Wednesday, February 28, 2007

Not-for-profit

Many people ask why Floyd is a not-for-profit hospital and what the advantages are. This is a very good question and I can only give a few thoughts. There is a recent government publication that addresses this issue in detail and was published in December of 2006. http://www.cbo.gov/ftpdocs/76xx/doc7695/12-06-Nonprofit.pdf

Many not-for-profit hospitals belong to a group or network of hospitals like the St’s Mary’s system, the Baptist system, or the Sutter system in California. Being part of a larger not-for-profit network can help by supporting each other in times of need, working together to improve clinical services and taking advantage of economies of scale. This collaborative effort may help ensure that our local hospitals remain open and available to the communities they serve.

In some small communities or isolated areas, these hospitals may be the only providers of 24-hour emergency and hospital services. They may not survive without the government subsidy provided by being not-for-profit.

As part of a larger network, it sometimes gives these smaller hospitals access to much-needed capital and interest rates well below those of many independent facilities.

Historically, not-for-profit institutions had to have open Medical Staffs and had to treat everyone that came through the door. This difference is now a mute point as our legal system has eliminated these differentiating factors.

Few of these reasons really apply to Floyd, so you have to then ask what are the perks associated with being not-for-profit.



The above graph really shows why hospitals want the not-for-profit status. It is very financially beneficial.

In addition, according to the above report, there is very little difference in Uncompensated Care provided by not-for-profit and for-profit institutions.



The question that comes to mind is why with all the subsidies and tax advantages are some not-for-profit institutions in communities like ours not more profitable. Could it be the management styles between the types of organizations?

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Tuesday, February 27, 2007

Board Meeting surely to be difficult

Tonight is the first scheduled Board meeting since the announcement of the financial pitfall that has occurred at Floyd. It is still sketchy as to exactly how extensive the problem is and we probably won’t know until the external audit is completed in ~90 days.

Even the newspapers are getting “difficult to decipher” information. The tribune The News and Tribune - Floyd Memorial's bad debt rising reported the following:

Many patient bills from 2006 haven’t been collected yet, Miles said. The hospital always maintains a reserve fund to cover bad debt, but with Medicaid and insurance contributions dropping in some cases and with more patients who can’t pay anything, the hospital needs to add another $11.5 million to that fund.

About $8 million of the shortfall comes from bills now deemed “uncollectible” and $3.5 million from accounts for lower Medicaid and insurance contributions, Miles said. He would not comment on whether the funding gap would endanger jobs or services.
The board will review the 2007 budget at a meeting within the next 30 days and decide how to reconcile the $11.5 million shortfall, which Miles said represents 3.9 percent of previously expected revenue for 2006.

The Courier Floyd Memorial might trim '07 budget reported:

In it, he said "anticipated revenue" from Medicare and Medicaid might fall short of amounts listed in the 2007 budget, which was adopted at the end of last year.

"Therefore, the 2007 budgeted expenses will have to be reduced," he wrote.

The reasons for the adjustments, Miles said, include plans by Indiana lawmakers to "flat line" Medicaid reimbursements and Bush administration intentions to reduce Medicare and Medicaid payments to health-care providers.

In addition, Miles said, Floyd Memorial probably will have to make adjustments in the amounts set aside to cover bills not paid by uninsured patients and other bad debts and shortfalls in expected payments from health-insurance companies.

Because board members "had signals" that the financial statements for last year included inadequate reserves, Miles said, they called an accounting company to examine them.
"Preliminary results show a need to adjust the 2006 financial statements acknowledging a shortfall" of $11.5 million in bad-debt reserves, almost 4 percent of the hospital's gross revenue last year, he said.

"We had not reserved enough to cover these shortfalls," he said.

And in the Chairman’s Corner The Chairman's Corner, Floyd Memorial Hospital, New Albany, Indiana, Mr. Miles stated the following:

Blue & Company, an independent CPA firm that specializes in healthcare, recently conducted an analysis of Floyd Memorial Hospital and Health Services' 2006 financial statements. Preliminary results show a need to adjust the 2006 financial statements acknowledging a shortfall in contractual adjustments, bad debt reserve and third party settlements. A complete audit is being scheduled and will take approximately 90 days for results to be finalized. The preliminary result is a non-cash entry to the balance sheet showing an adjustment of approximately $11.5 million, which is 3.9% of the hospital's gross revenues for 2006.

I am continually asked why the reports being given and questions from reporters are coming from the Chairman of the Board. This is a radical change from the previous 13 plus years.

I believe Mr. Miles is diligently working and gathering information from all available sources to sort through this mess and implement a workable solution.

As the courier stated above, this current Board needs to examine closely “the signals” that were present and I believe they will reach the correct informed decision.

