The current wave of swine flu may have peaked in most of the U.S., but the illness remains widespread and the threat of another wave remains, officials said. The news came as officials in Norway reported a mutation of the flu virus in two patients who died and one who became severely ill. The mutation, while seen before, appeared to make the H1N1 virus cause infection deeper in the respiratory system than the regular swine flu virus, a possible explanation for the more-severe cases, Norwegian scientists said. Swine flu cases appear to be declining in most of the U.S., the Centers for Disease Control and Prevention said. Flu activity is widespread in 43 states now, down from 46 last week, and 48 two weeks ago.
A new approach has transformed healthcare in India through a simple premise that works in other industries: economies of scale. By driving huge volumes, even of procedures as sophisticated, delicate, and dangerous as heart surgery, the theory has managed to drive down the cost of healthcare in his nation of one billion. The model offers insights for countries worldwide that are struggling with soaring medical costs, including the U.S. as it debates major healthcare overhaul.
Healthcare providers in Massachusetts are preparing for a dramatic change in how they get paid. But whether the state's proposed payment system overhaul can succeed in reining in costs and boosting the quality of care will depend on how it's structured and put into practice. That was the consensus of speakers on a health care panel during a summit on business leadership and public policy at the John F. Kennedy Library.
Massachusetts' largest hospitals say they have significantly cut the number of patients who acquire painful, costly, and sometimes deadly infections in their operating suites and intensive care units, suggesting that pressure from government regulators and patient groups, as well as a shift in doctors' attitudes, is starting to make medical care safer. Several academic medical centers in Boston said the number of ICU patients contracting bloodstream infections had dropped by at least half in the past several years because of new procedures to keep intravenous lines and other tubes cleaner. Hospitals also said they have reduced the number of patients on respirators who develop pneumonia. Beth Israel Deaconess Medical Center said so few patients now get this type of infection that the hospital was able to cancel plans to expand its ICU.
Despite the current economic downturn, hospital CEOs are actively recruiting physicians to their organizations, according to a new study.
Of the 284 hospital CEOs surveyed, more than half (54%) of them plan to increase recruitment efforts of physicians, according to "Clinical Workforce Issues: 2009 Survey of Hospital Chief Executive Officers" by AMN Healthcare, a healthcare staffing agency, in partnership with the research group, Council on Physician and Nurse Supply. In fact, the economic downturn actually has encouraged physician recruitment for some administrators; a quarter of CEOs boosted their efforts in the midst of the financial crisis.
When the rest of Americans are tightening their wallets, why are hospital CEOs loosening the purse strings to add physicians to their facilities? To fill doctor vacancies and to help the institution bounce back, CEOs reported.
Not like recession-proof lipstick
"We knew it was coming," said Kurt Mosley, vice president of business development of AMN Healthcare. "Healthcare isn't immune from the recession."
Although economic pundits recently declared that the "recession" is technically over because of increased nationwide spending, the current downturn has debunked the urban myth that hospitals would be invincible to the down economy.
Many once considered the healthcare field, like the cosmetic industry, recession proof, but that isn't the case, according to the survey. Hospitals that borrow from banks revealed an Achilles' heel, exposing themselves to the vulnerability of borrowing money, said Mosley.
"Hospitals showed that they are susceptible to banks and bonds that they weren't before," he said.
Shortage of physicians
On top of bruised hospital finances is the need for more physicians. Most CEOs believe there is a serious or moderate shortage of doctors that has especially worsened in the last six months.
"Shortages have always been there, and they always will be there," Mosley said.
Currently, there is a physician vacancy rate of 11%, reported CEOs.
With physician spots to fill and fewer patient admissions and procedures in hospital revenue, administrators are looking within to bounce back.
Regardless of the current economic state, "We are getting older, heavier, and living longer. It's a fact of life," he said.
And with older and sicker persons are patients in need of medicine.
"CEOs are tasked with taking care of patients," Mosley explained. Oftentimes, the physician vacancies are based on the community needs. For example, older populations might have a greater demand for cardiologists, and younger populations might demand family practitioners.
According to the survey, nearly all CEOs (99%) see physicians as important revenue drivers for hospitals. Out of all the healthcare professionals, most CEOs named physicians are the most important rainmakers, with the ability to draw in inpatient revenue from admissions and procedures, according to the survey.
Karen M. Cheung is associate editor at HCPro, Inc., contributing writer for HealthLeaders Media, and blogger for HospitalistLeadership.com. She can be contacted at kcheung@hcpro.com.
