Hospital Wellness Program Didn't Lower Costs

Wellness programs do not appear to lower overall healthcare costs, a new study shows, leading researchers to conclude the Affordable Care Act's wellness program incentives won't significantly reduce healthcare spending.

The study, published Monday in the journal Health Affairs, looked at a wellness program launched in 2005 by the St. Louis-based BJC Healthcare hospital system, which required employees wanting access to the system's most generous health plan to participate in the program.

To participate in the company's "Gold" health insurance plan, employees had to complete a web-based health risk assessment including blood pressure, serum glucose, height, weight, cholesterol readings and waist circumference. They also had to sign a pledge promising to eat healthy food and exercise regularly, and enroll in a smoking cessation program if they smoked.

The hospital system, for its part, held health fairs that provided physician referrals. Moreover, employees participating in the wellness program received discounted premiums in addition to access to the most generous plan.

While hospitalizations for conditions targeted by the program fell 41 percent compared with a nonparticipating employee group, the health system saw no significant decrease in other hospitalizations, according to the study. At the same time, inpatient costs fell as other expenses increased.

The result: BJC Healthcare did not save money, at least not in the short term.

In addition to raising questions about the cost-saving assumptions of the Affordable Care Act, the findings come at a time when more and more hospitals are offering employee wellness programs. The belief has been that wellness programs drive down healthcare costs.

To learn more:
- read the study abstract (subscription required for the full study)

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UPDATE 2-Tenet swings to profit as hospital visits rise

* Q4 profit 45 cts/shr vs loss 70 cts/shr year ago

* Outpatient visits up 7.3 pct

* Outpatient surgeries rise 13.9 pct

* Reiterates 2013 EBITDA outlook

* Shares down 1 percent

Feb 26 (Reuters) - Tenet Healthcare Corp on Tuesday reported a fourth-quarter profit versus a year-ago loss as outpatient hospital visits increased and said it sees health reform next year will have a positive impact on earnings.

An estimated 26 million people, many of them now uninsured, are expected to obtain coverage through health insurance exchanges being set up under the U.S. Patient Protection and Affordable Care Act.

Tenet, the No. 3 for-profit U.S. hospital chain, said it has traditionally served a larger number of uninsured patients than other publicly traded chains. This burden is expected to diminish as those patients are insured through the exchanges, beginning in 2014.

"We see a lot of upside in our markets," Tenet Chief Executive Trevor Fetter said on a conference call.

Fetter said Tenet recently signed its first contracts with three Blue Cross and Blue Shield plans for health insurance to be sold through the exchanges, covering about 30 percent of its hospitals. The plans have a similar structure as its commercial contracts, with a pricing discount of less than 10 percent from current rates.

"Where we have accepted any discount at all, it is for additional market share," Fetter said.

Tenet posted fourth-quarter earnings of $49 million, or 45 cents a share, compared with a loss of $76 million, or 70 cents a share, a year earlier, when the company took a large charge for the early retirement of debt.

Adjusted earnings before interest, taxes, depreciation and amortization (EBITDA) increased 16.7 percent to $336 million. Net operating revenue rose 7.3 percent to $2.33 billion.

Tenet reiterated its outlook for 2013 EBITDA of $1.325 billion to $1.425 billion.

In the fourth quarter, Dallas-based Tenet said adjusted patient admissions rose 2.9 percent, with outpatient visits up 7.3 percent and outpatient surgeries climbing 13.9 percent. Total admissions were flat, while emergency room visits increased 8.6 percent.

Uninsured and charity admissions rose 1.1 percent. Bad debt expenses as a percentage of revenue was 7.9 percent, up from 7.7 percent from a year ago, as more uninsured patients sought treatment, Tenet said.

Tenet shares were down 1.4 percent at $37.12 on the New York Stock Exchange.

