Unionized employees at Commonwealth Medical Center in Aliquippa, Pennsylvania have notified the facility that they might strike over firings and alleged unfair labor practices. The new ownership fired all its employees and then immediately rehired some.
Bethesda Memorial Hospital announced that the organization has exceeded the goal of raising $100 million during an eight-year capital campaign to expand and add services to the 49-year-old nonprofit hospital. Nearly 10,000 individuals and corporations have made more than 40,000 gifts since the capital campaign was launched in 2000, including more than 25 gifts or commitments of $1 million or more. Bethesda is preparing to open its capital-campaign crown, a $57 million heart institute on Feb. 4.
A legislative deadline has passed for Colorado hospitals to report rates of acquired infections. The requirement is due to a bill that mandates hospitals, ambulatory surgery centers and dialysis centers to report infection rates annually. The federal reporting system for hospital-acquired infections has proved difficult for many Colorado hospitals to navigate, according to state officials. In addition, the national database also is not set up to collect data from ambulatory surgery centers, making it impossible for Colorado's 102 centers to meet the mandate.
Critics are blasting the partnership of Rex Healthcare and a Florida for-profit healthcare company for planning to move a hospital from central Franklin County, NC, to a location near Wake County, NC. Rex and Franklin Regional have asked the state for permission to move the 70-bed Franklin Regional Medical Center in Louisburg 12 miles away to a planned $103.9 million building in Youngsville.
A new model of governance asks trustees to monitor more than the bottom line. Also, stories on retail clinics, bedside technology, and more. [Powered by Trinity Healthforce Learning.]
Only a few years ago, the majority of healthcare experts and analysts who follow physician supply trends supported the premise that the United States had too many physicians. Today, the majority now sees things the other way--a change reflected in the positions of such organizations as the Association of American Medical Colleges, the AMA, and the Council on Graduate Medical Education, all of which now project a physician shortage.
Nevertheless, pro-surplus theorists continue to make their case. Just last month, an article in the December The Atlantic Monthly reignited the debate between those who believe the United States has too many physicians and those who believe it has too few.
The two primary arguments recycled by those who contend there is a surplus of physicians are economic ones.
The first is that demand for medical services is driven by doctors themselves. The more physicians in a given population, the more medical services (and, therefore, the more medical spending) a population is likely to generate. The solution to high medical spending and to reducing unnecessary medical procedures, the argument goes, is to reduce the number of doctors.
The second argument is based on the outcomes achieved at medical centers with a relatively high number of physicians per patient population versus outcomes achieved at medical centers with a relatively low number of physicians per patient population.
According to a study conducted by Dartmouth researchers, patients do better at facilities such as the Mayo Clinic in Rochester, MN, which has a relatively low physician-per-patient ratio, than they do at facilities such as New York University Hospital, which has a relatively high physician-per-patient ratio. The way to improve outcomes, they conclude, is to reduce the number of doctors.
These arguments have been most conspicuously contested by Richard "Buz" Cooper, MD, an academic at the University of Pennsylvania and cochair of the Council on Physician and Nurse Supply. Note: The Council on Physician and Nurse Supply is funded by Merritt, Hawkins & Associates' parent company, AMN Healthcare.
Cooper argues that demand for medical services is largely driven by economic growth, technology, population growth, and other factors, not by physicians. He also argues that it is spurious to compare medical outcomes in relatively affluent, demographically homogenous cities like Rochester to economically and ethnically heterogeneous cities like New York.
Which side is right? Trends in physician recruiting incentives show that financial offers to physicians in most specialties have consistently increased in recent years, suggesting demand for physician services is growing and the supply of physicians is limited.
A key point to consider in the physician supply debate is that the supply of physicians cannot be increased if the number of residency slots available does not increase. However, no such increase will occur unless Congress removes the cap on what Medicare currently spends on residency training.
Although the physician supply debate largely takes place in academic circles, it has practical effects on physician compensation, recruitment, and retention. As long as the argument remains unresolved, physician supply is unlikely to increase and, based on physician demographics and other factors, can be expected to decrease.
That will put additional upward pressure on recruiting incentives and continued strain on hospitals, medical groups, and other organizations committed to maintaining or enhancing their medical staffs.
Mark Smith is president of Merritt, Hawkins & Associates, a national physician search and consulting firm and a division of AMN Healthcare. He can be reached at msmith@mhagroup.com.
Automating portions of the patient encounter--such as the initial call or patient check-in--can provide cost savings and help with the number of staff members required, but patients aren't always receptive to these technologies. The office staff members need to decide whether this is the program that will best suit their patients.
"There are going to be some people who just want to talk to a real person, and we should be giving them that option," says Charlene Burgett, administrator at North Scottsdale (AZ) Family Medicine. "There are also many people who would rather go through the automated system than to wait their turn in the calling line."
Bohler says the automated system has been a huge help for the patients at her practice. "I believe this has enhanced the communication abilities of this practice, and with each new change, the patient still has the freedom of choice," she says.
