Washington Healthcare News Archive of Prior Editions
New! October 2012 Edition: HR - Yes There is an App for that! For human resource (HR) professionals and people in the business of benefits, the influence of mobile apps on employee communications, retention and morale is becoming as significant as the internet has become on consumer purchasing behavior. Many employers already use mobile apps to simplify functions such as payroll, time tracking, recruiting, talent management, and training. Newfound mobility and each new advance in human resource management systems (HRMS) are quickly making outsourcing these functions a thing of the past. Read the complete newsletter...
September 2012 Edition: Molecular & Genetic Testing in Anatomic
Pathology For more than 100 years pathologists have been using microscopes to look at abnormal tissue and cells to better diagnose disease. Today, we are evolving beyond cellular examination to identify the root cause of these abnormalities within the genetic material of the cell itself. The mapping of the human genome has driven growth in molecular testing, which now allows laboratories to analyze tumor tissue and other specimens to determine likelihood of recurrence, source of disease and the best types of therapies to be used. Read the complete newsletter...
August 2012 Edition: What’s Driving the M&A Frenzy in Health Care IT? Information technology is at the
core of building the new 21st-century health care system. Yet transforming health care won’t be as easy as it’s been for many other industries that have experienced change through technology, such as financial services and manufacturing. Read the complete newsletter...
July 2012 Edition: HIPAA Civil Money Penalties: Is There A Limit? The Office for Civil Rights (“OCR”) recently posted the HIPAA training materials used to educate the State Attorneys General (“State AGs”). The Health Information Technology for Clinical and Economic Health (“HITECH”) Act, part of the American Recovery and Reinvestment Act of 2009, empowered State AGs to bring civil actions on behalf of their state residents for violations of the HIPAA Privacy and Security Rules. OCR created HIPAA training materials to familiarize the State AGs with OCR’s view of the HIPAA Privacy and Security Rules and how they presumed the State AGs would use their new authority to enforce HIPAA. Read the complete newsletter...
June 2012 Edition: As Hospitals Trend Toward Employee Physicians, What Are the Employment Law Consequences? The recent increase in hospital-employed physicians is expected to continue. This trend is motivated by a quest for unified quality of care, referrals and market share, uncertainty about the overhaul of the healthcare system and reimbursement changes, and physician desire for a better work-life balance. Regardless of the reasons, transitioning from an independent contractor relationship with a physician to an employee physician has many consequences in the employment law arena. Read the complete newsletter...
May 2012 Edition: Washington Health Plans Report Mixed Financial Results for Year End 2011 Fifteen of the largest health plans in Washington recently reported 2011 annual financials and the results were mixed with five reporting a loss. Eleven plans reported a lower underwriting gain (or bigger loss) and nine of the fifteen plans reported lower net income or a greater loss than the same period in 2010. Read the complete newsletter...
April 2012 Edition: Keeping Costs Down on Self-Funded Health Care Plans In the era of health care reform, one of the most significant issues everyone is facing is increasing costs. Yet organizations that have 50 or more employees can control expenses while maintaining valuable health care options for employees—through proper design and administration of a self-funded plan. Read the complete newsletter...
March 2012 Edition: Meeting the Challenge of Healthcare Reform: The Clinically Integrated Network This Time Is Different. The baby-boomer generation is now turning 65 at the rate of 10,000 a day and will continue to do so for the next 18 years. The average 65-year-old spends approximately four times as much on healthcare services as the average 40-year-old. These changing demographics, and the increasing healthcare costs associated with them, create a healthcare environment that differs from the past. Read the complete newsletter...
February 2012 Edition: In the Belly of the Beast - Hitting the Target with Mergers & Acquisitions Like any new relationship, mergers and acquisitions come with great expectations and enthusiasm. They bring the prospect of
increased market share, a strengthened core business, expanded product lines, enhanced technologies and, of course, reduced costs--all driven by the power of synergy. Read the complete newsletter...
January 2012 Edition: Washington Health Plans Report Solid Profits Through September 30, 2011 Washington domestic health plans recently reported third quarter 2011 financial results and eleven of the fourteen plans were profitable. However, nine of the plans reported lower underwriting gains, and six reported an underwriting loss, suggesting premiums may rise more than usual in 2012. This becomes even more likely when the uncertainties of healthcare reform are considered. Read the complete newsletter...
