Reliant Healthcare Professionals, Inc., which operates FASTAFF Travel Nursing and U.S. Nursing Corp., announced that Patrick Donovan has assumed the role of CEO. Donovan most recently served as President of Linde Healthcare and Kendall & Davis, respectively a locum tenens and permanent physician staffing agency. After founding the company in 1995, he led Linde Healthcare and Kendall & Davis to acquisition by MedFinders, now a Goldman Sachs Urban Investment Group company, in 2005.
Linda Satkoski has been named CEO of Starke Memorial Hospital, effective immediately. Satkoski, who previously was senior vice president of physician relations/patient care services for LaPorte Regional Health System, has been serving as interim CEO at Starke Memorial since July 1. Starke Memorial was recently acquired by LRHS.
Saint Thomas Hospital has named Tara Snow, RN, Director of Emergency Services. Snow has served as the interim director of the Emergency Department since April 2009. Snow has previously served in the Emergency Department as an admissions coordinator, nursing supervisor, manager for nursing resources, IV therapy nurse, nursing supervisor, and patient care services nurse.
Paul Boulis is retiring as president of Blue Cross and Blue Shield of Illinois, the state's largest health plan. Boulis, 59, will step down effective Dec. 31 after 25 years with Illinois Blue Cross, a subsidiary of Chicago-based Health Care Service Corp. He will be replaced by another Illinois Blue Cross veteran, Karen Atwood, 53, senior vice president of the company's national division, which manages more than 350 major national, municipal, and labor accounts. Under Boulis, Illinois Blue Cross grew to more than 7 million health plan subscribers and 30,000 employer groups. Like Atwood, he spent much of his career overseeing the important national accounts business, which is designed to cover employees at large multi-state employers.
Larry Meese has been named permanent CEO of Jackson Hospital. He took over this month and succeeded Richard McConahy, who has served as interim CEO since Jan. 1. Meese most recently served as CEO of Santa Rosa Medical Center in Milton and COO positions at Gadsden, AL, and Mooresville, NC, hospitals. He is a veteran of the United States Army.
There are a lot of things in healthcare that defy common sense. For example, healthcare is one of the few areas where new technology often adds to cost, and where the proverbial pound of cure is rewarded far more than the ounce of prevention.
So, it shouldn't have been a complete surprise to learn that—22 years after Congress passed legislation that would allow for a Healthcare Integrity and Protection Data Bank to document disciplinary problems among more healthcare professionals—hospitals and nursing homes still can't access the data.
According to the consumer group Public Citizen, the legislation that was supposed to allow access to the disciplinary data—Section 1921 of the Social Security Act—was enacted 1987, but HHS has never implemented Section 1921.
Until that happens, more than 5,000 non-federal hospitals and 700 nursing homes cannot access the data bank. In fact, under the law now, if a non-federal hospital or nursing home tried to access the data they'd run afoul of HIPAA laws.
A little perspective is needed here. In 1987, Ronald Reagan was president, Michael Douglas won an Oscar as Gordon Gekko in Wall Street, and The Simpsons made their first TV appearance on The Tracy Ullman Show.
"Many of these workers would not have jobs in the healthcare field if their current employers knew about their checkered pasts," says Sidney Wolfe, MD, director of Public Citizen's Health Research Group. "Keeping these records secret greatly increases the chance that patients will be injured or killed at the hands of their caretakers."
Public Citizen notes that, as of Dec. 31. 2007, the healthcare database listed:
More than 40,000 nurses sanctioned for health care-related violations, including unsafe practice or substandard care (23,551 reports), misconduct or abuse (10,930 reports), fraud/deception/ misrepresentation (3,437 reports), and improper prescribing/dispensing/administering drugs (7,526 reports).
More than 49,000 LPNs and nurse aides sanctioned for healthcare related violations such as unsafe practice or substandard care (16,110 reports), misconduct or abuse (12,197 reports), fraud/deception/misrepresentation (4,247 reports), and improper prescribing/dispensing/administering drugs (4,634 reports).
