2007 outlook for US health care provider sector viewed by Ernst & Young. - Pharma Marketletter

In 2007, the convergence of market pressures, public policy developments and cost recovery concerns in the US health care provider sector will drive momentum for wider adoption of electronic records, improved efficiencies, greater transparency and new metrics for quality care, according to professional services company Ernst & Young's health care provider practice.

'Health care is operating under a growing strain to serve more patients, cut costs and maintain - and demonstrate - quality of care,' said Dee Balle, America's provider care sector leader at Ernst & Young. 'We are likely to see more focus on a transformation in business processes and operations in the coming year as hospitals and hospital networks confront these challenges. And the leaders - those who get out front - will raise the bar and create a more competitive environment among health care providers,' she added.

According to Ernst & Young' study, among the key issues that will shape 2007 for the USA's health care provider industry are:

Cost recovery

Since 2000, the percentage of individuals without health insurance has increased from 14.2% to 15.9% of the US population. To compound the problem, states facing budget challenges are pushing back on their contributions to Medicaid and there is explicit concern regarding underfunding for Medicare and Medicaid.

The US Government Accountability Office (GAO) recently issued a report advising the incoming Congress to reform Medicare and Medicaid. 'Absent reform, Medicare's and Medicaid's long-term fiscal sustainability for supporting health care for elderly, disabled, and low-income Americans is in jeopardy,' reports the GAO. While resolution may be unlikely due to political posturing, the dialog around the problems and possible remedies will escalate.

Technology 'catch up'

The health care sector lags behind other industries in its use of technology for business processes; especially notable is that only a small percentage of medical records are computerized. To spur progress in this area, there is growing support for the federal government to play a leadership role in establishing standards and funding.

Before the 2006 US mid-term elections, two competing health information technology (health IT) bills were passed, one in the House and one in the Senate, but no further action was taken in the 109th Congress, which ended with 2006. There is a good possibility that health IT proposals will once again emerge during the 110th Congress. Incoming Senate Health Committee Chairman Edward Kennedy (Democrat, Massachusetts) has stated that one of his top priorities will be to pass health IT legislation.

Transparency

Congressional interest in health IT stems, in part, from patients (voters) who are demanding more information and services from their health care providers - on their terms. In August last year, President George W Bush signed an executive order requiring more transparency in pricing and quality reporting. Communities increasingly want to understand all hospitals' pricing and quality of treatment and outcomes.

There is an argument that greater transparency and communication will change attitudes about health care, give consumers the ability to make more intelligent choices about hospitals and physicians and enable hospitals to better track quality and efficiency and use that information to incentivize physicians.

Professional staffing challenges

Labor costs are rising at a faster rate than inflation at hospitals and skilled nursing facilities. With the aging baby boomer population expected to place unprecedented demands on the health care system, the US Department of Labor predicts an additional 5.3 million health care workers will be needed by 2010 (2.2 million replacements, 3.1 million new positions). Issues of cost and how to efficiently increase staff according to demand will receive much attention from health care administrators in 2007.

Pay for performance & gainsharing

In the interest of improving quality and reducing costs, health care payors, including Medicare, are looking to incentivize doctors and hospitals based on quality and safety performance. The US Centers for Medicare and Medicaid Systems (CMS) will implement a 'pay for performance' program in 2007, under which doctors serving Medicare patients can qualify for a 1.5% bonus if they report data on the quality of care, using measures specified by the government.

Gainsharing, says Ernst & Young, is another incentive program that is being discussed at many levels. Gainsharing occurs when hospitals provide physicians with a percentage of any reduction in hospital costs resulting from the physician re-engineering of patient care without sacrificing quality. The ultimate goal of gainsharing is to reduce overall costs.

Community benefit and tax exempt status

Not-for-profit hospitals are facing a growing burden to demonstrate their value to the community. As pressure increases on the federal deficit, discussion in Washington DC questions the benefits that tax-exempt hospitals provide that taxable hospitals do not, which gets to the very heart of whether they should, in fact, be granted tax-exempt status.

Private equity investment in health care

Private equity funds typically target companies with lagging performance, potential for profit growth and strong cash flow that can be leveraged to pay off incurred debt from the deal, all of which are characteristic of many health care organizations.

