Although there have been many attempts in the past to roll back some of the tax protections in place for non-profits, the ongoing economic malaise is forcing many states, counties and cities to push harder than they have in the past. It’s an effort one non-profit expert likened to scavenging for change under the sofa cushions.

The range of taxes, fees and levies that governments are considering is staggering. Just a few examples:

• A bill in Hawaii would require charities to pay a 1% tax.
• Kansas is weighing the possibility of making non-profits subject to sales tax.
• Pennsylvania, as well as several Kansas counties, may remove the exemption from property taxes for non-profits.
• Minneapolis recently made charities subject to the same fees for street lighting that residents and businesses already pay. The change is expected to bring in a whopping $155,000.

Critics worry that charging non-profits more will only hurt in the long-term. And with fewer funds, non-profit hospitals (and other organizations) will be able to provide less help with public health programs, educational tools, mental health outreach, etc. Those are services that are already underfunded by many governments — non-profits’ services help plug the gap.

But like it or not, too many states and cities are on the verge of financial crisis and someone’s going to have to pick up the tab.

Do you think non-profits should pay more for the government services they use? Share your thoughts in the comments.

According to a new study by University of Michigan researchers, the answer is: Doesn’t seem like it.

The researchers observed more than 3,000 patients for 30 days after they were discharged. All the patients were diagnosed with either congestive heart failure (CHF) or pneumonia.

The study found wide variances between what the lowest-cost and highest-cost hospitals typically spent per patient. Lowest cost hospitals spent just $1,522 on CHF patients and $1,897 on pneumonia patients. Their high-cost peers spent $18,927 and $15,829 respectively.

But the higher costs didn’t necessarily equate to higher quality of care scores, lower readmission rates or lower mortality.

Among the CHF patients:

• Those at low-cost hospitals had a readmission rate of 24.7% vs. 22.0% for high-cost hospitals.
• Quality of care scores for low-cost and high-cost hospitals were 85.5% and 89.9% respectively.
• Mortality rates were 10.8% at low-cost hospitals and 9.8% at high-cost facilities.

Among the pneumonia patients:

• Readmission rates were 17.9% at low-cost hospitals, and 17.3% high-cost ones.
• Quality of care scores at low-cost facilities were 86.6% compared to 85.5% at high-cost hospitals.

At 10:45 p.m. on Nov. 28, 2009, Joaquin Rivera went to the ED at Aria Health’s Frankford campus complaining of pain on the left side of his chest. At 10:56 p.m., security cameras show he stopped moving.

At 11:03 p.m., a hospital staffer went to the door of the waiting room, called his name and noticed that he was “staring” at the opposite wall.

No medical staff checked on his condition until another patient told a staffer that Rivera was dead — and his body had been robbed by a loiterer in the waiting room.

A state investigation determined that hospital staff weren’t properly trained on appropriate protocols for triaging and processing emergency patients.

Aria Health agreed to make a number of changes, including retraining staff on procedures, providing 24/7 security in the waiting area, and setting a time frame for recalling patients. The hospital will also mark with tape the spot in the waiting area to which staffers must walk when they’re checking on patients.

Stoned staffers roaming the halls present more than just the obvious risks to patients.

A recent case shows exactly how insidious the problem of addicted employees can be to health care organizations.

A former surgery technician has pleaded guilty to product tampering and obtaining controlled substances illegally. The tech, formerly employed at Rose Medical Center in Denver, injected herself with Fentanyl — then reloaded the syringes with saline and put them back in the anesthesia carts. It was later proven that her actions infected 17 patients with Hepatitis C.

It’s no secret that a few troubled health care workers help themselves to the pharmacy stock when they have the chance. But some argue that having an automated dispensing unit (ADU) on every floor actually makes it harder to check the misuse of drugs.

ADUs are fairly secure — if they are frequently monitored and audited for discrepancies. The problem is they can give a busy workforce a false sense of security since all access is recorded. If too much time passes between audits, it can be hard to identify the root of the problem. And all the while, abuse of prescription drugs continues in hospital halls.

Another potential loophole for drug-seeking staffers: wasted meds. While these “returned” doses are tracked, they often are treated less securely since they can’t be put back on the pharmacy shelves. Unusual volumes or patterns of waste should be examined as closely as any other drug discrepancy is.

Do you think your organization has adequate controls in place to prevent/identify drug diversion tactics? Sound off in the comments.

The procedures took place at St. Joseph Medical Center in Towson, Maryland. The hospital is currently under investigation for health care fraud.