Apparently, Section 1921 got whisker-close to implementation in October 2008, when HHS submitted a final draft to the Office of Management & Budget. However, the paperwork got lost in the presidential transition. As a result, the regulation will have to start anew through departmental clearance, which could delay access to the data bank until 2010 or beyond.
Of course, President Obama should not be singled out for blame on this issue. We can thank in equal parts Presidents Reagan, Bush XLI, Clinton, and Bush XLIII equally for their bipartisan indifference.
However, Obama is the man now and when he ran for the job last year he promised us "Change We Need." May I respectfully suggest he take up Section 1921—with all haste—and address the change we needed 22 years ago.
While they may look like common, innocuous problems to you, The Joint Commission life safety specialists may take a decidedly stricter view.
Corridor clutter, damaged fire-rated doors, and unsealed penetrations in rated barriers are three pieces of low-hanging fruit that life safety specialists will target—so it's worth educating all of your staff members to be on the lookout for these problems. The risk is real: In 2008, two fire-safety-related requirements made The Joint Commission's top 10 list of cited standards in accredited hospitals.
Remember, life safety specialists generally have backgrounds as facilities directors in hospitals, so they are attuned to this trio of fire protection problems:
Items that obstruct egress corridors: Most wheeled carts and equipment cannot remain parked in a corridor unless a staff member is actively using the item. For example, an environmental services worker can leave a housekeeping cart outside a patient room while he or she services the room.
"If a corridor looks cluttered, it probably is," said George Mills, FASHE, CHFM, CEM, senior engineer at The Joint Commission, who spoke at the American Society for Healthcare Engineering's annual conference in Anaheim, CA, this month.
Wheeled items in use by staff members can be left unattended in egress corridors for up to 30 minutes. Items left unattended, such as a dietary cart parked on the side of a corridor overnight, could result in citations.
Two important exceptions to note, as explained by Mills:
Crash carts can always remain in corridors so that staff members can quickly get to them in an emergency, with the understanding that if an alarm goes off or an evacuation is necessary, someone must move the crash carts out of the corridors
Infection control isolation carts can remain in corridors indefinitely as long as they are outside an active isolation patient's room (an important point to remember with pandemic flu planning)
Fire-rated doors with visible damage: It's not hard for a fire-rated door to get dented or knocked out of alignment by gurneys and other equipment hitting them each day.
However, even minor damage to these doors could void their technical rating, which then calls into question the doors' effectiveness at protecting people.
The whole door assembly (i.e., door and frame) is designed specifically to resist fire, safety consultant Steven MacArthur recently wrote on his blog, Mac's Safety Space. MacArthur works for The Greeley Company, a division of HCPro, Inc., in Marblehead, MA.
"If there's anything at all deficient about the door, you can't be assured it will do what it needs to in the event of a fire, which is to provide a sufficient barrier between flames and occupants," he wrote.
Improperly sealed penetrations poking through barriers: Outside contractors and in-house IT teams are constantly running pipes, ducts, and cables through rated smoke and fire barriers. Those holes should be sealed with an approved firestopping product, but that doesn't always happen, Mills said.
He has been warning hospital safety professionals to keep an eye out for penetration problems. These deficiencies not only risk the safety of patients, visitors, and employees during a fire, but also raise the issue of whether hospital leaders are aware of the work being done to their buildings' fire protection features, Mills said.
Okay, there was some deception in that headline. Parkland Health & Hospital System in Dallas is indeed the only AAA-rated hospital in the country, according to CFO John Dragovits, but he says the hospital owes much of this designation to the underlying credit worthiness and credit standing of Dallas County, as well as to the hospitals' strong operating performance.
Dallas County has been AAA rated for 30 years. The hospital, however, had to fight for its AAA rating from both Fitch Ratings and Standard & Poor's. Rating agencies have historically discounted hospital districts by a notch or so because they have the word hospital in their name, says Dragovits.
