Physician Hospitals of America is criticizing U.S. hospital associations for agreeing with the Obama administration to cut $155 billion in Medicare hospital spending and asking in return for payment rates in a public option to be higher than Medicare levels. The PHA calls the agreement "a desperate move aimed at reducing competition, garnering control of the entire industry, and eliminating patient choice," and that the associations "have bargained for the destruction of physician owned hospitals as a quid pro quo for the Medicare cost savings."
A Seattle primary care clinic that has cut insurers out of the equation just received $4 million in venture capital to expand. The physicians charge patients a $99 fee to join, and then a monthly rate of $39 to $119, depending on age and level of service. Patients aren't denied service for pre-existing conditions and get round-the-clock access to appointments.
As healthcare organizations continue to struggle with on-call compensation issues, hospitals, like physicians, are starting to push back.
Sixty-two percent of healthcare providers receive some form of additional compensation for on-call coverage—most as per diem or at an hourly rate—according to MGMA’s inaugural Medical Directorship/On-Call Compensation Survey Report.
But on-call compensation remains an area of contention.
Some hospitals are initiating new call programs with limited or capped budgets to manage call compensation, says Debbie Huber, MBA, vice president of sales and client services at EA Health Corp. in Solana Beach, CA.
In response, practices are demanding that hospitals demonstrate that limits are necessary, Huber says.
To successfully negotiate caps or reductions, hospitals may need to quantify call burden, Huber says. Factors may include:
Manpower available to take call
On-call frequency
Call-in frequency
Intensity and acuity of patients seen
Duration of services provided
Physicians’ liability exposure for the provision of on-call services
Since the call burden may differ across specialties, hospitals may need a mechanism to fairly align compensation based on the true burden of on-call services, Huber says.
Peg. L. Stone, a compensation consultant at Atlanta-based PLS Professional Associates, LLC, sees a growing need to defend on-call payments. "Hospitals and physicians need to document the reasonableness of any on-call payments and make sure they hold the test of being within a fair market value for the services," says Stone.
Questions to explore when considering such payments include:
Does the hospital have problems covering the on-call periods for the specialty?
Could the compensation be considered a double payment for physician services?
Is the compensation an incentive for the physician to refer patients to the hospital?
What is the likelihood that the physician will be called in during the on-call period?
What is the percentage of uncompensated care that the physician will be providing during the on-call period?
This article was adapted from one that originally ran in the July 2009 issue of Physician Compensation & Recruitment, a HealthLeaders Media publication.
The challenges associated with today's complex medical environment are well known and widely discussed—declining reimbursements, increasing uncompensated care, additional government intervention, and a troubled economy all require a tremendous amount of focus from the individuals in the C-level of any healthcare entity. All too often the demands required in these areas distract administrators from perhaps the most critical issue facing healthcare over the next 10 years—retention.
The shortages in the physician marketplace have been debated for some time, but ask any CEO who is recruiting internal medicine, neurology, or otolaryngology if there are shortages in these specialties and the resounding answer is yes. In 2010, there are a total of 210 physicians transitioning from training in otolaryngology to the full time practice of medicine. With over 5,700 hospitals in operation nationwide, (90+% of which are actively recruiting) the magnitude of the problem becomes clear. As a national physician placement firm that conducts well over 750 assignments annually, it seems clear to us that a comprehensive, well thought out retention plan will be critical for all facilities wishing to succeed in the future.
In 2008, Delta Physician Placement accepted a consulting assignment with a hospital system located throughout the Midwest to review and evaluate both their recruitment model and their retention plan for existing physicians on staff.
Of the hospitals surveyed, every facility indicated that their retention practices lacked structure, focus, and content. In fact, most of the facilities surveyed did not have a formalized retention plan on paper that was communicated across all organizational levels. This is not meant to convey that it wasn't an issue of importance for the system; instead it was not given the level of priority tasking necessary in today's environment.
