In a decade in which premiums have nearly doubled and the number of uninsured continues to grow, some people are enrolling in faith-based alternatives to health insurance. Christian Care Medi-Share, for example, is a charitable ministry that collects monthly contributions and disburses them among members to pay medical bills. Critics are wary of such organizations, however, because they operate with little government oversight and don't guarantee coverage.
St. Louis-based SSM St. Joseph Hospital has announced a partnership with six area physician practices in an effort to improve patient care and satisfaction. Through the joint venture, the new company will design and test patient care processes in a pilot nursing unit in the hospital. The improvements developed in the unit will provide the basis for how patient care is delivered when St. Joseph's moves to south St. Louis County in 2009.
Both nurse practitioners and physician assistants can be found everywhere in healthcare-related facilities--in medical clinics, doctor's offices, hospitals, and even in operating rooms. Oftentimes, they're performing duties you might be more accustomed to seeing handled by a doctor, such as conducting physical examinations, diagnosing illness, and prescribing drugs. While there are some differences between the nurse practitioner and physician assistant, there are not as many as there used to be.
When I was interviewing sources for this month's quality story for HealthLeaders magazine, I asked a representative from Press Ganey why a hospital would continue administering its own patient satisfaction survey when the federally-administered HCAHPS survey provides them with much of the same information. Her response was, "Why wouldn't you?"
But HealthStream Research, another survey vendor, tells me that many of their clients are opting away from customized surveys and using HCAHPS alone to measure patient satisfaction.
"[Hospitals] are delighted to hear that the HCAHPS survey is measuring the same thing. It eliminates the need for two separate surveys," says Thomas Hutchinson, senior vice president at HealthStream Research of Nashville. "There are too many conflicting points in trying to measure two different ways."
Hutchinson says a majority of the firm's clients are using HCAHPS as their sole way of measuring patient satisfaction. Many HealthStream hospitals are also adopting an HCAHPS-like survey to review areas that aren't covered by the HCAHPS survey--namely emergency and outpatient services. Using one type of survey helps hospitals spread the word about what patients think about their facility.
"It makes the communication of results fairly easy throughout the hospital," Hutchinson says. "It's easier than explaining, 'On HCAHPS we're on this scale, but in our ED, we're on this scale.' It's just easier to communicate the results."
William Powanda, vice president of Griffin Hospital in Derby, CT, says that HCAHPS is the first of many CAHPS surveys coming from the Centers for Medicare & Medicaid Services. Concentrating solely on the results of the HCAHPS survey will only help his hospital down the road, he says.
"We're convinced that HCAHPS is effective and realize that not so far down the road, CMS will roll out an ER survey and surveys for other areas," Powanda says.
But for Deirdre Mylod, PhD, vice president of public policy for Press Ganey, there's more to patient satisfaction than what's covered in HCAHPS. By using an "HCAHPS plus" survey, hospitals can get a bigger picture of the care that's offered at their facility, she says. The South Bend, IN-based vendor has developed a survey tool that asks the HCAHPS questions first, followed by "additional questions that allow patients to comment on the care they received--not just how well it met their needs," she says.
HCAHPS questions are broad--and providing patients with a place to expand on the information they reported on the HCAHPS survey may provide a hospital with insight about why patients are claiming their rooms weren't cleaned often enough, or their floor was too noisy at night.
"The HCAHPS survey does not include patient comments," Mylod says. "But with comments, you get real words from real patients. Real words can make things real for an organization. You can use them with your staff and say, 'Look what this patient thought about you.' That can be really key in keeping up the momentum for quality purposes."
Redge Hanna, director of service performance for Emory Healthcare in Atlanta, says having that additional data is the only way to truly satisfy patients.
"We try to measure everything we do, by looking at what we do and how we do it at the same time," he says. "That essence does not always come through in the HCAHPS survey. It doesn't give us comments or the overall perception we're leaving people with."
Donna Truesdell, RN, MSN, quality director at Cooley-Dickinson Hospital in Northampton, MA, says leaders must take every opportunity to proclaim a hospital's goal of reaching 100% quality care. Unless caregivers see that the effort is driven by hospital leadership, it won't be taken seriously, she says.
Based on information from past studies, including an American Medical Association estimate that doctors see only 11 cents of every dollar saved through the use of IT, BlueCross BlueShield of Massachusetts has announced that it has decided not to require physicians to install an EMR to participate in its bonus program. Blue Cross of Massachusets did conduct its own cost-benefit analysis, however, and concluded that computerized physician order entry makes financial sense in the hospital setting and will require health systems to install CPOE by 2012 to participate in the bonus program.
The Indiana Hospital Association board states that hospitals shouldn't seek payment for medical costs associated with 12 adverse events. Those events include death or serious disability associated with a medication error and surgery performed on the wrong body part. With the new billing policy, Indiana is one of only 11 states where hospitals have agreed formally to waive fees for certain errors or "never events".
In this San Francisco Chronicle article, Jan Gurley, MD, writes that while many people choose their doctor based on intelligence, medical training or kindness, they should also consider doctor "style." Doctor style is the variability in responses to the same clinical issue among competent physicians, Gurley says, and can mean the difference between life and death.
Infectious disease doctors are concerned that eventually the drugs they use to treat MRSA will stop working. Common infections are treated with a week or 10 days of antibiotics and they're gone, but physicians often have to try dozens of antibiotics to make even the smallest impact on MRSA.
Although healthcare is a top domestic priority in the presidential election and there is no lack of ideas on how to fix our system, the candidates are missing the bigger picture, says primary care physician Kevin Pho, MD, in this op-ed piece in USA Today. Primary care should be the backbone of any healthcare system, but the United States takes the opposite approach by emphasizing the specialist rather than the primary care physician, Pho says.
