Americans who are frustrated with shortages of swine flu vaccine place slightly more blame on drug companies than the federal government, a USA Today/Gallup Poll. With swine flu widespread in 48 states and pediatric deaths mounting, only 5% of respondents have received the vaccine since it became available in October, the poll shows. Fifty-eight percent place a great deal or moderate amount of the blame for the lack of vaccine on the federal government, the poll shows, and 62% blame drug companies.
U.S. physicians are torn over what the government should do to make healthcare more available and affordable, they're like-minded about one perceived scourge: the insurance industry, the Philadelphia Inquirer reports. A national survey of physicians found that most favored expanding health coverage to the uninsured through a government-sponsored program. Another survey found 70% of Massachusetts doctors support that state's three-year-old reform law, which increased public options, and created a government-regulated health insurance exchange.
Ninety-nine percent of hospital board chairmen think their hospital fares at least as well as a typical hospital on standard quality measures. Among the chairmen of hospitals that perform worst, 100% say their hospital performs at least as well as a typical hospital. The figures are from a survey published in the journal Health Affairs, based on responses from 722 people who chair the boards of nonprofit hospitals.
There have been major changes happening at medical schools across the United States as graduate schools try to catch up with the changing medical landscape, the Washington Post reports. The schools are now trying to prepare students for a world where mainstream doctors adopt holistic or alternative techniques, where doctors' offices portray themselves as "medical homes" offering "patient-centered" care, where primary-care physicians are increasingly in demand, and, where the system of paying for healthcare is likely to undergo a major upheaval, the Post reports. Catering to these needs, medical experts say, could help future doctors offer preventive care first, reactionary second.
With the House's passage of a sweeping healthcare overhaul, the advertising battle over reform has been pushed into a new phase as competing groups have taken to the airwaves to thank or punish Democrats for their votes, reports the Washington Post. There has already been more than $150 million spent this year on television ads related to the healthcare debate, according to the Campaign Media Analysis Group. As of Nov. 6, about $63 million had been spent on ads favoring Democrats' reform plans and $52 million on ads opposed, according to the analysis group.
Nearly three out of four physicians say they have less control over the way they practice medicine than they did five years ago, according to a new Internet survey from Jackson Healthcare.
The survey of 1,978 physicians in 50 states blamed the perceived loss of control on medical malpractice litigation, and insurance and government interference. However, 85% of the physicians say the threat of medical malpractice litigation is their primary obstacle to practicing medicine as they see fit.
"We found that regardless of a physician’s political affiliation, the respondents attributed the practice of defensive medicine to excessive waste in the healthcare system," said Rick Jackson, chairman/CEO of Jackson Healthcare, an HIT and clinician staffing provider based in Alpharetta, GA.
Jackson found that 62% of physicians disagreed with the American Medical Association's support of healthcare reform, including 46% who say they "strongly disagree." When asked which piece of existing legislation they most support, 44% selected HR 3400, 15% selected HR 3200, 7% selected the Senate Finance Committee bill, and 19% supported none of these plans. Although no piece of existing legislation "very strongly" represented physician views, 92% of respondents said tort reform had to be a primary component of any healthcare legislation..
Physicians also want healthcare reform legislation to include:
Private insurance industry reform, including the elimination of pre-existing condition refusals, the elimination of dropped coverage (except in instances of fraud), and portability (78%)
Allow professional, trade and industry associations, including Chambers of Commerce, to provide healthcare insurance to member groups (67%)
Allow individuals to opt-out of Medicare or their employer-sponsored plan, and provide credits for them to purchase a plan on the individual market (61%)
Create an insurance exchange that provides competition on health insurance plans (54%)
Of the 17 healthcare reform elements offered to respondents, a public option ranked 11th with 32% of physicians selecting it. A single-payer insurance system ranked 14th with 22% selecting it.
