All posts in Children’s Health

Internet Hospital Ratings (from Kaiser Health News)

The excerpt below is from the March 18, 2013, article written by Jordan Rau of Kaiser Health News.

Here is a guide to understanding the ways in which hospitals are rated on the Internet:

Medicare’s Hospital Compare: This government site publishes dozens of quality measures that private ratings groups use for their own rankings [comparing three hospitals at a time].

Consumer Reports: This nonprofit calculates a “safety score” on a 100-point scale based on infection, error and readmission rates as well as good communication from doctors and nurses [subscription needed].

Healthgrades: This private company rates hospitals in up to two dozen specialties and provides some of the Hospital Compare data in a user-friendly format. Healthgrades also gives out awards and distinctions in various specialties.

The Joint Commission: This accrediting group tells you if a hospital has passed its certification reviews.

Leapfrog Hospital Safety Score  This nonprofit group uses information from its own surveys as well as government data to come up with a letter grade for how well hospitals protect patients from unnecessary harm.

Truven Health Analytics 100 Top Hospitals This private company selects best hospitals in five categories based on their size and whether they are teaching institutions or community hospitals. It also picks 15 top hospital systems and best cardiovascular hospitals.

U.S. News and World Report Alone among raters, this media company surveys specialists for their opinions in choosing the best national and regional hospitals in different specialties. For 12 specialties, reputation makes up a third of the score, with data determining the rest. In four specialties the ratings are entirely based on reputation. U.S. News also ranks best children’s hospitals.

A Lesson from the Sneetches

This Practitioner Application to the article “Post Acute Care and Vertical Integration After the Patient Protection and Affordable Care Act” (by Patrick D. Shay and Stephen S. Mick) appeared in the January/February Edition (Volume 58, No. 1) of the Journal of Healthcare Management.

In his classic tale “The Sneetches,” Theodor Seuss Geisel (Dr. Seuss, 1961) created a society divided by entitlement in which the lines of separation were removed, thrusting its members together. A satire about discrimination, “The Sneetches” offers children an early introduction to the arbitrary walls that those forces governing society can build and destroy at their whim.

Shay and Mick may be said to describe a similar scenario as they apply provisions of the 2010 Affordable Care Act (ACA ) to post-acute care and vertical integration under the Medicare Shared Savings Program (also known as accountable care organizations or ACOs) and to bundled payment systems. They note that these are the areas in which the influences of the ACA are most apparent. In the process, Shay and Mick remind us that perception is formed largely on the basis of factors lurking beneath the surface that care little for public opinion. For example, much like Dr. Seuss’s Sneetches, Hurricane Sandy, which struck the East Coast shoreline in October 2012, rendered the “haves” and “have nots” almost indistinguishable. Bellevue Hospital, the oldest hospital operating in the United States, was capable of offering roughly as much care during and immediately following the hurricane as it was in 1736, when the New York City Almshouse designated six bedrooms as Bellevue’s first “ward.” Continue reading →

Redefining the Valuation Methods of Modern Day Hospital Care

This article was first published in the New York State Bar Association’s Health Law Journal, Vol. 17, No. 3 (Summer/Fall 2012).

Due to the sensitive nature of the industry it services, the American hospital must rightfully operate under copious federal and state regulations, in addition to volumes of rules and ordinances established by separate, non-governmental entities. Though policing policies such as accreditation, certification and periodic review come from a variety of both public and private sources, the goal is generally consistent: develop uniform standards to ensure that hospitals in the U.S. operate at an acceptable safety level while delivering quality patient care.

The Many Paths to Accreditation

Though its primary function is without question the delivery of accurate and effective medical treatment, health care is also big business. Continue reading →

CMS Issues Final Rules for EHR Incentive Programs, Stage Two


In 1996 the Federal government took on increased regulatory responsibility with the passage of the Health Insurance Portability and Accountability Act (HIPAA).

This multifaceted bill was broad in its jurisdiction over  both Medicare and American health care in general, as it sought to provide new Federal rules improving continuity  or “portability” of coverage in the large group, small group, and individual health insurance markets, while reinforcing the need to protect the privacy of patient health records.

Combining a group of disparate issues, Title I of HIPAA amended the Public Health Service Act, the Employee Retirement Income Security Act of 1974 (ERISA), and the Internal Revenue Code of 1986. In doing so, HIPAA strove to regulate the availability and scope of group health plans and many individual health insurance policies, including the protection of health coverage for workers and their families who have lost or changed jobs. Further provisions also limited a group health plan’s ability to restrict coverage for preexisting conditions. Continue reading →

Federal Grants Move Affordable Insurance Exchanges Forward

Beginning in 2014, individuals and small businesses will be able to purchase private health insurance through competitive marketplaces called Affordable Insurance Exchanges, or ‘‘Exchanges.’’  Recently, the U.S. Department of Health and Human Services (HHS) developed a few flexible programs that offer different Exchange models, as well as some additional options within each program.

The Federal Government also provides Exchange Establishment grants to States that are making progress in establishing Exchanges. States can decide when to apply for grant funding as needed, opting for multi-year funding (level two establishment grants) or yearly funding (level one establishment grants).

