Survey finds that 93 percent of hospital executives think Obamacare will improve systems and save costs

While there has been much grumbling about federal health reform, at least one very affected group of people think it's a great idea. A survey by Health Affairs found that 93 percent of hospital executives believe the Patient Protection and Affordable Care Act will make health care better, and cheaper, Ezra Klein reports for The Washington Post.

The magazine surveyed 74 senior executives at hospitals that had an average of 8,520 employees, and annual revenues of $1.5 billion, Klein reports. The survey found that 65 percent felt that by 2020 "the healthcare system as a whole will be somewhat or significantly better than it is today," and "93 percent predicted that the quality of care provided by their own health system would improve. This is probably related to efforts to diminish hospital acquired conditions, medication errors, and unnecessary re-admissions, as encouraged by financial penalties in the ACA." (Health Affairs graphic)

Executives also responded to favorably to other questions about reform, with 91 percent forecasting "improvements on metrics of cost within their own health system" and "85 percent expected their organization to have reduced its per patient operating costs" by 2020, Klein writes. "Overall, the average operating cost reduction expected was 11.7 percent, with a range from 0 percent to 30 percent. Most executives believed they could save an even higher percentage if Congress enacted legislation to accelerate the shift away from fee-for-service payment toward models like bundled payments. In such a case, the executives projected average annual savings of 16.0 percent, which, if applied across the healthcare system, would amount to savings of nearly $100 billion per year."

Respondents said savings can be achieved "through a combination of greater administrative efficiency, price reductions, and reduced reliance on hospital services," Klein reports. About 54 percent said this can be done by reducing the number of hospitalizations, 49 percent by reducing, re-admissions, 39 percent by reducing emergency room visits, 36 percent by reducing costs for medical devices, 27 percent by reducing costs for drugs, and 23 percent by improving office efficiency.

About 31 percent of respondents said another goal is to set "a specified timeline for transitioning Medicare reimbursement off of the fee-for-service payment system as a policy change that would facilitate cost control," Klein writes. "Another 30 percent supported aligning payment policies between Medicare and private insurers, and 28 percent supported separating funds for training and research from Medicare payment and maintaining current funding levels." (Read more)

McConnell shares excerpts from letters he received from Kentuckians who are frustrated by health-reform law

By Melissa Patrick
Kentucky Health News

Continuing his attack on Obamacare, Senate Republican Leader Mitch McConnell took to the floor last week to read excerpts from letters he received from Kentuckians who are angry about the Patient Protection and Affordable Health Care Act. UPDATE, Dec. 17: He did so again today; video is here.

Generally, the main issues cited by McConnell are frustration with President Obama's promise that people happy with their health insurance could keep it; anger that their premiums and deductibles had increased under new policies that meet the law's requirements; and dissatisfaction with their inability to choose and pay for only the services they wanted. For example, several constituents said they did not have children, but were required to pay for pediatric dental care and maternity care.

A 35-year-old college graduate and married father of two from Bowling Green told McConnell that his plan, which he said best met his family's needs, had been canceled. As he sought a new plan that met the requirements, he was told it would cost 124 percent more. He noted that Vice President Joe Biden said Sept. 27 that a family of four with $50,000 income could get health insurance for "as little as $106 per month." McConnell said the Bowling Green man was quoted a price eight times that amount and asked him, "Why should the price of a product be based on my ability to pay?" The law provides subsidies for insurance coverage based on income and the type of plan purchased through the state insurance exchange, Kynect, up to $94,000 for a family of four.

Sherry Harris of Nicholasville told McConnell she was concerned that Lake Cumberland Hospital in Somerset was not on the Anthem network, "which means anybody in Pulaski and surrounding counties that qualify for a subsidy and want to use it will have to drive to London, Corbin or Lexington to get care" if they have an Anthem policy. Insurance companies are being more selective about their care networks in an effort to reduce costs; for details, click here.

A "Mr. and Mrs. Spears" of Louisville told McConnell that when they signed her up for the Kentucky Health Cooperative plan on Kynect, they did not sign up for a subsidy and thus were told no income verification was necessary.  Since then, they have received mailings from the insurance exchange declining coverage unless they sent income verification.

Exchange spokeswoman Gwenda Bond told Kentucky Health News in an email, "A request for additional documentation related to income verification might be generated, if they are likely to qualify for a subsidy based on the information provided on the application. Everyone is eligible to purchase a qualified health plan at sticker price at any time." The sticker price is the amount before the subsidy is subtracted.

Mrs. Spears also questioned the exchange's request for her voter-registration information. Bond said the federal "motor voter" law requires public-assistance agencies to ask applicants if they would like to register to vote. "Because Kentucky’s exchange is a single streamlined system for both Medicaid and subsidies, applicants are asked if they would like to register to vote," she said. "A voter registration form is mailed to them if they request one. There is no follow-up related to whether an individual registers or not, and it does not have an impact on coverage."

Mike Conn of Prestonsburg was upset that a policy with similar coverage to his previous policy would cost double.  He told McConnell that he was informed by the individual who helped him find coverage that it was because he lived in Eastern Kentucky and his old insurance company was "apparently not available there." Humana Inc. chose not to offer plans in all parts of the state.

Federal budget deal targets Medicare payments, and that means Kentucky hospitals won't be happy

Looking for a way to localize the budget deal announced by congressional negotiators last night? Call up your local hospital.

David Rogers of Politico reports that hospitals are "furious with the fact that the deal offers no relief from future cuts on Medicare providers – and even extends these annual 2 percent reductions into 2022 and 2023." The cuts would be a continuation of those imposed by the "sequester" legislation that took effect when Congress failed to reach an anticipated deal on the federal deficit and taxes.

The $28 billion extension of the cuts, almost a third of the $85 billion total, "helps to dress up the package with tens of billions in savings, but at a time when hospital networks are already feeling the impact of health-care reform, there is a fear that Congress is not seeing the long term impact of these budget assumptions," Rogers writes.

Most rural hospitals are already facing Medicare cuts because reform law reduces the extra payments made to hospitals that have large percentages of Medicare patients. Those hospitals are disproportionately rural.

The deal also includes "a provision that aims to prevent fraud and abuse in the Medicaid program for the poor and disabled," Modern Healthcare reports. "According to a summary, the provision allows states to delay paying for suspect claims as long as the delay does not harm a beneficiary's access to care. It also would allow states to collect medical child support in cases where health insurance is available from a non-custodial parent and allows Medicaid to recoup costs from beneficiary-liability settlements."

Why cut Medicare payments? "Congressional staffers were not prepared to talk about the cuts on the record, but said it boiled down to Medicare providers being the least painful target. Democrats, they noted, have not traditionally been strong supporters of preserving the payments to providers, being much more concerned with maintaining funds for beneficiaries. Republicans saw extending for two years cuts that are already in the law for mandatory programs as a simple way to add deficit reduction to the replacement of sequestration for discretionary programs," Michael McAuliff reports on The Huffington Post.

