State regulators voted to accept a bid by a Massachusetts Catholic hospital chain and a secular health organization to provide health insurance to thousands of low-income residents. The Connector Authority board voted unanimously in favor of the joint venture proposed by Centene Corp., a St. Louis-based health organization, and Caritas Christi Health Care Network. The vote followed several closed-door sessions in which officials from Centene and Caritas assured regulators that women will have "ready access" to family planning and reproductive services, an issue that sparked concerns from abortion foes and reproductive rights activists.
Research continues to show that the clinical decision support systems intended to protect patients from medication errors prove in some ways to be more of a hindrance than a help to doctors, says this article published by the American Medical Association. The latest example is a study of the electronic prescribing records of nearly 2,900 community physicians and other prescribers: Nearly 230,000 times these doctors were warned about potential drug interactions, and 90% of the time they decided to proceed as if the alert had never appeared.
An Arkansas state court has ruled that Baptist Health, Arkansas' largest hospital system, acted improperly by inappropriately restricting hospital admitting privileges and interfering with the continuity of patient care. The ruling in Baptist v. Murphy permanently prohibits an economic credentialing policy adopted by Baptist Health in 2003, which would have allowed the hospital system to interfere in the patient-physician relationship by denying hospital-admitting privileges to medical staff members based on financial concerns.
A widely-known Massachusetts anesthesiologist, whose research has influenced how doctors treat surgery patients for pain, has been accused of fabricating results in at least 21 published papers, and in some cases even inventing patients. Colleagues say the case is one the largest ever of alleged medical research fraud. Scott Reuben, MD, works at Baystate Medical Center in Springfield, and has published dozens of articles on an important and emerging area of anesthesiology involving the use of more than one type of drug to relieve post-surgical pain and foster faster recovery.
The ever-increasing role of technology in healthcare will bring security and privacy challenges into the forefront for physician practices in 2009. Consider the following expert predictions.
Disaster recovery planning. Disaster recovery planning has always been a challenge, but it will pick up steam in 2009 because of the continued automation of healthcare records in the industry, says William M. Miaoulis, CISA, CISM, manager of HIPAA Security Services at Phoenix Health Systems in Montgomery, AL. To know whether your current disaster plan is up to par, Miaoulis says providers must first ask themselves these important questions:
If your computer systems went down, would you have access to medication history and lab results?
What would be the effect to your current patients?
Would the way you deliver care be affected?
Minimum necessary standard. The minimum necessary standard, a key protection of the HIPAA privacy rule, requires covered entities to make reasonable efforts to limit protected health information (PHI) to the minimum necessary.
The challenge is defining what is "reasonably necessary" and determining how you will manage these uses, disclosures, and requests.
The minimum standard doesn't apply when information is:
Requested by a provider for treatment
Authorized by the patient
Needed by the Department of Health and Human Services or the Office for Civil Rights for a complaint investigation or compliance review
Required by law
Required for HIPAA compliance
Security audits. The Office of Inspector General (OIG) released a report October 27, 2008, regarding how well CMS is enforcing the security rule.
Although the OIG's report did not specifically state whether the OIG has scheduled another performance review, it is highly likely it will revisit CMS' progress and activity in carrying out its HIPAA enforcement responsibilities, which should signal a red flag for organizations, says John Parmigiani, MS, BES, president of John C. Parmigiani & Associates, LLC, in Ellicott City, MD, and chair of the team that created the HIPAA security rule.
Organizations need to be aware that CMS and the OIG are continuing to audit for HIPAA security compliance. Health information technology initiatives, increased consumer awareness of data losses, and a new administration are additional drivers for increased compliance with healthcare privacy and security safeguards enforcement. Organizations may need to increase the money and internal resources they set aside for security compliance, says Parmigiani.
Medical identity theft. Healthcare organizations should also be aware of the Federal Trade Commission's Identity Theft Red Flags rule under the Fair and Accurate Credit Transactions Act of 2003 (FACTA), says Miaoulis, adding that the regulation requires many healthcare organizations to implement programs to prevent and detect identity theft by May 1.
