Ascend News Digest by gdf57j

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									Ascend News Digest                                                              brought to you by
News for Healthcare Administrators                                                                                     Monday, May 20, 2002

 “To meet the 2003 deadline, HIPAA compliance implementation is moving
   forward with all health care organizations. For its part, Ascend is now          In this issue
   offering full HIPAA compliance outsourcing services and HIM product
   solutions to its national client base.”                                          Cover Story
   - A. K. Jay Jaiswal CEO Ascend Healthcare Systems LLC.                              Financial – Hospitals Sometimes Lose Money
                                                                                          by Using a Supply Buying Group .............1
                                                                                    Financial ................................................... 2
                                                                                       UPMC's hospitals highly profitable ................2
    1     Financial – Hospitals Sometimes Lose Money by                             Legal.......................................................... 2
          Using a Supply Buying Group                                                  Medical residency system target of class
                                                                                          action suit.................................................2
          Hospitals are finding that they are not saving money by using
                                                                                       Feds join suit charging Duke with Medicare
          buying groups, which are designed to pool thousands of
                                                                                          fraud.........................................................2
          hospitals to negotiate a good price on the best products. A study
          by the General Accounting Office (G.A.O.) is challenging the                 Hospital group ends insurance bill support ....3
          claims of the two largest groups, which purchase for about half of           Medical society files suit against health
          the nation's non-profit hospitals. The study found that big buying              insurers ....................................................3
          groups "did not guarantee that the hospital saved money" and              Opinion ..................................................... 3
          that prices negotiated by the buying groups "were often higher               Insurance: You Pay, They Bait and Switch....3
          than prices paid by hospitals negotiating directly with vendors."
                                                                                    Staffing and Management ....................... 4
          The G.A.O. cautioned that its initial report was limited in scope            Newsday.com - Doctors Union Battles for
          and said it planned a broader inquiry. Officials of the two biggest              Survival ....................................................4
          buying groups, Premier and Novation, disputed the study's                    With Nurses in Short Supply, Patient Load
          methods and results.                                                             Becomes a Big Issue ...............................4
                                                                                       City radiologist is tele-consultant for US
          There has been a growing debate about whether buying groups                      hospitals...................................................5
          really lower the cost of medical products. The groups that buy
                                                                                    Programs .................................................. 5
          supplies are financed by the products' manufacturers and
          distributors, which pay the groups fees based on a percentage of             Many patients seek treatment - and lower bills
                                                                                          - in Mexico................................................5
          interest. That arrangement has raised questions about whether
          the buying groups have a conflict of interest.                               Test Marketing...............................................5
                                                                                    Medicare ................................................... 6
          Hospitals that have broken away from buying groups say they                  Medicare eyes boost for hospitals .................6
          get lower prices because they can negotiate with a larger
                                                                                       Medicare Payment for Cancer Drugs Is Seen
          number of manufacturers and can have shorter contracts, which
                                                                                         as Likely ...................................................6
          allows them to take advantage of falling prices. Another reason
          is that manufacturers pass the savings from not paying buying             Medical Research, Advancements &
          group fees to the hospitals.                                              Announcements....................................... 7
                                                                                       Minority health care still lags, study finds.......7
          The survey also found that large hospitals — those with more
                                                                                    Technology............................................... 7
          than 500 beds — often got lower prices on their own than by
          using a buying group. By contrast, small and medium hospitals                New post-lumpectomy therapy OKd ..............7
          tended to do better using a buying group. But even in that group,            'Hairdryer' device could save skin cancer lives
          government auditors found, the experience of hospitals differed.                 .................................................................7
          (Mary Williams Walsh and Barry Meier, The New York Times,                 Services .................................................... 8
          4/30)
                                                                                       Ascend Transcription Outsourcing Services
                                                                                          Now Offers HIPAA Compliance ...............8
          http://www.nytimes.com/2002/04/30/business/30BUYE.html



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                                                                                          visit www.ascendhealthcare.com.
Financial
Financial
2   UPMC's hospitals highly profitable
    UPMC Health System has some of the most profitable hospitals in the Pittsburgh region, despite its battles
    with Highmark Inc. for higher payments. UPMC spokeswoman Jane Duffield said the profits of UPMC's
    institutions were measures of its success in gaining efficiencies from mergers and of the quality of care they
    offer.

    Highmark Inc., the region's largest health insurer, suggests different reasons for UPMC's success. "It fits with
    what we've been saying, which is that the [UPMC] hospitals, on a comparative basis are reimbursed well and
    are doing well," said Dr. Kenneth Melani, Highmark's executive vice president of business development.
    Melani also said that UPMC's profitability argues against raising their reimbursements or giving them the $300
    million one-time payment they are demanding for past cuts and for investment expenses for cutting edge
    facilities and talent.

