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Teaching Hospital Update - September 15–19, 2008

 
 
By Reesa N. Benkoff*

Hospital to Pay Nearly $89 Million in Settlements

This week, the Justice Department announced that New York's Staten Island University Hospital has agreed to pay the United States and the State of New York nearly $89 million to settle a variety of Federal False Claims Act allegations brought by the federal government and private whistle-blowers. In a written statement, the 672-bed hospital said that the agreements stipulate that the settlements do not reflect an admission of liability and that the hospital "has already established and implemented strong programs for compliance and corporate integrity that were put into place while the investigations were ongoing."

In one such whistle-blower lawsuit, the widow of a Staten Island University Hospital cancer patient said the hospital defrauded Medicare and Tricare by knowingly using the wrong billing codes for stereotactic radiosurgery from 1996 to 2004. To settle this lawsuit, the hospital has agreed to pay the federal government $25 million, of which the widow, Elizabeth Ryan, is set to receive $3.75 million.

Gregg Blesch, Hospital to Pay Nearly $89 Million in Settlements, Modern Healthcare's Daily Dose, (Sept. 15, 2008) (note: registration is required to view this content).

Experiment Finds Health Content Placed in Grey's Anatomy Episode Quadrupled Awareness Among Audience

According to two new studies released by the Kaiser Family Foundation, many television viewers are being educated about important health issues while watching entertainment television. In order to document how well viewers learn health information from entertainment television, the Foundation worked with writers at Grey's Anatomy to embed a health message in an episode and then surveyed viewers on the topic before and after the episode aired. The storyline involved an HIV positive pregnant woman who learns that with the proper treatment, she has a 98% chance of having a healthy baby. The study found that the audience's awareness of this information increased by 46% (from 15% to 61%), a four-fold increase among all viewers. This translates to more than 8 million people learning correct information about mother-to-child HIV transmission rates from watching the episode.

The study (titled "Television as a Health Educator: A Case Study of Grey's Anatomy") included three national random-digit-dial telephone surveys of regular viewers of the show, conducted one week before, one week after, and—to test retention of the information—six weeks after the target episode aired. After six weeks, 45% of the episode's viewers correctly responded about the chances of mother-to-child HIV transmission—down from the high of 61% but still three times higher than before the episode aired. "For better or worse, viewers do absorb the health information they see on TV, so it's important for these shows to get it right," said Victoria Rideout, vice president and director of The Program for the Study of Media and Health at the Kaiser Family Foundation and author of the Grey's Anatomy study. "This study shows the enormous potential for entertainment television to serve as a health educator."

Another study released today by the Foundation and the USC Annenberg Norman Lear Center, "Hollywood, Health, and Society," indicates that health content is prevalent on popular prime time television. An analysis of three seasons (2004–2006) of top-ten-rated prime time scripted shows reveals that six out of ten episodes (59%) had at least one health storyline and most of those storylines provided a strong (32%) or moderate (29%) level of educational content. The typical episode in the analysis averaged about one and one half health storylines, indicating that millions of television viewers are regularly exposed to health content.

One measure of the effectiveness of public awareness campaigns is whether the audience takes an action based on the campaign. The study of Grey's Anatomy viewers found that 17% of regular viewers—or about
3 million people nationwide—said they had tried to "find more information" about a health issue or "spoken with a doctor or other healthcare professional" because of something they saw on the show.

Unique Experiment Finds Health Content Placed in Grey's Anatomy Episode Quadrupled Awareness Among Audience; Over Eight Million People Absorbed Key Health Message From the Show, Henry J. Kaiser Fam. Fdn. (Sept. 16, 2008).

Stark Offers Bill to Hasten e-Record Adoption

Republican Pete Stark, chairman of the House Ways and Means Health Subcommittee, introduced legislation geared toward speeding the adoption of electronic health records by physicians and hospitals, offering millions of dollars in incentive payments while promising stiff penalties for those who unlawfully use or share personal health data. The bill would use the Medicare reimbursement system as a linchpin to adoption, giving providers more dollars the sooner they commit to a certified system while eventually docking the pay for those who do not. The bill would also require the Department of Health and Human Services (HHS) to approve a set of standards by 2011.

Under provisions in the legislation, hospitals that use an approved information technology (IT) system would be eligible for more than
$1 million in incentive payments while physician groups could receive about $41,000 per doctor, according to legislative aides to the congressman who briefed reporters recently on Capitol Hill. Grant dollars would also be made available for providers in low-income and rural areas as well as nonprofit facilities. So far, provider groups say they are encouraged by the work the congressman has done on the bill, though the tenor of such debates can (and often does) change as the legislative process progresses.

