Patient Bill of Rights

Reform # 4

By: Carrie Stella



Congress must act now to bring a patient-centered focus to health care by enforcing a uniformed and comprehendible Patient Bill of Rights (PBR). This could be accomplished by expanding the Bipartisan Patient Protection Act and taking further action to make the bill laws, while also developing it to entail more coverage than a patient’s right to privacy. Hopefully this will lead to the higher usage of advance directive so that patients take a controlling stake at all stages of their health and thus eliminating various ethical dilemmas as states by BioInfoBank Libraries.

Currently, the American Hospital Association (AHA) provides a base of patient rights that all patients are entitled to within medical care. However, a patient’s rights may vary state to state and facility to facility because the AHA encourages the modification of the PBR to fit each specific area. The problem modification is the hardship it presents to the patient. Patients are supposed to be informed of their rights but with the variance in rights it is difficult to keep track. Using what the Board of Trustees of the AHA has put forth in the late 90’s a uniformed PBR can be created to encourage the patient to take hold of their health. Another problem with current PBR’s is that the first time that a patient sees one is when they are signing in for medical treatment. A patient’s mind is not in the right state to comprehend fully their rights when their focus is the reason that brought them to seek medical attention in the first place. This holds especially true in an inpatient facility, like a hospital, where dependent on the treatment one needs their rights could be read to them and seek verbal acceptance in a rapid amount of time.



According to the article, Public Awareness of Patient Rights, it appears that few people are aware that as patient’s we have rights, and an even smaller number understand what rights they are entitled to as patients. This act can increase the access to patient care, the quality a patient receives and save money for all parties involved in the health care process. Patients who are informed of their rights are more likely to take a vested interest in their health and seek out care that they are entitled to, especially in the area of primary care. Providers will work with patients to provide the best option for each individual patient. To enforce that the patient is receiving for appropriate access to and quality health care facilities should use of patient advocates. The use of more patient advocates, better described as a person employed specifically to see to the rights and needs of a patient, would smoothly transition the understanding and utilization of the Patient's Bill of Rights. Everyone understands that health care is expensive. However with patients taking a vested interest in their health there is decreased cost in unnecessary medical procedures as well as decreased chance of legal issues in reference to ethical dilemmas. Advance directive would also help lower cost by stating patient’s wishes clearly, alleviating the chance of prolong treatment where treatment is not wanted.



This is a better action then the one in place because it demands the enforcement of PBR thus making the patient take control of their health. Some may argue that the utilization of PBR’s take away to much control from health care providers and places to much power in the hands of the patient. One must remember that when it comes to health it is personal and all decisions must be okay with the individual that they are in reference to. Power should be with the patient and the provider is part of the patient health care team. Patients and providers must work together to ensure that individualized medical attention is being received leading to the best possible outcome.



The effectiveness of this act can be measured by the percentage of utilization of health care practices in comparison to overall patient satisfaction. PBR’s are powerful and can lead individuals to demand more of their health care system. A PBR is no use without a patient’s knowledge and use of said rights. It would be like a cake they never got to taste. One will never know the fulfillment of hunger without taking a big piece of the cake for themselves. We too must take our piece of cake and use our rights to our advantage. It is our health after all!





Sources:



(1) American Hospital Association. Issues: Patient Bill of Rights. Web. 23 March, 2010. http://www.patienttalk.info/AHA-Patient_Bill_of_Rights.htm

(2) Office of Managed Budget, "Bipartisan Patient Protection Act". White House. 3-23-2010 http://www.whitehouse.gov/omb/legislative/sap/107-1/s1052-s.aspx

(3) BioInfoBank Libraries, "Advance Directive". BioInfoBank Libraries. 3-23-2010 http://lib.bioinfo.pl/meid:211891

(4) Right Health Community, "Patient Bill of Rights". Right Health Community. 3-23-2010 http://www.righthealth.com/topic/Patients+Bill+Of+Rights/overview/rh_uniquecontent

(5) Julie, Dandy. "Public Awareness of Patient Rights, Consent Forms and Advance Statements ". Aslib Proceedings. 3-23-2010 http://www.emeraldinsight.com/Insight/viewContentItem.do?contentId=864002&contentType=Article

Reform 3: Improving Rural Healthcare

Rural hospitals provide essential health care services to nearly 54 million people, including 9 million Medicare beneficiaries. Rural hospitals face great pressures as government payments decline due to their small size, modest assets and financial reserves, and higher percentage of Medicare patients since rural populations are typically older than average urban populations (1). It is known that persons living in rural areas are at a disadvantage because many do not have access to the healthcare they need. One-fourth of America's population lives in rural areas. Compared with urban Americans, rural residents have higher poverty rates, a larger percentage of elderly, tend to be in poorer health, have fewer doctors, hospitals, and other health resources, and face more difficulty getting to health services (5).Congress should take action now to improve Federal funding for rural hospitals and Critical Access Hospitals.

