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Archive for the ‘Ethics’ Category

At long last, a favorable ruling  came in December 2016 for former patients at Yakima Regional Medical and Cardiac Center and Toppenish Community Hospital, both in Central Washington, when the hospitals agreed to pay $4.5 million into a settlement fund to compensate those who were wrongly denied financial  assistance from 2007-2014.  Last July, Yakima County Superior Court Judge Susan Hahn ruled that the hospitals had violated Washington’s Consumer Protection Act by failing to notify and screen low-income patients for free or reduced-cost care, as required under another state law, the Charity Care Act which was enacted in 1989. The Charity Care Act applies to all hospitals operating in Washington, and to all patients, insured or uninsured alike, who meet income eligibility requirements: those with incomes at 100% or less of the Federal Poverty Level  (FPL) are eligible for free care, and those whose incomes are at 101-200% of FPL are entitled to discounts.

The legal case on behalf of the patients took slightly over 3 years to be resolved. Due to record-keeping gaps at the hospitals, it is unknown how many former patients are potentially eligible for compensation under the settlement. Deliberate intent by the hospitals to withhold the required notice and eligibility screening was established during the proceedings.

Documents submitted in the lawsuit indicate hospital staff were given incentives and talking points to help them get as much money as possible from low-income patients, and that they were directed not to mention charity care as an option unless a patient knew to specifically ask for it.

In August 2016, the advocacy groups Northwest Health Law Advocates ( NoHLA) and OneAmerica published a report Yakima Regional and Toppenish Hospitals Fail to Provide Sufficient Charity Care   based on their research which revealed the financial hardships suffered by patients who could have been eligible for charity care. Likewise it was found that

Yakima Regional Medical & Cardiac Center

……although Yakima Regional is the most profitable hospital in Central Washington, it provides a significantly lower level of charity care than the regional average.

 

 

 

As a sidebar note since the settlement was announced, the two hospitals are due to soon change hands , for the third time in fourteen years. In 2003, the pair was sold to Health Management Associates and subsequently in 2014 to Tennessee-based Community Health Associates, both for-profit hospital chains. Unlike in other parts of the country, for-profit hospitals are uncommon in Washington. Commitment to upholding the Charity Care Act is one of the conditions for Department of Health approval of a hospital’s conversion from nonprofit-to-for profit.

Across the state, full compliance with the long-standing financial assistance rules can remain still elusive.  In June 2016 a class-action lawsuit against Northwest Hospital in Seattle for Charity Care violations was filed. State legislators seeking a remedy filed HB 1359  and companion SB 5231 early this year, to require that a written notice of the availability of Charity Care be included on all hospital bills. The House bill made it through the first cut-off date, and is moving forward in the legislative process. I will be posting on new developments, including provisions in the bill to ensure that notices are given in the language that patients understand.

 

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In the wake of the recent US measles outbreak, Public Health Seattle King County has published searchable data on student immunization levels covering all K-12 schools in the county.  Data fields include vaccination completion rates at each specific school ( color-coded to show rate levels); MMR immunization among kindergarteners; and immunization coverage rates in general among kindergarten and 6th grade students.  The sociodemographic correlations to vaccination  rates reflect the national trends that have made headlines, are not a surprise to locals. Kudos to the PHSKC  team for innovative use of technology in the public interest!

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Exciting news came at the end of the year for Gary Schwitzer’s Health News Review project which had lost the funding that supported the team of reviewers that analyzed the accuracy of health stories in the news and published their findings. HNR was awarded a two-year, $1.3 million grant from the Laura and John Arnold Foundation to continue and expand its work, which will now be housed in the new Center for Media Communication and Health in the U of Minnesota School of Public Health.

I’ll be looking forward to more important stories coming our way soon to share here.  And all of us can hone our critical thinking skills on health news stories by applying the HNR  framework anytime:

What’s the total cost?
How often do benefits occur?HealthNewsReview
How often do harms occur?
How strong is the evidence?
Is this condition exaggerated?
Are there alternative options?
Is this really a new approach?
Is it available to me?
Who’s promoting this?
Do they have a conflict of interest?

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A bevy of news stories local and national have highlighted the ever-worsening situation for consumers , especially  for folks who need so-called specialty drugs but also for the much larger segment of the population who use plain old generic medicines.  While raising awareness is essential, mostly what we are seeing, is increased an amount of talk about the problem, but less often are suggestions being offered in the way of sustainable solutions. Shock over the price for new Hepatitis C drug Sovaldi  was a wake-up call for policy makers and the public; it remains to be seen what will be prescribed as a remedy.  Here’s a sampling of  some more recent headlines:

Small group of specialty drugs could make up half of total pharmacy spending by 2018

Prices Soaring for Specialty Drugs, Researchers Find

Generic drug prices skyrocket in past year

Will Rising Prices for Some Generic Drugs Never End? Monthly Cost for One Heart Drug Can Approach $1,200

Pharmacists Report Soaring Generic Drug Purchasing Prices Impacting Patients, Pharmacies

New strategies needed to curb specialty drug costs

While some in Congress have been asking why in 2014, it remains to be seen if the political will can be mustered anytime soon to secure pricing changes from Big Biopharma.

