The Jefferson Parish Council has appointed former parish administrator Nancy Cassagne to lead West Jefferson Medical Centerin Marrero, LA. Cassagne had filled the job on an interim basis since the previous chief executive resigned in October 2007. The unanimous approval came the same week that anonymous complaints were made about Cassagne not meeting the requirements set out by the state Department of Health and Hospitals.
How to cut costs and control inventory. Plus, stories on reactions to physician complaints and patient complaints. [Powered by Trinity Healthforce Learning.]
Security may not be the top priority on your practice's implementation list, but it certainly is essential. It reduces liability, protects a practice's reputation, and guards other areas that could put your small, large, or private practice out of production.
The bottom line to successfully address security regulations and safety measures is to have an organized security plan, which should include the following three elements: adequate, regular training, current and communicative policies and procedures, and employee knowledge of government sanctions.
"Developing a sound security program is only effective in how it's built," says Chris Apgar, CISSP, president of Apgar & Associates, LLC, in Portland, OR. "Part of the plan is what security measures to follow, what are my needs. You need to put that together in an organized fashion."
Use these five steps to develop a successful staff plan and see results:
1. Research the best places to get information (e.g., HIPAA Academy).
2. Implement changes as needed. Set up a tool to easily insert new information into the system.
3. Staff training: Sign confidentiality agreements, documentation, and policies and procedures, and follow government sanctions.
4. Conduct a risk assessment, audit, and/or analysis. The assessment is the first way to prioritize the most important areas, examine the threats, and identify what is already in place for your plan. The audit is a way to detect what has happened with risk management areas of your practice.
5. Evaluation helps determine whether changes are working in the practice, whether the plan is effective, and whether there have been any significant changes in the market.
Shannon Sousa is the editor of The Doctor's Office. She may be reached at ssousa@hcpro.com. This story was adapted from one that first appeared in the February edition of The Doctor's Office, a monthly newsletter by HealthLeaders Media.
A bill that would expand the role of physician assistants has passed in the New Mexico Senate. The bill would allow physician assistants to direct the use of a prescription device, help assess functional impairment and be included in a list of practitioners that an individual may select for treatment of an illness or injury within the terms and limits of the individual's insurance coverage plan.
The sites for Merck's Januvia, for diabetes, and Singulair, for asthma and allergies, were the top two product sites visited by primary care doctors, according to results of a market research study by Manhattan Research. Merck's corporate site was tops among all U.S. doctors as well.
Second opinions have without a doubt saved many lives and are likely to gain in importance with a growing focus on medical errors. But they can be awkward for doctor and patient, and surprisingly little is known about them.
Wall Street Journal columnist Benjamin Brewer, MD, advocates for the patient-centered "medical home" model of primary care. Brewer claims he could provide comprehensive primary care on a subscription basis for $20 a month. The problem, however, is when it comes to reimbursement, for that care, he says.
Burnout among medical residents does not put patients at risk of medication errors, but depression does, according to researchers from Children's Hospital in Boston. Depressed pediatric residents made errors in ordering, transcribing, or administering medications 6 times more often than those who were not depressed. Error rates among residents that were suffering burnout, however, were no different than among those who were not, the researchers found.
When the Congressional debate over immigration reform collapsed last year it was a blow for national policy in general and for healthcare in particular.
The debate, as it played out in Congress and in the media, focused almost exclusively on what the United States should do about illegal immigration. Healthcare was brought into the discussion because of the increasing burden illegal immigrants are putting on hospitals and other government supported facilities and resources.
What received less attention was the link between healthcare delivery and legal immigration. While illegal immigrants may be eroding resources, legal immigrants are providing skills and services that are vital to the daily delivery of healthcare in the U.S.
Consider that the number of physicians being trained in the United States has remained static since 1980, though we have added 70 million people to the population in that time. We have been more proactive about training additional nurses, but our ability to do so has been stymied by an understaffed educational system. Over 147,000 qualified applicants to nursing programs were turned away last year, mostly because we do not have the faculty or the facilities to train them.
Given the current posture of physician and nurse training there is only one way to immediately increase the supply of needed clinical professionals, and that is through legal immigration. While most people agree that the goal should be to train more U.S. physicians and nurses, in practice it is not that simple. Physician training is a time consuming and expensive process. A concerted effort to train more U.S. physicians by building new medical schools and expanding residency programs would not bear fruit for 10 years, even if we began today. Nurse training offers faster turnaround times, but the nurse shortage is so severe that it too will take years to address.
Immigration offers the benefit of a qualified talent pool that could be readily available given a more practical and enlightened U.S. immigration policy. That is why the collapse of the Congressional immigration debate is likely to have serious if poorly understood consequences for healthcare. It left us with a legal immigration system that is completely out of touch with current realities.
