PinnacleHealth System will add two floors to its Alex Grass Medical Sciences Building at the corner of Second and Chestnut streets in Harrisburg. The work is scheduled to begin Saturday and be finished early next year. It might cause inconvenience for some people using the hospital or traveling or parking on nearby streets.

The new space will include a 38-bed long-term acute care facility operated by Select Medical. The Select-occupied space will amount to a new home for the long-term acute care facility Select operates on the fourth floor of a building on Pinnacle’s Polyclinic campus on North Third Street, Harrisburg. The new space also will house rooms devoted to Pinnacle orthopedic services.

The Alex Grass Medical Sciences building houses entities including doctor’s offices, lab services and a blood donation center.

Pinnacle spokeswoman Christina Persson said the emergency room entrance will remain open, as will both Pinnacle parking garages.

Get more details from the Patriot.

In northwest Indiana, Carrie Sota visits five or six doctors’ offices every work day as part of her new sales job.

But Sota isn’t selling the physicians on a prescription drug or a medical device. She’s promoting her hospital — the University of Chicago Medical Center.

Sota is one of four employees the academic medical center has hired in recent months to make “sales calls” on physicians in the hope that they will refer more patients to the hospital.  “We are trying to build meaningful relationships,” said Sota, who was previously a saleswoman for a small medical device company.

The University of Chicago Medical Center is one of a growing number of hospitals nationwide hiring former drug and device sales representatives to visit doctors’ offices to persuade them to use their services over competing facilities.

Rather than handing out samples of prescription drugs, the sales reps call on doctors armed with the latest information about their hospitals such as how they are reducing hospital-acquired infections and improving patient satisfaction scores.

Read more this sales strategy on Kaiser Health News here.

Repeat customers in hospitals are seen as a big problem – not to the hospitals themselves, which can profit from some patients’ frequent visits, but to the entities that pay for the care: Medicare, Medicaid and private insurers. The U.S. Department of Health and Human Services, especially, is taking hospitals’ repeat customers very seriously. Almost one out of five Medicare patients discharged from a hospital is back within 30 days. Research suggests as many as 75 percent of those return visits could be prevented with better treatment in the hospital and better care once people are back home.

As with many other problems in the health-care system, unnecessary hospital readmissions are associated with worse treatment and health outcomes, as well as higher costs to taxpayers – $15 billion a year for Medicare alone, according to a Medicare Payment Advisory Commission study.

Starting next fall, HHS will begin penalizing hospitals if their readmission rates are higher than expected for three conditions: heart attacks, heart failure and pneumonia. In the first year that penalties kick in, one percent of hospitals’ Medicare payments will be withheld, and that penalty will climb in subsequent years – at a time when payers are reducing fees to hospitals on a number of other fronts, too.

Read more on hospital readmission control from Kaiser Health News here.

In northwest Indiana, Carrie Sota visits five or six doctors’ offices every workday as part of her new sales job.

But Sota isn’t selling the physicians on a prescription drug or a medical device. She’s promoting her hospital — the University of Chicago Medical Center.

Sota, 30, is one of four employees the academic medical center has hired in recent months to make “sales calls” on physicians in the hope that they will send more patients to the hospital. “We are trying to build meaningful relationships,” said Sota, who was previously a saleswoman for a small medical device company.

The University of Chicago Medical Center is one of a growing number of hospitals nationwide hiring former drug and device sales reps to visit doctors’ offices to persuade them to use their services over competing facilities.

Rather than handing out samples of prescription drugs, the sales reps call on doctors armed with the latest information on how their facility is reducing hospital-acquired infections and improving patient-satisfaction scores.

In visits that can last five to 20 minutes, reps try to win doctors’ loyalty by helping them get better times on operating room schedules or easier patient referrals to hospital-based specialists. The sales reps can also carry messages back to the hospital, such as a doctor’s request for a new medical device to be available in surgery.

Find out more about this growing practice by checking out the article on USA Today’s website.

Under pressure to cut costs and prepare for the federal overhaul, the health industry is changing. Hospitals are bulking up into huge systems, merging with one another and building extensive new doctor work forces. They are exploring insurance-like setups, including direct approaches to employers that cut out the health-plan middleman.

