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Issues & Legislative Committee Report

February 8, 2007

Gainsharing/The Joint Commission (JCAHO) Update

Gainsharing Agreements

The word on the street is that there may be many variations of “gainsharing” agreements in place in hospitals and healthcare systems that have not been routed through the OIG and thus remain below the radar. This would make the process easier and less costly to manage, as well as more flexible and adaptable in all likelihood. This is not confirmed, but more for discussion topic of the committee.

Also, as a reminder from October, The Centers for Medicare and Medicaid Services (CMS) is involved in a project named DRA 5007 Medicare Hospital Gainsharing Demonstration. This demonstration will examine the effects of gainsharing aimed at improving the quality of care in a health delivery system. More specifically, the demonstration will determine if gainsharing is an effective means of aligning financial incentives to enhance quality and efficiency of care. This is a three-year project beginning January 2007 and ending December 2009.

Source: http://www.cms.hhs.gov/DemoProjectsEvalRpts/

JCAHO Changes Name to "The Joint Commission"

The Joint Commission is refreshing its brand visual identity (name and logo) in support of its continuing efforts to improve the value of accreditation and its utility as a mechanism for improving the quality and safety of patient care. The name Joint Commission on Accreditation of Healthcare Organizations is being shortened to The Joint Commission. The move to a shorter name is intended to both make the name more memorable and reflect current common practice.

The Joint Commission released a list of draft Goals and Requirements that may be considered for potential inclusion in the 2008 National Patient Safety Goals. The draft Goals include requiring organizations to:

Source: http://www.jointcommission.org

Ethics/Pharmaceutical and Vendor Gifts

The "HPN Daily Update" ran a story on December 5, 2006 regarding a senior NIH scientist who has been accused of taking $285,000 in fees from Pfizer, a drug company involved with his governmental research. This occurred over a period of five years.  He failed to get advance permission from NIH for this and did not disclose on his financial reports. His work for Pfizer included consultant status, but also involved him providing them with hundreds of spinal tap samples that might provide genetic clues leading to a treatment for Alzheimer’s disease. He can get up to one year in prison and be fined $100,000.

The Miami Herald reported in detail on a cardiologist employed by the University of Miami who functioned as the Interim Chief of Cardiology at Jackson Memorial Hospital.  He also holds prestigious positions at surrounding area hospitals. He became romantically involved with a St. Jude Medical representative, and sales for St Jude soared at hospitals he was involved with. They increased by about 400% with resulting loss for the competitive vendors. The physician has served as a consultant for Medtronic, St. Jude and Guidant, and claims that he has migrated to St. Jude because Medtronic stopped giving his department grants. The sales rep earned over $100,000 on sales to Jackson Memorial alone, and additional tens of thousands in other hospitals that the cardiologist worked. The cardiologist has since left Jackson Memorial, who had investigated him for ethics violations, and is now at another hospital as medical director. He continues to be employed by the University of Miami, which has indicated that they might launch another ethics investigation. He is still involved with the sales rep, and continues to order St. Jude devices.

The FBI is investigating a neurosurgeon who has been accused of asking his sales rep to split his commissions with him as a condition for him to use products from Osteotech, Alphatec, Orthofix and Signus. He is charged with receiving monthly cash payments beginning in January of 2004 from this sales rep. The penalty for receiving cash for medical products reimbursed by Medicare/ Medicaid is up to five years in prison and/or a $25,000 fine.

The New York Times reported on a campaign run by Eli Lily in which physicians were encouraged to prescribe Zyprexa, a drug for schizophrenia and bi-polar disorder, for older patients without either condition. These patients had symptoms of dementia, or dementia-related psychosis. The drug carries FDA warnings that it increases risk of death in these patients. However, since primary care physicians do not diagnose schizophrenia, which is the domain of psychiatrists, their use of the drug in an off label fashion was encouraged by the local representatives. This campaign, called Viva Ziprexa by Lily, resulted in doubling of company sales for the drug.  Representatives are incentivized for the number of prescriptions that convince physicians to write.

Ethics concerns have been elevated as discussion topics at many medical society meetings. However, these concerns cut through these organizations, whose meetings are usually sponsored directly or indirectly by drug companies. This controversy was highlighted recently when a proposed panel discussion at the American Society of Hypertension entitled “Conflicts of Interest” was rejected by the Society for presentation at their spring meeting. The presentation was rejected as being one sided and lacking scientific rigor.

Employees of hospitals and nursing homes are now required by law to report any observed medicare fraud if the facilities they work in do more than $5 million a year in Medicare business. Hospitals will be required to train their employees in ways to detect fraud, waste and abuse. They must inform their employees that they will be protected against retaliation, and that they may also be eligible for a share of the money recovered by the government. Hospital policies must also be established to make sure that their contractors report fraud. These include contracts with physicians, billing agents and vendors.

Sources:
(1) Berensen, Alex. “Drug Files Show Maker Promoted Unapproved Use”. New York Times, 12/18/06.
(2) Dorscher, John. “Jump in Medical Sales, Romance Coincide”. Miami Herald, 12/15/2006.
(3) HPN Daily Update: “Lessons in Detection of Fraud at Hospitals”. 12/27/2006.
(4) HPN Daily Update: “NIH Scientist Charge with Conflict”. 12/5/06.
(5) Rowland, Christopher. “Medical Group puts Stop to Talks on Drug-Firm Ties “. 
The Boston Globe, 1/2/2007.
(6) Young, Robin. “FBI Jails Neurosurgeon for Alleged Product Kickbacks”. Orthopedics This Week; Newsshorts. Vol2/issue31/09-20-06. 12/19/06.

Hospitals for a Healthy Environment (H2E)

The H2E website, www.h2e-online.org, has a slate of awards that hospitals can apply for in the area of Environmental Excellence. The awards are very easy to apply for and if more hospitals knew about this option many more would apply. It only takes a minute to glance at the list, and perhaps nudge the folks in your hospitals to apply where appropriate.