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May 1, 2007

Right to Sell Information on Physicians' Prescribing Habits Restored in NH

Today's New York Times online reports that a federal court in New Hampshire has struck down, on first amendment grounds, a state law that prevented the pharmacy industry from tracking physician prescribing habits and selling the information to drug manufacturers.

Excerpts from the article below the fold.

Continue reading "Right to Sell Information on Physicians' Prescribing Habits Restored in NH" »

May 3, 2007

New York Medicaid Is the Slowest Payor in the Nation

According to a survey conducted by Physicians Practice magazine and athenahealth, Inc., New York Medicaid's claim processing speed is at the bottom of the barrel:

* New York-Medicaid was the slowest payer to medical providers averaging over 111 days to process a claim. New York was not only the slowest payer among Medicaid plans but ranked the lowest among all payers nationally.

The surveyors cite the overall poor performance of Medicaid plans as a major factor in provider reluctance to participate in Medicaid and/or to accept new Medicaid patients.

May 10, 2007

NY Legislature Wants to Revisit Berger Commission Report

The New York Times reports today that state legislative leaders Joe Bruno and Sheldon Silver would like to reconsider the conclusions of the Berger Commission report, approved last year, which made major recommendations for reconfiguring hospitals across the state:

Legislators Ask to Revise Plan for Hospitals

The Republican and Democratic leaders of the State Legislature said Wednesday that they wanted Gov. Eliot Spitzer to reconsider a plan approved last year to close, merge or shrink dozens of hospitals across the state.

. . .

Last year, that commission — formally called the Commission on Health Care Facilities in the 21st Century — proposed a sweeping reorganization of the state’s hospitals through closings, mergers, downsizing, the elimination of some services, and the addition of others. The plan elicited sharp criticism from hospital executives and local elected officials, who pledged to fight it. But Mr. Spitzer, then the governor-elect, said he supported the plan, and the State Legislature, despite some grumbling, allowed it to take effect.

On Wednesday, however, Mr. Bruno said the commission’s recommendations were up for reconsideration. “We have to look at the ramifications of what we did and correct it,” he said. “We’re governing here on a daily basis. You don’t govern once a year.”

Mr. Silver said that his members were unhappy with some of the recommendations of the commission, and that it “should not be the end-all and the be-all.”

He also said that key Assembly lawmakers were in discussions with the state Department of Health regarding modifying some of the commission’s proposals, for example, by keeping open some hospitals that would have been closed and by reconfiguring some mergers so that other hospitals could continue to offer specific kinds of care.

Of course, it wouldn't be politics if everyone agreed:

But at a news conference later in the day, Mr. Spitzer suggested that those discussions were fairly limited in scope. “I don’t think the Berger commission recommendations will be reversed or revised,” he said, referring to the commission by the name of its chairman, Stephen Berger. “The issue now is implementing the Berger commission recommendations in a way that shows sensitivity to the communities affected in terms of the continuity of care, in terms of the financing of institutions and job retention that is affected thereby.”

May 17, 2007

State Offers Money to Facilitate Berger Commission Recommendations

The Spitzer administration is offering a substantial sum of money to assist health care facilities with the transitions recommended by the Berger commission. According to a Health Department press release:

New York State is offering up to $550 million in financial assistance in the current fiscal year to help health care facilities implementing the Berger Commission mandates.

In a formal Request for Applications (RFA), New York State Health Commissioner Richard F. Daines, M.D., announced today that the 81 affected hospitals and nursing homes can apply for financial assistance by 3 p.m. July 16 to support implementation of their Berger compliance plans. An applicants' conference will be held from 1-4 p.m. May 24 in the New York State Museum's Carol Huxley Theatre.

The RFA is available here.

May 23, 2007

More Opposition to Berger Commission Recommendations

This article posted today at The Business Review online details a poll conducted at the request of a Bellevue board member:

A poll of women in the Albany, N.Y., area, conducted by the Siena Research Institute, finds that respondents overwhelmingly want to see Bellevue Woman's Hospital remain open.

The random telephone survey of 402 women 18 years old and older found that 95 percent of respondents were aware that the hospital has been recommended for closure, and 85 percent felt that it should not close.


The Albany Times Union coverage of this poll is here.

Separately, the labor-affiliated Coalition for Economic Justice is voicing opposition to the Berger Commission recommendations in the western reaches of the state. According to this piece in the Business Review:

The Coalition for Economic Justice is calling for the immediate suspension of the health-care system reconfigurations mandated by a state commission.

The group, which is headquartered in Buffalo and is an affiliate of Jobs with Justice and the NYS Labor Religion Coalition, is also calling for a new planning process for the region that includes input from health-care workers, professionals and advocacy groups.


All public signals from the Spitzer administration thus far are that the Commission's recommendations will be implemented without reconsideration.

June 6, 2007

Study Questions Effectiveness of Pay-for-Performance

The Washington Post reports on a study that shows paying hospitals additional money for compliance with specific performance measures doesn't necessarily improve patient care. Or, more specifically, doesn't improve patient care any better than voluntary quality improvement:

In 2003, the Centers for Medicare and Medicaid Services (CMS) launched the largest pay-for-performance pilot project ever in the United States. It included financial incentives for sticking to heart attack care guidelines, the study said.

A first look at data from 54 hospitals in the "pay-for-performance" group found some improvement in performance, such as better attention to the rule for prescribing aspirin in heart attack cases, according to the report published in the June 6 issue of theJournal of the American Medical Association.

But when the researchers looked at comparable data from 446 hospitals with a voluntary quality improvement program that paid no money, they found similar improvements in quality of care and outcome.

"But I don't think this is the end of the pay-for-performance idea," Glickman [the study's author] said. "It is the end of the beginning."

Time will tell if P4P can be hammered into something useful or whether it's another fashionable flash in the pan. One facet of the study was particularly interesting:

One problem in evaluating the results is that all the hospitals were performing at relatively high levels, said Dr. Albert Wu, a health policy and management professor at Johns Hopkins University School of Public Health.

"The study was done within a large nationwide process to improve quality, and looked at this subgroup of hospitals. So it was not surprising that everyone improved," he said.

"In terms of giving aspirin, for example, they started at or above 85 percent," Wu added. "It's hard to improve on that."

Dr. Wu's comment suggest that P4P in its current form will prove most effective for hospitals that begin with poorer performance records. If a health plan has P4P dollars to spend, it will want to spend them on hospitals that will improve the most per dollar. But such a paradigm would essentially reward poor performers while leaving the leaders with only the warm fuzzies for having 'voluntarily' improved their care record.

The full WaPo article can be accessed here.

June 13, 2007

Progress on Berger Recommendations in Chautauqua

The Department of Health reports progress on implementing the Berger Commission recommendations as they relate to hospitals in Chautauqua County:

The chairmen of boards of Brooks Memorial Hospital and the TLC Heath Care Network have agreed to work on consolidations of their two hospital systems into one governance structure, including an active affiliation with Westfield Memorial Hospital. Westfield Memorial will seek to convert to an upgraded diagnostic and treatment center with emergency care, establishment of four "observation beds" for up to 24 hours of care, retention of its outpatient programs and elimination of its inpatient beds. Westfield will retain its affiliation with St. Vincent Health System in Erie, Pa., and seek affiliation with the new system created by the consolidating of Brooks Memorial the TLC Health Network, which operates Lake Shore Hospital and Tri-County Memorial Hospital.

On the other side of the state, efforts to merge Ellis Hospital and St. Clare's in Schenectady have slowed on the issue of St. Clare's underfunded pension. This from a June 7 piece in the Albany Times Union:

St. Clare's Hospital, which is mandated by the state to merge with Ellis Hospital by 2009, has had a shortfall in its defined-benefit plan since the beginning of the decade. The pension fund now is worth $35 million, but is short another $34 million due to investment losses and reduced payments from St. Clare's because of financial difficulties.

. . .

The two hospitals hope to get a piece of $550 million in grants the state is giving out this summer to the 81 hospitals and nursing homes that have been told to merge or close. More grant money could be available once this round is finished, according to the state Department of Health.

Claudia Hutton, a spokeswoman for the department, said the grants could cover pension costs, along with other closure expenses such as construction, legal fees, debt and severance fees.

But a dispute over who pays the pensions is not an excuse to stop merger talks, she said.

Meanwhile, Governor Spitzer remains unmoved by efforts to scale back the Berger recommendations:

Spitzer reaffirmed his view that the health care restructuring law passed six months ago should not be amended, although the health commissioner could adjust plans to meet with community needs. Bellevue Woman's Hospital is set to close under the plan.

June 21, 2007

Health Commissioner Likens GME in New York to "Australian Marsupials"

Addressing the New York State Council on Graduate Medical Education, Commissioner of Health Richard Daines suggested that GME programs in New York are aberrational:

My concerns chiefly have to do with all the external pressures, expectations, demands and perverse incentives piled upon GME in New York.

Like Australian marsupials, New York GME has evolved differently here than in most of the rest of the country. Enormous resources are channeled through GME and vast expectations are raised for fulfillment by GME. If we fail to deliver on those expectations, GME may be held to blame.

In the rest of the speech, the Commissioner raised four specific concerns with the current state of GME, reproduced here in excerpt:

First, there is a problem heading towards crisis across New York in the supply, specialization and geographic distribution of the practicing physician workforce. . . . In the first weeks in my new position I heard from several major groups that addressing this would require major new investments in GME. . . . If supporting the nation's largest, most expensive GME program were the answer to workforce shortages, New York would already be Nirvana.

. . .

Second, I am alarmed that funding channeled through graduate medical education has come to be regarded as a general and essential hospital revenue stream rather than as a proper payment for the proper costs and value of GME itself.

. . .

Third, I am unconvinced by the arguments made for disproportionately large GME expenditures and GME programs as independent economic drivers and therefore niches or sectors to be maximized on their own merits.

. . .

Fourth, I am troubled by the positive relationship that some draw between New York's reliance on GME and success in biomedical research. This is not borne out by the facts.

The full transcript of Dr. Daines' remarks is available on the Department of Health website here.


June 27, 2007

American Medical Association Cautious About Redi-Clinics

Despite being urged by some of its membership to call for an outright ban on retail-based redi-clinics, the American Medical Association has called for an "investigation" into conflicts of interest inherent in retail/provider partnerships.

Specifically, AMA voted to:

  • ask the appropriate state and federal agencies to investigate ventures between retail clinics and pharmacy chains with an emphasis on inherent conflicts of interest in such relationships, patients' welfare and risk, and professional liability concerns.
  • continue to work with interested state and specialty medical societies in developing guidelines for model legislation that regulates the operation of store-based health clinics.
  • oppose waiving any state and/or federal regulations for store-based health clinics that do not comply with existing standards of medical practice facilities.
. . .

But that's not all.

[In addition, p]hysicians today approved an additional principle that seeks equal treatment for physicians regarding health insurers' co-payment policies. These financial incentives may inappropriately steer patients to these clinics on the basis of cost rather than quality of care.

"Health insurers are allowing store-based health clinics to waive or lower patient co-payments, while forcing physicians to collect these fees, said Dr. Carmel. "The AMA believes health insurers should be prohibited from waiving or lowering co-payments only for patients that receive services at store-based health clinics."

This Chicago Tribune piece is interesting for this quote:

"There is no more urgent issue than this for the AMA," Dr. Kamran Hashemi, a family physician from South Barrington, said, urging the organization to push for more regulation of retail clinics. "This issue speaks to what all of us do every day in practice." If the AMA does nothing, Hashemi said, "in five years, the chairs [at the AMA] meeting will be filled with representatives from Walgreens, Wal-Mart" and other retail outlets.

July 3, 2007

HIPAA Stymies Useful Information Flows

An article in today's New York Times adds to the increasing body of complaints about the overzealous application of HIPAA:

Hipaa [sic.] was designed to allow Americans to take their health insurance coverage with them when they changed jobs, with provisions to keep medical information confidential. But new studies have found that some health care providers apply Hipaa regulations overzealously, leaving family members, caretakers, public health and law enforcement authorities stymied in their efforts to get information.

Experts say many providers do not understand the law, have not trained their staff members to apply it judiciously, or are fearful of the threat of fines and jail terms --- although no penalty has been levied in four years.

Among the experts cited in the article is the Health Law Section's own Robert Swidler:

Teaching staff to protect records is easier than teaching them to share them, said Robert N. Swidler, general counsel for Northeast Health, a nonprofit network in Troy, N.Y., that includes several hospitals.

"Over time, the staff has become a little more flexible and humane," Mr. Swidler said. "But nurses aren't lawyers. This is a hyper-technical law and it tells them they may disclose but doesn't say they have to."

Hyper-technical is right. Even short HIPAA legal opinions are lengthy and couched, and usually hedged to boot, and not just because they're written by lawyers.

Access the full article here.

July 9, 2007

Hospitals Building Out, Adding Amenities

An article in today's New York Times online discusses hospital construction projects in Westchester County:

At Westchester Medical Center in Valhalla, for example, the hospital recently established a concierge service for patients and their families, with operators on duty from 7 a.m. to 9 p.m. to provide notary services, direct them to nearby restaurants or provide directions to regional airports. The hospital will also invest $60 million this year in renovating patient rooms, building an 11-bed intensive-care unit and creating a new lobby entrance.

. . .

Officials at Hudson Valley Hospital Center in Cortlandt Manor, who last month announced a $100 million building project, say providing a pleasant environment can promote healing and position the institution for financial stability.

The project features the replacement of 84 beds in semiprivate rooms with 84 private rooms in the complex, which opened in its current location 41 years ago.

Read the full article here.

July 10, 2007

WSJ Rounds Up Hospital Data

Today's Wall Street Journal (subscription ordinarily required, although today - - 7/10/07 - - all online content is available free) rounds up a number of databases available online to consumers wishing to research hospitals. Notable inclusions appear below the fold.

Access the full article here.

Continue reading "WSJ Rounds Up Hospital Data" »

July 20, 2007

Bellevue Hospital to Fold Into Ellis

The Albany Times Union reports today that Bellevue Hospital, slated by the Berger commission to close, will instead fold into nearby Ellis Hospital by November 1.

The fight to save Bellevue Woman's Hospital ended in a truce Thursday with the announcement that Ellis Hospital will take over operation of the facility on Nov. 1.

Bellevue CEO Anne Saile, who fought ardently to prevent the hospital's closing, called it the second-best outcome, but a victory nonetheless. Bellevue will continue to operate as a stand-alone campus in Niskayuna for the foreseeable future, Saile said, but there is no guarantee it will remain permanently.

. . .

The Berger Commission ordered Bellevue to give up its certificate of operation by the end of the year, but it did not prevent Ellis from taking over the certificate and running Bellevue. The women's hospital is a 40-bed facility that specializes in births and women's health services. The hospital delivers about 2,000 babies and performs more than 3,000 surgeries annually.

