Advocates for workers, consumers, and employers have joined forces to urge Florida Gov. Charlie Crist to veto what's being called "direct payment" legislation, warning that it would result in higher and unexpected out-of-pocket healthcare costs. At a news conference in Tallahassee, Associated Industries of Florida; Council 79 of the American Federation of State, County and Municipal Employees, the public-employee union; Florida PIRG; the Florida Alliance for Retired Americans; and the Consumer Federation of the Southeast blasted the legislation, which they claim would allow doctors who are not members of PPO networks to receive payment from a patient's insurance company.
Under a proposed plan in Boston, the Massachusetts Mental Health Center in Mission Hill would be demolished and in its place Brigham and Women's Hospital would build a residential and medical complex. The hospital submitted to the city a proposal for a multibuilding development of more than 600,000 square feet. Brigham and Women's plans include a 57,000-square-foot laboratory and office building that would also include outpatient services, according to documents filed with the Boston Redevelopment Authority.
A prominent Nashville home healthcare executive and philanthropist is accused of making false claims that defrauded Medicare of $6.3 million. Ed Yarbrough, U.S. attorney for Middle Tennessee, accuses Jim Carell of installing a Missouri attorney as sham owner of three agencies that actually were owned by Carell's management company, to evade Medicare rules that limited a home health agency owner's compensation.
Kaiser Permanente has 30 farmers markets at medical facilities in four states where patients, staff and community members shop. Locally grown fruits and vegetables also are used in 23 Kaiser hospital kitchens. In an interview with the Los Angeles Times, Preston Maring, MD, says Kaiser Permanente's emphasis on preventive medicine seemed a good fit for farm-fresh food.
The village of Homer Glen in Illinois is close to having one of the state's few free-standing emergency centers, but questions remain over whether it should have a helicopter landing. For months, Joliet-based Silver Cross Hospital has been eyeing an existing medical center where it hopes to develop a free-standing emergency center. The Homer Glen facility would treat about 10,000 patients per year.
A coalition of labor groups is aiming at Senator Ron Wyden, a Democrat from Oregon, who supports taxing employer-provided health benefits as a way to pay for overhauling the healthcare system. An advertisement released by the American Federation of State, County and Municipal Employees, the United Food and Commercial Workers and the National Education Association says "the last thing we need is to pay more. But Senator Ron Wyden would tax the healthcare benefits we get at work—as if they were income. Taxing healthcare benefits? That doesn't make sense."
One survey. Five hospitals. More than 40 ambulatory and outpatient locations. When Joint Commission surveyors arrived at Lee Memorial Health Systems in Fort Myers, FL, the result was a weeklong survey on an epic scale.
The health system was ready, though, having mirrored their survey readiness plan on an unusual, but interestingly appropriate model: an emergency management plan.
Each surveyor was assigned a chaperone and a scribe.
"Everyone was educated in their roles for survey," says Chris Crawford, RN, MHA, LHRM, system director of standards and quality. "We had a command center set up, and if the surveyor had a need the scribe could call the command center to assure that whatever documentation the surveyor was looking for was made available to them . . . Our plan got blown up the first day."
They had initially anticipated that the surveyors would break up and go to different hospitals, with a surveyor to each hospital, two surveyors to the outpatient and ambulatory sites, plus a Life Safety Code® (LSC) surveyor. In anticipation of this, each hospital had a vice president of patient care service ready to act as chaperone, as well as someone who knew the system well to act as scribe.
"Of course, the surveyors made the decision to stay together and do each hospital as a group," says Crawford.
This led to some quick thinking and restructuring of the health system's plan.
"We had to rethink who we had stationed at each hospital," says Crawford. "As soon as we walked out of the opening conference [with the surveyors] . . . we immediately met to deploy staff to the hospital that would have all five surveyors at once."
Essentially, the first lesson of the survey was: be ready to change.