December 2011 Edition: Changing the Rules: The Federal Government Makes Union Organizing Easier Non-unionized health care employers – especially clinics and other non-hospital employers – may feel like the government has made them a target. Reacting, some pundits think, to Congress’s failure to pass the so-called “Employee Free Choice Act,” in recent months the National Labor Relations Board has taken several steps to make it easier for unions to organize new workplaces. These new regulations, proposed regulations and new decisions will change decades-old legal principles. Read the complete newsletter...
November 2011 Edition: Double Trouble – Disruptive Physicians and Hostile Work Environments The First Circuit’s August 29, 2011 decision in Tuli v. Brigham & Women’s Hospital depicts the harsh financial consequences that may arise when a hospital fails to investigate and reign in a disruptive physician. Read about this case and learn what can be done to reduce your workplace exposure to hostile work environment and retaliation issues. Read the complete newsletter...
October 2011 Edition: Health Care Reform Update: Insurance Exchanges and Insurer Risk Standards The Patient Protection and Affordable Care Act (PPACA) requires that by January 1, 2014, states operate health insurance exchanges to provide a competitive marketplace where individuals and small businesses may purchase affordable private health insurance coverage. It’s a colossal undertaking that also assumes the political willpower continues after the next presidential election. Even so, there is a lot to learn and much at stake right now for healthcare providers and employers of all sizes here in Washington State. Read the complete newsletter...
September 2011 Edition: ICD-10 Readiness and Adoption The Department of Health and Human Services has issued a final rule on HIPAA electronic standards that would replace ICD-9 code sets with the greatly expanded ICD-10 code sets for claims, remittance advice, eligibility inquiries, referral authorizations, and other transactions. Health care organizations without a solid upfront strategy in place prior to implementation could fall behind.
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August 2011 Edition: Washington Hospitals Post Strong 2010 Margins Of the Pacific Northwest States, Washington is best at making hospital financial information available to the general public. In our review of publicly available information on the Department of Health, Center for Health Statistics web site, we found thirty-six of the largest 40 Washington hospitals posted positive total margins in 2010. This was similar to 2009 when thirty-six of the largest forty hospitals reported positive total margins.
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July 2011 Edition: Retaliation Claims and Potential Claimants May Increase Litigation in the Medical Field After months of anticipation and speculation the Centers for Medicare and Medicaid Services issued proposed rules relating to a voluntary Shared Savings Program for Medicare providers and suppliers participating in Accountable Care Organizations (ACOs). Under the Shared Savings Program, providers and suppliers will continue to receive traditional Medicare fee-for-service payments under Parts A and B, and be eligible for additional payments if specified quality and savings requirements are met.
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June 2011 Edition: Retaliation Claims and Potential Claimants May Increase Litigation in the Medical Field Medical professionals are sensitive to potential claims from employees for age, gender, race, national origin, citizenship, religious, sexual orientation, and disability discrimination or workplace harassment claims. That said, the Equal Employment Opportunity Commission (EEOC) which investigates and prosecutes claimed violations of federal employment laws, reports that retaliation claims are on the rise and exceed those alleging any other type of claim at this point in its history. Retaliation is perceived as a “growth industry” for lawsuits. Read the complete newsletter...
May 2011 Edition: Sub-specialization in Anatomic Pathology Drives Consolidation and Quality Progress in modern medicine is driven by specialization. Serious illness is invariably referred to a specialist or a team of specialists who have the depth of knowledge to offer precise and accurate treatment and diagnosis. Read the complete newsletter...
April 2011 Edition: Maximizing Value from Purchased Services
No one knows whether the health care reform law will withstand the series of challenges that now confront it in the courts, Congress, and the states. But one thing is certain: Whether it’s through decreasing fraud and abuse or increasing operational efficiency, the drive to cut health care administrative costs will continue, no matter how the health care reform battle turns out in 2011 and 2012.
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March 2011 Edition: Improving the Health of Community Hospitals: Is Affiliation an Option?
In today's healthcare industry, community hospitals face unprecedented challenges. From problems with physician retention and recruitment, to increasing technology and compliance costs, to the lack of negotiating power with vendors and suppliers, many community hospitals are at a severe disadvantage. Is merger or affiliation an option to improve the health of community hospitals?
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February 2011 Edition: Washington Ambulatory Surgery Center
Association (WASCA) Promotes Collaboration to Reduce Health Costs
Ambulatory surgery centers are collaborating with public and private health plans to help reduce healthcare costs. We are also actively engaged with the Department of Health on patient safety issues.
