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The scary approach of the weekend in the hospital

January 29, 2015by Robert Whitcomb in Uncategorized tagged ,

 

In  a New England Journal of Medicine piece, Perri Klass, M.D., talks of her anxiety, in looking after her now-late mother’s care in a hospital, as the  weekends approach and so  much of  the hospital closed down, leaving patients vulnerable and family caregivers scared.

“I would start feeling tense every Thursday afternoon, every Friday morning, staving off panic by displaying a slightly frenetic need to get consults done, problems reassessed, orders written. I would waylay consultants, try to pin down residents about when they could come by and when they planned to sign out, press the nurses to page the attendings. I became one of those people I would have hated to encounter on a Friday afternoon….

….”I felt scared, as Thursday turned to Friday and the dark clouds gathered; I could feel the staff signing out, the hospital slowing down around us, and the weekend closing in.”

Will the understaffing on weekends of hospitals continue or even worsen with the Affordable Care Act and the flood of aging  and ailingf Baby Boomers swells.

Dramatic fraud trial about shut Chicago hospital

January 28, 2015by Robert Whitcomb in Uncategorized tagged ,

 

The Chicago Tribune reports that a federal prosecutor at a fraud trial charged that  greed-driven {administrators and physicians} at a now-closed Chicago institution, Sacred Heart Hospital,  grossly violated patients’ trust.

”But attorneys for two of the three former administrators on trial told jurors said underlings were to blame for the wrongdoing,” reported the Tribune.

The newspaper reported that ‘Federal authorities raided the hospital in 2013 amid bombshell allegations that doctors were performing medically unnecessary tracheotomies and giving heavy sedation to patients in a process called ‘snowing.’ At least five deaths at the hospital had been under scrutiny at one time, authorities said.”

”But when the indictment came six months later, none of the allegations involving patient deaths or oversedation was leveled against any of the defendants.”

”Prosecutors instead focused on kickbacks they allege were paid out on nearly every level to fill empty beds — with administrators doling out cash and gifts to physicians, ambulance companies, nursing homes and even van drivers. Physicians received kickbacks disguised as rent payments or teaching fees, according to prosecutors.”

 

 

 

Will they cut non-primary-care physicians’ fees?

January 28, 2015by Robert Whitcomb in Uncategorized tagged , , , ,

Medical Economics reports that the Medicare Payment Advisory Commission (MedPAC)   will recommend a 1.4 payment cut in 75 percent of non-primary care services in Medicare’s Physician Fee Schedule  in a bid  to continue funding a 10 percent bonus payment for primary-care physicians that expires at the end of 2015.

The American Academy of Family Physicians reported that MedPAC Commissioner Kathy Buto, MPA, said “I’ve been involved with the fee schedule from the start, and there’s never been a year when primary care was funded in a way that was appropriate.” AAFP said that she  suggested valuing primary care separately from specialty care covered by Medicare.

Commissioner William Hall, M.D., questioned whether the bonus payment is enough  to fix the problems with primary care. “If we double the salaries of primary care physicians, we would get more people in primary care, but we would have little or no impact on the system of care that people on Medicare need,” AAFP reported.

Nonprimary-care physicians have good lobbyists in Washington, D.C., too, so it’s hard to predict that their fees will be cut.

Big payers, players join to push ‘Triple Aim’

January 28, 2015by Robert Whitcomb in Uncategorized tagged , , , , , , ,

“You can always rely on America to do the right thing, once it has exhausted the alternatives.”

— Winston Churchill

Some very big payers and providers have joined in the Healthcare Transformation Task Force formed to push  faster toward the “Triple Aim” of better patient care, better patient outcomes (which you’d think would follow from the better care) and reduced, or at least more controlled, costs. They include Partners HealthCare, Heritage Provider Network, Dignity Health and Premier Inc.

 

Members seek to move three-quarters of their business into value-based models and away from the unsustainable fee-f0r-service model that threatens to  bankrupt America. The fee-for-service models reminds us of “cost-plus” Defense Department contracts.

HCTTF members include six of top  U.S. 15 health systems  and four of the top 25 payers.

 

 

RIP: Stanley M. Aronson, M.D., medical leader, essayist

January 28, 2015by Robert Whitcomb in Uncategorized tagged , ,

How very, very sad  today to hear of the death of Stanley M. Aronson, M.D., at age 92 after a long battle with age and illness that did not diminish his mental acuity and his love of life.

Stan was a giant of medical education,  at Brown University and elsewhere, a distinguished leader in global public health, especially in developing nations, and an elegant, learned and delightfully idiosyncratic writer. He somehow combined joy, enthusiasm and even exuberance with a deep skepticism and  (I think) a basically tragic view of life. And then there was his   amusement  in absurd situations, including involving himself.

I knew him in  the various roles we each had over the years,  but especially because of our editor-writer relationship.