    UPMC argues against Highmark's large financial reserves, which are the subject of lawsuits. Highmark's
    reserves totaled $2.3 billion last year. (Pamela Gaynor, Post-Gazette, 4/30)

    http://www.post-gazette.com/businessnews/20020430upmc0430bnp2.asp


Legal
3   Medical residency system target of class action suit
    I class action lawsuit that contends that the medical residency system violates federal antitrust law was filed in
    Washington. At the heart of the lawsuit is the National Resident Matching Program, which pairs medical
    school graduates with hospitals seeking residents. Selections are made by computer and students are stuck
    with the computers choice.

    Lawyers for residents contend that the seven medical organizations and more than 800 hospitals named as
    defendants in the class action suit have used the system to force residents to work long hours at low wages.
    Applicants, they say, have no say over where they go, what they do, or how much they make once they get
    there. The lawsuit seeks compensation for wages that residents should have earned going back to 1998.

    Health care officials say that if the lawsuit succeeds it could mean a crippling explosion of medical costs.
    They also say that the current system levels the playing field for all residents. Its demise would mean some
    residents would have an unfair advantage based on whom they know and under-the-table deals.

    Legal experts say that nonprofit hospitals may be able to arguer that the social benefits of the matching
    program outweigh the anti-competitive effects. Private hospitals, however, would not be able to use that
    argument. (Michael Stroh, Baltimore Sun, 5/8)

    http://www.baltimoresun.com/news/local/bal-md.match08may08.story?coll=bal-local-headlines


4   Feds join suit charging Duke with Medicare fraud
    The federal government has joined a civil suit that names about 100 hospitals. The suit accuses the hospitals
    of unlawfully billing the federal health care program for experimental heart procedures and devices that were
    not approved by the U.S. Food and Drug Administration. Fifteen of the hospitals have been publicly named.

    Duke University Medical Center is one of the hospitals named. It is accused of defrauding the Medicare
    program of more than $6 million from 1987-1994. The suits could total more than $250 million once all the
    hospitals are investigated.

                                                     2                           Ascend News Digest        5/16/2002
    Gary Stiles, chief medical officer of the Duke University Health System, disputed the suit, saying that the
    health system has been aware of the matter since it responded to a subpoena from the government in 1994.
    "We find it ironic that the federal government has chosen to pursue a lawsuit that disclaims its obligation to
    pay for the best available health care procedures for Medicare beneficiaries treated in the late 1980s to mid-
    1990s," a prepared statement from Duke said.

    Donald Warren, the lawyer that originally filed the suit on behalf of sales representative Kevin Cosens, said
    Duke deliberately circumvented government rules for profit, rather than using such avenues as federally
    approved National Institutes of Health research funds to provide the cutting-edge technologies to patients.
    (The Charlotte Observer, 5/8)

    http://www.charlotte.com/mld/observer/news/local/3218448.htm


5   Hospital group ends insurance bill support
    The Illinois Hospital Association said it is no longer supporting the Fairness in Contracting Act, which would
    give doctors more negotiating ability with insurers. Doctors claim the bill would prevent take-it-or-leave-it
    contracts. However, the hospital association has decided to take a neutral stance after some facilities said
    the bill could raise health-care costs.

    Without the hospital associations support the bill could be doomed, but the medical society remains
    undaunted. The doctor group's political action committee is a favorite of lawmakers and spends more on
    statewide elections than any other health-care group. Plus the hospital association is neutral, not opposed to
    the bill. Some individual hospitals are supporting the bill. (Bruce Jaspen, Chicago Tribune, 4/30)

    http://mv.chicagotribune.com/business/chi-0204300135apr30.story?coll=chi-business-hed


6   Medical society files suit against health insurers
    The Medical Society of New Jersey filed lawsuits against five managed care companies. The lawsuits ask a
    judge to order the companies to pay bills on time, stop overruling doctors' decisions without proper review,
    provide explanations for denied claims, and stop a series of efforts designed to reduce payments.

    The Medical Society lawsuits are patterned after similar lawsuits filed in Connecticut, New York, South
    Carolina and Tennessee. The companies named in the suits are: Aetna U.S. HealthCare Inc., AmeriHealth
    HMO of New Jersey, Inc.; Cigna Healthcare of New Jersey Inc., Health Net Inc., and Oxford Health Plans Inc.
    (Jason Method, Asbury Park Press, 5/9)

    http://www.app.com/app2001/story/0,21133,559265,00.html


Opinion
7   Insurance: You Pay, They Bait and Switch
    In this commentary, Jamie Court, executive director of the Santa Monica-based Foundation for Taxpayer and
    Consumer Rights, accuses health insurers of a bait-and-switch scam upon revelations that they are levying
    surcharges for the best hospitals.

