Atlanta-based Grady Memorial Hospital, on the verge of financial collapse about two years ago, has reached financial stability and improved patient care, hospital officials said. Two years ago, the hospital owed medical supply companies $40 million, owed Emory and Morehouse medical schools $60 million, and the Joint Commission had just inspected the hospital for medical care and issued a critical report that endangered its accreditation. Now, hospital officials tell the Atlanta Journal-Constitution that a turnaround has occurred.
Malpractice payments in 2009 were the lowest in inflation-adjusted dollars since 1992, according to Public Citizen, a liberal watchdog group.
The organization says its findings are consistent with a National Practitioner Data Bank update this week that showed fewer malpractice payments were made on behalf of doctors in 2009 than any year since 1990, when the data bank was created.
Public Citizen said the data contradict claims that malpractice litigation is to blame for rising healthcare costs, and that changing the liability system to the detriment of patients will not curb healthcare costs.
"Litigation accounts for a miniscule fraction of health costs, small enough to be a rounding error," said David Arkush, director of Public Citizen's Congress Watch division, in a media release. "It's ridiculous that certain members of Congress continue to obsess about this greatly exaggerated problem. They should know better, and they should focus instead on fixing real problems like the crisis of preventable medical errors."
AMA President J. James Rohack, MD, however, disputed the findings, and said Wednesday that Public Citizen "continues to rely on a flawed database as the source of its information."
"While [Public Citizen continues] to oppose improvements to our broken liability system, the AMA is focused on efforts to make it work better for patients and physicians," Rohack said.
"There are proven reforms working in California and Texas that keep doctors caring for patients and preserve patients' day in court. Today, President Obama included alternative medical liability reforms in his health system reform proposal because there is broad recognition that liability reform is needed to curb the growth in healthcare costs."
In a letter to congressional leadership this week, President Obama—under fire from the GOP for not better addressing tort reform in current healthcare legislation—called for funding alternative demonstration projects, such as health courts, for resolving medical malpractice disputes.
Public Citizen said the health courts would cost several times as much as the status quo, if administered fairly, and that the only way to save money would be to impose "draconian" compensation caps.
Public Citizen added that 2009 was the fifth straight year the number of malpractice payments has fallen and the sixth straight year in which the value of payments has fallen. In contrast, US healthcare costs have increased every year since 1965. Between 2000 and 2009, healthcare spending rose 83% while medical malpractice payments fell 8%—with both figures in unadjusted dollars. A total of 10,772 payments were made on behalf of doctors in 2009, totaling $3.5 billion. That figure equals .14% of the estimated $2.5 trillion that CMS estimated was spent on US healthcare in 2009, Public Citizen said.
The advocacy group added that numerous studies have found that injuries and deaths caused by medical errors dwarf the number of actual malpractice payments.
The healthcare sector created 12,000 new jobs in February, even as overall employment from all business sectors saw 36,000 jobs lost, according to Bureau of Labor Statistics preliminary data released this morning.
The national jobless rate remained steady at 9.7%.
Ambulatory services accounted for 6,700 payroll additions in February, and hospitals accounted for 1,300 new payroll additions. Nursing and residential care facilities reported 4,000 payroll additions in February, after reporting 4,900 reductions in January. Physicians' offices reported 900 payroll additions in February, after reporting 5,800 payroll additions in January.
The healthcare sector has been one of the few areas of job growth during the recession, and created 228,100 new jobs in 2009.
The BLS information from the last two months is considered preliminary and may be revised.
Though five years into the Medicare Part D drug program, CMS' efforts to root out fraud and waste are still "limited in scope and may not sufficiently protect the program," a federal inspector told Congress on Wednesday.
"Lack of effective oversight exposes the Part D program and Medicare beneficiaries to a wide range of fraud, waste, and abuse, including inappropriate billings, payments for excluded drugs, drug diversion, improper bid submissions, excessive premiums, and illegal marketing schemes," Robert Vito, a regional inspector general for HHS, told the Senate Committee on Homeland Security and Governmental Affairs.
