Patients of surgeons who were cited for unprofessional conduct had an 18% to 32% higher risk for complications.
Surgeons who are rude, disrespectful and unprofessional with coworkers are also more likely to have complications arise during and after operations, a new study shows.
Researchers at Vanderbilt University Medical Center examined the outcomes data from the National Surgical Quality Improvement Program for two academic medical centers, of 202 surgeons who operated on 13,600 patients between 2012 and 2016.
The researchers compared the outcomes of surgeons who had been reported by coworkers for unprofessional behavior with surgeons with no such reports.
Patients of surgeons who had one to three reports of unprofessional behavior had an 18% higher risk estimated for complications. Patients whose surgeons had four or more reports had a nearly 32% higher estimated risk compared to patients whose surgeons had no reports.
There was no difference in the percentage of patients who died, were readmitted within 30 days, or who needed additional surgery, according to the study, which was published in JAMA Surgery.
The unprofessional behaviors included shoddy operating room practices, disrespectful communications with coworkers, and failing to follow through on professional responsibilities, such as signing verbal orders, the study said.
The patients of disrespectful surgeons were also more likely to have complications such as wound infections, pneumonia, blood clots, renal failure, stroke and heart attack.
“It’s really about common sense,” study senior author Gerald Hickson, MD, said in comments accompanying the study. “Unprofessional behavior modeled by the team leads reduces the effectiveness of the team.”
“If someone is disrespectful to you, how willing are you to share information or ask for advice or help from that individual?” he said.
Women surgeons were much less likely to have unprofessional conduct reports leveled against them than were their male colleagues, the study found.
The good news, the researchers said, is that rude behavior can be corrected.
“Future work should assess whether improved interactions with patients, families and co-workers by surgeons who receive interventions for patterns of unprofessional behavior are also associated with improved surgical outcomes for their patients,” the study concluded.
Urban Institute study finds low-income, working people in Medicaid expansion states would be hardest hit.
More than 20 million nonelderly people will find themselves uninsured if an appellate court invalidates the Affordable Care Act, according to a new study from Urban Institute.
Most of those losing coverage would be young adults, or from lower-income, working families earning below 200% of the federal poverty level, or $12,490, for one person. Most of those people had gained coverage through the Medicaid expansion, which would be nullified if a federal appeals court sides with the 18 plaintiff Republican states in Texas v. United States, the study found.
Invalidating the ACA would also bump the nonelderly uninsured rate from its current 11% to 18%, with a total of 50.3 million people uninsured nationwide, the study said.
"Eliminating the ACA would be a major step backward for the millions of people who gained affordable healthcare coverage this decade," John Holahan, Institute Fellow at the Urban Institute, said in a media release. "Without access to the ACA's health and financial benefits, more low- and middle-income people would face higher financial burdens and less access to necessary medical care."
U.S. District Judge Reed O'Connor last December declared the entire ACA invalid, as the plaintiff states had requested. The ruling was appealed to the 5th U.S. Circuit Court of Appeals by a California-led 21-state coalition. Oral arguments are scheduled for July 9 in New Orleans.
The plaintiff states in Texas v. United States, led by Texas Republican Attorney General Ken Paxton, say the ACA was invalidated in its entirety when Congress eliminated the law's individual mandate, which they claimed was inseverable.
Led by California Democratic Attorney General Xavier Becerra, the intervening states say the Texas-led plaintiffs have no standing to challenge the individual mandate, because no plaintiffs were injured by the provision when Congress eliminated the tax penalty for failing to buy insurance.
Even if the lower court's ruling on the unconstitutionality of the individual mandate is upheld, the intervening AGs argue that the provision could still be cut from the ACA because Congress kept every other provision of the act when it cut the tax to zero.
Becerra's spokesperson, Sarah Lovenheim, said the Urban Institute report offers more evidence that eliminating the ACA "would wreak havoc on our entire American healthcare system, risking lives in every state."
"The Trump Administration claims it cares about the health and wellbeing of our families but all we have seen is repeal without replace," she said. "More than 133 million Americans with preexisting conditions rely on the ACA for access to affordable care and coverage, regardless of their background."