Monday, February 26, 2007

Problems in Delivery Systems


This recent survey is about as accurate as any I have seen. It highlights the continued and ongoing problems we observe in healthcare on a daily basis including Floyd and other area hospitals.

Even though some of these problems are multidisciplinary in nature, others are related to management styles and the environment created by administrations.

Virtually all of these problems deal with areas that can be improved with the acknowledgement and willingness to consider change.

In some cases, a complete paradigm shift in processes, attitudes and thinking may need to take place.

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Friday, February 23, 2007

Satire on Illegal Aliens

BECOMING ILLEGAL! (Letter from a Maryland resident to his senator)

The Honorable Paul S. Sarbanes
Senate Office Building
309 Hart
Washington DC, 20510

Dear Senator Sarbanes,

As a native Marylander and excellent customer of the Internal Revenue Service, I am writing to ask for your assistance. I have contacted the Department of Homeland Security in an effort to determine the process for becoming an illegal alien and they referred me to you.

My primary reason for wishing to change my status from U.S. Citizen to illegal alien stems from the bill which was recently passed by the Senate and for which you voted. If my understanding of this bill's provisions is accurate, as an illegal alien who has been in the United States for five years, all I need to do to become a citizen is to pay a $2,000 fine and income taxes for three of the last five years. I know a good deal when I see one and I am anxious to get the process started before everyone figures it out. Simply put, those of us who have been here legally have had to pay taxes every year so I'm excited about the prospect of avoiding two years of taxes in return for paying a $2,000 fine. Is there any way that I can apply to be illegal retroactively? This would yield an excellent result for me and my family because we paid heavy taxes in 2004 and 2005.

Additionally, as an illegal alien I could begin using the local emergency room as my primary health care provider. Once I have stopped paying premiums for medical insurance, my accountant figures I could save almost $10,000 a year. Another benefit in gaining illegal status would be that my daughter would receive preferential treatment relative to her law school applications, as well as "in-state" tuition rates for many colleges throughout the United States for my son.

Lastly, I understand that illegal status would relieve me of the burden of renewing my driver's license and making those burdensome car insurance premiums. This is very important to me given that I still have college age children driving my car. If you would provide me with an outline of the process to become illegal (retroactively if possible) and copies of the necessary forms, I would be most appreciative. Thank you for your assistance.

Your Loyal Constituent,

John Q. Public

Get your Forms (NOW)!! Call your Internal Revenue Service 1-800-289-1040.
Please pass this onto your friends so they can save on this great offer!!!!

Explain it to me once more: WHY do I have to "Press 1 for English"?

Source: email and origin unknown

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Thursday, February 22, 2007

Luxuries of Hospitals

Medical treatment in the past has been primarily focused on treating patients in a safe, sterile environment and on treating the patients' illnesses.

The hospital environment was never a high priority in the past leading to the perception of hospitals being “institutional” and impersonal.

The trend now and for the future seems far from institutional!

Hospitals are now competing in not only health delivery, but also in appearance and luxuries.

An example is the Memorial Hermann System in Texas. They recently compiled the top 10 trends in hospitals of the future. What's in and What's out!

1. Betsy Johnson PJ's to replace the open back hospital gowns
2. Gourmet chefs and room service served promptly to replace bland food served at 8 a.m., noon and 5 p.m.
3. Hands-free, wireless Vocera communication devices enabling
instant connectivity with others anywhere in the hospital rather than overhead paging
4. Paperless (save a life / save a tree) vs. file rooms
5. Operating room tracking patients through the surgical process via a large display screen vs. Pacing the halls and waiting in pre-op/post-op areas
6. Healing gardens, meditation rooms, music and massage therapy vs. old rooms with white institutional walls
7. Pet therapy vs. No pets allowed
8. Marble jacuzzi tubs vs. postage-sized shower stalls
9. All private rooms/concierge services vs. Semi-private rooms and isolation from daily activities
10. Aromatherapy vs. Rubbing alcohol and Disinfectant

With the average length of stay in a hospital for most patients ranging 2-4 days, how can these things contribute to lowering our healthcare costs?

I’d like to ask the people who continually demand such services this question;

Who is obligated to pay for these luxuries?

Wednesday, February 21, 2007

Charity Care

Shifting costs from the uninsured to the insured has always occurred in healthcare as well as most industries. You can bet that Hurricane Katrina will cause insurance rates to respond as cost shifting and cost sharing occur.

Hospital reporting Charity care is widely variable because of the inconsistencies in the way it is provided, reported and paid for.

The estimated number of uninsured Americans is somewhere around 45 million. Many small businesses no longer are providing coverage because it is too expensive, rising insurance premiums are causing many people to opt out of the insurance offered, and the economies up and downs will cause turnover and subsequent health insurance lapses.

