SHNstat: a quick look at healthcare news and numbers

More data on why health insurance, and reform, matters

posted by David Gulliver at 11 p.m. Wednesday, April 21.

Three-quarters of women with health insurance have had a mammogram within the past two years, almost twice the level of women who had no insurance.

Almost 60 percent of children under 17 with insurance had a dental exam in the last year, double the level of those withouth insurance.

Those are among the fascinating batch of findings from the Agency on Healthcare Research and Quality's National Healthcare Quality Report. We touched on its some of its findings on hospital safety and complications last week. The report also addresses several other aspects of care, including the disparities in care across people with and without insurance.

AHRQ researchers looked at 35 measures of medical care, such as women getting a mammogram every two years, where they also could determine the insurance status of the patient. (They looked only at patients under age 65, because those older all qualify for inruance under Medicare.) They found that 65 percent of people with insurance typically received the recommended services, compared to 50 percent of uninsured people.

That difference may seem small, though significant, but in some areas (like mammograms and children's dental care) the disparities are striking. Another example: About 48 percent of insured people ages 50 to 64 had a colonoscopy or similar procedure to check for cancer, compared to just 21 percent of the uninsured. About one-third of insured people at high risk of complications from flu received a vaccination, nearly double the percentage of uninsured people.

When supporters talk about how healthcare reform should end up saving us money, that's what they're talking about.

 

Physicians get a two-month reprieve on Medicare

posted by David Gulliver at 11 p.m. Wednesday, April 21

As widely reported, on April 15 the Senate finally passed the measure containing yet another postponement of the 21.2 percent cut to what Medicare pays physicians. The measure, which also extends unemployment, COBRA and other benefits, postpones the cuts to June 1.

The 59-38 vote came at 5:47 p.m. and the House of Representatives quickly followed suit at 8:08 p.m. with a 289-112 vote. President Obama signed the resolution into law that night. Locally, Rep. Vern Buchanan supported the measure, H.R. 4851, while Sen. Bill Nelson did not vote and Sen. George LeMieux opposed the bill.

The vote came a little too late to satisfy the 10-business-day delay in implementing the pay cut, but Medicare's parent agency has agreed to reprocess the payments at the pre-cutback rate. I heard anecdotal reports that some local physicians declined to see some patients in the few hours while the cut was in place.

Despite the latest fix, physicians are still wary, and weary. The passage likely means a repeat of the same process in June. And in a letter published today. Dr. James Rohack, president of the American Medical Association, said the payment cut has some 60 percent of AMA members considering limiting how many Medicare patients they see, and one in four Medicare patients is having trouble finding a physician. "If Congress does not take action now to repeal the formula that causes the annual payment cuts, boomers will be in for a shock when they begin seeking health care under Medicare," Rohack said.

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'Avoidable patient harm': Hospitals make little headway on patient safety

posted by David Gulliver at 2:30 p.m. Tuesday, April 13.

Despite a decade of publicity of unnecessary complications and deaths, the nation’s hospitals overall are making made little progress on patient safety, according to an authoritative report released today.

The findings come in the Agency for Healthcare Research and Quality’s National Healthcare Quality Report. The findings come from analysis of millions of actual patient cases in some 200 areas.

The report zeroes in on two areas that “merit urgent attention” -- patient safety and healthcare-associated infections.

Postoperative sepsis, a condition where a infection spreads via the bloodstream, actually increased 8 percent since 2003. Urinary tract infections stemming from catheter placement -- the cause of some 40 percent of all hospital-acquired infections -- increased 3.6 percent.

A broad class of other infection rose 1.6 percent. Infections from central venous catheter placements were unchanged over the study period. Only pneumonia cases improved significantly, some 11.6 percent.

A review of 33 measure of patient safety in hospitals found only 12 improved by 5 percent a year, while 16 were either worse or unchanged.

