WBEZ | healthcare http://www.wbez.org/tags/healthcare Latest from WBEZ Chicago Public Radio en Teaching hospitals hit hardest by medicare fines for patient safety http://www.wbez.org/news/teaching-hospitals-hit-hardest-medicare-fines-patient-safety-111272 <img typeof="foaf:Image" src="http://llnw.wbez.org/main-images/er.jpg" alt="" /><p><p>Medicare has begun punishing 721 hospitals with high rates of infections and other medical errors, cutting payments to half the nation&#39;s major teaching hospitals and many institutions that are marquee names.</p><p>Intermountain Medical Center in Utah, Ronald Reagan UCLA Medical Center in Los Angeles, the Cleveland Clinic, Geisinger Medical Center in Pennsylvania,&nbsp;Brigham and Women&#39;s Hospital in Boston, NYU Langone Medical Center and Northwestern Memorial Hospital in Chicago are all being docked 1 percent of their Medicare payments through next September,&nbsp;<a href="http://cdn.kaiserhealthnews.org/attachments/HACPenaltyChart.pdf">federal records show</a>.</p><p>In total, hospitals will forfeit $373 million, Medicare estimates.</p><p>The federal health law required Medicare to lower payments for the quarter of hospitals with the highest rates of hospital-acquired conditions, or HACs.</p><p>These&nbsp;<a href="https://www.qualitynet.org/dcs/ContentServer?c=Page&amp;pagename=QnetPublic%2FPage%2FQnetTier3&amp;cid=1228774294977">avoidable complications</a>&nbsp;include infections from central line catheters, blood clots and bed sores.</p><p>The penalties come as hospitals are showing some success in&nbsp;<a href="http://www.ahrq.gov/professionals/quality-patient-safety/pfp/interimhacrate2013.html">reducing harmful errors</a>. A recent federal report found the frequency of mistakes dropped by 17 percent between 2010 and 2013, an improvement Health and Human Services Secretary Sylvia Burwell called &quot;a big deal, but it&#39;s only a start.&quot; Even with the reduction, one in eight hospital admissions in 2013 included a patient injury.</p><p>Dr. Eric Schneider, a Boston health researcher, said studies have shown that medical errors can be reduced through a number of techniques, such as entering physician orders into computers rather than scrawling them on paper, better hand washing and checklists on procedures to follow during surgeries. &quot;Too many clinicians fail to use those techniques consistently,&quot; he said.</p><p>The quality penalties have &quot;put attention to the issue of complications and that attention wasn&#39;t everywhere,&quot; said Dr. John Bulger, chief quality officer at Geisinger Health System, based in Danville, Pa. However, he said hospitals like Geisinger&#39;s now must spend more time reviewing their Medicare billing records as the government uses those to evaluate patient safety. The penalty program, he said, &quot;has the potential to take the time that could be spent on improvement and [spend it instead] making sure the coding is accurate.&quot;</p><p>Hospitals complain there may be almost no difference between hospitals that are penalized and those that narrowly escape fines. &quot;Hospitals may be penalized on things they are getting safer on, and that sends a fairly mixed message,&quot; said Nancy Foster, a quality expert at the American Hospital Association.</p><p>The penalties come on top of other fines Medicare&nbsp;<a href="http://kaiserhealthnews.org/news/medicare-readmissions-penalties-2015/">has been levying</a>. With the HAC penalties now in place, the worst-performing hospitals this year risk losing more than 5 percent of their regular Medicare reimbursements.</p><p>About 1,400 hospitals are exempt from penalties because they provide specialized treatments such as psychiatry and rehabilitation or because they cater to a particular type of patient such as children and veterans. Small &quot;critical access hospitals&quot; that are mostly located in rural areas are also exempt, as are hospitals in Maryland, which have a special payment arrangement with the federal government.</p><p>In evaluating hospitals for the HAC penalties, the government adjusted infection rates by the type of hospital. When judging complications, it took into account the differing levels of sickness of each hospital&#39;s patients, their ages and other factors that might make the patients more fragile. Still, academic medical centers have been complaining that those&nbsp;<a href="http://www.npr.org/templates/transcript/transcript.php?storyId=323998618">adjustments are insufficient</a>&nbsp;given the especially complicated cases they handle, such as organ transplants.