The Joint Commission has officially announced the most-cited standards for the first half of 2009 and Life Safety standards top the list.
Back in 2007, Life Safety Code consisted of only a single standard (EC.5.20), but was subsequently split into seven standards, leading citations for this area to jump from 29% to 45% in 2008. Three of the top 10 most-cited standards (and the two most-cited) fell under the Life Safety chapter.
Those standards are:
LS.02.01.20 (45%)—maintaining means of egress. This standard was the most cited in the first half of 2009.
LS.02.01.10 (43%)—building and fire protection features minimize the effects of fire, smoke, and heat. This was the second-most cited standard.
LS.02.01.30 (36%)—provision and maintenance of building features to protect individuals from the hazards of fire and smoke. This was sixth among the top 10 standards.
Record of Care standards were found twice in the top 10 most-cited. Verbal orders (RC.02.03.7) were cited 40% of the time, the third-most cited standard, and requirements to maintain complete and accurate medical records (RC.01.01.01), always a trouble area for hospitals, was cited 33% of the time, making it the eighth most-cited standard.
Maintenance of fire safety equipment and fire safety building features (EC.02.03.07) retained a top spot among cited standards at 38%.
The National Patient Safety Goals (NPSG) were cut down significantly for 2010. Requirements for commonly cited NPSGs for critical tests and critical values have been loosened and will not likely appear on future lists of top-cited standards, at least for the time being. In the first half of 2009, however, critical tests/critical values (NPSG 02.03.10) were cited 38% of the time. Another top-cited NPSG in years past, do not use entries, has been moved to the standards and out of the goals.
Universal Protocol is another evolving requirement within the NPSGs and has received extensive review by The Joint Commission in 2009. It is the most cited sentinel event in The Joint Commission’s database, the accrediting body said at Executive Briefings in September. UP.01.03.01, requiring a time out performed immediately prior to starting procedures, was the seventh most-cited standard in the first half of 2009, cited 34% of the time.
Last, two Medication Management standards rounded out the top ten—MM.03.01.01 (33%), medication storage; and MM.04.01.01 (32%), clear and accurate medication orders.
Patients were more satisfied with their care at inpatient facilities than during any of the previous six years, according to a report released last week from Press Ganey Associates, Inc.
The 2009 Hospital Pulse Report: Patient Perspectives on American Health Care revealed this trend and others based on a survey of about three million patients at 2,000 hospitals across the country during 2008. Press Ganey, a company that works with 40% of U.S. hospitals to measure and improve the quality of care as well as administer the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey, also found that patients were more likely to recommend a facility at which they'd received care to family and friends.
Patient satisfaction has steadily increased since 2003, with 85% of those surveyed reporting satisfaction with care in October 2008. The report outlined some specific regional trends in patient satisfaction. The top five metropolitan areas that were rated highest by respondents were Baton Rouge, LA; Columbus, OH; Oklahoma City, OK; Cleveland, OH; and Toledo, OH. The top five states were Maine, South Carolina, New Hampshire, Wisconsin, and Montana.
"Overall, we are pleased to see the increased efforts and sustained results even through tough economic times," said Deirdre Mylod, PhD, vice president of hospital services, Press Ganey. "With healthcare reform on the horizon, we are optimistic we will see additional improvements in the patient experience, as hospitals will have even more evidence for the synergies between patient satisfaction and the bottom line, especially with regard to reimbursement."
The report identifies as a catalyst for quality improvement that hospitals began publicly HCAHPS data in March 2008, and in turn increased patient satisfaction scores. Some members of the public are turning to the site to find information for comparing inpatient care in their area. However, according to the report, the larger effect has been that providers are aware of their own scores, as well as competitors’ scores, and are putting more effort into delivering patient-centered care as a result.
So in what areas can hospitals improve upon? Respondents gave these suggestions:
Facilities can address the emotional needs of patients better
Staff members can keep patients more involved with care decisions and treatment plans
Nurses can communicate better with patients
Staff members can respond to patients more promptly when they use call buttons
Only you know the truth about your hospital's health.
Hospitals are struggling or just fine, depending on whose study or survey methodology you believe. Within the past week, two respected organizations—the American Hospital Association and Thomson Reuters—have come out with a survey and a study, respectively, that seem diametrically opposed to each other's conclusions.
The AHA said hospitals are continuing to struggle financially while the Thomson Reuters report said hospital financials have recovered to pre-recession levels. So who's right? Well, they both are, but the challenge in finding a true fiscal health snapshot of an entire industry lies in the methodology.