"The failure to address these vulnerabilities puts the scarce resources of the Medicare Trust Fund at risk," he added.
Medicare Part D was enacted in 2003, and operational by Jan. 1, 2006. Because of the "extremely short implementation schedule" of two years, Vito said CMS concentrated on "implementation activities, including the development of procedures, data systems, and infrastructure to carry out all the necessary functions."
Medicare Part D begins the current fiscal year with 27 million beneficiaries enrolled in the program, 17 million of whom are in stand-alone plans. Since the program's inception, Medicare has paid nearly $200 billion for the Part D program, Vito said.
Vito's office identified several problem areas:
The program was launched with limited safeguards. "CMS relied largely on complaints to identify potential fraud in Part D and not all of these complaints were investigated in a timely way. In addition, we found that no significant data analysis had been conducted specifically to detect or prevent fraud and abuse," Vito said.
Medicare Drug Integrity Contractors—MEDICs—monitoring Medicare Part D have identified most fraud though external sources, such as beneficiary complaints, rather than proactive methods. An OIG report in October noted that of the 4,194 potential fraud and abuse incidents that MEDICs identified in 2008, 87% were identified through external sources.
MEDICs complain of long delays and limited access to CMS data. "MEDICs also lack the authority to directly obtain information, such as prescriptions and medical records from pharmacies, pharmacy benefit managers, and physicians," Vito said.
Plan sponsors are supposed to have plans in place to identify fraud and abuse, but many did not meet CMS requirements, or contained only broad outlines. CMS has yet to finalize audits of plan sponsors' compliance plans.
Plan sponsors' efforts to identify fraud vary widely because the specifics of each plan's fraud identification program are left to each individual plan sponsor. OIG found that during the first six months of 2007, 90% of all fraud and abuse incidents were identified by only seven of 86 plan sponsors.
CMS' oversight of account payment accuracy is weak. The monthly payments that Medicare makes to plan sponsors for providing Part D coverage is based on estimates the sponsors provide in their approved bids, and include the sponsors' expected profits. "Inaccuracies in sponsors' bids have resulted in Medicare paying higher payments and beneficiaries paying higher premiums than they should have," Vito said.
Most Part D plans routinely overestimate their costs. In 2006, for example, Part D plans owed Medicare more than $4 billion. "We recommended that CMS ensure that sponsors' bids accurately reflect their costs of providing the benefit, and when sponsors fail to do so, that CMS hold sponsors more accountable for inaccuracies in the bids," Vito said.
CMS' Part D audits do not ensure accountability. The two audit mechanisms CMS has in place to ensure the accuracy of the bid—the bid audit and the financial audit—are largely ineffectual for detecting and correcting bid inaccuracies.
Vito offered the committee a handful of recommendations that he said would improve fraud identification and program accountability:
CMS should implement a comprehensive program integrity plan that includes specific action items, target dates, and assigned staff for follow up. It also is crucial that audits are conducted in a timely manner and that mechanisms are established to hold plan sponsors accountable for the problems identified.
CMS should improve oversight of MEDICs, including their analysis to detect fraud and abuse. MEDICs should be given the legal authority to obtain critical information directly from pharmacies, pharmacy benefit managers, and prescribing physicians.
CMS should ensure that plan sponsors are implementing effective compliance plans, so they can flag potentially fraudulent issues early on.
CMS, MEDICs, and plan sponsors need to perform innovative data analysis of claims and payment information, and embrace proactive methods of fraud detection.
At least a half-dozen House Democrats who voted against the healthcare bill say they are now undecided, and President Obama says he is willing to embrace several Republican ideas to collect more votes, the Wall Street Journal reports. Although it is adopting some Republican ideas, the White House hopes to win public support—and wavering Democrats—by painting the process as open and collaborative. Democratic leaders also expect some defections in the coming debate, especially among antiabortion Democrats who believe the Senate bill doesn't go far enough to limit federal funds from paying for abortions, the Journal reports.