</p><p>&quot;To lump in all of those things that are very complex procedures with simple things like pneumonia or hip replacements may not be giving an accurate result,&quot; said Dr. Atul Grover, the chief public policy officer of the Association of American Medical Colleges.</p><p>Medicare levied penalties against a third or more of the hospitals it assessed in Colorado, Connecticut, Delaware, Nevada, New Jersey, New Mexico, Rhode Island, Utah, Washington and the District of Columbia, a Kaiser Health News analysis found.</p><p>A separate analysis of the penalties that Dr. Ashish Jha, a professor at the Harvard School of Public Health, conducted for Kaiser Health News found that penalties were assessed against 32 percent of the hospitals with the sickest patients. Only 12 percent of hospitals with the least complex cases were punished.</p><p>Hospitals with the poorest patients were also more likely to be penalized, Jha found. A fourth of the nation&#39;s publicly owned hospitals, which often are the safety net for poor, sick people, are being punished.</p><p>&quot;I&#39;ve worked in community hospitals. I&#39;ve worked in teaching hospitals. My personal experience is teaching hospitals are at least as safe if not safer,&quot; Jha said. &quot;But they take care of sicker populations and more complex cases that are going to have more complications. The HAC penalty program is really a teaching hospital penalty program.&quot;</p><p>You can download the full list of hospital penalties&nbsp;<a href="http://cdn.kaiserhealthnews.org/attachments/HACPenaltyChart.pdf">here</a>.</p><p>&mdash; <a href="http://www.npr.org/blogs/health/2014/12/19/371862146/teaching-hospitals-hit-hardest-by-medicare-fines-for-patient-safety"><em>via NPR</em></a></p></p> Fri, 19 Dec 2014 12:22:00 -0600 http://www.wbez.org/news/teaching-hospitals-hit-hardest-medicare-fines-patient-safety-111272 The health problems facing rural and urban poor in Illinois http://www.wbez.org/news/health-problems-facing-rural-and-urban-poor-illinois-110959 <img typeof="foaf:Image" src="http://llnw.wbez.org/main-images/chinese.JPG" alt="" /><p><p>Each year, researchers at the University of Wisconsin&rsquo;s Population Health Institute put out the County Health Rankings. The rankings show how counties across the country match up on things like life expectancy and residents&rsquo; health.</p><p>Julie Willems Van Dijk is one of the directors.</p><p>&ldquo;The reason we do it is to raise awareness about how healthy our communities are, and how healthy they&rsquo;re not. To do so in a way that piques people&rsquo;s interest by comparing them to other counties in their community. And ultimately in a way that helps everybody see &hellip; that health in your community is not just about what the doctors and nurses do. But it really is about decisions that are made by businesses, by government,&rdquo; Willems Van Dijk says.</p><p>Most of the counties around Chicago do really well,&nbsp; but Cook County is way down near the bottom - 75 out of 102 Illinois counties in health outcomes.</p><p>Twenty spots down the list from Cook is Edwards County. Edwards County ranks 96th of all Illinois counties for health outcomes. It&rsquo;s worth looking at because unlike most of the sickest counties, it isn&rsquo;t particularly poor. Edwards County&rsquo;s poverty level is better than the state average.</p><p>&ldquo;Income, and especially poverty are definitely drivers of health,&rdquo; Willems Van Dijk says.</p><p>But that&rsquo;s not what&rsquo;s happening in Edwards County.</p><p>Edwards is due south from Chicago, down near where Illinois, Kentucky and Indiana meet. It&rsquo;s incredibly sparse with just 30 people per square mile. The Illinois average is almost eight times as much.</p><p>Misty Pearson is the administrator of the Edwards County Health Office.</p><p>Edwards is one of only two counties in Illinois without an official health department. That&rsquo;s why it&rsquo;s called a health office, instead of a department of health like in almost every other county.</p><p>&ldquo;We are not certified by the state of Illinois, by choice, I guess. Not my choice, I would change that if I could,&rdquo; Pearson says.</p><p>The health office isn&rsquo;t certified because Edwards County leaders are so against the state being involved in their county they refuse to take health funding from Illinois because it comes with strings attached - like state oversight.</p><p>&ldquo;Food sanitation, we don&rsquo;t have that. None of our restaurants are inspected. It does [make me nervous]. There are certain restaurants I won&rsquo;t eat at,&rdquo; Pearson says. &ldquo;The only thing we can do that a health department does is vaccines for children.