Officials from Temple University Health System, which operates Northeastern Hospital in Philadelphia, have agreed to delay for 30 days their plan to convert it into an outpatient-care facility by July 1, said state Rep. John Taylor. The agreement will give local elected leaders a chance to analyze Temple's decision to close Northeastern and to offer possible alternatives.
The Florida Board of Medicine tossed out charges against a renowned surgeon and professor who mistakenly left a clamp inside a patient.
Juan Asensio-Gonzalez is one of the most respected trauma surgeons in the country, and is director of the Trauma Critical Research and Training program at Jackson Memorial Hospital and a professor at University of Miami.
More than three years into Los Angeles' crackdown on patient dumping downtown, officials have reached settlements with four hospitals and collected millions in payments. But although enforcement has been aggressive, it remains to be decided where these patients should go. While activists decry the practice of hospitals simply dumping patients on skid row without planning where they will go, they admit that finding care for such patients is difficult.
Indigent and under-insured patients are turning to Cook County, IL's Stroger Hospital after not getting fully treated at non-profit hospitals, swamping the cash-strapped public facility while fueling the county's sky-high sales tax, according to the Chicago Tribune. Some of these patients arrive at Stroger's emergency room bearing discharge slips, prescriptions, even Yahoo and Google maps from non-profit hospitals, according to documents.
More than 800 employees at St. Elizabeth's Medical Center in Brighton will join the Service Employees International Union. Nearly three-quarters of those voting approved a plan to join Local 1199 of SEIU United Healthcare Workers East, union leaders said. St. Elizabeth's, the flagship of the Caritas Christi Health Care chain, is the first large Boston hospital to be organized by the SEIU, which in 2007 began a drive to unionize Boston's major hospitals.
Doctors at Massachusetts-based Partners HealthCare may no longer accept gifts and meals from drug and device firms, or travel the country as paid members of company "speakers bureaus," as the hospital and physician network adopts tougher restrictions to counter industry's influence over the drugs and treatments physicians prescribe. Partners, which includes the Harvard-affiliated Massachusetts General and Brigham and Women's hospitals in Boston, also is placing new limits on how physicians interact with company sales representatives and increasing oversight of these relationships.
President Obama announced that his administration will create an electronic record for veterans that will "contain their administrative and medical information from the day they first enlist to the day that they are laid to rest." Obama has made electronic record-keeping a key feature of his healthcare reform effort, but a problem is how the military and VA hospital systems will be able to communicate with each other.
At this point, you already know about the Obama administration's goals for widespread EHR adoption, about the $19 billion being invested in healthcare IT, and about the carrots being offered to entice hospitals and physicians to play along.
But is that all you know about the Health Information Technology for Economic and Clinical Health, or HITECH, Act? Did you catch the part about stricter HIPAA requirements and stiffer penalties for violations?
There has understandably been a lot of focus on the incentives—$19 billion makes for a big pile of money, after all. But it is so big that it seems to have developed its own gravitational field that has pulled the entire healthcare industry into its orbit, and so big that it casts a shadow over anything too close to it.
Changes to HIPAA understandably haven't been getting as much attention. And while it makes sense for physicians to make EHR implementation a top priority, preparing for these new HIPAA requirements will be part of the process, and physicians should be aware of how they will affect their practices.
The two issues are linked, in fact. With vast amounts of new electronic data come many new opportunities for identity theft and security breaches, and the privacy and security rules are being updated to protect patients in the new digital age. But the rules also apply to paper records in some cases, so physicians across the board will be affected, regardless of the technology they use.
Some of the changes include:
Stricter accounting of disclosures. Physicians using an EHR will have to be able to track any disclosure of a patient's medical information, including disclosures made for treatment and payment. That information must be made available to patients upon request. Before, providers weren't required to constantly track when information was disclosed, but electronic information is in some ways easier to track, and legislators expect providers to know at all times who has accessed data and when they accessed it.
Mandatory publicizing of breaches. If a breach of patient information happens at your practice, the legislation requires you to post information publicly about it if the security breach affects 10 or more patients. If a security breach affects 500 or more patients, practices must notify all of their patients, a local media outlet, and the HHS secretary.