Irvine hospital's Susan Starling wins American Hospital Association's award for leadership in small or rural hospitals

Susan L. Starling, president and CEO of Marcum & Wallace Memorial Hospital in Irvine, is the 2013 winner of the American Hospital Association’s Shirley Ann Munroe Leadership Award.

The award recognizes the accomplishments of small or rural hospital leaders who have improved health care delivery in their communities through innovative and progressive efforts. Starling was recognized "as a widely respected leader who fosters strong collaborative relationships that improve the health care of the rural community," says a press release from the American Hospital Association.

Serving a community of approximately 15,000 that covers several counties for the last 30 years, Starling has forged statewide partnerships, updated the Catholic Health Partners facility, provided leadership in initiatives such as Project HOME (Helpful Opportunities for Medical Care Enhancement), helped to connect uninsured and under-insured patients with preventive services, developed partnerships resulting in the first rural community lung-cancer screening and breast-cancer awareness and screening, and in 2010 provided "groundbreaking direction" for her hospital to be certified as the first Level IV trauma center in Kentucky, the release says.

Starling also received the Kentucky Rural Health Association’s Dan Martin Award for her dedication to rural health care in Kentucky in 2012, according to the release, and was recognized by the AHA's political action committee as its Most Valuable Player for her significant outreach and advocacy efforts.

Not only may you not get to keep your plan under Obamacare, you might not be able to keep your doctor; there are reasons

By Molly Burchett
Kentucky Health News

Part of the sales pitch for the federal health-care reform law was that people could keep their doctors, but many Americans and some Kentuckians won't because insurers are excluding some hospitals and doctors from policies in an effort to make the new, standardized plans on the insurance exchanges more affordable.

Eleven Kentucky hospitals have filed complaints with the state Department of Insurance, saying Anthem's policies on the state's exchange include only a narrow network of providers, excluding them. Limiting the number of providers on the exchanges is one seldom-mentioned way insurers are trying to reduce premiums for new policies.

The department upheld three of the complaints because the hospitals said they would be able to serve at least four of the state's eight Medicaid regions, a concern that led to their original exclusion. The department has since ordered Anthem to accept applications from those hospitals- UK Healthcare, Our Lady of Bellefonte in Ashland and Highlands Regional Medical Center in Prestonsburg, reports Mike Wynn of The Courier-Journal.

Insurance-company research shows that consumers’ highest priority when shopping for insurance is price. To compete on price, insurers contract with doctors and hospitals who charge them the lowest fees. Some prestigious and well-known academic medical schools that charge higher prices are being excluded from exchange plans, Forbes magazine reports.

These same market forces may also limit the ability for small hospitals and providers to provide care through exchange plans if their health systems lack economies of scale that enhance their negotiating power. UK has already negotiated a deal with Anthem, and the company's negotiations with Highlands and Bellefonte are ongoing.

Anthem is not the only insurance company with narrow networks. Stephen Miller, vice president of finance for the Kentucky Hospital Association, said other Kentucky insurers are also using network restrictions to "steer patients to hospitals with the best rates for the insurer," Wynn reports. Around the country, many plans have more narrow networks than previous plans in order to limit premiums, Politico reports.

This tactic lowers expenses for the insurers by bypassing higher-priced health systems but means that some patients may have to change doctors or hospitals, report Sandhya Somashekhar and Ariana Eunjung Cha in The Washington Post: "The result, some argue, is a two-tiered system of health care: Many of the people who buy health plans on the exchanges have fewer hospitals and doctors to choose from than those with coverage through their employers."

Consumer advocates say tighter networks will disrupt care and limit access for middle-and lower-income consumers, who may be sicker than the average consumer, reports Kaiser Health News: "Narrow networks present the opportunity for lower costs via discounts from select hospitals and doctors in return for patient volume. But smaller networks can require members to travel farther for care or make it hard to get appointments."

Anthem says limiting networks helps insurers save money, which is passed on to patients through reduced premiums. Critics say healthy people must pay more than their fair share to help provide coverage for sicker people. Health-reform advocates say the law's trade-offs are acceptable costs in exchange for getting health coverage to more needy people, but some wonder about that if they have to drive 30 miles to get it.

What is a narrow network?

An insurance company's health-care network is a group of physicians, hospitals and other providers that agree to provide medical services at pre-negotiated rates. The wider the insurance company's network, the more doctors and hospitals from which you can choose without paying more to see an out-of-network provider.

Anthem spokesman Tony Felts said the smaller networks are an attempt to keep exchange plans affordable and that the company worked hard to design products that would attract consumers to them. Four other companies are offering policies on Kynect, the state exchange: Humana, United Healthcare, Bluegrass Family Health and the Kentucky Health Cooperative. Anthem and the cooperative are the only two insurers offering individual plans statewide.

"Many companies have selectively entered the exchanges because they are concerned that they will be dominated by risky, high-using populations who wanted insurance and couldn't afford it" before the law took effect, Gail Wilsensky, a UnitedHealth director, told U.S. News. "They are pressed to narrow their networks to stay within the premiums."

The reform law requires insurers to provide enough doctors and hospitals to ensure quality care, but the federal government offers little guidance on how this is defined. The Kentucky Heath Benefit Exchange says at least 20 percent of available essential community providers in an exchange service area must be in its network, and insurers must contract with at least one of these providers in each county in the service area. However, these regulations don't specify a penalty for not adhering to the recommendation, and there is no guarantee that the network includes your doctor.

Consider a plan's network, premiums and out-of-pocket amounts

Patients may not realize whether or not their doctor is in a plan's network until January, when the new policies take effect. Therefore, consumers should be careful to check the details about an exchange plan's network. Consumers should also be aware of the plan's out-of-pocket costs; the cheapest exchange plans have high deductibles.

On Kynect, insurance shoppers can filter plans to see if a specific provider is included. Insurance Department spokeswoman Gwenda Bond said the agency relies on insurance companies to provide network information to be posted on the exchange. She said the department has experienced some minor issues with this process due to insurers using different names for the same provider.

To address this problem, Kynect also provides a link to each issuer’s web site for their provider directory, said Bond. "The issuer’s provider directory web site should contain the most current list of providers available in the issuer’s network. We continue to work with insurance companies to improve the lists," she said.

"Under Obamacare’s exchanges, people who really want to keep their doctor, at any price, will often have to pay higher premiums for the privilege. And people who prefer lower premiums, above all, might need to choose a different doctor," writes Avik Roy of Forbes.

As Medicaid enrollment grows, fewer providers accept it

At the same time some providers are being excluded by insurance companies or are choosing to exclude themselves, some providers are opting out of the exchanges and are not accepting Medicaid patients. A recent survey by the Medical Group Management Association found that 40 percent of its members are still deciding if they are going to accept insurance offered on the Obamacare marketplaces, CNN reports.