&rdquo;</p><p>So Edwards County - despite its low health ranking and relative economic strength - isn&rsquo;t the best indicator of the state&rsquo;s health needs overall.</p><p>The state government can&rsquo;t force people to vaccinate their kids or make counties take its money.</p><p>Still, experts say Illinois needs to come up with policies that work for Edwards County with 30-people per square mile, and Cook County with 5,500-people per square mile.</p><p>They say it can be done. Because despite their differences in population and demographics the two counties face similar health challenges.</p><p>At the top of the list is access to doctors.</p><p>The Illinois Department of Public Health has a map of areas with a dearth of primary care providers.</p><p>There are a lot of downstate counties shaded in - but there&rsquo;s also a bunch of Chicago neighborhoods -- from Rogers Park up north to Austin on the West Side and Chicago Heights down south.</p><p>Harold Pollack with the University of Chicago says the state could help poor people in urban and rural areas by raising Medicaid rates, or just paying its bills on time.</p><p>&ldquo;I can tell you that as someone who takes care of an adult on Medicaid that there are services that we can&rsquo;t use because the providers that we&rsquo;d like to use don&rsquo;t accept Medicaid,&rdquo; Pollack says.</p><p>So physician shortages might not be the happiest point of unity, but Misty Pearson in Edwards County and Harold Pollack in Chicago say they - and others - will be thinking of it when they go into the voting booth.</p><p>In a little more than a week there will be millions of people at the polls. They&rsquo;ll each have different experiences and different expectations, but they&rsquo;ll all be voting on the future of one state.</p><p>&ldquo;How are we going to make these budget numbers work &hellip; and also pay for the services that people in the state actually want and will continue to demand,&rdquo; says Pollack..</p><p><em>Patrick Smith is a WBEZ Reporter/Producer. Follow him on twitter <a href="http://twitter.com/pksmid" target="_blank">@pksmid</a>.</em></p></p> Fri, 17 Oct 2014 12:32:00 -0500 http://www.wbez.org/news/health-problems-facing-rural-and-urban-poor-illinois-110959 Morning Shift: Exploring options for caring for the elderly http://www.wbez.org/programs/morning-shift-tony-sarabia/2014-04-16/morning-shift-exploring-options-caring-elderly-110031 <img typeof="foaf:Image" src="http://llnw.wbez.org/main-images/old Flickr VinothChandar.jpg" alt="" /><p><p>We unpack some of the questions surrounding elder care. Also, a conversation with comedian Bob Saget, whose new book swings back and forth between funny and poignant.</p><div class="storify"><iframe src="//storify.com/WBEZ/morning-shift-exploring-options-for-caring-for-the/embed?header=false&border=false" width="100%" height=750 frameborder=no allowtransparency=true></iframe><script src="//storify.com/WBEZ/morning-shift-exploring-options-for-caring-for-the.js?header=false&border=false"></script><noscript>[<a href="//storify.com/WBEZ/morning-shift-exploring-options-for-caring-for-the" target="_blank">View the story "Morning Shift: Exploring options for caring for the elderly" on Storify</a>]</noscript></div></p> Wed, 16 Apr 2014 08:44:00 -0500 http://www.wbez.org/programs/morning-shift-tony-sarabia/2014-04-16/morning-shift-exploring-options-caring-elderly-110031 First day glitches as Affordable Care Act launches http://www.wbez.org/news/first-day-glitches-affordable-care-act-launches-108822 <img typeof="foaf:Image" src="http://llnw.wbez.org/main-images/getcoveredillinois.jpg" alt="" /><p><p dir="ltr">The government may have shut down today, but the Affordable Care Act is marching forward. The state website, <a href="http://getcoveredillinois.gov/">Get Covered Illinois,</a> was up by early this morning. And the <a href="https://www.healthcare.gov/">federal website,</a> where Illinois residents will shop on the marketplace for coverage, was also live. But many people encountered glitches, delays, and error messages.</p><p dir="ltr">Jose Galarza is the billing manager at the Infant Welfare Society on the Northwest side of Chicago. They don&rsquo;t have health navigators in their offices, but staff did receive training to sign people up on the marketplace and the organization is listed on the government&rsquo;s website<a href="http://getcoveredillinois.gov/get-help/"> as an official resource. </a></p><p dir="ltr">Galarza says his organization has been preparing for today for a long time. This morning he says he was full of nervous energy. &ldquo;I was up at 4:30 a.m. this morning, thinking about this the whole process and what to expect,&rdquo; he said.