Minnesota Gov. Tim Pawlenty and state Republican legislative leaders said they have produced a plan to break the impasse over providing health insurance for the state's poorest and sickest residents. To help repair a budget that's $1 billion out of balance, Pawlenty ended Minnesota's General Assistance Medical Care and moved recipients onto a program with less coverage and higher per-person costs. Pawlenty instructed the state Department of Human Services to shift about 32,000 current GAMC clients on April 1 to MinnesotaCare, an insurance program designed for lower-income working people and funded by premiums and a surcharge on healthcare providers and insurers. Legislative Democrats have hinted that GAMC advocates may file suit to block the program's elimination, the Minneapolis Star Tribune reports.
CMS has immediately suspended Fox Insurance Co. of New York from marketing and enrolling new members in its Medicare Part D prescription drug plan, after physicians and beneficiaries complained that Fox's drug plan hasn't met the prescription drug needs of some of its newest members.
"The plan has failed to fully meet its obligations to Medicare beneficiaries, particularly new enrollees, by failing to provide timely access to Part D drugs by imposing prior authorization and step therapy requirements that were not approved by CMS, not meeting the necessary appeals deadlines, and not meeting the requirements to transition new enrollees to the covered drugs," CMS said in a news release.
CMS learned of the problems from Fox drug plan members and their physicians, and will monitor the plan to determine that corrective actions have been taken. If Fox is not in compliance to Medicare requirements, CMS may fine or even terminate Fox's contract with Medicare, CMS said.
Fox was reportedly not compliant with Medicare coverage in areas that involved protected class drugs for the treatment of cancer, HIV/AIDS, seizure disorders, diabetes, and respiratory disease, CMS said.
Fox Insurance Co. did not return calls seeking comment Monday.
The Fox drug plan has members in Arkansas, Arizona, California, Colorado, Connecticut, Florida, Georgia, Hawaii, Illinois, Louisiana, Maryland, Missouri, North Carolina, New Jersey, New York, Nevada, Ohio, Pennsylvania, South Carolina, Texas, and West Virginia.
The Health Care District of Palm Beach County Board has approved the $250,000 bid to purchase the old Glades General Hospital on 14 acres in Belle Glade to Miami-based developers Castello Brothers, LLC.
"We are encouraged by the bidder's interest in developing new housing on the property, which would serve as a community resource and asset," Dwight D. Chenette, CEO of the healthcare district, said in prepared remarks. "The plans outlined by the bidder will put the property back on the tax rolls and may create additional jobs while renovations are underway."
Castello Brothers, which co-owns a 384-unit, multi-family Belle Glade Gardens development, said it will convert the Glades General Hospital property for residential use. The Castello Brothers' offer was the highest of two bids submitted in response to an invitation to bid issued in December. The healthcare district board approved the bid on Wednesday, and the deal is expected to close within the next two months.
Glades General Hospital served rural western Palm Beach County for more than 65 years before it shuttered on Oct. 15, when the county opened Lakeside Medical Center. The new 70-bed hospital is Palm Beach County's only public hospital.
Online job ads in many employment sectors across the nation dipped by nearly 67,000 listings in February and healthcare practitioners and technical occupations accounted for almost half of the decline, a new report shows.
The Conference Board's Help Wanted Online Data Series report, which tracks more than 1,000 online job boards across the United States, found that advertised vacancies for highly skilled healthcare practitioners and technical occupations, such as registered nurses and radiographic technologists, fell by 30,300 listings in February, for a total of 537,000.
Demand for healthcare support personal, such as dental assistants and home healthcare aides, also fell by 8,600 listing for the month, for a total of 110,700, the report shows.
"Contributing to this month's decline were fewer advertised vacancies for physical and occupational therapist assistants, mirroring the declines in the demand for practitioners in these areas," the report stated.
