Over the last few months at least 2 hospital systems have reported that there have been incidents where patient data has been compromised. One of the incidents affects over 4 million patients treated within an entire hospital network. It leads some to question whether or not hospitals (or any other type of facility/agency) are adequately prepared to protect confidential patient information. With cyber attacks increasing in frequency, it seems that anyone who deals with patient data would be exploring additional mechanisms to protect themselves from being susceptible to cyber attacks. The second breach is a result of a thumb drive being stolen from administrative office with the hospital system. The last attack calls into question whether or not there are internal policies & protocols in place that would have prevented this incident. Both incidents will lead for various fines and penalties for both agencies. The total cost and impact of the breach of the patient information is something will never really know.
Almost 2 weeks ago Community Health Systems announced that hackers had compromised their entire computer system. Community Health Systems operates 206 facilities in 29 states. The hackers were able to gain access to patient data for an estimated 4.5 million patients who either received treatment at one of their facilities or anyone who was referred to their facilities by outside doctors. This attack impacts 4 hospitals here in North Carolina- Davis Regional Medical Center (Statesville), Lake Norman Regional Medical Center (Mooresville), Martin General Hospital (Williamston), and Sandhills Regional Center (Hamlet). In this situation the hackers were able to steal the names of patients, social security numbers, their physical addresses, birthdays, and also the phone numbers of the patients that were associated with the hospital system for the last 5 years.
While the breech within the Community Health Systems network was reported recently according to the investigation conducted by an outside cyber security team, the actual attack occurred during April & June of this year. It is also believed that the hackers are a group from China that is also suspected of engaging in corporate espionage in the past. Due to the nature of the attack the cyber security team is now working with the FBI to attempt to put an end to the activities of the hackers. http://www.foxbusiness.com/industries/2014/08/18/community-health-systems-says-data-stolen-in-cyber-attack/
The second hospital system that reported a recent breech of confidential patient information, this time it was Duke University Health System. The health system announced that a thumb drive was stolen from one of their administrative offices. According the information released, the thumb drive was not encrypted (an internal security mechanism that typically requires a password to access data) and the thumb drive contained various types of patient data. The data was isolated to patients who were seen at Duke Children’s Health Center & Lenox Baker Children’s Hospital for the last 6 months (December 2013 thru January 2014. The data stored on the thumb drive included: patient names, names of their physicians, medical record numbers, and in some cases the name of other Duke University Health System facilities that they have received services. http://www.newsobserver.com/2014/08/29/4107042/stolen-thumbdrive-had-duke-medicine.html#storylink=cpy
In the case of Duke, the incident was noticed much quicker than the breach with Community Health Systems. The incident was recognized in 6 months of the theft. Compared to those who were involved in the Community Health System breach that occurred over years. Duke is working with law enforcement to determine how the theft occurred. According to Duke’s news release, to date none of the patient information had been used.
Regardless of whether the information is used or not, both situations are considered HIPPA violations and both agencies are highly likely to face fines and sanctions from federal agencies. They are also susceptible to face civil lawsuits from the patients whose information was compromised by the 2 separate incidents. According to various sources, fines for healthcare related breaches are some of the most expensive fines. On a positive note, one of the sanctions that could come out of the breaches is that both agencies are ordered to make “corrective actions.” Which might force both agencies to comply with orders to increase their current IT security infrastructure and precautions & protocols.http://www.beckershospitalreview.com/healthcare-information-technology/how-much-will-the-chs-breach-cost.html
With so much talk about the new changes that would come into effect January 1, 2014 when the Affordable Care Act (or Obamacare as some call it) officially became an enforceable law in America. Some haven’t really given much thought to any of it at all. While others are tired of hearing about it all together. There has also been much talk around the state of NC, especially since we were one of about 25 states that opted to decline federal funding to expand Medicaid. Many in the healthcare industry have mixed feelings. However still quite a few wonder what things would be like if our state had made some different decisions. It is estimated that if NC had participated in the Medicaid expansion around 500,000 individuals & families would have become eligible to enroll in Medicaid. This would have also helped to reduce the number of uninsured North Carolinians as well, which is estimated to be around 1.5 million. It also would have helped to create some competition among the private insurance companies that decided to participate in the federal insurance exchange marketplace. (There was only one company that decided to participate.) http://www.ncjustice.org/sites/default/files/Medicaid-Expansion-OnePager-NCJusticeCenter_0.pdf
In October 2013 at a speaking engagement in Washington D.C., North Carolina Gov. Pat McCrory cited a couple of concerns such as adding an additional 500,000 people to the state’s Medicaid program & also concern over whether or not the federal government would actually pay its portion of the cost of the program after the first 3 years as factors in why he ultimately chose to decline the federal funds for the Medicaid Expansion. http://www.charlotteobserver.com/2013/10/23/4410230/gov-mccrory saysnorthcarolina.html#.UuR4_WQo7BIThe Governor also admitted that due to another new piece of federal legislation that had recently become law, NC may not have a choice but to reconsider the Medicaid Expansion. The new federal law allows hospitals to make “presumptive eligibility” decisions for those uninsured patients they feel may qualify for Medicaid under the current NC Medicaid eligibility requirements. Based on the “presumptive” decisions made by hospital personnel the state can be billed for services received by the patient until a final decision is made, which can take up to 60 days. In the event that the hospital has made the wrong decision about a patient and their ability to qualify for Medicaid the state still has to pay for any services the patient received prior to a final decision made about their Medicaid eligibility, regardless of the fact that ultimately they did not qualify for services.