</p><p dir="ltr">When he got to the office the first thing Galarza did was to go to the website and try to fill out an application. &nbsp;He received error messages and never completed the process. Later, he couldn&rsquo;t get to the application at all and instead received a message that the site was overburned by traffic.</p><p dir="ltr">Galarza&rsquo;s experiences were not unique. Organizations and individuals across the city reported similar problems. Before today&rsquo;s launch officials said that some aspects of the site, such as the Spanish language version and small business site, wouldn&rsquo;t be entirely complete.</p><p dir="ltr">By 9:30 a.m. Galarza says three people called to say they would come in for help that day. &nbsp;&ldquo;I put myself in the client&#39;s shoes. If I am excited and I get myself &nbsp;prepared, and then come into a place like this... and [can&rsquo;t fill out an application], it would be very frustrating,&rdquo; he said.</p><p dir="ltr">Illinois Governor Pat Quinn cautioned against judging the Affordable Care Act based on first day problems. &nbsp;&ldquo;We understand with any new program there will be glitches and bumps along the way. When Apple unveils a new device, they may have some minor problems and glitches&hellip; but they go forward. They don&rsquo;t stop and say they will take a year off. They understand how important it is to complete the mission,&rdquo; said Quinn.</p><p dir="ltr">Despite his frustrations, Galarza had a positive message for his clients, one that wasn&rsquo;t that different from the Governor&#39;s. &ldquo;I would say just take a deep breath. We have until December 15th, which is the deadline for your coverage to start on January 1st,&rdquo; said Galarza.</p><p dir="ltr">According to the state, as of 6:00 p.m. more than 76,653 visitors &nbsp;had come to the online marketplace.</p><p>If you run into a problem or need help navigating the website, you can contact the state hotline at 1-866-311-1119.</p><p><em>Shannon Heffernan is a WBEZ reporter. Follow her <a href="https://twitter.com/shannon_h">@shannon_h</a></em></p></p> Wed, 02 Oct 2013 09:35:00 -0500 http://www.wbez.org/news/first-day-glitches-affordable-care-act-launches-108822 Illinois businesses work to sort out the Affordable Care Act http://www.wbez.org/news/illinois-businesses-work-sort-out-affordable-care-act-107194 <p><p>&nbsp;</p><p dir="ltr">Illinois businesses are preparing for the Affordable Care Act to go into full effect in 2014, and a leader from the Illinois Chamber of Commerce says some are considering limiting work hours to avoid future healthcare costs. But costs and logistics vary widely across different types of firms.</p><p dir="ltr">&ldquo;It&rsquo;s one giant puzzle within a puzzle within a puzzle,&rdquo; said Laura Minzer, the Executive Director of the Health Care Council for the for the Illinois Chamber of Commerce.</p><p dir="ltr">She says employers, small and large, are scrambling to figure out which provisions of the federal law will apply to them and their employees. Businesses with under 25 employees may become eligible for tax credits for providing health care, while businesses with over 50 workers could face fines if they don&rsquo;t provide affordable insurance for all employees working 30 hours or more.</p><p dir="ltr">The number of workers receiving employer-sponsored health care has declined steadily in recent years. Now, Minzer says limiting employee hours to under 30 is on the table for some bigger businesses worried about new health care costs.</p><p dir="ltr">&ldquo;The cost of their benefits is not going down and it will not go down with this law,&rdquo; said Minzer. Indeed, insurance premiums have been steadily rising, and experts expect to see a continued rise nationwide. But cuts to hours may be nothing new: the proportion of workers in part-time jobs has been on the rise since 2007.</p><p dir="ltr">One in five adults in Illinois is currently uninsured, and if they can&rsquo;t get employer insurance, some will become eligible for government subsidies through the &ldquo;marketplace&rdquo; (formerly known as the exchange), which is a state and/or federally-run service intended to centralize and streamline shopping for private health insurance. Sliding scale subsidies in the form of tax credits will be available to those making up to four times the federal poverty level. Currently, Illinois has agreed to an insurance marketplace run jointly by Illinois and the federal government, but Minzer says the Chamber of Commerce supports opening a state-run marketplace by 2015.