There are an estimated 10.3 million undocumented workers in the U.S. who do not apply for benefits for fear of immigration issues.

Because ER’s have to treat everyone, the free medical care for uninsured people is mounting. All of this adds to the numbers reported as Charity Care by hospitals.

A survey done by PricewaterhouseCoopers showed the following:
• Hospitals in the survey reported providing charity care equivalent to an average of 5 percent of net operating income, although many provided levels that are significantly higher.
• Ninety-two percent of hospitals surveyed said that part of their bad debt could be classified as charity.
• Hospitals increasingly are revising and communicating their charity care policies.

The question remains as to what is “Charity Care” and what is “bad debt” and this is where confusion is leading to more legislative action, litigation, and bad press.

This is also where some hospitals find themselves having trouble in their budget assumptions and profits.

Not for profit hospital’s like Floyd are required to quantify these numbers to qualify for exemptions. Making assumptions that are invalid can be troublesome when overestimated as well as underestimated.

There are very little well-defined standards accepted by all hospitals on what qualifies as Charity Care. Many hospitals do not comply with the requirements set by outside agencies. Patients also need to assist with providing accurate information to make these assignments correct.

Uncompensated care and Charity care are not necessarily interchangeable terms.

Most hospitals continue to base their Charity Care on charges rather than cost which tremendously overestimates what they actually provide.

True Charity Care is of major importance because it affects not only healthcare resources, bed utilization, physician time, staff time, but also how costs are reallocated to other patients.

If we believe the government should help provide for Charity Care, there needs to be some standards in place that are accurate and reproducible based on cost and not charges and all hospitals should calculate it the same.

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Tuesday, February 20, 2007

Uncompensated Care

Although we could discuss the current hospital situation for days now that the financial news has been made public, I am going to allow the new Chairman and the new Board some time to formulate their plan on dealing with the situation.

In the meantime, we will try to answer some other questions about different but related topics.

Last year, there was increased focus from the Healthcare Financial Management Association (HFMA) on uncompensated care and much attention was focused on the controversial issue of Medicare shortfalls and the roles these shortfalls play in accounting for the community benefits a hospital provides.

One issue of significant importance relates to revenue recognition. The HFMA believes hospitals should recognize revenue for patient services only when they can reasonably expect to collect payment. But this is not always the way accountants make the assumptions.

Gary Taylor, a healthcare facilities analyst with Banc of America Securities in a research report released last December stated that "aggressive revenue recognition", and not the uninsured, is really to blame for the alarming rise of hospital bad debt.

Modern Healthcare has covered this topic in recent issues as well.

The percentage of bad debt that all hospitals have reported in the past few years has risen at an alarming rate. In Taylor’s report, he states that comparing the rise in bad debt with other data on the growth of he uninsured doesn't match up.

Taylor also disagrees with the hospital’s recurring argument that "they are the victims of a societal issue". He doesn’t believe their arguments of the rising number of uninsured or the fact that all hospitals must treat emergency patients regardless of their ability to pay correlates with the actual data.

He gave examples that ambulance companies in particular will tell you that there is basically no significant increase in the number of uninsured patient volumes in the last few years.

Taylor believes the rise in reported bad debt by hospitals has to do with the fact that many hospitals inflate their revenue. They do this by aggressively raising the prices of everything. Hospitals still use a charge-based system rather than a cost-based system. In Taylor’s report, the growth in gross charges is in excess of 15% annually. This will naturally push your collection ratio down.

"As most now acknowledge, hospital charges have little basis in reality, but inflating them does appear to make a difference in the accounting. On average, Taylor says, hospital companies are booking three times more net revenue for patients without insurance than patients with insurance, and revenue that can't be collected eventually becomes bad debt-a write-off. It's an accounting game."

The American Institute of Certified Public Accountants will possibly recommend changes related to hospital revenue recognition standards sometime this year.

This will be of some help but it still makes everyone question the numbers that are presented.

The bottom line for accounting is:
**If you don’t believe it is collectable, don’t count it as revenue.


The odds of collecting the full charges from uninsured patients are extremely slim. Coming up a with a realistic collection percentage is the issue and this is where many hospitals err on the accounting side for various reasons. It results in their bottom line appearing different than reality.

The problem arises when budgets make these assumptions with over-inflated numbers because they will eventually spend more than they can collect.