Ellis, a Schenectady hospital with 368 beds, closed its maternity unit eight years ago. Ellis is still under a Berger mandate to merge with St. Clare's Hospital in Schenectady.

Not everyone is thrilled.

Bellevue leaders delivered the news to staff on Thursday afternoon, but Dr. Mary Joyce McGinnis, chief of obstetrics at Bellevue, missed the announcement while seeing patients. She saw a handwritten message on a patient board that said "Welcome to Bellellis."

"I didn't know what it meant," she said and she didn't find out until she was contacted by a reporter on Thursday evening. She's concerned about the Ellis takeover.

"There's a reason that Ellis closed their labor-and-delivery unit, which was they were never able to offer the quality that would attract patients and doctors," McGinnis said. "They were the people who couldn't do it well and got out of the business. I'm not sure you can place the future of women's health care in Schenectady in the hands of people who know nothing about it."

Read the full story here.

Governor Signs Legislation Governing Office Based Surgery

Governor Eliot Spitzer announced Friday that he signed legislation governing surgical procedures rendered in physician offices. The legislation: (1) requires office-based surgery ("OBS") to be performed in a setting that has obtained accreditation from an entity approved by the Commissioner of Health; and (2) requires physicians to report adverse OBS events within one business day to the Department of Health. The legislation also provides that providing OBS in an unaccredited office constitutes professional misconduct. The law takes effect in January 2008.

The law is based on recommendations made by the Committee on Quality Assurance in Office Based Surgery, established in 1997 by the New York State Public Health Council.

A copy of the law is available on the State Assembly's website here . The Governor's Press Release may be accessed here.

August 22, 2007

Nursing Home Quality/Inspection Data on DOH Website

According to the DOH website:

The New York State Department of Health has updated its Web site to include important information on nursing home quality --- including the results of state inspections.

People using the site, http://nursinghomes.nyhealth.gov, will be able to see specific deficiencies for which a nursing home has been cited, including their severity and the number of residents affected. Users of the site can also download and print the inspection reports.

Link to the website here.

The DOH press release is here.

September 7, 2007

HHC Puts Infection and Death Rates Online

From today's New York Times online:

The New York City Health and Hospitals Corporation, the nation's largest public health system, plans to begin publicly releasing data today on infection and death rates at its 11 hospitals, in response to widespread concern about deadly, preventable and costly hospital-acquired conditions and pressure to crack open the shrouded culture of many hospitals.

The full article is here. HHC's press release is here. The new section of HHC's website containing the data is supposed to be called "HHC In Focus" but so far I can't find it.

September 21, 2007

A New Twist on Retail Clinics

A new breed of retail clinics is springing up in Chicago. Here's the twist, as reported in the Chicago Tribune:

Unlike the burgeoning number of retail clinics that are largely staffed by advanced-degree nurses known as nurse practitioners, Medical Marts staffs its clinics with two full-time primary-care physicians, as well as two full-time medical assistants or licensed practical nurses. As the clinics grow, Medical Marts can add doctors or additional nurses or assistants.

Having a physician onsite answers concerns some have raised regarding the quality of care delivered at redi-clinics, but doesn't address the AMA's major issues regarding conflicts of interest, the appropriate regulation of medical facilities, and disparate treatment of redi-clinics and physician offices in terms of patient cost sharing.

It does, however, potentially broaden the contingency within the physician community that will support the advancement of redi-clinics, if they are seen as a potential source of gainful employment for physicians.

October 2, 2007

DOH Details First $363 Million of Berger Implementation Grants

The State Department of Health released details last week on the first round of grants provided to the nursing homes and hospitals slated for closure or merger under the Berger Commission recommendations:

Twenty-three hospitals and seven nursing homes around the state were notified today that they will receive $362.3 million to assist them in complying with the mandates of the Commission on Health Care Facilities in the 21st Century, known as the Berger Commission.

The awards are the latest to be approved by the state Department of Health and the Dormitory Authority of the State of New York from total funding of up to $550 million that was designated for assisting hospitals and nursing homes in implementing the provisions of the Berger Commission.

The Department will be announcing additional grants for the remaining $187.7 million in funding over the next few weeks as award decisions are made.

DOH's press release includes the amount received by each recipient. The highest grant, $25,100,000, was awarded to Lenox Hill Hospital on behalf of Manhattan Eye, Ear & Throat Hospital (MEETH).

October 22, 2007

FTC Likes Massachusetts Retail Clinic Regs

The US Federal Trade Commission released comments October 2nd on proposed regulations governing retail health clinics in Massachusetts. Here's a bit from the FTC's press release:

The FTC staff comments state that such clinics might expand access to basic health care services for certain consumers and might spur price or quality competition with more traditional clinics or physician practices. Therefore, DPH's proposal to permit them is commendable. The comments also state that the agency's proposal of regulatory flexibility "might be especially helpful in an emerging market, as health care providers explore different ways to deliver basic care on a competitive basis." At the same time, however, the comments state that the proposed requirement that all LSC advertising be pre-approved by the DPH "may be overly restrictive," and recommends that it be struck from the regulations.

For more detail read the FTC press release, FTC's comments dated September 27, 2007, or the proposed Massachusetts regulations.

November 2, 2007

Press Ganey 2007 Hospital Check-up

Press Ganey has released the 2007 "Hospital Check-Up Report: Nurse and Employee Perspectives on American Health Care." The report includes a summary of the case study on Hudson Valley Hospital Center in Cortlandt Manor, New York. The full version of the case study is available here.

November 13, 2007

Medical Centers Catching Retail Clinic Wave

Here's a bit from the Minnneapolis Star-Tribune:

Far from its world-renowned Rochester campus, the Mayo Clinic is conducting an intriguing research project in a low-slung Albert Lea mall, right next to a nail salon.

The ALMC Express Care clinic in this southern Minnesota town is a Mayo-affiliated retail operation, where a lone nurse practitioner treats simple ailments without appointments.

The 262-square-foot kiosk marks a stunning turnaround in how the medical establishment is reacting to the proliferation of MinuteClinics and other such outlets.

From the outset I have wondered why hospitals in New York were not going in this direction. Using a hospital extension site license would seem to resolve the icky issue of Article 28 licensure that standalone clinics otherwise have to face. It would also provide instant brand power in the local community where "St. ______ Hospital" is widely known and trusted but "MinuteClinic" is not.

DOH to Analyze "Near Misses" at NY Hospitals

From the DOH press release:

The state Health Department and the New York chapter of the American College of Physicians have agreed to analyze "near-misses" in New York hospitals - - events that could have harmed a patient, but did not - - to help prevent medical errors.

In a three-year demonstration program, the Health Department's Patient Safety Center will work with doctors-in-training in internal medicine to confidentially collect and analyze "near-misses" to help hospitals build safer health care systems to protect patients. This new system will complement New York's mandatory adverse event reporting system, New York Patient Occurrence Reporting and Tracking System (NYPORTS), which already collects information on serious injuries and deaths in hospitals.

The full press release is available here.

November 19, 2007

Clinical Trial Patient Has Hospital-Patient Relationship

Sosnoff v Jackman
2007 NY Slip Op 08439
(November 7, 2007)
Appellate Division, Second Department

[T]he Supreme Court erred in determining that the Hospital established the absence of any hospital-patient relationship. There is evidence in the record that when the plaintiff agreed to participate in the research program, she was not merely a subject or control person (see Payette v Rockefeller Univ., 220 AD2d 69, 72). Rather, she expected to receive medical treatment and services, and she reasonably accepted services from the physicians to whom she was assigned "with the expectation that proper professional skill would be employed" and that she could rely upon them for a proper diagnosis of her condition if she developed a malignant condition during the time they were regularly examining her (Bradley v St. Charles Hosp., 140 AD2d 403, 404; see Raptis-Smith v St. Joseph's Med. Ctr., 302 AD2d at 247).

The full decision is here.

December 2, 2007

DOH Reports Progress on Berger Commission Implementation

DOH has issued a status report on its implementation of the Berger Commission recommendations. The Berger Commission report was published in November 2006. DOH is reporting that the majority of the affected hospitals and nursing homes impacted by the Commission's recommendation are "taking steps" to implement the mandates. They were helped by $362.3 million in HEAL-NY grants, out of the total $550 million that DOH has earmarked for Berger Commission implementation. DOH expects to announce awards for the balance of the HEAL-NY funds shortly.

December 30, 2007

Hospitals Profit Collectively in '06

Saturday's Albany Times Union picked up a HANYS press release on New York hospitals' financial performance.

For the first time in nine years, New York's hospitals posted a net profit, but the margin was slim. More than 120 hospitals statewide collectively reported $386 million in profits in 2006, which is less than a 1 percent operating margin, according to the Healthcare Association of New York State.

The full Times Union article is here (time limited) and the HANYS press release is here.

January 9, 2008

"Peace Corps for Doctors"

Today's Albany Times Union provides details on another component of the Governor's health care reform plan:

Gov. Eliot Spitzer wants to pay off the student loans of physicians who agree to serve rural and urban areas facing shortages of doctors, an administration official said Tuesday. The program referred to internally as a Peace Corps for doctors is expected to be part of Spitzer's State of the State speech on Wednesday, the second of his administration.

The measure, if approved and funded by the Legislature, is aimed at relieving a shortage of medical care in the northern part of the state as well as inner cities, the official said on the condition of anonymity because the speech isn't yet finished.

"Doctors Across New York" would provide grants to repay student loans and other unspecified inducements to reach a goal of providing a family doctor for every New York household, the official said.

Read the full story here.

January 11, 2008

Boston Mayor: "Allowing retailers to make money off of sick people is wrong"

The Mayor of Boston has launched a public campaign against in-store retail clinics.

Menino blasted state regulators for paving the way Wednesday for the in-store clinics, which are designed to provide treatment for sore throats, poison ivy, and other minor illnesses.

The decision by the state Public Health Council, "jeopardizes patient safety," Menino said in a written statement. "Limited service medical clinics run by merchants in for-profit corporations will seriously compromise quality of care and hygiene. Allowing retailers to make money off of sick people is wrong."

That's a rather interesting perspective. Read the full article here.

January 18, 2008

DOH Releases More Berger Money

The State Department of Health yesterday announced a slew of grant awards in relation to the Berger commission recommendations, including:

This round is in addition to the $362.3 million awarded previously on September 28, 2007. Together with yesterday's announcement, most of the $550 million set aside for Berger recommendations has been awarded.

Provider Groups Oppose Spitzer Initiatives

Today's TimesUnion reports:

Gov. Eliot Spitzer hasn't even unveiled his proposed budget, but two major health care associations released reports Thursday warning about the dangers of cutting government funding to hospitals and nursing homes.

. . . The [New York Association of Homes and Services for the Aging]'s report said that one in 10 nursing homes are considering closure because of last year's cuts to Medicaid, and 17 percent are cutting back on plans for home care and other alternative services.

. . . The Healthcare Association of New York State, which represents 550 hospitals, released results of a poll Thursday. According to HANYS, the poll found that New Yorkers by a 3-1 margin oppose education increases if that means cuts to hospitals.

Read the full story here (time limited).

January 21, 2008

Aetna Halts Payments for "Never Events"

From Aetna's website:

As part of its commitment to improving patient safety, Aetna (NYSE: AET) has incorporated language from the Leapfrog Group's Never Events policy in its hospital contract templates for negotiations or renegotiations that use a new contract. 'Never events' are a list of occurrences compiled by the National Quality Forum that so threaten patient safety that they should never happen. These include surgery performed on the wrong body part or on the wrong patient, leaving a foreign object inside a patient after surgery, or discharging an infant to the wrong person.

Read the full press release here.

January 29, 2008

Retail Clinic Chain Closes Stores

Today's New York Times reports:

CheckUps, a start-up operator of walk-in medical clinics, has shut down 23 of the clinics operating in Wal-Mart stores in Florida and three other Southern states.

CheckUps, based in New York, fell behind in paying its nurses and other vendors late last year, apparently running short of cash to meet its bills, according to a lawyer for one of its creditors.

Read the full article here.

Update at 10:37 The Wall Street Journal's Health Blog treats the closings here.

February 8, 2008

Wal-Mart Leans Toward Co-Branded Retail Clinics

Yahoo! News reports:

Wal-Mart Stores Inc. will open its first in-store medical clinics under its own brand name after leasing space in dozens of stores to outside companies that operate the quick-service health stops. . . . Now Wal-Mart has signed a letter of intent to work with local hospital systems and RediClinic to open cobranded walk-in clinics in 200 Wal-Mart Supercenters. . . . Wal-Mart said this is the first step toward opening 400 cobranded clinics by 2010.

Co-branding means the clinics will jointly bear the names of Wal-Mart and its partners and have an identical look, prices and record keeping system, Wal-Mart spokeswoman Deisha Galberth said.

Having the local hospital system involved will also increase the level of trust among shoppers, Galberth said.

The last line in the excerpt echoes a point I made in an earlier post back in November.

Read the full Yahoo! article here.

February 11, 2008

Health Commissioner Highlights Budget Health Reform Objectives

Health Commissioner Richard F. Daines, M.D., outlined the key health reforms in Governor Spitzer's proposed 2008-2009 Executive Budget at a joint Assembly-Senate legislative hearing held February 6, 2008 in Albany.

The Department's short press release is here. The full text of the Commissioner's testimony is here. The press release suggests that the testimony can be viewed in a live webcast as well but as of this writing I don't see any such links available.

February 12, 2008

NYC Hospitals Revamping Emergency Care

Today's New York Times online carries an article about the redesign of today's emergency departments in New York city hospitals:

But now hospitals — public and private, large and small — are spending hundreds of millions of dollars renovating, rebuilding and expanding their emergency rooms. They are dividing them into treatment areas for the sickest patients with the most dire injuries and using quieter corners for the growing number of patients using emergency rooms for routine medical care.

And an increasing number are taking steps to bring civility and even hospitality to the emergency room, in part because, for all their turmoil, they remain vital points of entry for paying patients whose eventual admission accounts for needed revenue.

. . .

“The amount of emergency room use in New York has always been a source of criticism,” said Kenneth E. Raske, president of the Greater New York Hospital Association, an industry group. “But you can’t say to eight million people, ‘Don’t do this anymore.’ ”

True. Now if only the RIAA could get to that point as well, we'd be getting somewhere. Read the full NYTimes article here.

