As the bottom continues to drop out of the home healthcare business, here comes Carol Raphael to the rescue. Perhaps.
Raphael, a registered nurse, is president and chief executive officer of the Visiting Nurse Service of New York. She has been appointed to the Medicare Payment Advisory Commission, which advises Congress about Medicare payment and policy issues.
Raphael is the first person from the home health side of the industry to serve on the commission.
Congress recently raised the number of MedPAC commissioners to 17 from 15, because it wanted better representation from post-acute and rural interests.
With her industry in turmoil since Congress trimmed reimbursement rates and placed caps on individual patient expenditures as part of an interim payment system two years ago, might Raphael be tempted to push for higher home health reimbursements?
"For home health, these are very challenging times," she says, circumspectly. "At this point I really want to learn as much as I can about the whole set of post-acute-care issues. I do think it's important that MedPAC have someone who understands the Medicare home-care benefit and reimbursements, because (the panel is) taking a more active role in recommending to Congress on home-care changes."
Safe enough. Sounds like she's learning politics quickly.
Wake me when it's over. Hospital executives might be on the edge of their seats as they watch their peers on trial for Medicare fraud-especially after two of them were convicted last month in the Kansas City, Kan., kickback case (April 12, p. 2). But at least one juror couldn't keep her eyes open during the ongoing criminal trial of four Columbia/HCA Healthcare Corp. execs in Tampa, Fla. So she was dismissed.
According to reports circulated at a conference in Washington last week, the juror, bored to tears by the technical and complicated arguments of the prosecutors, told the judge she wanted off the case.
"I am falling asleep," she allegedly wrote to the judge.
Two other jurors also were dismissed from the case. One left because he needed to start a new job, and the other left for financial reasons.
Heading south of the border. In an unusual move, Canada has begun sending cancer patients to the U.S. for radiation treatment because its own healthcare system is suffering from a shortage of specialized clinicians.
Since early April, 52 patients from Ontario have traveled to U.S. facilities for care. As many as 200 are expected to come to the U.S. by early July, when the program will be evaluated, says Kristin Jenkins, spokeswoman for Cancer Care Ontario, a government agency that operates eight of the province's nine cancer centers. The other is run by Toronto's Princess Margaret Hospital.
Thirty-seven of the patients were treated at Roswell Park Cancer Institute in Buffalo, N.Y., 13 at Buffalo (N.Y.) General Hospital, and two at Detroit Medical Center's Karmanos Cancer Institute. The Cleveland Clinic also was selected as a referral site but has yet to receive patients.
The program is slated to continue as long as it takes to recruit and train more radiation therapists and medical physicists in Canada. A spokeswoman for Princess Margaret Hospital, Keri Schoonderwoerd, says the process could take up to a year. The Canadian Ministry of Health has increased funding to Ontario's cancer centers to pay radiation professionals to work longer hours, expand training and recruit from outside the province.
Charitable loan. It takes plenty of cash to keep a bankrupt hospital on its feet. Considering the risk of lending to a provider in Chapter 11, debtor-in-possession financing usually comes with all sorts of strings attached and a high interest rate to boot.
But when a 50-bed hospital in rural Ulster County, N.Y., filed for protection from creditors last month, it didn't rely on a traditional lender. Instead, it cut a deal with local philanthropist Louis Resnick.
Resnick, who is in his mid-80s, is a longtime benefactor of Ellenville (N.Y.) Community Hospital. He is perhaps better known as the scion of Ellenville's Resnick family, which made a fortune on the invention of the television antenna. His Channel Master Corp. has changed hands a couple of times now but still makes TV and satellite antennas.
Several healthcare financiers were willing to extend a line of credit but only if they were given dibs on all of Ellenville's assets, ahead of other secured creditors. Plus, Ellenville Community might have paid interest of 18% to 20% on the money, says Ronald Kossar, Resnick's attorney.
Resnick, by contrast, has agreed to loan up to $1 million with fewer strings and generous terms. According to bankruptcy court documents, advances on the loan will be made at an 8% interest rate. "It's a charitable transaction more than a business transaction," Kossar acknowledges.
A controversy is born. To some, a Sante Fe, N.M., hospital's life-size bronze sculpture of a woman giving birth is a beautiful depiction of the miracle of new life. Others say it's too personal, too private or downright disgusting.
Ernest Roberge, the Santa Fe artist who created the sculpture that sits on the grounds of St. Vincent Hospital, doesn't understand all the fuss. "No matter where you go on this planet, this is going to happen," he says of childbirth. "We all have to pass through. It's a step in life, I would think."
Laura Folsom, director of the hospital's foundation, says the sculpture, titled "The Birth," has attracted lots of attention since it was donated about six months ago. The sculpture depicts a woman giving birth in a squatting position, with the baby's head emerging.
Folsom says the sculpture-along with six other pieces by various artists-was placed in the hospital's sculpture garden. She says she has seen many visitors stop at Roberge's artwork, ignoring all the other pieces.
"If you can't put a sculpture of a woman having a baby at your local hospital, where can you put it?" she asks.
Folsom says she received an anonymous note a couple of months ago from someone who wrote "about how disgusting it was." She threw the note away.
"It's a natural thing," she says. "I don't know why people would be upset about it. Our labor and delivery nurses love it. Why is it any more controversial than Michelangelo's 'David' and Rodin's 'The Kiss'?"