The San Francisco Chronicle outlines the health related spending in the federal government's economic stimulus plan, including $87 billion added to Medicaid funding over the next two years; $24.7 billion to subsidize unemployed workers by 60% for up to nine months to stay on their employers' health plan; and $19 billion to modernize health information technology systems.
Water tests confirmed that two units at Atlanta-based Grady Memorial Hospital were the source of the bacteria that caused Legionnaires' disease in four patients. "We're comfortable right now that it’s only the two units," Leon Haley, MD, deputy senior vice president of medical affairs at Grady, told the Atlanta Journal-Constitution. The two Grady patient units—and 80 beds—have been closed since last week. Grady officials said crews are hyper-chlorinating additional floors and will continue testing throughout the hospital.
Uninsured or underinsured patients who receive basic medical care at East Hartford (CT) Community Care Inc. wait as long as nine months to see a specialist, and some never see one at all. Now a $50,000 state grant will allow the clinic to refer patients to specialists at the Eastern Connecticut Health Network and pay their consultation fees. If the partnership is successful, the program could be expanded, said state Sen. Mary Ann Handley. East Hartford Community Care officials said the money will pay for as many as 2,000 medical visits in 2009.
As thousands of people are losing jobs and medical coverage, the largest chain of medical clinics serving needy families in the Chicago area is raising charges for uninsured patients. Access Community Health Network will increase the minimum fee for an office visit to $45 come April 1, up from $15. The organization, which specializes in delivering primary care to low-income families, runs 51 clinics in Chicago and its suburbs, serving about 215,000 patients a year. The move is an attempt to stay afloat during perilous economic times, said Donna Thompson, Access Community's chief executive. Like other medical providers serving disadvantaged populations, Access Community is being squeezed financially by delayed Medicaid payments and growing numbers of uninsured patients.
Boston-based Tufts Medical Center has won approval as a major trauma center, a designation that will change where ambulances take some of the region's most critically injured patients. Until now, Tufts has been the only major Boston teaching hospital not approved as an adult trauma center. As a result, ambulances carrying victims of car accidents, falls, or violence often bypassed that hospital for Beth Israel Deaconess Medical Center, Boston Medical Center, Brigham and Women's Hospital, or Massachusetts General Hospital, all state-designated trauma centers. Some doctors at other Boston hospitals have argued that the city has enough trauma centers and that to spend several million dollars to open another one is a poor use of resources.
A blind man who appeared in a television commercial asking New York Gov. David A. Paterson, who is also legally blind, "Why are you doing this to me?" has been taken out of an advertising campaign paid for by healthcare interest groups. The move represents a softer approach by 1199 SEIU United Healthcare Workers East and the Greater New York Hospital Association, who have mounted a multimillion-dollar media campaign against the governor's budget proposal. Paterson, who has proposed trimming $3.5 billion from the state's healthcare budget, has said that the cuts are necessary, given the projected deficit of more than $13 billion for the coming fiscal year.
In a report from the House Committee on Appropriations, the committee outlines its rationale for including $1.1 billion for "comparative effectiveness research" in the massive economic stimulus bill. The research is "that done by doctors and statisticians who troll through large number of patient records to determine, for any particular disease, which treatments work best," says Washington Post columnist Steven Pearlstein. He says that while there's nothing particularly new about comparative effectiveness research, to some the wording in last month's House report was anything but innocuous.
The quality portion of the HealthLeaders Media Industry Survey 2009 offers insight into various aspects of healthcare quality—everything from infection control staffing levels to senior leaders' opinions—on the biggest barriers to improvement.
I am not a technophobe. I surf the Internet and listen to my iPod and watch digital TV just like the next fellow. Nevertheless, I also believe that technology can sometimes create barriers even as it spawns possibilities, and generate a false sense of security even as it protects us from bad things.
And so as much as electronic medical records, bar coding, radio frequency identification, and a host of other innovations have done to advance the cause of providing better, safer healthcare to patients, I confess I'm not entirely disappointed to see a growing emphasis on the fundamental human aspects of quality improvement.
In our HealthLeaders Media Industry Survey 2009 released this week, chief quality officers, chief nursing officers, and other executives charged with leading the quality and patient safety efforts at their organizations offered some intriguing thoughts on the role of technology in improving quality:
The best way to combat the spread of infections? Not even close—72% said hand washing.
When asked how effective EMR systems have been in improving quality and patient safety at their organizations, only 12% said an EMR was vital.
Thirty-three percent said their organization doesn't even have an EMR.
When asked to rate the effectiveness of eight measures in improving physicians' quality of care on a scale ranging from strongly effective to not effective, respondents' top answer was strongly effective for three of them: improved communication among doctors and hospitals, spending more time with patients, and a stronger focus on prevention and education.
Some notably low-tech perspectives, to be sure. The expanding awareness of the importance of seemingly simplistic practices can be seen elsewhere, as well. I talked to a quality leader at a California hospital for a story in the February issue of HealthLeaders magazine, also out this week, who told me her hospital cut medication errors by 20% in 30 days by having nurses wear vests when dispensing medications. Twenty percent in 30 days—just by creating a simple signal that certain people are not to be bothered when they're performing a certain task. And in the Wall Street Journal, I read a piece last week about how the Centers for Disease Control and Prevention says unsafe injection practices like reusing syringes are a leading cause of infections in physician offices and outpatient facilities. Reusing syringes? Seriously?
I know plenty of you could cite a litany of concrete improvements that provider organizations have realized from implementing high-tech initiatives. I know plenty of you would say that technology holds great promise for improving quality on a broad scale while also boosting efficiency and eliminating waste. And you'd be right on all counts. Technology can do a lot. But it can't do everything. Even if you have the most advanced computerized process in the world in use at your organization, it can still be undermined when human beings forget to wash their hands or don't dispose of a syringe or talk in the ear of a nurse who's dispensing medications.
The good news is that more and more healthcare leaders seem to be realizing the importance of addressing both the technological and human elements of quality improvement. Striking the proper balance between the two is the real challenge.
Jay Moore is managing editor for HealthLeaders magazine. He can be reached at jmoore@healthleadersmedia.com.
Note: You can sign up to receive HealthLeaders Media QualityLeaders, a free weekly e-newsletter that reports on the top quality issues facing healthcare leaders.
Two Texas Congressmen, Republican Michael C. Burgess and Democrat Gene Green, introduced two bills on Monday aimed at addressing physician shortage issues. One would establish a loan program to support residency training programs in rural hospitals, and the other would authorize $43 million in grants to public health teaching institutions.
