Paul Okunieff, MD, has been named director of the University of Florida Shands Cancer Center and chairman of the UF College of Medicine department of radiation oncology, effective Dec. 1. Okunieff is currently the Philip Rubin professor in radiation oncology and chair of the department of radiation oncology at the University of Rochester School of Medicine and Dentistry. He also is director of the University's Robert A. Flavin Radiosurgery Center. Prior to his appointment at Rochester in 1998, Okunieff served as branch chief of radiation oncology at the National Cancer Institute, overseeing clinical-translational research for the intramural NCI program.
Roland A. Goertz, MD, a family physician in Waco, TX, has been chosen president-elect of the American Academy of Family Physicians. Previously, he served three years as a member of the AAFP Board of Directors. The AAFP represents more than 94,600 physicians and medical students nationwide. Goertz was elected to the position by the Congress of Delegates, the AAFP's governing body, during the organization's annual meeting.
Park Nicollet Health Services' Board of Directors has elected David Abelson, MD, as Park Nicollet's new CEO, effective Jan. 1. Abelson will continue to serve as Park Nicollet's president. Park Nicollet's current CEO, David Wessner, announced his plans to retire from Park Nicollet in June 2009, effective on Dec. 31.
Stephen J. Parsons has been named CEO for the Baptist Health South Florida Foundation. The foundation oversees fundraising activities for Baptist Health, the largest not-for-profit healthcare organization in the region. It includes Baptist Hospital, Baptist Children's Hospital, South Miami Hospital, Doctors Hospital, Homestead Hospital, Mariners Hospital, Baptist Cardiac & Vascular Institute, and Baptist Outpatient Services. A certified fundraising executive, Parsons joined the Baptist Health Foundation in 1997. He was named vice president and chief development officer for the Foundation in 2004, with responsibility for overall fundraising and major gifts, the Corporate Partners program, and the Founders Society. Before joining Baptist Health, he was chief development officer at the American Red Cross of Greater Miami and the Keys.
Efforts to ban smoking in public places and eliminate secondhand smoke are making an impact in reducing heart disease among nonsmokers as well as smokers, a new study from the Institute of Medicine (IOM) finds.
"It's clear that smoking bans work," said Lynn Goldman, MD, professor of environmental health sciences at Johns Hopkins Bloomberg School of Public Health, Baltimore, and chair of the committee of experts that prepared the report.
Additional research is needed on how secondhand smoke—also known as environmental tobacco smoke—produces toxic effects, Goldman said. "However, there is no question that smoking bans have a positive health effect."
Approximately 43% of nonsmoking children and 37% of nonsmoking adults are exposed to secondhand smoke nationwide, according to public health data. However, despite reductions in the rate of individuals breathing environmental tobacco smoke over the past several years, an estimated 126 million nonsmokers were still being exposed in 2000.
A 2006 report from the U.S. Surgeon General's office had concluded that exposure to secondhand smoke can cause heart disease. It had indicated that moving toward smoke free policies would be the most economical and effective way to reduce exposure. However, the actual effectiveness of smoking bans to reduce heart problems was less clear cut.
Based on its research with 11 key studies, the IOM committee concluded that it is "biologically plausible" to have a relatively brief exposure to secondhand smoke "to cause an acute coronary event."
The IOM report was requested by the Centers for Disease Control and Prevention in the light of a growing number of studies in smoke free localities, states, and countries that found reductions in heart attack rates after smoke free laws were implemented.
Currently, 27 states, plus Washington, DC, and Puerto Rico, have passed smoke free laws that cover restaurants and bars.
A federal agency Friday said California should be made to pay back $45.5 million for foster care because children were living with their relatives in homes that didn't meet health and safety requirements.
The U.S. Health and Human Services Agency will make a final determination on whether California, which is trying to emerge from a $60 billion deficit over the last two years, will have to return the money, as the Office of Inspector General, Daniel R. Levinson, recommended.
"For the period October 1, 2000 through November 30, 2001, the State agency improperly claimed Federal reimbursement for county agency payments to relative homes that had not been approved based on State licensing standards," says the report.
Homes of caregivers who are relatives of the children must meet the same licensing requirements under a federal law established in January 2000, he wrote. Before that law was passed, standards for homes of relatives of foster child caregivers were not as strict.
