Amid the news about private-sector hospitals' billing problems and bankruptcies caused by an out-of-control accounts receivable firm comes a report that things are even worse at the Pentagon.
Military treatment facilities are treating dead patients, failing to collect insurance payments and having trouble keeping track of drugs.
A General Accounting Office investigation of patient records at one military hospital discovered that 41 of its patients had been listed as dead by the Social Security Administration the year before they were treated at the hospital. The Social Security numbers of another 225 patients at the same hospital also turned up in the death records, but with different names or birth dates. "Although these matches of information in death records and patients' records could be the result of clerical errors, someone may have fraudulently assumed the identity of a deceased person in order to receive free medical care," according to the report.
The dead patients were at one of three hospitals studied, though the GAO did not say which: Eisenhower Army Medical Center, Augusta, Ga.; Naval Medical Center, Portsmouth, Va.; and Wilford Hall Air Force Medical Center, San Antonio.
The GAO says the hospitals also are losing millions of dollars by not pursuing insurance payments for patients who have such coverage but also are entitled to free military medical care. Military hospitals legally can collect from insurance companies that cover patients who also are eligible for free military healthcare.
GAO investigators also uncovered potentially fraudulent uses of government credit cards at the hospitals and inadequate records of prescription drug inventories and use.
"As a result of these control weaknesses, millions of dollars that could be used for patient care may be unnecessarily spent on ineligible patients, unused pharmaceuticals or unneeded purchases," the GAO says.
The $24 billion Military Health System provides healthcare to more than 8 million eligible beneficiaries. Congress has been bumping up the military healthcare budget for years, but the Pentagon has needed supplemental appropriations for six of the past eight fiscal years.
Now we know why. For example, at Eisenhower only 15% of patients reviewed had completed insurance information in their files.
The GAO report has found "another example of Congress throwing good money after bad for another Defense Department program that fails to pass even the most basic accounting standards and lacks sufficient oversight," says U.S. Rep. Dennis Kucinich of Ohio, one of two House Democrats who had sought the GAO study.
One thing you can say in favor of National Century Financial Enterprises, the bankrupt accounts receivable financing company whose collapse has wreaked havoc among healthcare providers: The company sure had a way with words.
Two items came to mind after the fall of Dublin, Ohio-based NCFE. The more recent was a wraparound ad that graced the cover of the October issue of Connexion, the official publication of the Medical Group Management Association. The issue was passed out to attendees at the MGMA's annual meeting in Las Vegas in October. It read "Some visitors may just pass (our exhibit booth) by for the slots: (Losers)." On the back, it read: "Our accounts receivable financing program transforms healthcare providers into high rollers with the highest advance rate in the industry."
The second was a May 1996 article in Healthcare Financial Management, the official publication of the Healthcare Financial Management Association, titled "Avoiding potential problems when selling accounts receivable." Written by Donald Ayers, founder and then-vice chairman of NCFE, it reads, "Before entering into a financing agreement, organizations need to consider and take steps to avoid serious problems that can arise from participation in an accounts receivable financing program. For example, the purchaser may cease purchasing the receivables, leaving the organization without funding needed for operations. ... Sellers should be cognizant of the purchaser's source of funding, the stability and commitment of the funding source, as well as the track record and reputation of the purchasing entity."
Back to basics
You'd think this was something best handled in grammar school, but the federal Centers for Disease Control and Prevention has come out with some guidelines to help those adult healthcare workers keep their hands clean-just in time for Hand Washing Awareness Week Dec. 8-14.
There is some news in the recommendations: A key change in policy promotes the advantages of alcohol-based antibacterial hand gels over traditional soap-and-water washing for routine scrub-ups. The old method of ridding bacteria can be time-consuming and rough on the hands and causes many people to avoid washing unless their hands are visibly dirty.
Healthcare providers should "routinely use hand rubs either before or after patient contact," says John Boyce, M.D., lead author of the guidelines and chief of the section of infectious diseases at Hospital of Saint Raphael in New Haven, Conn. In general, nurses have the best hand-hygiene record, Boyce says, while doctors have the worst.
By placing hand-gel dispensers in key locations near patients and close to doorways, coupled with education on the importance of hand hygiene, hospitals can reduce the amount of poor hand hygiene that's long been linked with nosocomial infections. Boyce says hospitals also can motivate their workers to use the hand gels. He suggests using friendly reminders, such as cartoons that tout the benefits of hand hygiene.
Studies over the years show that, on average, healthcare workers wash only 40% of the time when they should. "With the rising number of antibiotic-resistant organisms seen in healthcare facilities," Boyce says, "we have to work a little harder to reduce the spread of bacterial infections."