There are already many Federal programs in place in order to help improve rural access to healthcare. The Rural Hospital Flexibility Grant Program is a program that provides funding to strengthen rural health. The FLEX program:

1.Allows small hospitals the flexibility to reconfigure operations and be licensed as Critical Access Hospital (CAHs).
2. Offers cost-based reimbursement for Medicare acute inpatient and outpatient services.
3. Encourages the development of rural-centric health networks.
4. Offers grants to States to help implement a CAH program in the context of broader initiatives to strengthen the rural health care infrastructure (3).

Programs such as the FLEX program are already working towards improving rural access to care, but more needs to be done. The Critical Access Hospital Program was created by the 1997 federal Balanced Budget Act as a safety net device, to assure Medicare beneficiaries access to health care services in rural areas. It was designed to allow more flexible staffing options relative to community need, simplify billing methods and create incentives to develop local integrated health delivery systems, including acute, primary, emergency and long-term care (2).

According to The Financial Effects of Wisconsin Critical Access Hospital Conversion, the Critical Access Hospital (CAH) program was created to improve the financial stability of small, rural facilities. These facilities were struggling with Medicare’s Prospective Payment
Systems (PPS). Medicare payments to these institutions were inadequate because they did not take into account low volumes and higher fixed costs. The financial deterioration of the hospitals resulted in a lack of capital investment. Some facilities closed. Lack of access to healthcare services became an issue in some areas. Currently, CAHs are paid 101% of their Medicare costs for inpatient services, outpatient services (including laboratory and therapy services), and post-acute services in swing beds. As a result, prior studies have shown that the CAH program has improved financial performance and access to capital.

The Wisconsin Medical Assistance Program has recently announced plans to reduce reimbursement to CAHs by an average of 10%. CAHs, which on average, have higher Medical Assistance utilization than PPS hospitals in Wisconsin, will need to contend with a reduction in reimbursement that will further stress their financial condition.
According to the study, in order to address these economic concerns, 90% of hospitals have made cutbacks to address economic challenges. Some of the cutbacks hospitals have taken are: reduced staff, administrative expense cuts, and reduced services such as behavioral health, post acute care, clinic, patient education and other subsidized services. (4).

It is clear that federal funding is needed in support of critical access hospitals and rural health care. Rural hospitals are already making cutbacks due to economic challenges and patient education, unfortunately, is a critical area that is losing funding. Funding given to rural health care and critical access hospitals would allow these facilities to employ more staff. This, in turn, would increase access. Access to higher quality care would cause an increase in quality of patients because they would be getting one-on-one attention. Many people might say that funding should be increased in urban areas because the population is greater in urban areas so more people would be reached. Residents of rural areas face health disparities that those living in urban populations do not face. Access to healthcare in rural areas needs to be addressed and federal funding must be increased for rural hospitals and critical access clinics.




(1) American Hospital Association. Issues: Rural Health Care. Web. 29 March, 2010. http://www.aha.org/aha_app/issues/Rural-Health-Care/index.jsp

(2) Washington State Department of Health. Rural Health Programs. Web. 28 March, 2010. http://www.doh.wa.gov/hsqa/ocrh/cah/cah399.html

(3) U.S. Department of Health and Human Services. Rural Health Policy. Web. 29 March, 2010. http://ruralhealth.hrsa.gov/funding/flex.htm

(4) Gullickson, Dale and Donkle, Richard. The Financial Effects of Critical Access Hospital Conversion. August, 2009. Web. 29 March, 2010. http://www.worh.org/files/FinConv09.pdf

(5) U.S. Department of Health and Human Services. Improving Healthcare for Rural Populations. March, 1996. Web. 29 March, 210. http://www.ahrq.gov/research/rural.htm