In the neutral language common of government reports, the authors said, “It is evident that more attention devoted to patient safety is needed to ensure that health care does not result in avoidable patient harm.”

The authors note that some of the increase may be because hospitals are getting better at detecting -- and reporting -- these problems. But they also note that the report is using a new system for analyzing data, a multi-year regression, that should be more accurate and less prone to fluctuations.

The body of the report shows detailed reports on 10 quality measures over the last two years. Five have improved, while two have declined and three have been unchanged.

We'll be writing much more about tpoics in the report in the coming weeks. If you want to take a look for yourself, the report is available at this link.

Congressional 'kick-the-can' continues

posted by David Gulliver at 2:30 p.m. Tuesday, April 13.

Congress continues to postpone any sort of long-term resolution to the issue of physicians’ Medicare payments.

At 5:31 p.m. Monday, the Senate voted 60-34 to cut off debate on a House of Representatives bill that includes another one-month reprieve of the planned 21.2 percent cut to what the seniors’ health program pays doctors.

(The bill also includes a number of recession-aimed measures, like extending unemployment benefits and COBRA health insurance benefits.)

The Senate is scheduled to return to the bill today. Should they approve it, the cut would be postponed -- yet again -- until April 30. That also would avoid upsetting the “grace period” of 10 business days that the Centers for Medicare and Medicaid Services set at the beginning of the month, which held up any payments that would have been affecting by the rate reduction.

We’ll continue to watch the bill’s progress. You can see more about the ongoing mess in the Editor’s Notebook column.

Important change to state's tool for checking on your doctor

posted by David Gulliver at 12:30 p.m. Friday, April 9; link fixed 2:30 p.m. Tuesday, April 13.

One major flaw in Florida's online information about physicians was that pending complaints and investigations were invisible. Final outcomes were available, but discipline actions often take more than a year to resolve, it meant patients might have no idea of a potential problem with their doctors.

The Florida Department of Health has fixed that, and is now adding pending complaints on doctors and any licensed health practitioner to the profile information on its website. You can check that information at this link, under the license verification tab.

Sarasota Memorial to begin power plant demolition

posted by David Gulliver at 12:30 p.m. Friday, April 9.

Sarasota Memorial Hospital will start clearing the way for its new nine-story tower on Monday, April 12, when it plans to start demolishing the old power plant at the front edge of the Tamiami Trail campus.

The next major steps will be the closing of Arlington Street, just past the emergency room drop-off, for installation of a construction crane, and the creation of a new entrance to the main garage. It will open onto Waldemere Street, instead of just to the right of the hospital entrance.

Sarasota Memorial's North Port ER blows away projections

posted by David Gulliver at noon Thursday, March 18.

Several months ago, I was talking with Sarasota Memorial officials as they prepared to open the new free-standing emergency room in North Port. I didn't take notes, but I remember them saying they expected perhaps 20 or so patients a day, akin to their walk-in urgent care centers at University Boulevard and South Tamiami Trail.

Maybe they were serious, or maybe they were just trying to downplay expectations, but I told them they were way off -- the pent-up demand in North Port would double that.

Well, the hospital's operations team recently issued their rundown on the first four months of operation. I was wrong. The ER more than doubled the projections.

The emergency care center piece of the operation -- the part most people focus on -- saw 6,361 patients, compared to a projected 2,745. That's more than 50 a day. The lab operation did nearly as well -- 11,406 patients, compared to the budgeted 6,162. Respiratory and physical therapy also beat the budget; radiology fell a little short.

More importantly (for the accountants, at least) was the money side of the picture. Net operating revenue of $2.3 million was $863,173 better than budgeted. That went a long way to reducing the much-discussed financial loss: The operation was expected to lose just over $2 million over that time, and instead lost just $1.6 million. (A side effect of having more patients than you expect is having more expenses, too.)