</p><p dir="ltr">&ldquo;Even with all the concerns that we have about affordability, we see value in...the fact that you have a one-stop-shop for health insurance,&rdquo; said Minzer. &ldquo;The state is in a better position to administer that.&rdquo;</p><p dir="ltr">States also have the option to expand Medicaid eligibility to adults making up to 138 percent of the federal poverty level, an option that&rsquo;s <a href="http://www.wbez.org/news/cook-county-begins-enrolling-250000-new-medicaid-recipients-103902">already being piloted in Cook County</a>. However, because of a controversial Supreme Court decision, states can opt out of the Medicaid expansion, and Illinois has yet to pass a bill that would expand Medicaid statewide in 2014.</p><p dir="ltr">Perhaps surprisingly, the Illinois Chamber of Commerce also supports the Medicaid expansion.</p><p dir="ltr">That&rsquo;s because there&rsquo;s a benefit for business: employees who receive Medicaid would do so without triggering penalties for their big employers (as opposed to seeking out insurance through the marketplace, which would trigger penalties). Recent reports have found that larger businesses have a financial incentive to support Medicaid expansion and avoid fees for not providing health insurance to low-income employees.</p><p dir="ltr">Bills to expand Medicaid and to establish a state-run insurance marketplace are creeping through the Illinois General Assembly, and the federal/state insurance marketplace is slated to open October 1, 2014.</p><p>Lewis Wallace is a Pritzker Journalism Fellow at WBEZ. Follow him <a href="http://twitter.com/lewispants">@lewispants</a>.</p></p> Thu, 16 May 2013 05:00:00 -0500 http://www.wbez.org/news/illinois-businesses-work-sort-out-affordable-care-act-107194 10 Years since Iraq: The Changing Face of War http://www.wbez.org/series/chicago-amplified/10-years-iraq-changing-face-war-107190 <p><p>This program to mark the tenth anniversary of the beginning of the Iraq War in 2003, includes a panel of speakers addressing the changing face of war. Abroad, the US&#39; increased use of drones for &quot;targeted killings&quot; in Afghanistan, Pakistan, Yemen, and Somalia, has resulted in the deaths of thousands of civilians. Here in the US, deadly cuts continue to be imposed on domestic programs in order to fund the Pentagon&#39;s excessive spending and line the pockets of wealthy corporations, such as Boeing. The fights for public education, housing, and healthcare are intricately tied to the fights against war and imperialism.</p><p><strong>Peter Lems</strong> is a leader in the American Friends Service Committee anti-drone effort. <strong>Kait McIntyre</strong> of the Anti-War Committee speaks about the local campaign targeting Boeing. <strong>Vince Emanuele</strong>, of the Iraq Veterans Against the War, served two tours in Iraq.</p><div class="image-insert-image "><img alt="" class="image-original_image" src="http://www.wbez.org/system/files/styles/original_image/llo/insert-images/AFSC-webstory_7.jpg" style="float: left;" title="" /></div><p>&nbsp;</p><p>&nbsp;</p><p><br />Recorded live Wednesday, March 20, 2013 at Grace Place.&nbsp;</p></p> Wed, 20 Mar 2013 15:37:00 -0500 http://www.wbez.org/series/chicago-amplified/10-years-iraq-changing-face-war-107190 Adjunct professors demand inclusion in health care reforms http://www.wbez.org/news/adjunct-professors-demand-inclusion-health-care-reforms-106034 <p><p>Starting in January 2014, large employers will be required to give health benefits to people who work at least 30 hours a week. The provision of the federal Affordable Care Act applies to anyone with more than 50 full-time employees &ndash; including all of Illinois&#39; community colleges.</p><p>Now some adjunct professors are worried they&rsquo;ll have their hours cut by colleges who don&rsquo;t want to shell out the cash come January.</p><p>Dennis Polkow joined a group of protesters Friday outside the Westin Hotel, where Illinois community college leaders were holding a weekend gathering. After working at Oakton Community College for 13 years, he&rsquo;s teaching 3 classes this semester and making less than 12 thousand dollars, he says, with no benefits<b style="font-weight: normal;"><span style="font-size: 16px; font-family: Arial; vertical-align: baseline; white-space: pre-wrap;">. </span></b>Like many other adjuncts, Polkow often juggles jobs at several colleges to make ends meet.</p><p>He said when he heard about the health care bill, &ldquo;I thought, hallelujah, affordable health care act. I&rsquo;ll be able to get affordable health care. Instead it&rsquo;s like...cut, cut, cut, cut, cut.