Although many might believe that not excepting federal funding for expanding Medicaid in NC was a good decision. When you think about the amount of money that hospitals across the state end up attempting to collect every year from those that are uninsured, it makes one wonder if some of the expenses can’t be avoided or decreased. It is estimated that within the first 8 years of expanding Medicaid an estimated $65 million could have been saved by providing coverage to those who would typically be uninsured. The North Carolina Hospital Association is even encouraging our Governor to reconsider his position on the Medicaid Expansion. The Hospital Association feels that this is an opportunity for hospitals to be compensated for services they provide (which they would normally be providing for free.) They also point out that expanding Medicaid would also be an opportunity to provide primary care to those who utilize emergency rooms across the state for non-emergent care regularly thus providing access to primary care for everyone & hopefully helping to close the gap in the access to care.
At the end of December 2013 our state ranked 6 out of all the states with individuals or families using the federal exchange marketplace to enroll in some type of healthcare coverage. According to the data in a New York Times article, there were a little more than 274,000 people enrolled in our state. Out of that number only a little more than 31,000 of them were found to qualify for Medicaid or CHIP (a type of medical insurance assistance program for children from the government.) http://www.nytimes.com/interactive/2014/01/13/us/state-healthcare-enrollment.html?_r=0 It seems like the residents of this state want affordable health insurance, improved access to care, and they don’t mind paying for it either.
When you consider the fact that the state has to budget for Medicaid expenses annually any way and one of the purposes of declining federal funding was to save NC money, you begin to wonder if that is still possible with some the new developments since the Governor made his decision. If the state will now be responsible for unknown amounts of hospital expenses regardless of whether or not an individual actually qualifies for Medicaid; you wonder will this plan lead to savings for the state? Or will this cost the state more in the long run? Will Gov. McCrory end up trying to get others in his party to reconsider accepting federal funding for the state to expand Medicaid? (Many believe this would be very difficult and therefore is very unlikely.) Whatever happens NC is sure to continue experiencing some growing pains with all of the changes that are sure to come as far as healthcare is concerned.
Dr. Carrol F. Landrum, an 88 year old physician who has been practicing medicine for approximately 55 years in rural and poverty stricken communities in Mississippi, is facing the loss of his medical license. Not only has Dr. Landrum served his local community of Edwards for decades, he also served his country as a WWII veteran. Currently he is the only practicing physician in Edwards.
For the last two years he has operated a mobile practice as a way to see & treat some patients in his community. Most of the patients that Dr. Landrum treats from his mobile practice would typically go without medical treatment. Dr. Landrum’s patients are predominately low-income and/or disabled persons, and many do not have transportation to go visit a doctor at their office. There are also many times that Dr. Landrum provides medical care to people in his community without being paid anything at all. Despite the fact that Dr. Landrum is able to reach those who would not have access to healthcare, the Mississippi State Medical Board is attempting to revoke the doctor’s ability to see any patients. The board feels that using a car for an examination room is not an acceptable way to treat patients. As a result the board set a date for the doctor to surrender his license in January. The date past and Dr. Landrum refused to surrender his medical license. http://goo.gl/7XiIvu
If Dr. Landrum is stripped of his ability to practice medicine, it will affect more than just the doctor. It will affect an entire community as well. Since Dr. Landrum has been threatened with the loss of his license, some of the residents in the community have organized a fundraiser to assist the doctor in obtaining new office space. Previously Dr. Landrum had office space, but was forced to leave due to increased gang activity and violence in the area.