Those figures don't include what SMH made on North Port patients eventually admitted to its main hospital, and there were 227 of them. (Another 152 were admitted to other hospitals.) But if a case was serious enough to merit admission at the main hospital, you can safely predict a significant bill and payment -- I'd ballpark it as at least $300,000 in actual revenue, and I'm probably underestimating.

SMH officials have always downplayed the importance of the North Port ER's referrals to the main campus, it's hard to imagine that SMH isn't happy about increasing its market share in south county, on the home turf of HMA's Venic e Regional Medical Center and HCA's Englewood Memorial and Fawcett Memorial hospitals.

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For children with cancer, and their families, fun and support

posted by David Gulliver at 11 pm Sunday, Feb. 28; added link, clarified attendance 3:30 pm Monday, March 1.

It's hard to imagine that families dealing with a child's cancer would have the desire, or energy, to spend an afternoon at a science museum. But for people who know them, it makes perfect sense.

"Kids are usually the first ones to push their families to have fun again," said Kyleen Slater, director of patient and family services at the Children's Cancer Center.

Slater was on a short break while a dozen kids, parents and siblings watched a film at Sarasota's G-Wiz science museum on Saturday. Her non-profit group has been helping pediatric cancer patients since 1976, mostly from its Tampa base. But a recent grant from insurer Humana has enabled them to expand their efforts. The free afternoon at G-Wiz was the kickoff of the center's outreach in Sarasota. About 20 families registered to attend.

Children's Cancer Center provides a range of services for children and families, from outings like Saturday's to counseling, mentoring, support groups, summer camps, financial aid and scholarships. While it has helped families from Sarasota before, staff recognized they needed to bring programs to this area. "It doesn't make sense for a Sarasota family to put the kids in the car for a night to drive to Tampa and back," Slater said.

So the group has partnered with the Sarasota-based Wellness Community of Southwest Florida, a cancer support group. It is putting on its first support group in Sarasota on March 8 at Wellness Community's center on Clark Road. For more information, call Children's Cancer Center at 813-FOR-KIDS (367-5437) or Wellness Community at 921-5539.

Even the slimmest connections can be valuable. The center recently took a phone call from a man in Oregon who had sun a simple Internet search on children and cancer, Slater said. While he lived too far away for the usual assistance, staff learned about his child's form of cancer, and connected him with a local mother whose child had a similar diagnosis and survived. The Oregon father later called back, Slater said. "That helped more than you could know," he told them.

For more information on the Center's programs, visit its website.

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Manatee Memorial names new CEO

posted by David Gulliver at 11 pm Sunday, Feb. 28.

Just a week after Manatee Memorial Hospital system's chief executive officer announced his surprise departure, the hospital system named his replacement.

Its Pennsylvania-based parent company, Universal Health Systems, kept it in the family and tapped a leading manager in the chain. Kevin DiLallo, currently chief executive officer at Wellington Regional Medical Center in Palm Beach County, will take over in Bradenton on March 15.

According to a Feb. 26 internal memo, DiLallo has received several internal UHS awards, and under his direction Wellington Regional received UHS's Service Excellence Award and four consecutive Solucient Top 100 national hospital awards. He has worked in healthcare administration for 25 years, is a fellow of the American College of Health Care Executives and has a master's degree in business administration from Florida Institute of Technology.

Manatee Memorial CEO to depart

posted by David Gulliver at 11:50 am Thursday, Feb. 18; updated 11:55 p.m. Thursday, Feb. 18.

Manatee Memorial Hospital’s chief executive officer, Moody Chisholm, is leaving the Bradenton safety-net facility to run a Jacksonville hospital system.

Chisholm will be chief executive officer of St. Vincent’s HealthCare, a division of Ascension Health. He will oversee two Jacksonville hospitals, St. Vincent’s Medical Center and St. Luke’s Hospital. The company reportedly plans a third hospital in nearby Clay County. Chisholm begins work there on April 5 and said he is leaving Manatee Memorial in early March.