Following completion of the consulting assignment, several key points were outlined as being critical in establishing a successful retention program:
A Formalized O3. (One on One) This process should be implemented during the first year of service. These sessions should take place at the 30, 60, 90, 180, and 365 day marks. It is important to note that these are not intended to be performance reviews. Instead, these are meetings designed to "check the pulse" of the physician and gain an understanding of the good, the bad, and the ugly from his or her point of view. The keys to good 03 sessions are simple: they are regularly scheduled; never missed; the primary focus is on the new physician; and careful, complete note taking and follow up is essential. By approaching the one-on-one process in this manner, facilities will see greater engagement and more collaboration from their new hires.
On Board for Success. Define and document a formalized on-boarding process for new physicians. Set them up for success from the beginning and you will be rewarded with a long-term provider. Successful facilities recognize that not one person can oversee the recruitment and liaison functions. This liaison function oversees both the physician's integration into the medical community and makes certain that the spouse and children are integrating into the community as well.
Don't Forget the Better Half. Formalized O3 meetings with the spouse/partner of the physician are also critical. While these do not need to occur with the same regularity as the physician, they should still be implemented at three month intervals over the first year of service.
The Pursuit of Happiness. Recognize that a positive, energized staff leads to the same sense of purpose within your physician structure. It is critical that facilities not kid themselves. Medicine is full of unique and different challenges that cannot always be foreseen. The energy created through growth and development of the staff is transferrable and can mean the world to a physician when times are tough.
Clean your own House. Hospital administration must be aware and understand the pressures physicians face. Reducing that pressure through effective supply management, IT support, and custodial services can make a huge impact in influencing retention.
Open Forums Work. A well marketed, inviting and open forum for physicians can foster an environment of trust. It is critical that administrators "close the loop" on feedback and ideas. Failure to do so will dramatically reduce trust and can be detrimental to the long term prospects for a physician. A very consistent comment made by physicians to recruiters is that their current hospital "just doesn't listen." Are you listening?
Generational Issues Matter. The perspective and reality of a Generation X physician varies wildly from those of a "Millennial" or those of a Baby Boomer physician. Understanding what is important to each generation can absolutely make the difference in a physician deciding to stay or leave a community.
Learn when they do Leave. All facilities will have providers who leave even under the best of circumstances. The very best organizations strive to learn something from each and every event. Exit interviews can give a facility unique insight into the mind of a physician.
Invite them Back. Just because a provider leaves your facility does not mean he or she cannot remain a member of the family. Thorough follow up with past members of your staff can give your facility both a leg up on securing a physician's return or a unique advantage in securing other providers who are close with your former employee. Does your facility have an alumni program? Do you invite them back for special events, holiday parties, etc.? These types of activities will create influencers and word of mouth advertising that is invaluable in today's market.
"We get far superior cooperation with kindness and communication," said one administrator in the St. Louis metropolitan area. "I'll ask my doctors what is lacking in our system that prevents them from getting their job done. You can change the relationship, but you do it with actions, not words."
It is easy for a facility to become fixated on short term issues or results, but a long term view needs to be a critical part of a facility's focus. Recognition at the national level that the shortages are real and legislation designed to improve physician supply seem to be imminent, but the length of time that these solutions will take to implement presents a challenge not easily surmountable. Those facilities with clearly defined goals and objectives in the arena of retention will consistently excel in physician relations, have greater buy-in for key initiatives (i.e., quality, pay for performance) and outperform peers who don't take the same steps.
Andy Guenther is a recruiting team lead with Delta Physician Placement, the full-service physician search firm of The Delta Companies, and is a member of The Delta Companies Thought Leadership Council.
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The reimbursement redistribution from specialists to primary care physicians that has been a long time coming may have begun last week when CMS announced what amounts to a nearly 8% reimbursement increase for primary care and a double-digit decrease for some specialties.
But read just a little bit of the 1128-page proposed rule for the 2010 Medicare Physician Fee Schedule and you'll start to get an idea of just how convoluted and arbitrary the current physician reimbursement system can be.
The cuts aren't coming from most of the procedures specialists perform. The real target is imaging.
