Surgery is surprisingly common in older people during the last year, month and even week of life, researchers reported Wednesday, a finding that is likely to stoke, but not resolve, the debate over whether medical care is overused and needlessly driving up medical costs. The most comprehensive examination of operations performed on Medicare recipients in the final year of life found that nationally in 2008, nearly one recipient in three had surgery in the last year of life. Nearly one in five had surgery in the last month of life. Nearly one in 10 had surgery in the last week of life.
Partners HealthCare and Blue Cross Blue Shield of Massachusetts announced a deal that will reduce the insurer's payments to the nine-hospital system by $240 million over the next three years, including $80 million next year. Under a renegotiated contract, rate increases between 2012 and 2014 will be held in line with general inflation. Blue Cross customers will still see premium increases during that period, but they would be less than they would have been. The main elements of the deal were reported last month by Globe reporter Robert Weisman. Partners hospitals -- many of which are among the highest paid in the state -- will now be paid under a "global payment" system, which will put them on a budget for patient care rather than reimbursing them for each patient visit and procedure. Blue Cross, the state's largest health insurer, has been moving health care providers to its version of global payments, called the alternative quality contract, since 2009.
Local hospitals in Westchester County and New York City's other northern suburbs are locked in a battle with a huge Manhattan-based cancer center as it looks to increase its presence in the affluent suburban market. On one side is Memorial Sloan-Kettering Cancer Center, which wants to set up a free-standing cancer treatment center in Harrison, N.Y., a few minutes from Scarsdale, where the median family income has been about $230,000 a year over the last few years, according to the Census Bureau. On the other side are the community hospitals in the suburbs, which say that if the treatment center is built, they will lose their most affluent, well-insured patients to Memorial's national marketing clout and reputation, even if they provide the same level of care. Both sides are furiously lobbying Albany, where the state health commissioner will make the ultimate decision, based on the recommendation of a planning council that is meeting Thursday.
Private medical data for nearly 20,000 emergency room patients at California's prestigious Stanford Hospital were exposed to public view for nearly a year because a billing contractor's marketing agent sent the electronic spreadsheet to a job prospect as part of a skills test, the hospital and contractors confirmed this week. The applicant then sought help by unwittingly posting the confidential data on a tutoring Web site. In an e-mail sent to a victim of the breach, the billing contractor, Joe Anthony Reyna, president of Multi-Specialty Collection Services in Los Angeles, explained that his marketing vendor, Frank Corcino, had received the data directly from Stanford Hospital, converted it to a new spreadsheet and then forwarded it to a woman he was considering for a short-term job. The job applicant apparently was challenged to convert the spreadsheet -- which included names, admission dates, diagnosis codes and billing charges -- into a bar graph and charts, Stanford Hospital officials said.
The cardiac intensive care unit at Egleston children's hospital in Atlanta gleams and hums with a dazzling array of scientific wonders that breathe for tiny lungs and monitor every beat of an infant heart. But on a recent visit, Dr. Donald Berwick was especially pleased by something decidedly low-tech: a quiet zone where nurses can place medication orders without being interrupted, even during emergencies. Hospital leaders created the zone -- little more than a computer terminal in a corner of the room behind an orange sign on the floor that reads "Shh … We're in the MedZone" -- two years ago after noticing that distracted staff members were making dangerous mistakes when ordering medicine. The deceptively simple system, built on a principle used in aviation, cut medication errors by two-thirds, saving money and lives.
The nation's worst hospitals treat twice the proportion of elderly black patients and poor patients than the best hospitals, and their patients are more likely to die of heart attacks and pneumonia, new research shows. Now, these hospitals, mostly in the South, may be at higher risk of financial failure, too. That's because the nation's new healthcare law punishes bad care by withholding some money, says the lead author of the study published Wednesday in the journal Health Affairs. "These hospitals are going to have a much harder time in the new funding environment," said Dr. Ashish Jha of the Harvard School of Public Health, who led the study. "I worry they're going to get worse over time and possibly even fail. I worry that we're going to see a bunch of that happening over next three to five years."