I'm prepared to give the Thomson Reuters report a little more credence. It's based on proprietary and public data about hospital financial metrics, and goes so far as to say "the recovery has been broad-based, with all classes of hospitals—small, medium and large community hospitals, teaching hospitals and major teaching hospitals—showing positive median margins."
However, the AHA survey indicates that 34% of hospitals expect to report losses in the first half of 2009, up from 29% for the same period last year. I think the key here is the word "expect." While the AHA report focuses on subjective opinions, the Thomson report bases its conclusions on actual statistics.
The AHA report is based on a survey completed by 768 hospital CEOs, and the data was collected in August.
That doesn't mean the survey isn't valid or useful.
One shortcoming of the Thomson Reuters study, for instance, doesn't appear to take into account the ways hospitals achieved margins comparable to pre-recessionary times. The AHA survey said some hospitals have taken drastic steps to contain costs, indicating to me that many hospitals have cut their way back to pre-recessionary margins. To wit:
A higher proportion of patients are unable to pay for care and many hospitals are seeing more patients covered by Medicaid and other public programs for low-income populations.
More than half of the hospitals surveyed have reduced staff.
Eight in 10 have cut administrative expenses.
One in five have reduced services that communities depend on, including behavioral health, post acute care, clinic, patient education, and other services that require subsidies.
I'm not one to denigrate surveys—HealthLeaders Media does one ourselves each year that we're very proud of—but under these circumstances, I think I'll trust the financial data contained in one report versus the best-guess data contained in the other. Let's not forget, as well, that the AHA's job is to advocate for its members. In these volatile times, as healthcare reform bills seesaw the future projections of revenues for hospitals, it helps to paint as negative a picture as possible, without skewing the data. Also, a survey is self-selective, and depends on the truthfulness of its respondents, not to mention the fact that without comprehensive data, it's difficult to draw broad conclusions.
Clearly, between 20% (Thomson Reuters) and 34% of hospital CEOs see negative margins in the second quarter of 2009. For those folks, it doesn't matter that overall, hospital margins have recovered. They're still facing tough times.
Your picture may not match up with either of these reports. There's no way to know what life is like in the trenches without a much deeper dive into each individual organization. Despite their shortcomings, both of these studies show that hospitals are making do with less, as most of us are.
No survey or study is going to tell you this, but if there's one thing I've learned in the past year in discussing the economy and healthcare reform with hospital and health system CEOs, they'll need to continue to do so.
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As the old saying goes: good people are hard to find. Fortunately—or unfortunately depending on one's point of view—good people are easier to find as a result of the Great Recession. While healthcare has not been hit as hard by the economic downtown as some market niches, our industry has not escaped completely and there have been job cuts. Whether from inside the industry, or as a result of career changes from other disciplines, in this bad economy we have the chance to find good people and bring them onto our teams.
The reason this is important is because whatever form healthcare reform finally takes, there is a call going out nationwide to improve the quality of healthcare. A higher quality of care means access to care, the ability to access that care more quickly and receive better service once care is accessed. The result, then, is improved patient outcomes. And all of this is achieved, hopefully, at a lower cost.
Much structural reform is needed to get to higher quality healthcare. My experience is that in the end it's people who make the difference. Good people, whether partners or employees, bring more than technical expertise. They bring a conscious, intellectual and emotional commitment to their job. To earn that commitment and in turn reward it requires a values-driven environment that nurtures people, rewards their commitment and ultimately drives to a visualized and clearly communicated goal of high quality care and improved results for patients.
A good example of a values-driven culture is Southwest Airlines.
Southwest instills its culture from the executive level down to new hires. Simply, the airline delivers great service; it's on time and offers customers low fares.
The carrier is known for its quick execution. The most common example is the airline's ability to turn around a plane in 20 minutes from the time it arrives at a gate to when it departs next. Some things are beyond its control, but the success of quick turnaround has given Southwest its legendary competitive advantage.
Southwest's dedication to quality is reflected in its use of technology. The most easily recognizable example is the replacement of old aircraft with new aircraft to improve performance efficiencies and passenger comfort.
Translated to healthcare, quality and value means buy-in across an organization-wide to a values-driven, patient-focused culture with its ultimate goal of superior care. It means looking at how we execute and seeking to do it more efficiently without losing our humanity. It means learning that we don't embrace the use of technology for technology's sake; rather we use it where the result is better care at lower cost.
