North Shore-LIJ (NY) Health System and the Environmental Protection Agency used Thursday's Earth Day celebrations to sign a five-year agreement on wide-ranging environmental stewardship programs.
The memorandum of understanding, signed by EPA Regional Administrator Judith Enck and North Shore-LIJ President/CEO Michael Dowling, places the health system's hospitals in Queens, Long Island, and Staten Island into programs for energy and water conservation, solid waste recycling, environmentally sensitive landscaping, combined heat and power plants, sustainable building and construction projects, and green cleaning.
"With a workforce of more than 38,000, the North Shore-LIJ Health System is the largest employer on Long Island and the ninth largest in New York City. We play a leading role not only by providing top-notch healthcare but promoting sustainable business practices to improve public health and minimize our impact on the environment," Dowling said in a prepared release.
"Our collective actions make a tangible difference in terms of reducing greenhouse emissions, conserving energy, wisely using natural resources, and at the same time, benefit from significant cost savings."
Maurice E. LaBonne, North Shore-LIJ's senior vice president of facilities services, said there is an incentive to be energy efficient and cost effective because hospitals operate 24 hours a day, 365 days a year, and continually use power to heat and cool facilities year round.
"Hospitals are well suited to sustainable design and construction because patients often have compromised immune systems; sustainable healing environments contribute to better patient outcomes," LaBonne said.
The agreement calls on North Shore-LIJ to:
Reduce energy consumption by at least 10%.
Implement a recycling program that includes paper, plastic, aluminum and cardboard and explore other opportunities for waste reduction and recycling.
Re-use landscaping materials wherever possible and re-use industrial materials for construction projects.
Increase the use of coal combustion waste products in construction activities. For example, in the Katz Women's Hospital construction project at North Shore University Hospital, cement will consist of 40% fly ash.
Recognize that the use of combined heat and power reduces environmental impacts while meeting the demand for energy. At LIJ Medical Center, a combined heat and power plant supplies electrical energy to the campus boiler/chiller operations and supplementary heat for steam and hot water requirements. The health system will try to enhance this plant and explore the application of this technology to other hospitals.
Continue to certify construction projects that are registered with the US Green Building Council. North Shore-LIJ also plans to certify major construction projects under the Leadership in Energy and Environmental Design rating system.
Eight in 10 Americans know that President Obama signed the health reform legislation into law, but 55% say they are confused about it, and 56% say they don't understand how it will affect them personally.
That's according to a new Kaiser Health Tracking Poll issued today, the first such poll conducted by Kaiser since the passage of the healthcare reform laws last month.
The survey of 1,208 adults, conducted April 9-14, finds that the public supports many of the provisions of health reform that are set to be implemented in the short term. When asked about 11 specific provisions scheduled to take effect this year, in each case a majority of Americans viewed them favorably, often with bipartisan support.
Still, the public remains divided on the law overall, with 46% viewing it favorably, 40% unfavorably, and 14% undecided. Similarly, 31% of Americans say they expect personally to be better off because of the law, 32% say they will be worse off, and 30% say they don't expect to be affected. The national telephone poll included 801 landline interviews, and 407 cell phone interviews. The poll was carried out in English and Spanish, with a margin of error of plus or minus 3%.
"People are struggling to understand how the law will affect them and their families and to separate fact from political spin," said Kaiser President/CEO Drew Altman.
The new law includes provisions that take effect this year so that the public will feel immediate tangible results. The poll tested the popularity of many of these early measures and finds widespread support for them, including from Republicans and independents.
For example; nearly nine in 10 Americans favor tax credits for small businesses to provide coverage for their workers, and eight in 10 favor provisions for access to basic preventive care with no copayments, provide financial help to seniors who hit the doughnut hole gap in Medicare drug coverage, and prohibit insurance companies from dropping people with major health problems. In each of these cases, at least two-thirds of Republicans and independents join most Democrats in viewing the provisions favorably.
The poll found that 55% of Americans are confused by the health reform law, with 61% of those who aren't in favor of the reforms expressing confusion, and 44% of those who support the reforms expressing confusion.
Anger is reported by 30% of the public, including16% who say they are "very angry." Asked what about health reform made them angry, that 30% divided as follows: 9% did not like the way the policymaking process worked, 7% did not like the final content, and 12% did not approve of either.