CMS is proposing to adjust the practice expense relative value units (PE RVUs), which provide reimbursement for the building space, equipment, and office supplies that are used for physician services.
Physicians who own imaging equipment receive payment via PE RVUs to offset some of their investment and maintenance costs. However, CMS thinks it has been overpaying physicians by underestimating how often physicians really use the equipment.
The current reimbursement formula assumes a 50% utilization rate—25 hours out of a 50 hour work week. However, a MedPAC study in 2006 found that MRI and CT machines are used at nearly twice that rate, meaning CMS has been paying too much (more usage means less need for a subsidy).
CMS has suspected this for some time but has admitted that there wasn't empirical evidence to justify another utilization rate. Essentially, the 50% estimate was a shot in the dark. Now, CMS wants to increase the estimate to 90% for all equipment over $1 million, which will reduce practice expense payments. But again there is little empirical evidence.
The MedPAC estimates were based on a survey of imaging providers in six markets that were not nationally representative, plus a survey of CT providers. Specialists that are lobbying against the change can use that shaky evidence to poke holes in CMS' estimates.
If you're a specialist who may lose reimbursement from this change, consider that piece of ammo a gift, because you may not like what I have to say next.
Although most physicians are in favor of increasing primary care reimbursement as long as it doesn't come from specialists' piece of the pie, that mutually beneficial outcome doesn't seem possible in an environment where costs are such a major concern. So this rebalancing of reimbursement is the best option and a necessary step in the right direction.
Most of the specialties hit hardest by this—cardiology, radiology, nuclear medicine, radiation oncology—already make over $400,000 at the median levels of MGMA's compensation surveys (for a full list of specialty reimbursement changes, see p. 716 of the fee schedule proposal). Primary care is still under $200,000, so this change will by no means close the payment gap.
I don't mean to dismiss the concerns of a cardiologist or radiologist looking at a potential 11% drop in reimbursement. I may not be making friends here, but I am trying to look at it from the perspective of what's best for the larger health system, and this change addresses two of its more significant problems—the lack of primary care physicians and the overutilization of imaging services.
And it's not that specialists' work is suddenly no longer valued. Most of the reimbursement for actual clinical work remains unchanged; it's just the subsidy for equipment expenses that took a hit. And you could argue they were being overpaid in the first place.
CMS' methodology could have been better and it would be nice to have some empirical evidence to show that CMS isn't now overestimating equipment utilization. But as the agency says in the proposed rule, it's hard to believe so many physicians would be making capital investments in expensive equipment that they only use 50% of the time.
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It's hard to tell who's cheating, who's lying, or who kicked whom out of the house first.
But the partnership between the American Medical Association and Sermo, the online physician social-networking site, is now in tatters, with such nasty invective it now seems way past divorce. Unseemly though it may seem, all-out war with the House of Medicine has now been declared.
The rancor surfaced July 1 when Sermo founder Daniel Palestrant, MD, posted a letter to the Sermo blog headlined "The Biggest Risk to US Physicians: The AMA."
Palestrant accused the AMA of lying to cover up a precipitous decline in its membership, having business conflicts of interest and cozy relationships with health insurers "while profiting from a reimbursement system (the CPT codes) that makes it increasingly difficult for physicians to practice medicine."
All this came just a few weeks after the AMA opposed backing a public plan option, which many Sermo members strongly support.
Now, the relationship between them, in which the AMA was allowed to use Sermo to access physicians' online dialogue and "and deliver that message to the powers that be" for a health reform agenda, Palestrant says, is definitely over.
As unlikely as it may seem, Sermo is a more likely choice to replace the AMA as the legitimate voice of America's doctors, he says.
Yesterday, Palestrant topped his July 1 posting by releasing results of a Sermo member survey showing the extent of the forum's dissatisfaction with the AMA.
The survey revealed that 54% of physicians responded that they were unaware the AMA owns, maintains, and profits from sales of the complex compendium of CPT (Current Procedural Terminology) codes, which have been in use for 43 years. Doctors use the codes as a kind of universal language to categorize the value and type of their care in order to bill payers, from insurance companies to the government, in order to be appropriately paid. The 2009 edition is available on Amazon for under $90.