Foreign medical graduates make up over 20 percent of physicians engaged in patient care in the United States and about the same percentage of doctors in training. Without them, access to medical services would be drastically curtailed and any hope of expanding healthcare coverage would be untenable. Foreign-born nurses compose only about 3.5 percent of the total nurse workforce, but they represented 15 percent of newly licensed nurses in the U.S. in the last two years, and they too are a vital resource on whom many hospitals depend.
Unfortunately, U.S. immigration policy is extremely restrictive when it comes to foreign born physicians and nurses. The Department of Labor has designated nursing as the number one shortage occupation in the country, yet foreign nurses are virtually excluded from accepting offers of employment here as they are unable to obtain permanent immigrant visas due to the limited supply.
Foreign physicians are restricted in their ability to work in the United States due to an annual cap on "H-1B" visas. The federal government received over 125,000 applications for such visas on April 3, 2007, the very first day that applications could be filed, even though only 65,000 H-1Bs are available each year. Once the cap has been reached, backlogs begin to develop which can exclude healthcare professionals from working in the United States for years and may cause them to seek employment elsewhere. Due to backlogs, foreign trained nurses are precluded from entering the United States for the next five years.
When Congress declined to act on illegal immigration, it also walked away from a broken and dysfunctional system of legal immigration. The essential problem is that so far Congress has linked these two issues, when they really should be regarded separately. It would be relatively easy for Congress to exempt "designated shortage professions" such as nurses from annual visa caps, or at least increase the quota of visas available to high-need professionals such as nurses and physicians. Congress also could act to recapture unused visas from prior years without undertaking comprehensive immigration reform. The Senate took action in October of 2007 by passing legislation that would do just that, allowing hospitals to resume hiring foreign nurses. Unfortunately, this legislation was rejected in the House of Representatives.
Practical remedies to our current legal immigration system are available, but it will take the full and vocal support of the healthcare industry to implement them. Advocating changes that would increase the supply of legal, well trained foreign health professionals should be an industry priority for 2008.
Susan Nowakowski is president and CEO of AMN Healthcare, the largest healthcare staffing company in the United States.
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Judging by recent happenings in the healthcare industry, I must have somehow slipped into the parallel Bizarro World.
In case you're not familiar with the Bizarro World--or Htrae--allow me to explain briefly, at the risk of exposing my inner nerd. The Bizarro World, as illustrated in Superman and other D.C. comics, is a backwards planet that is socially the exact opposite of our Earth. Down is up, black is white, good-bye is hello, and most importantly wrong is right.
I'm generally a well-balanced guy, but clearly I must have landed on D.C.'s Htrae. Why else would I see stories like these:
More physicians lead to worse care: As we anticipate millions of baby boomers getting older, sicker, and needing more medical care, some have concluded that we need fewer--not more--physicians. This article in The Atlantic (online) summarizes this position well. In the meantime, the number of primary care providers is dwindling and community hospitals across the nation--especially in rural regions--are beginning to see signs of a physician shortage. The story rightly points out that too many docs in urban markets can drive up the cost of care, but then the piece leaps into the Bizarro World when it claims that for the good of the nation's health we should clamp down on the number of physicians we train.
Bizarro Bush's budget: I wrote in last week's column about the president's proposed $3.1 trillion budget that calls for slashing that albatross entitlement program, Medicare. But what I didn't note is the negative effect the proposed 2009 budget would have on teaching hospitals. The Association of American Medical Colleges argues the plan would cut indirect medical education payments by more than 60 percent, with devastating effects on medical education in our country. Physician training and medical research clearly are not priorities on this backward planet I find myself on.
Blue Cross' bizarro biz plan: California's largest for-profit insurer had already battled bad press over unfairly canceling policies. What would be a good PR strategy? Well, on the Bizarro World you don't want good publicity, so the Blues plan sent a letter to providers telling them to report discrepancies between their patients' medical conditions and the information in their applications. In a sign that gives me some hope that I'm still home, the Golden State's doctors riled against the plan and the insurer back-peddled.
Why would ERs ever be a good safety net? The Los Angeles Times--the Bizarro World's favorite publication--picked up a study by the American College of Emergency Physicians that reported one in five emergency room physicians claim they "knew of a patient who had died because of having to wait too long for care." The article concludes that ERs lack the capacity to serve as the nation's healthcare safety net. One problem, of course, is the unreasonable expectation that ERs provide primary and often charity care rather than what they are designed to do.
Obviously, all of these disconnects are because I must have switched places with bizarro Rick, and they probably make perfect sense to you. Should I go missing, don't fear; I'm just off looking for a way back to my home planet. Until next time, hello.
