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April 2014

 

A Word from the President


Welcome to the April issue of NAMSS Gateway. We are all aware that we work in a dynamic industry, and the breadth of content in this issue reflects that vitality. Please read on for all the latest news--from trends in hospital consolidations, to the delay of ICD-10, to continuing advancements in the field of telehealth. One story that deeply troubled me is that of Legacy Emanuel Medical Center, which allegedly failed to investigate repeated complaints of abuse against one of its practitioners. Look below for this article and a reminder of the importance of communication between all hospital staff--from providers, to HR, to MSPs--in protecting patient safety.

As always, if you have any feedback about NAMSS Gateway, please contact the team at info@namss.org.

Until next month!

John Pastrano, BBA, CPCS, CPMSM
NAMSS President
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Headlines


News From NAMSS
Register Today for the NAMSS Regional Education Summit
Have You Visited the New NAMSS.org?
Online Sale - Save on Conference Recordings Value Package!

Industry News
"Healthcare Spending Growth Hits 10-Year High"
"Bruised by ICD-10 Delay, Healthcare Execs Huddle Over What to Do Next"
"Hospital Transaction Outlook for 2014: Six Things to Watch"
"Legacy Emanuel Bungled Patient Abuse Allegations Against ER Nurse Jeffrey McAllister: Federal Report"
"AMA Won't Stop Release of Medicare Doc Data"
"Dirty Doctors: Does Spike In Physician Arrests In New York Reflect Ethics Crisis In American Medicine?"
"AAAHC Grows Team With Focus on Accrediting Health Plans"
"Four Things Hospital CEOs Can Learn From General Motors"
"Hospital Consolidations Tend to Raise Prices, Lower Care, Change Priorities, Studies Find"
"New Telehealth Program Aims to Increase Specialist Care in Northern California"


News From NAMSS


Register Today for the NAMSS Regional Education Summit

June 6-7, 2014
JW Marriott Indianapolis
Indianapolis, Indiana


Whether you're preparing to take a certification exam or want an in-depth look at the credentialing process, the Regional Education Summit has something for you. Register now to join us June 6-7, at the JW Marriott in Indianapolis, Indiana.

The NAMSS Regional Education Summit features three high-quality NAMSS educational workshops: Hotel Details: Don't wait - Book your hotel online or call (317) 860-5800. NAMSS has secured a discount room rate of $169 per night plus taxes and fees for those attending the Regional Education Summit.

We'll see you in Indy!

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Have You Visited the New NAMSS.org?

We are excited to announce the release of our brand new website and user database! Visiting the NAMSS Website will bring you to an updated version of the content you are used to seeing. Among other new features, you’ll notice updates to the way you Log In, the way you update your User Profile, how you access the NAMSS Online Store, and how you access NAMSS PASS.

We know some of these changes may take time to get used to. To help you best leverage the new site, we’ve created an online tutorial to help you get familiar with it. Topics covered in the tutorial include:
  • Content Layout (Where to find things!)
  • Logging In / Password Requests
  • User Profiles
  • Accessing NAMSS PASS
  • And more!
Click here to access the website tutorial now. And, as always, if you have any questions, please do not hesitate to contact the NAMSS Executive Office at info@namss.org.
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Online Sale - Save on Conference Recordings Value Package!

Don't wait! Earn valuable CE credit by taking advantage of our online Conference Recordings package containing the following three session recordings from the 37th Education Conference held in September, 2013 in Hollywood, Florida. This value package includes:
  • High Risk Privileging: How to Treat Temporary Privileges and Locum Tenens with the Respect They Deserve -
    Sally Pelletier, CPMSM, CPCS and Carol Cairns, CPMSM, CPCS
  • A Risk Management Guide to Health Care Reform Credentialing -
    Fay Rozovsky, JD, MPH and Patricia Hughes, RN, MSN, CPHRM, FASHRM
  • Corporate Negligence and Medical Malpractice: Navigating the Potential Land Mines of Hiring, Credentialing, and Retention -
    Joshua McCaig, JD, MS
For a limited time save 10% off of the listed price! From now through April 30, this online education package worth 4.5 CE credits will be listed at a discount. Act now and don't miss out!
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Industry News


