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Teaching Hospital Update - February 8-12, 2010


Email Alert

By Leah Voigt*

February 12, 2010

Senate Bill Seeks to Clarify EHR Incentive Eligibility for Hospital-Based Doctors

The draft jobs bill released this week by the Senate Finance Committee seeks to clarify a contentious provision in last year's recovery act that had been interpreted by the Department of Health and Human Services (HHS) as excluding all hospital-based physicians from being eligible for federal health information technology adoption incentives.

In Section 620 of the draft Hiring Incentives to Restore Employment (HIRE) Act, Senate lawmakers have proposed changes to language from the Health Information Technology for Economic and Clinical Health (HITECH) Act that seeks to make clear that incentives for the meaningful use of electronic health records (EHRs) could be paid to all Medicare- and Medicaid-participating physicians, except those working only in inpatient or emergency room settings.

That would mean that physicians working in hospital-affiliated group practices and hospital-owned ambulatory clinics could be eligible for federal incentive payments of as much as $44,000 for adopting EHRs. Hospital and physician groups as well as lawmakers have raised concerns about the HITECH Act language and subsequent proposed rule from HHS to implement the incentive program, saying doctors working in outpatient settings should not be excluded from eligibility for the payments.

In the proposed meaningful use rule issued December 30, 2009, by the Centers for Medicare & Medicaid Services (CMS) and published in January of this year, federal regulators interpreted the HITECH Act language--which paved the way for federal incentives to healthcare providers for adopting EHRs in a meaningful way--as excluding all hospital-based doctors from being eligible for incentives.

Kendra Casey Plank, Senate Bill Seeks to Clarify EHR Incentive Eligibility for Some Hospital-Based Doctors, BNA's Health Care Daily Report (Feb. 12, 2010) (note: registration is required to view this content).

Commercials Are the Culprit in TV-Obesity Link

Too much time in front of the television has long been linked to childhood obesity. Now, new research suggests it is not the TV but the commercials that are making kids fat. In a study of more than 2,000 children, researchers from the University of California, Los Angeles, compared the time the kids spent viewing television and video. They asked caregivers to track children's media use during one weekday and one weekend day during 1997, then again in 2002. The findings showed that the amount of television a child watched was not a predictor of obesity risk. Instead, risk for being overweight increased the more television commercials a child was exposed to. There was no association with television viewing and obesity for those who watched videos or commercial-free programming.

Although the effect was seen among all children studied, it was strongest for children younger than seven, according to the report in The American Journal of Public Health.

Because people with more education and better eating habits might also insist that their children watch videos or PBS rather than commercial television, the study authors controlled for a number of other factors that might influence the findings. They looked at such variables as the mother's weight and education level, the child's starting weight and overall physical activity, time spent eating in front of the television, and even the amount of sleep children were getting. Even after controlling for these factors, the link between commercials and weight gain remained.

Although it has long been speculated that television viewing is associated with a lack of physical activity, that is often not the case. Young children often stand, jump, and wiggle while watching television, and children who play sports may also be watching more sports programming. The study was not able to document how much food advertising children were exposed to. But research shows that young children are exposed to about thirty hours of food-related advertising annually. During Saturday cartoons, children see an average of one food advertisement every five minutes, most of which are for junk food, the researchers noted.

Tara Parker-Pope, Commercials Are the Culprit in TV-Obesity Link, N.Y. TIMES (Feb. 9, 2010).

Study Finds New York City Academic Medical Centers Lag on Financial Indicators

Academic medical centers have the soundest finances of any grouping of hospitals in New York City, but their margins still lag behind those of their counterparts elsewhere in the United States, according to a study issued February 5, 2010.

The study by the United Hospital Fund (UHF), a New York philanthropic and research organization, sought to show how the city's teaching hospitals compare financially with seventeen peer institutions in other states as they brace for healthcare reform and other changes. "Financial reimbursement of hospitals is sure to change as the result of public policies at the state and federal levels and in response to commercial insurance practices," UHF President James R. Tallon Jr. said in a statement. "This report shows that changes in hospital payment methods, even those affecting New York's best-performing hospitals, must consider the unique characteristics of the New York market."

These include higher costs, a weaker payor mix, a less-profitable service mix, and more competition from other academic medical centers, the report said. More research is needed on how concentrations of poverty contribute to each of those factors, it added. The four New York academic medical centers in the study had "significantly lower margins" than the comparison hospitals, which were drawn from an "honor roll" list compiled by the magazine US News and World Report, the fund said.

In the lowest of four tiers grouped by financial performance, the New York City teaching hospitals showed the longest length of stay, the report found. It was 26% longer than hospitals in the top tier, and 11% longer than even those in the third tier, it said. The New York hospitals also have a weaker payor mix, treating proportionately more Medicaid patients and fewer patients covered by commercial insurance, the study found. While Medicaid pays at rates below a hospital's costs, it said, a congressional advisory commission has found that commercial insurers pay hospitals 132% of costs, on average.

Most U.S. academic medical centers have a near-monopoly on tertiary and quaternary services in their markets, but New York City's academic medical centers operate in a much more competitive market, the study continued. That may translate to pricing pressures and lower commercial margins, the report suggested.

Access the report.

John Herzfeld, New York City Academic Medical Centers Lag on Financial Indicators, Study Says, BNA's Health Care Daily Report (Feb. 11, 2010) (note: registration is required to view this content).