To address privacy concerns, the Stark bill aims to build on already existing Health Insurance Portability and Accountability Act of 1996 (HIPAA) requirements—but with some adjustments that staff say would "fill the holes" that have watered down privacy protections over the years. The bill expands the protections (and penalties) at the provider level and to outside groups, such as vendors. Additionally, the bill prohibits the sale of identifiable personal health information, with only minor exceptions. Stark aides said they have met with privacy advocates, adding that most are optimistic about the provisions. Still, concerns over patient protections have doomed previous attempts to pass comprehensive health IT legislation, including a Senate bill that has yet to build enough of a consensus among lawmakers to come up for a vote.

Matthew DoBias, Stark Offers Bill to Hasten e-Record Adoption, Modern Healthcare's Daily Dose, (Sept. 16, 2008) (note: registration is required to view this content).

Parents Seek Mental Healthcare for 15% of U.S. Kids

According to a recent study, parents of approximately 8.3 million children ages four to seventeen—who represent 14.5% of children in the U.S.—talked to a healthcare provider or a school employee about their child's emotional or behavioral problems. The researchers, from the Centers for Disease Control and Prevention's (CDC's) National Center for Health Statistics, based their report on the 2005-2006 National Health Interview Survey. Data was compiled through in-home interviews with parents of 17,157 children.

The researchers reported that males were more likely than females to have parents who sought help: 17.6% of males' parents sought help compared with 11.2% of females' parents. Age, on the other hand, was not a factor. Approximately 5% of all children, or 2.9 million children, were prescribed drugs during the study period, almost always for symptoms of attention deficit hyperactivity disorder such as concentration issues, hyperactivity, or impulsivity. Males were nearly twice as likely to be prescribed medication as females (6.6% compared with 3.4%). In addition, older males (ages eleven to seventeen) were more likely than younger males to be prescribed medication (7.6% compared with 5.8%), and older females were twice as likely to receive a prescription than younger females (4.4% compared with 2.6%).

Medication was not the sole therapy offered for emotional or behavioral problems: 2.9 million children (5.3%) received treatment other than, or in addition to, medication. Such treatment included behavioral therapy, family therapy, crisis intervention, and complementary therapy such as acupuncture. Boys were more likely to receive such treatment than girls (6.4% compared with 4.2%), as were older children compared with younger children (6.5% compared with 4.4%). About 40% of the children received treatment other than medication at their school, and
one-quarter received such services at a pediatric or general medicine practice. Recent research has also shown an increased use of psychotropic drugs to treat behavioral difficulties in children, the authors wrote. But less is known about the use of nonpharmacologic treatments. Their report indicates the need for greater access to a variety of mental health services for children, the authors concluded.

Emily P. Walker, Parents Seek Mental Healthcare for 15% of U.S. Kids, MedPage Today (Sept. 17, 2008).

AHRQ Report Finds Gain in 2006 Hospital Charges

According to a recently released report from the Agency for Healthcare Research and Quality (AHRQ), based on AHRQ's Healthcare Cost and Utilization Project, hospital charges rose 8% to $943 billion in 2006 nationwide, up from $873 billion the prior year, even though hospital admissions increased only slightly. For the uninsured, charges rose by 15% from 2005 to 2006, to $44 billion. Charges for Medicaid patients rose 9%, Medicare charges rose 8%, and private insurance patients paid 6% more over the one-year period, according to the report.

The charges involved 39.4 million hospital stays and did not include hospital outpatient care, physician fees for admissions or emergency visits for patients who were not admitted. Total hospital stays in 2005 were nearly the same, at 39.2 million, AHRQ reported. Over half the hospital charges in 2006 were for the twenty most expensive conditions. Ranking number one in costs was coronary artery disease, which accounted for 5.6% of total charges, followed closely by pregnancy and delivery, at 5.1%.

Rebecca Vesely, AHRQ Report Finds Gain in '06 Hospital Charges, Modern Healthcare's Daily Dose, (Sept. 17, 2008) (note: registration is required to view this content).

Common Chemical Linked to Metabolic and Cardiovascular Disorders

According to a recent study, exposure to a chemical commonly used in food packaging materials may be putting millions at an increased risk for cardiovascular disorders, diabetes, and liver abnormalities. Researchers reported urinary levels of bisphenol A (BPA) were significantly higher in people with diagnoses of angina, coronary heart disease, and diabetes; those who had suffered heart attacks; and those with elevated liver enzymes. BPA is a component of epoxy resins used to line food and beverage containers and in polycarbonate plastics contained in many consumer products. It is also present in drinking water and in household air, in the form of dust. The researchers cited data suggesting BPA is detectable in the urine of 90% of adult Americans.

The compound has been found to be toxic at low levels in some animal studies, with large variations by species. Last month, however, FDA Commissioner Andrew von Eschenbach, MD, wrote in his weekly column on the agency's website that "the science FDA has reviewed does not justify recommending that anyone discontinue using these products." A draft assessment prepared by FDA staffers found that daily exposure to BPA from food packaging materials is less than 3 mcg/kg in adults and less than 0.2 mcg/kg in infants, whereas they calculated a "no observed adverse effect level" of 5,000 mcg/kg from rodent studies.