Palestrant accuses the AMA of receiving "approximately $70 million in 'licensing fees' from anyone who needs to use those codes. Add to that insurance companies (who pay the AMA many of those millions) who can use the CPT coding system to further their own gains at the expense of the physicians, and it starts to make you realize why CPT codes have been so conveniently left out of the current debate."
"Do you think that it is right that the AMA makes more money from selling licensing for CPT codes than it does from membership dues?" his survey asked. 87% percent of 661 doctors answering said, "No."
In his posting yesterday, entitled "Why physicians always get screwed, Thanks AMA," Palestrant wrote, "Not only do we have to maintain an extraordinary overhead of staff to submit, resubmit and document around CPT codes, the system robs the physician of any leverage we have with payors."
The AMA yesterday was just starting to recover from the broadside. Last night, it sent a six-paragraph e-mail response from AMA board chair Rebecca J. Patchin, MD, which did not mention Sermo. It read in part:
"The AMA takes great pride in the precision and uniformity of CPT and invests millions of dollars annually to revise and maintain codes that reflect the ever-changing realities of medical practice.
"The AMA alone foots the bill. While these expenses are recouped and profits are gained from the sale and licensure of CPT products and information, the AMA uses this income to tackle a sizable agenda on behalf of America's patients and physicians – initiatives such as health insurance coverage for all Americans, Medicare payment reform, relief from unfair managed care business practices and championing important public health issues, to name just a few," she said.
Two years ago, when the relationship began, it was forged as a kind of trade. The AMA News ran ads for Sermo to recruit participants. In exchange Sermo let the AMA access the physicians' online conversation to get feedback from the front lines of medicine, for use in shaping legislative or organizational policies.
Yesterday, the AMA said its board member, Joseph M. Heyman, MD, posted this statement in response to Palestrant's on Sermo July 1.
"We need to set the record straight on the information in Dr. Palestrant's post. The truth is that AMA membership numbers are public information, and there has been no precipitous decline in AMA membership over the last two years, as Dr. Palestrant suggests," Heyman wrote. "With about a quarter million members, the AMA is the largest physician organization in the country, and through the AMA House of Delegates, comprised of elected physician and medical student representatives from all state and national medical specialty societies, it is the only physician organization that gives all physicians a voice in the future of medicine."
"Twice a year the AMA House of Delegates meets to debate and vote on in public the most important policy matters facing medicine today. Last month, for example, the AMA House of Delegates met to vote on key elements of health system reform. It was a vigorous debate that ended with the following declaration of commitment: AMA supports health system reform alternatives consistent with principles of pluralism, freedom of choice, freedom of practice and universal access for patients.
"At that same meeting, President Obama chose to give his major health reform speech to AMA physicians. Not only has President Obama shown that AMA physicians are integral to the health reform process, but a recent Kaiser Family Foundation poll shows that the American people trust physician groups like the AMA to do the right thing on health reform as well."
Heyman said in his post that AMA advocacy is "well documented and unfailing. We are actively engaged to permanently fix the broken Medicare physician payment system and have a big victory on that this week," and continue to work on antitrust, medical liability reforms, a streamlined insurance claims system, and so much more. "As for relationships with insurers, we continue our high-profile fight against insurer abuses that hurt physicians and patients."
"As for Dr. Palestrant's sudden 'change of heart' regarding the AMA, one can only speculate. He ardently courted the AMA when launching his business two years ago, and now he expresses scorn immediately following the end of that business relationship. The AMA door is always open to Dr. Palestrant and all physicians who would like to join with us to make a positive difference in medicine – especially those who feel their views differ from the policies set by the physicians of the House of Delegates. We urge you to join with us to make a positive difference in the lives of physicians and patients in our nation," Heyman wrote.
Meanwhile, the dialogue yesterday on Sermo was approaching 1,000 postings and has been colorful to say the least. While most seem to cheer Palestrant on, not all of them do.