    "Health maintenance organizations and insurers have similarly forced patients to pay extra for the most
    effective medications. Cancer patients who switched to Medicare HMOs with the promise of greater coverage
    have been charged hundreds of dollars as a co-payment for each radiation treatment, something traditional
    Medicare fully covers. Insurance, an agreement that for a fixed sum a company will pay for the costs if serious
    illness or injury strikes, has become a process of 'disinsurance,' turning the promise of protection into little
    more than a coupon book."

                                                    3                           Ascend News Digest        5/16/2002
    "Most disconcerting is that disinsurance is the health plans' back door to avoid California's new patients' rights
    laws. Since the California Department of Managed Health Care can prevent HMOs from restricting necessary
    access to physicians and hospitals, the plans simply started charging hefty prices for it." (Jamie Court, LA
    Times, 5/8)

    http://mv.latimes.com/news/opinion/commentary/la-000032648may08.story?coll=la-news-comment-opinions


Staffing and Management
8   Newsday.com - Doctors Union Battles for Survival
    The American Medical Association board has rejected a $1.6 million loan request from its Physicians for
    Responsible Negotiation (PRN) union, which could mean the end of the union. "Since the AMA has been our
    sole source of funding, at this point, it puts us in a bind," union president Dr. Mark Fox said. The union's
    money will probably run out this summer.

    Dr. J. Edward Hill, the AMA board of trustees' chairman-elect, suggested the board questioned the union's
    ability to repay a loan. Medical societies in several states have drafted resolutions seeking to overturn the
    board decision. The union's fate could be determined at the AMA's annual meeting next month.

    The AMA formed PRN in 1999 to help give doctors more leverage against managed care. However, its
    success has been mixed. Employers in a suburban Chicago hospital and in New Jersey have disputed the
    groups' right to organize. (Lindsey Tanner, Newsday, 5/9)

    http://mv.newsday.com/news/health/wire/sns-ap-ama-
    union0509may09.story?coll=sns%2Dap%2Dhealth%2Dheadlines


9   With Nurses in Short Supply, Patient Load Becomes a Big Issue
    Hospitals and nurses around the country are squaring off over how many patients nurses can safely care for
    at once. Hospital administrators say they are desperately searching for more nurses. Nurses say they are
    responsible for too many patients and that hospitals are putting the patients at risk.

    The battle is in the courts and several state legislatures. Nurses are pushing for new language in their
    contracts and regulations with specific nurse-to-patient ratios. Some nurses have gone on strike. Others are
    holding protests to draw attention to their concerns. The nurses say there are enough nurses out there, but
    many work outside hospitals due to the working conditions in hospitals.

    The nurses have had some success. Registered nurses from the Service Employees International Union
    reached a tentative agreement with Northridge Hospital in Los Angeles to form committees with nurses to
    address staffing concerns. Similar agreements last year were made with the California Nurses Association at
    17 other hospitals. At Crouse Hospital in Syracuse, nurses and managers are working together to establish
    appropriate staffing levels, and the hospital pays nurses money in addition to overtime if managers
    consistently ask their staffs to work with too few people.

    California now has proposed staffing ratios that call for four patients for every nurse in a pediatrics unit and
    eventually five patients per nurse on a general medical-surgical floor. Similar laws are being debated in
    Massachusetts and Florida, and staffing legislation has been introduced in Iowa and Kentucky.

    In some places, however, nurses are meeting resistance with hospitals saying there is nothing they can do as
    long as there are so many unfilled positions. They also argue that fixed staffing ratios are not useful because
    of differences among hospitals and the patients they treat and a need to be flexible in deciding how best to
    use employees.




                                                     4                            Ascend News Digest         5/16/2002
     There are more nurses working in hospitals today than a decade ago. However, patients tend to be sicker
     today and nurses have had to pick up work from other staff. The hospitals and nurses are finding it hard to
     agree on how many nurses are needed. (Reed Abelson, The New York Times, 5/6)

     http://www.nytimes.com/2002/05/06/health/06STAF.html


10   City radiologist is tele-consultant for US hospitals
     The advent of "Offshore Teleradiology" makes it possible for American hospitals to use radiologists on the
     other side of the world. The process is still in its infancy, but has potential to benefit American hospitals.
     "There is an explosion in emergency coverage during nights, and there is a 20 per cent shortage in radiology
     workforce in the US. Night call radiologists are expensive there. The idea is to exploit global time difference
     as a way to turn their night into my day. It is effective cost wise and gives me the opportunity to contribute to
     emergency care across the world," says Arjun Kalyanpur, a radiologist with Teleradiology Solutions in
     Bangalore, India.

