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If Sen. Charles Grassley has his way, nonprofit hospitals will have to prove they spend at least 5% of expenses on charity care if they are to keep their tax-exempt status. But a review of what's happened in Maryland suggests such a rule would be unrealistic and largely inappropriate.
That's the conclusion of a report, published recently in the online edition of the journal Health Affairs, which found extremely wide variation in levels of all types of community benefit each hospital reported.
For example, charity care, a subset of community benefit defined generally as that care given to patients without any expectation of payment, varied from 0.05% to 6.33%. Only two hospitals reported contributing 5% or more.
But total community benefit, which included other categories of uncompensated care, such as health professionals' education, community health services, and "mission-driven" programs and research, varied from 1.17% to 14%.
Source: HealthLeaders Media
A recent statement from U.S. Health and Human Services Secretary Kathleen Sebelius seems innocuous enough—many people seeking care in emergency departments are uninsured.
The nation's leading group of emergency physicians immediately took issue with her remarks, however. They chastised her for perpetuating a myth about hospital care and said she is oblivious to a much bigger problem.
In her statement, Sebelius cited statistics from a database managed by the Agency for Health Research and Quality. These statistics reveal that in 2006:
- One in 5 patients seen in emergency department settings was uninsured,
- Low-income patients accounted for almost one-third of patient visits,
- Residents of rural areas comprised one-fifth of emergency room care
Sebelius observed that uninsured patients often cannot afford primary care and must seek care in the ED. ED physicians, including Nick Jouriles, MD, president of the American College of Emergency Physicians, say this statement helps direct resources to managed care instead of emergency departments where they are most needed.
Source: HealthLeaders Media
When it comes to ED case management, it is possible to target certain populations for case management screening to determine involvement. These populations fall under the category of high-risk patients:
- Elderly fall
- Elderly extremity fracture
- Repeat visits for pain (back, abdominal, dental, migraines)
- Failure to thrive, frail elder
- Patients with multiple ED visits within the hospital-defined allotted time frame (e.g., more than two visits/month)
- Patients with readmissions within the time frames set by your facility (e.g., 48-72 hours from ED visit or inpatient admission, 30 days from inpatient admission, etc.)
- Patients with short- or long-term placement needs
- Patients with insurance red flags (e.g., managed care insurance plans, pay-for-performance insurance initiatives, uninsured/self pay)
To target specific populations, set up identifiers in the registration process to alert the case manager to targeted populations that may benefit from case management activities. Alerts can be set up and printed out as case manager worksheets.
Senators working on healthcare legislation or considering lessening the billions of dollars in tax breaks that go to nonprofit U.S. hospitals.
The senators contend that the charity care these hospitals provide is not reflective of the big tax breaks they receive. They say that healthcare reform would reduce the number of uninsured individuals and corresponding need for hospitals to take on the burden of charity care.
Hospitals counter that healthcare reform is unlikely to provide health insurance for everyone and that they will still need to provide care for the uninsured. Hospitals also say that providing charity care currently is difficult because they, like other U.S. industries, have been hit hard by the recession.
Source: The Wall Street Journal
Based on the Centers for Disease Control and Prevention’s (CDC) National Health Interview Survey, 43.8 million Americans did not have health insurance in 2008. That’s 700,000 more people than in 2007 and 2.8 million more than 1997.
The amount of children under 18 that were uninsured in 2008 remained the same as in 2007 at 8.9%, and was down from 1997 at 13.9%.
Massachusetts had the lowest rate of uninsured persons (3%), and Texas had the highest (22.9%).
The Pharmaceutical Research and Manufacturers of America, following negotiations with lawmakers, announced an agreement that calls for the industry to spend $80 billion over the next decade to assist Medicare beneficiaries and defray medication costs. The agreement calls for pharmaceutical companies to pay as much as half the cost of brand name drugs for lower- and middle-income senior citizens in the so called Medicare “doughnut hole.”
The doughnut hole occurs when patients’ total drug spending has exceeded $2,400. They must pay full cost for their medications until they have spent more than $3,850. And in 2007, about 15% of the 3.4 million Medicare beneficiaries who hit the doughnut hole quit taking their medications.
The agreement with the pharmaceutical industry marked a small victory for Sen. Max Baucus (D-MT), chairman of the Senate Finance Committee, who has been negotiating with health industry groups as he was working on drafting health reform legislation with his committee.
Source: HealthLeaders Media
The spotlight’s shining on readmission rates. A Commonwealth Fund–supported study published in the April New England Journal of Medicine found that one-fifth of Medicare beneficiaries return to the hospital within 30 days of discharge and one-third return within 90 days. The study stated that unplanned readmissions cost Medicare $17.4 billion in 2004.
Developed by Timothy Bickmore, PhD, assistant professor of computer and information science at Northeastern University in Boston, the virtual patient advocate is on clinical trial at Boston Medical Center to increase patient understanding of postdischarge self-care regimens. Bickmore and his team of researchers hope the system can decrease patient readmissions within 30 days of hospital discharge.
“Nationally, it’s been shown that about 20% of patients get readmitted within 30 days,” says Bickmore, who adds that one-third of those readmissions are preventable. “There is a lot of information patients need to know before they go home. The typical discharge in the [United States] lasts about eight minutes and it’s like, ‘Here are your prescriptions and a pat on the back.’ ”
Check out the July 2009 issue of Case Management Monthly to read the full article.
In an effort to reform healthcare and reduce costs, President Obama has called for $313 billion in healthcare spending cuts.
The proposed cuts include a $220 billion reduction in hospital payments over the next 10 years. The American Hospital Association (AHA) expressed deep disappointment and noted that hospitals already face a previously announced potential $38 billion cut and $41 billion in cuts under the proposed Medicare Inpatient Prospective Payment System rule.
AHA President and CEO, Rich Umbdenstock said, “Reform must improve care for patients without crippling hospitals’ ability to care for patients and communities.”
Source: AHA News Now
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