&rdquo;</p><p>Polkow&rsquo;s one of the people who&rsquo;d be covered under Obamacare. But this February he found out Oakton may limit adjunct course loads in preparation for the health care law to kick in.</p><p>The college caught flack from faculty over memos that circulated about limiting adjunct course hours, and now Oakton Community College President Peg Lee says nothing&rsquo;s been decided.</p><p>&ldquo;We don&rsquo;t even know how to define the number of hours,&rdquo; she said Friday.</p><p>Adjuncts are paid by the course hour rather than by hours worked, and federal guidelines for calculating who will get coverage are still under review. Lee says whatever the calculations, community colleges are already strapped for cash. Governor Quinn&rsquo;s 2014 budget slashes higher education by five percent, and Lee says Oakton&rsquo;s still waiting on state reimbursement checks from last year. Sequestration cuts could also limit the numbers of students bringing federal aid into the community college system.</p><p>&ldquo;As much as I believe in universal health care and a single payer, we can&rsquo;t be that universal health care and single payer provider,&rdquo; Lee said. &ldquo;We just don&rsquo;t have the money.&rdquo;<img alt="" class="image-original_image" src="http://www.wbez.org/system/files/styles/original_image/llo/insert-images/RS7114_051-scr.JPG" style="height: 187px; width: 280px; float: right;" title="Peg Lee (WBEZ/Lewis Wallace)" /></p><p>It&rsquo;s unclear whether most community colleges will adopt the practice of cutting adjunct hours to avoid Obamacare costs.</p><p>&ldquo;We&rsquo;re learning what the rules are and how they impact employees and employers, and the decisions that need to be made,&rdquo; said Mike Monaghan, director of the Illinois Community College Trustees Association. &ldquo;We have lots more work to do.&rdquo;</p><p>Still, he said the adjuncts&rsquo; concerns are legitimate.</p><p>&ldquo;Everybody has reason to be concerned, whether you&rsquo;re an employee or an employer,&rdquo; Monaghan said. &ldquo;Any additional expense puts pressure on declining budgets.&rdquo;</p><p>Cuts are already in place at Joliet Junior College (JJC).&nbsp;In anticipation of the health care reforms, the administration has placed a cap of six course hours per semester on all adjuncts&rsquo; schedules beginning this summer. At the protest Friday, JJC adjuncts&rsquo; union president Al Kennedy spoke quietly but urgently&nbsp;about the effect of the cuts on some union members.</p><p>&ldquo;Are they going to be able to pay their rent for their apartment? Are they gonna be able to put food on the table for the kids? They&rsquo;re just beside themselves,&rdquo; he said.</p><p>JJC stands by the decision, saying that planning for a law they still have so little information about is a balancing act.</p><p><img alt="" class="image-original_image" src="http://llnw.wbez.org/styles/original_image/llo/insert-images/RS7116_019-scr.JPG" style="height: 201px; width: 300px; float: left;" title="Steven Brody (WBEZ/Lewis Wallace)" />&ldquo;I think this is just one of the sort of byproducts of this law,&rdquo; said JJC spokesperson Kelly Rohder.</p><p>But to protester Steven Brody, also an Oakton adjunct, this is about &nbsp;more than a fight over health care.</p><p>&ldquo;This is simply the first reaction of every one of these colleges to having to finally come to grips with the fact that they overutilize and underpay their adjunct faculty,&rdquo; he said.</p><p><a href="http://www.academicworkforce.org/CAW_portrait_2012.pdf" target="_blank">A recent study</a> found that three quarters of college classes nationwide are taught by part-time or adjunct instructors, a dramatic shift from the 1970s when the majority of classes were taught by tenured faculty. Average pay for adjunct professors adds up to just over $20,000 a year for eight courses total, and most of the positions don&rsquo;t come with health insurance.</p><p><em>Follow <a href="https://twitter.com/LewisPants" target="_blank">Lewis Wallace on Twitter</a>.</em></p></p> Mon, 11 Mar 2013 16:44:00 -0500 http://www.wbez.org/news/adjunct-professors-demand-inclusion-health-care-reforms-106034 Business owner gets 10 years for health care fraud http://www.wbez.org/news/business-owner-gets-10-years-health-care-fraud-104528 <p><p>A federal judge has sentenced a suburban Chicago man to 10 years in prison for defrauding Medicare of more than $2.9 million in a home health-care scheme.</p><p>U.S. District Judge Charles Kocoras handed down the sentence Thursday against Bahir Haj Khalil of Palos Heights. He also ordered Khalil to pay restitution and forfeit his assets.