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In recent weeks I’ve received email alerts announcing  “Hospitals Making Progress on Health Care Disparities“, a new study from the American Hospital Association’s Hospitals in Pursuit of Excellence program and associated organizations.   I took a look  first at the infographic accompanying the notices, and then at the published study itself, the 2013 Diversity and Disparities: A Benchmark Study of U.S. Hospitals. It was no surprise to read that the demographic profile of hospital executives and boards is still so far from representative of  the general  population, since the last HPoE study in 2011. However, the 2013 study reports data on language services in hospitals that raised my eyebrows ( 2011 comparison data points shown in parentheses):   EquityofCareStudy

  • 95%  (90%) are collecting data on primary language of patients
  • 87% (80%) are translating forms and documents for patients
  • 66% (61%) collected information on patient language needs

Leaving aside the matter of ascertaining the difference between collecting “primary language of patient” and “patient language needs,” these highly encouraging results led me to seek details in the source report. Having recently done extensive research for my own presentation on the status of  language services in healthcare for the 2014 WASCLA Summit, the HPoE findings seemed even more amazing. What I found in the report itself , which did conclude that more needs to be done to achieve equity of care in the broader sense, was that some basic background and research points seemed not to have been included or were too limited in scope to be meaningful.  For example,  the report did not include the list of hospitals which had participated in the survey, nor how the recent cohort compares to the 2011 and 2009 participant groups. There was no discussion of the statistical validity of the response rate of 1109 hospitals (~19% of all 5922 AHA member hospitals invited to participate), nor how representative the response sample is for hospitals nationwide. For example, while the study noted that all data was self-reported,  there was no mention of the possibility that only hospitals which have disparities reduction initiatives chose to participate.  I am pursuing the actual data used for the study, and hope to have information to share soon.

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Old US Public Health Service Hospital (known as Pacific Tower during its tenure as Amazon HQ building) to become new satellite campus for allied health professions programs of Seattle Central Community College and serve as site for public agencies and NGOs. AmazonBeaconHillHQ*304

Seattleite Jeanne Sather, author of Assertive Cancer patient  blog ,died from metastatic breast cancer  15 years after her original diagnosis

In June the King County Board of Health unanimously approved creation of drug take-back system for county residents , to be financed by a 2-cent per Rx tax. On Dec. 1, PhRMA filed a lawsuit against King County , claiming that the plan causes a financial burden for patients and that in-home disposal of  medicines is the best way to keep Rx drugs out of the wrong hands.

State to review hospital affiliations — Catholic and otherwise

Public hospital CEO gets pay cut to $1 M per year, at Renton’s Valley Medical Center

Harborview to close  pediatrics, women’s, & family clinics

Health Care Reform for American Indians and Alaska Natives 2013  including WA-specific page

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Consumer info fact sheets  translated into WA’s threshold written languages   (Chinese, Lao, Khmer ( Cambodian), Korean, Russian,  Somali, Spanish, and Vietnamese) were posted on Dec. 16, just one week before the deadline to start an application for coverage to be effective Jan. 1, 2014. In an unrelated development, HBE  decided on this brief extension  for completing applications due to various  problems people have had in being able to use the online forms and or access phone customer services.  Regarding the translated fact sheets, it’s taken almost 6 months for their publication to replace the original problematic versions that were taken down from the site.
However, the new fact sheets are not easy to find as they are not posted on the consumer website,  but located exclusively on the HBE corporate website.  The corporate site features a line at top right-hand side of homepage entitled “Information in Other  Languages” which links to the fact sheets page, plus also links out to the consumer website.  In contrast, the consumer Healthplanfinder site (which is in both  English and Spanish) does not offer any such subject line, nor does it display a link to corporate site.  The Healthplanfinder site likewise does not contain any readily visible clear statement of consumer  language access or disability access rights, except for a message in tiny font on bottom of the homepage that says [sic] : If you need additional language or disability accomodations, you may call 1-855-WAFINDER (1-855-923-4633)  On the Spanish version of the website, this statement illustrates yet another example of  faulty translation, as the term “disability accomodation” is twice translated, and very ungrammatically, as  “discapacidad alojamiento”  which means disability lodging.  Sure enough, a quick check on Google Translate  English > Spanish reveals  “lodging” as the first  translation for “accommodation.”  Since 2012 advocates had been recommending the inclusion of multilingual tag lines and/or translated summaries sections for the website. Interpretersymbol

Information on some metrics for the Healthplanfinder call center became available last week with the release of the  November Healthplanfinder Data Report. On the language access side of things (p.10 of the report)  the numbers are not encouraging: the call center received almost 12,000 calls in Spanish, but handled only some 1600 of them. The call center in Spokane has bilingual Spanish-English staff (reported as 6 out of 80 employees at start-up) on site and routes calls in other languages to a telephonic interpreter service. For calls in all languages besides Spanish combined, 1045 were actually handled (answered)out of 3621 calls attempted. The report does not state if the multilingual calls are included in the totals for approximately 35,000 calls  handled in November or the almost  158,000 calls throttled (deflected from the system, i.e. not put into the queue to await a response).  While the HBE is said to be increasing staffing for the call center,  any increases planned for its language capacity are as yet unknown. Given the demand, it would seem that Spanish-speaking callers too could benefit from immediate access to interpreter services.

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