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Monday, February 19, 2007

Chairman's Corner

Physicians, staff and the community were informed on Friday of the financial situation at Floyd and we received the same letter as posted on the web site under the “Chairman’s Corner” The Chairman's Corner, Floyd Memorial Hospital, New Albany, Indiana

One statement in the letter is as follows:

“Preliminary results show a need to adjust the 2006 financial statements acknowledging a shortfall in contractual adjustments, bad debt reserve and third party settlements. A complete audit is being scheduled and will take approximately 90 days for results to be finalized. The preliminary result is a non-cash entry to the balance sheet showing an adjustment of approximately $11.5 million, which is 3.9% of the hospital's gross revenues for 2006.”

In laymen’s terms, they erred in accounting for $11.5 million that is considered an expense on the balance sheet. This is a culmination of a multi-year problem and further investigation with a complete audit is being scheduled according to his letter.

The new Board Chairman has a tremendous amount of Board experience and banking knowledge and we will await his and the Board’s decision on how to handle this situation.

After more than a year of postings, I’ll let the readers come to their own conclusions about this information and listen to what they have to say.

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Friday, February 16, 2007

Humorous thought of the day!


Some people are like Slinkies


Not really good for anything


But they still bring a smile to your face when pushed down the stairs!

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Thursday, February 15, 2007

Toxoplasma brain activity

Toxoplasma gondii is a common parasite that infects about 40% of the world’s population.

According to a recent study in Australia, it can increase a women's attractiveness to the opposite sex but also make men more stupid.

The infection in humans generally occurs when people eat raw or undercooked meat that has cysts containing the parasite, or accidentally ingest some of the parasite's eggs excreted by an infected cat.

The parasite is a dangerous to pregnant women as it can cause abortions or birth defects of the unborn child, and can also kill people whose immune systems are weakened.

Not until recently did research reveal its mind-altering properties.

But what is more interesting is the results of the study showing the effect of infection is different between men and women as Dr Boulter writes in a recent issue of Australasian Science magazine.

"Infected men have lower IQs, achieve a lower level of education and have shorter attention spans. They are also more likely to break rules and take risks, be more independent, more anti-social, suspicious, jealous and morose, and are deemed less attractive to women.”

"On the other hand, infected women tend to be more outgoing, friendly, more promiscuous, and are considered more attractive to men compared with non-infected controls.”

"In short, it can make men behave like alley cats and women behave like sex kittens".

This study was also backed up by a similar study in mice.

The mice were found to be more likely to take risks that increased their chance of being eaten by cats, which would allow the parasite to continue its life cycle and mice treated with drugs that killed the parasites reversed their behavior.

As always, the researches are requesting more government money to continue with more research.

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Wednesday, February 14, 2007

Minimizing conflicts of interest

Most readers know about the new hospital plans for I-65 and Veterans parkway that has been in the news for the past couple of years and will probably be built in the next 18 months or so.

After much thought, review and input from CPA’s, personal financial counselors and attorney’s, our physician group (Physician Associates of Floyds Knobs LLC) had decided in 2006 to invest in the endeavor. Our investment was going to be three percent and the terms had changed late in the year and therefore final papers have not been signed.

With the election of myself as the Vice Chief of Staff in November and my partner appointed as one of the new Board members in January, it became a conflict of interest to have this investment. After very personal conversations with friends, colleagues, the Board Chairman, and attorneys, our group has withdrawn from any vested interest in the hospital.

We believe any significant conflict would be a detriment to our roles at Floyd and we want to minimize and eliminate any and all possible perceptions.

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Current Bills for the Indiana Legislature

Listed below are some of the current bills being considered in Indiana. These summaries come from the Indiana State Medical Association.

Bill: SB 351 – Medical Review Panel
Author: Sen. Brent Steele, R-Bedford
ISMA Position: Support

This Week: The full Senate considered SB 351 and voted 46-3 in favor of the measure. The bill will now move to the House.
The bill, as amended, will require members of medical review panels to make two attempts to meet in person before the panel chairperson can allow a member to participate via telephone or videoconference.
Current law does not specifically allow a member of a medical review panel to participate in a panel meeting via telephone. While many physicians have participated on review panels on the telephone, the explicit allowance for such capability does not exist.

Bill: SB 503 – Healthier Indiana Insurance Program
Author: Sen. Patricia Miller, R-Indianapolis
ISMA Position: Support

This Week: The Senate Health and Provider Services Committee held a special hearing dedicated solely to this bill. Many advocates in the health care industry testified.
ISMA President Vidya Kora, M.D., testified on behalf of the association. His testimony focused on four key points the ISMA Commission on Legislation and ISMA leadership developed regarding the uninsured:
Access to quality medical care for all Hoosiers
Administrative simplicity for patients and providers
Reasonable reimbursement to cover costs
Stable financing
The bill was not voted on this week in order for the committee to take into consideration all the testimony that was offered. The bill is expected to be voted on at next week’s hearing, which coincides with ISMA’s Medicine Day.
The bill includes provisions necessary to enact the structural provisions of the Governor’s Plan to cover the uninsured. The bill also makes funding changes to the Hospital Care for the Indigent program, the Medicaid Disproportionate Share Hospital Program, and the Medicaid indigent care trust fund.
Furthermore, the bill requires the Indiana Comprehensive Health Insurance Association to establish a new concept termed Health for High-risk Hoosiers.

