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For-profit, or proprietary, home health agencies were banned from Medicare until 1980 but now account for a majority of the agencies that provide such services. Medicare home health costs have grown rapidly since the implementation of a risk-based prospective payment system in 2000. We analyzed recent national cost and case-mix-adjusted quality outcomes to assess the performance of for-profit and nonprofit home health agencies. For-profit agencies scored slightly but significantly worse on overall quality indicators compared to nonprofits (77.18 percent and 78.71 percent, respectively). Notably, for-profit agencies scored lower than nonprofits on the clinically important outcome “avoidance of hospitalization” (71.64 percent versus 73.53 percent). Scores on quality measures were lowest in the South, where for-profits predominate. Compared to nonprofits, proprietary agencies also had higher costs per patient ($4,827 versus $4,075), were more profitable, and had higher administrative costs. Our findings raise concerns about whether for-profit agencies should continue to be eligible for Medicare payments and about the efficiency of Medicare’s market-oriented, risk-based home care payment system.

Corruption, Crime & Compliance Tue Jan 27 2015,

From a corporate risk perspective, if your company is in the financial industry, healthcare, or defense industry, your greatest legal and compliance risk has to be the False Claims Act. I know that is heresy to all the legal "marketing/fear" publications focused on the FCPA, but for many companies, the FCA is a greater risk. Add to the FCA mix a well-established whistleblower scheme - qui tam relators - and there is your recipe for disaster. In the healthcare industry, the government is focused on providers, particularly hospitals. The government's motivation is easy to discern - they want to keep medical costs down and hospitals are the biggest factor in this payment mix. Healthcare clinics, home health services and skilled nursing facilities are other providers on the government hit list.

Community Health Systems, the largest operator of acute care hospitals, paid $98 million to settle seven lawsuits brought by qui tam relators, and entered into a five-year Corporate Integrity Agreement with HHS. Community Health Systems engaged in a deliberate strategy to increase inpatient admissions of patients who entered emergency departments. The relators in these cases included nurses, billing personnel, and emergency room physicians. Another significant hospital case was brought against Halifax Hospital Medical Center, which is based in Florida, that agreed to pay $85 million to resolve Stark law violations. In the home healthcare services area, Amedisys, one of the largest home healthcare providers agreed to pay $150 million to resolve a number of qui tam relator lawsuits, along with a five-year CIA with HHS. Amedisys billed Medicare for nursing and therapy services that were medically unnecessary or were for services to patients who were not limited to home residence.

National Post Mon Feb 2 2015

For the past eight years, Covenant Health has operated a unique employee engagement program utilizing hundreds of specially trained staff dubbed as engagement ambassadors to improve the lives of fellow employees. Specially trained in the issues surrounding engagement, the Edmonton-based health-care provider currently has 296 ambassadors charged with sharing knowledge of engagement best practices and promoting a positive work environment. "The senior team recognized the importance of focussing on employee engagement and created a program to support it," says Karen Zarsky, the health-care provider's director of organizational effectiveness, learning and development.

The ambassadors, spread out across the province of Alberta, have allowed the organization to provide training to leaders to support and strengthen employee engagement as well as to identify and celebrate "everyday heroes" who have done something large or small for patients or fellow employees. "To me, the biggest win [from the ambassador program] is celebrating our everyday heroes," says Zarsky. Engagement ambassadors also organize celebratory events for their teams, advocate for resources for their team or department and create new employee recognition programs. "I think that people are more open to sharing their ideas for improvement," says Sherry Lucas, a clinical safety co-ordinator with Covenant Health's Bonnyville Health Centre, with 335 employees located two hours north of Edmonton.

The Daily Gleaner (Fredericton) Wed Mar 11 2015

After a national survey of paramedics released last month documented high stress levels among New Brunswick's emergency medical professionals, officials with Ambulance New Brunswick announced they'd be bringing forward new programming to assist employees. So far there's no word on when those new programs will be available, though it looks like work is underway to prepare them for an upcoming roll-out. In October 2014, the Paramedic Association of Canada invited paramedics from coast to coast to fill out a confidential online survey, which asked questions to assess whether or not they've struggled with mental health problems.

Designed by a clinical psychologist who works with the Toronto Paramedic Services, the poll was completed by more than 6,000 paramedics. Nearly 350 of the roughly 1,100 paramedics working in New Brunswick shared their experiences for the survey. Their responses provided some troubling statistics about the pressures these skilled individuals face on the job and in their personal lives. About 30 per cent of the responding paramedics reported they'd contemplated suicide. When asked if they knew any co-workers who had thought about taking their own lives, that number more than doubled to 70 per cent. About 79 per cent said they've worried about a colleague's well-being.

Canadian Press Wed Mar 11 2015

EDMONTON - Alberta paramedics will be allowed to do more for patients to help relieve a bottleneck leading to long waits in emergency care. It's one of three initiatives announced Wednesday by Health Minister Stephen Mandel. He says as of this summer, paramedics will provide more front-line care in clinics and regional hospitals by handling duties such as portable lab analysis. The province also plans to open 311 new restorative care beds to help seniors transition from hospitals back to their homes

There is also to be $50 million to increase capacity and improve care in emergency rooms in Edmonton and Calgary over the next two years. Mandel says the government is working to protect front-line care, even though it is planning five per cent spending cuts across the board in the next budget. Sandra Azocar, executive director of Friends of Medicare, said the announcement included no details on how the funding would be allocated between the five facilities or what specific renovations or expansions would take place, nor did it say if any additional staff would be hired with the expansions.