Proposal 2: Non-Profit Hospitals

Congress should take action to require that all hospitals become non-profit organizations. If this were to occur, hospitals would still be able to make beyond the necessary reimbursements for their workers and procedures but the superfluous amount would be reinvested back into the health care system. Some examples of investments are developing research, opening new clinics, charity care, providing education to employees, and health promotion activities. Some would argue to make hospitals for-profit in order to promote competition and direct the system towards a free market. This idea is unreasonable due to the effects of cost and the needs of society. The government realizes that a free market system will not prevail and provides incentives for hospitals to convert to non-profit such as tax-exemption and discounts off property tax (1). According to the Illinois Business Law Journal, tax-exempt hospitals can't sell stock nor have shareholders. As of 2006, 85% of all hospitals were non-profit but the remaining for-profit hospitals consume a larger portion of the total health care expenditure per hospital (2). In 2001 for-profit hospitals received $6 billion of the $37 billion expenditure. Not only are they spending more but they also charge more. Investor owned hospitals charge 19% more than non-profit according to the Canadian Medical Association Journal which contracted U.S. data on profitable hospitals (4).

With a conversion to non-profit, the money benefitted will play a significant role within its community's health. Reinvested money goes towards charity care for the poor and other members of the community. Not only will the community receive better access they will also benefit in quality when the conversion gives a greater emphasis on certain employees. A common belief of non-profit hospitals is that their employees have lower wages than those of for-profit. Due to the 2003 National Compensation Survey, the average hourly salaries of for-profit and non-profit hospitals are compared. This survey shows that all profit employees make an average hourly salary less than non-profit hospital employees. There is a larger gap between full-time wages than part time wages, $0.99 to $0.27 respectively (5). Gaps are also present in the quantity of some medical professionals. Profitable hospitals have a significant amount of money contributing to administration and paperwork, 34% of costs compared to 24.5% in non-profit. On the other hand, non-profits have a comparable difference with a higher concentration of costs going to nurses and clinicians, 7% more of non-profit payroll than for-profit payroll. Placing a higher emphasis on more nurses and physicians can increase access and quality to anyone within the health care system. When investor owned hospitals contribute more money to administration the system loses the necessary focus on patient care and is rather placed on the process. This contribution to administration can decrease quality and access to patients seeking nursing and physician care. This study also recognizes that non-profit hospitals are usually larger by the number of employees than a majority of the for-profit hospitals. Out of the hospitals studied, 13% of the for-profit employed over 2,500 employees compared to 28% of the non-profit hospitals (4).

According to the New England Journal of Medicine another aspect of cost is the money spent on Medicare. A study was performed to compare for-profit, mixed, and not-for-profit hospitals and how much they spend on Medicare per capita. The study shows that each year not-for-profit hospitals spend less than for-profit and mixed hospitals on Medicare per capita in stable hospital service areas. It also shows that Medicare spending has increased dramatically since 1989 but the non-profit sector accounted for the least amount. Another portion of the study shows that after hospitals converted from non-profit to for-profit, Medicare spending increased. And vice versa, when for-profit converted to non-profit they spent less on Medicare after the transition (3).

Transitioning for-profit hospitals to non-for-profit will affect cost, quality, and access. Costs of the total health care expenditure will decrease by over $6 billion and 19% per person. Community members and the poor will also be able to access more charity care due to non-profit hospital investments. These contributions will ultimately allow the community to grow in population, in better health, and longer lives. Politicians may think that there are other proposals that would be more successful such as creating access to the health care system for every citizen. This proposal to convert every hospital to non-profit will help the system triangularly, it will increase access to care, decrease costs, and improve quality.


1. Congressional Budget Office. Nonprofit Hospitals and the Provision of Community Benefits. CBO.gov, December 2006. Web. 13 March, 2010. http://www.cbo.gov/ftpdocs/76xx/doc7695/12-06-Nonprofit.pdf

2. Illinios Business Law Journal. Non-Profit Hospitals' Tax-Exempt Status Under Fire From IRS, Local Governments. 20 October, 2006. Web. 13 March, 2010. http://iblsjournal.typepad.com/illinois_business_law_soc/2006/10/nonprofit_hospi.html

3. New England Journal of Medicine. The Association between For-Profit Hospital Ownership and Increased Medicare Spending. 5 August, 1999. Web. 13 March, 2010. http://content.nejm.org/cgi/content/full/341/6/420#T2

4. Physician's for a National Health Program. For-Profit Hospitals are Costlier Than Non-Profits. 7 June, 2004. Web. 13 March, 2010. http://www.pnhp.org/news/2004/june/forprofit_hospitals.php

5. Shahpoori, Karen P. and James Smith. United States Department of Labor-Bureau of Labor Statistics. Wages in Profit and Nonprofit Hospitals and Universities. 29 June, 2005. Web. 13 March, 2010. http://www.bls.gov/opub/cwc/cm20050624ar01p1.htm

Health Care Reform- Proposal 1

Congress should pass a law requiring hospitals to move towards electronic medical billing, appeals and records, and a smart card in an effort to decrease administrative costs. A study from the New England Journal of Medicine showed that the administrative costs in the U.S. and Canada vary significantly. The study, which was conducted in 2003 and analyzed data from 1999, showed that administrative costs totaled $1059 per capita in the U.S. compared to $307 per capita in Canada. The results of this study emphasize the need for lower administrative costs.