About 56,000 Kentuckians have enrolled in Kynect plans as of Nov. 22, and 82 percent of those are Medicaid plans. According to the Centers for Medicare and Medicaid Services, which administers the Medicaid program, three times more doctors are refusing Medicare patients than three years ago.

Doctors cite Medicare's increasing rules and lowered payment rates as reasons for not accepting Medicaid, and those who will see some Medicaid patients are limiting the number, reports The Wall Street Journal. Doctors also say administrative hassles and delays in getting paid also discourage them from accepting Medicaid, says the Center for Studying Health System Change.

Hospitals across the state have expressed concern about delayed payments from Kentucky's managed care companies as a result of the state's quick transition to a managed care model, and state officials are working to address this problem. Still, Kentucky's Medicaid payment rates are about 72 percent of Medicare rates. The reform law raised Medicaid fees to match what Medicare pays primary-care doctors, but only for two years and after much administrative hassle.

Haynes asks hospitals for a truce as they and state work through problems with managed-care Medicaid

Health and Family Services Secretary Audrey Haynes won a smattering of applause from Kentucky hospital officials Thursday as she called for "not a surrender, but a truce" as her cabinet continues to address the hospitals' complaints about the state's managed-care system for Medicaid, which recently entered its third year.

Haynes drew the ire of hospitals last month when she said some needed to change their business models to emphasize prevention and wellness, not cashing in on Medicaid payments for emergency-room care. Thursday, she said in a speech to the Kentucky Hospital Association in Louisville that she wants "to work more closely together, not only to improve your business practices," but to improve the health of Kentucky.

Haynes also called on the hospitals to join Appalachian Regional Healthcare and the University of Kentucky hospital in contacting past patients who lacked insurance and urge them to sign up for expanded Medicaid or private insurance on the state's Kynect website, under federal health reform. "I need your help," she said. "we're very excited about the opportunity for dramatic improvements in Kentucky's health status."

Also at the meeting, state Rep. Jimmie Lee, D-Elizabethtown, the House's health-care budget subcommittee chair, said he thought Haynes and the administration of Gov. Steve Beshear had largely resolved the "prompt pay" problems of hospitals not getting money they are owed by insurance companies. But Senate Health and Welfare Committee Chair Julie Denton, R-Louisville, called for more action on the subject, such as an independent review panel to review disputed claims.

Ky. Hospital Association defends 'critical access' designation that gives small, rural hospitals a federal financial boost

The Kentucky Hospital Association came out strongly for continued federal support of small, rural hospitals Thursday, objecting to a proposal that the "critical access hospital" designation be based entirely on distance from other hospitals. Kentucky has 29 such hospitals, which get slightly higher Medicare and Medicaid reimbursements in return for limiting their size and services.

Until 2006, states were allowed to make the designation based on a community's health status, poverty rate, rural nature and other factors. So many were designated that they became the majority of critical access hospitals. That is also the case in Kentucky.

The Office of Inspector General of the U.S. Department for Health and Human Services said in August that the government could save up to $1 billion a year if the designation were limited to the original criterion, being at least 35 miles from another acute-care facility, or 15 miles in mountainous areas. KHA's initial repsonse is here.

"The OIG report seeks to eradicate rural health care by shutting down rural hospitals," said Charles Lovell, CEO of Caldwell Medical Center, a critical access hospital in Princeton. "People call us Band-Aid stations," but he could provide a long list of lives saved at his hospital, he said. Other speakers cited hospitals' important role in providing jobs and recruiting doctors for small towns. Cutting the list "would only hurt our communities' physical and economic health," said Susan Starling, CEO of Marcum and Wallace Hospital in Irvine.

Fran Feltner, director of the University of Kentucky Center of Excellence in Rural Health, noted that it was National Rural Health Day and said, "I believe every Kentuckian should have access to the right care at the right time, and close to home."

Critical access hospitals make up only 22 percent of Kentucky hospitals, but maintaining their extra reimbursement would also help the chains that own some of them, because costs of the chain can be allocated to individual hospitals. Here are the critical access hospitals in Kentucky, by county:
Allen: The Medical Center at Scottsville
Breckinridge Memorial Hospital, Hardinsburg
Caldwell County Hospital, Princeton
Carroll County Hospital, Carrollton
Casey County Hospital, Liberty
Cumberland County Hospital, Burkesville
Estill: Marcum and Wallace Hospital, Irvine
Floyd: McDowell Appalachian Regional Hospital; Saint Joseph Martin
Grant: St. Elizabeth Medical Center Grant County, Williamstown
Green: Jane Todd Crawford Hospital, Greensburg
Hart: Caverna Memorial Hospital, Horse Cave
Knox County Hospital, Barbourville
Leslie: Mary Breckinridge Hospital, Hyden
Lincoln: Ephraim McDowell Fort Logan Hospital, Stanford
Livingston Hospital and Healthcare, Salem
Madison: Saint Joseph Berea
Marshall County Hospital, Benton
Mercer: James B. Haggin Memorial Hospital, Harrodsburg
Morgan County Appalachian Regional Hospital, West Liberty
Nicholas County Hospital, Carlisle
Ohio County Hospital, Hartford
Owen: New Horizons Medical Center, Owenton
Russell County Hospital, Russell Springs
Simpson: The Medical Center at Franklin
Trigg County Hospital, Cadiz
Union: Methodist Hospital Union County, Morganfield
Wayne County Hospital, Monticello
Woodford: Bluegrass Community Hospital, Versailles

Most Kentucky hospitals will pay Medicare penalties under health reform, one the country's largest; look them up here

More Kentucky hospitals are receiving penalties than bonuses in the second year of Medicare’s quality incentive programs, one of the federal health reform law’s changes designed to create financial rewards for doctors and hospitals to provide better care. Pineville Community Hospital is being assessed the highest penalty in the country for its readmission rates.

Medicare has two quality-care incentive programs for hospitals. Value-based purchasing gives bonuses and penalties based on 24 quality measures, and the other program levies penalties for readmissions. Thirty-one Kentucky hospitals were assessed a penalty while 26 were given a bonus for improved performance, says an analysis by Kaiser Health News. Here's a screen shot of the beginning of the list:

The law allows the federal government to withhold a portion of a hospital's Medicare reimbursement money, up to a 1.25 percent penalty or bonus for every bill paid between October 2013 and September 2014, based on assessments of these quality standards.

"The incentives are among the law’s few cost-control provisions that have kicked in, but it is too early to tell how effective they will be in making hospitals operate more efficiently," reports Kaiser's Jordan Rau.