A message from Dr. Monika Dutt At the end of August, Dr. Brian Day's legal team requested a delay of trial. Along with our allies, we at CDM were hopeful that the delay would lead to a resolution that defended Medicare against for-profit interests.  

But last week we learned that a resolution has not been reached, and the trial that threatens to destroy Canadian Medicare will begin this spring. On March 2, Day will re-launch his court challenge, alleging that the Canada Health Act is a violation of the Canadian Charter of Rights and Freedoms.

Toronto Star Sat Apr 11 2015

In late February, a first consultation with task force co-chairs Marilou McPhedran and Sheila Macdonald heard from experts in the field. A little more than a month later, three victims shared their testimonies publicly at a second session. Public consultations are not the only way for victims to tell their stories. In an email to the Star Thursday, David Jensen, a spokesman for Ontario's Ministry of Health and Long-Term Care, said three more victims have come forward to the task force during two private consultations. They can also request to tell their stories by telephone conversations, letters, emails or other written communication. When asked if she would consider telling her story at the next consultation on Monday, Brooks said she believes her story would "absolutely" be ignored. "If I thought there was any input that I could give that would actually make a difference, I would be front of the line. But I don't think there's anything that will change."

The ministry is using print advertising and social media to raise awareness about the consultations, said Jensen. They have also contacted survivor organizations, provided McPhedran and Macdonald with a list of contacts, and engaged both the Metropolitan Action Committee on Violence Against Women and Children and the Ontario Coalition of Rape Crisis Centres to help get the word out, he said. Nicole Pietsch, co-ordinator of the rape crisis centres coalition, said she was the one who reached out to the Ministry of Health after learning about the public consultations through a fellow community group. "You've got to think - we have 26 sexual assault centres across the province. That's all kinds of sexual violence, but I would say most centres are hearing from survivors of patient sexual abuse. We see those cases, not loads and loads, but every year we do see those cases," she said. The information about the session is reaching the public only now, Pietsch said. Consultations with the task are supposed to last only through April. Amanda Dale, executive director with woman's legal centre the Barbra Schlifer Clinic, said she only vaguely remembers getting a letter from the ministry about the consultation.

Hamilton Spectator Fri Apr 10 2015

Imagine you're a physician seeing a six-month-old child in clinic. She has a fever and cough, she's working hard to breathe and her oxygen levels are falling. You know she needs assessment in the emergency room and requires transportation in an ambulance in case her condition worsens en route. Her family understands the urgency of the situation, but asks, "Could we take her there in our car?" Experiencing a medical emergency is an incredibly stressful experience for patients and their families. This stress should not be compounded by worries about getting an ambulance bill they can't afford. As physicians, we know the importance of the first few minutes of an emergency situation, and the crucial role of emergency medical services (EMS) in saving lives. And yet ambulance fees remain a significant barrier to people receiving necessary care across Canada. One young mother recently spoke to the Saskatchewan press about receiving a bill of $7,000 after several ambulance trips were required for her severely ill daughter. Connie Newman of the Manitoba Association of Seniors Centres recently described to reporters the plight of an elderly woman who walked to hospital in -40 C weather because she could not afford an ambulance. How often are people forced to choose the unsafe option of driving themselves or their loved ones to hospital simply because they cannot afford to pay?

A recent CBC "Marketplace" survey revealed 19 per cent of Canadians did not call an ambulance due to cost. Clearly, this is an issue our provincial and territorial health ministers need to address.

The St. Catharines Standard Sat Apr 11 2015

Tammy McCormick Ferguson was alone at home Friday morning, waiting for a nurse she expected to see at 8 a.m.

he 48-year-old niagara Falls woman is in a wheelchair. She is non-verbal, unable to communicate except by messages on her ipad, and requires feeding and medication to be administered twice a day through a tube in her stomach. this is all new to her -until recently, she enjoyed an award-winning career in child development, before a neurological disorder took away not only her career but her ability to look after herself. She is one of 1,600 people in the niagara region who receives treatment from Carepartner nurses. Some clients are able to visit one of four clinics in the region, but she is one of many who receives nursing care at home. But Carepartner nurses went on strike Friday morning, unable to negotiate a contract agreement with their employer.