An article in the New York Times shows the benefits that an electronic medical record system would provide. This article shows that costs would be lowered, which would result in greater access and patients would also receive a better quality of care due to better accuracy. It's mentioned that an electronic medical system would result in less duplicate tests, reduced medical errors, and safer surgery among other benefits. A system that requires electronic medical records would allow patients to release their medical records to multiple providers with less hassle. This would allow providers to have all the information they need at their fingertips to provide the best quality of care.

Electronic medical billing provides many of the same advantages that electronic medical records provide. According to 2K Medical, a company that provides electronic billing, the advantages to electronic billing include reducing costs, increasing productivity, quicker payment, streamlined processes, and confirmation when submitting claims. The main cost saving advantage for electronic claim submission is the money that is saved on postage and paper which translates to better access. Electronic billing would not necessarily have a direct connection to improved quality because claim submission is on the provider side of health care, but there would be an indirect relationship to quality because more time and energy can be spent caring for the patients when administrative costs are lowered.

According to a publication from the Smart Card Alliance, smart cards can provide a variety of benefits for patients, providers, payors, and employers. Smart cards decrease administrative costs because medical records are electronic, there are less denied insurance claims due to the electronic medical records, duplicate records and duplicate procedures are eliminated, and administrative processes are streamlined. Cost saving is always a major issue for hospitals and a system that lowers the administrative costs benefits both the provider and the patient in the long run. Lower administrative costs translate to lower health care costs, which allows more people to access health care, especially when inpatient care is already quite expensive. Additionally, the implementation of a smart card would result in a better quality of health care. Providers would be able to easily access a patient's medical history which would result in fewer unnecessary tests and more accurate care. A smart card would speed up processes such as registration and would also incorporate better security measures within our health care system.

The health care industry is quite complex and it's difficult to cut costs. Many people have proposed cost-cutting ideas and they have failed. This idea of lowering administrative costs by moving to an electronic system is not only feasible, but it will work in terms of saving money. Each of the components of the proposal have been shown to work and lower costs separately. Incorporating all of these tactics into one plan will allow for greater efficiency and even greater cost savings.

With every proposal there are concerns and this proposal is no different. While technology is becoming necessary, people are still skeptical to trust today's technology. Electronic billing and medical records are no different. People are often concerned about viruses, hackers, power outages, etc. While these things are always possible, one must note the amount of security provided regarding patient information. Hospitals have IT departments working to ensure that all information is secure. Patient information is backed up regularly and stored on multiple servers. Additionally, hospitals are equipped with power supplies in the event of a power outage. Additionally, there have been arguments that the required software and training when going paperless is expensive and will increase administrative costs. An article in USA Today cites that the Obama administration says that there could be a total cost saving of $12 billion over the next ten years if the nation were to go paperless in terms of medical records. While technology may result in concerns due to reliability and cost, over the long run, it makes more sense to convert to an electronic system.

Sources:
Electronic claim benefits. (2008). Retrieved from http://www.2kmedicalbilling.net/eclaims/lytec_benefits.html

A Healthcare ceo's guide to smart card technology and applications. (2009). Smart Card Alliance, Retrieved from http://www.smartcardalliance.org/resources/lib/Healthcare_CFO_Guide_to_Smart_Cards_FINAL_012809.pdf

Brody, J. (2010, February 22). Medical paper trail takes electronic turn. New York Times, Retrieved from http://www.nytimes.com/2010/02/23/health/23brod.html

Hall, M. (2009, April 6). Push for digital health records sparks debate. USA Today, Retrieved from http://www.usatoday.com/tech/news/techpolicy/2009-04-06-health-records_N.htm

Woolhandler, S, Campbell, T, & Himmelstein, D. (2003). Costs of health care administration in the united states and canada. The New England Journal of Medicine, Retrieved from http://content.nejm.org/cgi/reprint/349/8/768.pdf