February 19, 2008

OHRP@ NIH: concludes compliance oversight evaluation case on university hospital project to reduce ICU infections

Feb.15, 08- In its "Good Clinical Practice Update" , OHRP (1)

...encourages continuance of work to reduce incidence of catheter-related infections and offers new guidance for future research. OHRP noted that the Johns Hopkins project has evolved to the point where the intervention, including the checklist, is now being used at certain Michigan hospitals solely for clinical purposes, not medical research or experimentation. Consequently, the regulations that govern human subjects research no longer apply and neither Johns Hopkins nor the Michigan hospitals need the approval of an institutional review board (IRB) to conduct the current phase of the project...
HHS is reviewing the application of OHRP rules to evidence-based quality improvement activities, like the Johns Hopkins project, and whether any changes are needed to encourage such work while safeguarding the rights and welfare of human subjects in research....

In response to a written complaint about this research, OHRP opened a compliance oversight evaluation with the Johns Hopkins University and the Michigan Health & Hospital Association, regarding allegations of non-compliance with HHS regulations for the protection of human subjects [2]... The complainant alleged that the research was conducted without prior review and approval by an IRB and without the informed consent of the human subjects who participated. OHRP has concluded that Michigan hospitals can continue implementing a checklist to reduce the rate of catheter-related infections in intensive care unit settings (ICUs) without falling under regulations governing human subjects research.
The Johns Hopkins study demonstrated that a comprehensive five-step program can dramatically reduce the incidence of catheter-borne infections in ICUs. HHS strongly encourages hospitals nationwide to adopt the program, which can save thousands of lives and millions of dollars each year. ... ...


(1) see February 2008 Update #3, http://www.fda.gov/ora/news/whatsnew.html, email news from OHRP-L@LIST.NIH.GOV sent to subscribers on behalf of Glen Drew [glen.drew@HHS.GOV], the Office for Human Research Protections (OHRP) -- part of the U.S. Department of Health and Human Services
[2] 45 CFR part 46 http://www.hhs.gov/ohrp/humansubjects/guidance/45cfr46.htm

Continue reading "OHRP@ NIH: concludes compliance oversight evaluation case on university hospital project to reduce ICU infections" »

February 24, 2008

FEB. 26! Stem Cell Experts and NYS Lt. Gov. Paterson to participate in 3rd Annual Stem Cell Summit

See the Feb. 19 press release of RRY Publications announcing keynote speakers at the 3rd Annual Stem Cell Summit at the Hilton New York, NYC on Feb. 26. NYS Lt. Gov. Paterson has been a stem cell proponent and he will provide closing remarks.

The Summit will bring together institutional investors, industry participants and researchers with a complete update on the stem cell industry. Attendees will learn about the investment opportunities in the stem cell marketplace, the groundbreaking stem cell products physicians are using today and the growing market potential in terms of revenues.
(`1)

Among Lt. Gov Paterson's priorities read about "Funding Stem Cell Research" (2) an important priority where

...New York had stepped in where the federal government has faltered. Stem cell research will provide hope and innovation to New York...
Medical research is an area in which new hope and opportunity is found every day in New York State. New York's research institutions, teaching hospitals and pharmaceutical companies are world leaders in disease prevention. Thousands of New Yorkers work tirelessly each day in the search for new cures and medicines. However, that critical progress has been hindered by Washington’s refusal to fund stem cell research.

... Over the next decade, $600 million in state funds will go to stem cell research. ...As we continue to innovate in the area of medical research, lives will be saved and new sectors of our economy will be born. Stem cell research offers New York profound economic opportunities and this funding commitment by the state will help position New York as a world leader in the field.

Already NYSTEM's work has resulted in important grant awards.

On January 7, 2008, the Funding Committee of the Empire State Stem Cell Board voted to authorize the Department of Health to proceed with the negotiation of a "Merit Peer Review" contract with the successful bidder, the American Institute of Biological Sciences (AIBS). The anticipated start date for this five-year contract is April 1, 2008.
On January 7, 2008, the Funding Committee also voted to award a total of $14.5 million to support stem cell research and training at 25 institutions that responded to a Request for Applications issued on November 14, 2007. The one-year institutional development awards were designed to increase the capacity of New York State research institutions to engage in stem cell research. Together these awards provide $6.1 million for direct stem cell research, $7.4 million for stem cell research infrastructure, and $1 million for stem cell research training.
(3)

The Summit agenda itself reveals how exciting the latest developments in stem cell research related to therapeutic areas are. Therapeutic areas to be presented on are: cardiovascular, autoimmune and anti-inflammatory, hematology and oncology musculoskeletal, neurology and nerve repair and regeneration . Over 32 participants in the stem cell research field will speak at this particular Summit. The field of stem cell related therapeutic research is building momentum each month with new developments and discoveries.
It will be an impressive day for all who attend. Registration is permitted at the door. (4)

(1) press release http://www.stemcellsummit.com/news-releases/02-19-08.pdf
(2) http://www.ny.gov/governor/press/lt_stemcell.html
(3) http://stemcell.ny.gov/research_support_grants_awards.html
(4) http://www.stemcellsummit.com/2008/agenda08.html

February 25, 2008

Doctors Across New York Gets Some Play in CA Paper

The San Francisco Chronicle is running a piece on Governor Spitzer's Doctors Across New York initiative:

In secluded corners of upstate New York and impoverished neighborhoods around New York City, the sick are less likely to see a doctor.

Hours from a big city, and a helicopter ride away from certain specialized medical treatments, Adirondack Medical Center is one of New York's medical outposts, struggling to compete with large metropolitan teaching hospitals when it comes to hiring physicians.

"It's what keeps us awake at night," CEO Chandler Ralph said. "How are we going to get enough doctors to take care of our community?"

That question could be answered with a new idea Gov. Eliot Spitzer announced as part of his executive budget. He's proposing an initiative to pay off student loans for doctors as a reward for working in underserved areas.

. . .

The Doctors Across New York initiative is supposed to help the more than 25 percent of New York's population who live in areas designated as underserved.

It would set aside $2 million a year to create a physician loan repayment program that would help as many as 100 doctors each year. If the doctor stays in an underserved area for the minimum requirement of two years, 30 percent of the loan would be paid off. Payments would grow each year to the point where it would be paid off after five years. The repayment maxes out at $150,000.


Read the full article here.

Update 2/29: The SF Chronical article was selected as a HealthLeaders Media "Editor's Pick" February 29, 2008.

New York Opposes Medicaid Funding Changes

Today's New York Times covers the winter National Governor's Association meeting and notes the bipartisan opposition to new Medicaid rules.

The rules, scheduled to take effect in the next few months, would reduce federal payments for public hospitals, teaching hospitals and services for the disabled, among others.

. . .

Federal health officials said the new rules were needed to end creative financing techniques that states had used to obtain excessive amounts of federal Medicaid money.

. . .

The federal government says this rule would save $1.8 billion over five years. But New York, which trains 15 percent of the nation's doctors, says it would lose more than that alone. State officials are also concerned about a rule that would eliminate federal contributions for a whole category of public spending on health care for the poor — specifically, spending by autonomous units of local government like the Denver Health and Hospital Authority.


Read the full article here.


March 6, 2008

IRS Guidance on Corporate Governance

The Internal Revenue Services has updated its guidance concerning the governance of tax-exempt organizations. The guidance should be required reading for board members of tax exempt hospitals and health systems. It updates and expands the prior guidance document "Good Governance Practices" that was promulgated in February 2007. The guidance recommends adoption of specific policies and practices in seven different ares: mission, organizational documents, governing body (duty of care, board size, board composition), governance and management policies (executive compensation, investments, fundraising, minute-taking, compliance), financial statements and Form 990 reporting, and transparency and accountability. New areas of focus include the board's duty to oversee the organization's investments, including joint ventures, for-profit subsidiaries, and financial products, and the costs and methods of fundraising.

March 13, 2008

Hospitals Win Favorable Medicare Settlement

In today's Wall Street Journal:

The federal government reached a $666 million settlement with 667 hospitals that had sued for back payments stemming from shifts in Medicare reimbursement policies dating back to the 1980s.

The deal, resulting from negotiations under way since April 2006, is among the largest government settlements paid to health-care providers

Link to the full article here. Also note that the WSJ is offering all its usual subscription content for "free" today. The article linked here is subscription content and may not be available after today.

March 17, 2008

NYC Nurses Frustrated With Expired Contracts

Today's New York Times online carries a piece about the tensions at a few New York City hospitals over nursing contracts:

The largest union of nurses in New York City is voicing dismay that contracts at four large hospitals expired weeks ago without a new agreement being reached.

Though the nurses have not threatened to strike, their frustration has been aggravated by their belief that the hospitals — St. Vincent's Hospital Manhattan, St. Luke's-Roosevelt hospitals and NewYork-Presbyterian/Columbia — should be generous in their contract offers in light of the nationwide nursing shortage.

Read the full piece here.

March 27, 2008

FDAAA of 2007 and "REMS"

From CDER's email news of today: FDA provides Q&A on the Federal Register Notice on Drugs and Biological Products Deemed to Have A Risk Evaluation and Mitigation Strategy ("REMS"). (1) [re: 3/27/08 Federal Register Notice see (2)] FDA is:

identifying drugs and biological products approved/licensed before the provisions of FDAAA that are deemed to have REMS...sponsors of these drug and biological products must submit a proposed REMS by [9/21/08]. This is the first notice FDA has issued under the new drug safety authorities in FDAAA.

REMS is a strategy to manage a known or potential serious risk associated with a drug or biological product. A REMS will be required if FDA finds that a REMS is necessary to ensure that the benefits of the drug or biological product outweigh the risks of the product, and FDA notifies the sponsor. A REMS can include a Medication Guide, Patient Package Insert, a communication plan, elements to assure safe use, and an implementation system, and must include a timetable for assessment of the REMS. Some drug and biological products that previously were approved/licensed with risk minimization action plans (RiskMAPs) will now be deemed to have REMS.
Elements to assure safe use include: --Health care providers who prescribe the drug have particular training or experience, or are specially certified; --pharmacies, practitioners, or health care settings that dispense the drug are specially certified; --the drug is dispensed to patients only in certain health care settings, such as hospitals; --the drug is dispensed to patients with evidence or other documentation of safe use conditions, such as laboratory test results; --each patient using the drug is subject to certain monitoring; or --each patient using the drug is enrolled in a registry (see section 505-1(f)(3) of the Act).
During the approval process, FDA will determine whether a REMS is required to ensure that the benefits of the drug or biological product outweigh the risks. If so, FDA will require the sponsor of the application to submit a proposed REMS and the REMS will be approved when the drug or biological product is approved/licensed. If a product is already approved/licensed and FDA becomes aware of new safety information that suggests a REMS is necessary to ensure that the benefits of the drug or biological product outweigh the risks, it will require a REMS.
New safety information is: Information derived from a clinical trial, an adverse event report, a postapproval study, or peer-reviewed biomedical literature; data derived from the postmarket risk identification and analysis system…or other scientific data deemed appropriate by the Secretary about a serious risk or an unexpected serious risk associated with use of the drug that the Secretary has become aware of (that may be based on a new analysis of existing information) since the drug was approved, since the REMS was required, or since the last assessment of the approved REMS; or the effectiveness of the approved REMS obtained since the last assessment of the strategy.' (See 505-1(b)(3) of the Act).

FDA "next steps" include an interim Guidance for industry that will describe the content and format of a proposed REMS.


(1) http://www.fda.gov/cder/regulatory/FDAAA/default.htm
(2) http://www.fda.gov/OHRMS/DOCKETS/98fr/E8-6201.pdf
(3) http://www.fda.gov/cder/regulatory/FDAAA/FR_QA.htm
(see below for their excerpt on FDA’s enforcement authority under this FDAAA provision)

Continue reading "FDAAA of 2007 and "REMS"" »

March 28, 2008

NGS to Administer Medicare Claims Payment in New York

From a CMS press release March 18, 2008:

The Centers for Medicare & Medicaid Services (CMS) today announced that National Government Services (NGS) has been awarded a contract of up to five years for the combined administration of Part A and Part B Medicare claims payment in Connecticut and New York.

. . .

NGS will serve as the first point of contact for the processing and payment of Medicare fee-for-service claims from hospitals, skilled nursing facilities, physicians and other health care practitioners in the two states. The new Part A/Part B Medicare Administrative Contractor (A/B MAC) was selected using competitive procedures in accordance with federal procurement rules.

The new contractor will take claims payment work now performed by two fiscal intermediaries and four carriers in the two states. The A/B MAC contract, which has an approximate value of $323 million over five years, will fulfill the requirements of the Medicare Modernization Act’s (MMA) contracting reform provisions.

Read the full press release here.

April 1, 2008

St. Vincent's, Activists Skirmish Over Development Proposal

Today's New York Times covers a developing battle over St. Vincent's Hospital's expansion plans:

At a highly anticipated public landmarks hearing on Tuesday, preservationists are expected to battle a controversial development proposal for St. Vincent's Hospital Manhattan in Greenwich Village.

Opponents fear that the city will sanction the destruction of nine buildings in a historic district and allow the construction of two enormous towers that they say would blight their low-rise neighborhood and undermine the value of landmark protection throughout the city.

But the hospital says that 3,000 people have joined a group supporting its plan, Friends of the New St. Vincent's.

Passions have run so high that the city's Landmarks Preservation Commission has abandoned its 50-seat hearing room in the Municipal Building for a 913-seat hall at the Borough of Manhattan Community College at 199 Chambers Street.

Read more here.

April 4, 2008

WSJ Calls Out Profits at Not-for-Profit Hospitals

Today's Wall Street Journal headlines with a writeup on "profits" at not-for-profit hospitals around the country:

Nonprofit hospitals, originally set up to serve the poor, have transformed themselves into profit machines. And as the money rolls in, the large tax breaks they receive are drawing fire.

Riding gains from investment portfolios and enjoying the pricing power that came from a decade of mergers, many nonprofit hospitals have seen earnings soar in recent years. The combined net income of the 50 largest nonprofit hospitals jumped nearly eight-fold to $4.27 billion between 2001 and 2006, according to a Wall Street Journal analysis of data from the American Hospital Directory.

The article, which is available online only to WSJ subscribers, specifically calls out Ascension Health for amassing a sizable reserve:

One nonprofit hospital system, Ascension Health, has a treasure chest of $7.4 billion - - more than many large, publicly traded companies.

Ascension runs a number of hospitals and hospital systems in New York, including St. Mary's Hospital in Amsterdam, Our Lady of Lourdes Memorial Hospital in Binghamton, Mount St. Mary's Hospital and Health Center in Lewiston, NY, and Seton Health in Troy.

The only other New York hospital mentioned in the article is New York-Presbyterian, cited for paying its CEO Herbert Pardes 3.5 million in total accrued compensation in 2006.