It seems that there should be some type of solution to this issue that the state medical board could offer, besides Dr. Landrum surrendering his license. Mississippi is currently ranked the unhealthiest state in America and the state also ranks the highest for the number of residents living in poverty. You would think that the board would be looking for ways to legally operate mobile practices or provide physician home visits to care for those who are unable to have access to care otherwise. http://goo.gl/uHXdlP
Hopefully Dr. Landrum will be allowed to maintain his license and practice medicine in his community. It is obvious that so many are depending on the doctor to help them manage everything from the common cold to chronic diseases that require ongoing monitoring and treatment (ex: asthma, congestive heart failure, diabetes, etc.…) Since the deadline for Dr. Landrum to surrender his medical license (and he did not comply) there hasn’t been any additional action taken to end the doctor’s ability to practice medicine. For the sake of the residents in the Edwards community and Dr. Landrum, let’s hope that it remains that way.
Last week the United States Supreme Court began hearing arguments in an Idaho case that could set a new precedent. The case centers on Idaho’s reimbursement rates for Medicaid providers. The case began in 2009 when 5 Idaho facilities sued the state in an effort to get an increase in the rates providers receive for treating Medicaid enrollees. The state lost the 2009 case and in 2011 a U.S. District Court ordered Idaho to increase reimbursement rates. Now the state has appealed the case all the way to the U.S. Supreme Court. The court’s ruling on this case could potentially affect Medicaid throughout all 50 states.
At the heart of the case is whether or not providers and other parties (such as patient advocacy groups) should be able to petition the courts in order to get states to increase reimbursement rates. Idaho officials have taken the position that reimbursement rates for Medicaid should only be set by states and federal government agencies. On the other hand, providers and others feel that they have no other option but to turn to the courts for assistance. With states “freezing” reimbursement rates for year or decades, Medicaid enrollees now face decreased access to care, and providers are faced with the decision as to whether or not they can afford to treat Medicaid patients. http://goo.gl/nMDyzs
Many are optimistic that the 5 agencies stand a chance to win this case due to compelling evidence that supports their argument. If Idaho losses this cases it will set a precedent and potentially open the doors for similar lawsuits in the future. The issue of “frozen” reimbursement is not a problem that is unique to only Idaho. There are other states like Florida and Pennsylvania that also have serious issues as well. Florida ranks as one of the lowest-paying states as it relates to reimbursing Medicaid providers. As a result of the low reimbursement, on December 31, 2014 a federal judge found that Florida violated federal Medicaid laws, because the state failed to ensure that Medicaid patients received care that they are guaranteed and entitled to as a Medicaid enrollee. In Pennsylvania, Medicaid reimbursement rates have been “frozen” at 1991 rate levels. As a result, it is estimated that Medicaid providers are only reimbursed for approximately 30% of the actual cost of each treatment for their Medicaid patient population. http://goo.gl/cgLqTW
Those who feel that a reimbursement rate increase is necessary, also believe the increase will help change the current way that many people have their healthcare needs met. It is believed that there will be an increase in patients who establish a “medical home” or primary care physician that they can see for routine types of visits. Which in turn will decrease the number of non-emergent visits to local emergency rooms, which are some of the most costly visits.
For now, we wait to see what the Supreme Court decides.
On behalf of Temp Chicks, we want to apologize for the long & unexpected absence from the blog. We thank all of our followers for sticking with us & continuing to follow the blog. We are looking forward to 2015 and all of the changes in healthcare that are sure to follow. We have plenty of ground to cover- from U.S. Supreme Court cases that could create a ripple effect across the country, to key state healthcare issues & hot topics.
Later on today we will publish our very first blog of the year. We hope that you enjoy it. The break is over… The Temp Chicks are back!!! Have a great day!