According to the Urban Institute study, eliminating the ACA would:
Increase the number of uninsured by 92% across the 34 states that expanded Medicaid, and 38% in non-expansion states.
Increase the number of uninsured by 71% among people with incomes under 138% of the federal poverty level, (annual income less than $16,753 for one adult), and 72% among those with incomes between 138% and 200% of FPL (annual income between $16,753 and $24,280 for one adult).
Increase the number of uninsured by 9.4 million non-Hispanic white people and 3.2 million black people.
Initially, the Trump Administration's DOJ offered a partial defense of the ACA before O'Connor, arguing that most of the sprawling healthcare legislation should remain intact, even if the ACA's individual mandate were to be struck down in light of Congress zeroing out its tax penalty.
O'Connor's ruling invalidating the ACA went much further than what DOJ had urged. Earlier this year, however, DOJ reversed course and notified the appeals court that it agrees with the plaintiffs' argument and O'Connor's ruling, and would entirely abandon its defense of the ACA.
A survey shows most providers believe they have the capacity to assume more risk and will do so within the next three years.
Hospitals and health systems are ready to take on more risk in contracts with commercial insurers, Medicare and Medicare Advantage, a new survey shows.
A Navigant-commissioned survey of 170 hospital senior finance executives found that 72% of them believe they have the capacity to take assume more risk, and will do so within the next three years.
Of those planning to assume more risk, 64% said they would do so with commercial payers, 57% said they'd do so with Medicare value-based models, and 51% said they'd do it with Medicare Advantage, the survey found.
The survey also found growing enthusiasm for partnering or starting provider-sponsored health plans under the risk-assumption strategy, with 44% of executives saying their hospital is already part of a PSHP and 19% say they plan to start one.
Navigant Managing Director Richard Bajner says the Affordable Care Act was supposed to make risk-based models "the new normal," but that didn't happen as quickly as anticipated. Nonetheless, providers appear to be accepting the inevitability of risk-models.
"With most health systems anticipating continued downward pressure on margins, accepting risk can represent a lever for revenue growth," Bajner says, "as long as providers clarify internal accountabilities and commit enough of their resources to risk models."
"These results show the value-based movement may be coming full circle, and this time providers will benefit from previous experiences in designing their approach," he says.
For those health systems that are taking on more risk, 62% said their biggest capital outlay will go toward improving technology. In addition, more than half of the respondents said they would work toward improving physician and patient engagement in the risk-based models.
The survey found that other factors that are driving the move toward risk include the growth of the Medicare rolls, which are adding 10,000 new enrollees every day, a decline in inpatient services, and consumer demand for coordinated care.
Of the hospital leaders who said they would not increase risk levels, 56% blamed a lack of local market demand, and 42% said operational obstacles, such as contract execution and care coordination and management, challenged their capacity.
Vath has served as interim-president and CEO at the six-hospital health system since March, when then-CEO Mike McBride was fired after a little more than one year on the job.
"Character in the face of adversity is often a true test of leadership," Sister Barbara Arceneaux, Regional Minister, Franciscan Missionaries of Our Lady, said in a media release.
"I will always be grateful for Dr. Vath's willingness to quickly step into an interim role as our health system leader earlier this spring. He is an advocate for Catholic healthcare and the unique opportunities we have to be the face of Christ to each person, especially those most in need," Arceneaux said.
The Franciscans health system fired McBride – without a vote of the board – in March, after 13 months on the job.
"Mr. McBride’s approach to his role as the leader of our system was not in keeping with our values and culture," Arceneaux told The Advocate at that time.
"The Sisters have the authority to take this action and, while unusual, we did so only after much prayer and discernment and continued communication with Mr. McBride about collaboration and the inclusion of others as demonstrating respect and shared responsibility," she said.
A day after McBride was fired Franciscan Health System Board Chairman James Moore Jr. resigned.
The leadership shuffle comes as Franciscan is finalizing a transfer of sponsorship of St. Dominic Health Services from Dominican Sisters. Upon completion of the transfer this summer, St. Dominic's will become part of the Franciscan Missionaries or Our Lady Health System.