Ascension runs 65 hospitals, so its $7.4 billion investment reserve amounts to about $113 million per hospital. That is certainly an impressive amount, but I have a hard time finding the problem with it. It also seems unnecessarily inflammatory to me to refer to reserves as a "treasure chest" and to hospitals in general as "profit machines."

Update 9:43: William Van Slyke, Vice President of Corporate Communications and Public Relations at the Healthcare Association of New York State, responded to the WSJ article in a Supraspinatus exclusive:

This is clearly not the New York experience. High costs, including medical malpractice insurance, and low reimbursement rates from both public and private payers continue to conspire to challenge our hospitals, the majority of which operate at a loss or barely break even.

Also, New York's hospitals each year provide more than $1.6 billion in care to those who cannot pay. We also have in New York one of the most comprehensive and progressive indigent care laws in the nation. So, New York's hospitals remain a model when it comes to providing community benefit.

April 7, 2008

Mass. Universal Coverage Overburdening Primary Care

Interesting article in today's New York Times focusing on the pressure that universal coverage has placed on the primary care delivery system in Massachusetts:

Now in Massachusetts, in an unintended consequence of universal coverage, the imbalance is being exacerbated by the state's new law requiring residents to have health insurance.

Since last year, when the landmark law took effect, about 340,000 of Massachusetts' estimated 600,000 uninsured have gained coverage. Many are now searching for doctors and scheduling appointments for long-deferred care.

Read the full article here.

April 10, 2008

Shift to Digital Mammograms Bumps Up Utilization

Today's New York Times has a piece about how the shift to digital mammogram technology has resulted in an increase in the number of mammograms.

It is a phone call that women dread. Something is not quite right on the mammogram: come back for another one. But don't worry, the script goes, most repeat tests wind up normal.

. . .

At many centers, these nerve-racking calls are on the rise, at least temporarily — the price of progress as more and more radiologists switch from traditional X-ray film to digital mammograms, in which the X-ray images are displayed on a computer monitor.

Read the full story here.

May 12, 2008

St. Vincent's Claims Hardship in Expansion

After losing its bid for approval of its expansion plans, St. Vincent Catholic Medical Centers tries a different tack, as reported today in the New York Times:

On Tuesday --- after the commission rebuffed the hospital's $1.6 billion development proposal --- Henry J. Amoroso, president of St. Vincent Catholic Medical Centers, the entity that includes the hospital, said it would file an application seeking hardship status.

He sought "the demolition of the O'Toole Building," he said, referring to the distinctive white monument on Seventh Avenue between 12th and 13th Streets that the hospital owns.

When it grants hardship status, the commission accepts nonprofit landlords' arguments that maintenance of buildings they own interferes with their ability --- physical or financial --- to carry out their charitable purpose.

Read the full article here.

May 14, 2008

GME Cuts Could Cost NY Hospitals Billions

Today's New York Times reports:

New York's public and private hospitals stand to lose more than $1 billion in state and federal funds for the training of doctors because of changes to the Medicaid program backed by the Bush administration, according to an analysis by the city's Independent Budget Office released on Tuesday.

The change would end a revenue stream that the medical residencies have relied on for more than 40 years and that have widespread ramifications, because New York hospitals train a large share of the nation's doctors, many of whom work in poor neighborhoods during their residencies.

Read the full article here.

May 21, 2008

Medical Schools Can Help Solve Rural Physician Shortage

"amednews.com" covers a new study in the journal of Academic Medicine:

Medical schools would more than double the number of new graduates going into rural practice if each adds a rural training program, according to a study in the journal Academic Medicine.

Read more here.

May 29, 2008

More on Mass. Primary Care Woes

An article today at boston.com provides more detail on the impact of universal coverage on primary care:

About 80 percent of the new patients at Framingham Community Health Center are covered under Chapter 58, the state's new health insurance program, and were formerly uninsured, said Claudia de Aguiar, a supervisor at the clinic. The result is a waiting list that now ranges from 150 to 200 patients, after peaking at 300, she said. Patients hoping to get an appointment with a doctor are being referred to the clinic's other site, Great Brook Valley Health Center in Worcester, she said.

Read more here.

June 4, 2008

St. Vincent's Delivers Expansion Ultimatum

Today's New York Times covers the latest development in St. Vincent's efforts to get an expansion project approved, and the hospital appears to have thrown down the gauntlet:

St. Vincent's Hospital Manhattan will have to shut its doors if it cannot build a medical tower in Greenwich Village, representatives of the hospital said Tuesday at a hearing of the New York City Landmarks Preservation Commission.

More here.

June 5, 2008

State Approves 40% Bump in Assisted Living Beds

From the DOH website, originally posted June 4:

New York State Health Commissioner Richard F. Daines, M.D., today announced approval of 1,584 new Assisted Living Program slots – an increase of nearly 40 percent over the current available beds statewide and the largest expansion of the program in more than a decade.

Read the press release, including a list of the bed allocations to each awarded facility, here.

June 19, 2008

Medicaid Primary Care Standards

The New York State Department of Health has issued draft practice standards for primary care clinicians and programs. Medicaid will require compliance with the standards in January 2009. DOH is seeking input on the draft standards by August 8, 2008. Specifically, DOH wants to know if these are the right standards to apply and whether providers can currently meet the standards.

June 27, 2008

Erie County Lawsuit Over Hospital Closure Ends

From Wednesday's Buffalo Business First:

Erie County's attempt to force for the state to close either Buffalo General Hospital or Erie County Medical Center has been dismissed in state Supreme Court.

Judge John Curran ended the effort in a decision Wednesday afternoon, indicating the June 23 settlement between the health systems averted any action to shutter a facility.

Read the rest here.

July 2, 2008

Insurance Department Delays Malpractice Premium Update

The Business Review in Albany covers the delay of the excess medical malpractice insurance premiums for '08-'09:

The New York State Insurance Department has postponed the setting of new medical malpractice insurance rates, originally scheduled for July 1.

Superintendent of Insurance Eric Dinallo said the delay will provide time for the negotiation of reforms to the malpractice system, which could result in reduced rates. When rates for 2008-2009 are determined, they will be retroactive to today.

Read the full story here.

July 3, 2008

Commissioner: Berger Commission Measures Implemented

Commissioner Daines reported July 2 that the Berger Commission's mandates, which involved closure of 9 hospitals and 7 nursing homes, as well as the downsizing and restructuring of dozens of other institutions, have been implemented.

Measures to reform and restructure New York's health care system as recommended by the Commission on Health Care Facilities in the 21st Century (Berger Commission) have been implemented, State Health Commissioner Richard F. Daines, M.D., reported today.

. . .

The Berger Commission recommendations became legal mandates in New York on January 1, 2007, and were given a June 30, 2008, deadline for implementation. The Commission cited the need to eliminate excess hospital and nursing home bed capacity, eliminate hospital duplication of services, modernize outdated health care facilities, and provide New Yorkers with greater access to primary and preventive care.

Dr. Daines' full press release is here. A comprehensive chart showing the original commission mandates and the status of the mandate, as well as the HEAL grant monies disbursed, is here.

July 8, 2008

Mixed Reviews of NY Hospitals in First DOH Infection Report

From the DOH website today:

New York hospitals have lower rates of central-line infections in pediatric and coronary intensive care units than the rest of the nation but higher rates in surgical intensive care units, the New York State Department of Health announced in a new report today.

Read the press release here. There are apparently two versions of the report, one to the legislature (32 pages) and one to the hospitals themselves (115 pages). The report to the legislature is here. The report to the hospitals is here.

July 9, 2008

Family of Deceased Psych Patient Will Sue

Unsurprisingly, the family of the patient who died waiting in HHC's psych ward intends to sue:

NEW YORK (AP) - - The daughter of a woman who died unnoticed on the floor of a hospital psychiatric unit called Tuesday for criminal prosecution of the workers who did nothing to help her.

"What I want is justice," Tecia Harrison said, hours after her family notified the hospital, the city and the city's Health and Hospitals Corporation that they intend to file a $25 million lawsuit. "Whoever committed a criminal act should be held responsible."

Read the USA Today story here. The prior Supraspinatus entry on the event is here.

July 10, 2008

Coming Soon From JCAHO: "Bad Behavior" Codes

The Joint Commission today announced its intention to limit bad behavior in the health care environment:

Intimidating and disruptive behaviors can foster medical errors,contribute to poor patient satisfaction and to preventable adverse outcomes, increase the cost of care, and cause qualified clinicians, administrators and managers to seek new positions in more professional environments. Safety and quality of patient care is dependent on teamwork, communication, and a collaborative work environment. To assure quality and to promote a culture of safety, health care organizations must address the problem of behaviors that threaten the performance of the health care team. (Citations omitted.)

Beginning January 1, 2009, the Joint Commission will review accreditation-seeking organizations on two new leadership standards targeted at bad behavior:

EP 4: The hospital/organization has a code of conduct that defines acceptable and disruptive and inappropriate behaviors.

EP 5: Leaders create and implement a process for managing disruptive and inappropriate behaviors.

Additional revisions to the Medical Staff chapter are also intended to address interpersonal skills and professionalism.

So what is disruptive behavior?

Intimidating and disruptive behaviors include overt actions such as verbal outbursts and physical threats, as well as passive activities such as refusing to perform assigned tasks or quietly exhibiting uncooperative attitudes during routine activities. Intimidating and disruptive behaviors are often manifested by health care professionals in positions of power. Such behaviors include reluctance or refusal to answer questions, return phone calls or pages; condescending language or voice intonation; and impatience with questions.

Hopefully the Joint Commission's effort will not bleed over into the world of fictional hospitals. Fans of the Fox TV series "House" would find themselves sorely disappointed with a main character that answers questions politely, does his clinic time willingly, and treats subordinate team members with patience and respect. Real world health care team members may, however, welcome the new code for its principles and the protections it will afford, even if administrators look forward to enforcement of the new standards with some trepidation.

Read the Joint Commission's July 9 press release here, and the related Sentinel Event Alert here.

July 21, 2008

Medical Home Projects Lifting Off

Today's New York Times has an interesting but not particularly deep piece on medical home projects:

The idea is that by paying family physicians, internists and pediatricians to devote more time and attention to their patients, insurers and patients can save thousands of dollars downstream on unnecessary tests, visits to expensive specialists and avoidable trips to the hospital.

Link to the article here.

July 31, 2008

Long Island College Hospital Shuttering Maternity Ward

From today's New York Times:

A community hospital in gentrifying Brooklyn is closing down its maternity ward and plans to sell the building that houses some of its obstetrical clinics and another building across the street.

The hospital, Long Island College Hospital in Cobble Hill, delivered 2,800 babies --- an average of seven or eight a day --- in 2007, officials said, although the numbers are expected to decline this year after some prominent obstetricians moved to nearby New York Methodist Hospital.

Read the full article here.

August 8, 2008

HHC Board Member Resigns Amid Questions

From today's NY Times:

A board member of New York City's Health and Hospitals Corporation resigned on Thursday, after the agency began an inquiry into his role in securing a 10-year, $100 million contract for a Caribbean medical school where he has long had a paid position.

Read the full story here.

1199/SEIU Wants To Legislate Home Health Aide Pay

According to the New York Times,

George Gresham, president of the 300,000-member union, insists that 1199 does not need any additional state funds to reach a settlement to raise what he says are often scandalously low wages. He said that what the union was seeking from Albany was legislation or regulations that require home care agencies to share more of their money with their workers.

The Times Article points out that 1199 typically asks for "tens of millions of dollars" for hospitals and nursing homes. Read the full article here.

September 3, 2008

Hospital CEO Advocates Single Payer System

James Barba, CEO of Albany Medical Center, comments in today's Albany Times Union in favor of a single payer system:

There appears to be no debate whatever that our current means of delivering health care has become cripplingly expensive. To devote more than 16 percent (and climbing) of our gross domestic product to a single service, no matter how important, is not sustainable. Once we decide that we will have universal coverage, the only approach that will allow actual and substantial savings is a single payer.

Read the full piece here.

September 4, 2008

New York Downtown Hospital Announces New Center

From a DOH press release yesterday, September 3:

Governor David A. Paterson today joined New York State Assembly Speaker Sheldon Silver, New York City Deputy Mayor Robert Lieber, community leaders and hospital officials to announce the future site of the Wellness and Prevention Center at New York Downtown Hospital as well as the future purchase of the first public MRI machine in Lower Manhattan.

Read the whole press release here.

September 8, 2008

Volunteer EMTs Are A Disappearing Species

Sunday's Albany Times Union led with the headline "EMS in Critical Condition," and the story provided some disheartening statistics:

In the six-county Adirondack/Appalachian region (which includes sparsely populated Hamilton County, an area of 1,720 square miles that's nearly the size of the state of Delaware), between September 1996 and January 2001 the number of EMS volunteers decreased 31 percent, and then leveled off. Retention rates are high, officials say, but new recruits are hard to attract, which is why some officials envision a day when EMS volunteers will be replaced with fully paid staffs, at taxpayers' expense.

Read the article here.

As a former volunteer EMT, the issues discussed in the article are personally familiar to me. The story of disappearing volunteers is the same all over the state, though the rural areas seem particularly more strapped. Rural ambulances also tend to be extensions of the fire department (instead of as independent or municipal services) and as such cannot (here in New York) charge for their services, leaves them without a revenue source to pay for paid/career EMTs. And there is just so much money you can wring from ice cream socials and boot drives.

Also undiscussed in the article is the fact that many volunteer EMTs left the service because the politics and infighting of their local squads were simply too much to endure. As volunteer bases shrink, the ability of those few bad apples to spoil the bunch only increases, leading to a sort of downspiral of morale that only exacerbates the problem.

For my own part, I stopped riding with the birth of my second son due to time constraints. As my kids age into independence, it is possible that I will reconsider and go back to riding. But my local service is funded through a combination of tax money and revenue from billing for its services. It now uses that money to pay for paramedic-level responders for first and second calls 24x7. So while volunteer EMTs might be nice to have, they are essentially un-essential to the service, and that of course diminishes the value of being a volunteer mightily.

Although lots of very smart people have been thinking about this issue for a long time, there are no clear answers and not even very many workable ideas for how to revive volunteerism. And the TimesUnion article admits that much, leaving the reader with dim hope that circumstances will change any time soon.

September 26, 2008

Hjelp! Jeg snakker ikkje norsk!

Modern HealthCare online reports:

The CMS will allow Det Norske Veritas Healthcare, or DNV, to accredit U.S. hospitals, a move that puts the Hovik, Norway-based company in a small group of "deemed" organizations and could bring an increased focus on international standards, most notably ISO 9001, to hospitals across the country.

Read more here.

October 17, 2008

Great Lakes Health System of WNY

From Business First of Buffalo:

The board overseeing the merger between Kaleida Health and Erie County Medical Center has selected a name for the new entity: Great Lakes Health System of Western New York.

