Tag Archives: senator chuck grassley

Grassley questions hospitals for HIT investigation

Fred Schulte and Emma Schwartz continue to stay on top of the stimulus/health information technology/Sen. Charles Grassley investigation story for the Huffington Post Investigative Fund, this time explaining how and why the Grassley-driven inquiry into plans to spend an estimated $19 billion in stimulus money on HIT is now asking leading hospitals for input on their experiences with EMRs. The reporters also posted a copy of Grassley’s Jan. 19 letter.

Sen. Charles Grassley

Sen. Charles Grassley

Grassley sent the 11-question letter to 31 hospital organizations and requested that they respond by Feb. 16.

At this point, Grassley seems focused on technical issues that threaten patient safety, as well as potential conflicts of interest. Here are some of his more prominent lines of inquiry:

  • How hospitals make purchasing HIT decisions.
  • Potential financial or incentive-based relationships between HIT vendors and hospitals.
  • Whether or not hospitals rely on outside contractors for HIT implementation.
  • Procedures for and costs of training staff on new technology.
  • Quality control and bug/problem-reporting procedures.
  • Communication with tech vendors, peers and government officials.
  • The relative liability of vendors and hospitals for HIT-related problems.

Grassley also asked hospitals to “provide a list of HIT problems or complaints that have been identified by or reported to your facility since January 2008 that directly or indirectly impacted patient safety or the delivery of care, including any complications or adverse events that have occurred as a result of HIT product design and/or usability.” He also requested that they “provide examples of contracts with HIT vendors that include non-disclosure clauses” and list any payments or discounts the hospitals received from those vendors.

Related: Fla. docs, vendors battle over EMR headaches

Sammy Mack’s piece for Health News Florida is a lively recounting of the complete meltdown that occurred between a group of Florida doctors and an EMR vendor, one rich in scandalous details like cease and desist letters and collection agencies. Mack’s work highlights the cultural divide between tech-savvy IT specialists and medical professionals and points out that the number of such conflicts is likely to increase as EMR adoption rises. Here’s Mack’s description of one such conflict, a dispute which happens to have a unique connection to journalism, medicine and ethics:

In another complaint against [EMR vendor Joe] Castranova, Dr. Linda Kaplan said she too was surprised by charges on her invoice. When they first met, Castranova recognized her as a former medical editor at the local NBC television affiliate. She said he offered to waive her software and training fees if she would endorse the product.

Kaplan agreed, but she said she was unimpressed with the system once it was installed in her Hallandale Beach office. She was reluctant to drum up business when she wasn’t a satisfied customer.

Kaplan said Castranova was displeased with her lackluster endorsement and locked her out of some 600 patient records on his server. He billed for the software system anyway.

Castranova said he gave her four months’ notice before locking her out – plenty of time to retrieve patient files.

Evaluation of nonprofits’ charity care continues

If you’re keeping a list of issues that have been rejuvenated through inclusion in the Baucus bill, you can safely add Iowa Sen. Chuck Grassley’s crusade to keep nonprofit hospitals accountable for the provision of adequate amounts of charity care. According to the Chicago Tribune‘s Bruce Japsen, the proposed bill includes Grassley’s provision to “improve the community service, transparency and billing practices of nonprofit hospitals.”

From Japsen’s story:

“For now, there’s no minimum percentage requirement for charity care and community benefit,” Grassley said in a statement on Baucus’ proposal. But Grassley is not ruling out a required level in the future, saying it needs “more study.”

“I agree with groups that take their charitable mission seriously … that a percentage payout requirement would become a ceiling, not a floor, like the private foundation payout of generally five percent,” Grassley said in a memo Thursday. “Instead, we need a formula that would maximize expenditures for charitable purposes.”

The Washington Post‘s Kathleen Day, meanwhile, reported on the results of a Grassley-backed Senate investigation into the charity care provided by nonprofit hospitals:

The investigators found that while federal law requires charity care in exchange for tax-exempt status, a 37-year-old IRS rule implementing the law is so vague that nonprofit hospitals have been able to exploit it by offering some free services but often little aid to the poorest people in their communities.

Nonprofits frequently charged higher prices to poorer people with no health insurance than they did to better-off patients who had coverage, researchers found. At the same time, many of the hospitals’ top executives enjoyed generous perks such as paid country club memberships and stays at expensive hotels.

GAO: Four percent of nursing homes are troubled

A new report from the Government Accountability Office report estimates that 580, or 4 percent, of America’s approximately 16,000 nursing homes are troubled enough to qualify for Centers for Medicare and Medicaid Services “Special Focus Facility” designation. Because of CMS’ limited resources, only 136 are.

Special Focus Facilities, which are evaluated based on deficiencies and revisited to ensure compliance, are chosen from a list of the 15 worst homes in each state. Using more objective criteria based on CMS recommendations, the GAO report found that, in reality, the nation’s worst homes don’t follow such a neat distribution “with 8 states having no such homes and 10 others having from 21 to 52 such homes.”

Legislators, including influential voices like Sen. Herb Kohl, D-Wis. and Sen. Chuck Grassley, R-Iowa, are saying the report shows that the “Special Focus Facility” program should be expanded to include more low-quality homes, Freking reported.

The GAO also released a profile of the most common sort of under-performing nursing home:

The worst-performing ones tend to be for-profit facilities affiliated with a chain of nursing homes. They are more likely to be a larger facility, averaging 102 residents, while other nursing homes not identified as among the worst had 89 residents on average.

Find the full 57-page report here.

Related article

Reporter discovers data missing from federal Nursing Home Compare
Member Duane Schrag of the Salina (Kan.) Journal tells AHCJ how he discovered that certain data was missing from the Nursing Home Compare database and chronicles his efforts to break through the CMS bureaucracy and figure out what was missing and why.

Grassley digs into journal ghostwriting practices

Ben Comer of Medical Marketing & Media reports that Iowa Republican Senator Chuck Grassley sent a letter to eight prominent medical journals, asking them to share their editorial policies regarding the disclosure third parties involved in the creation of journal articles, as well as the penalties they have set for authors who don’t follow those policies. Grassley asked the journals to respond by July 22. Read the senator’s press release here.