Large value-based bonuses are going to some major teaching hospitals and smaller institutions, such as Pikeville Medical Center. The state's average bonus is 0.25 percent, compared to the national average of 0.24 percent; Kentucky's penalties averaged minus 0.20 percent, for a total average of zero. It won't be known how much hospitals will receive or pay in dollar figures until next October since this depends on how much the hospital ends up billing Medicare, Kaiser reports.

However, as a result of the readmission program, Pineville Community Hospital is losing 2.57 percent of its reimbursements,the largest penalty in the country. Considering the impact of both the value-based program and readmissions program, Kaiser reports, two out of three hospitals are losing money starting last month.

Here's how the value-based score was figured: 45 percent on hospitals' use of clinical processes of care; 30 percent on patient experiences; and 25 percent on death rates. Hospitals were are also assessed by how they compared to other hospitals and how much they improved from two years ago, says Qualitynet.org.

Researchers are unsure whether the penalties are significant enough to trigger major improvements, writes Rau. And, some hospitals that have made improvements are still losing money because they haven't improved as much as other hospitals. On the other hand, some hospitals with subpar quality rankings are still getting more money because they showed improvement.

Nationwide, Medicare has raised payment rates to 1,231 hospitals and reduced payments to 1,451. Hospitals that are designated as critical access facilities and certain cancer hospitals were excluded from the program. But these facilities aren't immune to other portions of the health law, such as cuts in Disproportionate Share Hospital (DSH) program payments,for having a high percentage of Medicare and Medicaid patients.

New quality measures will be added to the value-based program for 2015, including comparisons of how much patients cost Medicare at different hospitals and rates of medical mishaps. In addition, the maximum readmission penalties grow to 3 percent next year, and a third incentive program will take an additional 1 percent of payments away from hospitals that have the most injuries or infections during patients' stays.

"Combined, these three quality programs have the potential to strip away as much as 5.5 percent of Medicare payments from the worst performing hospitals starting next October," reports Rau.

Dr. Patrick Conway, Medicare’s chief medical officer, says "We're moving away from volume and toward quality." Yet, to remain viable, some hospitals are being forced to make up for payment cuts by seeing more patients. Click here for the interactive chart.

Health care's culture doesn't encourage doctors to report medical errors of colleagues; article says patients should come first

By Melissa Patrick
Kentucky Health News

Doctors are often aware of their colleagues' medical errors, but fail to report them because of a culture that does not support or encourage such actions, Marshall Allen writes for ProPublica, a non-profit, non-partisan journalism organization.

Medical errors are estimated to kill 400,000 people in U.S. hospitals each year according to an online article by John T. James in the Journal of Patient Safety, causing some to say that medical errors are one of the nation's leading causes of death, Allen reports.

According to a report from the U.S. Department of Health and Human Services, most health-care providers employ a philosophy of "deny and defend" when confronted with issues related to medical errors. Providers fear full disclosure will lead to more lawsuits, higher jury awards, higher insurance premiums, and the loss of reputation or coverage for the provider, the opposite is true, the HHS report says. It says honest and open communication helps to lessen malpractice costs.

The Department of Veterans Affairs Medical Center in Lexington has led the way in the move toward health-provider transparency. It has worked under a philosophy of full transparency and disclosure since 1987, requiring prompt reporting and investigation of medical errors and near misses, full investigation, full disclosure of investigation results to the patients and families who have been injured because of accidents and medical negligence, and expressions of apology and  fair remedy, including compensation for injuries, according to the HHS report.

Several years ago, Allen contacted a Las Vegas surgeon to follow up on hospital data that showed peers of this surgeon that had high rates of surgical injuries. Allen reported that before he could reveal the list of peers to the surgeon and request his services in the investigation, the surgeon shared stories of the many surgeries he and his partners did to "clean up" the mistakes of "the worst surgeons in town" and said "he did not need a database to tell him which surgeons made the most mistakes."

An article in the New England Journal of Medicine, “Talking With Patients About Other Clinicians’ Errors,” says that although there is a common belief that there is an ethical duty to inform patients who have been harmed by medical errors, physicians often do not.

The existing guidelines emphasize ethical duties related to self reporting when physicians make  errors, says the report, but offers little guidance about what to do when they discover someone else's mistake.

In a survey separate from the New England Journal of Medicine report, but led by the same main author, more than half of doctors said that in the previous year they had identified at least one error by a colleague.  Gallagher told Allen that the survey did not ask what the doctors did about it.

For the New England Journal report, Dr. Thomas Gallagher, an internist and professor at the University of Washington, led a team of 15 experts who identified possible reasons doctors stay silent about errors by their peers. One reason is the system of referrals on which doctors depend, Allen reports; if a physician "becomes known as a tattler" he or she will lose referrals, and thus suffer financially.

The report lists other reasons for not reporting colleagues' medical errors, such as lack of time to investigate, a culture that promotes loyalty and solidarity, concerns about harming one's institution or becoming involved in a medical malpractice case,  concerns about causing a colleague to face legal issues,risk of acquiring an unfavorable reputation with colleagues and issues related to cultural differences, gender, race and seniority.

The bottom line, Gallagher told Allen, is that "physicians are not learning from their errors and patients are not getting the information they need to receive proper treatment or compensation when the outcome is harmful."

Dr. Brant Mittler, a cardiologist who works as a medical malpractice attorney in Texas, told Allen that in almost four decades in medicine he often saw errors and stayed quiet because "there would have been hostility" if he had reported them. “There’s not a culture where people care about feedback,” Mittler said. “You figure that if you make them mad they’ll come after you in peer review and quality assurance. They’ll figure out a way to get back at you."

Gallagher told Allen, "The result of this culture is too much leniency toward mistakes."

The New England Journal article said that despite the challenges of disclosure, the patient comes first, and doctors should "explore, not ignore" a colleague's error, Allen notes.

Once an error is suspected, the report suggests, the doctor recognizing the error should find the facts, starting with a direct conversation with the physician who made the error so together they can decide how to inform the patient. The article also suggests that hospitals and other health-care institutions lead by supporting transparency.

Dr. David Mayer, vice president of quality and safety at Medstar Health, which runs 10 hospitals in Maryland and Washington, D.C., told Allen that "reporting of medical errors (and near misses) is a top priority at the organization so everyone can learn from mistakes, saying that each month there are about 1,400 reported safety events."

The safety events are analyzed for trends, Mayer told Allen.  If a patient is harmed, an investigation is conducted and the information is disclosed to the patient and family, an apology can be made and compensation can be offered.

Dr. Humayun Chaudhry, president and CEO of the Federation of State Medical Boards, which provides guidance for how state boards regulate doctors, told Allen that doctors and other providers should be more assertive about reporting errors. "Failing to tell a patient about another doctor's mistake undermines the doctor-patient relationship," Chaudhry told Allen. "It makes patients wonder if they can trust their own physicians and the profession of medicine."