Great Lakes Health comprises Kaleida and ECMC, but also the University at Buffalo and physicians throughout the community. The organization represents a system of hospitals, health-care providers and specialty services in a two-county region.

More here.

October 24, 2008

Placebos Commonplace in Physician Prescribing Practices

From the Chicago Tribune online:

Treatment with placebos is far more common than you might think, according to a new national survey in which 46 percent to 58 percent of U.S. physicians admitted using placebos regularly. Only 5 percent said they tell patients explicitly that they are doing so.

Read the full piece here.

November 19, 2008

State Tries to Save Long Island College Maternity Ward

The Department of Health has offered a lifeline to Long Island College Hospital's maternity ward, which back in July was slated to close. From today's New York Times:

The State Health Department has promised a loan to a community hospital in Brooklyn's Cobble Hill neighborhood to help it keep its obstetric and pediatric services operating, but hospital officials said Tuesday that more money would be needed to keep the services running beyond the end of the year.

Read the rest here.

November 24, 2008

More Woe for Long Island College Hospital

In today's New York Times:

Continuum Health Partners, the company that runs [Long Island College Hospital], says the hospital is in deep debt and facing bankruptcy, and has sought to close its maternity and pediatric units, among others.

. . .

Part of Continuum's plan to shrink the hospital was rejected last week when the State Department of Health denied it permission to shut down the maternity and pediatric services, ruling that the other local hospitals cannot make up for the loss. The agency also approved a $3 million loan to the hospital, though Continuum said that money would last only until the end of the year.

Read more here.

November 26, 2008

NYS DOH Health IT-prescribing webinar series

From NYS DOH Health IT news Nov 18, 2008 "Electronic Prescribing Webinar Series"
eHealth Initiative Webinar Series offers a series of bi-monthly webinars (90 minute educational programs) focused on key topics related to electronic prescribing.(1)
Currently, registration to the webinars program is open to the general public. A nominal fee is charged to registrants who want to download the slides and/or audio after the event.
2 of the 4 Upcoming Webinars include:

Electronic Prescribing: Understanding Policies, Regulation and Legislation
Wednesday, December 10, 3:00 p.m. – 4:30 p.m. ET
This webinar will provide an overview of the federal, state and local policies, regulation and legislation which effect electronic prescribing. The new eRx regulations and physician payment incentives which go into effect January 1, 2009 will also be reviewed.
Speakers:Michael Rapp, MD, Director of the Quality Measurement & Health Assessment Group, CMS

The Basics of Electronic Prescribing
Monday, December 22, 3:00 to 4:30
This webinar will provide a basic overview of what e-prescribing is, how it works, what its benefits and challenges are, and the current environment impacting its widespread adoption.
Speakers:Scott Barclay, Senior Portfolio Manager of Strategy and Innovation, CVS Caremark Corporation
Kate Berry, Senior Vice President, Business Development, Executive Director, Center for Improving Medication Management, SureScripts-RxHub
Mark Gordon, Director of Policy, eHealth Initiative

The eHealth Initiative Electronic Prescribing (eRX) Resources provide a one-stop information and technical assistance repository that provides a wealth of up to date information on eRX.
The eHealth Initiative in collaboration with the Center for Improving Medication Management, with the strategic guidance and input from a diverse Steering Group made up of the many stakeholders in health care,has developed a series of reports (2) designed to help the U.S. health care system transition from a largely paper-based system of prescribing to electronic prescribing, to support more effective medication management.
(1)http://www.ehealthinitiative.org/eRx/education.mspx
(2)http://www.ehealthinitiative.org/eRx/default.mspx

December 22, 2008

New Conscience Regulation

The Bush administration has issued a new rule that will require hospitals and other facilities that receive federal funding to certify compliance with the federal healthcare conscience protection statutes, which protect an entity's and individual's right to refuse to participate in an abortion. New York law already prohibits an employer from discriminating against an employee who refuses to assist with performing an abortion due to his/her conscience or religious beliefs and has filed a prior written refusal with the appropriate person. The new rule requires health care entities, including individual physicians, to submit the following certification in an application for a grant, cooperative agreement, contract, grant under a contract, memorandum of understanding or other funding or employment instrument or contract or when receiving funds from a recipient of such instrument:

As the duly authorized representative of the recipient I certify that the recipient of funds made available through this instrument will not subject any institutional or individual health care entity to discrimination on the basis that the health care entity does not provide, pay for, provide coverage of, or refer for abortion as part of the federal program for which it receives funding.

The new rule goes into effect January 1, 2009, but HHS agencies have until October 1, 2009 to phase in the written certification requirement. Senators Clinton and Murry have introduced legislation to overturn the new rule.

February 2, 2009

Paterson's Health Proposals Draw Fire

From today's New York Times:

At a time when Gov. David A. Paterson can ill afford more negative attention, the state's most powerful health care interests are mounting a multimillion-dollar media campaign that excoriates the governor and his plans to cut funding for hospitals and other health care facilities.

In television commercials that will begin broadcasting statewide on Monday, nurses and patients take a personal swipe at the governor, imploring, "Why are you doing this?" At one point, a nurse says, "I can’t believe Governor Paterson is the one making this proposal." Then a man, blind and in a wheelchair, asks the governor, who is legally blind, "Why are you doing this to me?"

The New York Times piece is here.

In article, GNYHA president Ken Raske says, "From our point of view, we're between a rock and a hard place. We have no place to go but to the court of public opinion and make everyone aware of what is going on."

Of course, the ad doesn't really make anyone aware of "what is going on." The commercial itself isn't just thin on facts, it's utterly factless - - and leaves everything about "what's going on" to the imagination of the viewer.

The ad itself is on YouTube here. If you're not up on the governor's proposal, see the budget press release here, from which the following quote is extracted:

According to the most recent federal data, New York spends a greater amount on Medicaid per capita ($2,283) than any state in the nation and more than twice the national average ($1,026). Additionally, projected 2009-10 All Funds Medicaid spending ($45.4 billion) would still represent an increase of $15.3 billion or 51 percent compared to 1999-00.

The Executive Budget will produce health care savings across every sector, totaling $3.5 billion in 2009-10. None of these reductions will impact benefits currently given to individuals. A full, itemized list of individual health care savings actions is available at www.budget.state.ny.us.

February 12, 2009

Concierge Medicine: Physician's Boon or the Business of Insurance?

The Maryland Insurance Administration recently issued a report intended to help physicians engaging in "concierge medicine" avoid violating state laws against unlicensed insurance business.

Here's a graf from the MIA's press release:

"The central insurance regulatory issue addressed is whether any of these arrangements cross the line to trigger obligations as an authorized insurer," said Commissioner Tyler. "Some of the arrangements we learned about do meet legal definitions of accepting risk and other conditions making them insurance arrangements, while others do not. We encourage physicians who are using or are considering this model to review our guidance in order to avoid violations of the law, invite them to consult with us in making their choices, and suggest that they be sure to seek appropriate professional and legal advice in this area."

Read the full press release here. The report itself is here.

February 18, 2009

Governor Discusses Health Care Cuts at Health Reform Forum

During a health reform forum earlier today, Governor Patterson discussed proposed heath care cuts and the use of federal stimulus funds for health care reform. New York State is slated to receive $11 billion in Federal Medical Assistance Percentages-related funding. During his remarks, the Governor indicated that the State might not use the entire $11 billion for health care. Several health care advocacy groups, including the Greater New York Hospital Association and 1199 SEIU, have been lobbying to have the federal funds used to reduce or eliminate the health care cuts proposed in the 2009-2010 Executive Budget. Click here to read more.

March 5, 2009

Congress to Look at Hospital Executive Salaries

Senator Grassley of Iowa has a problem with hospital executive pay, or so says the Boston Globe:

Nonprofit hospital presidents earned nearly $500,000 a year on average in salary and other benefits, according to a recent IRS survey of 485 hospitals, and a smaller group more closely reviewed by the IRS had an average salary of $1.4 million. . . .

Senator Charles Grassley of Iowa, the top Republican on the Senate Finance Committee, said yesterday that he is concerned that such salaries may be too high and that the hospitals' boards of directors are not taking full responsibility for approving them. Grassley said he hopes to introduce legislation, possibly as part of a sweeping healthcare overhaul later this year, that would put more pressure on boards to keep salaries in check.

"It really concerns me, and something needs to be done about it," he said.

Read the rest here. And here's one more snippet:

The IRS report found that most hospitals surveyed were complying with regulations dictating how hospital boards should set compensation for executives, and that in cases where pay seemed unusually high, board decisions were generally justified.

Supraspinatus covered the IRS report when it first came out here.

March 10, 2009

Northeast Health Settles Nursing Antitrust Lawsuit

The New York Times reports today:

A hospital network in the Albany area has agreed to pay $1.25 million to settle a class-action antitrust lawsuit in which nurses asserted that hospitals in the area had illegally conspired to hold down their wages.

The settlement with the network, Northeast Health, based in Troy, N.Y., was the first to be reached in a series of related antitrust lawsuits that nurses have filed in Chicago, Detroit, Memphis and San Antonio.

Read the rest here. Northeast Health admitted no wrongdoing and issued a statement calling the nurses' allegations "completely false."

March 17, 2009

AHRQ: Methods Guide for Comparative Effectiveness Reviews

Newsletter excerpts from AHRQ News and Numbers 3/16/09 Issue #272 :

AHRQ is excited about the new opportunities under ARRA to provide patients, clinicians, and others evidence-based information to make informed decisions about health care. ARRA contains $1.1 billion for comparative effectiveness research. Of the total, $300 million is for AHRQ to build on its existing collaborative and transparent Effective Health Care program… Of the remaining funds,$400 million each will go to NIH and the Office of the HHS Secretary. The legislation calls on the IOM to recommend research priorities for these funds and gather stakeholder input. [Report due 6/30/09]. In addition, the Federal Coordinating Council for Comparative Effectiveness Research will be created to offer guidance and coordination on the use of these funds.

One of many helpful and educational topics: AHRQ the Methods Guide for Comparative Effectiveness Reviews:
Effectiveness and Comparative Effectiveness Reviews, systematic reviews of existing research on the effectiveness, comparative effectiveness, and comparative harms of different health care interventions, are intended to provide relevant evidence to inform real-world health care decisions for patients, providers, and policymakers. In an effort to improve the transparency, consistency, and scientific rigor of the work of the Effective Health Care Program, through a collaborative effort, [AHRQ], the Scientific Resource Center, and the Evidence-based Practice Centers have developed a Methods Guide for Comparative Effectiveness Reviews. We intend that these documents will serve as a resource for our EPCs as well as for other investigators interested in conducting Comparative Effectiveness Reviews....The first draft of the Methods Guide for Comparative Effectiveness Reviews was posted for public comment for 8 weeks in late 2007.... In response to requests from investigators and others interested in Comparative Effectiveness Review methods, we have reposted the original chapters of the draft guide….Comments and suggestions on the Methods Guide for Comparative Effectiveness Reviews and the Effective Health Care Program can be made at http://effectivehealthcare.ahrq.gov. (1)

Patients, health care providers (including nurses, doctors and other clinicians),and policymakers all share an interest in making the best health decisions. One of the greatest challenges is finding reliable and practical data that can inform these decisions.... The Effective Health Care Program follows 3 approaches to research in order to provide current, unbiased evidence on health care interventions.
-Review and synthesize published and unpublished scientific evidence.
-Promote and generate new scientific evidence and analytic tools in an accelerated and practical format.
-Compile the findings and translate them into a variety of useful formats for stakeholders.(2)

(1) http://effectivehealthcare.ahrq.gov/healthInfo.cfm?infotype=rr&ProcessID=60
(2)http://effectivehealthcare.ahrq.gov/aboutUs.cfm?abouttype=program

Brookdale Lays Off 240

From today's New York Times online:

A hospital in central Brooklyn laid off 240 doctors, nurses and other workers on Monday, signaling growing financial weakness in the hospital industry.

Officials at the hospital, Brookdale University Hospital and Medical Center, which serves Brownsville, East New York and Canarsie, blamed the bad economy for the layoffs.

Read the rest here.

March 23, 2009

More Health Layoffs

Hard on the heels of Brookdale's announcement last week comes this in last Friday's New York Times:

New York City's public hospital system announced Thursday that it was cutting 400 jobs and closing some children's mental-health programs, pharmacies and community clinics that serve more than 11,000 patients.

Read the rest here.

March 31, 2009

New NYLJ Health Article: "Handling Audits and Investigations of Health Care Providers"

Section Member Frank Serbaroli, with the New York office of Greenberg Traurig, writes a regular "Expert Analysis" column for the New York Law Journal. The latest article, "Handling Audits and Investigations of Health Care Providers," appears in the March 31, 2009 edition:

Providers such as hospitals, nursing homes, outpatient clinics, home health agencies, physician groups, clinical laboratories, imaging centers, medical equipment suppliers, and so on, account for the largest share of payments by the Medicare and Medicaid programs. As such, providers should be prepared to handle audits or investigations as more of them occur. This column is the first of two that discuss who conducts Medicare and Medicaid inquires, what can trigger them, how they are conducted, and some of the steps that providers should consider taking to protect themselves if they find themselves under audit or investigation.

Link to the reprint of the article posted on the Greenberg Traurig website.

April 8, 2009

LI Hospitals Face Budget Shortfalls

From today's Newsday online:

Now that the state budget is passed, Long Island hospitals, two-thirds of which will lose a total of more than $40 million, are scrambling to figure out how to close their budget gaps.

"I think we're going to see program closures," said Kevin Dahill, president of the Nassau-Suffolk Hospital Council.

Read the rest here.

April 15, 2009

Design-Build Helps Cut Construction Costs

From today's New York Times online:

The first free-standing hospital project in New York State in more than two decades, according to the state's Department of Health, is being built in Middletown, using an unusual construction method to cut costs by almost a third.

To build what is estimated to be a $269 million hospital, Orange Regional Medical Center chose a construction company that uses the design-build method, which differs from traditional construction because the architect and general contractor are from one company.


Read the rest here.

May 4, 2009

Berger In Retrospect

In today's Albany Times Union two CEOs comment on the Berger report.

The Berger Commission mandates dropped like a bomb on New York, and Schenectady was ground zero.

The commission ordered Bellevue Woman's Hospital to close, and St. Clare's Hospital to merge with Ellis Hospital.

"Did Berger get it right?" asked James W. Connolly, CEO of Ellis Hospital. "The answer is, unequivocally, yes."

Read the rest here.