Despite the current array of challenges facing health care today, PE funds have observed the combination of growth potential (note previously mentioned demographic trend) and opportunity for business operations improvement to increase efficiency and turn a healthier profit, says Ernst & Young. On the heels of the 2006 private equity deal for a large multi-hospital system, we can expect to see additional PE activity in the sector and will be watching how PE infusions of talent and cash may raise the bar for the competition.

Women and health in America: Historical readings - Medical History

Judith Walzer Leavitt (ed.), Women and health in America: historical readings, second edition, Madison, University of Wisconsin Press, 1999, pp. ix, 692, L22.50 (paperback 0-299-15694-7).

Until recently, traditional accounts of the history of medicine have largely ignored women's role as either givers or receivers of health care. Over the last few decades, more scholarship has focused on women's experiences, and it has become increasingly sophisticated and nuanced, moving away from a view in the 1970s of women as victims to women as agents who act in ways that both enable and challenge established medical practice. Women and health in America adds more detail to this increasingly complex picture. In this thoroughly revised second edition, Judith Walzer Leavitt has assembled another outstanding group of essays about women's experiences in the health care arena. This book is especially valuable since it collects in one volume existing scholarship that had been previously available only in a variety of disparate sources.

The volume is organized chronologically into three parts: the first covers subjects from the seventeenth and eighteenth centuries, while the second focuses on the nineteenth century. The third, which addresses health concerns from the late nineteenth to the twentieth century, is the largest unit, containing twenty-eight out of the thirty-five selections that comprise the volume. This final section is further subdivided into specific topics: body image and physical fitness; sexuality; fertility, abortion, and birth control; childbirth and motherhood; mental illness; health care providers (midwives, nurses, physicians); health reform and public health; and the medicalization of health practices.

Twelve brief, but helpful introductions precede every section, providing a concise overview of the subject and a pr&is of each article. Only six essays from the 1984 edition remain. The remaining twenty-nine were initially published over the last fifteen years, from as early as 1986 to as recently as 1996. Topics bearing on issues of race, ethnicity, class, and sexual orientation have a much more prominent place in this volume than in the first edition. Some contributors provide broad over-views of a particular subject, such as Nancy Dye and Daniel Smith's chapter on `Mother love and infant death, 1750-1920', which tracks maternal feelings and perceptions about children during this period through an examination of women's personal writings. Others narrow the focus considerably. In `From robust appetites to calorie counting: the emergence of dieting among Smith College students in the 1920s', Margaret Lowe probes the change in attitudes of Smith College students toward food and their bodies. Prior to the First World War, weight gain was perceived as a sign of health, but by the 1920s, dieting and weight loss became central concerns which, Lowe argues, 'signal a pivotal shift in the way white middle-class college women understood and shaped their bodies' (p. 173).

The range and depth of this book is impressive, and several themes emerge from even cursory browsing. First, medicine both shapes and reflects social attitudes of the time in ways that profoundly constrain and limit our knowledge of health and disease. Second, but related to the first point, medical and social understanding of health and illness have material consequences in people's lives. Conceptions about the body influence what a society considers appropriate or inappropriate behaviour based on age, gender, race, or condition of health, as Elizabeth Lunbeck's article, ''A new generation of women': progressive psychiatrists and the hypersexual female', vividly demonstrates. While it is important to recognize how these societal beliefs affected past medical practices, it is equally, if not more, important to be cognizant of how they continue to operate. Leavitt's book is a compelling testimony to how an appreciation for the contingencies of history and cultural values, particularly with regard to gender, can guide the current direction of health care in America. And this is Leavitt's express intent: 'It is my hope that the historical articles in this book can further that understanding by helping to inform current health policy debates.... By looking back while we plan ahead, the issues at the turn of the millennium ... can be put in a perspective and context that can maximize future development' (p. 7). Women and health in America thus provides a fascinating glimpse into the past, while furthering an understanding of the complex social factors that continue to shape health care in America today.

[Author Affiliation]

American health provider's IT hub to create 50 jobs - Belfast Telegraph

A COMPANY which is a household name in the US is to base an IToffice in Belfast and create 50 jobs over the next two years.