"This was all about being able to make adjustments on a dime," says Kathy Bridge-Liles, vice president of patient care services at the Children's Hospital campus.
This was Lee Memorial Health Systems' first unannounced survey, and the first since acquiring two additional hospitals. The survey seemed destined to be exciting.
"They originally showed up in September on the day of where we were preparing for a possible hurricane, and had to turn around and leave," says Crawford.
So by comparison, unexpected tactics by surveyors were not nearly as difficult to deal with as a natural disaster.
The Lee Memorial campus was selected first by the surveyors.
"It was interesting to see how they were going to work," says Sgarlata. "All of the surveyors at the same time. We had an opportunity to see what they were looking for, themes of where they would be headed for the rest of the campuses."
It was also interesting to watch how the surveyors worked together. The five surveyors who worked to survey the five hospital campuses had never worked together, and were all normally in a leadership role in other surveys.
"I thought they worked well together as a team themselves," says Mary Kirkwood, system director of medical staff quality. "They worked well with us but also collaboratively with each other—it was one of the best teams I've encountered."
Beneficial to both sides were some ground rules established for communication—surveyors would go through their team leader with requests for information, and information would be funneled back through the team leader from the hospital rather than sent directly to the requesting surveyor, in order to keep the transfer of information steady and accurate.
Representatives of the health system were pleased at the collaborative nature of the survey.
"We really enjoyed the time with the surveyors," says Cindy Brown, vice president of patient services at Health Park Medical Center. "There were two times when they brought staff and educators to the boardroom in Lee Memorial to talk about the process of education and how to prepare staff and make sure they're confident. It wasn't a ‘gotcha' discussion, it was a ‘share what we've learned' discussion."
Fears about a potential H1N1 flu pandemic have abated for the time being. But the outbreak—and the panic that ensued—did shine a light on the healthcare system's disaster preparedness plans. Hospitals and public health officials got a sneak peak at what processes worked well and what areas may need improvement in the event of a pandemic. Soon hospitals won't need an actual event to occur to improve the effectiveness of their disaster planning efforts, however.
Simulation and gaming technology can help healthcare organizations run drills with multiple players on various disaster scenarios. Unlike manual disaster drills, which hospitals only perform once a year or so because of cost constraints and the resources involved, virtual simulations could be used more frequently to help hospitals refine their manual drills and develop the most effective strategy for a plane crash, bioterrorist attack, or pandemic.
Simulators are not new to healthcare. Hospitals have been using mannequins to help clinicians practice clinical or surgical procedures for years. But healthcare organizations are just starting to investigate how virtual gaming technology can improve disaster training and preparedness.
One of the lessons learned during Katrina was that "even if every hospital had a perfect hurricane disaster plan, it didn’t do much good if 75% of hospitals were under water," says Paul Breslin, a senior principal at the Noblis Center for Health Innovation. "It was all about the system of systems."
Keeping clean water running, power on, and communicating when phone lines went down were more critical than anything else, he says, explaining that virtual simulations could enable organizations to test exactly that—what would happen if all the phone lines went down. What would people do and what decisions would they make?
Planning for a pandemic or bioterrorist attack is completely different than planning for a large train or plane crash. Hospitals can still take the lead, Breslin says, but focusing on their internal pandemic plan in terms of operations and isolating patients isn't enough. "We really need to be operating at a much higher level than the local hospital," he says.
Testing the community response to various situations is where virtual gaming technology may benefit health systems the most. It is difficult to run a disaster drill that includes all of the key players, such as local hospitals, clinics, physician offices, fire departments, police departments, and public health officials. But multiplayer gaming technology could enable each of these groups to sit at their desk and participate in a virtual disaster drill, and this reality may be closer than some hospital executives realize.