May 29, 2009

New NYLJ Health Article: "Handling Audits and Investigations Of Health Care Providers, Part 2"

Section Member Frank Serbaroli, with the New York office of Greenberg Traurig, writes a regular "Expert Analysis" column for the New York Law Journal. The latest article, "Handling Audits and Investigations of Health Care Providers, Part 2," appears in the May 29, 2009 edition:

As we noted in Part 1, there is no such thing as an “informal” audit or a “routine” investigation. Any inquiry by a government agency—such as the Office of Inspector General of the U.S. Department of Health and Human Services, the New York State Attorney General’s Medicaid Fraud Control Unit, the Office of New York State Medicaid Inspector General, or a government contractor such as a Medicare fiscal intermediary, carrier or Recovery Audit Contractor (RAC)— must be taken seriously.

Link to the reprint posted on the Greenberg Traurig website.

June 22, 2009

City Hospital Death Getting Attention Again

From today's NY Times online:

City investigators admitted Friday that the staff at a city-run hospital in Brooklyn failed to provide basic medical care to a psychiatric patient who died on a waiting room floor, and then tried to cover up their neglect.

The rest is here.

July 10, 2009

NY Readmission Rates Worse Than Elsewhere

From today's New York Times online:

Hospitals in New York State are significantly worse than those elsewhere in the nation at limiting patients from having to return shortly after being treated for a major illness, according to federal data released on Thursday.

Read the rest here.

July 20, 2009

UofR Study: Many Residents Find Hours Restrictions Problematic

From HealthLeaders Media today:

A significant portion of surgical residents think the hours imposed on their work schedules inhibit their surgical education and puts patients' safety at risk, according to a study published in the July Journal of the American College of Surgeons.

"We were surprised to find that nearly half of surgical residents believe work-hour restrictions are actually an impediment to their training," said Jacob Moalem, MD, Department of Surgery, University of Rochester (NY) Medical Center, and lead author of the study.

Read on here.

July 31, 2009

Nurse Sues Mt. Sinai Over Religious Beliefs Conflict

Today's Washington Times reports that a New York nurse is suing Mount Sinai Hospital for forcing her to participate in a late term abortion:

Catherina Lorena Cenzon-DeCarlo, 35, a Filipina nurse who is a permanent U.S. resident and married to an American, says that Mount Sinai Hospital in Manhattan "blatantly" violated a 35-year-old federal law that protects health care workers with religious objections from having to assist in performing abortions.

Read more here.

August 12, 2009

Governor Paterson Extends Malpractice Rate Freeze

Newsday picks up an AP feed regarding medical malpractice insurance rates:

Gov. David Paterson has signed legislation to freeze medical malpractice insurance rates in New York for another year, but the state's largest insurer said it leaves the company financially weaker while efforts to resolve malpractice issues are stalled.

More here.

September 14, 2009

Comptroller: Nursing Agencies Siphoned Off Medicaid Monies Intended for Complex Care Nurses

According to a press release issued by the State Comptroller September 10:

Significant portions of funds paid by New York State’s Medicaid program to better compensate nurses who care for children with complex medical problems are inappropriately being kept by the companies they work for, according to an audit released today by State Comptroller Thomas P. DiNapoli.

Read the release here.

October 13, 2009

Deal for Adirondack Medical Practices

Today's Albany TimesUnion reports on the woeful state of primary care in the North Country and a deal intended to stem the outflow of primary care physicians from the region:

Adirondack doctors have struck a groundbreaking deal with health insurers to bring more money into their starving medical practices while at the same time improving the care they deliver.

Six major insurance companies have agreed to give North Country doctors extra payments in return for the doctors' agreement to adopt electronic records and set targets for improving the health of their patients. If it works, doctors will earn more money as hospitalizations are reduced, lowering the overall cost of health care in the Adirondacks.

Read the rest here.

October 23, 2009

NY Caves on Healthworker Flu Vaccination Mandate

Today's New York Times reports:

The Paterson administration backed away on Thursday evening from a health regulation that would have compelled hundreds of thousands of health care workers and hospital volunteers to be vaccinated for seasonal and swine flu.

Read the article here.

Prior Supraspinatus coverage of this issue:

Health Worker Unions Angry Over Mandatory Vaccinations (9/22/09)
Nurses Threatening Suit Over H1N1 Vaccinations (10/13/09)
NYCLU Demands Withdrawal of H1N1 Vaccination Mandate (10/14/09)
Counting on vaccine doses for policy and law (10/20/09)

October 27, 2009

Physician Shortage Believed Worse Than Anticipated

The October 21 New York Times reports:

Whether the nation faces a doctor shortage is a matter of debate. But a new study suggests there are already fewer doctors practicing than had been estimated, because of a lag in reporting retirements.

The new study, published in the Oct. 21 issue of The Journal of the American Medical Association, estimates that the United States has 788,000 active doctors --- 65,000 fewer than calculations have suggested.

Read the rest here.

November 2, 2009

AG's UCR Database Gets a Name: FAIR Health, Inc.

The Attorney General released some details of the promised state-sponsored database intended to replace the private Ingenix database of out-of-network pricing information:

Attorney General Cuomo today [Oct. 27, 2009] announced historic nationwide reform of the consumer reimbursement system for out-of-network health care charges. A new not-for-profit company, FAIR Health, Inc., and an upstate research network headquartered at Syracuse University will develop a new independent database for consumer reimbursement and a new website where for the first time consumers can compare prices before they choose their doctors.

The Attorney General's press release contains a timeline and background on the AG's investigation.

To access prior Supraspinatus coverage follow the link or type "Ingenix" into the search window in the right-hand column of the Supraspinatus main page, just below the blue muscle image.

January 14, 2010

HHC Agrees to Straighten Out Kings County Hospital Center

From HealthLeaders Media January 12:

The New York City Health and Hospitals Corporation has entered into a consent agreement with federal authorities to clean up the troubled psychiatric emergency department and psychiatric in-patient units in its Kings County Hospital Center in Brooklyn.

The full post discusses the KCHC federal investigation and findings in more detail.

January 29, 2010

Coakley Report Dives Into Health Care Costs, Finds Wide Variations in Provider Payments

Boston.com covers a preliminary report issued by Massachusetts Attorney General Martha Coakley:

Massachusetts insurance companies pay some hospitals and doctors twice as much money as others for essentially the same patient care, according to a preliminary report by Attorney General Martha Coakley. It points to the market clout of the best-paid providers as a main driver of the state’s spiraling health care costs.

The yearlong investigation, set to be released today, found no evidence that the higher pay was a reward for better quality work or for treating sicker patients. In fact, eight of the 10 best-paid hospitals in one insurer’s network were community hospitals, which tend to have less complicated cases than teaching hospitals and do not bear the extra cost of training future physicians.

The preliminary report is available on the AG's website, as is its own press release.

February 5, 2010

Continuum Withdraws St. Vincent's Proposal

Published yesterday at the New York Times website:

Stan Brezenoff, president of Continuum Health Partners, a consortium of five hospitals in Manhattan and Brooklyn, said in a letter to Henry J. Amoroso, the president and chief executive of St. Vincent's, that he was withdrawing the offer because of what he said had been a negative reaction to it from both the State Health Department and St. Vincent's own board.

Read the rest of the article at the New York Times' website (enjoy it while you can, the Times will soon cease to offer free access to its online articles).

February 22, 2010

HHC Fears Budget Cuts

From today's New York Times online:

The city's public hospital system, the largest in the nation, is facing a fiscal crisis because New York State is threatening to cut its financing for the care of poor patients at a time when the number of uninsured patients has soared, city officials said Sunday.

Read the rest of the article at the NYTimes website.

February 25, 2010

New York Shunned in HealthGrades' 2010 "50 Best Hospitals" List

HealthGrades, a healthcare ratings organization based in Golden, Colorado, released its list of "America's 50 Best Hospitals" for 2010 yesterday. No New York hospitals were included in the list.

Also among the states unrepresented in HealthGrades' list are: Massachusetts, Connecticut, New Hampshire, and Vermont.

New Jersey made the list with Hackensack University Medical Center.

The full list is available on the HealthGrades website, as is the HealthGrades press release accompanying the list and an explanation of the methodology.

February 26, 2010

DOH Passes on New ER in Southern Saratoga County

From today's Albany Times-Union:

The state Health Department has told three hospitals that want to establish emergency rooms in southern Saratoga County that it currently doesn't see a need for those services.

Ellis Medicine and Seton Health both proposed putting emergency rooms in the Clifton Park/Halfmoon area, while Saratoga Hospital proposed a facility farther north, in Malta.

"Based on our analysis, we didn't see a community need," Health Department spokesman Jeffrey Hammond said Thursday. "We haven't denied their application or taken any formal action," he added.

The article also discusses the reaction on TimesUnion blogs, which was mostly critical of the state's position.

March 3, 2010

Conflict Board Fines Doc for Soliciting Intern Slots

The March 2 New York Times online reports on a physician fined for conflict of interest in soliciting intern spots for students of a medical school in which he held high-ranking paid positions.

A former board member of New York City's public hospital system has been fined $13,500 for his role in soliciting coveted training spots in city hospitals for students from a Caribbean medical school, the city's Conflicts of Interest Board said Tuesday.

The former board member, Dr. Daniel D. Ricciardi, agreed to the fine in a settlement in which he admitted that he had held high-ranking paid positions at St. George's University School of Medicine in Grenada while soliciting clinical clerkships --- a critical part of medical education --- from personnel in the city hospital system, which he also helped to lead.

The article is available here.

Nate Littauer Hospital Receives High Praise For Energy Conservation

Nathan Littauer Hospital and Nursing Home in Gloversville, NY (Fulton County) received recognition from PRES Energy for its efforts to reduce energy consumption in its facilities:

Nathan Littauer Hospital and Nursing Home recently received results of an audit conducted by PRES Energy LLC, which was formally presented to the New York Power Authority. . . . PRES Energy was engaged by the New York Power Authority and the New York State Governor's Office to perform energy audits for a representative sample of its business customers. The audit, conducted January 6, 2010, determines cost-effective measures that could be implemented to reduce energy costs and to improve the efficiency of buildings. The results of the audit were announced to Nathan Littauer's management team today.

The report concludes that Nathan Littauer's energy maintenance efforts are a benchmark for the health care industry.

Read the hospital's press release online.

March 22, 2010

TimesUnion Dives Into Hospital Medical Errors

The Sunday Albany Times-Union carried a lengthy piece on hospital medical errors, stating that two Capital Region hospitals had made a "watch list".

The safety analysis is part of a Hearst Newspapers' Dead by Mistake investigation into medical errors. NHQC [Niagara Health Quality Coalition], a nonprofit based in the Buffalo area, used hospital billing and discharge data that represents every patient encounter in 2007. The administrative data used for the analysis has known limitations, including gaps in the data and inputting errors, but it is recognized as the best available tool to evaluate hospital safety on a large scale. It is the first safety report to identify both the top and bottom hospitals in New York.

The article, available at the TimesUnion website, identifies the state's best and worst performers.

April 7, 2010

St. Vincent's to Close

Today's New York Times online reports:

The board of St. Vincent Catholic Medical Centers voted on Tuesday night to close its flagship hospital in Greenwich Village, ending its long struggle to stay afloat despite millions of dollars of debt.

The exact timing for the closing of St. Vincent's Hospital Manhattan, which has about 400 inpatient beds, was not immediately clear, but the process of shutting down has already begun, and the State Department of Health will become involved to ensure an orderly closing.

Read the rest of the article online at the NYTimes website.

For a compilation of Supraspinatus coverage of the St. Vincent's story, click "st vincent's" in the "Tags" grouping immediately below this post.

April 8, 2010

Roosevelt, Beth Israel Will Accommodate St. Vincent's Patients

Online today at the New York Times website:

Two private hospitals, Roosevelt, at 59th Street and 10th Avenue, and Beth Israel Medical Center at First Avenue and 16th Street, will increase the staff in their emergency rooms to accommodate patients who would have gone to St. Vincent's, said Jim Mandler, a spokesman for Continuum Health Partners, which runs the hospitals.

The article also reports that local politicians are urging St. Vincent's to stay open in some form as a urgent care facility. The shutdown is expected to take two to four months.

April 14, 2010

Is That Doctor a Doctor Doctor or Doctor-Nurse Doctor?

Online today at the Albany TimesUnion website:

With a looming shortage of primary care doctors, 28 states -- including New York -- are considering expanding the authority of nurse practitioners. These nurses with advanced degrees want the right to practice without a doctor's watchful eye and to prescribe narcotics. And if they hold a doctorate, they want to be called "Doctor."

Read the rest of the article on the TimesUnion website.

This is one of the areas where federal and state governments have a great opportuntity to enable real reductions in health costs and allow the market to find more efficient ways to deliver care. What they will do with the opportunity remains to be seen.

April 15, 2010

St. Vincent's Bankruptcy Official

At the New York Times website today:

St. Vincent's Hospital Manhattan filed its long-expected petition for bankruptcy on Wednesday, indicating that its largest unsecured creditor was a federal pension insurance agency.

Read the rest of the article on the Times website.

April 19, 2010

DOH: New York Hospitals Weakest in the Nation

From an AP wire 4/17:

The state's money for health care is spread so thin among its "too many hospitals" that its medical facilities are financially among the weakest in the nation, the health commissioner said.

Dr. Richard Daines spoke to The Associated Press on Friday as health officials were fielding proposals for St. Vincent's Hospital, a 160-year-old Greenwich Village facility with a debt of about $2 million per bed.

That's four times the state's average debt of $500,000 per hospital bed, Daines said.

Read the wire at Google news.

May 13, 2010

Study Casts Doubt on US News & World Report Hospital Rankings

Bloomberg Businessweek reports online April 19:

Hospitals rated as top by U.S. News & World Report are chosen using a system that reflects their reputation with little connection to objective measures of quality of care, a study said.

The hospitals ranked No. 1 for each of 12 medical specialties in the magazine survey reached the top spot based on their reputation scores alone, 100 percent of the time, according to an analysis published today in the Annals of Internal Medicine.

Read the Bloomberg article or click through to the abstract of the study on the Annals of Internal Medicine website (the study itself is available only by subscription).

St. Vincent's Closing May Halve Number of Midwives in New York

The May 6 New York Times covers an interesting aspect of the ongoing financial turmoil at St. Vincent's Hospital in Manhattan:

Seven of New York's 13 home-birth midwives . . . had an agreement with St. Vincent's Hospital Manhattan that its doctors would back them up in an emergency. But the bankrupt hospital closed on Friday, and those midwives have been unable to negotiate new practice agreements with other hospitals or obstetricians, as required by state law, leaving them in the position of risking their licenses if they choose to deliver babies.

Read the full article at the New York Times website.