     Kalyanpur is currently the only radiologist in India that consults through teleradiology with the US. He
     receives an average of 25 emergency scans per day from various hospitals in the US, like the Yale New
     Haven Hospital, University of Minnesota Clinical Centre and some hospitals in Pennsylvania. His job is to
     read these scans and send a detailed report back. Based on this report, doctors decide on how serious the
     problem is and what medical action needs to be taken. (Meghana Mathur, Times of India, 5/7)

     http://timesofindia.indiatimes.com/articleshow.asp?art_id=9101731


Programs
10   Many patients seek treatment - and lower bills - in Mexico
     Rising medical costs and language and cultural barriers make Mexico appealing for thousands of patients.
     With or without health insurance, U.S. residents – primarily tens of thousands of Mexican immigrants – are
     flocking to Mexico for medial treatment.

     Pete Duarte, executive director of El Paso's Thomason Hospital and a longtime advocate of affordable health
     care, said he had detected a significant trend. "What's new here," he said, "is that it's no longer just the poor
     seeking care across the border, but the middle-class, too."

     Residents of border communities have long crossed into Mexico for medical care or for cheaper prescriptions.
     Today, Mexico's affordable health care and medicine draw the poor and the middle-class who live hundreds
     of miles from the border.

     When it comes to major surgeries, like open-heart surgery, heart and organ transplants or cancer treatment
     programs, patients and physicians on both sides of the border say they generally prefer medical care in the
     United States, even though health care in Mexico is rapidly improving. However, for general primary care for
     basic treatments, the care in Mexico, especially in urban centers is "right on par with that of the United
     States," said Dr. Heriberto Salinas, a Dallas physician born and raised in Mexico and a graduate of Baylor
     University's medical program. (Alfredo Corchado and Alfredo Carbajal, The Dallas Morning News, 4/29)

     http://www.dallasnews.com/dmn/news/stories/042902dnnatmexhealth.4ceaf.html


11   Test Marketing
     Retail health testing centers are on the rise. Patients can get tests without doctor's orders and can get the
     results themselves and decide what to do with them. The direct-access testing centers, which began to
     appear in the Washington area last year and will number almost 30 here by year's end, generally require
     customers to pay out-of-pocket. But that hasn't stopped many patients from paying.
                                                      5                           Ascend News Digest        5/16/2002
     U.S. Wellness runs its clinics out of Giant supermarkets and hopes to be the Starbucks of medical testing and
     counseling services. Quest Diagnostics, the company that performs the test analyses for U.S. Wellness, has
     its own QuestDirect franchises operating in Colorado, Kansas and Missouri. Other clinics across the country
     offer full-body computerized tomography scans that likewise need no doctor referrals.

     The rise of self-initiated testing is the result of the public's frustration with the barriers created by managed
     care, a better informed and aging population, and the entrepreneurial spirit of medicine. It's also a natural
     extension of the health assessment testing offered at health fairs and some drugstores, and of the home
     testing devices that have been on the market for years.

     Opinions on the testing centers are split. Some prominent physicians say they understand the appeal of self-
     testing and see some potential value in the information it provides and the frustration it relieves. Others see
     the practice as worrisome or even dangerous, possibly leading to people getting unnecessary, more invasive
     tests to check results from testing centers. (Francesca Lunzer Kritz, The Washington Post, 4/30)

     http://www.washingtonpost.com/wp-dyn/articles/A2241-2002Apr29.html


Medicare
13   Medicare eyes boost for hospitals
     Medicare proposes to pay 2.75 percent more to hospitals for in-patient care of the elderly and disabled. The
     rate increase is slightly higher than Medicare previously had estimated, but lags the 3.3 percent increase in
     costs of in-patient care that Medicare says hospitals incurred during the past year.

     "That's a better number than we've been seeing . . . but it still falls short" of covering actual cost increases,
     Bob Moor, a vice president of Indiana Hospital and Health Association, said. Medicare patients take up 51
     percent of occupied beds in Indiana hospitals, but only provide 36 percent of revenue, according to the
     hospital association. The underpayments force hospitals to charge higher rates to their privately insured
     patients to make up for the Medicare shortfall.

     Medicare reimbursements to health care providers were cut in Congress' Balanced Budget Amendment of
     1997, and a restoration act two years ago so far has failed to make up for the shortfall, said Morr.