CVS Caremark, a Fortune 50 firm with approximately 200,000employees and 7,300 outlets across America, is the largest pharmacyhealthcare provider in the US and its planned information systemsdevelopment centre will be the company's first foray intointernational territory.

Invest Northern Ireland has offered Pounds 300,000 of support,while a further Pounds 200,000 of support has been offered under theDepartment for Employment and Learning's Assured Skills Programme.

The new jobs will contribute Pounds 1.5m to the economy annuallyand hiring is due to start within weeks.

Stephen Wrenn, senior vice- president of IT services of CVSCaremark Corporation, said that he has worked in Northern Irelandwith several different companies in his career and said that he has'always been amazed' at the quality of the workforce here and saidthat in terms of future expansion, 'the sky's the limit'.

'The IT talent in Northern Ireland has always been phenomenal. Icannot say enough about the university system here, and how theuniversities have always been so willing to tailor their curriculumsto what international investors are looking for,' he said.

'I have always been amazed at the quality, the discipline andlevel of commitment of the workforce and the friendliness of thebusiness community.

'We looked at lots of different regions but chose NorthernIreland for those reasons and also the security of the data systemsand legal system here which will allow us to protect the data andapplications that we are hoping to develop here in Northern Ireland.

'People do want to put numbers on everything but in terms ofexpansion I will say that if this works out there could be nolimitations to what we could do here.'

Enterprise Minister Arlene Foster said that the new office, thelocation of which has not been confirmed, will play a 'small butstrategic role' in the overall corporation.

She added that more and more investors are recognising thatNorthern Ireland is 'big enough to do business, but small enough tocare' adding that 80% of investors here end up re-investing.

'It's been said that companies come here for the cost and stayhere for the people,' she said.

'A lot of people here do not realise how central CVS is toeveryday life right across the US -- they are everywhere.

'Invest NI has been negotiating with the firm since October andStephen has remarked upon how quickly and easily everything has goneand the flexibility we can offer to international investors.'

Pounds 300,000

Rebounding Home-Health Provider CareSouth Builds for Future in Augusta, Ga. - Knight Ridder/Tribune Business News

By Damon Cline, The Augusta Chronicle, Ga. Knight Ridder/Tribune Business News

Feb. 15--CareSouth Homecare Professionals was created from the ashes of a scandal-ridden company's bankrupt assets, then nearly went bankrupt itself when the government changed how it paid home-health companies a few years ago.

Today, standing in CareSouth's new 30,000-square-foot headquarters on Walton Way Extension, where 200 workers last year processed more than $200 million in revenue, a visitor would consider that as ancient history.

Turnaround. Rebound. Rebirth. Whatever you call it, CareSouth has done it.

The 8-year-old company, which had $31 million in debt in 1998 and posted a $5 million loss in 2000, is on track to beat the $5 million profit it made in 2003.

CareSouth employs 650 at six home-health agencies in five states, where its registered nurses and aides provide doctor-prescribed, in-home care to elderly, debilitated and recovering patients.

The company also manages nearly 2 dozen more home-health operations for organizations such as University Hospital in Augusta and St. Joseph's/Candler in Savannah, Ga.

The company wants is hoping to get a bigger piece of the $40 billion home-health market through acquisitions and, possibly, by becoming a public company like home-health giant Gentiva Health Services, a $750 million, Nasdaq-traded corporation.

'Wall Street is looking at home health in a very positive light,' said CEO Rick W. Griffin. 'The future looks really, really bright where we're going.'

And why not? The Census Bureau estimates that more than one-fifth of the U.S. population will be 65 or older by 2030.

'That's a huge number,' Mr. Griffin said. 'Those are the people likely to utilize our service.'

Mr. Griffin was general counsel for the Central Georgia Health System, the Macon-based hospital network that created CareSouth in September 1995 when it paid $54.7 million for the assets of Augusta's Healthmaster Home Health Care, which was bankrupted by a Medicare fraud scandal that sent its owner and top two executives to prison.

CareSouth is now majority-owned by Alexandria, Va.-based venture capital firm Capitol Partners LLC, with Mr. Griffin and other key managers holding small equity stakes.

The management buy-out deal was consummated March 9, 1998. Twenty-one days later, when the Medicare home-health payment system was overhauled, CareSouth nearly went under, like more than 3,000 of its competitors.