FactCheck.org finds little support for Sen. Rand Paul's claim that Medicaid expansion will 'bankrupt' Kentucky hospitals

U.S. Sen. Rand Paul said on ABC's "This Week" Sunday, Nov. 3 that the federal health-reform law may "bankrupt" rural Kentucky hospitals "by overwhelming them with Medicaid patients." However, health-care leaders in the state "say its hospitals stand to benefit, since the expansion would provide insurance to those who otherwise wouldn’t be able to pay their hospital bills," reports FactCheck.org, a nonpartisan service of the Annenberg Public Policy Center at the University of Pennsylvania.

Sen. Rand Paul (ABC News)

Paul made his remarks when host George Stephanopoulos asked him if the successful launch of the state's insurance exchange showed that Obamacare can be successful. "Well, nearly 90 percent of them are signing up for Medicaid, free health insurance from the government," Paul replied. "My concern is not that we shouldn’t help people. I do want to help these people to get insurance. But there is going to be a cost. And in my state, we have a lot of rural hospitals that teeter in the balance. My fear is that these hospitals may be bankrupt by overwhelming them with Medicaid patients."

At the time Paul spoke, the latest figures were that 85.7 percent of Kentucky enrollees were in Medicaid. A week later, the figure had declined to 82 percent of a total of 40,572. Exchange Director Carrie Banahan said Nov. 10 that she expects the Medicaid percentage to be about 70 percent by Dec. 31. She noted that Medicaid qualification is faster than enrolling in a private health plan because the income qualification is automatic, and 16,425 people have been determined eligible for subsidies for private plans through the exchange.

Gov. Steve Beshear announced in May that the state would expand Medicaid to people with incomes up to 138 percent of the federal poverty level; the previous threshold was 69 percent.

Eugene Kiely of FactCheck notes that the Robert Wood Johnson Foundation and Urban Institute said in March 2013 that hospitals should expect more revenue from Medicaid expansion; that the month before, Kentucky Hospital Association President Michael Rust said likewise; and so did Foundation for a Healthy Kentucky President Susan Zepeda several months earlier.

"That’s not to say there are no concerns in Kentucky about expanding Medicaid," Kiely writes. The state does not have enough medical providers to serve its population, even without the 300,000 residents who are newly eligible for Medicaid. In an email to Kiely, Zepeda said the foundation "remains very concerned about the capacity of the state's health-care system, particularly in rural areas, to cost effectively care for a much larger number of patients."

Zepeda also noted the problems that hospitals have had being paid by insurance companies that are now managing Medicaid for the states, but the foundation "still believes the state’s residents and hospitals will benefit from the expansion," Kiely reports.

Paul's staff did not respond to inquiries from FactCheck. For its analysis, click here.

Prescriptions for better health care and health: empowering patients, increasing health education and collaboration

By Melissa Patrick
University of Kentucky School of Journalism and Telecommunications

The importance of empowering patients, increasing health education and collaboration were a few of the topics discussed at the Health Watch USA 2013 Conference in Lexington Nov. 1.

"Patients must be empowered with knowledge" was the primary message of Dr. Joycelyn Elders, professor emeritus of pediatric endocrinology at the University of Arkansas School of Medical Science and former surgeon general under President Clinton.

“You can’t keep ignorant people healthy,” Elders said. “We must educate our patients or we will continue to have major problems.”

Elders called for doctors to fight for comprehensive health education, everyone must be involved – the schools, the Internet, social media – and said that as a country we need to embrace comprehensive health education instead of being afraid that all discussions will lead to sex.

Patients have a responsibility to ask questions about their health care, Elders said, and if people are better educated in health care they will have a better idea of what to ask.

Karen Meyers, who works with catastrophic-injury victims and health-care providers, shared the story about her elderly mother who was critically injured during a fall; the doctor said she was terminal. Meyer persuaded the physicians to try to save her critically injured mother eight years ago, and that spurred her passion for the importance of patient and family-centered care. She attributes her mom’s recovery to doctors who listened to her and excellent nursing care.

 “Patient and family centered care,” Meyers said, “is based in dignity, respect, information sharing, participation and collaboration. We must teach doctors collaboration and that the patient and family are part of the team. We are not a threat. We are not ignorant. We should not be dismissed.”

Meyers went on to say that “The home care agency of the future is the patient, the family and the support systems. We have to have a support system that works and we have to include them.”

Elders also talked about collaboration between physicians. She said they need to provide integrated, comprehensive and transparent care because when a patient is seen on the same day by a team of specialist, they receive better care and experience better outcomes.

Martha Deed, a retired psychologist and a member of the Consumers Union Safe Patient Project's patient safety advocates network, was a seasoned patient advocate for her daughter, Millie Niss. who had Behcet's disease, a chronic disorder of the blood vessels.  Millie was hospitalized with a severe case of swine flu in 2009, coding within one hour of arrival at the hospital, and died less than a month later.

While in the hospital, Deed and Niss documented everything.  They voiced their concerns, followed the proper channels of communication, documented faulty medical equipment, found inaccuracies in nursing and doctor reports and requested test.  Despite this high level of advocacy, Millie died.

Millie's autopsy revealed a missed diagnosis that might have saved her if it had been discovered and treated, Deed said. She has since applied her research skill to investigate both the specific medical as well as hospital culture/system causes of her daughter's death. Her goal is to prevent future premature deaths in the hospital. "Patients and families very much need to be listened to," Deed said.

Elders offered advice on how to be an empowered, health literate patient:
• Take a trusted person with you when you go to the doctor
• Ask questions, write them down before you go to the doctor
• Bring all of your medications with you to each doctor visit
• Ask the doctor to write down suggested actions and medications
• Let your doctor know if you have vision and/or hearing problems
• Ask your doctor about the results of your test and what they mean

“Our health care system is presently physician centered, but patients need to be involved,” Elders said. “The largest health care work force that we are going to have is our own patients. We need to push for education.”

Health Watch USA, based in Somerset, was founded by Dr. Kevin Kavanagh to promote health care transparency and patient advocacy, says its website.

Speakers at conference discuss impacts and possible solutions for deadly mistakes and near misses in hospitals

By Melissa Patrick
Kentucky Health News

Medical mistakes made in hospitals cause 98,000 deaths per year. Or four times that many?

That is the widely accepted number based on a 1999 Institute of Medicine report, but a study published in the Journal of Patient Safety says that as many as 210,000 to 440,000 Americans die each year in the hospital because of a preventable harm, Marshall Allen of ProPublica reports on NPR. But the current culture in health care does not support the reporting of mistakes or near misses, said speakers at the Health Watch USA 2013 Conference on Nov. 1 in Lexington.