</p><p>Authorities say the 34-year-old Khalil was co-owner and executive manager of House Call Physicians, a home health business that submitted tens of thousands of false claims for unnecessary medical services.</p><p>Khalil was convicted in September. He&#39;s the last of three defendants to be sentenced.</p><p>The judge says he wants the sentence to send the message that such crimes will be treated harshly. Prosecutors say Khalil preyed on elderly victims and used them to enrich himself.</p></p> Fri, 21 Dec 2012 08:31:00 -0600 http://www.wbez.org/news/business-owner-gets-10-years-health-care-fraud-104528 Uninsured patients sue Chicago nonprofit hospital http://www.wbez.org/news/uninsured-patients-sue-chicago-nonprofit-hospital-104105 <p><p>A lawsuit filed Thursday claims a nonprofit hospital in northwest Chicago failed to provide charity care to two low-income, uninsured patients, reopening a longstanding controversy in Illinois over whether hospitals are doing enough charitable work to qualify for lucrative tax exemptions.</p><p>Swedish Covenant Hospital repeatedly lost one patient&#39;s financial assistance application and threatened to send her bill to a collection agency, according to the lawsuit. The hospital incorrectly told another patient she was ineligible for assistance and demanded cash from her, the complaint alleges.</p><p>The practices amount to &quot;bureaucratic barriers&quot; that prevent eligible patients from getting free care, according to the lawsuit, and the hospital has a policy of attempting to collect from &quot;even the poorest of patients&quot; through bill collectors and wage garnishment.</p><p>The hospital gets about $8 million in annual tax breaks and owes the community a more reliable charity care system, the plaintiffs&#39; attorney Alan Alop of the legal services group LAF said at a press conference Thursday in Chicago. The lawsuit claims unfair practices under the Illinois consumer fraud law and seeks $50,000 in punitive damages and a change in hospital policy.</p><p>Swedish Covenant spokeswoman Leigh Ginther said Thursday she couldn&#39;t comment on the lawsuit, but she said every patient who is identified as uninsured is given an application for charity care and a personal explanation of the process.</p><p>&quot;It is the patient&#39;s responsibility to return the completed paperwork,&quot; Ginther said. The hospital reported $6.2 million in charity care expenses last year, nearly 3 percent of its net revenue.</p><p>Nearly 2 million Illinois residents are uninsured, or about 15 percent. The state constitution, court decisions and state law require Illinois hospitals that receive tax exemptions to provide charity care, but until this year the definition of charity wasn&#39;t clear.</p><p>The lawsuit comes as Illinois Attorney General Lisa Madigan is writing new standards on hospital charity care as required by a law passed earlier this year.</p><p>A Chicago-based advocacy group, the Fair Care Coalition, wants Madigan to recommend that a standard, universal financial assistance application be used by all Illinois hospitals. The group also wants a thorough reporting mechanism so the public can check that hospitals are obeying the law, said Janna Simon of the coalition.</p><p>At the press conference, plaintiff Ramona Ortiz-Patino described filling out multiple applications for financial assistance and later being told the hospital hadn&#39;t received them. An unemployed diabetic, she was facing charges for emergency room visits for extreme pain in her right leg.</p><p>After Ortiz-Patino submitted a third application, a hospital employee telephoned her and &quot;let me know that my bill would be going to collections because I hadn&#39;t paid it,&quot; she said. &quot;I didn&#39;t understand why the hospital was threatening me when they knew I had zero income and I submitted three applications&quot; for financial assistance.</p><p>How much charity care should nonprofit hospitals provide? The issue has been brewing for years in Illinois.</p><p>In 2009, two large Illinois hospital systems settled class-action lawsuits that claimed they had overcharged uninsured patients. In separate settlements, Resurrection Health Care and Advocate Health Care agreed to pay refunds to tens of thousands of individuals.</p><p>Next, a 2010 Illinois Supreme Court ruling suggested nonprofit hospitals that behave like businesses shouldn&#39;t qualify for tax exemptions. Citing that court decision, the state Department of Revenue denied tax exemptions to three hospitals in 2011 and signaled more denials for other hospitals could follow.</p><p>That set off a storm of controversy the Legislature addressed this year.