Breast MRI Does Not Reduce Reoperation Rate

Adding magnetic resonance imaging (MRI) to conventional breast cancer diagnostic techniques failed to reduce the rate of reoperation for incomplete tumor excision, results of a large randomized clinical trial showed.

The reoperation rate was 19% in patients who had preoperative MRI in addition to clinical, radiologic, and pathologic assessment, and in those who had only the usual "diagnostic triad," investigators reported in the February 13, 2010, issue of The Lancet. The findings suggest preoperative MRI has no role in reducing the frequency of reoperation in patients with primary breast cancer, according to researchers at the Royal Hull Infirmary in Hull, England. "Our results show that addition of MRI to conventional triple assessment has no benefit on reduction of reoperation rate," they wrote in conclusion.

"MRI is an expensive procedure," the researchers added. "Because surgical use of MR data to direct wide local excision is similar worldwide, we believe that our findings are generalizable to all healthcare providers, and show that MRI might not be necessary in this population of patients in terms of reduction of reoperation rates." Studies of dynamic contrast-enhanced MRI in patients scheduled for breast-conserving surgery suggest the imaging results alter clinical management in 14% to 18% of cases, detecting more extensive disease than initially diagnosed. The cost effectiveness of that application of MRI has not been determined, the authors wrote.

Primary source: L. Turnbull et al., Comparative Effectiveness of MRI in Breast Cancer (COMICE) Trial: A Randomized Controlled Trial, 375 LANCET 563-71 (2010).

Charles Bankhead, Breast MRI Does Not Reduce Reoperation Rate, MedPage Today (Feb. 11, 2010).

Sebelius to GOP: "Don't Get Wrong Impression" About Obama Health Summit

A day after President Barack Obama invited Republicans in Congress to a bipartisan healthcare summit, HHS Secretary Kathleen Sebelius said no one should get the wrong impression. "A lot of people ask if this is starting over (on a health overhaul), the answer is absolutely not," she said Monday in a talk at the AcademyHealth policy conference in Washington. Instead, she said that the February 25, 2010, televised event is to "get Republicans to re-engage in the process. It is not acceptable that half the legislative body pushed away from the table months ago and said 'we do not want to participate.'"

In January, two days after Republican Scott Brown (R-MA) changed the dynamics of the debate by winning a special Senate election in Massachusetts and ending Democrats' filibuster-proof majority, House Minority Leader John Boehner (R-OH) said that the healthcare bill that passed the House in November was "dead" but "maybe not quite as dead as I want it." Boehner said that Republicans in the House were not interested in working with Democrats to modify the existing bill, which he called a "monstrosity"--although he said Republicans were ready to work with the White House and congressional Democrats to craft a bill from scratch.

Sebelius said she hopes Republicans will put forward "a real plan, not just criticisms." She said any healthcare overhaul that prohibits insurers from charging higher rates or denying coverage for people with preexisting medical conditions also must have an individual insurance mandate. Republicans have staunchly opposed the mandate as an infringement on individual rights. "It is disingenuous to say you are for insurance reforms, but not support the notion that everyone has to come into the marketplace," Sebelius said.

While polls that show Americans' waning support for the healthcare overhaul bills, Sebelius insists that there is "overwhelming support" for the provisions in the bills. The problem, Sebelius said, is the process Congress took to craft the legislation. "When people look up close at the personal activities of Congress they are confused and disgusted with the whole process and too afraid that whatever is going on can't possibly be good for them or their families."

Phil Galewitz, Sebelius To GOP: "Don't Get Wrong Impression" About Obama Health Summit, Kaiser Health News (Feb. 8, 2010).

Mental Health Treatment Varies by Location

Two new studies have found different problems in the treatment some U.S. patients receive for mental health issues. One study determined that most adults diagnosed with depression are not receiving guideline-based care. A second study found that psychiatrists are prescribing multiple psychotropic medications to many patients, thus increasing the possibility of harmful drug interactions. Both studies appear in the January Archives of General Psychiatry.

The study on depression care said 8.3% of nearly 16,000 adults interviewed had major depression, and more than half of the adults received therapy. But only about one in five treated had received therapy recommended by guidelines, such as those published by the American Psychiatric Association, researchers said. Depression is projected to become the second leading cause of disability in the world and the leading cause of disability in high-income nations, including the United States, according to the study. Researchers also examined differences in depression care received by whites, Mexican-Americans, Puerto Ricans, Caribbean blacks, and African-Americans. The lowest rates of care were among Mexican-Americans and African-Americans, said the study's lead author.

A second study in the Archives of General Psychiatry found that an increasing number of U.S. adults are being prescribed multiple antidepressants, antipsychotics, mood stabilizers, and sedative-hypnotics. The study determined that office visits to psychiatrists in which two or more of the medications were prescribed increased from about 40% in 1996 to nearly 60% in 2006.

Some combinations are appropriate, said the second study's lead author. Combining medications may be done to alleviate side effects, but many combinations may not be appropriate. And many patients with psychiatric disorders also may take medications for medical conditions such as high cholesterol, diabetes, or hypertension, further increasing the risk for interactions.

Susan J. Landers, Mental Health Treatment Varies by Location, Am. Med. News (Feb. 8, 2010).

AHLA Teaching Hospital Updates are intended to provide quick summaries of cutting-edge issues of interest to teaching hospitals and their counsel. Additional information and more in-depth coverage on these topics may be available from AHLA Health Lawyers Weekly and appropriate AHLA Practice Groups.

*We would like to thank Leah Voigt, Esquire (Squire Sanders & Dempsey LLP, Washington, DC), for providing this week's update.

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