     According the Thomas Scully, administrator of Medicare for the U.S. Centers for Medicare and Medicaid
     Services, the increase "should be a pleasant surprise for hospitals" because it's 0.5 percentage point higher
     than the projected increase. The Medicare fee increase proposal will face 60 days of public comment,
     followed by congressional review, before final enactment in early fall. (Jeff Swiatek, The Indianapolis Star,
     5/11)

     http://www.indystar.com/article.php?medicare11.html


14   Medicare Payment for Cancer Drugs Is Seen as Likely
     According to lawmakers and lobbyists, Congress appears likely to provide coverage for cancer drugs under
     Medicare this year. Congress is unable to agree on a plan to offer comprehensive drug benefits, but has may
     have been able reach a compromise on cancer drugs. That compromise would be a first step toward solving
     the problem of older Americans that cannot afford drugs.

     The bill Congress appears likely to pass would provide coverage for all oral anticancer drugs. It would
     authorize payment for a wide range of pills and tablets not currently covered under Medicare. These include
     tamoxifen, used for breast cancer; Gleevec, for certain types of leukemia and gastrointestinal tumors; and
     thalidomide, for a deadly blood cancer known as multiple myeloma. (Robert Pear, The New York Times,
     4/28)

     http://www.nytimes.com/2002/04/29/politics/29DRUG.html
                                                       6                            Ascend News Digest         5/16/2002
Medical Research, Advancements & Announcements
15   Minority health care still lags, study finds
     According to a new study by the Commonwealth Fund, minorities receive generally worse treatment than
     whites. Hispanic- and Asian-Americans receive the worst health care. There has been some progress in
     improving health care for African-Americans.

     "Most of the medical literature in the past has focused on disparities between whites and blacks, but we are
     really just beginning to understand what is happening to the other minority populations in our country," said
     Dr. Karen Scott Collins, vice president of the Commonwealth Fund.

     In March, a report by the Institute of Medicine concluded that racial stereotyping by doctors contributed to
     shorter life spans for African-Americans. Collins' study confirmed that blacks receive worse care than whites
     in several areas. But the survey also found that a greater percentage of blacks (57 percent) than whites (47
     percent) received a physical exam during the past year. More blacks (84 percent) than whites (73 percent)
     received eye screenings for glaucoma during that time, and a greater percentage of blacks than whites
     received a Pap smear test for cancer (60 percent vs. 53 percent).

     Collins said she was encouraged by these findings, suggesting they might mean recent aggressive efforts to
     target blacks for screenings are working. More disturbing, Collins said, was that health care quality for
     Hispanics and Asians often lagged behind the care for whites and blacks, often because of language and
     cultural barriers. (Tom Pelton, Baltimore Sun, 5/8)

     http://mv.sunspot.net/news/health/bal-te.disparity08may08.story?coll=bal%2Dhealth%2Dheadlines


Technology
16   New post-lumpectomy therapy OKd
     Women now have a new option for the required follow-up treatment after the removal of a cancerous lump
     from their breast. Targeted internal radiation, called brachytherapy, radiates just the tumor site instead of the
     whole breast. It has long been available to men suffering prostate cancer and some doctors had mastered
     ways to deliver radiation deep into a breast as well. But now, Proxima Therapeutics Inc.'s MammoSite is
     designed specifically for breast brachytherapy, and the Food and Drug Administration's approval potentially
     opens the method to more widespread use in breast cancer patients.

     MammoSite-style radiation treatment takes five days instead of up to seven weeks that external radiation can
     require. That lengthy follow-up treatment is considered one reason that many women choose mastectomy
     when they could have a lumpectomy. (Lauran Neergaard, Chicago Tribune, 5/7)

     http://mv.chicagotribune.com/news/nationworld/chi-
     0205070217may07.story?coll=chi%2Dnewsnationworld%2Dhed


17   'Hairdryer' device could save skin cancer lives
     An Australian device that scans spots on a patient's skin and decides if they are harmful could save
     thousands of lives. The device, called the SolarScan, looks like a hairdryer and picks up on tiny changes that
     a doctor may not be able to see. It works by taking a cleaned-up picture of the blemish and comparing details
     like its shape and color with a database of benign and unhealthy skin spots. The device could also reduce
     the number of unnecessary operations on people with benign spots. (Ananova, 5/7)

     http://www.ananova.com/news/story/sm_582636.html?menu=news.scienceanddiscovery



                                                      7                           Ascend News Digest        5/16/2002
Services
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                                                    8                          Ascend News Digest       5/16/2002
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