'It was a nightmare,' Mr. Griffin said.

CareSouth, like most of its peers, gets 90 percent of its payments from Medicare, the federal health insurance program for people over 65.

Medicare's home-health payment system has changed many times since it was created in 1965, but no change was more dramatic than the 1997 Balanced Budget Act, which converted the government's payment method from 'cost-based' to 'prospective-based.'

Under the cost structure, Medicare simply reimbursed home care companies dollar-for-dollar for their services. With no incentives to prompt efficiency, fraud and abuse became rampant, as in the Healthmaster case.

The prospective system aimed to change that by reimbursing companies in 60-day intervals based on the patient's condition and geographic location. That brought efficiency because companies would incur a loss if their treatment costs exceeded the government's reimbursement.

'It's a good system,' Mr. Griffin said. 'The companies that deliver the best care in the most efficient manner are the ones that are the most successful financially.'

The problem for CareSouth and the rest of the industry was that the system took two years to implement, instead of months as the government had forecast.

The interim system designed to be a transition was simply the old cost system with reduced reimbursements. Not only that, but the reductions were made retroactive for a year, meaning companies such as CareSouth had to give back what the government said were overpayments.

'When that happened, we were absolutely guaranteed a huge loss,' Mr. Griffin said. 'They basically said that when we were reimbursed $100, we should have only been paid $75.'

So, on April 1, 1998, when the intermediate system went into effect, CareSouth suddenly owed the Medicare program $14 million. That violated the company's loan covenants with Bank of America, which called due the company's $17 million debt.

Had it not been for the cash infusion from Capitol Partners, CareSouth would have perished like 3,000 other home health companies between 1998 and 2000, based on figures from the National Association for Home Care in Washington, D.C.

'They kept it alive,' Mr. Griffin said.

With the dark days behind it, CareSouth hopes to bring more business to its Augusta office, which opened in January 2003. The renovated facility in the Walton's Corner office-retail park was formerly occupied by an Eckerd drugstore and a Winn-Dixie supermarket.

'We have a large infrastructure in Augusta that will allow us to take in additional business without incurring extra cost,' said Mr. Griffin, whose office was the frozen-meat section in its past life.

There probably will be more Medicare twists and turns ahead. Mr. Griffin said the fundamentals of CareSouth and home health care won't change.

'We believe in the long term, this is an industry the country needs,' he said.

To see more of The Augusta Chronicle, or to subscribe to the newspaper, go to http://augustachronicle.com/

(c) 2004, The Augusta Chronicle, Ga. Distributed by Knight Ridder/Tribune Business News.

Access to care and factors that impact access, patients as partners in care and changing roles of health providers.(Brief article)(Book review) - Reference & Research Book News

9780857247155

Access to care and factors that impact access, patients as partners in care and changing roles of health providers.

Ed. by Jennie Jacobs Kronefeld.

Emerald Group Publishing

2011

297 pages

$134.95

Hardcover

Research in the sociology of health care; v.29

RA394

Sociologists and other social scientists, and medical and other health-care researchers explore sociological dimensions of relations between health care and people. The overall themes are providers of care, patients as consumers of health-care services, and modifications and reforms in health-care systems. Among the topics are insider knowledge and male nurses, medical interpreting by bilingual staff whose primary role is not interpreting, emergency situations when older homebound women had fortuitous help and a typology of helpers who were involved, feminist centers negotiating medical authority in the 21st century and implications for feminist care and the US women's health movement, and privatization in Malaysia and its effects on the health-care system. There is no index. Distributed in North America by Turpin Distribution.

Day to honor women and health providers - Chicago Sun-Times

The month of March is one in which women and families arecelebrated. Today is International Women's Day, focusing on the keyrole of women in all aspects of life - at home, at work, ingovernment and politics and more. And March 10 is ProviderAppreciation Day, a day to honor those committed and brave workerswho staff the family planning clinics of this nation and providewomen with much-needed reproductive health care and services.

We believe that today is a time for the United States to honorthe commitment made at the 1994 International Conference onPopulation and Development in Cairo. This conference called foraccess to quality and affordable reproductive health care; reductionsin infant, child and maternal mortality, and gender equality,including girls' access to education. Many of these goals can be metby ensuring access to family planning. Family planning addresses allof these issues.