On the other side, insurers are buying health-care providers, or seeking to work with them on new cooperative deals and payment models that share the risks of health coverage. And employers are starting to take a far more active role in their workers’ care.

Such shifts have been gathering force for a while, but the economic downturn has accelerated the push for efficiency. The federal legislation, which creates new health-insurance marketplaces and requires most people to carry coverage, may unleash additional demand for health care once it fully takes effect in 2014. Even if the Supreme Court unwinds part of the law, the changes occurring now aren’t likely to stop because the pressure to reduce the price of health coverage won’t go away.

Read more on the possibilites of U.S. Health Care’s future from the WSJ here.

With each passing year, it was getting more difficult to tell the difference between the waiting room at Sewickley Valley Hospital’s emergency department and the one at the Greyhound bus depot.

That’s not the view of some disgruntled patient. That’s straight from the CEO’s mouth.

“Sewickley was last renovated in 1976,” said Norm Mitry, president and CEO of Heritage Valley Health System, which owns both Heritage Valley Beaver and Heritage Valley Sewickley, the new name for the former Sewickley Valley.

Both hospitals’ ERs were undersized, overutilized — and, ultimately, past their expiration dates, he said. That’s why the nonprofit health system spent more than $26 million two years ago improving the hospitals and expanding the emergency departments.

If this story sounds familiar, that’s because it is: Across southwestern Pennsylvania, emergency rooms have spent the last five years expanding, improving and, in many cases, rebooting from scratch.

It is, experts say, an unprecedented building spree, mirrored nationally and brought on by a variety of factors. But while hospitals say the construction was driven by a need to upgrade aging facilities, insurers and industry watchdogs worry about ER arms races, mainly because ER care for routine injuries is often four times the cost of the same care when it’s dispensed at a doctor’s office or urgent care clinic.
Get all the details on which hospitals are being renovated and how from the Post-Gazette.

There are forgotten people in the health care system — uninsured, usually undocumented, without resources and stuck in the system’s most expensive course of care. Some are abandoned by or estranged from relatives; some belong in rehabilitation centers, where care is much cheaper, but because of their immigration status they are not enrolled in Medicaid or Medicare, so the places will not take them.

In cities with a large immigrant populations, it is not rare for hospitals to have one or more patients who, for reasons unrelated to their medical condition, do not seem to leave. In the case of Mr. Fok’s hospital–Downtown–a bed costs  more than $2,000 a day, and there are currently three long-term patients who no longer need acute care but cannot be discharged because they have nowhere to go. The hospital pays nearly all costs for these patients’ treatment. One man left recently after a stay of more than five years.

To read more about Mr. Fok’s story and the Medicare/Medicaid issues facing hospitals and their populations, see the New York Times here.

Palliative care is defined as an area of healthcare that focuses on relieving and preventing the suffering of patients. Unlike hospice care, palliative medicine is appropriate for patients in all disease stages, including those undergoing treatment for curable illnesses and those living with chronic diseases, as well as patients who are nearing the end of life.

While emergency departments are designed to deal with trauma and all-out rescue operations, they often receive patients who are suffering from severe pain as a result of chemotherapy, rheumatoid arthritis, and other chronic conditions.

Reports the Philadelphia Inquirer:

[Meg] Greene [a nurse care manager at Bryn Mawr Hospital] is part of a small but growing group of medical providers who say many patients in emergency departments are not appropriate for the all-out rescue medicine these units are designed to deliver. Instead, they are suffering from the pain and inexorable decline of cancer and chronic illness or old age, and may be better served by care aimed at comfort, not cure.

…

Palliative care, which focuses on treating the symptoms of diseases either fatal or curable, has become increasingly common in U.S. hospitals. According to the Center to Advance Palliative Care, the percentage of hospitals with palliative-care teams jumped from 24.5 percent in 2000 to 63 percent in 2009. But emergency departments are a new frontier for a specialty more commonly seen in intensive care or oncology units.

“I would say, over the last five years, the conversation and growth around palliative care in the emergency department has been exponential,” said Tammie Quest, an Emory University doctor who is board-certified in emergency medicine and palliative care.

