Friday, August 28, 2009

Nonprofit Hospital Executive Shares Health Reform Worries

Charles J. Barnett, chief executive of the Seton Family of Hospitals, a nonprofit hospital group in Texas, shared his concerns about challenges hospitals may face after the health care overhaul takes place.

Barnett believes that providing coverage to the uninsured is only the first step to reform; however, he worries about access being compromised if the physician shortage continues and if the new policies create reduced revenue for hospitals.

Barnett isn't the only one worrying. Hospital executives nationwide have been wary of reform proposals offered by the Obama administration and Congress, fearing that unintended effects of the change will actually hinder, rather than help hospitals provide care to their communities.

For the full article, click here:

Source: The Washington Post

CMS Continues Recognition of AOA Deeming Authority for Hospitals

The Centers for Medicare & Medicaid Services (CMS) has published an announcement in the August 28, 2009 Federal Register approving continued recognition of the American Osteopathic Association's (AOA) deeming authority for hospitals. The renewed deeming authority runs from September 25, 2009 to September 25, 2013.

CMS has determined that the AOA's standards and survey process "meet or exceed" the Medicare Conditions of Participation for hospitals. The announcement includes several changes that the AOA made to its requirements in order to become more aligned with the CoPs.

To read the full announcement, click here:

Source: Federal Register

Thursday, August 27, 2009

TJC Releases Sentinel Event Alert on Leadership

The Joint Commission (TJC) has released a Sentinel Event Alert describing the importance of leadership in ensuring the quality and safety of care. TJC reports that "inadequate leadership was a contributing factor in 50 percent of the sentinel events reported to The Joint Commission in 2006."

While TJC realizes that the healthcare industry has not yet developed the "zero-defect" approach adopted by other industries, they provide several suggestions for how adverse events should be treated and actions senior leadership, the governing body, and medical and clinical staff leaders should take in order to avoid adverse events due to poor leadership direction. This guidance should be shared with your facility's administration and medical staff leaders.

TJC's Sentinel Event Alert on leadership can be found here:

Tuesday, August 25, 2009

Arkansas Doctor and Hospital Employees Plead Guilty to HIPAA Violations

A doctor and two hospital employees at St. Vincent Infirmary Medical Center in Arkansas face a maximum penalty of one year in prison and/or a fine of up to $50,000 because of their curiosity. All three parties have pled guilty to unrelated misdemeanor violations of HIPAA laws.

Dr. Jay Holland admitted to accessing a patient's record after seeing a news report. Dr. Holland accessed the record in order to determine if the news report was true. His privileges were suspended for two weeks and was required to complete on-line HIPAA training.

Sarah Elizabeth Miller, a former account representative at St. Vincent, admitted to accessing a patient's records 12 times. Miller, who had received HIPAA training, was fired after admitting that curiosity was the reason why she had accessed the records.

Canada Griffin, an emergency room unit coordinator, was asked to set up an alias for a patient. After the patient was moved the the ICU, Griffin was curious about the patient and looked up the patient's medical charts. Griffin was also fired from St. Vincent.

All three situations show how simple curiosity can turn into a serious HIPAA violation that can compromise your employment. Make sure that the members of your medical staff and staff in your medical services office are well-trained in HIPAA to prevent violations in your facility.

Source: Federal Bureau of Investigation, Little Rock

TJC Names Two New Commissioners to Board

The Joint Commission has named two new members to its Board of Commissioners. The members were appointed by the American Hospital Association for three-year terms, starting in January 2010.

"Nancy Howell Agee is the chief operating officer and executive vice president for Carilion Clinic in Roanoke, Virginia. Her primary responsibility is serving as the chief executive officer of Carilion Medical Center, an 825-bed tertiary care teaching hospital, which serves as one of five Level I Trauma Centers in Virginia, and co-leading the development of an organized medical group. In addition to her work at Carilion, Agee was appointed by the governor of Virginia to the Radford University Board of Visitors, and she currently chairs the Board of the Virginia Hospital and Healthcare Association and the Foundation of Roanoke Valley. Agee earned an undergraduate degree at the University of Virginia, received a master’s degree from Emory University and participated in postgraduate studies at the Kellogg School of Business, Northwestern University.

R. Timothy Rice, F.A.C.H.E., has served as president and chief executive officer of the Moses Cone Health System in Greensboro, North Carolina since 2004. He earned a bachelor of science in pharmacy from Washington State University and a master’s in health administration from Duke University. He is a Fellow in the American College of Healthcare Executives and chair-elect of the board of directors of the North Carolina Hospital Association. Rice is active in the community serving as a board chair for the Greensboro Partnership, the Central Atlantic VHA Board, and the United Way of Greensboro Campaign. "

The 29-member Board of Commissioners is TJC's governing body. The Board is composed of representatives from the American Hospital Association, American Medical Association, American College of Physicians, American College of Surgeons, American Dental Association, six public members, one representative of the nursing profession, and president Mark Chassin, M.D., M.P.P., M.P.H.

Thursday, August 20, 2009

Peer Review Privilege Can Be Undermined by State Freedom of Information Law, According to Connecticut Court

The Connecticut Supreme Court has ruled that peer review records may be subject to disclosure for use in a civil lawsuit under the provisions of the state's Freedom of Information Act (FOIA).

In its decision (Director of Health Affairs, University of Connecticut Health Center v. Freedom of Information Commission), the court noted that this ruling will not substantially affect the privacy of peer review records since most hospitals are private and therefore, are not subject to FOIA rules. The court also noted that while a party may be able to access this information during the discovery process to prepare for trial, peer review records are still privileged information that cannot be entered as evidence in a civil action.

Source: BNA

Monday, August 10, 2009

South Carolina RAC Releases List of Audit Areas

Connolly Consulting, the Medicare Recovery Audit Contractor (RAC) of Region C, has released the first set of issues eligible for audit. While these areas only apply to South Carolina at the moment, it is believed that other states will eventually adopt these areas as well.

The RAC program was developed to help identify areas of overpayment and underpayment in the Medicare system. The RAC reviews claims histories to determine improper payment situations, offsetting overpayments with underpayments when possible.

The areas of audit include announced for Region C include:
  • Blood transfusions;
  • Untimed codes;
  • IV Hydration therapy;
  • Bronchoscopy services;
  • Once in a lifetime procedures;
  • Pediatric codes exceeding age limits;
  • And Pegfilgrastim injections.

Source: Modern Healthcare

Friday, August 7, 2009

HASC Estimates $500 Billion Savings by Reducing Administrative Costs

In its latest report, the Healthcare Administrative Simplification Coalition (HASC) estimates that the US can save up to $500 billion over ten years by reducing administrative costs by just 10 percent.

The report, titled "Bringing Better Value: Recommendations to Address the Costs and Causes of Administrative Complexity in the Nation's Healthcare System," offers four suggested areas of improvement:

  • Implementation of a universal credentialing form for payers, hospitals, and other institutions;
  • Using electronic patient data to help speed up determinations on insurance coverage eligibility;
  • Standardization of patient ID cards;
  • And standardization of the prior authorization process for radiology and pharmacy services.

The report makes many references to cost savings for clerical work; however, MSPs know that the major focus of our work is at a higher level. Clerical work is one of those necessary-but-not-valued responsibilities.

As the experts of the credentialing process, there is a great opportunity for us to share our best practices and be a part of healthcare reform.

To read the full report, click here:

Source: HASC