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Hospital Chain Flouts NLRB Order After Court Ruling On Recess Appointments

Last week’s radical federal appeals court ruling that called into question hundreds of presidential recess appointments made over the last 150 years is already taking a toll. While the decision finding unconstitutional President Obama’s appointment last January of three members to the National Labor Relations Board invalidated just one particular NLRB decision, a hospital chain declared this week that the ruling exempts them from all NLRB rulings over the last year, and is refusing to comply with rulings that require them to collect dues from union members, according to a Reuters exclusive:

Prime Healthcare was not a party in the cases involving union dues and internal investigations. But on Friday the company told the SEIU-United Healthcare Workers West that following the D.C. Circuit decision, it would disregard the NLRB rulings.

“The D.C. Circuit’s ruling from last Friday held all the Board’s cases decided by the recess appointments are void,” wrote Prime Healthcare’s assistant general counsel, Mary Schottmiller, in an email to Reuters. “As such, it would violate the law if we followed the Board’s rulings … regarding union dues and witness statements.”

Schottmiller told Reuters that Prime Healthcare’s response to the union needed no further elaboration because the D.C. Circuit’s opinion was clear. “Void is void,” she said, adding that all of the company’s hospitals would take the same legal position on the issue.

Contrary to Schottmiller’s statement, the ruling by the U.S. Court of Appeals for the D.C. Circuit did not hold that all cases decided by the recess appointees are void. It invalidated the one decision before the court, and only that one. The ruling does suggest that all other decisions are more susceptible to court challenge — if the D.C. Circuit’s ruling is not overturned, either on rehearing or by the U.S. Supreme Court. But other federal appeals courts have already come to opposite conclusions about such recess appointments in the past, and are incredibly likely to do the same in the future, so a challenge before another appeals court could have an entirely different outcome. As NLRB Chairman Mark Gaston Pearce pointed out in a statement he issued following the ruling, “It should be noted that this order applies to only one specific case, Noel Canning, and that similar questions have been raised in more than a dozen cases pending in other courts of appeals.”

Although Prime Healthcare is definitively not entitled to defy NLRB orders based on the D.C. Circuit’s decision, the decision does create extreme uncertainty as entities subject to those rulings plan for the future. The ruling calls into question, at the very least, the concurrent appointment by President Obama of Consumer Financial Protection Bureau Director Richard Cordray, and the continuing validity of any other appointment made during an “intrasession” recess.

If the ruling’s reasoning were more broadly adopted, it would not only invalidate all recent NLRB decisions (a quorum of 3 members is required), all CFPB actions that required a director, and potentially affect the functioning of any other agencies with similar recess appointees. It would also so neuter the president’s power to make recess appointments that agencies lacking legally required personnel to do their work would be immobilized, thanks to Senate Republicans’ commitment to block absolutely anybody nominated to positions they’d rather see left empty.

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Possible HIV exposure at Buffalo VA hospital

BUFFALO, N.Y. -- More than 700 patients at the Buffalo Veterans Administration Center may have been exposed to HIV, hepatitis B or hepatitis C because of accidental reuse of insulin pens, according to a hospital statement and published reports.

Authorities told The Buffalo News there is a "very small risk" for the diabetic patients who may have been exposed to the reused insulin pens between Oct. 19, 2010 and November 2012. The VA memo obtained by the News said the problem was discovered by a routine pharmacy inspection last Nov. 1. The News first published the report on its website Friday.

The VA also notified western New York members of Congress of the possible exposure.

In a statement to The Associated Press, VA spokeswoman Evangeline Conley said the hospital "recently discovered that in some cases, insulin pens were not labeled for individual patients." She added that "although the pen needles were always changed, an insulin pen may have been used on more than one patient."

Conley said that once this was discovered the hospital took "immediate action" to ensure the insulin pens were being used according to pharmaceutical guidelines.

Insulin pens used by diabetics to inject insulin can be disposable or reusable with replaceable needles and cartridges. But according to the Institute for Safe Medication Practices, even reusable pens should not be used on more than one patient.

After seeing the VA's memo, Rep. Chris Collins, a Republican who represents the Buffalo area, said he spoke with Dr. Robert A. Petzel, undersecretary for health at the Department of Veterans Affairs.