"Dan, you are out of line," wrote one obstetrician gynecologist who objected to Palestrant's use of the survey to criticize the AMA. "The AMA may not represent all my views, but they certainly represent them more than you do. I always thought you created Sermo to allow honest dialogue between physicians. Now it feels like you did it in order to create a platform for yourself."
But far more contributions are like this one: "The AMA having the rights to license CPT codes and forcing us to use them is antitrust in that there is no alternative. This is called a 'monopoly' and is against the law."
And this one. "The AMA, by creating and promoting CPT codes, the same CPT codes which have made our jobs so unpleasant and costly, have clearly shown their allegiance is NOT with physicians, but rather with themselves and insurance companies. . . .They should call themselves the American Insurance Association, since that is who they benefit the most."
Palestrant, a surgical resident in Boston until three years ago, decided to launch Sermo, a Latin word meaning "conversation" to enable physicians who normally practice in isolation to talk to each other.
Sermo does not accept advertising or charge physicians who become users, he says. But it does make money by serving as a vehicle through which pharmaceutical companies, government entities, market researchers and others pay Sermo to access what those practicing on the front lines have to say.
He said the partnership with the AMA was originally a good thing. But over the years, he said, "it became increasingly clear, the AMA didn't care about what we had to say. And we began to have more and more questions about AMA business practices and the size of their community.
"It all came to a head with the current healthcare debate, and our community felt very strongly that the AMA was fabricating its membership numbers. Health reform is now taking place. And the physician community is so angry. We knew we had to take action."
Meanwhile, physician bloggers are having a field day with the fight as well.
"Wow, things are starting to get quite nasty here. The marriage has turned into an ugly war," wrote Joseph Kim, MD, an MIT engineer.
"I'm not sure bashing the most influential physician advocacy organization in the country, in terms of Congressional lobbying power and money, is the most productive strategy right now," wrote blogger Kevin Pho, an internal medicine physician in Nashua, NH. "Politicians will find it easier to ignore multiple, fragmented physician advocacy groups rather than a single, unified physician voice."
The high-profile announcement this week that the nation's hospitals will sacrifice about $155 billion in Medicare and Medicaid payments over the next decade to help pay for healthcare reform is just smoke to hide the true cost of healthcare reform from taxpayers, one critic says.
"It's a shell game. It's political fanfare, but there is no substance to this," says Dennis Smith, a senior fellow at The Heritage Foundation, and a former acting administrator of CMS under President George W. Bush. "The hospitals and the administration are touting this great agreement. But in many respects all they are trying to do is fool people into believing there is something real behind this, and there is not."
Smith says the $155 billion represents only about 1.5% of the $10.5 trillion in payments that U.S. hospitals are expected to receive between 2009 and 2018 from Medicare/Medicaid and private insurers. "It sounds big, and they want everybody to believe it is big. The hospitals are saying 'we are giving up $155 billion.' We should ask: 'what are they going to get in return?'"
Smith says hospitals already get about 31% of total healthcare spending. If healthcare reform increases federal spending by $1 trillion over the next decade—a ballpark figure, Smith concedes, for simplicity's sake—that's an additional $310 billion for hospitals. "So they just lost $155 billion but they're getting another $155 billion back. Where's the pain in that?" Smith says.
The Obama administration, Senate Democrats, and hospital groups have said that the $155 billion of projected savings would come from an estimated $40 billion to $50 billion decrease in disproportionate share payments for providing care to uninsured and low income patients. Medicaid cuts would be apportioned state by state, using a 10% annual reductions starting in 2015. Roughly $100 billion more would come from reductions in Medicare payments to hospitals. Some of that money is coming from the money hospitals save by eliminating or preventing some hospital readmissions.
In return, hospitals want any public insurance plan to reimburse them above the rates Medicare and Medicaid would pay if the option is approved.
