Marie Beatrice "Bea" Grause
President and Chief Executive OfficerFebruary 2002
Legislators in Montpelier and Washington D.C. are in full swing with political, budget and health care issues. In Montpelier the political agenda is now focused on reapportionment. A purely partisan political phenomenon, reapportionment must take place every 10 years to ensure that legislative districts accurately represent the same number of voters from district to district. With the November elections looming on the horizon, it could take weeks before the two parties agree on new district lines. This political debate however, could push other important issues off this year's legislative agenda.
On health care matters, the committees in both the House and Senate have been embroiled in health care details. The Senate Committee on Finance is likely to approve the Governor's proposal that would allow certain individuals and businesses to buy into the Vermont Health Access Plan, the Senate Health and Welfare Committee is in it's third week of hearings on Certificate of Need legislation and the House Health and Welfare committee has just released legislation that would wholly re-vamp the Medicaid program.
The outcome of this legislative work on our issues will very much depend on the conversations we have with them. The Association has given testimony to the relevant committees on our issues, but the exchange doesn't - or shouldn't - end there. Understanding the full impact of any proposed legislative change requires tremendous effort and thought in order to place the change in its proper context. For example, a Medicaid change that would create a new class of beneficiaries must clearly be evaluated from a financial perspective. Legislators, however, must also consider how this change would impact the beneficiary, the commercial insurance market, providers and local communities. It's a complicated context to consider.
Hospital trustees can help provide this context to legislators. As integral and active members of their hospital communities, trustees can provide valuable feedback to legislators on any proposed health care idea or bill. In addition, trustees can help educate legislators about the important role their hospital plays in their community - including details about how hospitals meet their patients' needs, keep their costs down and ensure that their communities stay healthy. For example, hospital trustees can share with legislators some of the unexpected expenses hospitals face to keep qualified professional staff: the cost of "travelers," recruitment costs and significant salary and benefit increases. In short, trustees are our best advocates.
To help facilitate these important conversations, the Association will sponsor five Regional Trustee Political Forum Meetings in March. These meetings will be held in Brattleboro, St. Johnsbury, White River Junction, Burlington and Rutland. We hope our trustees and legislators will make every effort to attend these important meetings.
On the federal front, the Bush Administration released a proposed FY 2003 budget that is most notable for what is did not contain: additional Medicare cuts.The $2.13 trillion budget health care priorities include increased funding to prepare against bioterrorism, tax credits to help make health care coverage more affordable and funding for prescription drug benefits for low-income Medicare beneficiaries. The President also proposed immediate implementation of a discount drug card program to give seniors access to discounts achieved through volume discounts and manufacturer rebates.
Good news for Critical Access Hospitals! The American Hospital Association (AHA) reports that Thomas Scully, Administrator of the Centers for Medicare and Medicaid Services (CMS), plans to direct surveyors to stop enforcing completion of the Minimum Data Set (MDS) for patients in Critical Access Hospitals (CAH) swing beds. Administrator Scully conceded to AHA's arguments that the MDS forms, initially designed for care planning in long-term facilities, were inapplicable to CAH swing beds because of patients' short lengths of stay and because the MDS form is not used in any way for payment. The formal removal of this requirement will be incorporated into federal regulations that will be released this spring. There are 3 CAHs in Vermont: Grace Cottage, Mt. Ascutney and Gifford hospitals.
The American Organization of Nurse Executives recently released a 2000 survey of nurse executives on registered nurse vacancy and turnover rates in 693 acute-care hospitals. This study found that R.N. vacancy rates for specific departments and functions ranged from 14.6 percent for critical care to 6.5 % for nurse managers. Fifty-four percent of hospitals reported using temporary staff. The national average turnover rate was 21.3 percent in 2000, with the majority of respondents citing relocation as the top reason for turnover. The report, "Acute Care Hospital Survey of RN Vacancy and Turnover Rates in 2000," is available online at www.aone.org. This report is consistent with Vermont's assessment of our state-wide nursing shortage.