"What's interesting is that the majority of physicians surveyed are in favor of healthcare reform," says Jackson. "We found that many believe their voice is not being heard and the issues most important to many physicians are not a high priority in the current debate and reform efforts."
The online survey was conducted between Sept. 23 and Oct. 18 with a response rate of 1.71% from the 110,328 invitations distributed. The survey has an error range of +/- 1.42%, at the 95% confidence level.
The concept of "doing today's work today" through open access or same-day scheduling has been well known in practice management circles for years, and most practices that have tried it can vouch that adopting this technique increases patient, staff, and physician satisfaction, and decreases no-shows and wasted work.
Despite the rave reviews, open access—reserving a number of appointment slots for same-day appointments—is not wildly popular in practice.
One reason: "To doctors, volume is money. And they look at gaps in the schedule and almost panic," says Dawn Blazier, office manager at My Family Doctor, PC, in Brodheadsville, PA, where she's been using open access scheduling since 2004. "But at the end of the week, you're seeing just as many patients, but the stress is taken out of the schedule."
Further, traditional schedules often leave staff members spending significant time trying to squeeze in patients who need to be seen quickly, says Christine Ingram, a senior consultant with The Coker Group in Alpharetta, GA. For some practices, every day is a struggle to decide how to fit every patient into the schedule. And when this can't be done, patients go unseen and unsatisfied, she adds.
Despite the benefits, open access can go awry if not planned and executed properly. Here are six steps to help ensure open access success:
1. Educate and obtain buy-in. Make sure you have educated your staff and physicians on the reasons for adopting the new scheduling system, says Ingram. Start by clearing up misconceptions, particularly the idea that you'll be giving up control of the schedule.
"Believe it or not, you'll have a more predictable schedule, even though it's not people that you see on paper. Plus, physicians more often get to see their own patients. Patients don't have to see someone who just happens to have an open emergency slot," she says.
What many physicians and staff members may not realize is that open access is fully customizable to each practice's needs. Not all physicians need to use the system, nor do all physicians need to reserve the same amount of open access time. And it's perfectly acceptable—essential, even—to make changes throughout the year due to seasonal volume differences as well as trial and error, Blazier says.
2. Determine the scope of open access that is right for your practice. "Do your homework first," Blazier says. This means keeping a phone log of the number of calls the practice gets each day and the type of appointments requested, and watching trends develop for a few weeks, keeping in mind seasonal variability. "You're going to have to adjust, but you don't want to add 10 hours a week of open access when you only needed six," she says.
Meanwhile, take the time to conduct a quick operations check to ensure you aren't performing redundant front-end processes, such as collecting the same information at more than one time or place. This step will automatically improve the efficiency of your practice and clear the way for a smooth transition to open access, Ingram says.
Also understand that open access may not work for every physician or practice. For example, this type of scheduling is best suited to primary care or specialties that aren't heavily referral based. A doctor who does a lot of surgical consults, on the other hand, is probably not a good fit, Ingram says.
3. Simplify your scheduling codes (reasons for visit). Settle on no more than three to four standard codes, Ingram says. You may also want to standardize the length of each visit, no matter what visit type, she adds.
4. Work down your backlog before going live. If your practice is very busy, it may take some time to reduce your patient backlog before you can add same-day slots to your schedule. Some practices hasten this process by temporarily adding physician hours and shifts. This work-intense phase is the most challenging part of the implementation for many practices, Ingram says, but it pays off once your scheduling becomes virtually stress free.
5. Be flexible, but disciplined. Although you will find the need to make changes as you go along (e.g., more slots for back-to-school physicals and a slower implementation period for certain physicians), resist the urge to fill open access slots with anything but same-day calls. "The tendency is, ‘Oh, this patient needs to get in for a routine visit, and here's an empty [open access] slot for tomorrow,' " Blazier says. "At first, we struggled to keep these slots off-limits, but now we don't even look at them. If we do prebook an appointment, we're always sorry. If someone wants to call the next day, we're happy to put them in, but we won't prebook appointments that are reserved for same-day."