This year North Carolina’s Department of Health and Human Services has remained under the spotlight of the General Assembly, as well as the residents of the state. DHHS has faced many issues over the last year; ranging from potential sanctions from the federal government due to backlogs with the food stamp program to legislators questioning the ability of the leadership of the agency. Now DHHS Secretary Dr. Aldona Wos is preparing to face the joint oversight committee to discuss multiple issues regarding the status of the agency. The most serious topics of discussion are things such as: updates on restructuring of DHHS, costly contracts for consultants, ongoing issues with the NC Fast (food stamp program), reviewing fiscal performance for 2013-2014, and reviewing the overall budget for Medicaid.
Both Democrats and Republicans share some of the same concerns when it comes to DHHS. While other concerns are split between the two parties. Democrats seem to have their sights set on obtaining answers to the inability of DHHS to completely resolve the backlog with the NC Fast and NC Tracks applications and their ongoing software issues. The Republican leaders are more concerned with the lack of predictability regarding Medicaid costs for the state and they are also proposing privatizing Medicaid. The oversight committee will also be looking into the accuracy of fiscal data that has been presented previously and recently regarding whether or not DHHS ended fiscal year 2013-2014 with a surplus or not. Secretary Wos recently informed legislators with reports stating that the Medicaid program had a surplus of $63 million. However in April, the CFO of DHHS projected a shortfall in the ballpark of $120-140 million for the same fiscal year. Which leaves many legislators questioning how Secretary Wos obtained her figures and whether or not the data they are provided is accurate or not. http://goo.gl/ZELxw7
Some Republicans have suggested that the state’s Medicaid program no longer remain under the control of DHHS. In addition to removing Medicaid from DHHS’ control, there have also been suggestions that a new state governed agency be created to provide oversight for Medicaid. Secretary Wos disagrees with the suggestion to remove Medicaid from DHHS. Her rationale is that removing the Medicaid program from DHHS would undermine plans to restructure the entire agency, which would be the first major overhaul of DHHS since the late 70’s. Under the Secretary’s restructuring plans, DHHS would create five separate divisions that would create an agency that can better serve the residents of North Carolina. http://goo.gl/bSr318
There seems to be concerns across the board regarding many aspects of what is going on with DHHS. Hopefully in the upcoming hearings and meetings held by the joint oversight committee there will be some clarification on many of the issues that surround DHHS. Whatever happens Secretary Wos should be prepared to not only answer the many questions and concerns of the committee members, but also be prepared to provide data/evidence to support what she is reporting. Otherwise concerns about DHHS will continue to linger in the minds of committee members and the residents of North Carolina.
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Since July 1, 2011 North Carolina’s Division of Health Regulation Service (DHRS) Acute and Home Care Licensure and Certification Section (a division of North Carolina Department of Health and Human Services) has placed a 3-year moratorium on issuing new Home Care Agency licenses for in-home aide services. This July marks the end of the 3-year moratorium and many aspiring Home Care Agencies and current Home Care Agencies that are looking to expand the services they offer. Many are wondering if DHRS will lift the ban. As of May 2014 according to data published by DHRS, there are currently 1,000’s of Home Care Agencies across the state of NC offering different services that range from Private Duty Nursing, Infusion Services, Hospice Services, Medical Social Work, and in-home aides.
There is some speculation that there are hundreds of applications that have already been filed with DHRS in an effort to be one of the first agencies in line to be issued a license to offer or add in-home aide services to their agencies. However many are still question whether or not the moratorium will actually end in July. So far there has been no indication from the DHRS that they intend to begin to accept applications again on a specific date or that they will be extending the moratorium until further notice (or another specified date.) It seems that there are so many unanswered questions at this point as far as in-home aide services are concerned at this point. Which leaves many to begin exploring alternative options with so much uncertainty and July 11th quickly approaching.
What some people fail to understand is, everyone that is sick or who might have a minor injury, or may undergo a minor surgical procedure does not belong in the hospital or a nursing home or rehabilitation facility. Many times procedures can be provided in an outpatient setting, which would allow patients to recover in the comforts of their own home. In some cases those who have had minor injuries and/or procedures just need a little assistance and that’s where in-home aides play such a valuable role. In-home aids are able to assist with things like meal preparation, medication reminders, and can assist with allowing other healthcare providers to gain access to the patient/client so that they can receive additional medical treatment in their home. Aides often times make being at home a safer and a more comfortable environment for some and provide an additional support system in other situations while loved ones go to work.