Vath joined Franciscan in 2006 after two decades of private practice in pulmonology. He has served as chief medical officer at Our Lady of the Lake Regional Medical Center in Baton Rouge before joining the health system as its chief transformation officer.
Big Blue and subsidiary Cúram Software allegedly made promises about their IT platform capabilities that they couldn't back up.
IBM Corp. and subsidiary Cúram Software Ltd. will pay $14.8 million to settle allegations that the vendors made "misleading statements" about the abilities of an IT platform they sold the Maryland Health Benefit Exchange, the Department of Justice said.
IBM bought Cúram Software on Dec. 19, 2011. On that same day, Cúram submitted its Cúram for Health Care Reform software proposal to Maryland to support its HIX.
On Jan. 5, 2012, with IBM’s knowledge, Cúram pitched its product to Maryland officials, promising that its platform could provide a plethora of services, including interoperability with other software, eligibility determinations for health assistance coverage, calculating applicable tax credits, and changes in life events.
Maryland awarded the contract to Cúram a month later, paying for the services with grants from the Department of Health and Human Services, DOJ said.
Allegedly, the software did not work as advertised.
From 2011 through mid-2014, DOJ said the vendors misrepresented the ability of the snafu-plagued software to meet the state's technical and interoperability requirements.
"After repeated problems following the launch of the HIX website in October 2013, Maryland, acting through MHBE, terminated the contract and replaced the HIX website and IT platform, including the Cúram software," DOJ said.
"Making misleading statements to win contract awards violates fundamental tenets of government contracting and harms the government and taxpayers," Assistant Attorney General Jody Hunt for DOJ's Civil Division, said in a media release.
The settlement is the latest setback for IBM's venture into the healthcare space. The company's Watson Health has been plagued by problems and overpromises that have come back to haunt the subsidiary since its inception.
When IBM bought Curam in 2011, the computer giant said the acquisition "expands IBM's ability to help cities and governments serve citizens better by adopting more intelligent and efficient ways to assess needs, execute social programs, and maximize program results."
The Urban Institute estimates the savings that come with a public option health plan, capping provider payment rates, and financial aid for the middle-class.
The federal government could save $12 billion and add 1.2 million people to the health insurance rolls if it adopted initiatives that include a public health plan option, according to a new analysis from the Urban Institute.
The public option, along with capping provider payment rates, and offering targeted financial assistance to middle class families, would lower premiums and out-of-pocket costs by $9.2 billion.
The initiatives would also cut the cost of individual insurance premiums by $200 a month—2% of the current cost—for people earning more than $49,960 a year (400% of the federal poverty level), according to the study, which was commissioned by the Robert Wood Johnson Foundation.
"Creating a public option or capped provider payment rates along with extending financial assistance to middle-class Americans would make a significant difference in improving healthcare affordability for millions of consumers," Linda Blumberg, Institute Fellow at the Urban Institute, said in a media release.
Medicare for All and public-option health plans are getting a lot of media play as the Democratic candidates for president jockey for position, but it's almost certain that no action would be taken on either sweeping reform before then 2020 election. And even then, Democrats would likely have to control the House, the Senate, and the White House.
Former Vice President Joe Biden, currently leading Democratic presidential candidates in the polls, has rejected single-payer but he supports a public-option plan as a workable alternative. Other candidates, including Sen. Bernie Sanders, I-Vermont, are calling for Medicare for All, although the Democratic Socialist has yet to say how much it will cost, or how he'd pay for it.
Democratic-controlled states have attempted to implement public option plans, but have been hobbled by costs and political pressure. The Connecticut House earlier this month overwhelmingly passed a public-option bill, but a watered-down version stalled in the Senate. Proponents of the legislation said it was kneecapped by powerful insurance companies that threatened to leave the state if the bill was passed.
The Urban Institute's Blumberg said a public plan could reduce premiums in the non-group insurance market by setting payment rates for healthcare providers at Medicare levels.