6. Track your success. Periodically check in with physicians, staff members, and patients to gauge how the schedule is working and determine whether you need to make any tweaks. Also monitor whether you see a drop in no shows and patient complaints.
It can take time to find the right mix of prescheduled and open access and work out the kinks, Blazier says, adding that it's well worth the effort. "I've been in the practice office for over 21 years, and to me, [open access] is the best way to schedule. I would never want to go back to an environment to have to squeeze in patients and double book," she says.
"The patients are absolutely thrilled," Blazier adds. "They're kind of trained by now that if they call in the morning, they're almost guaranteed an appointment that day. And that gives them peace of mind that they can pick up the phone and get what they want. And when we can give them what they want, it really makes for a nice relationship."
If a hospital staged a disaster drill for a hurricane, chances are the exercise would focus on the actions of caregivers.
But would the drill also include a medical center's IT technicians?
It should, said Jim Grogan, vice president of consulting and software product marketing for SunGard Availability Services, in Wayne, PA. SunGard provides IT disaster recovery assistance and managed IT services to 10,000 customers in North America and Europe.
If IT systems go down in a hospital as part of a real disaster, the effects will be felt on the clinical front line, Grogan said. With systems down, nurses may need to send designated "runners" with diagnostic tests to the laboratory and be prepared to wait four hours for results instead of just 15 minutes electronically.
Workers may have to re-enter reimbursement information from patient charts into a rebooted billing system. In the worst IT crashes, the emergency department might have to close temporarily.
Actively including IT representatives in drills will ease interdepartmental confusion and force all sides to appreciate what others view as the consequences of disasters, Grogan said. Simply put, nurses look at mission critical systems as lab testing equipment and ventilators. IT techs view disks and servers as mission critical needs.
When both sides participate in disaster exercises and learn how IT will recover the hospital's systems, those perspectives become more open, Grogan said.
SunGard, which has clients within healthcare and other industries, offers the following three strategies for IT recovery drills:
Test your plans frequently. Drills make participants feel more comfortable with response plans. SunGard recommends conducting disaster recovery exercises at least twice a year, which for hospitals reflect Joint Commission emergency management requirements.
Push the envelope with unexpected scenarios. "It's not just the regularity of testing, but the variety of testing," Grogan said. Do nurses understand how the pharmacy operates if there's an IT failure, for example? Likewise, do IT techs realize how their systems' down time affects computer-aided diagnoses? The Joint Commission expects at least one drill each year to simulate an escalating series of events in which the local community can't support the hospital. Such approaches also work for IT recovery exercises, Grogan said.
Encourage communication between clinical and IT departments. Nurses need to explain what the most critical IT factors are for them during a disaster response. For example, if a hospital uses an electronic medical records system, nurses need to outline at what point printouts of the records may be necessary (e.g., patient evacuations).
Conducting risk assessments is a good start to uncovering IT-related and other vulnerabilities in advance of a real disaster, said Timothy Rearick, FACHE, manager at the Tallahassee, FL, location of North Highland, a management and technology consulting firm. He recently spoke to HealthLeaders' sister publication, Briefings on HIPAA.
Rearick said you can reduce risks by taking the following steps:
Identify threats. Consider the risks to your organization using the categories of natural threats (e.g., tornadoes, hurricanes, and floods), human threats (e.g., staff shortages), and environmental threats (e.g., power failures).
Recognize vulnerabilities. Take our initial hurricane scenario and imagine your hospital in the midst of it. What if your emergency generator is in the basement and you're close to sea level? The likelihood that you will lose electric power—and potentially IT systems—because of a hurricane and flooding is your vulnerability.
Determine the effect. If a flood causes you to lose power, what other problems will it lead to? How will this affect your organization?
Develop a list of remediation activities. Figure out possible steps to offset the various threats and vulnerabilities you've identified.