Cable television news was the biggest source of information about healthcare reform for all respondents, regardless of their political leanings. More than one third (36%) cited cable TV news stations and their Web sites as their most important outlet, followed by network news (16%), newspapers (12%), friends and family (10%) and the radio (9%).
Republicans were more likely to name cable TV as their most important news source, with 45% saying so compared to 30% of Democrats. Democrats were twice as likely as Republicans and independents to say that they got most of their information from network news (23% of Democrats compared to 12% of the other two groups).
Overall sentiment about the new law breaks sharply along partisan lines. Nearly eight in 10 Democrats favor the new law, while about as many Republicans do not, a mix similar to that seen before the bill's passage in March. Independents tilt against the law—46% opposed compared to 37% in favor—while self-described moderates favor the measure 55% to 31%.
"The AMA is offering its support to physicians who are now receiving mailings containing details and claim forms regarding the historic UnitedHealth settlement," said AMA President J. James Rohack, MD, in a media release. "The new AMA guide provides physicians with step-by-step assistance in determining eligibility, assembling documentation and filing a claim under the terms of the settlement."
New York Attorney General Andrew Cuomo announced the settlement with UnitedHealth Group in January, 2009 after a year-long investigation into what Cuomo called "a scheme to defraud consumers" by underpaying patients by hundreds of millions of dollars over the last decade.
The investigation was initially sparked by a 2000 lawsuit from the AMA, which was concerned that the underpayments were driving a wedge between patients and doctors.
"The AMA's persistent efforts have earned significant results for physicians that extend far beyond the recovery of damages," Rohack said. "Every physician and patient will benefit from the stand the AMA took against UnitedHealth."
The UnitedHealth settlement is governed by a series of court-imposed deadlines that physicians must follow. The current settlement deadlines include the following key dates:
July 27 – Deadline for filing objections to the settlement or for opting out of the settlement.
Sept. 13 – Date for the final settlement hearing to consider any filed objections.
Oct. 5 – Deadline for filing a claim to share in the settlement fund.
Sanford Health is partnering with Rady Children's Hospital-San Diego to open a pediatric clinic in Oceanside, CA, the two health systems announced today.
Using a portion of a $2.5 million donation from philanthropists Pamela and Martin Wygod and the Rose Foundation, the health systems plan to jointly purchase and share a 28,500-square-foot building in Oceanside.
Sanford Children's will open a general pediatric clinic using 6,000 square feet of the building. Rady Children's will consolidate four nearby specialty clinics into the facility, providing primary care, psychiatry, developmental services, various specialty clinics, and the Chadwick Center. The building will also house a pediatric urgent care, after-hours clinic. The clinic is expected to open in early 2011.
"The variety of services offered—developmental evaluations, occupational therapy, urgent care, pediatric subspecialty physician services, the expertise of the Chadwick Center for Children and Families—will provide parents with an expanded and vitally needed range of care," said Kathleen Sellick, president/CEO of Rady Children's Hospital.
Sanford Children's Clinic in Oceanside is the third Sanford Children's World Clinic announced by Sioux Falls, SD-based Sanford Health as part of the initiatives outlined after a $400 million donation from Denny Sanford in 2007.
Sanford Children's Clinic in Duncan, OK, opened August 2009. Sanford Children's Clinic in Belize City, Belize, will open in 2011.
Overall drug price inflation will be 1.3% in 2010 for acute care hospitals, according to estimates released today by Novation Pharmacy Program.
The estimate, published in Irving, TX-based Novation's 2010 Drug Price Forecast, anticipates that the price change for contract products from July 1, 2010 through June 30, 2011 will be 0.99% while noncontract products will be 1.83%.
The forecast is focused on pharmaceutical use in acute care hospitals. The drugs analyzed represent the top 80% of pharmaceutical purchases through pharmacy authorized distributors from Nov. 1, 2008, through Oct. 31, 2009, by Novation Pharmacy Program participants.
The report usually includes estimates for volume and mix changes, and an estimate for additional new drug expense taken from the American Journal of Health-System Pharmacy's annual future drug expenditures report. However, the 2010 edition of the AJHSP report had not been published when Novation's report was finalized.
Novation said it will update its forecast with this information when it is available.
The Federal Trade Commission and the Justice Department have opened a month-long public comment period for a proposed revision of Horizontal Merger Guidelines.
The updated guidelines detail how the agencies evaluate the competitive impact of mergers and whether those mergers run afoul of antitrust law. The guidelines were issued in 1992 and were last revised in 1997. The current revisions are designed to reflect the way the FTC and DOJ now conduct merger reviews, the two agencies said in a joint statement.