Or, private insurers selling individual coverage in Affordable Care Act marketplaces could see their payment rates capped at the same levels.
Either approach would best help rural areas with scant competition among health, and low-earning, older adults who are now ineligible for premium assistance. However, the reforms would also require larger prescription drug rebates in the non-group market, the study said.
"These two reforms alone wouldn’t address every gap in America’s health care system," Blumberg said, "but would provide significant savings for people in areas where premiums tend to be higher and for some people ineligible for ACA tax credits today. Importantly, the two reforms combined would not require new sources of federal revenue."
Feds say the new rule will benefit 800,000 employers, and more than 11 million employees and their families, including 800,000 previously uninsured people.
The Trump Administration on Thursday released a final rule that expands access to tax-free health reimbursement arrangements (HRAs) for employer-sponsored health insurance.
The new rule – released jointly by the Treasury Department, Department of Labor and the Department of Health and Human Services – lets employers offer HRAs that workers can use to pay premiums for Medicare Parts A, B, C, D or Medigap policies, or to buy coverage in individual markets.
The rule, which takes effect in January 2020, also creates a "limited excepted benefit" HRA for alternative health plans outside of an employer-sponsored plan, and eliminates an Obama-era Treasure rule that blocked HRAs that were not part of a comprehensive employer-sponsored plan.
The Trump Administration estimates that the new rule will benefit about 800,000 employers, and more than 11 million employees and their families, including 800,000 previously uninsured people.
"The HRA final rule offers millions of American workers more health coverage choices and portability," Labor Secretary Alex Acosta said in a media release. "HRAs create a great opportunity for job creators to support their employees and for those employees to be empowered to make the best healthcare decisions for their families."
Critics contend that the proposalcould allow employers to push higher-risk employees away from company-sponsored coverage and into individual coverage offered through the Affordable Care Act's Marketplaces.
The Trump Administration says there are conditions built into the proposal to "mitigate the risk that health-based discrimination that could increase adverse selection in the individual market." Those conditions include a disclosure provision to ensure employees understand the benefit.
Chad Brooker, associate principal at Avalere Health consultants, says the final rule "underscores the administration's focus on granting employers and individuals enhanced flexibility, including tax-advantaged account-based benefits."
"Long term, this added flexibility may reshape a significant number of employer coverage offerings and result in sizable shifts from employer to individual coverage," he says.
Other observers are less enthusiastic.
Kim Buckey, vice president of client services at DirectPath, says she doesn't believe the HRAs will "see much interest from large employers, as the plans they already offer provide them with a competitive advantage."
"Small to midsize employers seeking to provide some level of support for their employees and to avoid the employer mandate penalty may well be interested if they are not put off by the compliance and administrative aspects of setting up an HRA," Buckey says in an email exchange with HealthLeaders.
Furthermore, the response to the HRAs could be tepid from healthcare consumers, Buckey says, who are already "baffled by health insurance" and rely on their employers to narrow their choices.
"Employers who back out of this 'contract' may face some substantial employee relations issues as well as attraction/retention challenges," Buckey says. "If employers are considering the DC approach to health care, they’d better be willing to commit to a lengthy and robust communications campaign to ensure that their employees understand what it is they are buying, and how to shop effectively (not just on premium cost)."
DOJ said the developers of the 106-bed Lakeway (Texas) Regional Medical Center 'participated in a scheme to improperly obtain the FHA-insured loan.'
Four development companies and their executives will pay the federal government $1.1 million to settle allegations that they improperly obtained and distributed money from a Federal Housing Administration loan for a Texas hospital project, the Department of Justice said.
DOJ said the developers of the 106-bed Lakeway (Texas) Regional Medical Center "participated in a scheme to improperly obtain the FHA-insured loan by delaying refunds to investors who had cancelled their investments to make it appear as if the project satisfied mortgage covenants regarding the cash on hand required to close the loan."
The developers named in the settlement are San Diego-based Pacific Medical Buildings LLC, PMB Lakeway LLC, RD Development Partners LLC, Lakeway Management LLC, J&L Rush Family Partnership LP, Jeff Rush, and Brad Daniel.