We all have the opportunity to create a values-driven culture that results in a positive, welcoming, healing environment for patients that delivers high quality care. We have found that we can create this culture by:
Treating patients, their families, and each other with respect. Make the patients feel cared for. Pay attention to their concerns. Do the same for colleagues and peers. And do it every time.
Living and demonstrating integrity. Do what we say we're going to do. Stick to our commitments and abide by our organization's structure and guidelines. And abide by the laws and regulations that pertain to our industry.
Communicating with the patient, with the patient's family and with each other. Act quickly on requests, whether from patients, from physicians or from each other—and always follow up. Survey patients, get their feedback and act on the information they provide. And do this with consistency.
Being efficient. Time is precious. Yes, it's money (another old saying), but it is also finite. We only have so much of it. Plan and prioritize and then follow that plan. Ensure that you are using the organization's technological resources wisely, acquiring new technology when appropriate, not just because it's the latest thing. Use the other resources offered by the organization and your peers efficiently and effectively.
We created a values-driven, patient-focused culture based on the steps I have just described. Using a formal process, it helped establish the guidelines and metrics to create an inclusive, patient-centric environment and measure our performance and how to improve it. The result is a healing environment that also nurtures our staff and clinicians while delivering the highest quality care to patients.
It is possible to create a values-driven culture within your organization, but a reminder that it must be driven from top down. The entire management structure must buy in if the staff is eventually to buy in. If you are partnering with other facilities or physicians, you must make certain that they share your vision and determination to incorporate, nurture—and push from time-to-time—a values-driven culture.
With metrics in place, you'll be able to measure performance and success. Frankly, though, you'll know it before any metric confirms it. You'll be able to physically see it in the day-to-day operations, in how people behave and perform—and in how patients respond. Of course, once such an environment is achieved, you must perpetuate it by keeping to the fundamentals that helped you create such an environment.
My experience is that when we create a better environment for our people and our patients, the results are happier patients and patient families, and happier staffs that perform at higher levels. Certainly it's more than just everyone being happy. Such a total healing environment helps patients recover faster and leave the hospital sooner, which lowers costs. Improved patient outcomes translate into higher patient satisfaction—and of course most important, a patient's return to health.
Finding good people is hard. Keeping them requires our dedication and continuous effort regardless of the economic conditions. Yet the lessons can be applied across the industry. Investing in our culture and living to a higher professional standard every day results in retaining a committed, happy staff. Most important: it creates a healing environment that delivers the very best in patient care and provides a lesson for healthcare reform.
Tom Mallon is co-founder and CEO of Regent Surgical Health, which works with physician and hospital partners in the development, management and turnaround of surgery centers and specialty hospitals. He may be reached at 708-492-0531.For information on how you can contribute to HealthLeaders Media online, please read our Editorial Guidelines.
The House of Representatives, voting 243 to 183 mostly along party lines on Thursday afternoon, approved a bill (HR 3961) that would prevent a 21% cut in the Medicare physician payment rate scheduled at the beginning of January 2010. Instead, as proposed under the House measure, physicians would receive a 1.2% annual increase.
The bill, known as the Medicare Physician Payment Reform Act, calls for replacing the sustainable growth rate (SGR) formula, that was enacted more than a decade ago to help keep physician costs down. During the subsequent years, Congress usually had stepped in annually to override the cuts called for with the SGR.
House Minority Leader John Boehner (R OH) said in a statement that the House had created a "doc fix" that would add approximately $300 billion to the federal budget deficit--outside of the House healthcare reform bill approved by the House last month.
The Congressional Budget Office (CBO) said in a memo Thursday that enacting both HR 3961 and the House healthcare reform bill (HR 3962) together would add $89 billion to budget deficits over the 2010-2019 period.
However, House Majority Leader Steny Hoyer (D-MD) said that the Medicare payment measure was "a separate bill that we've done on a regular basis." Hoyer said, "It is part of healthcare, but it's not healthcare reform.
The Democrats have said that the Medicare physician payment reform legislation would come under the "pay as you go" principle of budget discipline that requires Congress to find a way to pay for any new spending--outside of an economic crisis.
The White House on Thursday called the measure "an important step forward," and congratulated the House "for taking action to protect the care and physician choice that Medicare beneficiaries and TRICARE (military) patients have earned."
AMA President J. James Rohack, MD, said in a statement that "fixing the Medicare physician payment formula once and for all is an essential element of comprehensive health reform." He added that "physicians must be assured of stable payments so they can continue to care for seniors, baby boomers, and military families.