May 19, 2010

Hospital Group Linked to Seminerio Scandal

Reported in the New York Post May 2:

A hospital group linked to an influence-peddling scandal in Albany put three members of a prominent family of Brooklyn politicians on its payroll, records and e-mails obtained by The Post show.

Prosecutors say MediSys Health Network, which runs Jamaica, Flushing and Brookdale hospitals and other ventures, gave $390,000 in "corrupt payments" to crooked ex-Assemblyman Anthony Seminerio's bogus consulting firm for help with government funding and acquisition of hospitals.

Read the rest of the article at the New York Post's website, or see The Medical News's May 18 treatment which includes some discussion of interaction between the executives and board.

June 11, 2010

HHS Patient Safety and Medical Liability Grants-AHRQ

The HHS Agency for Healthcare Research and Quality (AHRQ) today announced grants to support efforts by States and health systems to implement and evaluate patient safety approaches and medical liability reforms. (1) 13 planning grants (total $3.5 million) and 7 demonstration grants (total $19.7 million) were awarded. The grants represent a variety of models that meet one or more of the patient safety and medical liability reform goals, including:
-Supporting the development of a "safe harbor" for physicians who can prove they followed State-endorsed evidence-based care guidelines.
-Promoting shared decisionmaking.
-Supporting early disclosure and offer models, which inform injured patients and families promptly, and make efforts to provide prompt compensation.
-Promoting transparency and enhanced communication between providers and patients when avoidable injuries occur.
-Reducing preventable harms.
-Informing injured patients promptly, and making efforts to provide prompt compensation.
-Promoting early disclosures and settlement, through a court-directed alternative dispute resolution model.
Demonstration Grants include an award to Judy Kluger, J.D. New York State Unified Court System, New York, NY, $2,999,787: This project aims to protect obstetrical and/or surgery patients from injuries caused by providers' mistakes and reduce the cost of medical malpractice through the use of an expanded and enhanced Judge-Directed Negotiation Program currently used in New York's courts, coupled with a new hospital early disclosure and settlement model. (2)
The evidence regarding the impact of prior efforts to reduce the occurrence of lawsuits and improve patient safety is mixed. In particular, evidence regarding the impact of specific medical liability reforms on health care quality and patient safety is almost nonexistent; these grants will address that essential gap. (3)
(1) http://www.hhs.gov/news/press/2010pres/06/20100611a.html
(2) http://www.ahrq.gov/qual/liability/demogrants.htm
(3)http://www.hhs.gov/news/press/2010pres/06/patient_safety_and_medical_liability_initiative.html

June 17, 2010

The FDA Postmarketing Drug Safety Information website

From the FDA news (1):

On June 15, 2010, FDA began posting summaries of Agency safety analyses of recently approved drug and biologic products. These summaries are intended to share what the FDA has learned about the safety of products 18 months after approval or after the medicine was used in 10,000 patients, whichever was later. The safety summaries are for recently approved drugs with active ingredients that are new to the market or in some cases contain previously approved active ingredients. The website will also post safety data for certain biologic products, including vaccines. The summaries describe any new, potentially important, safety information about each drug that has become known since it was first marketed. They also specify when analyses did not show evidence of a new safety concern and, as necessary, the steps FDA is taking to address any identified safety issue.
These new safety summaries are different from, but complement other important drug safety information already included in the product label or issued in a Drug Safety Communication. This is a new approach to providing safety information to the public. Instead of focusing on one or two new toxicities or safety issues discovered, the postmarketing safety summaries of recently approved drugs and biologics reflect a comprehensive FDA look at the safety of individual products… Although premarket safety information is sufficient to form the basis of approval for a medicine's benefits and risks in the clinical trial population, the clinical trial populations may not be entirely representative of the general public. Previously unknown side effects may become apparent when the medicine becomes available to a larger, more demographically and medically diverse population....Information about drug risks, including newly identified concerns about potential risks, is an important tool for providers and patients.(2)

Note: FDA announced a 2-day public meeting on July 27-28, 2010 (3) to obtain public comment about REMS for drugs and their impact, and to gather additional input on a 10/1/09 draft guidance (entitled:Format and Content of Proposed Risk Evaluation and Mitigation Strategies (REMS), REMS Assessments, and Proposed REMS Modifications).
(1)http://www.fda.gov/Drugs/GuidanceComplianceRegulatoryInformation/Surveillance/ucm204091.htm(2)http://www.fda.gov/Drugs/GuidanceComplianceRegulatoryInformation/Surveillance/ucm214547.htm
(3)http://www.fda.gov/Drugs/NewsEvents/ucm210201.htm

NY Launches Malpractice Cost Reduction Program

From today's Albany TimesUnion:

The state health department and court system are joining together to develop a creative way to reduce medical malpractice costs and compensate victims of medical errors more quickly. Under the plan announced Wednesday, hospitals will disclose medical errors quickly to patients and make early offers to compensate the families, if appropriate. Specially-trained judges will help negotiate the settlements, though victims and hospitals can opt for a jury trial. Five downstate hospitals will participate in a three-year demonstration project to test the system.

Read the rest of the article on the TimesUnion website.

June 23, 2010

More Details on Capital Region Hospital Merger Emerge

Today's Albany TimesUnion reports:

The CEOs of Northeast Health, Seton Health and St. Peter's Health Care Services on Tuesday shared more details on a merger that will create the Capital Region's largest private-sector employer. Among the changes:

Samaritan Hospital in Troy would become the inpatient institution for the east side of the Hudson River, while Seton/St. Mary's, also in Troy, would provide ambulatory care, including a new outpatient cancer treatment center. Inpatient behavioral health beds now at Samaritan would be shifted to Seton/St. Mary's, while angioplasty treatments would be offered for the first time at Samaritan.

Read the rest of the article on the TimesUnion website.

July 16, 2010

2010-11 Best Hospitals

US News & World Report has released its 2010-11 "Best Hospitals" list.

Kudos to New York-Presbyterian University Hospital of Columbia and Cornell for being the only New York hospital to make the "Honor Roll."

In addition, the following hospitals received noteworthy placement in the indicated specialty/ies:

Memorial Sloan-Kettering Cancer Center (2nd - Cancer)
Mount Sinai Medical Center (1st - Geriatrics)
Hospital for Special Surgery (1st - Orthopedics, 3rd - Rheumatology)

See the full list(s) and much more at the US News "Best Hospitals" website.

August 13, 2010

North Short/LIJ Hospital to Buy St. Vincent's Home Health

Reported in HealthLeaders Media today:

North Shore-LIJ Health System member North Shore University Hospital will buy the bankrupt Saint Vincent’s Catholic Medical Center Certified Home Health Agency for $17 million, the Great Neck, NY-based health system announced this week.

Read the rest of the article here.

August 17, 2010

Post St. Vincent's: The Inevitable Lawsuit

Associated Press reports today:

The now-defunct St. Vincent's Hospital was destroyed by mismanagement as it teetered at the edge of bankruptcy_ including a $278,000 golf outing and more than $100 million in unspecified spending for just one year, according to a lawsuit filed Monday.

Read more on the AP newswire.

October 12, 2010

Closure of St. Vincent's Rains Fallout on Area Hospitals

Yesterday FierceHealth covered the New York Daily News piece on the fallout from the closure of St. Vincen'ts emergency department:

Manhattan hospitals have been deluged by a flood of patients since last April's closing of St. Vincent's Hospital in Greenwich Village, the New York Daily News reports.

Bellevue Hospital's chief of emergency medicine, Dr. Lewis Goldfrank, described St. Vincent's closure as "a significant disaster" for emergency care. The facility saw ER visits jump 25 percent to 10,000 a month from an average 8,000. And the number of patients brought by ambulance rose by 40 percent, if one compares the number of patients that came in September with the month before St. Vincent's closed its doors.

Read the full article at FierceHealth, with links to the New York Daily News article as well as an article at DNA Info.

October 13, 2010

Long Island College Hospital to Merge With SUNY Downstate

In the New York Post October 11:

Financially struggling Long Island College Hospital will be saved through a merger deal with SUNY Downstate Medical Center that was quietly approved last week by board members from LICH, a 152-year-old Cobble Hill facility, sources told The Post.

Read the article on the Post's website.

October 18, 2010

SUNY Downstate Will Use State Grant to Acquire LICH

On the DOH website October 14, 2010:

Governor David A. Paterson today announced that State University of New York (SUNY) Downstate Medical Center has been awarded a $40 million State grant to acquire and operate Long Island College Hospital (LICH), which will become a second campus of University Hospital of Brooklyn (UHB). The grant will enable SUNY Downstate to expand UHB's capacity to meet the expected growth in demand for inpatient services and specialized care.

Read the DOH press release here.

November 8, 2010

Medical Student Education is Part of Plan for Fighting Health Care Fraud

At a health care fraud prevention summit in Brooklyn on November 5, U.S. Attorney General Eric Holder and Department of Health and Human Services Secretary Kathleen Sebelius discussed the Obama administration's efforts to combat health care fraud and abuse. Among the topics of discussion was an Internet-based program to explain the federal fraud and abuse laws to medical students, "so they can comply with federal law, avoid liability and spot signs of potential fraud" when they become practicing physicians. Read more about the summit and find links to the medical student training program here.

December 1, 2010

National Debt Commission's Proposal Includes Medicaid Reforms

On December 1, President Obama's National Commission on Fiscal Responsibility and Reform released its report with recommendations for reducing the United States debt. Pages 36 to 42 of the report focus on how reforming the health care system can contribute to this goal. Among the suggestions in the report are several Medicaid-related proposals such as restricting or eliminating what the Commission calls the "Medicaid tax gimmick," placing dual eligibles in Medicaid managed care, and reducing funding to states for Medicaid administrative costs. Other recommendations in the report include cutting Medicare payments to hospitals for bad debts, medical malpractice reform, and reforming or repealing the CLASS Act long term care insurance program established by the Patient Protection and Affordable Care Act. Read the report here.

December 8, 2010

FDA's Safe Medication Use Initiative

Read about the launching of FDA’s Safe Use Initiative and the dedicated webpage.(1) The Agenda and transcripts of the respective presentations and discussion from the Nov 16-17 CDER public workshop spotlights some of the opportunities in certain drugs, drug classes or therapeutic areas that could benefit from stakeholder collaboration.(2)

The mission of the Safe Use Initiative is to create and facilitate public and private collaborations within the healthcare community. The goal of the Safe Use Initiative is to reduce preventable harm by identifying specific, preventable medication risks and developing, implementing and evaluating cross-sector interventions with partners who are committed to safe medication use. Potential partners for the Safe Use Initiative include Federal agencies, healthcare professionals and professional societies, pharmacies, hospitals, and other health care entities, patients, caregivers, consumers, and their representative organizations.Through coordinated efforts, significant improvements can be made in the safe use of medications and reduce preventable harm from medication misuse, abuse, and errors.
See here for the Federal Register Notice announcement of the Safe Use Initiative and the opening of a docket for comments regarding the initiative. Comments can be made to the Safe Use Initiative docket #FDA-2009-N-0526
(1) http://www.fda.gov/Drugs/DrugSafety/ucm187806.htm
(2)http://www.fda.gov/Drugs/NewsEvents/ucm227408.htm
(3) http://www.fda.gov/Drugs/DrugSafety/ucm188762.htm

January 11, 2011

Electronic Certificate of Need System Launched


Hospitals, nursing homes and other health care providers may now file Certificate of Need (CON) applications online. The New York State Department of Health (DOH) announced on December 21, 2010 that the New York State Electronic Certificate of Need application system (NYSE-CON) will facilitate the planning and promotion of health care services for New York State communities. In addition, DOH noted that more information about CONs will be made available to the public through DOH's website. Read the press release here and find out more about NYSE-CON here.

January 17, 2011

NYC Ambulance Fee Stirs Up a Brouhaha



From the Wall Street Journal December 9, 2010:

New York City will begin charging private hospitals as much as $1 million a year for hospital ambulances dispatched by the city's 911 system, a controversial initiative that some medical professionals fear will prompt hospitals to stop providing the service.

Read the rest of the article on the Wall Street Journal website.

January 21, 2011

HANYS Report Details Physician Shortage


HANYS has released a new report entitled "Help Wanted: New York's Physician Shortage Continues to Worsen." A few excerpts from the executive summary and key findings:

Access to care in communities across New York State is threatened by growing physician shortages. HANYS' members reported a dramatic increase in the number of departing physicians and severe difficulty in recruiting replacements in 2009. As a result, both emergency and routine services are becoming less available in many of New York's communities.

Sixty-nine percent of hospitals indicated there were times when the physician shortage left their emergency department without coverage for certain specialties, requiring patients to transfer to other hospitals for treatment, an increase of more than
50% from the previous year.

Nearly 1,600 physicians retired or left their communities in 2009.

View the full report on the HANYS website.

March 24, 2011

Area hospitals receive reimbursements for meeting health-care goals » Local News » Press-Republican

Upstate hospitals are figuring out how to get more for quality care:

Excellus Blue Cross/Blue Shield has distributed more than $19 million to hospitals across the state, including checks to CVPH Medical Center in Plattsburgh, Alice Hyde Medical Center in Malone and Adirondack Medical Center in Saranac Lake. The reimbursement funds are part of the Hospital Performance Incentive Program.

Read the rest of the article on the Press Republican's website.

March 27, 2011

Update on NIH/FDA Pluripotent Stem Cells in Translation: Early Decisions

The event notice indicates that the meeting will be webcast at a link to be announced and many speakers indicated that their slide presentations will also be available - a significant and valuable resource to take advantage of.
Stand out meeting sessions from a legal perspective includes- Session 1 FDA Roles in the Translation Process, NIH roles in the Translation Process, in Session 2 Regulatory Challenges , in Session 3 NIH Guidelines, FDA Donor Eligibility and Cell Banking requirements, in Session 5 Here's what we expect (FDA) . Session speakers confirmed what one described: that early decisions made in research could be show stoppers at therapy stage.
Issues about donor eligibility and testing requirements were recurring subjects. Presentations revealed complex compliance issues. Attention was called to the importance of developing products with the needs of the future clinical site and staff in mind. Some of the early decisions in research/product development that could impact future clinical use included: the need to retain samples, check vendor supply chain and lot variability, check reagents for their pathogenic status, check the kinds of surfaces used for HESC growth, even the scale of vessels containing the growing cells is important since both nutrients and oxygenation make big differences for growth. Having a pure product is important but beyond that, knowing fully what the composition of the product is is as important. Each day ended with Wrap-ups/ Summaries -great ways to pull together and recap highlights of the day's sessions. FDA and NIH wrap ups noted that best practices were emerging- what are the early decisions in R&D that will impact clinical products, the control of cell and reagent sources, donor testing, knowing about any inherent characteristics incompatible with commercial scale product, stability and issues in scalability in stem cell manufacturing, and informed consent requirements. Another challenge: IVF practices in regard to their testing of couples among other issues.
The presentations also provide references for exploration -a few are listed below.