For example, Zero Hour: America's Medic is a single-player game designed to give EMT/Paramedics the chance to test their skills in response to four different scenarios—a SARS-like pandemic, earthquake, a derailment with chemical leak, and a sports complex explosion. The game, designed by George Washington University, provides first responders the opportunity to practice and refine their skills in four key areas: CBRNE (chemical, biological, radiological, nuclear, and explosives) detection, triage, information collection and threat recognition, and information sharing and collaboration. Players encounter different patients, scene hazards, and have different resources to call upon each time they play the game.
The Stanford University Medical Media and Instructional Technology group has also developed "virtual worlds" in which the patient, the clinical facility, and all personnel are represented as an avatar on the screen. Stanford's 3-D virtual ED, for example, can help train medical students and residents in different trauma scenarios.
Similarly, Noblis researchers developed HotZone, a game that allows first responders to react to a chemical and explosive attack in a virtual shopping mall. The game includes data extraction technology, which can be analyzed to see which strategy saved the most lives.
"One team did the exercise in 20 minutes and had zero fatalities and another took 30 minutes longer and had five fatalities," Breslin says. "The real value is having 50 people playing their roles in an event, looking at same scenario, making their own decision, and seeing how it might impact someone else," he says.
The benefit of this type of gaming technology is organizations can run drills over and over again and evaluate the data to see what strategies have the best results. "That is too cost prohibitive in manual events." Breslin says.
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Editor's Note: This is the first in a two-part series about the partnership between Glen Cove Hospital and the National Health Service Elect.
British healthcare leaders recently visited a prominent U.S. hospital to share orthopedic best practices and workforce development—a partnership that both sides say could ultimately benefit their national health systems.
Krauss and his team at Glen Cove perform more than 1,100 joint replacements annually with an infection rate of virtually zero. It is touted as one of the premier joint replacement models in the U.S.
"For them to be interested in a cooperative program with myself and my program at Glen Cove Hospital-North Shore was a wonderful opportunity and honor for us," Krauss says. "The goal was 'can we reproduce our efficiency models and can we help them?'"
According to Peter Kay, MD, president-elect of the British Orthopedic Association and one of the UK's representatives in the partnership, the lessons learned from examples at Glen Cove will help as the UK tries to achieve the NHS goal of having wait times for elective surgery reduced to no more than 18 weeks.
Kay notes that as recently as a few years ago, U.K. patients would have to wait two or three years for a joint replacement.
"What we call the patient pathway was getting a bit long and a bit complicated, so the big push has been to rationalize all of that to make it must simpler, and much quicker to get patients through the system," says Kay, who is also a practicing orthopedic surgeon at Wrightington Hospital in the UK. "And obviously in order to do that, we've had to modernize and change what we do."
In addition to observing during the surgeries, healthcare leaders from both sides of the pond discussed surgical methods, efficiency models, and tactics used by the surgical team. The 30 people who visited Glen Cove included representatives from the National Health Service and West Suffolk NHS Trust Hospital.
The program's agenda also included site visits to North Shore-LIJ's Center for Learning and Innovation and its Patient Safety Institute in Lake Success, NY, as well as the health system's Bioskills Education Center, a state-of-the art surgical training center. Discussions took place about workforce development and the role of nurses, nurse practitioners, and physician assistants in delivering orthopedic care to patients in the continuum of care.
"Much of what I've done in our field is related to that continuum of care," says Krauss. "You break down the process to multiple, small quality assurance steps. There is a whole team involved."
This team-oriented process is very important, which he says he tried to get across to the team from the UK. He says Glen Cove has joint replacement teams that have been working together since 1993, allowing for a seamless process from consultation to follow-up care that is best for the patient, as well as the staff.
This team effort allows for Glen Cove to conduct 12-14 joint replacements in a single day—with superior outcomes.
"It's like dancing a ballet with all the same partners—it's not like a pickup team," Krauss says. "People have this idea that if you do a lot of these they must be not as good quality—but the opposite is true. When you do a lot, you have a center of excellence and they are better."