Bill: HB 1547 – Health Care Certificate of Need
Author: Rep. Ralph Foley, R-Martinsville
ISMA Position: Oppose

This Week: The House Public Health Committee heard this bill on Wednesday, Jan. 31. Testimony in support of the bill came from the local county hospital in the bill author’s district. Also, testimony in support was offered by one large hospital chain and by an auto manufacturer concerned with rising health care costs.
The ISMA opposed the legislation, stressing that competition in the health care market is of utmost importance, especially when a tremendous amount of industry regulation exists at the federal and state levels. Also opposing the bill was the Indiana Hospital and Health Association, the Indiana Federation of Ambulatory Surgical Centers and the Indiana Academy of Ophthalmology.
Rep. Charlie Brown, D-Gary, chairman of the House Public Health Committee, did not vote the bill at the request of the author, Rep. Foley, R-Martinsville.
The bill would require the Indiana State Department of Health to re-institute a certificate of need program for Indiana. Certificates of need would be required to build or expand any hospital, ambulatory surgery center or comprehensive care bed.

Bill: HB 1607 – Regulation of Hospitals
Author: Rep. Charlie Brown, D-Gary
ISMA Position: Neutral

This Week: The House Public Health Committee heard this bill on Monday, Jan.29. The committee approved the measure, and it will move to the House floor for consideration.
The ISMA remains neutral on this legislation at the current time, though some physicians are expressing concern regarding the measure.
The bill would not allow a licensed hospital to use the term “hospital” in its name or advertisements unless the facility is equipped, prepared and staffed to provide medical care for emergency patients. The bill does not inhibit licensure of hospitals that do not provide for emergency services.

Bill: HB 1378 – Insurance Coverage Exclusion for Intoxication
Author: Rep. Trent Van Haaften, D-Mount Vernon
ISMA Position: Support

This Week: The ISMA reported last week that this bill was held in committee so amendments could be drafted to ensure the bill would accomplish its goal. It was anticipated the bill would be heard on Jan. 31; however, the bill was not heard. HB 1378 is now posted for a hearing on Feb. 7, ISMA’s Medicine Day.
HB 1378 aims to prohibit insurers from excluding coverage for injuries the insured sustains while intoxicated. An insurer’s ability to deny coverage for injuries sustained by an intoxicated insured stems from a 1947 model law called the Uniform Accident and Sickness Policy Provisions Law (UPPL).
In 2001 the organization that proposed the 1947 model law recommended the exclusion for intoxication be repealed as it applies to health benefit plans.

Bill: SB 327 – HPV Vaccination for 6 th grade girls
Author: Sen. Connie Lawson, R-Danville
ISMA Position: Support

This week: SB 327 was heard Jan. 31 in the Health and Provider Services Committee. The ISMA testified in support of the bill. An amendment was adopted that changed the provision that allowed for a child or parent to opt-out of the vaccination to an opt-in provision.
This bill would have required female students entering grade 6 to be immunized against HPV beginning in the 2008-09 school year.
As amended, the bill now provides that parents or guardians will receive information on the vaccination and have the option of having the student receive it. The amended bill passed unanimously out of the committee and now moves on to the Senate floor for consideration.

Bill: SB 0010 – Repeal of Student Scoliosis Testing Requirement Author:
Sen. Patricia Miller, R-Indianapolis
ISMA Position: Support

This week: SB 10 passed the Senate by a vote of 37-11 and will be considered in the House during the second half of session. Rep. Peggy Welch, D-Bloomington, will sponsor the bill in the House.
This bill repeals the student scoliosis testing requirement in schools for students in the 5 th, 7 th and 9 th grades. The U.S. Preventive Services Task Force gave the screening test a D, the lowest grade.

Bill: HB 1241 – Physician Assistants Prescribing Authority Author:
Rep. Peggy Welch, D-BloomingtonISMA
Position: Oppose

This week: HB 1241 was heard Jan. 31 by the House Public Health Committee. The bill was amended in committee to include that a physician assistant must have obtained 30 contact hours in pharmacology and be employed by the physician for one year before prescriptive authority can be granted.
Two doctors testified in opposition on behalf of the ISMA. After hearing from both proponents and opponents of the bill, Chairman Brown declined to take a vote after concern was raised during testimony about the definition of “immediately present.”
This concern echoes the ISMA’s first principle to be included in any law authorizing physician-delegated prescribing authority for physician assistants. The ISMA will work with the bill’s author to define the term “immediately present.” The bill will be heard again at an upcoming committee hearing.