It is still rare for hospitals to have a staffer such as Greene who specializes in palliative care on-site in the emergency department. Mark Rosenberg, chairman of the emergency department at St. Joseph’s Regional Medical Center in Paterson, N.J., said he was one of only 37 emergency physicians nationwide who were also board-certified in palliative care.

Several local hospitals, including Abington Memorial, Cooper University, and Thomas Jefferson University Hospitals and Albert Einstein Medical Center, said their palliative-care teams do consultations for emergency patients.

…

The emergency department is a focal point because it is where most patients who are admitted start out and “the final common pathway of a broken system,” said Diane Meier, director of the palliative-care center at Mount Sinai School of Medicine. By that, she means that many people go to the emergency department because they have not gotten good primary care or chronic-disease management.

Also, she and other experts said, many patients have not been told explicitly that they are dying, do not understand the symptoms of dying, or have caregivers who feel unable to handle those symptoms at home.

…

Many patients also have been given poor pain treatment. “Most doctors don’t know how to manage pain,” Meier said. “It’s not taught in medical school. The general public finds this frankly unbelievable. . . . It’s just unfortunately a fact.”

Find out more at the Inquirer.

Says PHC4 in a press release issued today:

Ambulatory surgery centers (ASCs) in Pennsylvania remained financially healthy overall in fiscal year 2010 (FY10), according to a new report from the Pennsylvania Health Care Cost Containment Council (PHC4). The statewide average operating and total margins for ASCs were 26.20% and 26.29%, respectively. The margins remained in the 26.00% to 26.30% range over the last three-year period (FY08 to FY10).

The ASCs’ average total margins among the nine regions in Pennsylvania ranged from a low of 17.66% to a high of 35.04%.

“In general, ambulatory surgery centers in Pennsylvania are thriving,” said Joe Martin, Executive Director of PHC4. “After a decade of considerable growth, the number of ASCs increased only marginally between FY09 and FY10.”

Eight new facilities opened and four closed, for a net growth of only four facilities in FY10. In the period from FY01 to FY09, the number of ASCs increased from 98 to 262, an average increase of 18 facilities per year.

In response, the Hospital & Healthsystem Association of PA released a statement saying that the data in the report continues to raise questions about the ability of the uninsured and people on Medicare and Medicaid to gain and maintain their access to health care.

Writes HAP in a press release:

According to PHC4, there are now 266 ambulatory surgery centers (ASC) in the state, up from 72 ten years ago, far exceeding the number of general acute care hospitals (165). ASC total profit margins have exceeded 26 percent in each of the past three years. This is in part due to the fact that Medicaid accounted for only 4.5 percent of ASC revenue in 2010, compared to 11.8 percent of general acute care outpatient revenue.

“As the congressional deficit-reduction ’super committee’ gets to work this fall, it is imperative that members of the panel—and by extension all members of Congress—understand the pivotal role that acute care hospitals play in providing a health care safety net for our most vulnerable citizens,” said HAP President and CEO Carolyn F. Scanlan. “With ASCs treating healthier, and usually better insured, patients, the financial and clinical demands on acute care hospitals, which are a safety net for all Pennsylvanians, continue to grow.”

“Under the original Affordable Care Act health reform law, hospitals nationwide already have accepted shared sacrifice amounting to $155 billion in payment reductions—$9 billion in Pennsylvania alone,” Scanlan said. “In addition, Pennsylvania’s fiscal year 2011-2012 state budget cut Medicaid payments to hospitals by 4 percent.”

Scanlan noted that these cuts do not include additional cuts imposed by regulations, and she said that the Medicare and Medicaid programs already underpay hospitals, paying less than the cost of care.

“The bottom line for our patients is access,” Scanlan said. “We continue to support maximizing insurance coverage for all Americans, but it cannot be done by reductions to providers, without whom nobody — insured or not — will be able to get care.”

UPMC and Washington Hospital are considering teaming up to open urgent care centers in Western PA.

The U.S. Department of Labor is investigating Erie-located Stairways Behavioral Health for noncompliance.

A doctor at Abington Memorial Hospital is battling against an insurance company in order to get care for his patient with a rare disease.