Once you've completed these steps, establish your priorities, Rearick said. Use an orderly, logical approach to determine which of your identified threats and vulnerabilities are most significant with respect to cost and risk, and then act on them.
"With the proliferation of the Web and Web-based applications, you're opening up your systems," he said. "There is risk now in the way we exchange information."
Don't always conduct IT recovery exercises with worst-case scenarios, Grogan said. More mundane, but more likely, events often aren't reflected in recovery plans, which is a mistake, he added. Take a look at what IT incidents have caused disruptions in the past and use them as the basis for drill scenarios.
We hear a lot about patient safety, and rightly so. We've all read the statistics that as many as 100,000 Americans die each year from preventable medical errors.
What doesn't get as much attention is healthcare worker safety, unless it's in the context of front-burner issues like the H1N1 influenza pandemic, or the spate of recent and unrelated assaults at Boston area healthcare facilities.
The fact is that working at a hospital can be hazardous to your health. According to the U.S. Bureau of Labor Statistics'Annual Occupational Illnesses and Injuries report, the rate of injury and illness for hospital workers was 7.6 cases per 100 full-time employees in 2008, compared with a rate of 6.3 cases per 100 FTEs among 19 million or so state and local government workers—including police and fire—and 3.9 cases per 100 FTEs in all industries across the private sector.
Nancy Foster, vice president for quality and patient safety policy at the American Hospital Association, says the data show that employee safety is a constant concern for hospitals.
"This is really about people working in a high-risk environment," Foster says. "That isn't surprising when you think about, first of all, we have very fast-paced environment. When one is working swiftly on something, the opportunity for some sort of mishap increases. Beyond that, there are a number of risks that exist in our environment. We make use of big, heavy equipment, often made of metal and other hard substances which could cause injury. We work with lots of sharps, needles, scalpels, all sorts of cutting instruments. We work in an environment where we are constantly cleaning things, and that means wet floors and other slippery environments."
Dealing with patients, of course, opens up a whole range of health risks for hospital workers, including exposure to communicable or infectious diseases, back injuries suffered while moving heavy patients, and violence. Foster says employee safety is sometimes compromised to ensure patient safety. For example, hospitals have evolved away from using restraints on violent or disruptive patients because the straps pose the risk of injury. While that creates a safer environment for the patient, it also creates a hazardous environment for the hospital worker.
"Those who work in a healthcare environment are really heroic because they do put themselves at risk just by coming into work every day," Foster says.
Jim Conway, senior vice president of the Institute for Healthcare Improvement, says too many people within healthcare believe that injuries and illness are part of the job description.
"So much of this is about poor design," he says. "What we have to do is, first of all, declare this current state to be unacceptable. Then we have to look at how we can redesign the workplace, like we did with needles and the patient care units, to reduce the chances of injury and illness from happening."
Conway says hospitals should consider workplace safety in the context of efficiencies. "If you drive out the things that are causing people to hurt themselves, then you are probably driving out poor processes and driving out things that don't add value," he says.
The spike in bariatric procedures provides an excellent example of how procedures can be re-examined to make the transfer of heavy patients safer for healthcare employees.
"With appropriate training and equipment, patients can be transferred very safely from beds to wheelchairs or beds to stretchers, from stretchers to X-ray machines, if you have the right training, equipment, and the right number of staff," Conway says. "But if you miss any of those, there is a much higher chance that the employee is at risk of harm."
Hospitals are high-risk environments. Given the vitally important nature of the job, that risk will never be completely eradicated. That should heighten our respect and appreciation for the work of healthcare professionals. That doesn't mean that we must accept that their workplace cannot be made safer. We owe it to them.
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Robert H. Frank,an economist at Cornell University, examines how the healthcare reform proposals under consideration seek to reduce U.S. health costs. The spending gap stems largely from a conflict inherent in how American physicians are paid, he says. Under most American health plans, including Medicare and Medicaid, doctors are reimbursed according to how many tests and procedures they perform, Frank notes.