Kay says he is impressed that patients really felt like they were being looked after by a good team, and the staff seemed to be really enjoying their jobs.
"That's quite important, because we've been pushed over the last few years to do more and more, the staff were getting tired, and sometimes it could be the tendency of patients to sometimes feel like they were just being pushed through the system as quickly as possible."
Kay says the UK team went back "buzzing" with ideas to improve efficiency, some of them as simple as reconfiguring how they schedule the operating theater. In the UK, facilities typically have one surgeon and one operating room. At Glen Cove, Krauss moves between four operating rooms, with other surgeons and healthcare workers assisting with preparation and post-operative care.
Differences in staffing could also attribute to the joint replacement efficiency at Glen Cove as well, Kay says. For example, there are very few physician assistants in the UK, and surgeons usually rely on junior doctors to assist with surgeries. New directives to reduce doctor hours are hindering this trait, however, and Kay says the UK needs to transfer their workforce to cope with the reduction in the number of doctors that handle these tasks.
The British Hip Society, of which Kay is the past president, is already working to strengthen the healthcare workforce to include people with extended skills, such as physician assistants and nurse practitioners that are used in the United States.
This extension of the workforce, as well as training them to work together in the joint replacement process, will be invaluable as the UK tries to improve joint replacement efficiency while at the same time maintaining quality, he says.
"What we saw at Glen Cove was some fantastic examples of how these people worked," Kay says. "We've set up a project at the Department of Health to really bring forward the curriculum and the development of the type of workers you have. Anything we can do to improve our efficiency and improve our workforce to deliver more, is the sort of thing we need to be interested in, and Glen Cove was giving us some real ideas on how to do that."
And it is far from a one-sided exchange, Krauss says. North Shore-LBJ can benefit from Wrightington Hospital's innovations in orthopedic care, he says, adding that in the 1950s Wrightington was the site of the world's first hip replacement surgery.
Kay notes that while some U.S. facilities may be more efficient and more production oriented with excellent outcomes, there are many aspects of their system they are measuring to ensure quality—something that will likely become more important as the U.S. continues its health reform efforts.
"Their metrics for measuring outcomes are better than ours, they have national standards, and we don't," Krauss says. "Every joint replacement done in Great Britain goes into a national registry. They can tell you which implant is better, which hospital has better outcomes."
The partnership will continue in the future as well. Representatives from Glen Cove will visit the UK in September to discuss, among other things, how to further the information exchange.
Kay says that if the partnership is successful, the lessons learned have the potential to expand and benefit not just joint replacement, but the structure of health systems in both countries.
"What we're trying to do at the Department of Health is to bring all of this together to see if we can not just change those three organizations, but using those as sort of exemplar sites to develop change across much more of the NHS," Kay said.
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The United States is the only nation among 22 wealthy countries that fails to guarantee sick workers some type of paid sick leave or paid sick days, according to a new report from the Center for Economic and Policy Research in Washington.
The report, Contagion Nation: A Comparison of Paid Sick Day Policies in 22 Countries, also found that the U.S. is the only country in the study that does not provide paid sick leave for a worker undergoing a 50-day cancer treatment; only three countries--the U.S., Canada and Japan--have no national policy requiring employers to provide sick days for workers who may miss five days or more of work to recover from the flu.
Many working Americans can't afford to stay home when they're sick because they don't have paid sick days, according to Jody Heymann, director of the Institute for Health and Social Policy and professor of epidemiology at McGill University, who was the lead author of the report.
The lack of paid sick days can put Americans "at substantially greater risk of contagious diseases--from the flu, which kills thousands annually, to diarrheal disease, respiratory infections, and the threat of new diseases like the H1N1 flu virus," she said in a statement.
To compare the U.S. with the national policies of the 21 other countries, the authors calculated employer- or government-provided financial support available to workers with the flu, which requires they miss five days of work or a cancer treatment requiring that they miss 50 days of work.