Ascension, based in St. Louis, Mo., is a Catholic-founded health ministry and one of the nation’s largest non-profit healthcare providers. It has with 113,000 employees at its 500 hospitals, nursing homes and other facilities in 19 states, according to its annual report.

It represents a step up in the size of facilities for Chisholm. St. Vincent’s has 528 licensed beds, and St. Luke’s has another 313. Manatee Memorial has 319 beds and its sister hospital, Lakewood Ranch Medical Center (which has its own CEO), has another 120.

Chisholm has spent some 20 years with Manatee Memorial’s parent company, Pennsylvania-based Universal Health Systems, and also served as a vice president of its acute-care division.

He came to Bradenton in 2006, inheriting both a hospital and a medical staff frustrated by bad debt from the area’s uninsured and low-income patients. Physicians credit him with working with them to improve reimbursement and for working to revise how Manatee County compensates the hospital for unpaid care.

In an brief email yesterday, Chisholm said it was difficult for him to leave a company he had been with for so long, and a hospital that he loved and worked so hard, but that Ascension offered him a great opportunity for him and his family.

A Manatee Memorial spokesman said the hospital had no information yet on interim leadership or plans to recruit a full-time successor.

From Manatee Memorial's press release Thursday afternoon:

In reflecting on his career in Bradenton, Mr. Chisholm said:  “We have accomplished so much with the wonderful staff, physicians, Boards, and volunteers at Manatee Health System over the past several years, and the thought of leaving has been very difficult.

 This has been a painful decision process, because we love Bradenton, we have so many friends, wonderful co-workers and physicians, but in the end, this is a wonderful opportunity that allows me to advance my leadership role and settle my family in one location, hopefully for my entire career, before my children start kindergarten.

 I am thankful for the success our team has had here, with so much help from leaders in the community, County administration staff and Ed Hunzeker, Chamber leadership, our Boards, and former and current community servants like Pat Glass, Carol Whitmore and several other commissioners, as well as Mayor Poston and Representative Galvano.  I shouldn’t mention anyone by name, because there are so many to thank.

I hope and pray that the county and commission continue to support the community commitment that Manatee Health System has made, and continues to make in Bradenton and Lakewood Ranch.  I really don’t think most people in the area are aware that Manatee provides the highest percentage of indigent and charity care within at least 30 miles, yet we pay taxes and receive no direct tax subsidy. 

Manatee physicians and staff provide an incredible service to this community, and we are proud of that service.  I thank everyone here for their commitment to caring, professional, quality care for all those that put their trust in us, and I pray that this team, and those committed to a moral approach to healthcare are blessed with increasing success in the years to come. 

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More proof that what you spend on care depends on where you live

posted by David Gulliver at 9:00 am Friday, Feb. 12.

When we spoke at the Landings community last week, Sarasota Memorial CEO Gwen MacKenzie and I both touched on research that shows, essentially, that the same level of medical care can cost much more or much less depending on where you live. (See previous post from Feb. 5, below).

Our comments on the overall cost curve of Medicare were bolstered by information coming out that day. As it turns out, there also was new supporting evidence for our comments on these regional variations in costs. But first a little background.

Researchers at Dartmouth College have looked at many years of Medicare spending and broken it down by small regions. By looking at Medicare spending, they are looking at patients with largely the same health concerns. So one would expect Medicare to spend about the same amoutn per beneficiary everywhere.

Instead, they find that places like Miami and New York City cost far more than places like Salem, Oregon. As I noted, even areas that were spending the same amount in the mid-1990s -- like San Francisco and Long Island -- have diverged widely over time. And as MacKenzie noted, Sarasota is much less expensive than Miami, even though the demographics are similar.

In late January, an article in the policy journal Health Affairs tackled one of the lurking statistical issues -- how much of the difference in per-patient spending comes from the higher costs of goods and services in different markets?

