclear why women are less likely to get transplants.

Arkansas Hospitals Quiz
(answers below)

1. Who is the 1998-99 chairman of the Arkansas Hospital Association?

2. The Arkansas Hospital Association Workers' Compensation Self-Insured Trust has merged with what reciprocal company?

3. Lewis E. Epley, Jr. of Eureka Springs and Dr. Sandra Nichols of Little Rock received the _____________ Award during the AHA annual meeting.

4. True or False: A recent survey indicates there is no nursing shortage in Arkansas hospitals.

5. The AHA's 1998 Diamond Awards were presented to ___ hospitals for excellence in hospital public relations and marketing.

6. The American Hospital Association's annual membership meeting will be held when?

7. True or False: The Arkansas Patient Protection Act of 1995, also known as the state's Any Willing Provider Law, has been ruled unenforceable.

8. What is a hospitalist?

9. A statewide cardiac project initiated by the Arkansas Foundation for Medical Care has resulted in a nearly____increase in the use of potentially life-saving drugs called beta blockers by Arkansas physicians.

10. True or False: The JCAHO may make surprise visits to accredited organizations that are suspected of engaging in unethical or fraudulent behavior.

Quiz Answers:

1. Gary Bebow of Batesville

2. The Virginia Insurance Reciprocal

3. Distinguished Service

4. False

5. 15

6. January 31 - February 2

7. True

8. Primary doctors who manage inpatient care for hospitals or physician groups

9. 60%

10. True

Workplace Absenteeism Costs Millions

Dollars lost to absenteeism have jumped 32% since last year, a recent survey of 401 human-resource officials found. Family issues now are the most often-cited reason for time off, along with other non-sickness reasons such as stress and personal demands.

Employee absenteeism jumped 25% since last year, according to the survey of absences from June 1997 to May 1998 by CCH, a provider of human resources and employment law information.

The annual average cost of absenteeism rose from $572 per employee to as high as $757 in 1998, the survey said. The cost was figured from the employees' pay and did not include such indirect costs as paying other workers overtime or hiring temporary workers, both of which could mean substantial monetary hits to a company.

Work demands are one reason for the rise in unscheduled absences. With a low October unemployment rate of 4.6%, workers are finding themselves stressed by intensified productivity demands and doing more with less due to layoffs. To keep absences from eroding earnings and hampering employee retention, some larger companies are offering backup centers for employees when child care falls through; on-site child care centers that also include nurses for sick children; and alternative work arrangements or flexible scheduling for employees.