Keith Widmeier, training officer for the Wayne County Emergency Medical Service, talked about the importance of reporting medical errors: "How are we supposed to fix things if we don't address the near misses?" he asked. "We must look at patterns and address them, learn from the data. Reliable data helps promote systemic change. The current system creates a system of not reporting."

Helen Haskell, president of the grassroots patient-safety organization Mothers Against Medical Error, said there are many contributing factors to this culture, and suggested that there is much to be learned from patient stories.

She told story after tragic story of young patients who had died because of medical error, including the story of her son, Lewis Blackman.

Lewis was a healthy 15-year-old who developed severe upper abdominal pain while on a non-steroidal anti-inflammatory drug and a narcotic following an elective surgery. Nurses and residents failed to act upon increasing signs of instability, including 24 hours with no urine output and four hours with no blood pressure. Haskell asked repeatedly for an attending physician. Four days after the operation, her son died. The autopsy showed a giant duodenal ulcer and 2.8 liters of blood and gastric secretions in the peritoneal cavity. He had been bleeding internally.

It is the responsibility of our health care system to become more transparent, listen to people's stories and put systems in place to decrease the chance of medical errors, Haskell said. Health care must improve in the areas that errors most commonly occur, she said, such as true informed consent, unnecessary surgeries, medication and diagnostic error, failure to rescue, and communication errors.

To decrease medical errors, Haskell suggested that the system use technology as the driver of improvement, providing continuous feedback between everyone involved in the care of a patient and involve the community and government.

Nurse burnout and job dissatisfaction also lead to medical error in hospitals.

"We cannot expect high quality health care with burnout," said Jeannie Cimiotte, a Ph.D., RN and associate professor at the Rutgers University College of Nursing and executive director of the New Jersey Collaborating Center for Nursing.
Cimiotte cited a Pennsylvania study that found the implications of increases in nurse workload are burnout and job dissatisfaction, missing important changes in patient conditions and failing to report important patient information at shift change. She said the study also found high nurse burnout appears to be a possible explanation for the association between nurse staffing and infection, jeopardizing patient safety resulting in hospital-acquired conditions and poor health care outcomes.

A culture of change and transparency has been implemented and is working at the Department of Veterans Affairs hospitals in Lexington since 1987, said Dr. Steve Kraman, who was chief of staff and chairman of the Risk Management Committee of the hospitals from 1986 to 2003. They not only require the reporting of medical errors and near misses, but provide full disclosure to patients who have been injured because of accidents or medical negligence, and offer fair compensation for injuries, Kraman said.

The VA has used this model since 1987 and has had "encouragingly moderate liability payments," said Kraman. In 2010, the University of Michigan reported remarkable decreases in suits, costs, trials and time to resolution. They also linked the openness of such a program with patient safety benefits due to reduced need for secrecy surrounding errors. The University of Illinois reports no increase in either number or suits or payouts since participating in this model of care, according to Kraman.

Kraman asked the participants: Is full accountability and transparency the way we should do health care? The answer was a resounding yes.

"This is a decision based on how we behave in society.  We should behave in a stand-up manner," Kraman said.

Health Watch USA, based in Somerset, was founded by Dr. Kevin Kavanagh to promote health care transparency and patient advocacy, says its website.

New CEO of Owensboro Health says hospitals are working to improve care, regardless of federal health reform

Philip Patterson, the new CEO of the Owensboro Health, says hospitals are moving towards health reform regardless of what happens with the Patient Protection and Affordable Care Act.

Patterson is coming to Owensboro from Bon Secours Charity Health System in New York and New Jersey, a three-hospital system with net patient revenue of nearly $500 million.  Patterson says he wants to build a stronger network for regional care in the Owensboro area.

The Affordable Care Act has changed physician and hospital payment structures, encouraging wellness participation, Patterson said in an interview with Ryan Alessi of cn|2's "Pure Politics." Patterson said the law creates incentives for hospitals to keep patients from being readmitted, and to only provide necessary care.

Regardless of what happens with the law, health organizations and providers need to be more than providers, Patterson said: They need to be health partners to their communities, to improve community members' overall health by managing care through screenings and education.

The health care law penalizes health systems for providing care that is not needed, and it encourages a change in thinking for providers who need to start providing care more economically, said Patterson. One way to do that is by building a strong network of providers who coordinate care.

"To create a sustainable system, you've got to cover a unique and significant population," he told Alessi. To cover a larger geographic area in New York and New Jersey, Patterson said, he created a loosely affiliated network of independent facilities that all worked toward the common goals of improving care coordination and quality.

As a result of Medicaid expansion in Kentucky, which now covers households earning up to 138 percent of the poverty level, an additional 400,000 people may have health insurance coverage that have never had it before.

"There's always a cost when you build something new and try to integrate a population into it," said Patterson. Unfortunately, those who lack insurance tend to have lower education levels and potentially neglected health care needs as a result of not having coverage or the perception of not having access to health care, Patterson told Alessi.

"The process of making this [integration] work is going to be clearly on the structure of health care providers as they try to manage that population to keep them out of the hospital where the most expense is," he said. Provider networks can coordinate to manage disease processes before they require care, and education and communication about how to access care is crucial, Patterson told Alessi.

Asked what will happen to hospitals if the health law is delayed or repealed, Patterson said, "It really hasn't been rolled out yet. We are still in a wait and see mode in a lot of these pieces." He said if health care systems buy into the law's overall goals, and they are already working towards the goal of better health care management. "The issue is the infrastructure and how to pay for it," he said.

"Repeal? I don't know what's going to happen there. I think as long as the goals are to create a better health model for a community, you're going to work towards them anyway," said Patterson.

Beshear says his managed-care plan is saving money and improving health outcomes; state points finger at hospitals

Six months ago, Gov. Steve Beshear applied an intensive plan to solve Medicaid managed-care implementation issues. On Thursday, he said the system is working more effectively for both providers and managed care organizations. He also said hospitals' complaints were overstated and some of them need to adapt to the new system, which will be two years old Nov. 1.

Gov. Steve Beshear

"There will still be a few—be they hospital or individual medical providers—who will say the program doesn't work, but it's tough to refute the facts," Beshear said at a news conference and in a press release. All but three states use managed care to save money and improve health.

Beshear asked each managed-care organization (MCO) to meet with every hospital in their networks to look over their accounts receivable to resolve billing disputes. "The final analysis—the MCOs and hospitals agreed that what was actually disputed and owed was a tiny fraction—just 2 percent of the original $346.6 million claim," the release says in boldface type.

The Kentucky Hospital Association said in a news release Friday, "The overwhelming majority of hospitals still report significant dollar amounts owed to them by the MCOs in unpaid claims. . . . While hospitals have seen a slight improvement in current claims processing and a slight decline in overall accounts receivables since the Governor issued his directive to the MCOs to clean up these claims, the amount of unpaid claims actually owed to hospitals (not billed amounts) is 60 to 70 percent higher compared to unpaid bills in October 2011 before managed care was implemented."

