The Department of Health and Human Services (HHS) issued a final regulation to review large health insurance premium increases while at the same time providing consumers with clear access to this information.

HHS hopes that this transparency will help lower insurance costs, especially when in September 2011 state or federal agencies must review rate increases of 10-percent or more.

“Effective rate review works – it does so by protecting consumers from unreasonable rate increases and bringing needed transparency to the marketplace,” said HHS Secretary Kathleen Sebelius. “During the past year we have worked closely with states to strengthen their ability to review, revise or reject unreasonable rate hikes. This final rule helps build on that partnership to protect consumers.”

Starting September 1, 2011, the rule requires independent experts to review any proposed increase of 10-percent for most individual and small group health insurance plans. States will have the primary responsibility for oversight, and HHS will serve in a backup role if certain states are unable or unwilling to comply. Starting September 2012, the 10-percent threshold will be replaced by state-specific thresholds that reflect the insurance and health care cost trends in each state.

“Strong and transparent rate review processes are necessary to help bring down costs for consumers,” said Steve Larsen, director of the Center for Consumer Information and Insurance Oversight. “Rate review will ensure that increases are based on reasonable estimates and real-time data on medical cost trends and health care utilization.”

For more information about recent trends in health insurance rates and the final rule, visit HERE.

The Centers for Disease Control and Prevention has posted information on how to prepare in the event of a zombie invasion. Assistant Surgeon General Ali Khan provides valuable information from stocking up on food to first aid supplies to “where you would go and who you would call if zombies started appearing outside your door step.”

The CDC blog also explains:  “If zombies did start roaming the streets, CDC would conduct an investigation much like any other disease outbreak, CDC would provide technical assistance to cities, states, or international partners dealing with a zombie infestation. This assistance might include consultation, lab testing and analysis, patient management and care, tracking of contacts, and infection control (including isolation and quarantine).”

Among other things, the CDC also recommends advance planning of the appropriate escape route:  ”Plan your evacuation route. When zombies are hungry they won’t stop until they get food (i.e., brains), which means you need to get out of town fast! Plan where you would go and multiple routes you would take ahead of time so that the flesh eaters don’t have a chance! This is also helpful when natural disasters strike and you have to take shelter fast.”

For more information about what to do when the zombies arrive, or information about disaster preparedness in general, visit the CDC’s Website HERE.

Hello Everyone:

In many respects, today is like any other for Coast Plaza Hospital. Just as we have since opening our doors more than 50 years ago, we stand proud and ready to address any emergency our community might face, welcoming one and all in times of need. And yet, though unbeknownst to our many neighbors, patients and friends who have come to look upon the hospital as a constant, fixed entity toward which to turn in the midst of chaos, behind the scenes a torch will shortly be passed from one hospital owner to another.

Under the past twenty-one years of present ownership I have shared the title of Chief Executive Officer with only one other. In this, my final report to the Coast Plaza Hospital community, I would like to honor the individual who held my title for the 12 years before me, my father, Gerald J. Garner, since in my opinion it is his legacy that has made our hospital a name our community has come to trust.

Born December 17, 1936, my father was raised in New York and did not move his family to California until he was 40. It was to be another decade before he assumed the position of Coast Plaza’s CEO, a role he accepted with pride. His sudden death on April 28, 2002 came as a great surprise to both his immediate family and the employees at Coast Plaza, many of whom knew him from the beginning of his tenure.

Today, my father is survived by my mother Joan, my sister Robyn and her husband Keith, my brother Scott and his wife Karen, me and my wife Natalya, and six grandchildren. While he adored Robyn and Keith’s children Tyler and Evan, sadly Gerald never had the chance to meet Scott and Karen’s three children, Espen, Annika, and Helena, or our newborn son Rodion. I like to think he would be proud of the new elements within his family.

Gerald taught many people many things in life, but it was perhaps his passing that taught our hospital family its most important lesson: We achieve greatness together, and only together. I have heard it said that the whole is by nature greater than the sum of its parts, and when it comes to health care in the modern age that is certainly true, be it the correlation between community and hospital, employees and hospital, or even investors and hospital. As different as each of these entities may seem from the others, all three survive only by existing together. Just as the loss of my father affected my immediate family greatly, the transition from old guard to new will have its moments of uncertainty for the Coast Plaza family. Even so, though these past few weeks have given me the opportunity to witness first hand the ways in which change can make for a stressful environment, I have also been pleased to regard the strength and dedication shown by our members in their effort to maintain the superlative standard of health care that our community has come to expect, regardless of any temporary internal fluctuations. Nine years of consistency will undoubtedly lead to a certain amount of confusion for a time, no matter who is waiting in the “on-deck circle.”

