LA County finds health-code violations in Skid Row

LOS ANGELES (AP) — The city of Los Angeles is violating the county health code in its Skid Row area by allowing the nation's densest population of homeless people to live on streets infested with rats, human excrement and used hypodermic needles, the Los Angeles County Department of Public Health has found.

An extensive agency inspection of the downtown district found nearly 90 rats' nests, mostly around street planters, people living in about 60 tents on sidewalks — some with animals — and 90 piles of human waste. The inspection last month focused on eight blocks of the 10-block district. On one block alone, close to 30 piles of excrement were noted.

The department ordered the city to clean up the area by this week and will start making routine inspections, roughly every week, to ensure hygiene is maintained, said Jonathan Fielding, county director of public health.

"There are clear health risks," he said. "Conditions seem to have been exacerbated there. There are more people, more material of different kinds on the sidewalks."

Some 800 people bed down on Skid Row sidewalks nightly, and 3,000 others cram into its shelters and special housing. During the day, they teem into the streets. Most are mentally ill or substance abusers.

The May 21 Health Department report underscores the precarious conditions that homeless advocates have long decried.

Inspectors found 13 hypodermic needles strewn on the ground and disposable rubber gloves tucked under tree roots. They also found people were disposing of human waste — including vomit, feces and buckets of urine — in storm drains.

The crowded, unsanitary conditions make the area a high risk for communicable disease. Four cases of meningococcal disease cropped up in March 2011, and outbreaks of staph infection were reported in 2005, inspectors said.

The report recommended the city install more trash cans and public toilets, provide soap, water and hand basins, and step up waste collection.

The city must implement a vermin-control program in the area and monitor for hypodermic needle litter, the report said.

Inspectors also noted the desperate condition of many of Skid Row's residents, including one man observed crawling across the street on his hands and knees, another eating out of a trash can and many unkempt people living amid garbage and debris. They recommended increasing efforts to get more social services to people.

Sanitation workers have been intensely cleaning the neighborhood to remedy the violations, and are developing a maintenance plan, said Jane Usher, special assistant city attorney.

Public health officials have conducted inspections of Skid Row in the past in response to specific complaints, but this was the first comprehensive look at the neighborhood's overall sanitation, Fielding said.

The inspection last month was requested by the city attorney's office as it gathers evidence in a bid to overturn a federal judge's order last year prohibiting the seizure of homeless people's property from sidewalks without notice.

The city says the order is making it difficult to clean up the area as sanitation workers are not sure what is personal property and what is trash. Meanwhile, nearby businesses and residents have complained about the proliferation of furniture and shopping carts and people living in tents as police have stopped removing tents due to the order.

"The deposits on sidewalks have reached a crisis point," Usher said. "Conditions have deteriorated."

Fielding said the county Health Department will continue to press the city on the problems.

"The city has demonstrated a willingness to address the concerns, but ultimately, it is our responsibility," he said.

For homeless advocates, who have long criticized the city's neglect of Skid Row, the violations are a black eye for the city.

Attorney Carol Sobel, who sued the city over the destruction of homeless people's property, said providing toilets, trash bins and soap to people has nothing to do with confiscating people's belongings, including important papers and medications, without warning.

"This really is a condemnation of the city," she said. "The county is saying, 'Come out and clean it.'"

Residents said they hoped the cleanups would be ongoing.

"I've been trying to get the county Public Health Department out here for years," said community activist Jeff Page, who goes by General Jeff. "It's not like Skid Row suddenly got dirty and infected. It's always been like this. But at least it's something."

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Contact the reporter: http://twitter.com/ChristinaHoag

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Health Care Market Analysis Finds Pittsburgh Uses Substantially More Services, Resulting in Higher Costs to Employers

PITTSBURGH, March 26, 2012  /PRNewswire/ -- To provide its members with a baseline understanding of health care delivery and costs in the Pittsburgh region, the non-profit Pittsburgh Business Group on Health (PBGH), an employer-led coalition, commissioned a health care market analysis that found the Pittsburgh region uses substantially more health care services, than comparative markets — Cleveland, St. Louis, and Cincinnati. As analyzed, the Pittsburgh region's annual burden for additional hospitalizations was $187 million.

