Even though more than half of all students attending U.S. medical schools are female, the neurosurgery field is having difficulty attracting and retaining women to the profession, according to a new report. The lack of women specialists in surgery of the brain and nervous system highlights a potential problem that could lead to a shortage of neurosurgeons as a whole given the increasing role of women in medicine, say the study's authors. Female board-certified neurosurgeons currently account for less than 6% of a neurosurgical work force that numbers more than 3,000.
Monroeville, PA-based medical supply company Intermedics-McCullough has filed suit against six medical device companies, alleging they made kickback payments to several Pittsburgh-area doctors to gain a competitive edge. In the suit, the owners of Intermedics-McCullough say the companies blocked them out of the market with inferior and more costly products by offering kickbacks "for the purpose of gaining exclusive access to the lucrative replacement hip, knee and joint industry and to the orthopedic industry in general." In addition to the six companies, more than two dozen physicians also are mentioned in the suit, with a listing of payments allegedly made to them by the defendants. The payments ranged from less than $100 to more than $8 million.
ProHealth Care and Children's Hospital of Wisconsin are in discussions with Waukesha Memorial Hospital's to have Waukesha's neonatal intensive care unit and its inpatient pediatric unit become part of Children's Hospital. Children's Hospital has similar arrangements with Kenosha Medical Center and Theda Clark Medical Center in Neenah. The agreement would enable Children's Hospital to provide care closer to home for children in the Waukesha County area. It also would enable Waukesha Memorial to affiliate with one of the largest children's hospitals in the country.
The University of Kansas Hospital has implemented a mandatory training program—the first of its kind in the nation—to train staff on how to handle delivery emergencies. The exercises are designed to save newborns and their mothers during potentially catastrophic emergencies. About 100 members of the hospital's staff have been going through two days of classroom and hands-on training. They have been learning how to deal as a team with a variety of obstetrical emergencies that are each relatively rare, but account for many of the deaths and serious injuries of childbirth.
Over the next few years, the world is likely to see a lot more investment, medical staff, and patients crossing borders into other countries. The surge in global medical tourism could prove a powerful catalyst for government bureaucracies and sclerotic American health-maintenance organizations to think afresh about what they do, according to this article in The Economist. It may even introduce competition to private healthcare in America and elsewhere, say the authors.
Is there a point where CMS' demands will become more important to hospitals than providing actual patient care? I suspect that most CEOs would immediately answer "No!" But as CMS reporting requirements continue to increase, there may come a time when healthcare organizations are forced to choose between collecting data and providing patient care.
The 13 new reporting requirements added by CMS late last month probably won't add too much of an additional reporting burden on most hospitals. Most of the 13 added indicators are already calculated from Medicare billing information. But by adding these 13 requirements, CMS is sending a clear message to hospitals that data reporting is the way of the future, and many in the industry believe these new mandates are the tip of the iceberg. There may come a day when a hospital will have to choose between hiring an additional nurse for the intensive care unit, or an additional staffer to collect and report data.
Which will you choose?
Answering that question will no doubt be difficult. Hospital executives know how important reimbursement from CMS is to the financial health of a hospital, and they must do everything they can to position their organization to receive the appropriate amount. But on the other hand, making someone a data collector rather than a caregiver seems to go against the mission of any hospital. And as patients get more demanding, the care you offer them can also have a financial impact on your organization.
Studies have shown that patients remain unconcerned with data when it comes to healthcare, and they are even less interested when the data is something that they don't understand. Most patients, for example, don't know why the time between when a patient comes out of surgery and when he or she receives a beta blocker is important. What does matters most to patients is that they have a nurse who responds quickly when they hit the call button, gives them medication on schedule, and helps them out of bed to use the restroom. For patients, quality is receiving the care they need when they need it. And if they don't receive the care they want, they're likely to take their business elsewhere, and that of friends and family who hear about their poor hospital experience.
Thankfully, the 13 additional reporting indicators that CMS will require in this year's rule won't be significantly taxing to a hospital's resources. The new requirements are significantly less than the 43 the agency proposed earlier this year. However, I'm not convinced that the 30 requirements that didn't make this year's cut are gone forever. Down the road, CMS will place further reporting mandates on America's hospitals, and at some point, executives might have tough choices between patient care and the organization's financial wellbeing.
Maureen Larkin is quality editor with HealthLeaders magazine. She can be reached at mlarkin@healthleadersmedia.com.