HB 1241 grants prescriptive authority to physicians assistants (PAs).
The ISMA opposes the bill; however, the ISMA’s 2006 House of Delegates passed a resolution stating if prescriptive authority were to be granted to PAs that we urge the following conditions to be part of the law:
PAs may prescribe only while a doctor is physically present.
Privileges for PA prescribing are delegated by a supervising physician.
PAs must obtain an adequate number of contact hours in pharmacology at an ARC-PA accredited school.
Prescriptions are limited to a 7-day supply of any scheduled drug with no refills.

Bill: HB 1349 – Legend Drug Prescriptions by Optometrists
Author: Rep. Peggy Welch, D-Bloomington
ISMA Position: Oppose

This week: HB 1349 was heard Jan. 29 in the House Public Health Committee. The ISMA opposed the bill. However, it passed out of committee 8-3 and now moves to the House floor for consideration.
This bill allows optometrists certified by the optometric board to administer, dispense and prescribe certain narcotic drugs, codeine with compounds, and hydrocodone with compounds.

Bill: SB 505 –Physician Medicaid Reimbursement Rates
Author: Sen. Patricia Miller, R-IndianapolisISMA
Position: Support

Requires the Office of Medicaid Policy and Planning to increase physician reimbursement by 10 percent in 2007 and 10 percent in 2008 in Medicaid managed care programs, fee-for-service programs and demonstration projects.

Tuesday, February 13, 2007

Medicaid increase proposal


There is some good news in the Legislature. A new bill being proposed would increase Medicaid rates to providers over the next two years.

You'll remember that Medicaid had not increased their rates since around 1989.

This will still have to pass both houses before being implemented, but it is a hopeful sign.

The changes Medicaid implemented and were to have in place by January 1 did not go as planned. There are thousands of patients who were not assigned their correct provider and many physicians who dropped Medicaid all together.

We predicted these things would happen and unfortunately the patients are the ones with most of the hassles.

The rate increase will incentivize a few more physicians to consider getting back into the program if it passes. If not, the ER will continue to be a primary care center for many of these patients.

Monday, February 12, 2007

Effective Leaders

With the local politics revving up as well as other issues in and around the community including Healthcare, let’s talk about effective leadership and what it requires. The courier had an article in yesterday mentioning the effectiveness of our current NAFC school superintendent and it sounds like he has many of the characteristics mentioned. How many of our other local leaders would get similar responses?

Communication: This is the single most important characteristic of leadership and probably the single biggest disappointment in our current president. Everyone can talk, but not everyone communicates. In medicine, communication is probably the single largest cause of malpractice issues. There are many less competent physicians who communicate well and rarely have any malpractice issues whereas highly competent physicians get sued all the time and many times because of communication issues.

Adaptability: Charles Darwin said, “It’s not the strongest of the species, nor the most intelligent, that survive; it’s the one most responsive to change.” Effective leaders must allow change to occur and better yet, many will actually be the catalyst. Maintaining the status-quo usually creates a roadblock to progress. Leader should challenge both the process and the current thinking biases. Leaders must recognize the time for paradigm shifts. Leaders must be adaptable to change. Effective leaders will lead rather than manage.

Accountability: Effective leaders remain accountable not only to Boards or stockholders, but accountable to the employees and customers. They should encourage challenges with open dialogue and two-way communication. Manipulation and limiting the free flow of all available information does not provide adequate accountability and breeds mistrust. Having well-defined goals that are measurable and objective are key to accountability. The goals should be adequate to really define the health of the organization. When they are not met, there needs to be consequences. If goals are measurable, it removes many of the emotions associated with the consequences.

Considerate: Leaders should primarily be “others-oriented”. They should always consider every task and comment carefully on the effect it will have on the organization as well as the individual. They should be willing to take the heat but always be positive in the responses. Leaders should not use their position to gain perks and should readily give credit for the successes to those who worked for it. Good leaders give the credit to others for successes and take the heat for failures

Having a plan and being Optimistic: Leaders should be the epitome of demonstrating a positive attitude in every public venue when dealing with employees. They should take every opportunity to respond in a positive manner as well as initiating words of encouragement. It is the responsibility of the leader to instill a sense of direction for the organization. It is meaningless to be a leader if you have no clue of where you are going. They must provide a clear vision for the future. Leaders should never discourage visionary ideas from employees and be willing to look at all ideas with enthusiasm and realism. The attitude of how ideas are accepted from the leader sets the tone of the organization. One of the worst faults a leader can do is become obsessed with the “legacy” they want at the organization. This type of thinking stifles creativity for fear of failure with the leader and a fear of rocking the boat.