"The argument is we should have at least the same credit standing as Dallas County since they are the same tax base and the underlying support for the hospital district is the county," he says. "The real story was the fact that we were able to make strong cases to the rating agencies that that was actually the case."
Well, we all like a success story in these tough economic times and attaining a AAA rating is only part of Parkland's recent good news. With many public hospitals facing serious financial challenges, Parkland with 685-beds has been preparing over the last two years for a $1.27 billion construction project, which includes a 862-bed replacement hospital, an outpatient center, office center and parking.
The hospital project has not been without its challenges, though. Leaders have had to contend with gaining tax payer approval for the project during the collapse of the capital markets—a time when states and counties are broke and most hospitals are stalling capital projects. On top of that, leaders faced the prospect of higher than expected interest rates.
So how is a public hospital able to pull off such a feat? Dragovits says it has a lot to do with the Dallas spirit. "Dallas likes winners, and they like winners in everything." To that end, the community has rallied around its safety-net hospital. In November 2008, Dallas County voters approved $705 million general obligation bonds to help pay for the new hospital and agreed to increase property taxes up to 2 ½ cents per $100 of taxable value to pay for the debt service on the bonds. The vote passed by an overwhelming 82%.
Dragovits says $680 million of the $705 million will be in bonds issued through the Build America Bonds federal program, which came about as a result of the American Recovery and Reinvestment Act that President Barack Obama signed into law earlier this year. Under BAB, the federal government will subsidize 35% of the interest payment. "These bonds are taxable bonds and will have higher interest rates," says Dragovits. "The federal government subsidizes us for the difference." Dragovits estimates that the hospital will save $60 million to $80 million over the life of the bond.
The cost of borrowing under the BAB—less than 4%—is significantly less than what was originally projected even back when the credit markets were great, says Dragovits. "There was a time we targeted around 4.5% back in the good old days when the market went well and money was free." Once the markets froze and interest rates spiked, he says the hospital was looking at 5% to 6% in interest.
Because the project is in its early stages, Dragovits says that he has essentially been waiting to see if anything moved in the market or the government. "Well two things happened: The government came along with Build America Bonds and the markets have opened up, so the combination of both and the fact that we were successful in being highly rated has given us the opportunity to potentially save tax payers a couple million dollars a year in interest costs."
Now onto the hard part: building a new facility. Construction is due to start in early 2011.
A new study is generating talk about the value of hospitalists and what they actually do for quality. Hospitalists, or hospital physicians dedicated to inpatient care, serve clinical positions, and oftentimes administrative, teaching, and leadership roles. Researchers at Massachusetts General Hospital, Brigham and Women's Hospital, and Harvard University in Boston found that hospitals with hospitalists performed better than hospitals without.
"We now know for sure that, nationally, hospitals with hospitalists show better quality scores," said lead author Lenny Lopez, MD, MPH, hospitalist at Brigham and Women's Hospital, instructor at Harvard Medical School, and assistant in health policy at the Massachusetts General Hospital Institute for Health Policy.
Study details
The study, "Hospitalists and the Quality of Care in Hospitals," published in the August issue of Archives of Internal Medicine, looked at more than 3,600 hospitals in the country. It linked national measures from the Hospital Quality Alliance, under the Centers for Medicaid and Medicare Services, with data from the American Hospital Association, regarding three quality indicators: acute myocardial infarction, congestive heart failure, and pneumonia.
What researchers found was promising. Institutions that utilized hospitalists scored higher in two of the three quality markers: acute myocardial infarction and pneumonia, although there was no difference in congestive heart failure cases. Why?
Study authors believe that hospitalists link to quality but admit there may be other things inside the hospital at play.
"There are other things that contribute to high hospital scores," said Lopez about nurse staff ratios and health information technology. "Hospitalists are one of a series of things that improve overall quality; they are definitely a contributing factor," he said.