In the abstract, the authors provide a convenient two-word answer: "not much." By my reading of the analysis, market costs account for about 16 percent of the difference in spending. And when Miami, the nation's most expensive market, costs double the average (and triple the cost of Salem), that doesn't make a dent in the difference. McAllen, Texas, made infamous for its high costs in a widely-read New Yorker article, actually gets more expensive.

So why is Miami so expensive? It's not simply the age and health of patients -- the study adjusted for that. A health care consultant recently gave me a good hint.

The consultant told me a major challenge in cutting costs at a Miami-area hospital is simply the culture of care: Patients expect their doctors to bring in multiple specialists on every health problem, and the doctors, who want to retain their patients, oblige them. And the Health Affair study bears that out, pointing to "utilization" -- the number of doctor visits and consultations -- as the main reason for the variation in spending.

Miami, though, suffers a double whammy of sorts. The study also notes that much of Miami's additional cost stems from much greater purchasing of home health care, durable medical equipment and other Medicare services, and said that may in part be due to fraud.

Until very recently, the full study was still available online. You can see the abstract, and pay for a copy of the article, at this link.

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A story that got results

posted by David Gulliver at 8:00 am Friday, Feb. 12.

Readers know we're not really in the business of linking to stories here; we're more about original reporting. That said, Walt Bogdanich, a New York Times investigative reporter, recently had a pair of stories on how patients are getting too much radiation from CT scans and other treatments because of complex equipment and insufficiently trained staff. You can read them here and here. If you haven't seen the stories -- which ran in shorter form in some papers -- you should take a look.

This week, Bogdanich reported that the Food and Drug Administration is going to beef up its regulation of CT scans and other devices, and that the leading radiation oncology group and the device manufacturers are supporting the move. The Times does report that the FDA has been looking at this for a while, but you can be sure the Times has been digging into it for a while too. And FDA's announcement, a few weeks after the Times put the issue in the spotlight, is almost certainly no coincidence.

Expensive new proof of the need for healthcare reform

posted by David Gulliver at 8:45 am Friday, Feb. 5.

If people needed one more bit of proof that the country needed healthcare reform, they now have it.

Spending on health care grew 5.7 percent in 2009, to $2.5 trillion, according to estimates issued Thursday by the Centers for Medicare and Medicaid Services and published in the respected journal Health Affairs.

While that’s an almost incomprehensibly large figure, its significance is in its relation to the bigger economic picture. And by pure coincidence, I was explaining that issue to a group of some 75 people just as CMS was giving reporters the new estimates.

Over the past 40 years, healthcare spending has grown much faster than the rest of the economy -- on average, about 2.5 percent faster, according to an analysis by Princeton University health economist Uwe Reinhardt.

And over time, that means healthcare is eating up more and more of the dollars available for everything -- be it homes, new cars, college tuitions, fighter planes, philanthropy or research.

Over the four decades, the economy, measured by gross domestic product, has averaged just under a 2 percent growth rate. Over the same period, health spending clocked in at 4.4 percent average growth.

The new estimates pain an even bleaker picture. In 2009, that 5.7 percent health spending increase growth was paired with a 1.1 percent decrease in GDP.

“As a result,” the CMS actuaries wrote, “the health share of GDP is expected to have increased from 16.2 percent in 2008 to 17.3 percent in 2009, which would represent the largest increase in history.”

In other words, healthcare spending rose far more than usual even as the country struggled through a recession.

It rose as millions of people lost their jobs and insurance, and almost everyone lost savings and investments -- presumably forcing them to put off elective procedures, and maybe even routine care.

Simply: Spending rose even as demand should have been low. The only way that happens is if prices soar.

It gets worse. While the actuaries estimate that health spending will decrease to 3.9 percent next year, that’s largely due to the law requiring a 21 percent cut in physician payments from Medicare -- a cut that is almost certainly going to be cancelled, as it has been annually for years.

Meanwhile, they estimate that through 2019, spending on hospital services will grow 6.1 percent a year, spending on prescription drugs will grow 6.3 percent a year and spending on physician services will grow 5.4 percent a year.

