Investors who sought refuge in healthcare have reason to feel less queasy than most in an economy where no industry has been recession-proof. Healthcare stocks posted the second-smallest loss over the past year among 10 sectors tracked by Standard & Poor's, with an average decline of 21.6% through the end of January. But now comes the tricky part: figuring out how much safe-harbor staying power healthcare has left 14 months into the recession.
Patients who got hepatitis from contaminated syringes and medicine vials are joining infection control advocates to warn Americans about the problem. A recent federal study found more than 60,000 people were exposed to hepatitis, and at least 400 people were infected with it in 33 outbreaks linked with blatant safety violations. The report covered the period from 1998 to 2008, and
many of the cases involved reuse of syringes: Health workers likely thought they were being safe by discarding the syringes' used needles and snapping on sterile ones. They were apparently unaware that the plastic barrel part of a syringe can become contaminated, and reusing it even with a fresh needle also can contaminate the medicine vial.
Officials at Atlanta-based Grady Memorial Hospital are investigating a spike in Legionnaires' disease. Four patients who were recently hospitalized at Grady have contracted the bacterial infection in the past month, according to Grady's Web site. In a typical year, the hospital might see two or three cases. Matt Gove, Grady senior vice president, said parts of the 11th and 12th floors have been shut down while the hospital tests water and tries to determine if the disease is originating inside the hospital. About 80 beds out of 953 are closed for now.
Surgeon Beth DuPree's dream of a specialized hospital for breast-cancer patients has closed. She says the Comprehensive Breast Care Institute at DSI of Bucks County, PA, was a victim of the economy and naive business planning. But for her, the closing of the freestanding, for-profit hospital in Bensalem, PA, is both cautionary tale and learning experience.
Cigna Corp. said rising unemployment levels should continue to whittle away at enrollment in 2009, as the managed-care provider posted a fourth-quarter loss due in part to investment losses. Managed-care providers have been battling pricing difficulties, rising costs, investment losses, and tight commercial-risk enrollment, a problem exacerbated by rising unemployment. In response, some insurers have trimmed their work forces.
To get through the current economic climate and, even more importantly, be positioned for success when the recovery comes, St. Vincent Carmel (IN) Hospital is going back to basics. +
A day after an attorney claimed that mold at Tampa, FL-based St. Joseph’s Hospital killed three young cancer patients, the hospital released a statement that emphasized its safety measures and highlighted the deadliness of cancer. The hospital’s statement did not address an attorney’s contention that mold released during the renovation of the ground floor of its children’s oncology center led to fatal infections in three children who died within a month of one another in 2007. The attorney sued the hospital for negligence on behalf of the three children’s families.
As a physician, if you provide quality care to your patients, does it really matter if they don't know who the heck you are?
Researchers at the University of Chicago Medical Center talked to 2,807 patients who were admitted to the hospital during a 15-month period. The patients had been seen by teams of caregivers, including attending physicians, resident physicians, interns, and medical students, were admitted by a night resident, and handed off to other caregivers the following morning. Researchers asked the patients to name the physicians who cared for them and to characterize their understanding of each doctor's role.
Some of you may have seen this study published last week in the Archives of Internal Medicine, but even if you haven't, you can probably guess where this is headed. Seventy-five percent of patients couldn't name a single physician on their care team. What's more, of the 25% who did offer a name, only 40% were correct. Which means, if my questionable math skills aren't failing me, that roughly 90% of the total respondent pool couldn't offer a correct name.
Now, such findings conceivably could be attributed to several different factors. Insufficient patient education processes. Lackluster communication efforts by caregivers. Faulty research methods. Dumb patients.
I'm leaning toward the first two explanations, since there's no reason to believe the research is anything but sound and the patients are anything but smart—especially given another statistic from the study. Fifty-six percent of participants rated their understanding of their physicians' roles as very good or excellent. In other words, although only a small minority of patients knew their physicians' names, a majority said they understood their various caregivers' roles.
That said, isn't it more important that patients understand the various steps of their care and the function of each provider than it is for patients to remember names? "Do you really need to know who your doctor is, or is it more important to know some processes that will help you get at the information you need?" said Ernest Moy, MD, medical officer at the Agency for Healthcare Research and Quality, in a New York Times piece on this subject.
Debatable, of course. I do think these kinds of findings can be symptomatic of a deeper problem: a lack of interventions by providers to ensure patient awareness when multiple handoffs occur. As a patient, I guess I'd like to understand care processes and know my doctor's name. But then again, if I'm a patient who is sick, nervous, and not thinking clearly, a physician could tell me his name three times and tape a photo ID badge to his forehead and I still might not remember his name when asked about it later. Ultimately, if I have a team of physicians caring for me, I would like to know their names—but what I really want to know is that they're good.
Jay Moore is managing editor for HealthLeaders magazine. He can be reached at jmoore@healthleadersmedia.com.