The licensing standards include requirements for inspections, the physical environment of the homes, criminal background checks and clearances for all adults in the homes. They also include requirements for bedrooms and sleeping arrangements for children and adults, and safety standards for fixtures, furniture, equipment and supplies and safety release devices for security windows.
The agency's review was based just on a survey of homes in Los Angeles County during that period, because that county had the most relative home placements of any in California, and accounted for 40% of the statewide total.
State officials vehemently disagreed in written correspondence with Levinson's agency saying they did not believe the payments were in error and that any concerns about process had been corrected. However, Levinson indicated that the state had not provided information that would change the OIG's position.
"These deficiencies occurred because the State agency disagreed that the licensing standards used for nonrelative homes were required to be used for relative homes and had not instructed the county agency to discontinue claiming payments as of Sept. 28, 2000 for approved relative homes to which those standards had not been applied," the OIG stated.
"For the 100 sampled relative homes, the State agency improperly claimed $1.268 million ($650,324 Federal share) in Title IV-E foster care maintenance payments."
With cases (and fear) of H1N1 spreading across the country, the pandemic has the potential to overburden already stressed emergency rooms and doctors offices, but an interactive Web site is designed to advise patients based on the severity of their symptoms.
Using an assessment tool licensed by Emory University, Microsoft's H1N1 Response Center aims to help consumers' determine whether or not their symptoms are consistent with the H1N1 virus and if they should seek medical help.
The H1N1 Response Center asks a series of questions to help determine the severity of the case. The individual answering the questionnaire must disclose his or her age, gender, and zip code, and answer questions relating to how long they have felt like they might have the flu.
"The tool asks a series of questions, based on who you are: male/female, what age you are—there is all different branching logic that takes place in order for us to come up with the best assessment of how we believe we should guide you," says David Cerino, general manager of Microsoft Health Solutions Group.
The site creates an "interactive experience that is more convenient for the consumer, while at the same time being overall better for public health in terms of people not going to emergency rooms," Cerino added.
Based on how the individual answers each question, the H1N1 Response Center will format an individualized response. If the symptoms are severe, then the Web site suggests you see a doctor immediately. If the answers are less severe, the site suggests visiting a walk-in clinic, or even simply staying in bed, taking fever medicine, and drinking plenty of fluids.
The self assessment licensed from Emory University is based on "Strategy for Off-site Rapid Triage.' SORT reflects current public health and clinical science, vetted by a national network of experts from public health, clinical medicine, health education, and infectious disease.
The self-assessment tool allows patients and their families to enter specific information and be given back—in very clear, understandable terms—advice representing the best available clinical and public health science on what to do, says Arthur Kellermann, MD, professor of emergency medicine and an associate dean at Emory School of Medicine.
"It's a major tool to help reduce surge on the system in a safe and proven manner, but it's just as importantly a way to pull the right people into the healthcare system so they are not discouraged by long lines or fear that they won't ever get in to see somebody," Kellermann says. "It saves people money, discomfort, and the hazard of long, unnecessary trip to the emergency room."
Kellermann notes that the H1N1 pandemic is the first true pandemic the United States has faced in 40 years, and it has the potential to sicken tens of millions of people. The challenge, he says, is that with the U.S. healthcare system already facing a shortage a primary care doctors and overcrowded emergency rooms, it simply cannot sustain "tens of millions of people barreling into the nearest doctor's office or nearest ER as soon as they get flu symptoms."
"However, we absolutely need to see the ones who are severely ill, who need immediate stabilization, and those who are in these definable risk groups who are at high risk for becoming severely ill," Kellermann says. "We never want a person who needs us to be deterred by an overcrowded system. This [self assessment] allows the lanes of traffic to flow smoothly to get the patients to America's doctors and nurses who need to be there."
Kellermann says Emory worked for months getting input from the nation's experts, professional societies, public health authorities, and the Centers for Disease Control & Prevention to ensure the right questions were asked in the self assessment.
The site will also be updated immediately as new information arises on H1N1, including risk factors and precautions.
"The beauty of having this on the Web is the tool can evolve as rapidly as the virus does," Kellermann says.
And it will very likely help, Kellermann says. He adds that predictions say this particular strain of H1N1 could affect 20%-40% of the U.S. population this year, and educating consumers on the best way to proceed is good policy to provide quality care to not just flu patients, but those with other conditions as well.