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January 2011 Edition: Federal Healthcare Reform Begins for Health Plans
The passage of federal healthcare reform in 2010 marks a new era for employer-sponsored health plans. Along with the requirements of other recently passed laws, group health plans must comply with several new provisions of the Patient Protection and Affordable Care Act (“PPACA”) summarized in this article.
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December 2010 Edition: 60 Minutes is Calling...and News Helicopters are Overhead!
Such frenzied messages are the stuff of sleepless nights for hospital administrators. But, in spite of administrators’ best efforts, these calls are a given hazard of the business, and this was indeed the call received several years ago by a startled Los Angeles hospital CEO. As now seen in the rear-view mirror, the call was proceeded by an unfortunate series of events that started with a paraplegic homeless person presenting at the hospital’s Emergency Department.
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November 2010 Edition: How Texting Patient Information Can Increase Risk
In some hospitals, some communications about a patient’s health care have moved from the bedside or telephone to the exchange of health care information via text messages. Having ready electronic access to a provider has many virtues, but the exchange of patient information via texting has many risks associated with it. This article will review the potential risks that arise from the use of texting as a means of sharing patient information between health care providers.
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October 2010 Edition: HR Strategy: Taking Advantage of Healthcare Reform's Vapor Trail
The Patient Protection and Affordable Care Act (PPACA) is now law, and the regulations supporting this monumental piece of legislation have been pouring in ever since. Like many of you, I have been spending a great deal of time trying to determine what the compliance issues and practical applications of the PPACA will be for employers.
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September 2010 Edition: HITECH “Check-up”: Where are you on the Road to Compliance?
Readers of the Washington Healthcare News are undoubtedly familiar with changes to HIPAA included in the HITECH Act, creating new privacy and security requirements and enhancing current enforcement tools. This article is intended to help organizations take a step back to reasonably ensure they are compliant with HIPAA/HITECH and if not, what key risk areas to address first.
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August 2010 Edition: Accountable Care Organizations and the Future of Healthcare
The late John Wooden, who will forever be known as the wise man of college basketball, once said that “Teamwork isn’t a preference, it’s a requirement.” Wooden was talking about hoops, of course, but he easily could have been referring to America’s current healthcare delivery system, which is in desperate need of greater integration and coordination.
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July 2010 Edition: Hospital Medicare Reimbursement: Moving
to Reimbursement Based on Quality of Care
The Patient Protection and Affordable Care Act of 2010, as amended by the Health Care Education Affordability Reconciliation Act of 2010 (collectively “Healthcare Reform”) will force a dramatic change in the Medicare payment methodology. Within the next two-and-a-half years Medicare will undergo a complete transformation so that Medicare reimbursement will be based on quality of care delivered and not just quantity of care delivered.
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June 2010 Edition: Health Care Reform's Big Impact on HR
Few people have read all 3,000-plus pages of the recently enacted Patient Protection & Affordable Care Act (Act) and the ensuing Health Care and Education Reconciliation Act of 2010, but no one doubts the compliance headaches these contentious pieces of legislation will present for human resource personnel for years to come. This article discusses the broad brushstroke requirements under the health care legislation which will go into effect on various dates over the next several years, and provides guidance for HR personnel to both understand and prepare for the changes ahead.
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May 2010 Edition: Information Technology and the New Pathology "Supergroup"
A regional Model for the Delivery of Pathology Healthcare in the 21st Centery
Anatomic pathology is unlike any other medical specialty. For patients, pathologists are the most important doctor they will never see. For physicians, a trusting relationship with a pathologist colleague is critical for medical decision making. For healthcare in general, pathology/laboratory findings drive 60-70% of healthcare decisions and profoundly influence costs. How a pathology laboratory integrates IT into their practice can have a significant impact on these relationships.
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April 2010 Edition: Northwest Health Insurers Report Profits in 2009
Northwest health insurance companies continued their profitable ways in 2009 despite the region's difficult economic conditions. Year-end membership for the six largest companies decreased, and underwriting gains, the profit an insurance company makes on business aside from investments, income taxes and other non-operations related revenues and expenses, were lower at 19 of the 24 companies reviewed. Net income increased as investment gains offset the reduction in underwriting gains. Total adjusted capital, or net worth with adjustments for insurance industry accounting rules, increased considerably due mainly to investment gains.
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March 2010 Edition: Board Governance: The Fun is Just Beginning
The start of a new decade brings a number of challenges to hospitals and their governing boards. In addition to the numerous issues now facing governing bodies, 2010 will include a greater focus on board governance, including, for starters, the possible implementation of healthcare reform, increased oversight of patient safety and quality of care, and the prevention of fraud and abuse. Hospital governing boards are up to the challenge.