At federal investigators’ request, the hospital reviewed patient records and uncovered several hundred patients with “variances” in their medical histories. Essentially, they had minimal blockages for which stents were not an appropriate treatment. (Some of the patients appeared to have no blockages at all.)

According to the hospital, all of the unnecessary procedures were performed by Dr. Mark G. Midei. He stopped practicing and lost his hospital privileges last summer. Neither Midei nor the hospital have commented on the case, although Midei issued a statement saying he expects to be exonerated and resume his practice.

Not surprisingly, most patients aren’t pleased.

Patients who received the stents unnecessarily were exposed to risks from the actual procedure, and will have to take blood thinners for the rest of their lives — leaving them open to a number of additional risks. On top of that, many have said they’ve suffered adverse psychological effects from being deceived about having a serious cardiac condition.

However, some patients who received word that their blockages were smaller than they were told stand by the doctor, saying their symptoms have improved.

An estimated 275,000 people will die in the next decade because of a lack of health insurance. That’s the conclusion of a new report by Families USA.

The report is in line with other research that pinned deaths due in part to lack of health insurance at 18,000 in 2000 (Institute of Medicine), and 22,000 in 2006 (Urban Institute).

The reason: Uninsured patients are less likely to get regular check-ups and screenings that can catch serious conditions when they’re more treatable. The uninsured are also more likely to forgo or skip treatments, like getting prescriptions refilled, due to the extra costs.

The report is likely a conservative estimate — it calculated that uninsured patients’ mortality rates are 25% higher — but other, more recent research shows death rates increasing by closer to 40%.

According to the report, roughly 64% of the deaths are projected to be in just 12 states. They are:

• California (34,600)
• Texas (31,700)
• Florida (25,400)
• New York (13,900)
• Georgia (11.500)
• North Carolina (9,600)
• Illinois (9,400)
• Ohio (8,900)
• Louisiana (7,700)
• Michigan (7,600)
• Pennsylvania (7,500), and
• Tennessee (7,500).

BJC HealthCare, a St. Louis-based affiliate of the Washington University School of Medicine, was looking to significantly increase the number of staffers who got the flu vaccine. In 2006, 54% of BJC employees were vaccinated — higher than the national average, but far below the hospital’s goal of 80%.

BJC already offered the vaccine for free to employees and also had an education/incentive program in place to encourage them to make use of the program.

The health system took a series of steps each year that gradually increased the number of employees who got vaccinated:

In 2007, employees who declined to get the shot were asked to sign a form indicating  they knew the risks that presented to them, their families and patients. That year the vaccination rate shot up from 54% to 71%.

In 2008, BJC made vaccinations mandatory for any employee who didn’t get a medical or religious waiver. At the same time, the hospital stepped up its education campaign. That year, 98.4% of employees were vaccinated.

Among those who didn’t get the vaccine, 0.3% had a religious waiver, and 1.2% received a medical waiver  — usually due to a history of either allergic reactions or Guillain-Barre syndrome.

Interestingly, many of the people who applied for a medical waiver were confused about their actual risk: Several employees cited asthma or a suppressed immune system as reasons to skip the vaccine. Of course, those are two conditions that put people in the high-risk group for flu and make it even more important to get vaccinated.

According to a Jackson Healthcare poll of physicians conducted by Gallup, 73% of doctors said they had practiced defensive medicine in the past year by ordering tests or procedures that could protect them from frivolous malpractice lawsuits.

The respondents indicated those extraneous procedures accounted for 26% of total health care spending.

The poll was co-sponsored by the Center for Health Transformation.

Of course, one person’s “frivolous” procedure is another’s way of investigating all possible diagnoses. And while unneeded procedures may give physicians an apparent safety net, all procedures and tests carry some risk to the patient. A negative outcome from a less-than-necessary test could actually open the door to a malpractice lawsuit.

Are you seeing widespread defensive medicine in your organization? If you are — do you think it’s understandable and ethical? Share your experiences in the comments.

According to the latest numbers from the Bureau of Labor Statistics, in 2009, 13.6% of workers in the “Healthcare Practitioner and Technical Occupations” group were union members. That’s more than 960,000 workers. In 2000, 12.9% of health care workers (approximately 693,000 total) were union members.

The “healthcare”  group includes doctors, dentists, veterinarians, nurses, and other therapists and technicians. But most of the growth in union membership has been among nurses and other non-physicians employed in hospitals.

Looking at the numbers, it’s clear that some of the growth comes from the health care sector simply adding a lot of jobs. But current economic and political trends are making union membership more attractive to many workers.

Between the cost-cutting measures that often ask workers to do more work for the same pay and uncertainty about how health reform may affect their jobs/salaries, workers are more likely to see union protections as appealing.

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