To mitigate the risk of identity theft, Miaoulis says organizations should take the following steps:
1. Research the FACTA Identity Theft Red Flags rule.
2. Implement the HIPAA minimum necessary standards to include demographic information. "Specifically, organizations should inventory which systems maintain the Social Security numbers and patients' birth dates," Miaoulis says.
3. Determine who has access to information and whether access is appropriate. For roles that require the use of patients' Social Security numbers, determine whether limiting access to the last four or five digits of the number would be sufficient. Organizations could also consider limiting the use of patients' birth dates, Miaoulis says, noting that it may not compromise patient care to see someone was born in May 1970 versus May 15, 1970.
Editor's note: This article was adapted from one that originally appeared in the January issue ofBriefings on HIPAA, a publication from HCPro, Inc.
As expected, there was a lot of talk about the economic recession at the American Medical Group Association's annual conference in Las Vegas last week. I could barely walk between sessions without hearing someone ask, "Did you see how much the stock market dropped today?" And I heard from plenty of physicians and practice managers about budget strains and areas they have been forced to cut.
But attendees didn't travel to Caesar's Palace (a surreal place to be given the current economic climate) to talk about cutting budgets. They were there to learn where and how to invest the limited resources that remain in this challenging environment. Leaders are being forced to trim operating expenditures, but they must be careful not to cut the legs out from under the organization while doing so.
For me, the most important takeaway from the more than three days I spent at the conference was a phrase delivered by Tanya Chermak from Harvard Vanguard Medical Associates before the conference officially began.
"Leadership training and development can't be cut, even in hard economic times," she said during a presentation that was part of a day-long, pre-conference physician leadership workshop.
Some areas require more, not less, investment in a recession, and for many attendees and presenters in Las Vegas, physician leadership was one of those areas.
It isn't just enough to search for physicians with leadership potential or support existing leaders. Organizations are spending money to actively train physicians for leadership roles ranging from clinical department heads to vice presidents and CEOs.
They're teaching physicians to be better leaders the same way you teach almost any subject: In a classroom.
Harvard Vanguard was just one of several organizations experimenting with regular leadership classes designed to train physicians business and leadership skills. Chermak started Harvard Vanguard's leadership academy with 19 physicians in February of last year, and it has grown in popularity—the latest class has nearly 40 participants.
Physicians are nominated by department heads to add an element of prestige to the academy, and a mix of in-house experts and external consultants teach classes ranging from basic economics ("running a lemonade stand") to dealing with disruptive doctors and managing more complicated budgets.
Nancy J. Gagliano, MD, vice president for practice improvement for Massachusetts General Physicians Organization, has developed a similar program that provides a monthly, four-hour class for selected physicians over a two-year cycle. So far, the results have been overwhelmingly positive, she says. Each month, budding leaders come to class with stories about how a previous class has already helped them manage a problem within their department. After a class on how to talk to disruptive physicians, one participant was able to diffuse a situation with an older doctor in his department who had been clashing with nursing staff, for instance.
Johnathan Schwartz, MD, MBA, director of managed care for Henry Ford Medical Group talked about a "managed care college" that teaches physicians basic business concepts, including acronyms and the fundamental language used in budgets and other business transactions.
I could go on. There were a wide range of approaches to leadership development at the AMGA workshop, but the common thread was recognition that the transition from physician to physician leader isn't one that often happens without guidance.
As organizations undergo major changes, driven both by the markets and by federal healthcare reform, leadership in all forms is an increasingly valuable asset—which perhaps explains why the Commission on Accreditation of Healthcare Management Education is seeing substantial increases in applicants.
Medical groups and hospitals that continue to invest in developing physician leaders at all levels will see the rewards as delivering healthcare becomes even more complex.
Elyas Bakhtiari is a managing editor with HealthLeaders Media. He can be reached at ebakhtiari@healthleadersmedia.com.
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