The Health Care Incentives Improvement Institute (HCI3), a non-profit organization focused on improving health care quality and value through evidence-based incentive and provider payment solutions, worked with PBGH to analyze the market comparison to better understand the relationship between the supply of hospital beds and the frequency of hospitalizations in the four comparable U.S. metropolitan areas. The findings and recommendations were released today in an HCI3 Issue Brief. The initial research was conducted by FORTE Information Resources.

"Due to the uncertainty of the changing landscape of health care, nationally and in the Pittsburgh region, and the potential impact this may have on employers' benefits programs, it was critical to develop a baseline understanding of the delivery and cost of health care in our market," said M. Christine Whipple, PBGH executive director. "It was equally important to determine if the cost and use of health care services is different, and if so, examine how and why. We found that the higher use of services in the Pittsburgh region is producing higher costs for health care. However, without knowing the actual payments to providers for health care services (and the link to the information), it is unclear just how much more employers, and their employees, are paying for health care in our region."

Cheryl Melinchak, PBGH board president and director, Benefits, Westinghouse Electric Company, LLC, indicated, "These studies raise thought-provoking questions about health care in the Pittsburgh region. Based on this type of information, and the current climate, employers have the best opportunity in years to influence the payments and delivery of health care services in our region."

Results
Both Cleveland and Pittsburgh have a higher number of beds per 1,000 residents than are found in Cincinnati or St. Louis. Among these communities, Cincinnati has the fewest hospitals, yet its occupancy rate is among the lowest despite having one of the highest Medicare patient case mix severity adjustments. Adjusted length of stay is second only to that of Pittsburgh.

"Whether one compares U.S. regions or the care major academic medical centers provide — a large fraction of the nearly two-fold differences in per-patient costs that are observed, after accounting for patient case-mix, are due to differences in utilization rates of supply sensitive services," said Elliott S. Fisher, MD, MPH, professor of Medicine at the Dartmouth Medical School and director, Population Health and Policy at The Dartmouth Institute for Health Policy and Clinical Practice. "Patients cared for in regions that have a greater relative supply of beds and physicians spend more time in the hospital, have more frequent physician visits (especially by specialists), and get more diagnostic tests and imaging services."

Francois de Brantes, HCI3 executive director noted, "By making data available on the costs and quality of care, we can better identify where employers, insurers and providers can collaborate to improve health care in Pittsburgh. Two such areas are payment reform and the use of value-based purchasing and benefit designs. Employers should demand from their health plans new payment models that impose financial risk on providers for excessive and unwarranted use of services. Additionally, Pittsburgh's employers would benefit by being more aggressive in incenting employees to use low cost, high-value providers. Benefit designs can provide the practical way to drive employees to use higher value hospitals that can result in providers moderating their price increases."

Study methodology
Two separate analyses were conducted to measure total hospital capacity in each community and the contribution of that capacity to health care costs. First, PBGH commissioned FORTE to develop the Pittsburgh Health Care Market Comparison, which provides a market assessment of demographic and general health care characteristics, hospital utilization and discharge analyses of specific diagnoses and procedures in each of the four regions. Secondly, HCI3 standardized the community-wide information and using its internal benchmark data of commercially insured health plan members estimated the average national cost of a bed day. This estimate was used to compare the potential added cost of hospital usage on total health care costs in Pittsburgh against that of the other markets.

About the Health Care Incentives Improvement Institute™, Inc.
The Health Care Incentives Improvement Institute, Inc. (HCI3) is a non-profit multi-stakeholder umbrella organization for Bridges to Excellence® and PROMETHEUS Payment®. The mission of the organization is to create significant improvements in the quality and affordability of health care by developing and implementing programs that recognize and reward physicians, hospitals and other health care providers that deliver safe, timely, effective, efficient, equitable and patient-centered care. HCI3 offers a comprehensive package of solutions to employers, health plans and coalitions to improve the flawed incentives that currently permeate the U.S. health care system. www.HCI3.org

About the Pittsburgh Business Group on Health
Founded in 1981, the Pittsburgh Business Group on Health (PBGH) is an employer-led coalition representing over 80 members regional and national members. The coalition, promoting education, collaboration, and innovation to manage costs and drive value in health care and benefits, raises awareness and highlights leading edge strategies through its community forums, members' only meetings, annual conferences and health care market analyses and benchmarking surveys. www.pbghpa.com.