Following is a list of devices to consider in making the flow of appointment scheduling, patient telephone calls, reminders, and confirmations easier in your busy practice.
Interactive voice response (IVR): This is a telephone technology that allows patients to interact with a database to acquire information or enter data. Your practice can set up the IVR system to offer any automated features needed, including office announcements about when nurses and physicians will be available, office hours, emergency calls, prescriptions, after hours, and holiday and weekend calls. Practices can purchase and install basic, self-service, or full configuration models. This system generally fares well in handling large call volumes, particularly in busy physician practices.
Kiosk: This is an interactive display or terminal stationed inside the office and used as a patient check-in method, similar to what a person would do at an airport. The patient would punch in his or her name, and the device updates the demographics and insurance card information before the patient even speaks with a receptionist or sees the doctor. Kiosks save patients from filling out forms and allow receptionists to avoid entering the data into computers and placing daily calls to insurance companies.
Portable buzzer: The buzzer is used for the patient. This allows him or her to tend to other priorities instead of being in the waiting room for a long period of time. If the patient decides to leave the building but stays within range, the buzzer will sound and the patient can then return.
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 January edition of The Doctor's Office, a monthly newsletter by HCPro Inc. For information on all of HCPro's products, visit www.hcmarketplace.com.
The Department of Health and Human Services is seeking cuts to the Medicaid rate paid to doctors in hospital-based practices, and the rate reduction appears to affect about 43 percent of all physicians in Maine. Members of the Maine Hospital Association say that the irony is any doctors in private practice won't take new Medicaid patients because their reimbursement is so low, and now the state is about to penalize the hospital-based physicians practices that do see them.
Under what circumstances can a patient in an emergency room be forced to submit to a procedure that doctors deem to be medically necessary? That question--and the notion of informed consent--is at the heart of a civil case Brian Persaud, a 38-year-old construction worker who lives in Brooklyn. Persaud asserts that he was forced to undergo a rectal examination after sustaining a head injury in an on-the-job accident.
A cursory scan of news reports about the healthcare industry could make one wonder why hospitals and physicians today seem fiercely at odds with each other.
Docs are not only entering business ventures to open up new revenue streams, they're also competing in many cases directly against hospitals in profitable service lines.
Hospital administrators are complaining more and more that there are fewer physicians to maintain key services, and many of the physicians they have now refuse to take ED call or expect to get reimbursed for it.
Don't get me wrong, hospitals and physicians need each other now more than ever. Reimbursements remain tight and the cost of running a medical group has never been higher. Many physicians are looking to their hospital partners for relief in the form of administrative and technical support.
But true hospital-physician alignment is a tough task in no small part because hospitals and medical groups operate in such fundamentally different ways.
Hospital-physician alignment strategies was the topic of conversation at a recent HealthLeaders Media Roundtable that I hosted in downtown Nashville. As a reporter, I follow these issues closely, but there is no substitute for getting out of my cluttered office and having direct, in-person conversations with physicians and administrators.
Our panel of experts pointed out that medical groups and hospitals still struggle to speak the same language and understand each other's distinct business needs. This inability to communicate effectively can be a major barrier for dissimilar organizations that are trying to align objectives.
Jeffry James, CFO and COO for Christie Clinic, an 85-physician multispecialty medical group based in Champaign, IL, said that reimbursements, regulations, and expectations for medical groups and hospitals are so different that it's hard for a clinic to grasp all the things that hospitals need, and the lack of understanding can breed distrust.
"Take data transparency, for example," James said. "It's very difficult for us on the physician side to really understand how the numbers at the hospital work because they don't relate directly to what we do. When a hospital talks about losses per physician that they employ, we don't know whether that includes credit that the hospital may be receiving or not receiving for ancillary services. When a hospital talks about finances, it's hard for us to put it in terms that we can understand, because the way we account is different than the ways hospitals account."
So a hospital might share data with its volunteer medical staff in an effort to be transparent with its business partners, but if the physicians and medical group administrators don't fully understand the data, what good is it? Certainly, the data won't factor into the physicians' negotiation strategy to increase pay for call coverage.
The incentives today for hospital-physician alignment are great, said John Phillips, president of PivotHealth, a practice management firm based in Brentwood, TN. But the organizations need to begin a difficult dialog about how to align incentives.
And James said that in many cases it comes down to whether a hospital is proactive or reactive in reaching out to its medical staff. "The reactive hospital can do more harm than just encouraging a physician down the path of adding services for themselves; that stance actually pushes physicians away," he said. "In our market right now, we have one hospital that is very proactive, and one hospital that is being very reactive. This is pushing our physicians toward a hospital that they typically did not practice at. By proactive, I mean that the administration is talking to us about marketing strategies, EMR, and generally about how we get on the same page. At the same time, the reactive hospital's administration is talking about curtailing our privileges, recruiting against us, and changing the way unassigned call is provided. I think the way these two hospitals are interacting with volunteer medical staff is going to change the landscape in our market."
