The administration for Gov. Ed Rendell has violated the Pennsylvania Constitution and law by not funding a program to reduce doctors' malpractice costs, the Hospital & HealthSystem Association of Pennsylvania has charged in a petition in Commonwealth Court. The state's hospital lobby asked the court to order the administration to fully fund the state-funded program to reduce doctors' malpractice costs. A spokesman for Rendell said the hospital association clearly didn't understand the law "because the legislation does not provide for continued subsidies for malpractice costs for doctors and hospitals."
CIGNA HealthCare and Eastern Connecticut Health Network have reached an agreement that will allow thousands of patients to continue using Manchester and Rockville hospitals and affiliated doctors instead of having to find new ones. The agreement in principle, coming just three weeks before the old contract expires, resolves a dispute over reimbursement offered by CIGNA. The accord "will more appropriately reimburse ECHN for the healthcare services we provide to those covered by CIGNA," said Peter Karl, president and chief executive of ECHN.
The cost of installing new computer software to operate Wisconsin's Medicaid program was $12 million more than originally estimated and the project ended a year behind schedule, auditors have reported.
In a wide-ranging report on the $4.9 billion Medical Assistance program, auditors also identified potentially improper payments totaling $268,000. State Auditor Jan Mueller said her agency looked into the state's Medicaid program because Medicaid has been identified nationally as at high risk for fraud.
A Lake County, IL, family will receive about $9 million in a medical malpractice case involving the death of a 12-year-old boy.
In 1999, Andrew Muno died on an operating table in Condell Medical Center in Libertyville, IL, while undergoing surgery to repair a cut tendon in his arm. The family sued the two doctors who worked on their son, a surgeon and an anesthesiologist.
While healthcare real estate stocks are taking a beating, industry watchers say the long-term prognosis is sound, saved by a large aging population expected to nearly double by 2030. That's buffered the sector as the overall economy struggles through a real-estate sparked recession: So far this year, healthcare REITs have slumped nearly 22%.
In the last several months there have been reports in medical journals about an impending shortage of primary care physicians, notes Paline W. Chen, MD, in a column for the New York Times. But the recent survey from The Physicians' Foundation, a nonprofit organization that supports physicians' work with patients, indicates that the primary care crisis may not be looming on the horizon; it may already be at our back door, Chen says.
A new study that surveys 3,562 emergency department clinicians in 65 hospitals raises concerns about the safety of critically ill patients who are parked in hallways and denied timely care in overcrowded EDs. +
This week CMS offered a glimpse at a possible replacement for Medicare?s fee-for-service physician reimbursement system, and so far, there are far more questions than answers about what physicians can expect. +
Owned primary care practices have long been a financial backwater as far as hospitals were concerned—but one they couldn't do without. Writing off losses was seen as a necessary evil as primary care practices drove referrals to much more profitable inpatient episodes of care. Despite that, primary care has more recently become a land-grab as smart hospitals look to own physician practices. +
The whole premise behind promoting medical travel to U.S. consumers is founded on the potential for significant cost savings. But if consumers don?t realize huge cost savings, few will consider it. +
See if you recognize any of the following phrases:
"The initiative required physician buy-in.?"
"We have a commitment to innovation."
"Support has to be top-down."
"To make [insert concept here] work, it must become part of the organization's culture."
"Communication is critical."
I'll stop there. But there are others.
Any of those sound familiar? They should. We all hear and read these kinds of phrases a lot. Constantly, in fact. Maybe it's not in the exact form I listed above, but it's usually pretty close. It might be a hospital's renewed effort to enforce hand washing requirements. Maybe it's a push to post a health system's quality data for all to see. Or a program to reduce bullying among caregivers. Or any number of other admirable goals. It doesn't seem to matter—one way or the other, one or more of these kinds of phrases are offered as key elements of success.
Big, broad concepts. Many of them in connection with some pretty important undertakings. Communicate, collaborate, innovate.
I just have to say one thing: Enough, already.
Now, before you fire off a scathing e-mail in defense of such concepts, please understand: Yes, I believe endeavoring to make a program part of an organization's workplace culture demonstrates a commitment that, say, an isolated directive given to a lone manager does not. Yes, leadership support is crucial. Yes, communication is a good thing. I can't imagine an initiative that would be made more effective by less communication.
But when it comes to making meaningful strides in the realm of quality and patient safety, big-picture generalities can only go so far. Saying communication or leadership support is important to the success of a healthcare quality initiative is like saying tasty food is important to the success of a restaurant. Yes, I know you want to emphasize infection control as part of your organizational culture. How? What are you really doing differently now than you were two years ago, when infection control wasn't part of your "culture?"
As a healthcare journalist, I get to talk to some brilliant minds—people who know significantly more about the industry than I do. But curiously, one of the most consistent challenges journalists face is getting senior leaders to look past the platitudes and offer specific examples of creative actions their organizations have taken. So I can't help but wonder: How does the average healthcare worker look upon the themes emanating from above? If a senior leader speaks of changing the organization's culture, do staff members nod in agreement or just nod off?
Not long ago I read about a study presented at the American Society of Anesthesiologists' annual conference that concluded that some of the best ways to reduce medication errors are some of the smallest steps you can think of—standardizing medication labels, for instance. Steps rooted not in abstract management theory but in everyday operational reality. Things that plenty of organizations have been doing for years, but things that are also easy to overlook in the search for grander solutions.
So the secret to quality improvement isn't better communication, but color coding medication bottles? Uh... no. Actually, heck if I know what the secret is. But asking ourselves what substance lies beneath all of that leadership buy-in and cultural shifting might be a good start in finding it. I heard some interesting discussion in Nashville this week at the Institute for Healthcare Improvement's National Forum on Quality Improvement in Healthcare about some efforts to uncover some of that substance. IHI President and CEO Donald Berwick, MD, talked yesterday about the IHI's follow-up initiative to the 100,000 Lives and 5 Million Lives Campaigns: the "Improvement Map," or what Berwick called "a master, overarching agenda of processes" that must be improved to achieve the highest level of patient care. The Improvement Map, Berwick said, is meant to reach beyond the focus on reducing needless deaths and injuries to address the entire spectrum of hospital care by analyzing the myriad processes that go into the running of a hospital.
Berwick's address wasn't the only intriguing session at the conference. I heard an engaging description of the IHI's partnership with the National Health Service in Scotland to improve quality and patient safety in the acute-care sector in that country; I also listened to some detailed descriptions from Gary Kaplan, MD, CEO at Virginia Mason Medical Center in Seattle, and Jim Anderson, president and CEO at Cincinnati Children's Hospital Medical Center, of the changes in their respective organizations. I'll delve more deeply into the IHI's latest efforts in next week's column.
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A Montana judge has ruled that the Montana state constitution's protections for human dignity and individual privacy permit competent, terminally-ill Montana residents to get medications causing a peaceful death. The ruling makes Montana the third state to allow doctor-assisted suicide after Oregon and Washington.