Beshear ordered that complaints about MCOs' payments be handled by the Department of Insurance instead of the Department for Medicaid Services. He said it has closed or nearly closed two-thirds of the 1,935 complaints it received. "Most complaints were related not to prompt pa y— which is what hospitals alleged — but instead related to claim denials, prior authorization disputes or unsatisfactory settlement offers," the release says.

The Insurance Department said MCOs often failed to offer a good explanation for denying claims. The Medicaid agency "sent corrective action plans to Coventry and Wellcare," the two MCOs operating outside the Louisville region. They will report progress each quarterly.

In general, the reviews didn't find that MCOs were holding payments on a regular basis, but concluded that Coventry Cares did not follow the state law requiring prompt payment if insurance claims. The Insurance Department has proposed that the company pay a civil penalty of $9,000.

Managed care has reduced "unnecessary ER use and inpatient hospital days in favor of more consistent disease management and prevention," Audrey Tayse Haynes, secretary of the Cabinet for Health and Family Services, said in the release. Kentucky has many people who go to the ER 10 times or more in a year, contributing to total ER expenses of $340 million for Medicaid. Unfortunately, Haynes said, some hospitals have used ERs to create revenue to support operations, "even advertising the average wait time in their ERs on their websites. For some communities, the ER has been the de facto primary care center." Haynes said hospitals have to put together a new business model that "dovetails with the goal of preventive care and wellness instead of high-cost emergency treatment."

The hospital association said it supports the state's efforts to reduce ER abuse, but "That project does not and will not solve the ongoing problem of WellCare and Coventry continuing to pay hospitals only $50 for emergency room care by reclassifying, on average, 50 percent of all ER patients, as non-emergency — under criteria they refuse to share with hospitals."

The implementation of the managed health care plan has saved money and improved health care, Beshear said. Per-patient costs are below predicted amounts and new enrollment is the same or declining. In November 2011, budget analysts predicted that the state would save $1.3 billion in the next two years, and "to date, Kentucky is still on target to meet that savings amount," the release said.

Statistics about health show the improvements to the system. For example, there has been a 93 percent increase in consultations to stop smoking, a 33 percent increase in flu vaccines for children, huge increases in mammograms and screenings for heart problems, and a 17 percent decrease in amputations (often because of untreated diabetes), and nearly an 11 percent decrease in CT scans.

Lexington TV reporter was moved to donate a kidney to a still-unknown stranger and hopes her story will encourage others

Lexington television reporter Leigh Searcy donated one of her kidneys to an unknown stranger and explained it to her 5-year-old  daughter and 6-year-old son this way: "It's like having two cookies and sharing one with someone who doesn't have one," reports Valarie Honeycutt Spears of the Lexington Herald-Leader.

Searcy, a fixture on WLEX-TV, told Spears that she had not considered donating a kidney until she reported a story about the family of a man who needed a kidney. What inspired her about this family was that it reminded her of her own: young, with two children. The man followed a regimented kidney dialysis schedule and strict diet that dictated his daily routine, but what he really needed was a kidney.

"It's hard to explain," Searcy told Spears. "But I left that home thinking, 'I'm going to get tested to see if I'm a match for him.'" She was not a match for that man, but he eventually got one as a result of her story, and she continued with further testing to see if she would match with someone else who needed a kidney.

Eventually, she was found to be a match for a would-be recipient. Searcy still does not know who the recipient was, but told Spears it was a woman "whom I'm told is doing very well and I'm happy for her." Searcy's surgery took place Aug. 29 and the recipient, who was in the same hospital, received the kidney almost immediately, reports Spears.

Searcy, told University of Kentucky Chandler Hospital officials that she would like to meet the recipient if the woman is willing but understands if it never takes place, Spears reports. "If I don't, I just hope my kidney is doing its job for her ... I just really hope it continues to work for her,'' Searcy said.

Stephen Strup, the James F. Glenn Professor and chief of urology in UK's College of Medicine, told Spears that it's unusual for someone to donate a kidney without having some knowledge of the recipient.
He said Searcy went into the donation with "eyes wide open and really thought about it and felt like it was something she was called to do," he said.

"I was healthy, had healthy children and most importantly, had no family history of kidney problems. Why not help someone if I can? It was a very matter-of-fact decision for me," she told Spears. "I considered the risks. My father pointed out more than once the fact I have two young kids; what if something happened?" Strup, the physician, told Spears, "Life with one kidney is really no different than life with two."

Searcy's husband, Versailles policeman Heath Dotson, told Spears that he decided that it was his wife's decision. "From the beginning, I didn't try to talk her out of it," he said. "I was very proud of her."

Lynne Polly, a donor coordinator at the hospital, told Spears that about 365 people are waiting to get a kidney there. "This year there were about 20 living donors  and 70 deceased donors," Spears writes. "Of the living donors in 2013, only Searcy and one other donor did not know the recipient."
Searcy told Spears the surgery had not affected her lifestyle, and that she is not aware of the missing kidney. A month of the surgery, she was running again, back to her normal routine and had no diet restrictions.

She told Spears that she agreed to share her story with the Herald-Leader because she wants others to consider becoming living donors. "The more people realize how far transplants have come," Searcy said, "the more people will be open to getting tested." (Read moreore)

Want to help? Contact Lynne Polly at (859) 323-5737 or lynne.polly@uky.edu. For more information about being a living donor, visit UKhealthcare.uky.edu/trans.

Adair County residents will get an extra tax bill as trustees of bankrupt hospital vote to levy a tax to pay its debts

Facing a $20 million debt and in bankruptcy, the Adair County Hospital District trustees voted unanimously Oct. 4 to impose a 10 cents-per-$100 value property tax, effective immediately.

In August, in a move perhaps unprecedented in Kentucky, the district filed for protection under Chapter 9 of the bankruptcy code, which is designed to allow time for a government debtor to reorganize and restructure its debt.

As a result of the filing, creditors such as Farmers National Bank of Danville have sued the district in state court, seeking to force the district to levy a tax to pay its debts. In addition to passing the tax on real estate, the trustees also passed a 10-cent tax on motor vehicles and watercraft, effective in January, reports the Adair County Community Voice. Part of Green River Lake lies in Adair County.

"Neal Gold, vice chair of the board, who has been overseeing hospital operations, said after the meeting they could have taxed Adair County at a higher rate but couldn’t morally do so and decided to stick to the 10-cent minimum," the Voice reports.

Adair County Property Valuation Administrator Junior Feese told the Voice that the real-estate tax will generate $573,000 this year. He said Adair County residents can expect a separate tax bill in the mail this week because this year’s tax bills had been mailed.

