The Pennsylvania Health Care Cost Containment Council (PHC4) could soon cease to exist, if state lawmakers don't extend its authorization by the end of the month. Although the watchdog agency has strong support in the state's General Assembly, some insurance lobbyists contend PHC4 has failed in its mission to contain costs because healthcare costs continue to rise.
A patient safety bill agreement announced this week by New York Gov. David A. Paterson now requires the names of doctors charged with misconduct to be made public. Also, these physicians now will be given just one day from the time formal charges are made to provide office records to investigators. The bill was created in response to the case of a Long Island doctor who put patients' lives in danger by practicing improper infection control.
A recent HealthGrades study has found that best-performing hospitals offer higher quality of maternity and cardiovascular care for women than poor-performing hospitals. The study shows that top-performing hospitals report much fewer maternal complications than lower-performing facilities, and that mortality rates for women treated for cardiovascular disease have dropped in recent years.
Nebulous. That's how Eric Dobkin, MD, chief quality officer at Crozer-Keystone Health System describes the responsibilities of a hospital quality officer in this month's HealthLeaders magazine.
Infection control, clinical outcomes, and compliance with The Joint Commissions' standards are common tasks assigned to a quality officer, but often, the responsibilities don't end there. CQOs hear about it when the hospital noise level is too loud or the cleaning staff misses a spot on the hallway floor.
"You could make the argument that quality should only be measured by the outcomes required, or you can look at the food served in the cafeteria," says Dobkin, who also serves as the vice president of patient safety for the five hospital system in Delaware County, PA. "They all fall into the rubric of quality."
While the role may be nebulous, the growing importance of hospital quality isn't, evidenced by the number of hospitals—big and small—that are bringing quality responsibilities to the executive table by creating the chief quality officer role.
"Patients, regulatory agencies, the government—they're all demanding quality, says Beka Warren, RN, chief quality officer at The Memorial Hospital in Craig, CO. "In the past, what has been important to the board of trustees is the financial component. If we were doing well financially, we were considered to be doing well. [Today] in this hospital, we look very much at the quality things that are going on."
And just as a CEO has a chief executive who deals with the financial, he or she also should have an executive to oversee quality. But appointing just anyone to the position is ill-advised, Dobkin and Warren say. To be a good CQO, a person must work well with numbers, make sense of statistics, and be optimistic. They must always strive for excellence and be able to lead, even when they encounter resistance.
"It's your job to inspire a hospital to more than what's easy," Dobkin says. "Part of a CQOs job is to educate everyone—from the board to the C-suite to the staff level—about what quality and patient safety are all about."
But perhaps the most important thing that a CEO should remember when hiring a quality officer is that assigning an executive to oversee quality doesn't mean he or she can wash her hands of that responsibility. At The Memorial Hospital, CEO George Rohrich makes daily rounds and meets with his executive team to discuss what he observes on these rounds. He remains on the front lines of the 25-bed hospital's quality improvement efforts, and talks about it often with staff at all levels.
There’s no question that quality is important to him, Warren says, and his emphasis shows the importance of it.
Maureen Larkin is quality editor with HealthLeaders magazine. She can be reached at mlarkin@healthleadersmedia.com.
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As a hospitalist, Philip Vaidyan, MD, saw patients on nearly every floor and in a variety of units. He soon found he was spending too much time moving among patients or answering pages from another area of the hospital. Then Vaidyan learned about a growing number of hospitals that reduced these frustrations by assigning hospitalists to specific units of the hospital. These hospitals, including SSM St. Mary's Health Center in St. Louis, say the move has nearly eliminated wasted travel time and given physicians more time with patients, families and staff. The hospitals also hope better access to physicians will lead to better communication, and allow treatment to begin sooner.
A bill passed by the Louisiana Senate will allow two doctors to remain on St. Bernard Parish's hospital commission while also being employed by the Franciscan Mission. The Mission is competing with Ochsner to operate a still-to-be-built hospital in the parish. However, while the doctors can serve on the St. Bernard Hospital Service District Commission, they will not be allowed to vote on any issue involving the Franciscan group. The bill now heads to Gov. Bobby Jindal.
SSM Healthcare-St. Louis recently announced another round of departures, another example of hospitals facing increasing pressure to improve care while cutting costs. In addition, quality directives from managed-care companies and the government are coming with slight, if any, increases in payment. St. Louis Post-Dispatch columnist Mary Jo Feldstein notes that one source of the economic problems facing hospitals is that as health plans raise the patients' portion of their medical bills and more families have fewer dollars to spend, some might be holding off on care. The problem is worsened as outpatient and testing services continue to grow and sends more patients out of the hospital for care, Feldstein says.
As one of the fastest growing counties in the country, Montgomery County, TX, sees nearly a thousand trauma cases annually, but a scarcity of necessary medical staff at local hospitals has left the county in critical need of even basic trauma services, according to a new report.