The program affords States several options for grant funding, a necessary component to the program as each State’s insurance market needs may be considerably different. Presently, forty-nine States and the District of Columbia received up to $1 million in Exchange Planning Grants. Four territories received similar grants in March 2011. These funds were used to conduct Exchange feasibility studies and community forums. Six states and a multi-state consortium led by the University of Massachusetts Medical School received over $241 million in Early Innovator grants to develop model Exchange IT systems. Early Innovator states pledge that their Exchange technology is reusable and transferable to other States. Additional information in the HHS Press Release appears here.  An interactive state map providing details about the different Exchange programs can be found here.

Final Rules for Hospital Inpatient Prospective Payment Systems

The Centers for Medicare & Medicaid Services released the final rule for the Medicare inpatient prospective payment systems (IPPS) for the 2013 fiscal year (effective for discharges occurring on or after October 1, 2012).  The final rule revises the IPPS for operating and capital-related costs of acute care hospitals and incorporates certain statutory provisions contained in the 2010 Patient Protection and Affordable Care Act, as amended in part by the  Health Care and Education Reconciliation Act of 2010.

Additionally, the final rule updates the rate-of-increase limits for certain hospitals excluded from the IPPS, as well as the payment policies and annual payment rates for the Medicare prospective payment system (PPS) relating to long-term care hospitals. The final rule changes the ways in which a hospital determines its full-time equivalent (FTE) resident cap for graduate medical education (GME) and indirect medical education (IME) payments.

The final rule also establishes requirements for the Hospital Value-Based Purchasing (VBP) Program and the Hospital Readmissions Reduction Program.

The entire final rule, which will be codified in 42 CFR Parts 412, 413, 424 and 476 can be seen here.

Vaccination Recommendations for Teens

The Office of Adolescent Health (OAH) recently published immunization recommendations for adolescents.  According to the OAH, at the age of 11 or 12 all adolescents should receive the following three important vaccines (as well as an annual flu shot):

  • Tetanus, diphtheria, and pertussis vaccine (1 dose): a booster to protect against these three infectious diseases (pertussis is also called “whooping cough”);
  • Meningococcal conjugate vaccine (2 doses) (MCV4 or MenACWY): an immunization to protect against meningococcal disease (such as meningitis or sepsis, a blood infection);
  • Human papillomavirus (HPV) vaccine (3 doses) (Cervarix or Gardasil): an immunization recommended for both boys (Gardasil only) and girls (both Cervarix or Gardasil) to protect against many HPV-related cancers;
  • Influenza (flu) vaccine (each year): a vaccine (either the flu shot or nasal spray) that is recommended yearly for everyone over 6 months of age to protect against different strains of seasonal influenza.

Additional information about vaccinations, as well as an interactive chart, can be found on the OAH’s Website.

How To Form An ACO

An accountable care organization (ACO) is a Medicare shared savings program that promotes accountability for a patient population, coordinates items and services under Medicare parts A and B, and encourages investment in infrastructure and redesigned care processes for high quality and efficient services.  In early July 2012 the United States Department of Health and Human Services (HHS) announced the approval of 89 new ACOs, joining the 27 previously approved ACOs participating in the Medicare shared savings program. The new ACOs did not include those already participating in the Pioneer ACO Model or the Physician Group Practice Transition Demonstration.

The statutory authority for ACOs is set forth in 42 U.S.C. § 1395jjj: “Not later than January 1, 2012, the Secretary shall establish a shared savings program (in this section referred to as the ‘‘program’’) that promotes accountability for a patient population and coordinates items and services under parts A and B, and encourages investment in infrastructure and redesigned care processes for high quality and efficient service delivery.” Continue reading →

Improving Coverage Under the Affordable Care Act

While the success of the Affordable Care Act remains to be seen, there is no shortage of ways in which the Federal Government hopes to improve coverage.

The following is a sampling of some statutory provisions (42 U.S.C. sections 300gg-1, 2, 3, 4, 5, 6, 7, 8, 9, 11 and 12) designed to make American health better.

  1. Guaranteed issuance of coverage in the individual and group market
  2. Guaranteed renewability of coverage
  3. Prohibition of preexisting condition exclusions or other discrimination based on health status
  4. Prohibiting discrimination against individual participants and beneficiaries based on health status
  5. Parity in mental health and substance use disorder benefits
  6. Comprehensive health insurance coverage
  7. Prohibition on excessive waiting periods
  8. Coverage for individuals participating in approved clinical trials
  9. Disclosure of information
  10. No lifetime or annual limits
  11. Prohibition on rescissions

Expanding Insurance for Dependants

Last week the Federal Government issued proposed regulations for Federal Employee Health Benefits (FEHB) Program enrollees.

Expanding upon the Affordable Care Act’s insurance provision for dependents until the age of 26 (42 U.S.C. § 300gg-14(a)), the proposed regulations will afford the same coverage for FEHB-enrollee children of same-sex domestic partners.

The regulations also allow children of same-sex domestic partners to be covered family members under the Federal Employees Dental and Vision Insurance Program (FEDVIP). Continue reading →


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