Sarasota Memorial CEO Gwen MacKenzie, my fellow panelist at the Landings lecture series, summed up the growth in health spending: “That’s unsustainable.”

And neither of us had seen the new numbers yet.

(For those with a high tolerance for numbers, here is a copy of the full report. Go to this link for a summary.)

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Suncoast Communities Blood Bank sends help to Haiti

posted by David Gulliver at 2 pm Monday, Feb. 1.

Sarasota's Suncoast Communities Blood Bank is sending 25 units of blood and blood products to Haiti today to assist in medical care for people injured in the Jan. 12 earthquake.

The blood bank is sending packed red blood cells, mostly derived from type O positive, with some from type O negative and some from types A and B, spokeswoman Julie Platt said. It expects to send out the supplies at 3 p.m. via FedEx to Fort Lauderdale and then on to Haiti. The effort is in response to a nationwide call from AABB, formerly known as the American Association of Blood Banks, which organized a shipment of 350 units of blood products.

"We are proud to assist the doctors and medical teams in Haiti, who are dealing with life-threatening cases," Suncoast Director Dr. Mark J. Magenheim said in a prepared statement. Suncoast is getting no reimbursement for the shipment, which cost about $5,000 to collect, process and pack, the blood bank said.

The blood bank did not need to do a special drive for the additional units, Platt said, a testament to the generosity of its donor base.

Meanwhile, late last week, Suncoast staff were circulating a link to a video, produced for the blood bank by Ringling College of Art and Design students Shane Miller and David Trujillo. Check it out at this (safe) link to YouTube.

In 2008, I spent several days at Suncoast and around the area producing a two-part series that traced a unit of blood from the donor to the patient who received it, a story that I think is unprecedented. You can read it at this link.

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posted by David Gulliver at 5:30 pm Monday, Jan. 25.

We’ve all heard that exercise will keep you healthier -- specifically, it’s good for your cardiovascular system. But studies published today indicate that exercise also may keep you both in better general health, safer and mentally sharper as well.

The studies appear in the July 25 edition of the Archives of Internal Medicine. In a commentary accompanying the studies, University of Florida physicians Jeff Williamson and Marco Pahor write that exercise has been linked to positive effects on everything from heart and lung disease to cancer and and diabetes.

But these studies help explain the “full range of important aging-related outcomes for which exercise has a clinically relevant impact,” they wrote.

A summary of the studies:

-- Women who had regular physical activity during middle age are more likely to be in better overall health.

Rsearchers from Harvard School of Public Health, Brigham and Women’s Hospital and Harvard Medical School examined data from 13,335 people participating in a large health study.

Women reported their activity levels at an average age of 60, in 1986. By age 70, those who reported higher levels of activity at the outset were less likely to have chronic diseases, heart surgery or any physical or mental impairments.

-- Weight training and even moderate physical activity seem to keep people sharper.

A researcher at University of British Columbia in Vancouver looked at a group of 154 women ages 65 to 75. One-third performed resistance training twice a week, one-third did so once a week, and one-third did balance and tone training. The weight training was at levels recommended for seniors.

After a year, the two weight training groups significantly improved their scores on tests of maintaining mental focus and conflict resolution. It also improved their muscle function.

In another study, a German researcher tracked the physical activity and cognitive function of 3,903 people ages 55 and older for two years.

About 13.9 percent of those with low physical activity developed cognitive impairment. Only 6.7 percent of those with moderate activity, and 5.1 percent of those with high activity, developed cognitive impairment.

-- Older women who exercise appear to have stronger bones and fall less frequently.

Researchers at a German university looked at 227 women 65 and older, where half exercised regularly and half participated in a program that emphasized well-being. The 115 who exercised had higher bone density in the spine and hip and a much lower risk of falls. The risk of cardiovascular disease dropped in both groups.