"Eighteen years have passed since the Horizontal Merger Guidelines were revised. During that time, the agencies' approach has evolved significantly, and the guidelines should reflect that," FTC Chairman Jon Leibowitz said. "The proposed guidelines put out for comment today reflect the current state of merger analysis at the FTC and DOJ, and will help make the process more transparent to American businesses and courts. By inviting comments from all stakeholders, we'll make sure that the final Guidelines are clear and accurate in conveying the agencies' merger enforcement intentions."
The proposed revisions reflect public comments from five public workshops that the two agencies held over the past six months to determine whether an update is needed. Many parts of the proposed guidelines reflect changes identified in the Commentary on the Horizontal Merger Guidelines, which the agencies issued in 2006.
The proposed guideline changes would:
Clarify that merger analysis is a fact-specific process through which the agencies analyze the evidence to determine whether a merger may lessen competition.
Create a new section on "Evidence of Adverse Competitive Effects," using past experiences that the agencies have found predict the competitive effects of mergers.
Explain that market definition is not an end itself or a necessary starting point of merger analysis, but a tool that illuminates a merger's competitive effects.
Update the hypothetical monopolist test used to define antitrust markets and how the agencies implement that test in practice.
Expand discussion of how the agencies evaluate unilateral competitive effects, including effects on innovation.
Clarify that coordinated effects, like unilateral effects, include conduct not otherwise condemned by the antitrust laws.
Add new sections on powerful buyers, mergers between competing buyers, and partial acquisitions.
Women undergoing heart surgery and interventions are at a much greater risk of dying than are men undergoing the same procedures in the same hospitals, according to HealthGrades' Seventh Annual Women's Health in American Hospitals.
Women had a higher risk of mortality in three cardiovascular procedures: valve-replacement surgery (52.8% higher), coronary bypass surgery (36.6%), and coronary interventional procedures (19.5%). Women also had a 5.8% higher risk of dying after a stroke. Women had a better chance of surviving hospitalization than men for: chronic obstructive pulmonary disease (16.4% lower risk), heart failure (12.8%), pneumonia (10.6%), and heart attack (2.4%).
"The finding that women's outcomes vary so dramatically from men's is surprising not in its result, as this disparity has been documented before, especially in cardiovascular care, but in its magnitude," said Rick May, MD, vice president with HealthGrades and an author of the study. "The differences in many areas are huge."
Women's patient outcomes not only varied when compared to men's, but also varied widely among hospitals. HealthGrades analyzed patient outcomes for women, age 65 or older, at all of the nation's nearly 5,000 nonfederal hospitals and identified those hospitals that are in the top 5% in the nation.
The top-performing hospitals had mortality rates for women that were 40.5% lower than the category of poorest performing hospitals, and complication rates for women that were 19.1% lower than the poorest performers. In addition, top-performing hospitals improved their mortality rates over the three-year period studied at a faster rate when compared to all other hospitals.
The study suggests that if all hospitals nationwide performed at the level of the top hospitals, 16,863 women could have potentially survived their hospitalization and 4,735 women could have potentially avoided a major in-hospital complication. Of the 16,863 potentially preventable deaths, 80.7% were associated with pneumonia, heart failure, stroke, and heart attack.
The annual study used Medicare data from 50 states from 2006 through 2008.
In addition, most specialties reported a drop in the cost and resources associated with filling these positions, which MGMA attributes to the economic downturn and a 30% increase in the use of Internet job boards as a primary recruiting tool.
MGMA and the Association of Staff Physician Recruiters produced the survey for the second year.
"The 2010 report shows in-house professionals were able to control cost and be effective, realizing a slight increase in the overall percentage of positions filled," said Shelley Tudor, co-chair of the ASPR Benchmarking Committee. "However, ASPR professionals are careful to point out that while days to fill a position may be lower, the survey does not capture the number of positions that go unfilled each year. Additionally, the days to fill a position in non-metropolitan areas (where the impact of the primary care shortage is greatest) are higher than those found in large population centers."
The MGMA survey focused on cost, duration, location, and frequency of physician searches, and physician turnover as reported by "in-house" physician recruiters.
In 2008, physician recruitment directors posted a nearly 6% increase in compensation; recruitment managers experienced close to 10% salary increases and those with a "physician recruiter" title reported a 1% salary increase.