Healthcare Spending Growth Hits 10-Year High
USA Today (04/01/14) Davidson, Paul

The Bureau of Economic Analysis has revealed that in the fourth quarter, expenses for healthcare rose at a 5.6 percent annual rate, representing the fastest rate in 10 years. Much of the increase was due to an $8 billion rise in hospital revenue, according to the Census Bureau and Royal Bank of Scotland (RBS), which is perplexing because the number of inpatient days declined 1 percent during the fourth quarter, according to RBS' Omair Sharif. Avalere Health's Dan Mendelson notes that insurance companies increasingly have shifted costs to patients through high-deductible plans and other measures, prompting Americans to limit visits to doctors and hospitals. However, he adds that those trends may be leveling off amid the growth of costly high-tech treatments and other upward pressures on healthcare costs.
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Bruised by ICD-10 Delay, Healthcare Execs Huddle Over What to Do Next
Modern Healthcare (04/05/14) Carlson, Joe; Conn, Joseph; Robeznieks, Andis

Catholic Health Initiatives (CHI) executives rolled out new electronic health-record systems across 89 U.S. hospitals while meeting the Oct. 1 federal deadline for implementing the complex new ICD-10 coding system. CHI officials knew the two big tasks could not both be done in the time available, and so they spent millions of dollars remediating outdated "legacy" software programs in some hospitals so that they could run on ICD-10 coding for as many years as it would take to install new EHRs. Those remediation funds may have been wasted due to Congress' surprise decision to delay the switch to ICD-10 until at least Oct. 1, 2015, and possibly longer. Michael O'Rourke, chief information officer at the $11 billion Catholic Health Initiatives system, remarks, "We made decisions 18 months or two years ago that we are going to do certain things and postpone certain things based on having to implement ICD-10. Had we known this would be delayed, things would have been different." Healthcare providers and other organizations will now have to debate when they think the U.S. government will ultimately give the go-ahead to ICD-10 with regards to when they should start or restart training their doctors and other staffers.
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Hospital Transaction Outlook for 2014: Six Things to Watch
Becker's Hospital Review (04/04/14) Herman, Bob

According to a recent white paper from healthcare financial advisory firm Ponder & Co., hospital merger and acquisition activity surged to high levels between 2001 and 2013. The current year is shaping up to be no different. Researchers note that there are six specific trends to watch for in 2014. The paper expects for-profit chains to be less aggressive this year, while large, healthy nonprofit systems will be wary of troubled hospital transactions. Ponder added that there will likely continue to be many large, nonprofit transactions between now and the end of December, with regional system mergers expected to increase. Finally, the paper noted that some states are running out of independent hospitals to acquire and outpatient facilities will be more attractive acquisiton targets than inpatient facilities.
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Legacy Emanuel Bungled Patient Abuse Allegations Against ER Nurse Jeffrey McAllister: Federal Report
Oregon Live (04/04/2014) Bernstein, Maxine

The Centers for Medicare and Medicaid Services recently threatened to halt Medicare funding for one of Portland's premier hospitals, Legacy Emanuel Medical Center, after finding that it had failed to thoroughly investigate a series of complaints from patients who accused an emergency room nurse of sexual abuse. The investigation revealed how hospital staff repeatedly bungled their handling of the complaints against nurse Jeffrey N. McAllister. According to the federal findings, the hospital failed to properly document complaints, dismissed patient allegations, kept McAllister on the job during inquiries, and put one patient at risk by e-mailing her detailed allegations directly to McAllister. The hospital fired McAllister one year ago, and he has since been indicted and accused of sexually abusing 10 patients at the hospital between October 2009 and April 2013. In November, hospital administrators hurried to draft an action plan to respond to the findings and avoid losing an estimated $250 million a year in Medicare funding. The plan has been accepted by federal officials after seeing revamped policies and enhanced staff training.
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AMA Won't Stop Release of Medicare Doc Data
Modern Healthcare (04/08/14)

The American Medical Association (AMA) recently said it would not try to block Medicare's release of billing records for 880,000 doctors, although it continues to oppose the federal government's recent decision to open up the massive data trove. The Medicare claims database has been off-limits to the public for decades, blocked in the courts by physician groups who argue is release would do more harm than good. But employers, insurers, media organizations, and consumer groups have been pressing the government to open the file. Combining the billing data with other sources of information, analysts could be able to essentially peer over the shoulders of individual physicians. The data could also be used to spot fraud. But such scrutiny could accelerate trends toward large medical groups and doctors working as employees instead of small practices. The AMA responds that unfiltered files could contain inaccuracies and could make accomplished doctors who take on the most severely ill patients look bad.
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Dirty Doctors: Does Spike In Physician Arrests In New York Reflect Ethics Crisis In American Medicine?
International Business Times (04/01/14) Reno, Jamie