"Just do the math: If half of those people feel bad, that's tens of millions of folks who have substantial flu symptoms—our healthcare system cannot absorb that many people coming in the door," Kellermann says. "That makes having this type of capability out there to allow the American people to self-assess their condition based on expert guidance an essential part of a public health strategy."
HCPro, Inc. Editor Sarah Kearns contributed to this report.
In his weekly address on Saturday, President Obama aimed sharp criticism at the health insurance industry over recent actions related to health reform—and implied he may push for legislation now pending on Capitol Hill to dissolve the industry's 60-year-old antitrust exemption.
In his remarks, Obama thanked a variety of groups for support of the Senate Finance Committee's bill, the last healthcare reform measure pending approval by a congressional panel. He specifically cited the work of a "broad and growing coalition of doctors and nurses, workers and businesses, hospitals and even drug companies—folks who represent different parties and perspectives."
However, "there are still those who would try to kill reform at any cost," said the president, referring to efforts by the health insurance industry to challenge healthcare reform with a study that said insurance costs would rapidly increase under the Finance Committee plan.
Obama even offered another study—one from the Business Roundtable—as counter to the findings from the health insurance industry. Their report said that annual healthcare costs for employers will rise 166% over the next decade, from $10,743 per employee today to $28,530 by 2019.
"This is the unsustainable path we're on, and it's the path the insurers want to keep us on. In fact, the insurance industry is rolling out the big guns and breaking open their massive war chest to marshal their forces for one last fight to save the status quo," said President Obama, referring to recent studies and advertisement campaigns by the insurance industry in several states challenging changes to the Medicare Advantage program.
Obama went on to say that the insurance industry "is making this last ditch effort to stop reform" as they're "earning these profits and bonuses while enjoying a privileged exception from our antitrust laws, a matter that Congress is rightfully reviewing."
Last week, the Senate Judiciary Committee held hearings in which Senate Majority Leader Harry Reid (D-NV) testified to repeal health insurance and medical malpractice insurance companies' antitrust exemption, which is part of the McCarran Ferguson Act.
When asked about that statement on the ABC show "This Week" on Sunday, David Axelrod, a senior adviser to the president, said that is would be it is Congress's call what to do about the exemption.
"Congress is . . . reviewing that. He (President Obama) said it's appropriate that they review that . . . We'll see what Congress does," Axelrod said. "One of the problems we have is we have a healthcare system now that functions very well for the insurance industry, but not well for the customers."
In the ideal hospital of the future, quality improvement will be hardwired into the culture of the organization. Outcomes data will not only drive macro-level hospital changes, but also individual physician-patient interactions. Quality will extend beyond hospital walls into patient communities and include preventive health improvement and management, rather than only reactive treatment.
But there is a long road to better outcomes and quality for many hospitals, and everyone from employers to physicians to members of Congress is trying to figure out how to fix the flaws in the current system and get more value from the healthcare dollar.
Four healthcare leaders offered a glimpse at how the best hospitals and payers in the industry are making progress on improving outcomes in a panel discussion at HealthLeaders Media 09: The Hospital of the Future Now in Chicago on Friday.
The panelists offered five strategies for improving healthcare outcomes from the bottom up:
1. Make quality permanent. Shortly after being hired, every new staff member—from receptionists to physicians—at Monoroe Carell Jr. Children's Hospital at Vanderbilt goes through a three-day training session that focuses on the importance quality plays in Vanderbilt's overall mission. There is followup on a weekly and monthly basis, and the goal is to instill the importance of quality improvement into new employees from day one, said Kevin B. Churchwell, MD, CEO and executive director for the hospital.
"Quality has to become the foundation on which all all initiatives are built upon," added Jay Srini, chief innovation officer for UPMC Health Plan.
2. Seek the right outcomes. Panelists agreed about the importance of simplifying outcome measurement to avoid overwhelming staff and get at the core of quality improvement. For instance, although an organization may measure multiple indicators related to catheter- or ventilator-acquired infections, the goal for a wide range of measures can be boiled down to improving handwashing rates, said Churchwell. "That's one example of trying to simplify and get at the core measures of what really makes a difference."