New type of artificial knee, designed for individual patients, is being implanted at St. Joseph East in Lexington

Saint Joseph East hospital in Lexington is Kentucky's first hospital to offer a customized total knee replacement system in which each the knee implant is made to match the individual patient’s anatomy, says a news release from ConforMIS, manufacturer of the implants. So far, about 20 patients in Lexington have received the ConforMIS total-knee replacement surgery, says the release.

“With this new technology, we’re able to offer an implant that is molded to each individual patient precisely,” said Wallace Huff of Bluegrass Orthopaedics, part of KentuckyOne Health, which includes Saint Joseph. “We’re seeing patients healing faster and more easily acclimating to the new knee.”

Typically, knees are replaced due to osteoarthritis and its breakdown and eventual loss of cartilage of one or more joints. Unlike traditional knee replacements, the ConforMIS system uses technology to design and manufacture knee implants for each individual patient, so less bone is removed during the surgical procedure. This provides the potential for faster recovery from the surgery.

KentuckyOne Health to start around-the-clock online or phone access to health-care providers for $35 a visit on Nov. 1

Hospital group KentuckyOne Health says it will launch a program on Nov. 1 that will let Kentuckians get urgent care at any time by consulting with a medical professional over the phone or web camera. The group says KentuckyOne Anywhere Care is among the first such programs in the nation.

“KentuckyOne Health’s purpose is to expand access to quality health care, no matter where you live in the Commonwealth; is one way we are doing that,” CEO Ruth W. Brinkley said. “We can provide primary care to more Kentuckians, while saving them time, hassle and expense. We can treat conditions before they become more acute, as well as prevent unnecessary and costly emergency room visits.”

The service will cost patients $35 per visit, whether or not they are covered by insurance. "The cost is less than typical urgent care and a fraction of the cost of a normal emergency room visit," KentuckyOne said in a press release. Patients will be able to request a visit online or through a toll-free phone number. They will receive a phone call or video call from a medical provider within 30 minutes, the release promises.

"Patients will have access to board-certified doctors and nurse practitioners," the release says. "If needed, the KentuckyOne Anywhere Care provider will refer patients for a follow-up clinic visit or to an emergency department," and may prescribe medications, but won't prescribe or refill prescriptions for controlled substances.

The system will be operated by Carena Inc., which has been doing such work since 2010 and serves more than 500,000 patients in corporate programs and more than 1 million for the Franciscan Health System in Tacoma, Wash. The firm says it has a 98 percent satisfaction rating among patients.

Before going public, the new service will get a shakedown cruise by serving KentuckyOne employees who live in Kentucky. The group, Kentucky's largest, comprises Jewish Hospital & St. Mary’s HealthCare in Louisville; the Lexington-based Saint Joseph Health System, which includes hospitals in Bardstown, Berea, London, Martin, Mount Sterling and Shelbyville; and the University of Louisville Hospital and James Graham Brown Cancer Center. (Read more)

Ashland hospital lays off another 4 percent, citing lower revenue

King's Daughters Medical Center in Ashland is laying off another 4 percent of its payroll and closing satellite centers in Pikeville and Russell, citing lower numbers of patients and reduced federal and state reimbursements.

"It is the most recent in a series of layoffs for the medical center, which saw layoffs and shift reductions for more than 100 employees in 2010 and an undisclosed number of layoffs in 2012," reports Beth Hendricks of The Herald-Dispatch in Huntington, W.Va. "Most affected positions are in support, administration and supervisory areas, according to KDMC spokesman Tom Dearing. Staffing levels for direct patient care remain unchanged. Physicians at the closing family-care offices will be relocated to other centers."

Mike James of The Independent in Ashland reports, "Some workers had their hours cut from full time to part time, Dearing said. . . . CEO Fred Jackson ... said the cuts were part of a national slump in the health care business. . . . Jackson’s email blamed 'a perfect storm of a shifting business model, changing federal and state reimbursements, increasing demand for charity care, and a weak economy' and said the hospital would look to outpatient services and its community outreach centers for future growth."

Jackson has been under fire from the Service Employees International Union for his total compensation of $1.37 million in 2010, the figure reported on the not-for-profit hospital's most recent IRS Form 990. "By comparison, a CEO at a Huntington-based hospital earned $725,744," Hendricks reports. "Five additional KDMC senior management officials saw a combined $300,000 in increased wages over the same period."

Hendricks writes, "Ashland City Commissioner Kevin Gunderson said the layoffs Thursday, coupled by layoffs in recent years, raises questions about whether the board and management at King's Daughters have overspent on various outreach clinics, some of which are closing. 'They should have focused on their core medical center instead of building outreach centers in Pikeville, Prestonsburg, Flatwoods, Cannonsburg, Russell and South Shore and Jackson, Ironton, Burlington and a large one in Portsmouth,' Gunderson said. 'I just drove by there today, and they had people out planting shrubbery.' . . . This week's layoffs are the latest in a string of woes for the hospital, which lost its contract with Medicaid managed-care organization CoventryCares in late 2012. King's Daughters is also under a Department of Justice investigation into its cardiac program."

Federal report says many hospitals wouldn't keep critical-access designation if distance rules were strictly enforced

More than two dozen Kentucky communities still have hospitals because of the critical-access hospital program, in which small, isolated hospitals get higher Medicare and Medicaid reimbursements in return for limiting their size and services. Now federal officials appear to be considering a move that could cost the hospitals money and perhaps put them at risk of closing.

Most of the hospitals would not meet current location requirements if required to re-enroll to get reimbursements from Medicare, and the Centers for Medicare and Medicaid Services could realize substantial savings by revoking certification to some of these hospitals and reimbursing them at lower rates set by prospective payment systems and fee schedules rather than at 101 percent of costs, according to a report by the Department of Health and Human Services.

The agency found that "the program costs the government and Medicare beneficiaries up to a billion dollars a year more than the original parameters of the law allowed," Jenny Gold reports for Kaiser Health News. If forced to re-enroll, 849 of the 1,329 hospitals in the program would not meet the requirements -- having 25 or fewer beds and being at least 35 miles away from another facility (15 miles in mountainous terrain) in communities that would otherwise have limited access to health services.

"Until 2006, states were allowed to waive the distance requirement and designate small hospitals considered 'necessary providers' as critical access hospitals as well, even if they were close to other facilities," Gold reports. "The program grew quickly and now nearly one in four acute care hospitals are getting the extra payments. Congress got rid of the loophole in 2006, but hospitals that already had the exemption were grandfathered." (Read more)

Critical-access hospitals are located in Barbourville, Berea, Burkesville, Cadiz, Carlisle, Carrollton, Franklin, Greensburg, Hardinsburg, Hartford, Harrodsburg, Horse Cave, Irvine, Liberty, Martin, McDowell, Monticello, Morganfield, Owenton, Princeton, Russell Springs, Salem, Scottsville, Stanford, Versailles and Williamstown. For a detailed list, click here.