</p><p>Nonprofit hospitals won a broad definition of charity care from Springfield in a new state law that will allow them to continue their tax-exempt status. Hospitals were required to provide free care to patients of certain income levels, and the attorney general was directed to write standards for hospital financial assistance applications.</p></p> Thu, 29 Nov 2012 10:56:00 -0600 http://www.wbez.org/news/uninsured-patients-sue-chicago-nonprofit-hospital-104105 Cook County begins enrolling 250,000 new Medicaid recipients http://www.wbez.org/news/cook-county-begins-enrolling-250000-new-medicaid-recipients-103902 <img typeof="foaf:Image" src="http://llnw.wbez.org/main-images/Dr Raju Headshot 2012.jpg" alt="" /><p><p>This week Cook County will start sending letters to about 115,000 of its low-income residents inviting them to enroll in the county&rsquo;s new Medicaid program.</p><p>Adults under 65 with an income of up to 133% of the <a href="http://aspe.hhs.gov/poverty/figures-fed-reg.shtml">federal poverty level</a> will be eligible for Medicaid beginning in 2014 in states that choose to participate in the Affordable Care Act Medicaid expansion.</p><p>In Cook County, the expanded eligibility will begin even sooner, in January 2013. Cook County applied for and received a federal waiver to let the law kick in a year early.</p><p>&ldquo;We are excited not only because we got the waiver, we also get an opportunity to transform our healthcare system into the way it should be,&rdquo; said Dr. Ram Raju, CEO of Cook County Health Services.</p><p>The new Medicaid program, called County Care, will operate on a &ldquo;medical home&rdquo; model - which means the county&rsquo;s patients would have a doctor, a nurse, a social worker, and a medical assistant assigned to manage their health care.</p><p>&ldquo;What we do in the old model is, if you come through the door, you are my problem, I&rsquo;ll treat you well, I&rsquo;ll give you prescriptions. Then, you are not my problem until you come back next time six months later,&rdquo; said Dr. Raju. &ldquo;In the medical home model, even when you go home, you are still my responsibility.&rdquo;</p><p>To begin enrollment County Care, the county plans to reach out to every single eligible person currently on its books.</p><p>&ldquo;It&rsquo;s a massive task, because it is a lot of people we need to reach within a short period of time,&rdquo; said Dr. Raju. &ldquo;But one good advantage is that most of the people are already in our system.&rdquo;</p><p>A total of about 250,000 people in Cook County are probably eligible for County Care, but the county first plans to make contact with those who have already come through the Cook County system or one of its community health centers. After Nov. 26, low-income adults who are not already on the books will be able to call to find out whether they are eligible.</p><p><strong>County Care to provide mental health and substance abuse services</strong></p><p>Medicaid is generally administered by states, but the federal waiver offered under Obamacare allowed counties to apply to create Medicaid programs jointly operated by the county and the federal government. The costs of the expanded coverage under County Care bypass the Illinois&rsquo; <a href="http://will.illinois.edu/news/spotstory/ill.-house-votes-to-slash-medicaid-funding/">fiscally rocky Medicaid system</a>&nbsp;&ndash; they&rsquo;re split between the county and the federal government.</p><p>Come 2014, eligible people will be able to leave County Care and enroll in Medicaid through the state of Illinois. County Care patients are required to go to a provider within the county&rsquo;s network of hospitals and affiliated Federally Qualified Health Centers, whereas recipients of state Medicaid can go to any doctor that accepts Medicaid.</p><p>But Dr. Raju said he hopes that by then, they will want to choose County Care. In addition to setting up patients in a &ldquo;medical home&rdquo;, County Care will provide mental health and substance abuse services, which Illinois Medicaid currently does not cover. The lack of mental health services in the region has been a topic of <a href="http://www.wbez.org/news/dart-%E2%80%98we%E2%80%99re-criminalizing-mental-health%E2%80%99-102218">ongoing controversy</a>.</p><p>&ldquo;If there are substance abuse issues, we do not want them to get lost in the system,&rdquo; he said. And he thinks the medical home model should be in use around the country. &ldquo;We believe that is the future of the healthcare delivery model in this country.&rdquo;</p></p> Mon, 19 Nov 2012 00:00:00 -0600 http://www.wbez.org/news/cook-county-begins-enrolling-250000-new-medicaid-recipients-103902