This blog post from a psychiatrist compares the practice styles of physicians on the east and west coasts. The medical hierarchy is more obvious on the east coast, and doctors in that region tend to do more physical work, like blood draws and patient transports, she says.
A new Environmental Protection Agency (EPA) rule—which has an important notification deadline coming up—will affect about 1,600 of the nation's 5,800 hospitals.
The regulation deals with ethylene oxide, commonly abbreviated as EtO. While EtO may not be part of your everyday language, the gas is used often in hospitals as a sterilizer for medical instruments.
If CEOs and hospital managers aren't aware of the new rule, they should make themselves familiar with it, says Janet Brown, director of sustainable operations at Practice Greenhealth, a national group that promotes environmentally friendly practices in healthcare.
The rule generally mandates that hospitals run full loads in their EtO sterilizers, unless a physician, administrator, or central services representative determines it is medically necessary to run a partial load. The definition of medical necessity in this case is left to individual hospitals.
For example, the EPA states the medical necessity clause could be invoked to sterilize medical devices that are under research and development and thus may not have established sterilization cycles. In such cases, keeping them separate from regular medical instruments would be prudent.
If your hospital uses an EtO sterilizer that existed before November 6, 2006, you have until June 26, 2009, to file an initial notification with the agency letting it know what your compliance status is with the rule.
Newly constructed sterilizers must send in initial notification within 180 days of start-up.
Michael D. Shaw, vice president of Interscan Corp., in Chatsworth, CA, says that hospitals must indicate one of the following two notification provisions to the EPA:
The facility will run fully loaded ethylene oxide sterilizers unless it is deemed medically necessary to run a partial load
As an alternative, the facility will install an EtO emission control device and operate it in accordance with state or local regulations, as well as the manufacturer's recommended procedures
Interscan manufactures gas monitors and detectors. Based on his work, Shaw says he hasn't seen many major problems for hospital central processing departments to comply with the new EtO notification.
As part of the regulation, hospitals must document every sterilizer load and, when loads aren't full, note the medical reasons and their authorizers.
The reasoning behind the EPA rule is that EtO exhaust creates pollution. No single hospital is a major EtO polluter, according to the EPA. However, the agency found that, taken together, EtO sterilizers in medical centers account for a significant source of pollution.
Beyond environmental concerns, EtO can also be dangerous to workers and others who touch or inhale the substance.
Since 2005, at least four hospitals in Alabama, California, New Hampshire, and Rhode Island have had to call emergency authorities to respond to alarms for EtO leaks within the facilities.
Department of Health and Human Service Secretary Kathleen Sebelius, during her first full week on the job, paid a visit to Capitol Hill Wednesday morning for her first formal opportunity—aside from the confirmation process—to discuss healthcare reform. Chief question on the minds of House Ways and Means Committee members during her conversation in front of the panel: what is President Obama's vision for a public health plan?
She said she shared the president's belief "that reform must guarantee choice of doctors and health plans," along with the public and private plan options, she told the panel. "No one should be forced to give up a doctor they trust or a health plan they like. Comprehensive reform shouldn't force any Americans [to give up] their coverage to make changes."
She sees the public plan option operating much like state employee health plans currently operating in 30 states, including Kansas. The public option plans generally are offered side by side with private plans to state employees—giving them competitive choices from which to select their coverage, she added.
She also noted that a number of states have established health insurance plans for children with side-by-side private and public providers. "It's about the rules that are established in the beginning, and the president and I are committed to working with members [on Ways and Means] and other members of Congress to make sure that the playing field is level."
By level playing field, she explained that for years, many private insurers operated on a "tilted field" where cherry- picking—or selectively choosing healthier patients—"is a strategy to make a profit," she said. This could make insurance unaffordable or unattainable for some individuals. "That doesn't work in a health exchange," she said.
If the rules are the same with public and private plans, the individuals with lower incomes or previously uninsurable conditions that come into the health exchange can choose between public and private plan options with the same rules. The goal, she told the panel, is for public and private plans to "compete on practice and protocol, on lowering overhead costs, on lowering administrative costs, and driving benefits to their incoming enrollees."
As to what the president is expecting to see in terms of healthcare reform in Congress, she assured the panel that he does not have a specific plan sitting in his desk drawer on reforming the health system. "I can assure you that it does not exist," she said.
Instead, she said his goal was to get the ball on healthcare reform moving forward. "His charge to me as the new secretary is to work closely with [congressional] committees as proposals are being developed," she said. "But the specific legislative language, the framework of exactly what the benefit package ultimately looks like, what the exchange may or may not look like will be a collaborative effort . . . primarily engaged in by Congress."
