Doctors are being swamped by patients complaining of flu-like symptoms. Flu activity levels are measured by the percent of outpatient visits due to flu compared to the average during the fall and spring. The article is a snapshot of flu activity in all 50 states and the District of Columbia.
Under an arcane hospital payment system, Nantucket Cottage's rural designation has allowed the state's 81 other hospitals to collectively reap between a $256.6 million and $367 million annual bonus for the last two years—at the expense of other states. An Institute of Medicine report released in July referred politely to the bonanza as the "Nantucket effect." Now a coalition of 21 states is seeking to reverse the windfall, calling it the "Bay State boondoggle," the product of "Yankee ingenuity"—the artful manipulation of obscure payment formulas. "The entire way the payment system is now calculated has become so complex and so susceptible to gaming and manipulation that you'd play the game yourself if you were running a hospital, to make sure your reimbursements continue to go up," said Dr. Donald Berwick, President Obama's former administrator of the Centers for Medicare and Medicaid Services and a health policy lecturer at Harvard Medical School.
Patients can refuse a flu shot. Should doctors and nurses have that right, too? That is the thorny question surfacing as U.S. hospitals increasingly crack down on employees who won't get flu shots, with some workers losing their jobs over their refusal. "Where does it say that I am no longer a patient if I'm a nurse," wondered Carrie Calhoun, a longtime critical care nurse in suburban Chicago who was fired last month after she refused a flu shot.
In a bold experiment in performance pay, complaints from patients at New York City's public hospitals and other measures of their care—like how long before they are discharged and how they fare afterward—will be reflected in doctors' paychecks under a plan being negotiated by the physicians and their hospitals. The proposal represents a broad national push away from the traditional model of rewarding doctors for the volume of services they order, a system that has been criticized for promoting unnecessary treatment.
A nagging issue for healthcare reformers is the disincentive for many providers to adopt innovative approaches to care that improve health and cut costs. If you're paid a fee for each service you provide in your office, why would you invest in technologies and procedures that led to fewer billable services? One reason is to achieve better results, and that's good enough for some providers. But the Medicare program is supplying another rationale. It started cracking down last year on hospitals that readmit too many patients soon after discharging them. That penalty has led hospitals to pay more attention to technologies that can keep track of patients' progress at home, according to Anthony Shimkin, a senior marketing director for Qualcomm Life.
In early 2011, federal and state officials asked 200 Southern California hospitals to provide information about their ability to survive a catastrophic earthquake along the southern San Andreas Fault. The hospitals were asked, for example, how many backup generators they had on hand, what fuel they burned and whether their water tanks could survive the deadly rupture long predicted for one of the nation's most dangerous faults. But nearly two years later, almost half of the hospitals still have not responded, leaving some disaster officials frustrated over their inability to help the hospitals plan for the worst.