But that is what makes a hospital such a special place to work. As chaos tries to rule the day, something happens, and a wake up call of sorts is given, reminding us all of the reason we have come together in this building on any given day. Our daily dose of reality connects us with the real issues at hand, as we remember that our community truly values the support we provide in times of need, just as we do the same for one another. After all, that is what relationships are all about.

Throughout this period of transition, Coast Plaza Hospital did exactly as it should, relying on a network of relationships already in place and building on the new to continue its focus on providing care to the community. In hindsight, the past nine years under my tenure were in many ways defined by these relationships, and our focus was strong. As a result, the community received exactly what it had come to expect and deserve — a first-rate hospital.

Seven months ago I met the individuals who will write the next chapter for Coast Plaza Hospital. They are a competent, generous, able group, to be sure. But though they may steer the course, they will not write this story alone. If there is one fact which Gerald and I knew to be true while tending our posts, it is that the strength of this particular hospital comes not from its leadership, but from the dedication of its nearly 400 stellar employees. Working together for the common good, you are indeed greater than the sum of your parts, and I do not expect that to change.

Regardless of what the future holds for Coast Plaza, there is one thing of which I am sure: The extended family that has for nine years made it an honor and a privilege for me to lead this hospital will continue to provide excellence in care for the people in and around Norwalk. Indeed, that is what health care at Coast Plaza Hospital is all about.

Thank you all.

The Centers for Medicare and Medicaid Services (CMS) will start paying hospitals bonuses based upon performance, an adherence to quality measures, and on patient satisfaction.  These final Medicare rules were published last week. This Hospital Value-Based Purchasing Program is another step toward shifting the reimbursement infrastructure from the cost of services during a hospital stay to improvements in patient health and performance during a hospital stay.

Proponents of this idea — which was part of the Patient Protection and Affordable Care Act — contend it could help save money in the Medicare system as it improves patient care nationwide. “For the first time, hospitals are going to be paid for inpatient hospital quality, not just the quantity of the care they provide,” CMS administrator Donald Berwick, MD, told reporters on Friday morning.

The rule goes into effect in October 2012. In the program’s first year, hospitals will be entitled to share bonus money from an $850 million fund based upon their performance. For a complete list of the quality measures, visit here.  CMS will also evaluate patient satisfaction during hospital stays. Quality measures will weigh at 70% and patient satisfaction results at 30%.

In fiscal year 2013 (starting October 2012), hospitals will face a 1% reduction overall on Medicare payments under the Inpatient Prospective Payment System (IPPS) as these funds will be used to pay for the performance bonuses. By 2015, hospitals who continue to show poor performance ratings will not only be excluded from the bonus pool, they will also face additional cuts in reimbursement.

When asked if the rule would be unfair to hospitals with less money who might have greater challenges adhering to the quality measures and focusing on patient scores, Berwick stated: “We need all boats to rise on the rising tide of quality.”

In February, Hospital Stay posted an overview on California’s seismic safety requirements for hospitals.  That article can be found HERE.  Recently Governor Brown signed SB 90 and AB 113, which in part provide hospitals with a possible seven year extension to comply with the State’s seismic safety requirements.

To qualify, there are some legislative events which must occur first on both a state and federal level. If and when that occurs the seismic extensions set forth in SB 90 last up to seven years, but no later than 2020.  For a hospital to obtain this optional extension, OSHPD must consider public safety when determining whether to grant an extension or length of an extension on a case-by-case basis using the following criteria:

• Structural integrity of the building based on its HAZUS score. HAZUS is a nationally applicable standardized methodology that contains models for estimating potential losses from earthquakes, as well as other natural disasters.
• Community access to health care if the hospital building is closed.
• Financial capacity of hospitals to complete the construction project.

No later than March 31, 2012, hospitals that wish to apply for the extension must:

• Submit a letter requesting an extension.
• Specify what the project will be (rebuild, retrofit, other).
• Specify the time necessary for the project.
• Submit a schedule detailing the extension work.
• Specify how the project will stay on track as proposed.

No later than September 30, 2012, a hospital must submit its HAZUS application No later than January 1, 2015, a hospital shall:

• Submit plans and a schedule for the project identified.
• Submit a financial report describing the ability to complete the project.

No later than July 1, 2018, a hospital must obtain a building permit for its project, thereby ensuring sufficient time to meet the statutory deadline.

A recent study published in the Journal of Human Capital examines movie star marriages in an attempt to identify why people often marry someone with a similar educational background. According to Gustaf Bruze, an economist at the Aarhus School of Business and Social Sciences in Denmark, the answer has less to do with financial or professional considerations, and that just because a couple attended the same school is not necessarily conclusive.

Bruze reviewed information about the top movie stars’ marriages, earnings, and education levels. The analysis showed that the level of formal education may have little to no correlation with success (either financial or the likelihood of winning an industry award).  Notwithstanding, movie stars who marry still tend to have similar educational backgrounds, even though it is unlikely a couple met in school or on a film set as a result of their their education level.