Demand in the healthcare labor market varies substantially from the higher-paying practitioner and technical jobs to the lower-paying support occupations. In January, advertised vacancies for healthcare practitioners or technical occupations outnumbered the unemployed looking for work in this field by more than 3 to 1, and the average wage in these occupations is $32.64/hour.
The average wage for healthcare support occupations is $12.66/hour and there were more than two unemployed people looking for work in the field for every advertised vacancy, the report said.
The dip of 66,900 online listings to 3.9 million in all job sectors in February follows an increase of almost 750,000 listings in the previous three-month period.
Recent declines in the number of unemployed coupled with the rise in the number of advertised vacancies has narrowed the gap between labor supply and labor demand by 1.5 million. In January, the latest month of unemployment numbers, there were 10.8 million or 3.69 unemployed for every online advertised vacancy, the report stated.
"Although labor demand dipped slightly, the large gains in the last few months have provided a positive sign of a turnaround in employer labor demand," said June Shelp, vice president at The Conference Board. "Currently, labor demand, as measured by online job postings, is close to the levels in November 2008, just prior to the huge losses from the financial crisis. The numbers indicate that the economy is recovering from the recession and companies are filling vacant positions, but it is still unclear if employers are willing to significantly expand their workforce."
Atlanta-based Mariner Health Care Inc., subsidiary SavaSeniorCare Administrative Services LLC, and their principals will pay the federal government and several states $14 million to settle kickback allegations, the Justice Department has announced.
Federal prosecutors alleged that the defendants solicited kickback payments from pharmacy giant Omnicare in exchange for agreements by Mariner and Sava to continue using Omnicare's pharmacy services for 15 years. In November, the federal government, several states, and Omnicare entered into a $98 million settlement that resolved Omnicare's civil liability in the investigation, according to the Justice Department.
"The allegations raised by the government concern a transaction that occurred before SavaSeniorCare commenced operations, and well before the current operations management team was in place," said SavaSeniorCare in a statement. "SavaSeniorCare did not contribute to the settlement amount. The company remains committed to providing quality care and services to more than 18,000 individuals every day."
Federal investigators alleged in a whistleblower suit filed last year that Omnicare, Mariner, Sava, and principals Leonard Grunstein, Murray Forman, and Rubin Schron arranged for Omnicare to pay Mariner and Sava $50 million in exchange for the right to continue providing pharmacy services to the nursing homes, which together constituted one of Omnicare's largest customers, according to the government.
They allegedly tried to disguise the kickback as a payment to acquire a small Mariner business that had two employees and was worth far less than $50 million. Investigators said Omnicare paid $40 million before acquiring the Mariner business. At the same time, Omnicare obtained 15-year pharmacy contracts from Mariner and from Sava, a new nursing home chain that Grunstein and Forman created from the Mariner chain, according to the Justice Department.
Prosecutors alleged that Grunstein and Forman illegally tied the new pharmacy contracts to Omnicare's purchase of the small Mariner business unit, and that the total $50 million purchase price for the business unit actually was a kickback by Omnicare to keep the future business of Mariner and Sava, according to the feds.
Approximately $7.84 million of the settlement will go to the federal government, while $6.16 million has been allocated to several state Medicaid programs that the federal government did not identify.
Federal prosecutors also alleged that after the government issued subpoenas about the transaction in 2006, the defendants created backdated documents to hide the kickback. "Kickbacks in all forms are insidious because they distort medical decisions affecting Medicare and Medicaid beneficiaries," said HHS Inspector General Daniel R. Levinson. "We will vigilantly scrutinize attempts to disguise kickbacks as legitimate business transactions and work to hold payers and recipients of kickbacks accountable."
Mariner has entered into a corporate integrity agreement with HHS, which retains the authority to exclude Sava, Grunstein, Forman, and Schron from participating in Medicare, Medicaid, and other federal healthcare programs.