Hospitals Invited To Take Advantage of CMS Open Door Conference Calls
As a part of the "open door" policy of Health and Human Services Secretary Thompson, the Center for Medicare and Medicaid Services (CMS) has scheduled a series of open door conference calls on various health topics. CMS Administrator Tom Scully quite often participates on these calls. The Dial-In number for all of these calls is: 800-837-1935. If you are unable to participate, recordings of the calls are available for 72 hours after the call at: 800-642-1687. The access code for this Encore Feature is the call ID number of the meeting. Over the next few weeks, the following calls are scheduled. All calls are Eastern Time:
Hospital Open
ID 2813693 Tuesday, 3/12/02 at 10:00 AM
ID 2813694 Wednesday, 4/10/02 at 10:00 AMHome Health Open
ID 2813753 Tuesday, 3/5/02 at 10:00 AM
ID 2813184 Tuesday, 4/9/02 at 10:00 AMRural Health Open
ID 2813443 Tuesday, 2/26/02 at 2:00 PM
ID 2813445 Tuesday, 3/26/02 at 2:00 PMLong-Term Care
ID 2813538 Tuesday, 2/26/02 at 6:00 PM
ID 2813539 Tuesday, 3/26/02 at 6:00 PMPharmacy
ID 2813936 Wednesday, 3/6/02 at 2:00 PM
ID 2813937 Wednesday, 4/3/02 at 2:00 PMNurses and Allied Health
ID 2813951 Wednesday, 3/13/02 at 10:00 AM
ID 2813952 Thursday, 4/11/02 at 10:00 AMEnd Stage Renal Disease
ID 2815663 Thursday, 3/14/02 at 1:00 PMPhysician
ID 1639817 Monday, 2/25/02 at 2:00 PM
ID 1639818 Monday, 3/18/02 at 2:00 PMFor further information about these meetings, contact Peter Holman at VAHHS, or Bill MacKenzie of the CMS Boston office at 617-565-1696. Meetings on each topic are scheduled through the end of 2002, and VAHHS will continue to update these listings in future editions of this newsletter.
Vermont Hospitals Seek Additional Sources for Blood Products
Fletcher Allen Health Care "SUN" Newsletter, Jan. 30, 2002In the spring of 2001, the national American Red Cross decided to limit the number of blood products it offers hospitals. Specifically, the Red Cross eliminated the sale of commonly used red blood cell units and began supplying only blood with the white cells removed - also called "leuko-reduced blood."
According to Ted Bovill, M.D., Fletcher Allen's Director of Pathology, "Physicians at Fletcher Allen want a choice of blood products when treating their patients. Only 40 percent of our patients require leuko-reduced blood due to having suppressed immune systems. We transfuse the majority of our patients with non leuko-reduced blood."
In addition, the Red Cross unexpectedly imposed a substantial price increase on the blood it sells to hospitals. Increasing the cost of blood by nearly one-third, the Red Cross forced Vermont's 14 hospitals to incur an additional $1 million annual expense. This additional expense comes at a time when the State of Vermont continues to criticize hospitals for their role in the rising cost of health care.
Tom Wadsworth, Pathology Administrative Director for Fletcher Allen and past president of the Clinical Laboratory Managers of Vermont, also is concerned that the Red Cross may have a difficult time meeting the state-wide demand for blood. "The demand for blood in Vermont increases at a rate of three to five percent annually. Blood shortages resulting from decreasing donations could severely impact patient care in the future if we don't ensure adequate supplies," Wadsworth said.
Due to these developments, Vermont's 14 hospitals are exploring supplemental sources of blood products to preserve physician choice, guarantee adequate supply of high-quality, safe products, and secure the lowest-cost blood products for patients.
"Vermont's hospitals are looking for every possible way to keep health care costs down," said Beatrice Grause, R.N., J.D., President of the Vermont Association of Hospitals and Health Systems. "We have a responsibility to give patients access to reasonably priced, high quality blood. Patients may think that the blood supply is free, but it is not free. We all pay for it."
Options that are being explored include purchasing blood from a private supplier from out of state and/or creating a Vermont blood donor system for Vermont hospitals. Several other New England hospitals, including Dartmouth Hitchcock Medical Center, Maine Medical Center and Eastern Maine Medical Center, all have instituted blood supply alternatives to supplement the Red Cross supply in their respective geographical areas.
State of Vermont to Receive $6.8 Million in Federal Bioterrorism Funds
The US Department of Health and Human Services (HHS) recently allocated $1.1 billion, including $6.8 million for Vermont, to help states better prepare for bioterrorism. Each state will receive a base amount, plus additional funding based on population. Under the plan, the Vermont Department of Health (VDH) will receive $6,355,143 through the U.S. Centers for Disease Control (CDC) and $485,864 through the Health Resources and Services Administration (HRSA). The Hospital Preparedness Program will be administered by the Health Resources and Services Administration (HRSA). Funds for the program are intended to supplement, not supplant other Federal, State, and local public health funds available for emergency activities to combat threats to public health.
Vermont Explor: Data Developments
Vermont Explor, the Association’s data collection enterprise, is currently involved in a number of health data initiatives.
Greg Farnum, Vice President, and Lauri Scharf, Data Analyst, oversee the collection of hospital discharge data from all Vermont acute care hospitals. They will be submitting a preliminary data set to Vermont state government including January-June, 2001 discharges. The Dept. of Health is considering new injury surveillance uses for the data, now that we collect all Emergency Room visits. Those are in addition to all inpatient visits, observation room visits, and outpatient surgeries.
As a co-founder and coordinator of NHVShip, a volunteer group preparing for HIPAA compliance, Greg contributes heavily to the understanding of HIPAA among providers in Vermont and New Hampshire. The group meets regularly at the VA in White River Junction. See www.nhvship.org for more details.
Vermont Explor is coordinating the AHA’s Annual Survey in Vermont. All of our hospitals participate in this survey on personnel, financials, patients and services.