NOTE TO EDITORS: The PBGH Pittsburgh Health Care Market Comparison available to accredited media upon request.

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Health Care Benefits Changes on the Horizon, Towers Watson/National Business Group on Health Study Finds

Thu, Mar 8, 2012, 7:00 PM EST - U.S. Markets closed

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Health Organizations Count on Clinical Informatics to Improve Patient Health and Reduce Healthcare Costs, Finds PwC ...

NEW YORK, March 2, 2012 /PRNewswire/ -- Clinical informatics may hold the key to better population health and a reduction of the healthcare costs in the United States if health organizations can use it to engage patients in managing their own health.  A new PwC US Health Research Institute (HRI) report published today suggests that health organizations view clinical informatics – the integration of information technology into healthcare – as paramount to their financial success and ability to effectively and affordably manage patient care and wellness.

(Logo: http://photos.prnewswire.com/prnh/20100917/NY66894LOGO)

While improved patient care and safety is a top goal of their clinical informatics efforts, few health organizations have found ways of using health information to engage patients in managing their own health. A recent PwC HRI survey of more than 600 health management professionals across the country found:

Only 15 percent of health insurers and 13 percent of hospitals, physicians groups and other providers believe they have been able to successfully influence patient behavior through their informatics efforts.Nearly eight in 10 providers (79 percent) are looking to clinical informatics to help reduce medical errors, 61 percent hope to use it to improve population health, and 52 percent hope it will help them reduce costs by involving patients in preventative care routines.Eighty-five percent of health insurers are counting on clinical informatics to improve management of complex cases such as care for patients diagnosed with cancer, 80 percent are seeking a reduction in preventable emergency room visits and hospital readmission rates, and 56 percent hope that findings from their clinical informatics programs will lead to earlier diagnosis and prevention.

The HRI report, titled Needles in a haystack, Seeking knowledge with clinical informatics, looks at the state of clinical informatics in the industry and the needs, goals, barriers and opportunities that health organizations face in expanding their informatics capabilities. To inform its findings, PwC US surveyed health management professionals, including those from hospitals and physician groups, health insurers, pharmaceutical companies and life sciences companies, and conducted in-depth interviews with 30 chief information officers, chief medical informatics officers, and clinical leaders at health organizations across the country.

PwC found that all of the organizations it studied are now focused on clinical informatics capabilities, a nascent, fast-growing field that combines technology, patient care, financial reporting and collaborative information-sharing. While organizations have different needs, expectations for their informatics programs, the one common informatics goal PwC found they all share is a better understanding of medication compliance. Billions of dollars a year in wasteful healthcare spending can be attributed to excess hospitalizations, premature deaths and other avoidable expenditures caused by patients who do not take medications as prescribed. PwC's survey found:

Nearly 60 percent of providers and 91 percent of insurers said that improving patient compliance and adherence to prescribed medication is a goal of their clinical informatics program over the next two years. Nearly three-quarters (71 percent) of pharmaceutical companies believe that access to information in electronic health records could help them better understand what factors lead to noncompliance as well as the factors affecting the safety and efficacy of patients' drug usage.

"Health organizations recognize the value of effective informatics and analytics, but they are struggling to institutionalize the insight, make it actionable and use it for competitive advantage," said Daniel Garrett, Health Information Technology practice leader, PwC. "They need strategies for mining data, conducting and integrating evidence-based research, translating findings into practice, and influencing patients to participate in the process."

The state of clinical informatics in the health industry

PwC reports that clinical informatics is likely to become even more important in healthcare as the reimbursement landscape shifts from a fee-for-service or volume-based model to an outcomes-based model. Comparative effectiveness research has made it incumbent upon providers, drug makers and medical device manufacturers to understand and demonstrate how different treatments, tests, or procedures work compared to others.