With proper monitoring and management of in-home aides and protocols in place to follow-up with the satisfaction of the patient/client, quality service can be provided without wasting tax dollars or other insurance benefits (which ultimately drives up the cost of care for other patients.) When the announcement was made and the moratorium was put into effect in 2011, no reason or rationale was ever given, and to this day there is still no known reason. Until July, those of us in the healthcare industry will wait and see what DHRS decides to do.
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In a field that many consider to be stable, things are changing. For those that don’t know, the nursing environment is changing- it isn’t the same way it was even 10 years ago. For nurses that are Licensed Practical Nurses (LPN’s) or Associate Degree Nurses (ADN’s) the opportunities for employment are becoming limited. LPN’s are being squeezed out of places where they normally flourished like assisted living facilities or long-term care facilities (nursing homes) and now they are being replaced with Medication Technicians (or Med Techs.) Yes, Med Techs have to be supervised, however they can provide medications to patients/residents for a lower fee compared to a nurse (even if the nurse is an LPN.)
ADN’s are also seeing changes in their options for potential places of employment. For so many years ADN’s were viewed as being no different than nurses who went to 4 year colleges and/or universities and earned their undergraduate degree in nursing. However times are also changing for ADN’s as well. Many hospitals are moving to no longer allow ADN’s to work within their major hospitals in an inpatient setting, however they are allowed to work in their hospital owned outpatient clinics.
With this new twist in the ever-evolving field of healthcare, it always leaves one wondering what’s to come next. While it might seem like a way to save money by hiring Medication Techs to provide patients/ residents with one aspect of care that is vital to a portion of their daily needs. It seems like it increases the pressure and responsibility on whatever nurse is on duty (regardless of whether it is an ADN, LPN, or RN.) Not only is the nurse responsible for the administration of medication by the Med Techs, they are also responsible for any other staff such as CNA’s too. And anyone who has even witnessed staffing or managed staffing for a facility like assisted living or long-term care knows that it is pretty rare for all of your staff to show up. Guess we’ll see how this plays out.
Earlier this year on February 11th many North Carolinians took a deep sigh of relief; when the NC Department of Health and Human Services Secretary Dr. Alona Woss declared that NC had met the February 10th deadline imposed by the United States Department of Agriculture and the goals they had outlined that the state needed to meet. http://www.ncdhhs.gov/pressrel/2014/2014-02-14_FINS_deadline_met.htm At that time the USDA imposed the deadline, it also warned the state failure to meet the deadline could result in the state losing $88 million in federal funding, which the state uses to pay for administrative costs associated with running the food & nutrition Services programs for the state.
Unfortunately its been about 30 days and the state is now facing another deadline, again imposed by the USDA, and again the state stands to lose $88 million in federal funding. This time the USDA is mandating that NC handle any applications that have been waiting to be processed for 30 days or more (which is considered “untimely”, legally applications are supposed to be processed within 30 days) and process all emergency requests for assistance that have been waiting more than 7 days. Secretary Woss gave a report to the NC Legislative Oversight Committee on March 12th and at that time she reported that the state had made progress in decreasing the number of backlogged food stamp applications to 1,700. She also continued to point out that counties are doing everything they can to clear the backlog. However she also pointed out that there are still things that are hindering the process of clearing the backlog. http://www.news-record.com/news/local_news/article_011ec218-b6b5-11e3-bead-0017a43b2370.html
Today with a little time to spare the Director of Guilford County’s DSS announced that his agency had met the deadline. Unfortunately several hours earlier Guilford County DSS Director Robert Williams also announced that he was resigning. http://www.wfmynews2.com/story/news/local/2014/03/31/guilford-county-dss-director-robert-williams-resigns/7117287/ Director Williams explained previously that he was under the impression that there were 3,100 backlogged cases and he was made aware of the discrepancy in the numbers when the state analyst discovered it last week. Once again North Carolinians can breathe yet another sigh of relief. The USDA will not be withholding $88 million in federal funding for the state. The question still remains- is the NC Fast system the right system for the state? And regardless of the fact that once again the state met another USDA deadline; what’s going to keep this from happening again, in another county? The one thing each of these situations have in common, is the system they are entering the information into.