THE NATIONAL Thu Mar 19 2015,

WENDY MESLEY (HOST): All that medicine isn't cheap either. Canadians spent an estimated 22 billion dollars a year on prescriptions in 2013, almost twice what they spent in 2001. One in ten struggle to afford it. It's big business and big drug companies know it, spending billions marketing it right back to you. VOICE OF UNIDENTIFIED WOMAN (ANNOUNCER): (Advertisement) Ask your doctor if Lunesta is right for you. WENDY MESLEY (HOST):

So are we over- or under-medicated? Is the high cost of prescription drugs failing to help Canadians in need? And what should we be watching for next? So we'll start with that middle question, like, who is not covered? Who is falling through the cracks? You must all see this in your practices? Danielle, what are you seeing? DANIELLE MARTIN (FAMILY PHYSICIAN, WOMEN'S COLLEGE HOSPITAL): In fact, millions of Canadians have no drug coverage whatsoever and millions more don't have adequate coverage for their needs. In my practice I see it all the time among the self-employed, people who are working in small businesses, people who are working part-time and don't have employer-based coverage. It's the taxi drivers, it's the people who are working in a part-time job, but it's also middle-income people who are consultants or working in small businesses who don't have coverage. So this isn't just a problem for the poor. It's a problem for people across socioeconomic lines.

Toronto Star Fri Mar 27 2015

Imagine you're a physician seeing a 6-month-old child in clinic. She has a fever and cough, she's working hard to breathe and her oxygen levels are falling. You know she needs assessment in the emergency room and requires transportation in an ambulance in case her condition worsens en route. Her family understands the urgency of the situation, but asks, "Could we take her there in our car?" Experiencing a medical emergency is an incredibly stressful experience for patients and their families. This stress should not be compounded by worries about getting an ambulance bill they can't afford. As physicians, we know the importance of the first few minutes of an emergency situation, and the crucial role of Emergency Medical Services (EMS) in saving lives. And yet ambulance fees remain a significant barrier to people receiving necessary care across Canada.

One young mother recently spoke to the Saskatchewan press about receiving a bill of $7,000 after several ambulance trips were required for her severely ill daughter. Connie Newman of the Manitoba Association of Seniors Centres recently described to reporters the plight of an elderly woman who walked to the hospital in -40 C because she could not afford an ambulance. How often are people forced to choose the unsafe option of driving themselves or their loved ones to hospital simply because they cannot afford to pay? A recent CBC Marketplace survey revealed that 19 per cent of Canadians did not call an ambulance due to cost. Clearly, this is an issue that our provincial and territorial health ministers need to address. A look across our provinces and territories reveals a patchwork system for financing ambulance services. New Brunswick has recently removed ambulance fees for anyone who does not have private insurance coverage. All other provinces and territories in Canada - with the exception of the Yukon - charge ambulance fees. The burden of cost to patients is highest in the prairies: Manitoba charges up to $530 per trip, and Saskatchewan tacks on fees for interhospital transfers on top of the $245-$325 fee for an ambulance pickup from home.

The Globe and Mail Wed Nov 18 2015

apicard@globeandmail.com What country has the world's best health system? That is one of those unanswerable questions that health-policy geeks like to ponder and debate. There have even been serious attempts at measuring and ranking. In 2000, the World Health Organization (in)famously produced a report that concluded that France had the world's best health system, followed by those of Italy, San Marino, Andorra and Malta.

The business publication Bloomberg produces an annual ranking that emphasizes value for money from health spending; the 2014 ranking places Singapore on top, followed by Hong Kong, Italy, Japan and South Korea. The Economist Intelligence Unit compares 166 countries, and ranks Japan as No. 1, followed by Singapore, Switzerland, Iceland and Australia. The Commonwealth Fund ranks health care in 11 Western countries and gives the nod to the U.K., followed by Switzerland, Sweden, Australia and Germany. The problem with these exercises is that no one can really agree on what should be measured and, even when they do settle on measures, data are not always reliable and comparable.

The Globe and Mail Mon Dec 7 2015

The intellectual-property provisions in the Trans-Pacific Partnership agreement will drive up global drug prices and make it harder to treat diseases in developing countries, Medecins sans Frontieres (Doctors Without Borders) says. A month after the final text of the TPP was released, the medical humanitarian organization has completed its analysis of the portions of the massive trade pact that will affect drug costs.

Despite changes from earlier leaked versions of the text, there are still serious problems, Judit Rius, MSF's U.S. legal policy adviser, said. "This is catastrophic. This is very negative. The impact is going to be at multiple levels," Ms. Rius said in an interview. "First of all, it is going to delay access to generic competition [for brand-name drugs], which is a proven intervention to reduce the price of medicines."

December 8, 2015

By: Natalie Mehra, Executive Director, Ontario Health Coalition Today, a high-profile report tracking health care wait times was released from the Wait Times Alliance. Eliminating Code Gridlock in Canada’s Health Care System, is a credible summary and a useful addition to public policy decisions about health care planning. It is written by an alliance of physician specialists’ organizations to track progress in wait times and public reporting.

Fraser Institute

Toronto Star Fri Oct 23 2015

Canada can - and should - move pharmacare from its perennial wish list to its under-construction file, says a new report from the C.D. Howe Institute. It is feasible right now to guarantee every Canadian access to medically necessary drugs, the authors contend.

Colin Busby, a senior policy analyst at the institute and Ake Blomqvist, a health economist at Carleton, acknowledge their model won't please everyone. It wouldn't bring drug coverage into medicare. But it would break the political logjam that has obstructed progress for so long. It would bring down the "runaway cost" pharmaceuticals. And it would help low-income patients fill their prescriptions.