WORKFORCE ISSUES

How Many Nurses are on the Floor?

On May 16, Vermont Gov. James Douglas signed HB 227, which requires hospitals to post, in a public area, information on the number of patients and nurses for every unit and shift. Particular levels of staffing are not mandated. Hospitals must post information on nurse staffing levels and maximum patient loads at least once a day. The bill also mandates the creation of a task force to identify nursing quality indicators that should be included in a hospital’s annual report. “Easily accessible staffing levels will help force hospitals to end the dangerous practice of requiring nurses to care for too many patients,” said Candice Owley from AFT Healthcare, parent union of Vermont Federation of Nurses and Health Professionals. “Short of specific staffing levels, every state in the interest of its citizens should pass a consumer-friendly disclosure law.” Vermont joins New Jersey and Illinois as the only states to have disclosure laws for hospitals. California is currently the only state that requires specific nurse to patient staffing ratios.

Increasing Reimbursement

In an effort to attract and retain mental health-care providers in North Carolina, state officials have announced that they want to pay psychiatrists 33 percent more for some treatments for Medicaid patients. Part of an "Action Agenda" for improving the state's mental-health system, the change would affect about 300 psychiatrists and cost the state between $1.5 million and $3 million, officials said. "We simply don't have enough psychiatrists, especially child psychiatrists, to meet our needs," Dr. Allen Dobson of the state Department of Health and Human Services told the Winston-Salem Journal. Health officials believe increasing reimbursement will be an investment, possibly resulting in fewer visits to emergency rooms and savings in other areas. The Action Agenda also calls for directing money to training more psychiatrists, increasing access to prescription medication for the poor, increasing monitoring of medical providers' accreditation and possibly consolidating some mental-health services into fewer buildings. Rep. Verla Insko, co-chair of the oversight committee for mental health services, said she welcomes the proposed goals, adding that they are “consistent” with the committee’s efforts.

SUBSTANCE ABUSE

Online Databases Prevent Painkiller Abuse

A new Virginia law (H 2429) designed to prevent prescription drug abuse took effect last week, requiring the state’s 2,000 pharmacies to submit patient names and prescription information for certain medications to an online database administered by the state’s Department of Health Professions, the Roanoke Times recently reported. The database will allow doctors to make sure suspected drug abusers aren’t “doctor shopping”—or getting multiple prescriptions for painkillers like OxyContin and methadone from more than one physician at a time. The law expands a 2003 pilot program authorized by the General Assembly that collected information on a limited number of medications in southwestern Virginia. Deaths from prescription drug overdoses in that region of the state have tripled over the past decade, to over 200 per year, according to the state medical examiner, the Times reported. The now-statewide database will include not just prescriptions for potent Schedule II painkillers, as in the pilot program, but Schedule III and IV drugs like Vicodin as well. Access to the database—which already has 2.1 million records from the pilot project in southwest Virginia—is limited to physicians who have obtained consent from their patients and law enforcement officials already investigating a suspected drug abuser. Virginia is the 23^rd state to adopt a prescription tracking program, according to the National Alliance for Model State Drug Laws.

HEALTH INFORMATION TECHNOLOGY

E-Scripts

In 2005 in Nevada, at least one person died from a prescription mix-up, and 27 individuals lodged official complaints with the State Pharmacy Board. To reduce medication errors, Sierra Health Services, Nevada’s largest health plan, has teamed up with the Clark County Medical Society, the state’s largest medical group, to provide electronic prescribing technology to each physician in the state. Under the initiative, doctors who are members of the Nevada State Medical Association can receive an Allscripts’ Electronic Health Record software license free of charge for 10 years, and free monthly maintenance for up to two years. Physicians who are not members of the association are eligible to receive the software at no cost but will have to pay a $20 monthly fee to use it. All physicians will be responsible for their own hardware. Last year, Southwest Medical Associates (SMA), a unit of Sierra Health Services, launched a pilot project and successfully deployed Allscripts to its nearly 250 providers. Over the course of the year, physicians wrote over 1 million electronic prescriptions for their patients, making them the leading electronic prescribing practice in the country. E-prescribing reduced prescription errors and significantly increased the use of generic drugs, Sierra Health Services said, so the plan decided to implement the technology statewide.

HEALTH SYSTEM FINANCING

Cost-Shifting Grows Worse

U.S. employers and consumers are paying billions of extra dollars each year for medical care in hospitals and doctors' offices to offset underpayments from Medicare and Medicaid, according to a study released May 31 by Seattle-based health insurer Premera Blue Cross. In 2004, hospitals in Washington charged an additional $738 million to private payers to make up for underpayments from Medicare and Medicaid, the study says. The same year, in-state physicians charged private payers an extra $620 million to compensate for losses from the government programs. In 1997, Washington hospitals had a profit margin of 2.9 percent for delivering Medicare services, but in 2004, they lost 15.4 percent from Medicare. During the same period, hospitals' profit margins from patients with employer-sponsored health plans increased from 5 percent to 16.4 percent. According to the study, Medicare pays physicians 25 percent to 31 percent less than private insurers in Washington, and Medicaid pays about 30 percent less than private insurers for children's office visits and up to 54 percent less for adults' office visits.  All told, employers pay an additional $902 per family insurance policy per year to make up for the losses incurred by Medicare and Medicaid. The Washington State Medical Association says 65 percent of physicians in the state have stopped accepting new Medicare and Medicaid patients because of low reimbursement rates. The Premera Blue Cross study is available online.

A Vicious Cycle

A second study commissioned by Blue Shield of California finds that health plans and consumers in California paid an additional $4.5 billion 2004 for hospital care to make up for underpayments by Medicare and Medicaid. The study did not examine trends for physicians' offices. Employers say the rising health-care costs are contributing to the growing number of people without insurance, adding that when uninsured people check into hospitals, they generate even higher costs for those employers and consumers who pay insurance premiums, according to the New York Times. “The reports show employers and policymakers that they need to address an unsustainable trend in the growth of cost-shifting,” Rich Maturi, a senior vice president at Premera, told the Times. “This is a serious national problem, and it is only going to get much worse," said Helen Darling, president of the National Business Group on Health.

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