A recent spike in physician arrests in New York is causing many to wonder whether an ethics crisis in the medical field has arisen. According to the U.S. Attorney's Office, District of New York, at least 19 New York-area doctors have been prosecuted in the past year compared to just seven the year before. The physicians' alleged crimes include mail fraud, insurance fraud, Medicare and employment fraud, accepting bribes, and the illegal sale of narcotic prescription drugs. New Jersey U.S. Attorney spokesperson Rebekah Carmichael was hesitant to call the increased number of doctor prosecutions a trend, but said there has been a "definite increase, a spike" in arrests and that the actual number could be even higher than 19." Dr. Evan Levine, a New York cardiologist and clinical assistant professor of medicine at Montefiore Medical Center-Albert Einstein College of Medicine, said the arrests are evidence of a disturbing trend not only in New York, but in all of American medicine.
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AAAHC Grows Team With Focus on Accrediting Health Plans
Chicago Tribune (04/04/14)

The Accreditation Association for Ambulatory Health Care (AAAHC) recently announced the addition of Tom Tassone as Director of Health Plans to its team of executive personnel. Tassone is tasked with expanding the accreditation of Qualified Health Plans, as well as developing relationships and successful re-accreditation with currently accredited health plans. Prior to the announcement, Tassone worked in member engagement with IlliniCare Health Plan in Illinois, where he was part of a medical management team that helped create an integrated care program to replace Medicaid. "Tom's experience in health plan expansion as well as his acumen for new business development makes him an ideal fit for this new position," said John Burke, president and CEO of AAAHC. "He understands the challenges health plans face and can help them meet the necessary standards to achieve accreditation with AAAHC -- one of the most powerful ways to demonstrate that health plan is meeting industry standards."
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Four Things Hospital CEOs Can Learn From General Motors
Becker's Hospital Review (04/04/14) Gamble, Molly

General Motors CEO Mary Barra recently appeared on Capitol Hill where lawmakers grilled her and the motor company on why it took 10 years to issue a recall for an ignition defect that has killed at least 13 people. The hearings have sparked a lot of discussion about the overall role of CEOs, especially in times of crisis. One of the key takeaways from the hearings is the larger an organization gets, the less likely it is bad news will travel smoothly up the chain of command. The hearings also made clear that CEOs often do not learn of events until it is too late and are destined to reach crisis-level proportions. A third lesson learned is that, while it can be challenging to create a work culture where reporting of negative information is valued, it is possible. Finally, it is important to remember that the flow of information should not stop with the CEO. The chief executive should be equally transparent with board members.
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Hospital Consolidations Tend to Raise Prices, Lower Care, Change Priorities, Studies Find
MLive.com (03/18/14) Edgar, Julie

According to The Synthesis Project, an ongoing national study by the Robert Wood Johnson Foundation, hospital consolidation generally results in higher prices and a decline in care quality. A second study in the project concludes that for-profit hospitals are more likely to focus on highly profitable services than nonprofit hospitals. Between 1988 and 1996, for-profit hospitals offered home healthcare more often than government hospitals and nonprofits; the percentage of for-profit hospitals offering the service more than tripled from 17.5 percent to 60.9 percent. The 2012 findings of the project concluded that when hospitals merge in concentrated markets, healthcare costs can rise more than 20 percent, and those increases are passed onto consumers in the form of higher premiums. The study found that when hospitals face competition, they compete to bring in the most patients either on price or care quality.
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New Telehealth Program Aims to Increase Specialist Care in Northern California
California Healthline (04/03/14) Edlin, Mari

Two years ago, Blue Shield of California began to look for new ways to meet the needs of a growing insured population especially in remote areas. To extend its reach and improve care access, Blue Shield forged a relationship with Adventist Health, a faith-based integrated health care delivery system with 19 hospital and 200 clinics, 53 of which serve rural communities. At the heart of the partnership is telehealth, a growing practice of delivering health care services via telecommunications technology. All Blue Shield individual and family plan customers, including those who purchased coverage via Covered California, can seek specialty care not available in their areas through the telehealth network that launched in March. When a patient reports to a rural clinic, the care coordinator connects the member and specialist using a clinical mobile chart outfitted with a variety of assessment tools, such as digital stethoscopes, examination cameras, image screens, vital sign monitors, electrocardiogram devices, and more. Currently, a dozen physicians representing 11 specialties are participating in the program.
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