PRESIDENT OBAMA BACKS NATIONAL COUNCIL POSITION ON NEW FEDERAL DEFINITION FOR COMMUNITY MENTAL HEALTH PROVIDERS. - States News Service

ROCKVILLE, MD -- The following information was released by the National Council for Community Behavioral Healthcare:

In the compromise health care reform proposal released by the White House yesterday, President Obama calls for a new federal definition for Community Mental Health Centers (CMHCs) and other community-based mental health and addiction providers. The details of the Administration proposal are strikingly similar to the Federally Qualified Behavioral Health Center (FQBHC) definition that the National Council has been actively pursuing throughout the health reform care debate.

In July 2009, the House Energy and Commerce Committee adopted an amendment co-sponsored by Rep. Doris Matsui (D-CA) and Rep. Elliot Engel (D-NY) to the House health care reform bill that authorizes the new FQBHCs. This legislation takes a critical first step toward achieving parity between community behavioral health providers and other parts of America's safety net including public hospitals and Community Health Centers. In addition, the House measure more accurately reflects the evidenced-based and recovery-focused services that National Council members provide while establishing nationwide accountability and reporting requirements.

These new standards should help to avert instances in which unscrupulous entities have exploited the 1981 CMHC definition to engage in fraudulent Medicare billing practices. After nearly three decades of minimal federal leadership, the Matsui/Engel FQBHC proposal will achieve the goals that President Obama announced today while, at the time, improving health outcomes for millions of low-income Americans living with mental illnesses and addiction disorders.

REPRODUCTIVE HEALTH PROVIDERS AND ADVOCATES CELEBRATE LIFE AND ACCOMPLISHMENTS OF ARHP MEDICAL DIRECTOR EMERITUS, LOUISE TYRER, MD. - States News Service

WASHINGTON, DC -- The following information was released by the Association of Reproductive Health Professionals:

The Association of Reproductive Health Professionals (ARHP), representing more than 12,000 reproductive health care providers, researchers, and educators, is mourning the loss of Louise Tyrer, MD, who passed away on May 20 at the age of 89.

Dr. Tyrer was a legend in the international community of family planners and reproductive rights advocates. She broke barriers as a pioneering woman in medicine and make major contributions as a reproductive rights leader.

In 1971, Dr. Tyrer was the first female physician hired by American College of Obstetricians and Gynecologists (ACOG), where she served as director of family planning. She was the vice president of medical affairs at Planned Parenthood Federation of America (PPFA) for 15 years where she developed national medical standards and guidelines for contraception use and established two medical review committees to improve patient care.

Dr. Tyrer was a founding member of ARHP in 1963 and served as the organization's medical director from 1991 until 2002. According to Wayne Shields, ARHP's president and CEO, 'She was an amazing obstetrician/gynecologist provider prior to Roe v. Wade, when abortion was illegal. She was one of the 'first voices' for the pro-choice movement.'

A special tribute to the incredible life and contributions of Dr. Tyrer is being planned for Reproductive Health 2010, the annual meeting hosted jointly by ARHP, PPFA, and the Society of Family Planning. Reproductive Health 2010 will take place September 22-25 in Atlanta.

Fuel's surge a headache for home health providers - AP Online

Stethoscope? Check. Bandages and medications? Check. Money for fuel? Uh-oh.

U.S. home health care workers, particularly those in rural areas, are suffering from financial headaches caused by the escalating cost of transportation, forcing some to borrow cash from co-workers in between paychecks and others to consider leaving the industry altogether.

Providers of home care in New York, California and other states are doling out prepaid gas cards, rental cars and other perks in an effort to retain their workers, who care for roughly 12 million elderly and disabled patients nationwide and drive an estimated 5 billion miles a year, according to a recent study by the National Association for Home Care and Hospice.

The industry is also contemplating abandoning uneconomical home visits in far-flung locations, and increasingly checking patients' blood pressures, heart rates, blood-sugar levels and other vital signs via remote monitoring systems, which many companies previously deemed too expensive.