Collaboration: Leaders need to enhance and encourage collective intelligence and teamwork. Leaders should provide adequate resources that allows for and encourages ongoing learning and advancement in each job. Leaders need to eliminate any perception of “sacred cows” and break down any perceived walls within the organization. Organizations have a tremendous amount of collective knowledge that should be made readily available. The authoritarian style of leadership often has a negative impact in many of these other areas.

Trustworthiness: Leaders must earn the trust of their employees and colleagues. They accomplish this by being fair, by doing what they say they’ll do, and by allowing for challenges and disagreement without fear of repercussions. They must create an environment that encourages each employee to feel comfortable and safe. A leader that is trusted creates an environment of commitment and loyalty. A leader that has lost the trust of the workers creates an environment of suspicion and fear and can destroy an organization. Once lost, a leader rarely is able to earn it back. It hangs over the leader and the organization like a ‘black cloud”.

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Friday, February 09, 2007

Purity Ball 2007


Tonight is the 4th annual Purity Ball event at Northside Christian Church. This year has been sold out with a waiting list for cancellations. The event begins at 5:45 p.m. with pictures, quartet music, and snacks

The formal part of the event begins at 6:30 pm and will last until 11:00 pm or later. Both dads and daughters are again excited and looking forward to the event.

Mom’s, friends and other family members are volunteering in multiple areas with registration, serving and photography.

Since last year, another local church has also begun a similar program and reported it as a great event as well.

Everyone on the planning committee appreciates the community wide support for the event as well as the sponsors of the event.

Thursday, February 08, 2007

New Tattoo ink

A small group of physicians and investigators plan to market a removable tattoo ink next year. The inventors believe that if all goes as planned, dermatologists will be able to remove permanent tattoos with a single laser treatment.

This new ink is made of microencapsulated biocompatible pigments that are absorbed by the body when the “capsule” is broken up by a laser treatment.

Since tattoo’s are notorious for not responding to typical treatments, this would really be a breakthrough and very innovative. Current ink being used has really no regulation and very little oversight or control. Therefore the composition can vary greatly and no one really knows what is in it. The FDA would be regulating this new compound which may or may not make some people feel safer.

Current laser treatments for tattoo removal can take anywhere from 6 to 16 sessions and even then removal is incomplete and quite possibly unsafe. Current inks have heavy metals and carcinogenic materials that theoretically could be absorbed when the laser breaks them down.

Current statistics show that almost one-quarter of Americans between 18 and 50 years of age (24%) are tattooed, and about one-quarter of these men and women had regrets about their tattoos. Many people try to cover their tattoos with a new one or more acceptable one.

The process of bringing this new ink to the market has taken more than 6 years already. There were some patent issues and some haggling over whether it was too similar to the ink used for skin marking in surgery. The patent judge encouraged them to settle the dispute on their own. They eventually merged the two companies

Studies are underway and hopefully the ink will be available sometime in 2007. Whether tattoo artist will actually use the new ink is yet to be determined. Since they have their own techniques and familiarity with products they already use, they may be resistant to change.

Wednesday, February 07, 2007

Rescinding rule

After careful consideration and discussion with individuals I respect, I have decided to rescind the previous comment moderation and reopen the Blog to even those who comment anonymously.

Using my current internet browser, I will have the ability to delete comments after they have been posted if they seem objectionable. The old browser I was using (Opera) did not allow this function because of some setting problems, but the new browser seems more functional.

Deletions of what seems objectionable will occur only after they are posted and will not in any way prevent comments being posted in “real time”. No comment will be screened before being posted, but could be deleted later if it seems too rude or personal and directed towards a "non-public" official.

I apologize to the readers if I have missed overly rude or inappropriate comments in the past. I do not always have the time to look back at some late comments that are posted and will try harder to not overlook them.

Again, the goal of this blog is to be informative as well as challenging and we should hold those in power accountable to the duties for which they are hired and/or elected.

I appreciate the comments, emails, and phone calls I have received from many friends and colleagues including “lawguy”, “iamhoosier”, concernedemployee and several others.

I continue to encourage rational discourse in the discussion of all topics. It remains disappointing there are those in power who continue to hide behind the veil of secrecy and anonymity and cannot admit their biases and personal agendas.

Tuesday, February 06, 2007

A new way to deny coverage

We’ve talked before about bariatric surgeries (procedures for obese patients to lose weight) and the difficulties as well as the cost. Patient advocates are now upset because of a new kind of coverage policy instituted by Blue Cross and Blue Shield of Tennessee. This new original policy requires seriously obese members to undergo intelligence testing before being approved for bariatric surgery.