Using data from 1,455 participants in the National Health and Nutrition Examination Survey (NHANES) from 2003 to 2004 in whom urine levels of BPA and creatinine were measured, the study's researchers correlated levels of the chemical with the presence of various common disorders. The researchers set forth odds ratios for each standard deviation of urinary BPA above the mean after adjusting for age, sex, urinary creatinine, race and ethnicity, education, income, smoking status, body mass index, and waist circumference. The researchers, who made no regulatory recommendations on restricting BPA use on the basis of their findings, also looked for possible associations with cancer, arthritis, overt liver disease, chronic respiratory diseases, stroke, and thyroid disease, but found none.

The researchers call for independent replication to confirm the associations reported and to provide evidence on whether the associations are causal. The researchers claim that, although preliminary with regard to these diseases in humans, the findings should spur U.S. regulatory agencies to follow the recent action taken by Canadian regulatory agencies, which have declared BPA a "toxic chemical" requiring aggressive action to limit human and environmental exposures. They alleged that "an aggressive disinformation campaign," seeking to undermine the reliability of independent scientific findings on the compound's dangers, has discouraged the FDA and European regulators from restricting BPA use before now. The researchers also stated that even without the new findings in humans, the data represented "overwhelming evidence of harm." They added, however, that banning the chemical may not stop its contributions to disease.

John Gever, Common Chemical Linked to Metabolic and Cardiovascular Disorders, MedPage Today (Sept. 16, 2008).

IRS Presentations at AHLA Tax Issues for Healthcare Organizations Conference

The Internal Revenue Service (IRS) is currently reviewing a number of Section 501(c)(3) exemption applications from regional health information organizations (RHIOs) and expects "in the very near future" to make a determination on whether they will qualify, Steven Grodnitzky, a manager in the IRS exempt organizations division, said on September 11. At the AHLA Tax Issues for Healthcare Organizations conference, Grodnitzky explained that the IRS specifically is looking at whether such organizations, which commonly charge fees to users to access the network and its data, qualify for exemption because they: (1) promote health within the meaning of Section 501(c)(3); (2) further education as a tax-exempt purpose; (3) provide systems that lessen the burden of government; and (4) do not confer too much private benefit to either providers or payers who access the network.

Grodnitzky also signaled that the release of the IRS final report on exempt hospitals, community benefits they provide, and executive compensation they pay is imminent. The final report will document responses to the questionnaire sent to almost 500 exempt hospitals. Grodnitzky said nearly 100% of the hospitals complied with the "voluntary" questionnaire, adding that the ones that did not reply have been referred to IRS' review of operations unit. The study will provide further analysis on demographics and reported community benefit expenditures from the hospitals studied and will set forth its findings on executive compensation paid at these institutions, an issue not addressed in the preliminary report.

Ron Schultz, senior technical adviser to the commissioner of tax-exempt and government entities, told the gathering that the IRS is poised to launch a parallel survey of colleges and universities. That survey will be mailed very soon to a cross-section of 400 public and private institutions and will focus on unrelated business income, executive compensation, and use of endowments, he said. Although this survey will not directly affect healthcare entities, except possibly academic medical centers, indirect effects are likely. Schultz said a generic copy of the questionnaire would be posted on the IRS website as soon as they are mailed.

In a separate presentation at the conference, Don Spellmann, senior counsel with the IRS Office of Chief Counsel Tax Exempt and Government Entities, said the litigation focus of the IRS in the exempt healthcare arena remains on the Vision Services Plan (VSP) and medical resident Federal Insurance Contributions Act (FICA) tax withholding cases that continue to be waged in various federal courts throughout the country. Spellmann also addressed a recent Ninth Circuit Court decision in a VSP case that is the subject of a pending petition for U.S. Supreme Court review. With respect to pending FICA cases—which concern whether medical residents are "students" exempt from withholding or "employees" subject to tax under FICA—Spellmann said he did not foresee the IRS embarking on any broad-based settlement initiatives. The service is defending its regulations that declare medical residents are not exempt under the FICA student exemption and is litigating in many courts the relevant issues that arise differently at different healthcare institutions. While the service always is willing to discuss settlements in specific cases, no settlement program currently is being considered, he said.

The IRS also addressed Form 990 data mining, the globalization of healthcare, and the streamlining of the advanced ruling process for organizations seeking exemption as publicly supported charities.

Diane Freda & Peyton Sturges, IRS Close to Ruling on RHIO Exemption, Releasing Hospital Survey, IRS Officials Say, BNA'S Health L. Rep.
(Sept. 18, 2008) (note: registration is required to view this content).

*We would like to thank Reesa N. Benkoff, Esquire (Hall Render Killian Heath & Lyman PLLC, Troy, MI) for providing this week's Teaching Hospital Update.

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