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More evidence shows that medication is often just as effective as an artery-opening angioplasty for patients with chronic chest pain. Although angioplasty remains the top treatment for such patients, the number of those performed has declined since 2007.
Physician practices do not always realize the level of change necessary to successfully implement and use a pay-for-performance (P4P) program. Before you can see the benefits of P4P, you first have to weave through some obstacles and find new ways to approach quality performance.
One of the obstacles many physicians face when starting a P4P plan is changing the practice's perspective of clinical care to match set requirements. Consider these three steps to resolve this issue:
1. Restructure your practice. Meet with the front office staff and educate them about this program. Teaching staff members the measurements will help doctors achieve their performance. For example, staff members need to know which patients have diabetes in the office. They need to know what specialist to refer the patient to, and they must give clinical staff members the proper follow-up information for a particular patient.
2. Organize physician notes. Practices' patient information system need to be redesigned to show patients' demographics, such as weight, height, age, and medication documentation.
For example, group all the major diabetes medicines by blood pressure and cholesterol.
3. Implement a health maintenance profile. The profile could be a list of metrics for a diabetes patient, including dates for his or her flu shot, when he or she needs to see a specialist, and when the previous blood work appointment was made, for example. Be sure to update these regularly.
P4P can be complicated to understand and requires the practice and its physicians to change their perspectives of care in order to see rewards. Consider the following questions before diving into a commitment.
Can this plan help with quality of care in my practice? Do the cost benefits add up in my favor? Am I ready to change?
What conditions and protocols or procedures will I measure with this P4P program?
Who will analyze the charts, data, and patient information to measure my performance accurately and according to the plan?
This article was adapted from one that originally ran in the August issue of The Doctor's Office, a HealthLeaders Media publication.
Editor's Note: In this monthly forum, attorney Jim Saxton (Stevens & Lee, Lancaster, PA) answers your questions about risk management and liability reduction and provides practical, how-to information on risk-reduction strategies.Dear Jim,
I have just gotten flooded with emails and concerns about the so called "never events." As I read through from a commentary, I actually find myself getting more concerned. Is this one of those trends that is going to quickly fade in and out?
Betty Jones
Hospital Risk Manager
Dear Betty:
Let me make a fairly broad statement here. I think we should refrain from using the phrase "never events." Never, as defined by a standard dictionary, is an event which "on no occasion can occur," "cannot happen." I am at a loss to know how that concept applies to occurrences in hospitals such as falls or bed sores.
Wouldn’t it be more appropriate, as to some of these occurrences, to refer to these events as "reducible safety issues?" There is little doubt that greater emphasis should continue to be placed on reducing medical errors and unsafe circumstances. This is a complex subject and there are many facets to it. However, the thought that a fall in a hospital should never occur would appear to be flawed. There will be significant financial implications, but this column is not the time to discuss the reimbursement and financial implications. However, there are also clearly liability implications.
We need to remember that the lay public who are reading about these "never events" are our jurors. The sound bites and headlines actually make it sound more than shocking that these events can occur. Let me make it clear that I am firmly onboard with the safety movement. Much of the work of our team has been dedicated to promoting the same. I just think concurrently we have to be evaluating the pragmatic risk management issues.
For now, you should make sure that your committees within the hospital are carefully reviewing the way these events are described. They should carefully look at the reimbursement implications and how communications with patients or family members will occur. You should certainly begin to sort out what is a reimbursement decision (a third party payer’s decision not to reimburse a certain service) and an evidentiary issue which may occur in the courtroom. Your lawyers will be able to address the latter.
This change in reimbursement policy should not be meant to establish a near perfect (or perfect) standard of care. Many plaintiff attorneys would try to argue that these occurrences are negligence or worse. I would argue that that certainly is not the case and, in fact, plan on filing appropriate motions so that terms like "never events" are not even used in court. We need to be prepared to articulate our positions as the first set of legal rulings take place, and appeal when necessary. Those first, well thought-out decisions as to what "never events" mean will be important.
Let’s continue this effort in the name of safety but not assume that this is a reimbursement issue only. If we do, our liability insurers will be paying for known complications of procedures and you will see the soft market harden pretty quickly.
A bill signed into law this week in New York now allows officials to publicly identify physicians who have been charged with misconduct or malpractice. It also gives the state Department of Health the power to investigate medical wrongdoing. The new law was prompted by a doctor who was accused of malpractice in 2004.