"His thought was that it's a very, very low chance of passing infection," Collins said. "But it's not out of the realm of possibility, and that's why they're testing everyone," Collins told the News.

Collins said that even with a fresh needle, contamination could have occurred if bodily fluid flowed back into the insulin pens.

The VA said it is offering free blood tests to rule out any infections.

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Hundreds Of Veterans Accidentally Exposed To HIV At New York Hospital

Over 700 veterans may have been exposed to the HIV, hepatitis B, and hepatitis C viruses after a medical oversight allowed insulin pens to be shared between multiple patients at a Buffalo, NY hospital. According to hospital officials, the insulin pens — which are each supposed to be designated for a single patient, to help prevent the spread of diseases — were used incorrectly over a two-year period.

In November, pharmacy inspection rounds revealed that the hospital was storing insulin pens in supply drawers without any patient labels on them — despite the fact that the federal government has been warning against the practice of sharing insulin needles for years. In 2009, after a similar incident at a Texas hospital put more than 2,000 patients at risk, the Food and Drug Administration issued an alert about the issue.

“What has happened can only be described as the grossest of irresponsible and dangerous behavior,” Sen. Charles Schumer (D-NY) said of the incident. And representatives from the Buffalo area, including Rep. Brian Higgins (D) and Rep. Chris Collins (R), are now seeking an investigation into the hospital’s practices:

“Beyond the fact that the error occurred at all, most concerning was the length of time it took the Buffalo VA to catch the error — over two years, as well as the three-month delay in informing patients who may have been exposed,” Higgins, whose district includes the city of Buffalo, wrote in a letter to the VA on Monday. “Also detail why affected patients weren’t notified immediately.” [...]

“Unfortunately, since the day that new technology was introduced at the VA, they did not have a protocol in place that let the nurses know they were not supposed to use the cartridge on more than one patient,” Republican U.S. Rep. Chris Collins told CNN affiliate WGRZ. Collins also called the situation in Buffalo “unacceptable.” [...]

Higgins has also requested a detailed response outlining what steps will be taken to prevent any similar issues in the future.

An official from the Centers for Disease Control, Dr. Melissa Schaefer, told the Associated Press the CDC believes these incidents still go underreported despite previous warnings from federal public health officials. Part of the problem may be that some medical professionals, like the staff at the Buffalo-area hospital, may believe it’s safe to reuse insulin pens if they simply change the needle within the pen.

But Scaefer explained that’s not the case. “Reuse of insulin pens for more than one patient essentially is akin to syringe reuse,” she said. “You can get back flow of blood into that syringe or cartridge that contains the insulin and then you potentially expose others patients. And changing the needle wouldn’t make it safe for multi-patient use.”

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Hillary Clinton Discharged From Hospital

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Hillary Clinton admitted to hospital after doctors discover blood clot

Secretary of State Hillary Clinton was hospitalized on Sunday after doctors found a blood clot.

Clinton is receiving treatment at Presbyterian Hospital in New York where doctors will monitor her for the next 48 hours, her spokesman Philippe Reines said in a statement. 

The clot, resulting from a concussion she suffered earlier in December, was found during a follow-up exam on Sunday, according to the State Department.

"Her doctors will continue to assess her condition, including other issues associated with her concussion. They will determine if any further action is required," Reines said.

Clinton fainted and suffered a concussion earlier in the month when she was suffering from a stomach virus. At the time, the State Department said that she would continue her recovery at home and was being monitored by her physicians.

The illness forced the secretary to cancel a trip to the Middle East and an appearance before Congress.

Clinton was due to testify before Congress on Dec. 20 about the investigation into the September attack on the U.S. Consulate in Benghazi, Libya, which killed four Americans.

Two senior aides to Clinton testified on her behalf, but Republicans, who have been sharply critical of the administration’s handling of security for the Benghazi mission, have said they still expect Clinton testify in person.

Clinton has said she will step down from her post as the nation’s top diplomat, and President Obama has nominated Sen. John Kerry (D-Mass.) to succeed her.

— Amie Parnes contributed to this report.

— Updated at 10:03 p.m.

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