I  had been well aware of his distinguished career well before I became The Providence Journal’s editorial-page editor, in 1992.

But it was then, at the encouragement of my wife, Nancy, that we became friends after I hired him  to do a weekly column for The Journal’s Commentary pages on medicine, history, science, language and a few hundred other topics. My wife had  become a fan while reading Stan’s columns in  Medicine/Health Rhode Island, the  journal of the Rhode Island Medical Journal, where she had done some art and graphics work.

I left The Journal, except as a rarely read freelance columnist, in 2013, but my successor, Edward Achorn, also long a fan of Stan’s, has continued to run the columns, many of which have been reprinted in newspapers across America and Canada. Collections of his columns have comprised the contents of three books.

Stan continued to write these essays until his death:  His work ethic was the equal of  his other legendary attributes.  His work has enriched the lives of multitudes and will continue to do so. Meanwhile, his many friends will mourn him as long as they live.

How resonant it is that his Jan. 19 column for The Journal was entitled “And death shall have no dominion”.

 

— Robert Whitcomb

Administrators vs. the storm

January 28, 2015by Robert Whitcomb in Uncategorized tagged

blizz

Massachusetts hospitals display  creativity in addressing the challenges of a blizzard.

Oregon’s secret to healthcare reform

January 28, 2015by Robert Whitcomb in Uncategorized tagged , , , , ,

welcome

William A. Galston writes in a very important piece in today’s  Wall Street Journal that Oregon is so far succeeding with its 15 regional Coordinated Care Organizations  involving Medicaid patients “designed to break down the multiple ‘silos’ of health services and provide integrated, patient-centered  services with a focus on primary and preventive care.”

Oregon’s governor, John Kitzhaber, M.D., is leading the way in developing this national model of reform.

So far, the plan seems to be succeeding in saving money while improving healthcare delivery. If it goes on like this, says Mr. Galston, “the results would be revolutionary….for the country as a whole, implementation of the Oregon model could save Medicaid more than $900 billion over the next decade.”

Cambridge Management Group has been working  intensely in Oregon on coordinated-care community-health projects and is very pleased that Mr. Galston is touting what we at CMG also see as potentially revolutionary improvements.

He notes that the Center for American Progress suggests expansion of the Oregon model ”to cover all healthcare spending, public and private,” in the U.S.

 

Florida moves toward Medicaid expansion

January 27, 2015by Robert Whitcomb in Uncategorized tagged , ,

 

More and more it looks likely that Florida, despite its conservative politics, will expand Medicaid under the Affordable Care Act.  Big business associations — Associated Industries of Florida and the Florida Chamber of Commerce — are pushing for it in part because businesses could soon  be fine for failing to provide healthcare coverage to employees.

 

Also getting their attention are estimates by a state-hire consultant that Sunshine State hospitals could lose  $1.3 billion in federal funds to help hospitals treat poor and/or uninsured patients. This, The Miami Herald noted,  raises the possibility that legislators would have to raise  to replace those dollars. And higher taxes are anathema is very-GOP Florida.

 

 

 

 

 

Vast differences in costs in one market

January 27, 2015by Robert Whitcomb in Uncategorized tagged ,

 

hollywood

Even in the same geographical area,  hospital prices for routine knee- and hip-replacement surgeries vary vastly.

For instance, show that hip-replacement costs in the  Los Angeles-Long Beach market,  ranged from $17,260 to $46,448, say claims data from the Blue Cross  and Blue Shield Association.

How much will patients react to this long-suppressed information? Will many still favor the sexier academic hospital systems over the cheaper nonteaching hospitals now that new high-deductible plans give insured patients more financial skin in the game?

 

Tips for hospital social-media sites

January 27, 2015by Robert Whitcomb in Uncategorized tagged , ,

 

Scott Kashman, chief administrative officer of Cape Coral (Fla.) Hospital, and Nancy Travis, the hospital’s director of women’s services, write about how they use social media to promote the hospital.

One of the things that the hospital did was to start a hospital Facebook page.

Some of the ways they optimized social media to engage with patients:

  • ”We use our page to connect with our clients and families to post news of events that will be happening and to provide them with education on topics related to pregnancy and childbirth.
  • ”It allows us to get our message out to the community.
  • ”Social media provides patients and families another way to contact us prior to their admission or after discharge and ask questions and get a response quickly.
  • ”We celebrate the great things we do on our unit by sharing pictures with our followers.”

Here are some of their tips for  social-media sites:

  • ”Posts need to be made several times per week.
  • ”Activity needs to be monitored on a minimum of two times per day, but ideally more often.
  • ”People who are asking questions on social media want a response quickly.
  • ”Monitor the check-ins to your facility, respond to concerns or compliments and use it as a tool to promote exceptional patient experience.”

 

 

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