Kathleen Sebelius, the Obama administration's senior healthcare official, flatly rejected the idea of taking over the nation's medical insurance system. She said the federal government did not want to assume management of healthcare coverage. Sebelius, in her first appearance before Congress since being confirmed as the secretary of Health and Human Services, said the administration wanted a "public plan option" to encourage competition.
The nation's largest emergency physicians' group called newly appointed HHS Secretary Kathleen Sebelius "uninformed" and accused her of "perpetuating myths" about their role in delivering healthcare after she said this week that emergency room care presents the "least effective, most expensive" option.
American College of Emergency Physicians President Nicolas J. Jouriles, MD, called on Sebelius and the Obama administration to "engage" emergency physicians and provide them with a speaking role in the ongoing healthcare reform discussion.
"We are dismayed the top health official in the United States appears uninformed about the crisis in emergency medical care," Jouriles says. "The public and policymakers, including Secretary Sebelius, have a tendency to engage in perpetuating myths about the causes of emergency department crowding. The bottom line is that larger numbers of patients are drawing on fewer resources, and most patients in the emergency department need to be there. Instead of trivializing the nation's emergency care system, I am asking Secretary Sebelius to involve emergency physicians to help to address the problems facing emergency patients."
Sebelius appeared Sunday on NBC's Meet The Press and said using emergency rooms as the first line of treatment for the uninsured "presents itself as why we desperately need a reformation of the health system."
"One of the reasons people visit emergency rooms is that we have far too many Americans who don't have health coverage, who don't have a doctor to call, who don't have a health home. This situation that we're in links directly into health reform," Sebelius said. On Wednesday, Sebelius told the House Ways & Means Committee that the nation must move to a medical home primary care model because emergency care is the "least effective, most expensive" option.
Those comments riled the 27,000-member ACEP. "Emergency medical care is extremely effective, which is why primary care physicians refer their patients to us," Jouriles says. "The streams of patients fearing swine flu that flooded emergency departments last week point to the central fallacy of the 'medical home:' In an emergency–which a pandemic certainly is–the emergency department is everyone's medical home. Many of the patients who came to the emergency department were sent there by their primary care physicians."
Jouriles says Sebelius should know that the Centers for Disease Control and Prevention, an HHS agency, reports that only 12% of emergency visits are for non-urgent medical conditions. He also noted that emergency physicians treat about 120 million patients each year but their costs represents about 3% of the $1.5 trillion spent each year on healthcare in this country.
While the ACEP supports universal health coverage, Jouriles says it won't ease emergency room crowding. He noted that Massachusetts' statewide mandated care experiment increased ER volumes. "Universal coverage does not lead to universal access, nor does it put an end to emergencies," he says.
A Massachusetts commission is poised to recommend this month that insurers radically change how they pay doctors and hospitals. Commission members said they will urge Gov. Deval Patrick and the Legislature to replace the current system, in which insurers typically pay doctors and hospitals a negotiated fee for each individual procedure or visit, with a set payment for each patient that covers all that person's care for an entire year. Massachusetts would be the first state to broadly adopt such a system, which would essentially put doctors and hospitals on a budget in an effort to restrain health spending.
Chicago employers lowered costs for their workers with diabetes by more than $1,400 per employee over a year's time thanks to an experimental program that helped pay for their drugs and provided consultations at the pharmacy counter. The pilot program, launched in 2007, saved four Chicago-area employers $1,467 per worker, or more than $126,000, said the Midwest Business Group on Health. Direct and indirect costs of diabetes to the U.S. healthcare system are more than $130 billion a year and include emergency room visits, extended hospital stays, and absenteeism, the group said.
Representative Charles B. Rangel, chairman of the House Ways and Means Committee, said that there was "no way" he would support taxing employer-provided health benefits, Americans' leading source of coverage. The comment came after a committee hearing with the new secretary of health and human services, Kathleen Sebelius. Rangel's remark was the clearest indication yet of the difficulties Democrats may have in raising money to fulfill President Obama's campaign promise of offering health insurance to all Americans.
The Obama administration plans to spend $1.1 billion over the next few years on studies to compare the effectiveness of competing treatments for common conditions like back pain, heart disease, and prostate cancer. The studies will be publicly released, to help doctors and patients decide which treatment options they want to pursue. Supporters include many medical researchers, consumer groups, unions, and insurers. But potential opponents warn that the comparative effectiveness movement could lead to inadequate treatment for some patients and even the rationing of healthcare.
The Centers for Medicare and Medicaid Services unleashed its actuaries to determine whether hospitals received excess payments as a result of coding increased severity under the MS-DRGs that didn't reflect a real change in case mix. The actuaries have completed their analysis of FY 2008 claims and found that hospitals were overpaid 2.5%, or $2.2 billion, in that year alone. As a result, CMS is proposing "draconian" corrective action, says this analysis from Sg2.