St. Joseph Health System boils narrows nearly 300 indicators that are measured in its quality report to about 15 work processes in order to keep improvement achievable. "If we can't design reliable clinical work then the [outcome measurement] experience is moot," said Dan Varga, MD, chief medical officer for the system.
3. Include a broad community. "Know your community," advised Ken Anderson, DO, MS, CPE, chief quality officer for NorthShore University HealthSystem Medical Group. Leaders should focus beyond hospital walls to patient communities and at-risk populations. Quality isn't just about improving outcomes from procedures; it requires managing chronic conditions and improving health through behavior changes, the panelists said.
That can be particularly challenging for facilities with high-risk populations or in rural areas that are difficult to reach. Success requires partnerships with governments, schools, patients, and even other hospitals, said Churchwell. "You can say we're in competition at some level but we're really not. We're all in the business of taking care of patients. That's the most important thing to do and we can collaborate in doing that," he said.
4. Use technology to support, not drive, improvement. Top leadership teams use robots, telemedicine, EHR systems, and other health IT to better track outcomes and improve care coordination. However, they do not let technology become a solution in itself. For instance, decision-support tools can be valuable for physicians if used correctly, but alerts and guidelines can lead to an information overload—and will be ignored—if they are not delivered with thought to genuinely enhancing clinical care.
5. Get ready for integration. True integration extends across multiple stakeholders, including patients and employers, Srini said. New models like medical homes and accountable care organizations show promises, but it's important for leaders to continue innovating and looking for new solutions, panelists said.
Any major transition between one major business or regulatory model and another is inherently disruptive, as the healthcare industry has learned during a healthcare reform process that has gone on for months and has been coming for years. But during disruptive times, leaders are able to see the future world and prepare for it, while trailers fight the changes and ultimately lag behind.
After a day-and-a-half of in-depth panels and discussions about improving outcomes, design, patient experience, culture, and talent in tomorrow's hospitals, the HealthLeaders Media '09: The Hospital of the Future Now concluded in Chicago on Friday with a leadership luncheon that focused on healthcare finances and the uncertain future of reform.
There was little optimism from the panel of CEOs about the final legislation expected to make it out of Congress. Patricia A. Gabow, MD, CEO of Denver Health, saw some positives in reform—including the potential reduction in uninsured patients, who make up 46% of Denver Health's patient population—but was worried that if the reform was insufficient politicians wouldn't have the stomach to continue the process and learn from mistakes.
Peter S. Fine, FACHE, president and CEO of Banner Health in Phoenix, AZ, echoed concerns that the reform process would be incomplete. Fine had recently met with Arizona Senator Jon Kyl, who told him that the current battle was as much about ideology as improving healthcare or health insurance.
The third panelist was Charlie Baker, Jr., former CEO of Harvard Pilgrim Health Care and current gubernatorial candidate in Massachusetts. Although Baker had a first-hand account of similar healthcare reform efforts in Massachusetts, he said the model couldn't be applied to the rest of the United States. "Massachusetts is really different than Colorado, Arizona, and basically all of the other 49 states," he said. What the healthcare industry could expect, he predicted, was a bigger role for the federal government as a researcher, investigator, and regulator in healthcare.
Healthcare has grown up around misaligned incentives, and Congress has so far missed an opportunity to tackle payment reform, panelists said. Baker offered as an example the gap between primary care physicians and some specialists. An hour with a primary care doctor reimburses about $250, but orthopedic surgeons get about $4,000 and cardiologists $5,000 for the same amount of time, he said. Although healthcare reform legislation includes bonuses and payment increases for primary care, none of the bills address the fundamental flaws of the reimbursement system.
Despite reservations about the future of healthcare, panelists are already preparing for the future world and demonstrating that success can come despite difficult challenges. Denver Health and Banner Health both began months ago and invested millions into physical plants to expand capacity, as well as needed IT projects, for instance.
Their recent financial success has given the systems breathing room to prepare for coming changes. Denver Health won this year's Top Leadership Teams award for large hospitals in part because it has used Lean management approaches to become one of most efficient and highly-integrated systems in the country.
Banner Health has also done well using what Fine called a "common sense" management approach and limiting overhead costs to 7% of revenue. "It's really an attitude within the organization: You've got to live within your means," he said.