Continue reading "Update on NIH/FDA Pluripotent Stem Cells in Translation: Early Decisions" »

February 11, 2011

New NYLJ Article: "Feds Taking Aim At In-House Lawyers, Executives"

Section Member Frank Serbaroli, with the New York office of Greenberg Traurig, writes a regular "Expert Analysis" column for the New York Law Journal. The latest article, "Feds Taking Aim At In-House Lawyers, Executives," appears in the February 2, 2011 edition of the Journal:

Federal prosecutors, apparently frustrated that unprecedented fines and penalties and burdensome corporate integrity agreements are proving to be insufficient deterrents, now appear determined to bring criminal cases against corporate executives in the health care industry, including in-house lawyers and chief compliance officers, using the responsible corporate officer doctrine. The government's intent is evident in recent pronouncements, and in the culmination of a case where the general counsel and two senior executives of a pharmaceutical company were not only criminally convicted, but subsequently excluded from all government health benefit programs.

For the full article, link to the reprint posted on Greenberg Traurig's website.

April 6, 2011

New NYLJ Article: "When to Get Counsel Involved in Audits, Investigations and Self-Disclosures"

Section Member Frank Serbaroli, with the New York office of Greenberg Traurig, writes a regular "Expert Analysis" column for the New York Law Journal. The latest article, "When to Get Counsel Involved in Audits, Investigations and Self-Disclosures," appears in the March 22, 2011 edition of the Journal:

We are frequently asked whether and when a provider should engage counsel when the provider is contacted by a government agency or contractor with questions about is Medicare or Medicaid billings, its cost report, or its business practices. The answer is: It depends upon the subject matter and scope of the audit or inquiry, and which agency has contacted the provider.

For the full article, link to the reprint posted on Greenberg Traurig's website.

CDT highlights its concerns: the US Supreme court case Sorrell v IMS Health Inc.

3/22- CDT's Health Privacy Project published a memo (5pp) on the US Supreme Court case Sorrell V. IMS Health Inc. (arguments scheduled to be heard on April 26)-CDT focuses on nuances in understanding privacy in its discussion of 2 aspects of this case 1. the valid distinctions between personally identifiable data and 'de-identified' data, and 2. the claim regarding doctors having a 'privacy' right in their drug prescribing practices. (1) The Question Presented on the SCOTUS case docket indicates that the law at issue in this case, Vermont's Prescription Confidentiality Law, affords prescribers the right to consent before info linking them to prescriptions for particular drugs can be sold or used for marketing. It also provides a helpful sketch showing the context of the generation of and use of such data use and then frames the Question Presented. The list of Amicus briefs is impressive, promising an impressive read on the subject.(2)

(1)http://www.cdt.org/paper/memo-sorrell-v-ims-health-inc-supreme-court-case-requires-nuanced-understanding-privacy Deven McGraw is the Director of the Health Privacy Project at CDT. The Project is focused on developing and promoting workable privacy and security protections for electronic personal health information.
(2)http://www.supremecourt.gov/Search.aspx?FileName=/docketfiles/10-779.htm

April 8, 2011

Judge Approves Sale of St. Vincent's Hospital Campus - NYTimes.com

From today's New York Times online:

A plan to build a luxury housing development and an emergency medical center in Greenwich Village came a step closer to reality on Thursday as a federal bankruptcy judge approved the sale of the bankrupt St. Vincent's Hospital Manhattan campus.

Read the full article on the New York Times website.

May 19, 2011

Collaborative Drug Therapy by Pharmacists approved



A bill (S2958 Lavalle/A. 4579 Canestrari) allowing pharmacists to practice collaborative drug therapy in conjunction with physicians under certain circumstances has passed both houses. As it was delivered to the Governor more than 10 days ago and has not been vetoed, it is now considered approved. (Chapter number not currently available)

Text of the new law is available here.

NACHGR open session meeting (5/11); EuroGentest

Progress in the complex area of human genetics research and innovation engenders a lot of popular discussion. Learn more about some of the people involved and what they are doing via the recent meeting of the National Advisory Council for Human Genome Research, an open session videocast ( archived at videocast.nih.gov). (1) NHGRI Director Eric Green M.D. Ph.D. reports on an array of genetics topics, reports, NEJM's recent articles on genomic medicine, the recent conference at Cold Spring Harbor NY (a place where great science is being done). He also calls attention to the larger context of genomic scientific research as described in May 2011 Report entitled Economic Impact of the Human Genome Project; the Report describes how a $3.8 billion investment drove $796 billion in economic impact, created 310, 000 jobs and launched the genomic revolution.
Also of interest is the EuroGentest website (2 ) which provides various EU perspectives on aspects of genetic testing. In brief, for example, read about points to consider regarding clinical indications for genetic testing or a list of the diseases for which they show clinical utility gene cards info. A summary table provides a quick look at some of the big issues involved in genetic testing and an overview of certain laws/regulations, or lack thereof. Lists of entities(w/website info) around the world that focus on the genetics subject area around are also provided.
A European Commission Green Paper (2/11) entitled From Challenges to Opportunities: Towards a Common Strategic Framework for EU Research and Innovation funding describes their common strategic framework in research and innovation funding. It is indicated that under the current programming period (2007-2013) FP7's budget of 53.3 billion euros supports research, technological development and demonstration activities across the EU along with additional budgets in related areas of competitiveness and the like. (3)
(1)http://www.genome.gov/27544346
(2) http://www.eurogentest.org/web/index.xhtml; see also, Nature's European jounal of Genetics
http://www.nature.com/ejhg/archive/categ_genecard_012010.html for a list of 2010 clinical utility gene cards
(3)http://europa.eu/documentation/official-docs/index_en.htm find it under the English 'Gateway to Europa' heading, European Commission, Official documents from EU institutions, agencies and other bodies.

May 25, 2011

NY Mulls Physician 'Dress Code Council' Bill

HealthLeaders Media includes a fairly lengthy review of New York's hygienic dress code bill:

Physicians, nurses, and midwives might have to toss their neckties, jewelry, and lab coats under an infection prevention effort making its way through the New York State Legislature.

Sen. Jeffrey Klein's (D) bill S4909 would establish a 25-member "Hygienic Dress Code Council" appointed by the Health Commissioner to advise on whether banning such clothing and accessories in healthcare settings could prevent infections such as methicillin-resistant staphylococcus aureus (MRSA).

Read the full article on the HealthLeaders website.

July 20, 2011

New NYLJ Article, "Antitrust Enforcers Target Hospital Consolidations"


Section Chair Frank Serbaroli, with the New York office of Greenberg Traurig, writes a regular "Expert Analysis" column for the New York Law Journal. The latest article, "Antitrust Enforcers Target Hospital Consolidations," appears in the May 24, 2011 edition of the Journal:

Many hospitals--both for-profit and not-forprofit-- have been consolidating into regional systems. Their rationale has been that such consolidations can bring about cost efficiencies,increased access to medical services for their communities, improved quality of care, and lower prices. Until recently, there have been relatively few antitrust challenges to hospital mergers. For a time in the late 1990s the federal government's challenges to hospital mergers were largely unsuccessful. But things have changed, and hospitals should take careful note of some important recent cases where mergers have been challenged.
(Citations omitted.) For the full article, link to the reprint posted on Greenberg Traurig's website.

August 11, 2011

Health Sector Growing Despite Poor Economy

Today's TimesUnion reports that health jobs are weather the recession fairly well:

Home health aides like [Letricia] Smith and other health care workers are among one of the fastest-growing employment sectors in New York and the nation, but uncertainty over health reform and the economy may change the picture.

From 2008 and 2009, when all other sectors lost 290,000 jobs, health employment increased by 17,000 -- including 11,000 upstate -- according to a report released by the Center for Health Workforce Studies at the University at Albany.

Read the full article on the TimesUnion website.

September 9, 2011

New Deadline for Applications to Receive St. Vincent's Resident Cap Slots


CMS announced that the deadline for applications from hospitals seeking to take over FTE slots from St. Vincent's Medical Center's former residency training programs is now December 1, 2011. The prior deadline was September 28, 2011. Read the CMS notice in the Federal Register from September 9, 2011 here.

September 13, 2011

NY hospital readmissions cost state $3.7B a year - The Business Review

Richard D'Errico at the Business Review covers a NYSHF report on hospital readmissions in New York:

A report released today says the cost of patients returning to hospitals within 30 days of a stay--known as readmissions--is costing the state $3.7 billion each year.

The New York State Health Foundation's report, "Reducing Hospital Readmissions in New York State," said about 15 percent of all initial hospital stays resulted in a readmission. That's 274,000 additional hospital stays.

See the Business Review piece here, or link to the full report on the New York State Health Foundation website.

September 14, 2011

NY Nurses Stayed With Critical Care Patients During Hurricane Irene

There is a nice writeup at HealthLeaders Media on how Hurricane Irene played out at one of New York City's medical facilities:

Nurses at NYU Langone Medical Center didn't bat an eyelid when Hurricane Irene started barreling toward the northeast last month. The hospital, just steps away from New York's East River was ordered evacuated, along with four others in harm's way, by Mayor Michael Bloomberg.

But NYU-Langone refused to move six of its ICU patients, warning they were so desperately ill that moving them threatened their lives. The ICU's nurses instead opted to stay with their patients through whatever the storm threatened to bring.

Read the full article on the HealthLeaders Media website.

September 27, 2011

Surgical infections an issue for area hospitals - Business First

Last week Buffalo Business First covered a recent report from the New York State Department of Health on hospital infection rates.

Western New York area hospitals continue to experience higher levels of surgical site infections than at other hospitals across the state, according to a new report released this week by the state Department of Health.


On a statewide level, however, the total number of infections acquired by patients while in New York hospitals continues to decline. The fourth annual report includes details on hospital-acquired infection (HAI) in 2010 at 177 acute care hospitals in the state. The report includes data on more than a dozen different procedures resulting in an HAI, an infection acquired as a result of treatment in a hospital.

Read the rest of the article at Buffalo Business First.

Read the DOH press release here, or access the full report here.

November 11, 2011

Wal-Mart: "We are not building a national, integrated, low-cost primary care health care platform"

The New York Times health section covers a stir around a recent Wal-Mart RFI, which went to several dozen providers and suppliers.

Wal-Mart would not disclose which medical care providers or suppliers received the requests, but analysts said what the retailer is considering the kind of partnerships with hospitals and clinics that are being formed by chains like CVS and Walgreen Company.

Apparently the wording of the RFI raised some eyebrows, as Kaiser Health News published the document itself and also quoted it in an article as illustrating Wal-Mart's intent to "dramatically ... lower the cost of healthcare ... by becoming the largest provider of primary healthcare services in the nation."

Wal-Mart, through Dr. John Agwunobi, President of its health and wellness operations in the U.S., responded with denials both categorical and specific, including this one: "We are not building a national, integrated, low-cost primary care health care platform."

Which is too bad, because that's exactly what we need.

December 29, 2011

Montefiore Nurses Dispute Heats Up

From the City Room at the New York Times online December 29th:

In an unexpected move, nurses at Montefiore Medical Center in the Bronx said Wednesday that they would strike on Jan. 10 if they could not resolve issues involving staffing levels and salaries.

Read the full story here.

St. Luke's-Roosevelt and Mount Sinai Settle Respective Nursing Disputes

From the City Room at the New York Times online December 29th:

A nursing strike has been averted at two of Manhattan's busiest hospital centers, as union and hospital negotiators reached tentative deals over pay and benefits, officials involved in the talks said Tuesday. The 1,300 nurses at St. Luke's-Roosevelt Hospital Center had given notice they would strike on Jan. 3 but were able to resolve disagreements over health benefits. Officials at Mount Sinai Medical Center said Tuesday that they, too, had reached a tentative settlement with the nurses' union, though details of the deal were not available.

Read the full story here.

St. John's Episcopal Hospital Laboratory Permit Suspended for 30 Days

From the Department of Health website December 16th:

The New York State Department of Health (DOH) has suspended the laboratory permit of St John's Episcopal Hospital in Far Rockaway, Queens, for blood transfusion and related testing.

Read the DOH press release online at the DOH website.

January 24, 2012

Hospital "Amenities Units" in the Spotlight


The January 22 issue of the NY Times featured an article written by a journalist after her "unofficial visits" to hospital rooms specially designed to attract patients paying cash.

Read "Chefs, Butlers, Marble Baths: Hospitals Vie for the Affluent" here.

January 25, 2012

HANYS Study: Gloomy Forecast on Physician Shortage

Released January 24, 2012:

Hospitals across the state are facing a serious physician shortage that is expected to worsen as the pace of pysician departures and retirements accelerates, and hospitals are having problems recruiting new doctors, according to a new report by the Healthcare Association of New York States (HANYS).

Read the HANYS press release, then click through to the full report on the HANYS website.

February 13, 2012

Study Finds New York Hospitals Flout Charity Rules - NYTimes.com

From today's New York Times:

New York's charity care system, partly financed by an 8.95 percent surcharge on hospital bills, is one of the most complicated in the nation, but many states have wrestled with aggressive debt collection by hospitals in recent years. Like New York, several passed laws curbing hospitals' pursuit of unpaid bills, including Illinois, California and Minnesota.

But a new study of New York hospitals' practices and state records finds that most medical centers are violating the rules without consequences, even as the state government ignores glaring problems in the hospitals' own reports.

Read the full article on the New York Times website.

March 7, 2012

St. Francis Hospital, Mercy Medical Center win patient safety kudos | Long Island Business News

From today's Long Island Business News:

A medical malpractice insurer has singled out two Catholic Health Services of Long Island hospitals for a collaboration they say improves care and could be a model for other medical centers.

St. Francis Hospital, with 364 beds, and Mercy Medical Center, a 375-bed hospital, were honored for an electronic reporting system they developed to identify serious patient and visitor incidents.

Read the rest of the article at Long Island Business News website.

30 New York-area hospitals hit with poor ratings - New York Daily News

From the New York Daily News March 1:

THIRTY NEW York-area hospitals were given a code blue for patient safety by Consumer Reports -- and the Bronx's Jacobi was labeled worst in the country.

Local hospital officials insisted the ratings were misleading, based on older data that don't reflect more recent strides to protect patients.

Read the rest of the article at the New York Daily News website.

About Health Care Providers

This page contains an archive of all entries posted to S U P R A S P I N A T U S in the Health Care Providers category. They are listed from oldest to newest.

Fraud, Abuse & Compliance is the previous category.

Information Technology is the next category.

Many more can be found on the main index page or by looking through the archives.