Industry officials said they had not heard of any instances where a patient's care was compromised by the high cost of getting a health care professional to their home, though they are worried it could happen. After some home health providers threatened earlier this year to cease operations in rural parts of South Dakota, Democratic Sen. Tim Johnson said he would push Congress to revamp the Medicare payment system to account for the industry's rising fuel bill.

While lots of industries are suffering as a result of gasoline prices that have risen more than 80 percent in the past 18 months, experts said it's a particularly knotty problem for nurses, aides and other employees of home health care agencies _ many of whom are responsible for their own travel expenses and depend on government reimbursements that haven't yet caught up with the rising prices at the pump.

A recent survey by the National Association of Area Agencies on Aging underscores the impact: half of the respondents said they had already cut back on home visits because of surging fuel costs _ and 90 percent said they expected to make cuts in 2009.

The Northern Montana Home Health Care and Bear Paw Hospice, a not-for-profit company based in Havre, Mont., that covers two counties made up of 24,000 people across 7,136 square miles, is looking at discontinuing service in the state's back country.

The company's director, Lisa Genereux, said the formula underpinning Medicare reimbursements simply doesn't account for $4.09-a-gallon gasoline, the average price at the pumps in the Rocky Mountain states these days.

Donald Wagoner, a nurse who travels up to 100 miles a day traversing New York's Adirondack region, said his newest professional challenge these days is simply not running out of fuel. "I've come close a couple of times," said Wagoner, who drives a Saturn Vue SUV that gets around 25 miles to the gallon.

For the most part, providers are taking steps to make sure their staffs can afford to travel from home to home and, when they cannot, that patients continue to get the care they need.

_ AristoCare Home Health Services, which operates in Arizona and California, recently began paying a $10-$15 travel stipend for trips outside downtown Tucson, and uses computer mapping software to reduce the number of miles home care workers drive between assignments.

"With as much driving as they do, we had to do something," said Cyndy Michaud, the Tucson, Ariz.-based company's branch relations manager.

_ Bons Secours Home Care in Newport News, Va., has arranged with a rental-car company to provide 15 fuel-sipping Toyota Corollas for its registered nurses. The nurses pay $150 a month for the car, they can drive it for personal use, and the agency picks up the cost of gas for the first 20,000 miles driven each year.

"As soon as we were able to start offering these cars, I had people knocking down my doors," said Sharon Riddick, the agency's director. "Now I'm fully staffed for the first time in seven years."

For its part, the Home Care Technology Association of America is lobbying Congress for changes in Medicare to allow companies that use remote monitoring systems to get reimbursed for it _ a major reason more companies haven't embraced the technology.

Even if remote monitoring technology becomes more widely embraced, patients requiring wound care, physical therapy and other hands-on attention will always receive it, the trade group's executive director, Bob Walters, said.

Many home health agencies reimburse workers for fuel on a per-mile basis. But with paychecks often two weeks or more apart, employees must cover rising gas costs out-of-pocket _ an extra burden for those working in rural areas, where pay tends to be lower but the distances between patients is higher.

Kathy Liddell, assistant director of patient services of North Country Home Services in New York's Adirondack Mountains said some home health aides _ who start at $9 an hour _ have had to borrow gas money from office staff to make it from one paycheck to the next. The Saranac Lake company's 250 employees collectively travel about 7,000 miles a day serving patients in a 5,000-square-mile patch in northern New York.

Part of the problem is that the agency can't afford to keep raising its reimbursement rate to keep pace with the price of gas.

"When gas was around $2 a gallon, we were paying 30.5 cents a mile. Now we're up to 42.5 cents," she said.

The Internal Revenue Service as of July 1 raised the automobile mileage rate that businesses and others can claim from 50.5 cents per mile to 58.5 cents per mile.

Most home care is funded through Medicaid and Medicare programs using fixed payment rates _ some of which are only adjusted annually _ based on estimates of the cost of providing care. But those costs _ like gasoline _ can rise sharply between adjustments. That makes it difficult for some to raise the fuel reimbursement for employees without busting its own budget, said North Country's Liddell.

The Association for Home Care and Hospice _ a trade group representing publicly traded companies such as Amedisys Inc. and Gentiva Health Services as well as smaller agencies _ also is pushing for changes in Congress.