PwC's research found:

More than half (56 percent) of health organizations now have a formal clinical informatics program in place.Six in 10 (61 percent) hospitals and physician groups have a formal clinical informatics program, compared to 59 percent of health insurers and 33 percent of pharmaceutical / life sciences companies, which have been more likely to outsource their informatics functions.All health organizations – especially health insurers – have plans to increase informatics staffing over the next two years. Nearly half (48 percent) of providers plan to increase technical analysts and 35 percent will add clinical informaticists. Among insurers, 70 percent will increase technical staff and 30 percent will add clinical informaticists. Among pharmaceutical / life sciences companies, 39 percent intend to add technical staff and 38 will add clinical informaticists.Within the next two years, nearly two-thirds of providers will look to clinical informatics to help them improve care delivery by better understanding variances in performance, while 60 percent of health insurers will use clinical informatics to identify lower-cost, high-quality providers. Health organizations that already have formal informatics programs have made greater progress than those that do not on business strategies that position them to compete for patients and revenue in the new health market. They are:  More likely to be sharing data outside the organization and participating in new care delivery models.More likely to have advanced informatics functionality needed to meet requirements for meaningful use of electronic health records, such as the ability to integrate and aggregate data, measure performance and deliver information to the point of care.More likely to be considering new collaborative strategies to expand informatics capabilities with other organizations and patients.Health industry converges around clinical informatics

The nature of the once adversarial relationship among payers, providers and pharmaceutical / life sciences companies is becoming more collaborative in an outcomes-based reimbursement environment as health organizations discover they need each other and access to one another's information and capabilities.

Clinical informatics is spurring an increase in collaborative agreements, partnerships and deal activity among health organizations, suppliers, private equity firms and other market participants.

PwC's research found barriers that may slow collaboration and progress in the use of clinical informatics. 

Fewer than half of health companies are exchanging information externally today. Only 31 percent of providers, 47 percent of insurers and 49 percent of pharmaceutical / life sciences companies participate in external data exchange.Despite the need for clinical information, the two biggest challenges health organizations face in expanding their clinical informatics efforts is data integration and lack of industry-wide data standards, leading to distrust in the data itself and its usage.Nine in 10 (90 percent) of pharmaceutical / life sciences respondents said that access to the clinical  data stored in electronic health records would help with drug research and development, and 85 percent said it would help clinical trial protocol design and recruitment, yet 87 percent also expressed concerns in the quality of EHR data. Pharmaceutical companies, which have historically purchased clinical information, have decreased purchasing activity from 45 percent in 2009 to 24 percent in 2011. More than half (54 percent) of providers said they would like to provide feedback into evidence-based protocols, yet only 20 percent of health insurers are "very confident" in their ability to offer providers access to evidence-based protocols.Seven in 10 providers and health insurers said that their top technical goal is integrating data from multiple sources, and only 17 percent of providers and 16 percent of health insurers are very confident that their health information exchange vendor will be able to meet their analytic and integration needs over the next two years.

A copy of PwC's clinical informatics report is available for download at www.pwc.com/us/hitinformatics.

About PwC's Health Research Institute (HRI)

PwC's Health Research Institute provides new intelligence, perspectives, and analysis on trends affecting all health-related industries. The Health Research Institute helps executive decision makers navigate change through primary research and collaborative exchange. Our views are shaped by a network of professionals with executive and day-to-day experience in the health industry. HRI research is not sponsored by businesses, government, or other institutions.

About PwC's Health Industries Group

PwC's Health Industries Group (www.pwc.com/us/healthindustries) is a leading advisor to public and private organizations across the health industries, including healthcare providers, pharmaceuticals, health and life sciences, payers, employers, academic institutions and non-health organizations with significant presence in the health market. Follow PwC Health Industries at http://twitter.com/PwCHealth.

About the PwC Network

PwC firms help organizations and individuals create the value they're looking for.  We're a network of firms in 158 countries with close to 169,000 people who are committed to delivering quality in assurance, tax and advisory services.  Tell us what matters to you and find out more by visiting us at www.pwc.com.

© 2012 PricewaterhouseCoopers LLP, a Delaware limited liability partnership. All rights reserved. PwC refers to the US member firm, and may sometimes refer to the PwC network. Each member firm is a separate legal entity. Please see www.pwc.com/structure for further details.