At least one local hospital says a lack of physicians interested in providing trauma care has left them struggling to obtain Level III certification. "Our plan, even independent of this study was to move back to being a Level III trauma center. The major thing we are facing is our ability to recruit physicians. It's a very time consuming practice, and not everyone is cut out to do it. Our timeframe for getting certified basically has to do with how soon we can find physicians who want to do this work," says Conroe Regional Medical Center CEO Jerry Nash. Conroe Regional dropped its Level III center in 2005 because it could not find physicians who were willing to be on call to the extent needed for trauma care. Nash says the hospital is attempting to regain its certification because there is such a demand for critical care in the area.
Officials at Memorial Hermann-The Woodlands say they also recognize the need for trauma services in Montgomery County and hope to obtain certification at that hospital in the spring of next year. Ann Brimberry, director of public relations for the Memorial Hermann System says, "Trauma care is not a given for any one hospital. It requires a collaborative effort between the hospital and physicians along with talented and dedicated staff, facilities, equipment, and financial resources. With overburdened Level I Trauma Centers in Houston, the need for Level III and perhaps higher level trauma centers in the suburbs is critical," she says.
The study by The Abaris Group says that costs and the ability to find willing and able surgeons will remain a challenge; however, it says the area has enough trauma patients each year to support a Level III trauma center and in five years could could most likely support a Level II facility. The researchers also determined that hospitals can profit from a Level III trauma center. It is estimated that the annual cost to run a trauma center would be $730,000.
Although medical-ethics teams are increasingly the arbiters of agonizing health decisions, there are questions about how qualified some of these professionals are to render life-and-death advice. The complex ethical issues arising from new life-prolonging medical technologies are throwing up new challenges, and hospitals face potential legal liability if patients and families feel they haven't been properly counseled or provided with all the information they need to make decisions.
There were two themes I heard repeatedly at the America's Health Insurance Plans (AHIP) conference in San Francisco last week:
Consumer-directed healthcare (CDH) is more than shifting health costs onto members; it is a way to put consumers in charge of their healthcare and provide them with the tools to make educated decisions.
Creating personal health record (PHR) portals is not enough. Consumers have not shown much interest in PHRs because the portals are used simply as a place to dump information rather than interactive tools for members to become more informed.
CDH
Sander Domaszewicz, senior consultant at Mercer Human Resources Consulting in Newport Beach, CA, said consumer-directed healthcare isn't about forcing employees to pay a greater share of their healthcare bills. A CDH plan design will fail without consumer tools like physician and hospital quality data and funding sources such as health savings accounts or health reimbursement accounts.
Domaszewicz said health plans have an opportunity to help educate their members. Though studies show that patients trust their physicians more than health plans and employers, Domaszewicz said 70% rely on family and friends for healthcare advice, half admit they haven't followed their doctors' advice, and nearly half of people reject care management program offerings.
“There is a disconnect between what is the best thing for them and their families, and what they're doing,” he said.
The challenge is engaging those people, changing their minds and behaviors, and making them part of the healthcare team. Simply creating a health plan with deductibles and health savings accounts as a way to pass healthcare costs onto employees is not the way to make an educated consumer—or a happy employee.
PHRs
Dennis Schmuland, U.S. health plans industry solutions director at Microsoft, told me health plan member portal traffic has been lower than hoped because the portals are too stagnant.
Microsoft's entry into the personal health record market last year was met with anticipation. Microsoft's personal health record, HealthVault, allows people to populate a PHR and share the information with third parties to create health, wellness, and fitness services. The technology giant added to its offerings last week with a new consumer health platform to help payers connect services like HealthVault and Windows Live, which Microsoft says will allow the user to help manage health through continuity of care documents, prescription medication lists, health histories, hospital discharge summaries, and lab test results.
Schmuland says the patient portal is an important channel, but is only one way to reach members. Health plans must provide a multi-channel approach if they expect to impact their members' health and lower costs.
“That's really where health plans need to go—to go where the consumer goes,” says Schmuland.
What can you do?
That these two topics were so prominent at AHIP should not be surprising. Both go to the heart of one of the major challenges in the health plan industry: to produce products and services that engage the member. Simply creating programs, such as a PHR or CHD will not work—consumers have shown us that.
Both have not impacted healthcare as hoped, and a reason for that is there simply isn't enough interactivity. Look at it this way: Millions of Americans don't stay up-to-date with their personal financial records like balancing checkbooks. So why would healthcare expect consumers to log in to their PHRs? You must give them a compelling reason.
The solution is to offer them valuable information that interests a member's specific needs and find out how and by what means to best reach that individual. That could mean a phone call, e-mail, instant message, interactive Web site, text messages, or any other emerging form of technology to create a multi-channel approach.
Health plans need to find ways to make valuable connections to members in order to remain competitive in this increasingly technologically-advanced marketplace. Simply transferring costs on members and uploading a PHR onto a Web site doesn't cut it.
Les Masterson is senior editor of Health Plan Insider. He can be reached at lmasterson@healthleadersmedia.com .
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