St. David's Medical Center has named Susan E. Griffin as CNO. Griffin, formerly CNO of Memorial Hermann The Woodlands Hospital—a part of the Memorial Hermann Healthcare System in Houston—has more than 15 years of experience in the CNO role and more than 31 years of experience in nursing.
Trinity Health has named Paul G. Neumann general counsel and senior vice president. Most recently, Neumann served as general counsel of Catholic Health Initiatives. With Neumann's arrival on Nov. 2, Daniel Hale, who has served as Trinity Health's legal counsel for the past 13 years, will transition to executive vice president of Trinity Health's Institute for Health and Community Benefit focusing on community programs and chronic health issues.
Annie Holt has been named president/CEO of Alaska Regional Hospital, effective Oct. 13. Holt has 30 years of hospital administration experience, most recently as the vice president of the Quality and Service Line Department for HCA Mountain Division, the parent company of Alaska Regional. Her previous positions include COO/CCO at St. Mark's Hospital in Salt Lake City, CEO at Indianapolis Women's Hospital, and CEO at Methodist Children's Hospital and Women's Services in San Antonio, TX. She succeeds Ed Lamb, who resigned last month after 10 years with Alaska Regional to become CEO of an HCA hospital in Corpus Christi, TX.
In this commentary published on MSNBC.com, medical ethicist Arthur Caplan says doctors, nurses, respiratory therapists, nurses' aides, and anyone else who has regular contact with patients should be required to get a flu shot or "find another line of work." Getting a flu shot is "the least those who claim to be bound by professional ethics ought to do," Caplan adds.
David Letterman apologized on the air October 5 to his wife, Regina, for his revelation of his sexual relationships with staff members, saying she had been "horribly hurt" and adding, "I've got my work cut out for me" to mend the relationship. Letterman made the remarks at the start of the taping of his show on CBS. They were his first public comments since he revealed details of an alleged extortion attempt tied to sexual relationships with his staff members. These details were also revealed on air.
In the past few months, the term "bending the curve" has taken on a new urgency in determining if healthcare reform legislation can be passed that slows—and readjusts downward—healthcare costs.
In late summer a group of 10 national health policy experts convened by the Engelberg Center for Health Care Reform at Brookings, with support from the Robert Wood Johnson Foundation, developed a report on "Bending the Curve." It looked at ways to hold spending while "transitioning to a system of greater accountability" provides greater flexibility for private and public stakeholders.
Using this as a support, they have reviewed the legislation introduced by Senate Finance Committee Chairman Max Baucus (D-MT), which will be voted on by full committee on Tuesday. The experts looked at a side by side summary of key provisions of the report to see if the Baucus proposal does bend the curve.
They found that the Senate Finance proposal does offer provisions found in the report that could offer opportunities for slowing long term spending growth by:
Creating an independent entity (a patient centered outcomes research institute) to allocate comparative effectiveness research funding.
Increasing payment rates for primary care physicians.
Establishing several steps to increasingly link provider reimbursement to quality and efficiency, including by establishing accountable care organizations (ACOs).
Expanding and streamlining Centers for Medicare and Medicaid Services (CMS) piloting authority and resources to support the testing, evaluation, and expansion or modification of new payment models in Medicare and Medicaid, such as patient centered medical homes.
Moving to a Medicare Advantage competitive bidding system.
Establishing an individual insurance requirement, insurance exchanges, rating regulations, and sliding scale subsidies to ensure that insurers compete on price and quality, and help consumers make better health plan decisions.
Reducing tax expenditures on high cost health plans by imposing an excise tax on insurers if the value of health coverage exceeds a certain capped amount.
Several current gaps in the proposal should be addressed, they suggested, to "effectively bend the cost curve." They include:
Using new payment reforms that would "apply significant reimbursement pressure? on providers in certain regions experiencing high spending growth—such as freezing or slowing marketbasket updates for providers in high growth regions that choose not to participate in available accountable payment systems such as ACOs, medical homes, or other reforms.
Instituting medical liability reforms providing greater liability protections for healthcare providers and insurers.
They also indentified a where modifications could strengthen the bill by:
Ensuring that all payment reforms are on a path to ?fostering greater accountability? for overall cost and quality by linking bonuses to, for instance, health outcomes and patient experience.