The legacy of hospital medicine
Proving the value of hospitalists has been a question since the inception of hospital medicine in 1996 when the word "hospitalist" was first coined: Do hospitalists improve care? Do they help the bottom line?
With more than 20,000 hospitalists in the U.S., according to the Society of Hospital Medicine, this practice is the fastest growing specialty in the nation. But it isn't always the most lucrative. These types of hospitals with hospitalists tend to be nonprofit, large, teaching facilities in southern states, according to the study, and often cater to non-procedure-based practice that includes the uninsured and underinsured population.
Previous studies have shown that hospitalists do, in fact, shorten patient length of stay, adhere to treatment guidelines, and give better follow up care. But are they really the ones to improve quality of care?
Yes, if they are good hospitalists, according to Robert Centor, MD, associate dean for the Huntsville Regional Medical Campus of the University of Alabama, School of Medicine, in Birmingham.
Hospitalists have been traditionally known for their consistency of care because they "live" in the hospital with varying work schedules and staffing levels.
"With their experience, they understand how the system runs, improve length of stay, improve revenue, and understand day-to-day operations," said Centor.
The good, the bad, and the average
Centor, editorial commenter on the study, would like to see what elements of hospitalist program structure make it successful.
"Forward-thinking hospitals have good hospitalist programs, but there is a difference between good and mediocre hospitals," said Centor. "If you hire people to look after patients but aren't involved in the processes or systems, then you don't have a hospitalist program, you have a bunch of hospitalists," he said.
Hospitalists worth the dollars?
In the end, many hospital administrators wonder if implementing a new or pursuing an existing hospitalist program will benefit the overall hospital.
"Hospitals that invest in hospitalists contribute to high quality," said Lopez. "The C-suite may need to supplement their clinical revenue [from other procedure based specialties], which translates into better quality care, which translates to better scores and higher rankings . . . that is a worthwhile investment," he said.
Centor adds, "It's an investment that pays off, but it is an investment."
Rapidly rising healthcare costs, which are taking up greater portions of the gross domestic product (GDP), are having an adverse effect on many major industries—especially those that have higher percentages of workers with employer-sponsored insurance, according to a new study from Rand.
For example, between 1987 to 2005, when healthcare costs rose rapidly from 10.8% to 15.2% of the GDP, the workforces in industries with larger percentages of workers with employer-sponsored insurance grew more slowly, said Neeraj Sood, a RAND senior economist, and one of the study authors, in a presentation on Capitol Hill. The study looked at 38 different industries.
For instance, in the utilities industry, in which about 84% of workers have employer-sponsored insurance, the workforce shrank by 2.8%. On the other hand, the workforce in the construction industry, with only about 43% of workers having employer-sponsored insurance, was up about 2.1% annually; and in the hotel industry, in which 54% of workers have health insurance, the workforce grew 1%.
Sood and his colleagues compared American industries with their Canadian counterparts to rule out possibilities that the economic effects were the result of industry wide factors—rather than the effect of employer-sponsored insurance and rising healthcare costs.
Since Canada has universal healthcare that is publicly financed, growth trends in its industries cannot be influenced by employer-sponsored insurance, Sood said. What they found was that "in Canada there is no relationship," which suggests that excess growth in healthcare costs can have adverse economic effects. These effects are more evident in industries with a higher percentage of workers with employer-sponsored insurance, said Sood.
Overall, when all 38 industries were examined, a 10% increase in excess healthcare cost growth was expected to result in about 120,800 fewer jobs, $28 billion in lost revenues, and about $14 billion in lost value added, Sood noted. These effects, though, might be slowed down by workers moving to other industries—albeit industries with lower percentages of workers with employer-sponsored insurance.
Sood said he couldn't predict the effect on healthcare reform related to these trends. However, the findings do "show a need for healthcare reform," Sood said. "This establishes that the status quo is hurting the economic performance of industry. And given the economy we have now, the impetus for healthcare reform is even larger."
