When nursing homes complained to Congress that inspectors were severely punishing them for minor infractions, Sen. Charles Grassley (R-Iowa) took them seriously. Six months later, he took them to task for using questionable information to back up their claims.
When the General Accounting Office issued a report in March on severe problems in nursing homes, the American Health Care Association issued a press release saying the federal inspection system was "a bureaucratic government program out of control. Inspectors have closed down facilities, without consulting residents and their families, for technical violations posing no jeopardy to residents."
Grassley, chairman of the Senate Special Committee on Aging, asked the AHCA to prove those claims. Grassley says he received an information packet in May with 10 examples of "overzealous regulation" of nursing homes, which he turned over to the GAO for analysis.
Grassley unveiled the results last week to his congressional colleagues. In eight of the 10 examples, the GAO concluded regulators acted properly. The AHCA itself was overzealous, not the regulators, said the GAO.
One of those eight involved a regulator who nixed free coffee for staff, residents and family members at a Michigan facility-a practice for which the home was "severely punished," said the AHCA. But the GAO said the regulator cited the home because "vulnerable" residents might pull on the spigot and suffer burns.
"Credibility is like an old maple tree," Grassley says. "It takes years to develop, but a good storm can wipe it out just like that."
AHCA spokeswoman Laura Fenwick told Outliers that the group agreed with the GAO's assessment of three of the 10 examples. "We don't want to debate anecdotes," Fenwick says. "We are really just interested in working with all parties on the issues (affecting nursing homes), and there are going to be differences of opinion."
Reading between the lines. If Rep. William Thomas (R-Calif.) is the uncrowned king of healthcare policy in the House, some of his colleagues chafe at the idea of paying homage to him. And they recently let it be known-subtly.
At a press conference to unveil their managed-care reform bill, Reps. Tom Coburn (R-Okla.), a physician, and John Shadegg (R-Ariz.) suggested that the GOP leadership hadn't yet come out in favor of the bill because Thomas, chairman of the House Ways and Means health subcommittee, was not pleased that the legislation had been developed without the panel's advice.
After initially hinting that they needed to nurse the bruised egos of unnamed members, the authors finally disclosed what was delaying the leadership's endorsement: "This is a bill that did not go through the committee process," Shadegg says. Adds Coburn: "There are very few people who understand all of the issues involved, and they aren't committee chairmen."
You get what you pay for. Consider these three new surveys.
The National Association of Public Hospitals and Health Systems released the results of a survey last week that says most Americans approve of spending tax dollars on hospitals that serve the uninsured. The survey, commissioned by the Washington-based NAPHHS, says most respondents would pay up to $60 per year to help fund safety-net hospitals. The findings will help the NAPHHS push a proposal for a four-year, $1 billion program to finance safety-net reforms in 100 communities around the country.
The results of a second survey released last week, this one by the George Washington University Center for Health Services Research and Policy, contend more home-health agencies must screen out costly patients to beef up their bottom lines in the face of Medicare reductions. Of the 28 home-health agencies surveyed, 21% reported overtly screening out high-cost patients. The National Association for Home Care and the Home Health Services and Staffing Association funded the study.
Finally, the New York Times reported on a study by the Lewin Group that says seriously overweight adults disproportionately drive up national healthcare spending on the treatment of 15 diseases, including diabetes and heart disease, and more should be done to recognize and fight obesity and its consequences. The American Obesity Association commissioned the study, the Times said.
Stay healthy till the off season. You've heard of seasonal price increases at hotels. Now hospitals are getting into the act. Martha's Vineyard Hospital, Oak Bluffs, Mass., has decided to raise prices for emergency care and certain other outpatient services by 10% for the rest of the tourist season, according to interim Administrator Paul DellaRocco. Prices will return to normal Oct. 1, he says.
"In any tourist economy, price varies according to season," he told the Wall Street Journal's New England section. "You have to garner enough income in-season to subsidize the off season."
The price change, decided in late July, is raising eyebrows.
"I can't imagine charging more if you break your leg on the golf course in July than if you're skiing in February," says Leslie Hawkins, president of Mount Desert Island Hospital in Bar Harbor, Maine. Officials at the American Hospital Association and its New England affiliates say they've never heard of seasonal pricing by a hospital.
Executives say the move is designed to improve the finances of troubled 22-bed Martha's Vineyard Hospital, which emerged from bankruptcy protection last fall. Officials say its resources are strained by an island population of 14,000, which swells to 100,000 in the summer. In the winter, the number of occupied beds drops by half, and only a few patients come to the emergency room each day. But overhead costs remain high, mostly because of the remote setting.
President Clinton recently attended a fund-raiser for the hospital while on vacation in Martha's Vineyard (Aug. 30, p. 68).
Quotable. "We're hearing as many as 50 rural hospitals could close in the next five or six years. That's 50 out of 160. And that's not off base. The (Balanced Budget Act of 1997) didn't just nibble at our backsides, it plum took off the whole backside and most of the leg."
-Marvin Cole, past chairman of the Hospitals and Community Health Systems Constituency Group of the National Rural Health Association.