Expanding the scope of a new Medicare commission to include Medicaid, while permitting proposals other than those related to provider reimbursements.
Ensuring "meaningful, person level measures" of cost and quality are piloted and identifying whether payment and delivery system reform pilots are actually achieving their purpose.
Providing greater institutional support at CMS and Health and Human Services to support increasing needs for data and other systems related demands.
Based on new research, total national healthcare spending could drop by about 0.5%—or $11 billion—if tort reform was enacted by 2010, according to the Congressional Budget Office (CBO).
In response to a query from Sen. Orrin Hatch (R-UT), a member of the Senate Finance Committee, CBO said in a letter from CBO Director Douglas Elmendorf that tort reform could affect costs for healthcare both directly (by 0.2%) through lowering premiums for medical liability insurance, and indirectly (by 0.3%) by reducing the use of diagnostic tests and other healthcare services when providers recommend those services specifically to reduce their potential exposure to lawsuits.
Enactment of a tort reform package also could reduce mandatory spending for Medicare, Medicaid, the Children's Health Insurance Program, and the Federal Employees Health Benefits program by an estimated $41 billion over the next 10 years, CBO said.
That figure includes a larger rate of decline in Medicare's spending than many other private sector programs because the bulk of Medicare's spending has been on a fee for service basis—rather than managed care basis. Managed care plans are more likely to limit the use of services that have marginal or no benefit to patients, and less likely to encourage greater use of defensive medical practices. In the long run, this can control costs and keep premiums lower, CBO said.
Since much of the private sector healthcare is provided through employment based insurance—which is nontaxable compensation—lower costs for healthcare arising from those proposals addressing tort reform could lead to higher taxable wages. This could mean an increase in federal tax revenues by an estimated $13 billion during the next decade, according to estimates from the staff of the Joint Committee on Taxation. In the long run, federal budget deficits by could decrease by a total of $54 billion over the next 10 years.
The CBO estimate already takes into account the fact that many states already have implemented some of the changes in the package, a "significant fraction of the potential cost savings" that has already been realized, CBO said.
The impact on health outcomes is less clear cut, according to CBO. For instance, some recent research has found that tort reform may adversely affect outcomes, but other studies have concluded that "tort reform generated no significant adverse outcomes for patients' health."
The 206 people who received "significant" overdoses of radiation eight times above expected levels were undergoing CT scans for detection of stroke at Cedars -Sinai Medical Center in Los Angeles, federal and hospital officials confirmed on Friday.
The incidents, which may have occurred over an 18-month period starting in February 2008, is under investigation by California public health officials and the U.S. Food and Drug Administration.
The multi-slice CT scanner involved was manufactured by GE Health Care, said Mary Long, spokewoman for the FDA. "We are evaluating information to determine if this is a more widespread problem with CT protocols and not limited to one facility or scan," she said. The FDA wants hospitals that may have had similar problems with such scans to file a voluntary report to the agency's Medwatch Web site.
"We are collecting information from the manufacturer and the facility relating to both the equipment and its use," she added.
Sandy Van, spokesman for Cedars-Sinai, said the problem was noticed in August 2009, "when a patient who had previously received a scan contacted the medical center after noticing temporary patchy hair loss.
"Since this is not a common side-effect from CT brain perfusion scans, Cedars- Sinai immediately began an investigation of the equipment involved and the protocols used for CT brain perfusion scans," Van said in a statement. "No additional CT brain perfusion scans were done until the investigation was completed."
Van did not answer a question about how many patients had experienced symptoms linked with radiation overdose, but according to a Los Angeles Times article on Saturday, a hospital spokesman said about 40% of the patients lost patches of hair as a result of the overdoses. It is unclear why the problem with the scans was not recognized until August.
GE Healthcare said in a statement "there were no malfunctions or defects in any of the GE Healthcare equipment involved in the incident."
They emphasized that "patients and families should continue to have confidence in their doctor's recommendation for a CT scan."
Also, the company said GE "continues to offer dose-reducing technologies and expand key CT training initiatives to raise awareness of dose optimization and use of appropriate exam protocols.
"GE Healthcare CT products require that: 1) users carefully evaluate user-defined scanning protocols against the validated protocols that are provided on the scanners during installation, 2) like dose recommendations for drugs, the recommended dose for a prescribed medical imaging scan is an important clinical decision that should be made by a licensed professional in the context of healthcare delivery."