Coupled with a nearly 10% increase in active searches, MGMA found that more than half of the survey respondents employed one or fewer in-house recruiters while 32% employed two or three recruiters.
The survey shows searches per full-time equivalent recruiter ranged from five to 15 per year depending on the size of the organization's metro area. Seven states had the most active searches: Wisconsin (11.2%), Minnesota (8.7%), Washington (8.4%), Pennsylvania (7.7%), Michigan (6.3%), North Carolina (6.2%), and Arizona (5%).
How many staff members do you need to maximize productivity and quality while containing costs?
The bible of practice staffing ratios, Rightsizing: Appropriate Staffing for Your Medical Practice by Deborah L. Walker and David Gans, notes that understaffing can negatively impact employee recruiting and retention, disrupt physician productivity, hinder patient service, and place patients and business operations at risk.
On the flip side, Walker and Gans note that overstaffing can lead to poor staff interactions with physicians, a decrease in productivity, and a decrease in the bottom line.
Adequate staffing is one of the more complicated and important issues in healthcare. It's a nettlesome problem that every practice manager will face at one or more points in his or her career.
The issue gets cloudier when you factor in the dearth of qualified clinicians in most areas of the nation and try to determine the impact of healthcare reform and the adaptation of meaningful use for EMRs in your physician practice.
Fortunately, the answer to the question of what determines adequate staffing is simple: It depends.
"It is a balancing act. The more physicians you have, the more patients you see, the more staff you should anticipate to take care of them," says Christopher Clarke, practice administrator at South Coast Orthopaedic Associates, an eight-physician practice in Coos Bay, OR. "But you can't get to a level where it's just going to be breaking even. You have enough staff to take care of everybody, but you aren't making money. That is where you have to push the efficiencies."
Clarke says South Coast Orthopaedic stresses cross-training with its five mid-level providers, four physician assistants, and 15 other staff members.
"We do a lot of cross-training—and not just within departments. Each billing staff [member] can do every job in billing," he says. "We also cross-train our medical assistants to work at the front desk; the chart room people too. Anyone can answer the phone. We try to make sure that everybody is cross-trained to the best level possible. That really helps with our efficiencies."
Generally accepted staffing ratios can vary greatly depending on the subspecialty. Clarke says the Medical Group Management Association best practices recommend 7.7 full-time employees (FTE) for each full-time physician at his orthopedic group. "We are at five FTEs, and a lot of it is the efficiency of our staff," Clarke says. "You have to make sure you have the right people in the right jobs being as efficient as possible, and you have to evaluate that and watch your staff."
Staff size by formula
Barbara Daiker, executive director of NorthwestEye, which serves the Twin Cities area of Minnesota, says the 21-physician group uses a formula to determine staff size. "But it's not by doctor. We do it by encounters. We look at how many encounters a doctor has, and we try to staff accordingly," Daiker says.
NorthwestEye, which has 150 employees serving eight clinics and one surgery center, has developed specific encounter ratios for clinical and front desk staff.
"We also use a different kind of number for our business office, based on revenues, FTEs per revenue, so they're handling dollars as well," Daiker says.
With its encounters, NorthwestEye also takes into account the number of tests ordered. For example, the patient visit itself is a single encounter, but some patients may have two or three tests during their visit, and those may have to be included.
Even using the ratio can be a bit of a challenge as the physician group encounters ebbs and flows of patients in the annual business cycle.
"It's a bit of a floating number," Daiker says, adding that NorthwestEye is currently in its seasonal lull. "We can't change our FTEs per se, based on the lull. We have to ask, 'What do we think will happen over the next six to nine months?' and see if we can flex the hours a little bit now based on where we think we are going to be once we hit our busy time. We don't want to do any kinds of layoffs or staffing up until we can be sure where we are."
Unexpected stability
The recession and overall economic malaise that have gripped the nation for more than two years have had at least one unexpected upside for office administrators: Staff is staying put.
"We have had no resignations for four or five months at this point, which is a long time for us. It's not like we are a place where people bail from, but people get relocated or they have babies or whatever, so it is kind of unusual to go that long," Daiker says.
When a job opening is posted, NorthwestEye gets flooded with applicants who aren't necessarily qualified. "That makes it hard because you have to sort through a lot of stuff to find qualified applicants," says Daiker. "It used to be recruitment was expensive when the labor market was tight. Now, it doesn't cost much to recruit, but it is the training, the orientation, that takes a lot. Even if they come from another eye group, they don't necessarily know how to do it our way."