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February 2010 Edition: Lean in 2010: Are Healthcare Systems There Yet?
Best known as the driving force beyond car manufacturer Toyota’s success, Lean production practices “consider the expenditure of resources for any goal other than the creation of value for the end customer to be wasteful, and thus a target for elimination.” (Wikipedia) In healthcare organizations, using a car manufacturer’s method, however successful, to address operational issues may have once seemed like trying to fit a square peg in a round hole. That’s no longer the case.
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January 2010 Edition: It Takes a Physician: Achieving the Value Equation in Healthcare
In July 2009, I had the honor to represent The Everett Clinic in Washington D.C. at a symposium sponsored by the Institute for Healthcare Improvement titled “How Do They Do That? Low-Cost, High-Quality Health Care in America.” Dave Brooks, CEO of Providence Regional Medical Center Everett, and Rich Maturi, Senior Vice President of Healthcare Delivery Services at Premera Blue Cross, joined me at the conference to represent Everett, which was selected as one of 10 communities across the country identified as providing relatively low cost and high quality care.
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December 2009 Edition: State Medicaid Rate Cuts: Legal Challenges and Possible Solutions.
The largest recession in recent history has forced many states to drastically cut payments for health care services provided to Medicaid enrollees. Medicaid, which provides coverage to indigent patients, is a jointly funded state/federal program in which the federal government matches a percentage of the funds expended by a state on Medicaid services.
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November 2009 Edition: HITECH Health Reform
Health IT Funding, HIPAA 2.0 and the Impact of the HITECH Act
While the debate heats up again in Washington D.C. over healthcare reform, those tracking developments in the health information technology space know that an initial wave of health reform arrived back in February. When President Obama signed the American Recovery and Reinvestment Act of 2009, including the Health Information Technology for Economic and Clinical Health ("HITECH") Act provisions, the administration scored an initial victory in its efforts to reform the U.S. healthcare system.
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October 2009 Edition: Community Health Centers: Vital to Healthcare's Present and Future
"For every one percent increase in unemployment, more than one million people lose their health insurance and another million enroll in Medicaid and SCHIP." The final statement of the National Association of Community Health Center's (NACHC) one-page summary on the economic stimulus probably should be the first. If more people could truly absorb that, perhaps the concept of healthcare reform wouldn't be so controversial.
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September 2009 Edition: Patient Safety: Demand for Change in Anatomic Pathology
Today, more than ever, health care providers are facing increased demands to control costs and address patient safety issues. One attractive area for all medical specialties is to reduce errors. Published data indicate that laboratory services, while consuming about 10% of the health care budget, drive 60% to 70% of health care decisions. In no area is this more apparent than Anatomic Pathology, where patients experience surgery, radiation, chemotherapeutic and other treatments - all critically dependent on the accuracy of pathologic diagnosis.
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August 2009 Edition: Human Resources in the New World - Globalization, Technology and Outsourcing
"Never in the field of human endeavor was so much owed by so many to so few," was directed to the Royal Air Force as they fought in the skies over the English Channel during WWII. Winston Churchill did not have human resource professionals in mind when he said it. But the quote did pop to mind as I read through another study suggesting an erosion of the HR to employee ratio.
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July 2009 Edition: Certificate of Need Strategy
Lessons Learned from Recent Washington Court Cases
Washington courts have recently issued several significant decisions relating to the state's Certificate of Need (CN) laws. Collectively, these decisions illustrate that a CN applicant must fully understand each step of the CN process, and how each step relates to the others, in order to adopt the correct strategies, avoid procedural pitfalls, and maximize the likelihood that its application will be granted and survive legal challenges.
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June 2009 Edition: Taking Rural Healthcare to Heart
Creativity, collaboration and Commitment Bring Specialist Care to the Peninsulas
Forks, Washington is lucky. Not because it boasts a lush green landscape fed by nearly 100 inches of rain annually. Or even because of its recent claim to fame as the setting for the popular Twilight books. It's lucky because the residents have access to specialist care - locally.
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May 2009 Edition: Electronic Medical Records: Friend or Foe?
Hypothetical: A medical malpractice lawsuit alleges a failure to diagnose the aortic dissection that caused the sudden death of the patient.