Bruze noted that the findings suggest education is not dependent upon financial or professional  connections. “What it says is that men and women have very strong preferences for nonfinancial partner traits correlated with education. And educational sorting would remain even if the tendency of men and women to work with colleagues of a similar educational background were to disappear or if the role of educational institutions as a meeting place for future husbands and wives were to disappear.”

A Punch Up At A Wedding

Between 1892 and 1954, Ellis Island served as the only entry point into the United States for more than twelve million immigrants. A small island inside New York Harbor located just off the New Jersey coast and the nearby Statute of Liberty, Ellis Island grew over the years from its original 3.3 acres to 27.5 acres in size.

Before 1890, individual states regulated immigration. When the Federal government assumed this responsibility, it constructed and operated a new facility on Ellis Island, opening its doors on January 1, 1892.

For the most part, class and status dictated whether an immigrant was sent to Ellis Island. Travelling across the Atlantic Ocean (the only real viable option at the time), first and second-class passengers were only sent to Ellis Island if they were sick (or had legal issues).  Third class passengers, also known as “steerage”, would almost always be sent to Ellis Island by ferry or barge for a medical examination.

If one’s legal documents were in order and he or she appeared to be in good health, the time spent on Ellis Island would be brief.  Doctors conducted medical examinations by quickly scan all newcomers for obvious physical ailments (sometimes referred to as the “six second physical”).

Fearing danger to the public health, immigrants with contagious diseases were excluded from entry into the United States. As a result, a hospital was needed on Ellis Island to treat the immigrants and protect the public health, and it opened in 1902. The contagious disease hospital was built with 18 wards for specific diseases, and it also included a psychiatric hospital.  Eventually the hospital would grow to include 22 buildings on Ellis Island.

A report by Assistant Surgeon General H.D. Geddings in 1906 stated: “The hospital building is of modern construction, on the block plan, of brick and stone construction, architecturally very handsome, and three stories and an attic in height, with a basement.  The general plan of the building is a central portion for executive and administrative purposes, with wings containing large and small wards.”

The Ellis Island Hospital received heat, light and power from a plant on Ellis Island. The hospital’s kitchen prepared 2,000 meals each day for the immigrants and 300 employees. According to the Commissioner of Immigration, Federic C. Howe, in 1916 Ellis Island would accommodate “as many as 10,000 people temporarily or permanently.”

The Ellis Island Hospital handled all diseases, including measles, mumps, diphtheria, and whooping cough. The hospital also had its own state-of-the-art laboratory, critical at the time to identify cases such as pulmonary tuberculosis. Indeed, the hospital reported only one employee death due to infection with contagious disease (tuberculosis) while working with the immigrants.

According to Dr. Milton Foster in 1915, “The medical inspection of arriving immigrants is made chiefly for two purposes; first, to see that they are strong, well, and bright enough to be able to earn a living and get along in this country; and second, to ascertain that they do not have certain diseases which they might transmit to their new neighbors in America.” While it treated disease and the passing of 3,500 patients, Ellis Island Hospital also delivered 350 babies (receiving immediate citizenship at birth).

The hospital screened immigrants for mental illness as well, usually a process initiated with an “X” chalk marked on the jacket or dress of the immigrant.  According to Dr. Thomas Salmon in 1905: “Justice to the immigrant requires a carefully considered diagnosis; while on the other hand, the interests of this country demand an unremitting search for the insane persons among the hundreds of thousands of immigrants who present themselves annually at our ports of entry.”

Physicians from the U.S. Public Health Services were required to rotate through the hospital. The patient load on Ellis Island was challenging. According to Dr. Foster, the volume compared to that of the hospitals in both Boston and Washington, D.C.:

“Take any week in the year and imagine that, during this week, all the people who were sick and needed treatment in [Boston and Washington, D.C.] were to be sent to one hospital.  Assume, also, that this hospital was a real general hospital, in the fullest sense of the word, and that it accepted not only ordinary patients but also the insane and those suffering from contagious diseases. Let us also further suppose that all . . . were inspected and that all those who were suspected of having latent disorders, like tuberculosis or syphilis, were also sent to this hospital for examination and treatment. Grant all of these conditions and you will have a pretty fair idea of the total amount of work performed by the hospital at Ellis Island last year.”

Restrictions on immigration ultimately proved to be the end of Ellis Island Hospital. Additionally, physical screenings were conducted overseas before transatlantic voyage was permitted.

As the number of patients began to decrease, Ellis Island was used by other government agencies such as the FBI (using the island to deport possible foreign spies), the U.S. Army (during World War II for its disabled servicemen as well as German and Italian prisoners of war), and finally the U.S. Coast Guard. In fact, it was the U.S. Coast Guard that ultimately closed the facility in 1954.

Photographs from EllisIsland.org, NewYorkTimes.com, and U.S. DHHS.