The primary focus for practices should be on preventing breaches from happening in the first place. But leaders should also prepare for worst-case scenarios. How will you handle the fallout if you are required to report a breach to all your patients? Local reporters love these types of stories, so you'd better be prepared to deal with the media as well.
Extension of requirements to business associates. Some of the burden for protecting patient data is now also on business associates that process or handle patient information on behalf of a practice. This includes any third party that has access to a patient's record—consultants, lawyers, and even vendors that offer personal health records. Business associates are now essentially subject to the same rules as practices—they can be fined and must comply with the breach requirements.
Harsher penalties. Although it has caused administrative headaches and major changes to practice structures since its introduction, HIPAA has essentially been a toothless tiger for most of its existence. The specter of fines and penalties was ever-present, but most cases were rarely prosecuted, and most prosecutions were resolved without fine.
That is changing. Seattle-based Providence Health & Services made an initial splash last fall when it was hit with a $100,000 penalty after losing information on about 365,000 home health patients, and more recently CVS was fined $2.25 million after allegedly disposing of patient information in unsecured dumpsters outside stores.
HITECH calls for beefed up enforcement rules and new aggressiveness in assigning fines, which start at $100 and can go as high as $1.5 million. The legislation also empowers state attorney generals to enforce some HIPAA elements, which could lead to more scrutiny from prosecutors looking for high-profile cases.
But, as is the case with many of the new requirements coming out of the stimulus package, the full impact of the HIPAA changes remains to be seen. Much of the legislation hinges on the protection of "unsecured patient health information," but we still don't have a clear-cut definition of that term.
It seems as if many of the requirements can be taken care of by simply encrypting patient data, but again, we're waiting on the details of what types of encryption software are endorsed under the legislation.
So at this point, the changes aren't worth losing a lot of sleep over. The bulk of HIPAA remains the same, and if you were compliant before, it won't be too hard to adapt. At the same time, we may see a wave of new fines and penalties, so the changes shouldn't be ignored, either.
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Data released by the Medical Group Management Association show that medical directors in non-hospital physician groups earn 69% more than practices owned by a hospital. The research also shows that medical directors in primary care groups earn more within a hospital-owned practice, and compensation for physician leaders varies by specialty. Physician education duties increases primary care compensation by 82%, the data states, while surgical and nonsurgical specialist compensation increases more than 100%.
Many doctors would classify the current economic downturn as a threat to their business. But others, even within the same practice, might view the financial climate as an opportunity for growth.
In the end, the important fact isn't how the situation is labeled, but that physician leaders are talking about it. And they are more likely to discuss what's going on in- and outside their office if their practice conducts an analysis of its strengths, weaknesses, opportunities, and threats (SWOT).
The purpose of a SWOT analysis is for a business to scrutinize these elements as it begins to create a strategic plan. Strengths and weaknesses refer only to internal factors, while opportunities and threats can refer to internal and external factors.
It's important for practices to conduct regular SWOT analyses because it helps physician leaders take a step back from day-to-day difficulties and understand the larger picture.
Physician practices should conduct a SWOT analysis each year, but they don't always have to start from scratch. If the prior year's analysis is still relevant, practice managers may decide to review and update it for the coming year.
Larger organizations often focus on developing various components of the strategic plan on a rotating schedule, says Jennie Campbell, CMPE, chief operating officer of Summit Medical Group in Knoxville, TN.
"If you want to look at practice growth and you've got a multiple-location practice, you can look at that every few years," she says. "And then on other years, look at things like physician compensation strategy, etc."
The number of people involved in a SWOT analysis depends on the practice size. For a smaller practice, the analysis meeting should consist of four to six people, including the physicians, practice manager, and practice administrator, Campbell says. SWOT analysis meetings for larger practices should include the board of directors or strategic plan committee.
The facilitator plays the most important role during a SWOT analysis, because he or she engages participants in discussion, settles disputes, and writes ideas down on a whiteboard or flip chart. Many practices choose a staff member to be the facilitator, whereas others use an outside consultant.
The most common difficulties during a SWOT analysis usually emerge in the meeting part of the process. Another common snag occurs when people get bogged down trying to categorize a certain item, such as whether the stagnant economy should be considered a threat or an opportunity. The facilitator is useful in a situation like this.
This article was adapted from one that originally ran in the April 2009 issue of The Doctor's Office, a HealthLeaders Media publication.