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Every physician office needs a compliance plan—a written document that outlines proper policies and procedures for coding, billing, and managing other regulations that apply to physician practices. Ideally, your compliance plan will keep you out of hot water with the Office of Inspector General (OIG) and health plan or government auditors.
But should you be accused of noncompliance, simply having a written plan protects a practice from penalties and other damages that can be levied against it in the event of incidents without intent. Not developing and implementing a compliance plan essentially removes those protections.
Although most facilities have such a plan, some are slow to adjust their policies based on changes within the practice. Others simply fail to follow procedures defined within their plan. It's crucial to keep compliance a priority, however, to avoid government penalties and withheld reimbursement.
"The OIG Work Plan is the government crystal ball," says Curtis J. Udell, CPAR, CPC, senior advisor at Health Care Advisors, Inc., in Annandale, VA.
The Work Plan outlines seven general guidelines for compliance plan development and implementation:
1. Conduct internal monitoring and auditing.
2. Establish policies and procedures that include an examination of risk areas specific to your practice, such as those relating to coding and billing; reasonable and necessary services; documentation; and improper inducements, kickbacks, and self-referrals.
3. Designate a compliance officer or contact to monitor compliance efforts and enforce practice standards.
4. Conduct compliance training, particularly in regard to coding and billing.
5. Respond to and investigate detected violations, disclose any such incidents to the appropriate government agencies, and develop corrective action initiatives.
6. Keep the lines of communication open via discussions at staff meetings or community bulletin boards. Janet Burch, administrator at Pikes Peak Nephrology Associates, PC, a nine-provider practice in Colorado Springs, CO, says to delegate some of the development and implementation work to staff members, making the process a team effort. "It allows everyone to take more ownership in the practice," Burch says.
7. Publicize guidelines and enforce disciplinary standards.
These seven elements are just a starting point for practices' compliance efforts, says Udell. "It must be an active part of practice operations," he says, noting that regular reviews, revisions, and updates are crucial for any plan.
This article was adapted from one that originally appeared in the February 2009 issue ofThe Doctor's Office, a HealthLeaders Media publication.
Fee for service has to go, that much we know. Among its many flaws as a reimbursement system, perhaps its greatest is that it offers few financial incentives for preventative medicine and primary care, which will become increasingly important to meeting the growing demand for healthcare services in coming years.
So the multi-billion dollar question now is: What replaces fee for service? We've seen wish lists from CMS and other industry players for more emphasis on pay for performance and similar types of value-based purchasing, but absent from the discussion has been consensus on an overarching payment structure to replace the current one.
One of the leading candidates has been a bundled payment system that reimburses physicians and hospitals for episodes of care, such as months of cancer treatment, that under the current system involve many separate billable procedures. Medicare is piloting a program in which bundled payments are split between physicians and hospitals, and some private insurers are experimenting with it as well.
When it comes to large scale reform, this payment system lost a strong advocate this week when Tom Daschle withdrew from consideration as nominee for Health and Human Services Secretary, but be careful about reading too much into that. Senator Max Baucus (D-MT), who may play a large role in shaping healthcare reform as chairman of the Senate Finance Committee, also favors bundled payments, as do other influential policy makers, according to the Wall Street Journal.
I can certainly see the appeal. It is in many ways a "middle road" that seeks to avoid the pitfalls of fee for service without venturing into capitation, which pays a fixed rate per patient and has been criticized for creating incentives for providers to cut costs and withhold treatments for patients.
But healthcare policy makers didn't see many of those unintended consequences coming when capitation was touted as a physician reimbursement solution, just as many of the flaws in the fee-for-service model weren't always apparent. So before moving forward with a bundled system, policy makers should carefully examine the incentives it will create and do their best to foresee possible unintended consequences.
Take hospital and physician relationships, for instance. In some cases, when bundled payments are made for hospital-based episodes of care, the hospital is in charge of doling out the money to physicians. And if you can't see the potential problems that will cause, you haven't been paying attention to the healthcare industry.
Physicians are worried that they will have to constantly negotiate with hospitals to receive a fair share of the payment—that may be less of a problem as more hospitals employ doctors outright, but it could hurt relations with those in private practice. And because many of these episodes of care involve multidisciplinary teams, physicians are already competing with one another to make a case for why their specialty deserves a larger piece of the pie.
Proponents of bundled payments are trying to avoid many of these hurdles by adding caveats and conditions for payment. But the more complicated any payment system becomes, the more likely it is that payments will influence provider behavior in ways that haven't even been considered.
If policy makers aren't careful, their worthwhile attempts to fix the flaws in the fee-for-service system may just create a whole new set of problems.
Elyas Bakhtiari is a managing editor with HealthLeaders Media. He can be reached at ebakhtiari@healthleadersmedia.com.
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