The test involves a fairly extensive medical and psychological evaluation prior to the procedure and the Obesity Action Coalition has asked for it to be stopped immediately.

The coalition believes the policy is discriminatory and sets a dangerous precedent of denying access to care based on a patient’s intellect.

The quote out of Modern Healthcare was “They’re perpetuating the ugliest of stereotypes associated with obesity today—that the obese are somehow of lower intelligence than the general public,” says coalition spokesman James Zervios. “It’s just another hurdle for the obese patient to overcome in trying to access life-saving treatment.”

This is the first time we have heard of an insurance company requiring this type of testing for any medical procedure although I know there are less rigorous psychological tests done before transplant surgeries. Whether this is required by the insurance company or just the “Standard of Care” is unknown.

This insurance company states it has never denied coverage based on a patient’s IQ score and the testing is to help ensure that patients are “mentally equipped” to undergo the procedure.

Typical Bariatric procedures cause a major lifestyle changes and adjustments and poor adjustment to the changes can hinder the success of the procedure as well as increase the morbidity.

Lower scores could help the physician and healthcare workers to decide which patients may need closer follow-up and more intensive interventions.

As reported in an earlier blog, many of these procedures are not covered by insurance and if the ~$25,000 procedure were offered to everyone, companies may not be able to afford to provide insurance for their employees.

Many patient advocates are concerned that this policy will set a standard that will be used later to deny other benefits.

Monday, February 05, 2007

Bariatric complications

Recent studies demonstrate that obesity is not just a simple process too many calories. It entails a whole pathophysiologic cascade of mechanisms and alterations in the body and brain. There is some evidence linking obesity to specific genes but it is still unclear.

Treatment continues to involve lifestyle modifications as well as pharmacological treatments. Both of these treatments give an average of 10% weight reduction with limited long term success of keeping the weight off. For the extremely obese patient, this is rarely enough to achieve a healthy body weight.

Bariatric surgery is being performed more frequently than in the past, but it is not without complications. Most studies reveal complication rates ranging from 20-30% and overall, about 18% of patients require ER, outpatient, or hospital admissions to treat these problems.

The bottom line is that it requires a multidisciplinary approach with education, patient motivation, education, dieticians, physicians, medication, and surgical intervention when appropriate for ultimate success.

Our American diet and lifestyle only contribute to the overall problem. Payment for these procedures is becoming more and more controversial.

Friday, February 02, 2007

IUS Lecture series


IU Southeast is hosting a historic collection of literary works on loan from The Remnant Trust from now until April 23, 2007.

In addition to the displays, there were a series of lectures this past week which were free and open to the public.

I had the opportunity over the past few days to take advantage of these wonderful lectures. The lectures offered an opportunity to learn more about these original and early edition documents.

Speakers and the works discussed were:
Jan 29, J. Barry, Professor of Philosophy, Hobbes’ Leviathan.
Jan 30, George Harvey, Professor of Philosophy, Plato’s Republic.
Jan 31, Tom Kotulak, Professor of Political Science, Constitution/Bill of Rights.
Feb 1, Tom Kotulak, Federalist Papers.


Some of the items on display date back as early as 1250. It is a wonderful outreach program and has been very informative.

In addition, the schedule shown above is more upcoming lectures offered free to the public as well.

More information can be found at the website:
http://www.ius.edu/commonexperience

Thursday, February 01, 2007

New Rules of Engagement

It is regrettable, but after some anonymous postings I feel have been inappropriate, there will now be comment moderation added to this site.

Anonymity continues to be a mode of expression I believe is worthwhile especially for individuals in subordinate positions. It allows them a voice they may not otherwise have.

But after yesterday’s anonymous posting, I will now moderate what gets posted and what does not.

The recent Board elections on Tuesday were not accepted well by a few individuals. I know this because I received a “not very nice” email from one of them blaming me for the outcome.

In addition, an anonymous poster wrote yesterday something I believe to be inappropriate. There were only ~20 people in the board room that were able to hear a speech given. An anonymous posting yesterday quoted directly from that speech and had to originate from someone inside the Board room.

This I find inappropriate. I have been and continue to be open in my disagreements with policies and certain decisions being made. I’ve encouraged open communication with anyone including Board members and administration wanting to discuss the issues.

Having someone in the administration or on the Board make anonymous comments will not be accepted on this blog. The readers have a right to know that some of these comments are originating from members of the administration and/or Board.

For the time being, all postings will be sent to my email address and will be screened. If I do not know the poster, it will be left to my discretion to publish it. I encourage anyone wanting to post anonymously to choose a screen name using the “other” category. I already know some of the more frequent posters identities. For the others, let me know who you are and I will gladly post your comments as appropriate.