The settlement also resolves allegations that the developers took "impermissible distributions of project funds," DOJ said.
The FHA backs loans to build hospitals in underserved areas.
"It is deeply disconcerting when industry professionals, who have fiduciary responsibilities and are expected to act as honest brokers, exploit federal programs created to aid legitimate medical facilities," said Robert Kwalwasser, with the Housing and Urban Development Office of Inspector General.
PMB issued a statement saying it is "extremely proud of the work it was contracted to complete on the Lakeway Regional Medical Center."
"With respect to the settlement, it was the most cost‐effective way to resolve allegations which PMB, Jeff Rush and Brad Daniel deny," the statement read. "Indeed, the settlement signifies no finding of wrongdoing on the part of the parties, and specifically no finding that their behavior in anyway undermined federal insurance programs."
Lakeway Regional Medical Center suffered financial difficulties soon after it opened in 2012, and defaulted on a $164 million HUD loan in August 2013, In September 2016, HUD sold the defaulted for $50 million according to The Austin American Statesman.
The health system issued a statement noting that "these allegations have nothing to do with Baylor Scott & White Health or the hospital it operates as Baylor Scott & White Medical Center – Lakeway. These allegations relate to matters that occurred long before we acquired the operations of this hospital."
A cardiologist with a history of False Claims Act settlements says the federal government is abusing the whistleblower process.
Wichita, Kansas cardiologist Joseph P. Galichia, MD, has a beef with the Department of Justice.
Galichia – who last week paid $5.8 million after negotiating his third False Claims Act settlement in 20 years – says the federal government is abusing the whistleblower process, and using it to take back money that was rightfully earned by physicians and hospitals.
"Unfortunately, the federal government has chosen to solve its financial problems with Medicare by pursuing physicians, hospitals, and other healthcare providers to seek reimbursement of money paid for legitimate patient care," Galichia says in a media release this week.
He's asking Congress to investigate "the DOJ's flawed probe, according to board certified experts based on a whistleblower's civil action, and the effect that questionable legal precedents are having on cardiologists nationwide."
"This national trend of accusing providers seriously interferes with the patient-physician relationship and leaves many patients without the care they need because physicians and other providers are intimidated by the risk of a fraud allegation by the federal government," he says.
DOJ said in a media release last week that Galichia improperly billing federal healthcare programs for medically unnecessary balloon angioplasties from 2008 through 2014.
The settlement stems from a whistleblower lawsuit filed by Aly Gadalla, MD, that the federal government joined in 2014. Gadalla will get $1.16 million from the settlement, DOJ said.
"Performing medically unnecessary procedures puts patients at risk and defrauds federal health care programs," said Stephen McAllister, U.S. Attorney for the District of Kansas.
Despite the settlement, Galichia "firmly denies" the allegations, and referred to Gadalla as "a disgruntled former employee who started the entire action and is not even a cardiologist."
Galichia claims he settled "only because, after seven years of cooperating with the investigation, the action was taking up far too much time and energy."
"Further, it simply became too costly to keep defending against these false accusations," he said. "The federal government decides, after the fact, what care the patient should have received, second-guessing the physician and the patient regardless of the health or satisfaction of the patient."
Galichia says his patients weren't in danger because they got the correct care, a claim that he says is supported by "expert interventional cardiologists" who reviewed the government's 100 cases against him and "unanimously agreed that our treatment was appropriate."
The former two-term president of the International Society of Cardiovascular Interventionists settled claims alleging improper documentation in 2000, and again in 2009, agreeing to pay the federal government $1.5 million and $1.3 million, respectively, to resolve the allegations.
Galichia's attorney, Gary Ayers, said "disgruntled whistleblowers and their lawyers" are incentivized to make "false allegations" with the hope of cashing in on a big settlement.
"The government pays a physician 'expert' to second-guess another physician's medical judgment, then alleges this supposed disagreement over treatment is fraud," Ayers said. "In Dr. Galichia's case, the government's 'expert opinion' was absolutely wrong according to four independent, board-certified interventional cardiologists who reviewed the same cases."