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Health Law Would Not Implode Without Mandate, RAND Study Finds

If the Supreme Court knocked out the health care reform law’s individual mandate, but preserved everything else, the sky would not fall, according to a new analysis from RAND Health.

The study, published on Thursday, looked at the effects of enrollment and premium increases in a universe in which health care reform stayed on the books without the controversial requirement that everyone have health insurance or pay a fine. In briefs before the Supreme Court, the Obama administration is arguing that the mandate is the key piece of a larger regulatory structure that  expands coverage without causing premiums to skyrocket.

The experiences of states that have tried insurance reforms without a mandate bear out this argument, and two prior studies of the federal law concluded that prices would go way up and enrollment way down without a requirement to buy insurance.

The argument for the mandate--originally made by conservatives during 1990s-era efforts at health care reform--is that without it, too many younger, healthier people will gamble on going without health insurance, driving up costs as only those with a greater immediate need for insurance buy it.

The RAND report agrees with those other analyses that fewer people would have health insurance without the mandate—87 percent of the non-elderly population versus 91 percent with a requirement. And it also concludes that insurance premiums would increase.

But by looking at the actual premiums new enrollees would pay, RAND finds that prices for most individuals would rise by only 2.4 percent, compared to the 10 percent or higher average premiums calculated by the prior studies. That could be a difference between what some critics have called a “death spiral” of adverse selection and the sort of change that would keep insurance relatively affordable for those who choose to buy it.

The RAND report did not, however, conclude that health care reform without a mandate would be a big bargain for the government. Because more people who bought insurance without a mandate would be old and sick, the government’s bill for tax credits to help middle-income Americans afford their premiums would not go down by very much. If Congress made no other policy changes, the cost would be $109 billion with a mandate versus $99 billion without—a difference in per-person cost of $7,468 versus $3,659.

According to RAND’s Christine Eibner, the report shows that the mandate could probably be severed from the rest of the law without causing calamitous results. But that doesn’t necessarily make it a good idea.

“That depends on your policy goals,” she said.

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Health care Alberta's biggest election issue, finds CBC poll

Health care tops the list of issues facing Alberta, according to a poll done for the CBC.

While health care remains the dominant issue among Albertans at 41 per cent, concerns about the economy at 31 per cent and the oil and gas sector at 27 per cent increased significantly compared to a similar survey done by Return on Insight (ROI) in January 2008.

"The fact that health care dominates isn't a change," says pollster Bruce Cameron. "It's still important ... but the interesting thing is how much concerns about oil and gas and the economy have come up. I guess it's a residual impact of the recession."

Alberta voters named the Progressive Conservatives as the best party to deal with most issues identified by CBC's poll.

Forty-three per cent of telephone respondents chose the Tories as the best party to manage the provincial economy.

The Wildrose Party trails the PCs by almost 20 points, or more, on all economic and management issues identified by poll participants.

The Tories scored better than most other parties on health care and education, but not on the environment or social problems.

The PCs are viewed as the best party to deal with education by one third, or 33 per cent, well ahead of the Wildrose Party.

Voters, in fact, rated the NDP higher on dealing with education at 19 per cent compared to the Wildrose Party's 13 per cent.

The NDP shows considerable strength in voters' minds in terms of being the best party to deal with issues such as environmental protection (tied with the PCs at 25 per cent) and addressing social issues — 27 per cent compared to 24 per cent for the governing PCs.

Mount Royal University policy studies professor Lori Williams says health care presents a potential strength for the Tories.

"There's a fight for how to solve health care on the left — and frankly, I think health care is one of the issues that leaves the Wildrose [Party] flat footed because they don't have a simple, tangible solution to the problems," Williams told CBC.

"They seem to be more associated with cutting the debt and the deficit."

Political scientist David Taras predicts the Tories are planning what he calls an "oxygen suppression campaign" in the coming spring election.

"What the Tories are going to try and do is cut off avenues of attack and prevent the Wildrose [Party] from having any oxygen at all," said Taras.

"The Tories know," he added, "that if they can play no errors baseball, they are likely to win a real hefty majority."

ROI's poll for CBC surveyed 803 Albertans from Jan. 25 to Jan. 31. The poll is considered accurate within +/- 3.5 percentage points 19 times out 20.

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