The investigation revealed that some scans "were delivering a higher dose of radiation than anticipated, which could cause temporary hair-loss or skin-reddening in some patients," Van said.
Additional double-checks and equipment protocols have been instituted "to ensure that this does not happen again."
Van said that although the hair loss or skin reddening would have occurred within six weeks of the scans, the hospital contacted 206 patients who had a scan between February 2008 and August 2009 in the interest of keeping those patients informed.
The problem also was reported to the California Department of Public Health as an unusual event.
The FDA said in an initial notice about the patient over-exposure that "instead of receiving the expected dose of .5 Gy (maximum) to the head, these patients received 3-4 Gy (a unit of absorbed radiation dose due to ionizing radiation).
"In some cases, this excessive dose resulted in hair loss and erythema (redness of skin). The facility has notified all patients who received the overexposure and provided resources for additional information," the agency said.
The FDA's Long emphasized that the FDA wants every facility that performs CT imaging to review its protocols "and be aware of the dose indices normally displayed on the control panel. These indices include the volume computed tomography dose index (abbreviated CTDI in units of "milligray" or "mGy") and the dose-length product (DLP, in units of milligray-centimeter" or "mGy-cm").
The warning continued to say that for each protocol selected and before scanning each patient, "carefully monitor the dose indices displayed on the control panel. To prevent accidental overexposure, make sure that the values displayed reasonably correspond to the doses normally associated with the protocol. Confirm this again after the patient has been scanned."
Cedars-Sinai officials also were not able to say what level of multi-slice machine or machines were linked to the overdoses. It also is unclear whether the patients are at increased risk of cancer or other medical problems months or years later.
They also did not explain whether the malfunction was caused by the protocol or the machinery itself. Cedars-Sinai officials did not say whether the patients are undergoing any follow-up care or whether they have received any compensation for any harm or risk of harm they may endure.
Cedars-Sinai is certified by the Joint Commission as a primary stroke center. It is listed as one of the U.S. News and World Report's best hospitals in 11 categories, including neurology and neurosurgery.
"This year's winners represent the best of what is possible in improving the safety and quality of healthcare," says Janet Corrigan, PhD, MBA, president and CEO of the National Quality Forum. "They are at the forefront of their fields and have taken risks to improve healthcare by addressing the way care is delivered. They have carried on John Eisenberg's commitment to safety and quality and have truly improved healthcare.
For the first time, the 2009 award contained an international category, and the winner this year, Noreen Zafar, MD, FRCOG, from Pakistan, works to promote gynecological wellness in women.
Other winners included:
Gary S. Kaplan, MD, Virginia Mason Medical Center, Seattle, for using the Toyota Production System model to put patients first. He created the Virginia Mason Production System as a means of doing so.
Tejal Gandhi, MD, Brigham and Women's Hospital, Boston, for increasing awareness of patient safety issues in the outpatient setting.
Michigan Health & Hospital Association (MHA) Keystone Center for Patient Safety & Quality, Lansing, MI, for implementing two successful programs that prevent central line-associated bloodstream infections and promote comprehensive unit based safety programs.
Mercy Hospital Anderson, Cincinnati, OH, for implementing an automated modified early warning system which scores patients' vital signs.
The award is given each year in honor of Eisenberg, who was former administrator of the Agency for Healthcare Research and Quality (AHRQ) and one of the founders of the NQF.
"The Eisenberg Award shines a spotlight on the frontline work that is occurring worldwide to improve healthcare quality by making a difference in patient safety," says Mark R. Chassin, MD, MPP, MPH, president of The Joint Commission. "These innovations and public commitments to safe, reliable care serve as an example for what can be achieved."
The 2009 awards will be presented next week at the National Quality Forum's Annual National Policy Conference on Quality, which is taking place from October 14-16 in Washington, DC.
The insurance industry plans to strike out against President Obama's healthcare overhaul effort with a report warning that the typical family premium in 2019 could cost $4,000 more than projected. Industry officials said they intend to circulate the report prepared by PricewaterhouseCoopers on Capitol Hill and promote it in new advertisements. Administration officials questioned the timing and authorship of the report, which was paid for by America's Health Insurance Plans, reports the Washington Post.