Smith says that if hospitals are serious about making sacrifices they can start with surrendering all of their DSH payments. "Under Medicaid, that is about $175 billion federal and state over the next 10 years and Medicare is about another $100 billion over 10 years," he says. "If everybody is insured, why do you need DSH at all? At a minimum, they should be willing to give up $275 billion."
It's not just the hospitals that are running the shell game, Smith says. He also rejected as a publicity stunt the drug makers plan to chip in $80 billion in savings in over the next 10 years in the form of prescription drug discounts for government programs.
"This is about filling the donut hole," Smith says, referring to the gap in Medicare coverage that charges some seniors for the full cost of their medications if they surpass a spending cap.
"When seniors are in the donut hole, they buy less-expensive generic drugs. By filling the donut hole PhRMA gets to sell more of its high-priced brand name drugs," he says.
Nor are doctors absolved of any role in the healthcare reform dog and pony show, Smith says. There will be a lot of public wailing and moaning over the proposed 21.5% reduction in Medicare reimbursements in 2010 that are mandated under the sustainable growth formula. However, as in the past seven years, those cuts won't happen.
"It's the 'physicians fix,' as it is referred to in Washington. Congress is going to step in and make that go away. That is going to happen if nothing else changes because that is what happens under current law," he says. "Because of the power of the baseline, that if you fix it this year but not next year, the drop gets steeper, Congress, as part of healthcare reform, is going to buy off the doctors by doing the Medicare doc fix."
This tale may make you put down your coffee and verify how tightly you protect computer servers at your hospital and any leased facilities.
The FBI arrested a man whom authorities said hacked into a Dallas healthcare building's IT system and was prepared to take over the heating, ventilation, and air-conditioning (HVAC) system. The suspect, who worked as an overnight security officer for the site, allegedly had bigger plans of using the compromised computers to instigate a massive attack on other computers elsewhere.
Consider asking your own security director and emergency planner about this type of scenario, or better yet, have them conduct a drill on it. As you'll see, the details truly meet the popular notion of "pushing the envelope" with drill scenarios.
Actions could have risked patient safety
The security officer in question, Jesse William McGraw of Arlington, TX, is allegedly part of a hacker group called the Electronik Tribulation Army. McGraw—who used online aliases "GhostExodus" and "PhantomExodizzmo"—was ordered held without bail by a judge on July 1, said Kathy Colvin, a spokesperson for U.S. Attorney's Office in Dallas. The government will present its case to a grand jury by the end of the month.
McGraw's immediate actions could have allowed him to shut down the HVAC system at a Dallas building which contains the Carrell Clinic orthopedics facility and North Central Surgical Center. A loss of air-conditioning in the hot Texas weather could have threatened the safety of patients, staff members, and visitors. McGraw "did jeopardize [the HVAC] system," Colvin said. "It's frightening."
McGraw worked at the building as a contracted security officer and was employed by United Protective Services, Inc., in Dallas, according to authorities.
Complaint details YouTube posting
Colvin did not have further information on the investigation available, but the Dallas Morning Newsposted the criminal complaint against McGraw on its Web site.
A cooperating witness who is a network security researcher allegedly received e-mails from someone in the Electronik Tribulation Army about video posted on You Tube. The video allegedly showed a person—believed to be McGraw—demonstrating how he hacked into the Dallas building's HVAC computer. Further information from an alleged Craigslist post by the suspect, in addition to additional research by the cooperating witness and the Texas Attorney General's Office, led authorities to identify and arrest McGraw, according to the criminal complaint.
Building experiences prior problems
Tenants of the Dallas building told FBI agents that they had experienced some HVAC problems prior to McGraw's arrest. A review of the HVAC computers later showed someone had downloaded malicious software that would allow someone to assume remote control of the HVAC system.
The Carrell Clinic and North Central Surgical Center lease their space in the building. It wasn't immediately clear whether the alleged hacker's actions affected all of the building.
A call by HealthLeaders Media to Tom Blair, administrator at the Carrell Clinic, wasn't returned. However, Blair told the Dallas Morning News that there was no evidence that patient information was compromised by McGraw's actions.