Although cutting back hours to maintain adequate staffing is preferable to layoffs, it can still get tricky. "We try to solicit reduced hours from employees, but you can only do that so much before people get skittish," Daiker says. "We try to be fair. It's easier for everyone to lose an hour than it is for one person to lose eight hours. Also, because we are in Minnesota, when the weather gets nicer, people are a little more open to cutting back some hours and heading outside."
Regardless of how you feel about Andy Stern, president of the 2.2 million-member Service Employees International Union, there is no denying that he is the most important labor leader of his generation.
So, it came as a surprise when he announced last week that he would resign the position he has held since 1996. His resignation—two years before his term ends—comes at an apparent high point for organized labor. SEIU, with half of its membership from the healthcare sector, played a crucial role in raising money, and electing President Barack Obama and the Democratic majority in Congress. The union worked hard for the passage of the jobs bill and healthcare reform by targeting wavering Democratic lawmakers and bolstering their support. In return, Stern has had unfettered access to the White House, with nearly 40 trips since Obama took office, according to several media accounts.
Labor was expected to make a concerted push this year for the Employee Free Choice Act—or a watered down version of it—which still would be the most sweeping pro-labor legislation in decades. After the bruising healthcare reforms fight, however, the labor bill's fate is in limbo.
Why did Andy Stern quit? Pose that question on Google and you'll get rampant speculation and intrigue.
In a video message to SEIU's members, however, Stern touted his accomplishments, insisted he had no immediate future plans, and suggested that he is burned out. "I've seen too many leaders who've stayed on too long. I have no intention of being one of them . . . I leave the job I love by choice," Stern said. "But for all the joy, there has been sorrow as well. The loss of my 13-year-old daughter Cassie (in 2002) and the 24/7 responsibilities of this job have left me at times not paying enough attention to the personal dimensions of my life."
The news of Stern's departure brought swift and unequivocal reactions across ideological rainbow, from inside organized labor and well without. The Wall Street Journal said in a scathing editorial that Stern is leaving the SEIU $85 million in debt—right before Republicans are expected to make significant gains in November, thus weakening labor's hand.
Sal Rosselli, interim president of the breakaway National Union of Healthcare Workers, and a bitter foe of the SEIU, said Stern's "legacy is that he took control of an organization built by more than a million hardworking janitors, healthcare workers, and public servants, and used their resources primarily to secure his own political power."
Marick F. Masters, director of the Fraser Center for Workplace Issues and Labor at Wayne State University in Detroit, said he's inclined to take Stern at his word. "He had the presence of mind to leave when he is at the top rather than to stay longer," Masters says. "And the fact is he has been the leader of that organization since 1996. How many corporate executives stay at the helm for as long as he has? You are talking about 14 years being the head of an organization that has been at the center of most of the controversies that labor has been involved in that time period. It's reasonable that he could be a little tired."
Masters says Stern leaves now to ensure that new leadership is well in place to help Democrats in the fall elections. "If his union is going to play as effective a role as he wants, he would want somebody else at the helm to begin to take over the reins," Masters says.
Jim Trivisonno, president of Detroit-based IRI Consultants to Management, Inc., says Stern, with his Ivy League education, high articulation, and global perspective, was extremely effective, even though he didn't fit the classic image of the rough-and-tumble labor leader. "He will be difficult to replace," Trivisonno says. "From a strict leadership standpoint, folks like Stern don't come around very often and he accomplished a lot of organized labor generally and SEIU specifically."
Stern did not say exactly when he would leave. Secretary-Treasurer Anna Burger will serve for 30 days after Stern's departure, when a new president will be elected by the SEIU board to finish Stern's term.
"Some of the people being mentioned to replace him are probably capable, but they will definitely have a different style—some more aggressive, others not," Trivisonno says. "But the SEUI has a pretty good infrastructure and they are focused on healthcare, which is a right area for organized unions."
It's hard for me to imagine that someone like Stern—who joined the union as a 22-year-old and worked his entire life to make it the leading voice in organized labor—would suddenly walk away from his job two years before his term expires—just as the union appeared poised to enjoy the fruits of its labor. We are talking about the most powerful person in organized labor, the head of an organization representing 2.2 million people. It has been my experience–after covering politics for more than two decades—that people in power do not readily give up that power unless someone or something is shoving them out the door.
Burn out? Sorry, I don't buy it.
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