Ayers said that "hundreds if not thousands of providers across the country have experienced this same phenomenon."
"Congress needs to reign in the federal government's overreaching and abusive behavior, because it puts patients at risk of not receiving the medical care they need and deserve," Ayers said.
A new study challenges the rationale used to reject the use of vital organs harvested from deceased opioid users.
One morbid benefit of the long and deadly opioid epidemic that claims tens of thousands of lives every year in the United States is an increase in available human organs for transplant.
Now, a new study in The Annals of Thoracic Surgery shows that the hearts removed from overdose death donors (ODD), who often tend to be younger and healthier, provide "favorable heart donor quality" and as-good-or-better outcomes than organs harvested from donors who died from other causes.
"One of the roles of the transplant community is to at least partially mitigate the tragedy of this exponentially growing problem by maximizing the utilization of organs from ODD," said study lead author Nader Moazami, MD, of NYU Langone Health in New York, in accompanying remarks.
Using data from the Scientific Registry of Transplant Recipients for the years 2000 to 2017, Moazami's researchers looked at trends in organ donation and transplants among drug overdose deaths.
Of the nearly 16,000 heart transplants from adult donors during this period, opioid overdoses (10.8%) were the fourth most common cause of death, behind blunt injury (30.5%), hemorrhage/stroke (22.1%), and gunshot wound (18.3%).
The statistics from the opioid epidemic are staggering. More than 700,000 people died from drug overdoses between 1999 and 2017, including about 400,000 people who overdosed on an opioid. More than two-thirds (68%) of the nation's 70,200 drug overdose deaths in 2017 involved an opioid. On average, 130 people die every day in the United States from an opioid overdose, according to statistics cited by the Centers for Disease Control & Prevention.
In 2017, according to Moazami's research, overdoses accounted for more than 20% of donor deaths in 11 states. In 2000, the highest state's rate was 5.6% and 33 states had less than 1% of donor deaths attributed to overdoses.
A record 36,500 organ transplants were performed in 2018, and 3,400 of those were heart transplants. Even with the influx of new donors, however, the demand for vital organs far outstrips the supply. On average, 18 people died every day waiting for an organ transplant in 2017, according to the United Network for Organ Sharing.
The researchers also saw a hike in the percentage of transplants that utilized ODD hearts: 1.1% in 2000; 6% in 2012; and 14.2% in 2017. The current rate of ODD utilized for heart transplantation is 16.9%, a 14-fold increase from 2000.
"The dramatic increase in the rate of ODD utilization was striking, and it has increased concordantly with the rate of overdose deaths," Moazami said. "The significant impact of the opioid epidemic on transplantation is one of the major reasons that organ transplant numbers have increased over the last several years."
Donors who died from opioid overdoses were often younger than age 40 and had higher rates of substance abuse. They also had lower rates of diabetes and hypertension. Because of that, Moazami said that ODD organs had "favorable heart donor quality" and as-good or better outcomes than non-overdose organs.
"We do not believe that overdose status alone is a valid reason to discard an otherwise viable donor heart, and this study supports that ODD organs should not be rejected due to inappropriate bias," he said.
"With no significant difference in survival between ODD and non-ODD recipients, further expansion of this donor pool may be appropriate, with more hearts potentially used for transplantation," he said.
The opioid epidemic has also increased the numbers of other vital organs available for donation, Moazami said. ODD provided 7% of the transplanted lungs from 2010-2017, up from 2% in 2000-2007. And as with the findings on the heart donors, the research suggests that ODD lungs are not an extra safety concern for recipients.
The recent surge in hepatitis C contamination and its correlation with drug use has raised concerns about the safety of using organs from overdose death donors. Moazami said that medical advances and sophisticated testing have minimized the risks of transplanting an infected organ.
Robert S.D. Higgins, MD, surgeon-in-chief of The Johns Hopkins Hospital in Baltimore, who was not involved in the study, said Moazami's findings "highlights the need for additional research in this area to further define the 'risk' as well as the reward of expanding the donor pool to save more lives."