McGraw had given notice to United Protective Services just prior to his arrest.
As part of an annual performance improvement review in 2007, Leisa Butler, RHIA, CPHQ, performance manager in the quality management services department at Self Regional Healthcare (SRH) in Greenwood, SC, began tracking safety events occurring within the facility with an identification (ID) events team, consisting of staff members from the operating room, emergency care center (ECC), laboratory, and risk management department.
From this performance improvement review, Butler and her team discovered that patient ID events comprised the majority of safety events occurring at SRH. In targeting patient ID processes, SRH managed to reduce ID events by 65% after one month of implementing a new plan. These ID events included misidentification of a patient, specimen, medication, test results, and medical record.
"We conducted a common cause analysis, and after looking at why the events occurred and the circumstances under which they occurred, we found that the vast majority of patient identification errors were in specimen IDs," says Butler. "The specimens were either mislabeled or not labeled at all." The specimen ID errors occurred on everything from blood to urine to tissue samples.
Bar codes give edge and help with efficiency
Once the aforementioned problems were addressed, Butler and her team focused on preventing patient ID errors. Part of the solution came to Butler via ADMIN RX, an electronic device that scans the bar code on patient ID bands, then scans the medication and confirms the appropriateness of that medication based on pharmacy profiling.
This system essentially helps the nurse confirm that the correct patient is receiving the correct medication.
"We thought to ourselves, 'Why can't we use the scanners on ADMIN RX and give every patient an ID band with a bar code that confirms all the information and is usable for other scanner programs?' " says Butler.
Butler and her team developed a plan that would allow SRH to distribute bar codes to all patients, as well as provide a label for specimens being sent to different areas of the hospital. The team reviewed the cost of supplying the entire facility with bedside scanners and the kind of printer needed to print a scannable armband.
"Printers that would print labels for the ID armband were found. Scanners were purchased that would scan a patient's ID band and generate a label with unique patient identifiers that could be placed on the specimen at the point of collection," says Butler.
In the first month after implementation, SRH managed to reduce ID events by 65% just by implementing the new technology and using the scannable armbands and labels.
Clarifying delivery and ID
The team then analyzed the areas in the hospital from which specimens were coming and found that a vast majority of the specimen ID errors were occurring in the ED and the lab.
Butler and her team decided to map out the actual process of specimen collection in several areas in the hospital and examine how the specimens were sent and received in the lab. Primary areas of focus included the ECC, the OR, and pre-op testing.
"Things like where the patient received their bar-coded arm band, who collected the specimen versus how and when it was labeled, and how the specimen was then sent on to the lab all varied depending on the area," says Butler. "So as a team, we decided to come up with a core common process."
In developing a common core process, the team decided that there could be no exceptions to key components. This was decided as a means of decreasing the variability found during the initial assessment. However, the team decided to allow specialty areas to add a step in the process, if necessary. For example, in the OR, there are additional steps for processing and transferring specimens.
Along with that process, Butler and her team noted that steps could be added, but no steps could be left out during the processing or transferring of specimens.
"If an event occurs that deals with specimen labeling or ID labeling, then the standard flow chart must be reviewed, and it has to be noted where in the process things failed," says Butler.
Transparency is the key to success
SRH was so successful with the new patient ID processes because information was communicated and understood clearly by all staff members, says Butler. "The staff was very receptive of the new processes," she says. "I think because everything was communicated from the top and that these processes were going to make us better, staff members understood this and were willing to work towards improving patient safety."
Other facilities should define an "event" when initiating a performance improvement project such as this. "We talked to other hospitals, and our definition particularly related to ID events differs from theirs, so they collect data based on their own definition," says Butler.
As the Obama administration hopes to boost its healthcare reform effort with financial concessions from the hospital and pharmaceutical industries, it is instead confronting deep dissension from the Democratic ranks and possible defections among key constituencies. There are several other warning signs for the administration as it pushes health reform, including a slipping timetable in the Senate, internal division in the hospital industry and mounting tensions between AARP and the pharmaceutical industry.