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April 2009 Edition: Northwest Health Insurance Industry Capital Drops $959 Million in 2008
Drop is temporary if stock markets rebound in 2009
It wasn't long ago that many regulators, legislators, providers and other interested parties viewed the statutory capital held by some of the larger health insurance companies as excessive.
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March 2009 Edition: Maintaining an Effective and Low Cost Compliance Program for Rural Hospitals
The goal of this article is to provide ideas on how to keep your compliance program focused and effective on an organization-wide basis through the use of low-cost means.
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February 2009 Edition: Employer Beware: 2009 to Bring Significant Employment Law Changes
Healthcare employers will encounter significant changes in the legal landscape as new legislation giving more rights to employees become effective in 2009.
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January 2009 Edition: DEJA VU ALL OVER AGAIN
CMS Changes Rules for Diagnostic Testing Arrangements (Again)
It is becoming an annual event. Once again the new year brings rule changes from CMS modifying how physician groups may provide and bill for in-office diagnostic tests.
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December 2008 Edition: Stevens Hospital: Not So Typical and Rather Remarkable
Stevens Hospital is located just north of Seattle in Edmonds, Washington. Like many Washington State hospitals, the competitive issues facing Stevens are different than those faced by hospitals in other parts of the country.
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November 2008 Edition: Your Insurance Broker: Providing Value Beyond Just Finding Carriers
Even though current financial markets are in a state of flux, and floods and hurricanes have recently wreaked havoc on Midwestern and Southern Communities, the insurance industry is still flush with capacity.
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October 2008 Edition: Third Party Administrators - Service Providers to Self-Funded Health Plans
The topic of Third Party Administrators of health benefits directly relates to self-funding of health benefits.
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September 2008 Edition: Community Health Centers Proffer a Comprehensive Plan to Provide Care
For more than four decades, America's Community Health Centers have put care first, serving those who need care regardless of insurance status or ability to pay.
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August 2008 Edition: New Washington State Law to Create Challenges for HR Executives
Most employer-sponsored group health plans offer coverage for employees, their spouses and dependent children.
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July 2008 Edition: In Touch and Inspired - Health Care Facility Design has a New Face
Health care facilities traditionally haven't been places people look forward to visiting.
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June 2008 Edition: Grandview's Birch Street Clinic: Rural Health Care Measures Up
Grandview, in the heart of Yakima Valley, boasts a growing community of 8,700 and truly grand views of Mt. Rainier and Mt. Adams.
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May 2008 Edition: Inland Northwest Health Services Connects Washington - Grows Nationally
When I first met Kalen Privatsky, President of the Washington State Medical Group Management Association, he told me that health care facilities in eastern Washington had a better infrastructure in place for information sharing with hospitals than health care facilities in western Washington.
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April 2008 Edition: Health Insurance Industry Profits Down in 2007: Executives Explain Why
Financials from Washington State insurers came in this month and it's evident that the real estate and mortgage industries weren't the only ones feeling the pinch after a rocky 2007.
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March 2008 Edition: Health Care in Crises: Perspectives of Rural Hospital CEOs
Rural hospitals face difficult times. Patient health status and mix, access to capital, staffing constraints, coordination of care with urban hospitals and other providers, and the percentage of uninsured relative to insured are serious challenges testing some of our most seasoned hospital executives.
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February 2008 Edition: Cures for our Ailing Healthcare System
Clearly change is necessary, the current system is not cost effective. However, a dramatic overhaul of the current system is not necessary, nor wise.
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January 2008 Edition: Legislators Rank Cost Greatest Concern of Washington's Health Care System
Should the health care industry be concerned that both state legislative bodies and both major political parties identify cost as the greatest concern facing the Washington State health care system?
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December 2007 Edition: Practice Administrators of Today: Champions of Challenge and Change
Sally just returned from a negotiation meeting with a large healthcare organization.
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November 2007 Edition: Providence Health & Services: Evaluating Our Largest Hospital System
Most of the hospitals and hospital systems in Washington State are medium sized organizations that serve relatively small catchment areas.
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October 2007 Edition: Community Health Centers - Growing from Movement to Mainstream
Working with community health centers (CHCs) for the past 25 years has convinced me that the existing health center model should be available to everyone in our country.
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September 2007 Edition: Carrier and Administrator Choices Abundant in Washington State
The major components of the Washington State health care system include:
- Purchasers
- Providers
- Carriers and administrators
Purchasers include consumers, employers, government, insurance brokers and agents as well as others. These are the people and organizations that negotiate payment and/or pay for health care services.
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