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Probe suggests Joint Commission accreditation a joke

The Joint Commission, the accrediting organization for about 80 percent of U.S. hospitals,  rarely revokes its approval of facilities out of compliance with Medicare rules, reports The Wall Street Journal.

The WSJ, after digging into  Joint Commission inspection reports from 2014 through 2016, found that in 2014, about 350 hospitals with Joint Commission accreditation had violated Medicare requirements that year, and about a third had additional violations in 2014, 2015 and 2016.

The paper reported that the commission  revoked accreditation for just 1 percent of hospitals out of compliance with Medicare. More than 30 hospitals retained their accreditations even though the Centers for Medicare & Medicaid Services found their violations important enough to cause, or likely cause, serious patient injury or death.

“It’s clearly a failed system and time for a change,” said Ashish Jha, M.D., a health policy researcher at Harvard’s T.H. Chan School of Public Health and a practicing internist, told the paper.  The probe “shows accreditation is basically meaningless—it doesn’t mean a hospital is safe.”

To read more, please hit this link.

Parlor games to strengthen clinical teams

— Photo by Jennifer Belaco

Fred Pelzman, M.D., a New York primary-care physician, writes about how to make a better clinical team with higher morale, “at the cost of a truth and a lie” at some nice parties.

He writes:

“Lately, I’ve felt sort of giddy, as our team may have discovered the secret sauce, the magic that might make us work better together.

“Believe it or not, we call these Color Group Socials.

“Our practice is divided into the Red, Green, Blue, Purple, and Yellow teams, and each area has a practice leader.

“On our administrative morning, when the practice is closed, we divide up into our separate areas and everyone gathers in the waiting areas where patients usually sit, and we play parlor games.

“It has been remarkable to watch how much fun everybody has, how relaxed everyone is, and how the barriers between us all fall away, as we play something as simple as A Truth and A Lie.

“Everyone writes down on a slip of paper something true about themselves, and something false. Then everybody has to try to guess who wrote which, and which is the truth and which is the falsehood.

“Everyone ends up laughing and having a great time, and we’ve learned that people have amazing lives beyond the walls of the office, beyond the roles we fill when we come to work.”

To read his essay, please hit this link. 

Physicians’ attitudes on over-treatment


A survey published in PLOS ONE gives  physicians’ perspective on over-treatment.  Of the  2,327 respondents, nearly 85 percent cited fear of malpractice suits as a major cause of unnecessary care. They  cited  pressure from patients  59 percent of the time, and around 38 percent referenced issues regarding access to medical records.

Daniel Brotman, M.D., professor of medicine at Johns Hopkins University School of Medicine, and one of the report’s authors, wrote: “Interestingly, but not surprisingly, physicians implicated their colleagues (more so than themselves) in providing wasteful care. This highlights the need to objectively measure and report wasteful practices on a provider or practice level.”

In the course of the survey, researchers also solicited potential solutions to the problem from physicians. The top three responses, as summarized by FierceHealthcare:

  • “Improve training for medical residents so that they monitor specific criteria related to the appropriateness of a given procedure, test or prescription.
  • “Continue to work to improve access to health records so that physicians have the information they need to make fully informed decisions about necessary tests and treatment.
  • “Improve guidelines for evidence-based care practices, so that doctors and patients can refer to a scientific basis for the best avenue of treatment for a given diagnosis.”

To read the survey article, please hit this link. To read the FierceHealthcare commentary on it, please hit this link.



How insurers ‘set up patients to fail’


David Russo, M.D., an Oregon psychiatrist, writes about how insurers set up patients to fail.

He writes in the (Portland Oregonian):

“Here’s how it works: First, a doctor comprehensively evaluates and diagnoses a patient’s health condition and counsels them about the benefits and trade-offs of various treatments. Then, the doctor prescribes a therapy best suited to the patient’s condition. But, more often these days, patients are stymied by the insurance company’s denial of the physician’s plan. Making matters worse, insurers will only approve the physician’s plan after the patient proves that they ‘failed first’ on the insurance company’s preferred alternative.”

“Patients shouldn’t suffer at the hands of insurance providers’ cost-cutting measures. It wasn’t Edison’s failure to first improve the candle that led to his breakthrough invention of the light bulb. When my patients fall victim to the arduous step therapy system, I join forces with them to battle the approval processes until they receive coverage for the right treatment plan — without substitutions.”

To read more, please hit this link.


Sutter shifting 10,000 Medi-Cal patients to FQHCs


The Sacramento Bee reports  that  Sutter Medical Group is shifting about 10,000 adult Medi-Cal {the state Medicaid program} enrollees with Anthem Blue Cross  to primary-care physicians at Federally Qualified Health Centers.

Ken Ashley, M.D., the medical director for primary care at Sutter Medical Group, asserts that  the change in providers will give the patients  access to more services.

“Some of the things that the (community health centers) can provide with the funding that they are receiving are things that sometimes we struggle to find for our Medi-Cal patients, things like optometry and dental, behavioral medicine,” Dr. Ashley told The Bee. “I feel like these patients are finally going to receive things I could not provide as their primary-care doctor. I’m OK with our partners helping to take care of these patients.”

He noted that the huge increase in the number of new patients as a result of the Affordable Care Act   has put great pressure on many providers as they seek to make appointments available. Meanwhile, the ACA has made more resources available to FQHCs.

Sutter, Dignity Health, the University of California at Davis and other providers have  contributed funding and expertise to expand the network of the FQHCs, the newspaper reported.

To read more, please hit this link.



Video: Addressing rural staffing shortages

Video: Benjamin Chaska, M.D., chief medical officer of Catholic Health Initiatives’s North Dakota/Minnesota Division, discusses CHI’s team-based strategy to deal with rural staffing shortages. He advises thinking long term.

To watch the video, please hit this link.


How to ensure Medicaid patients have enough access to specialists?


Michael H.  Katz, M.D.,   writes in JAMA:

“Timely access to specialists has been a longstanding concern for patients with Medicaid compared with patients who have private insurance. Thus, instituting requirements that Medicaid managed care plans adhere to timeliness and proximity standards seems like an excellent solution to a longstanding problem. However, as with so many things in health care, the issue is more complicated.”

To read his essay, please hit this link.


The powerful benefits of clinical ‘design thinking’

Amitha Kalaichandran, M.D., a hospital resident physician and journalist based in Toronto, writes in The New York Times about the growing attraction of “design thinking” by clinical teams. (Cambridge Management Group has done a lot of work in such design thinking.)

Dr. Kalaichandran  writes: “In recent years, a growing number of healthcare workers have been stepping up to create innovations by applying ‘design thinking’ – a human-centered approach to innovation that was originally developed in the business world to create new products. Traditionally, hospitals were designed with input from administrators. With design thinking, the innovations come from those who actually work there, providing feedback to designers to improve the final product.

“A 2016 report that looked at ways in which a health system can implement design thinking identified three principles behind the approach: empathy for the user, in this case a patient, doctor or other health care provider; the involvement of an interdisciplinary team; and rapid prototyping of the idea. To develop a truly useful product, a comprehensive understanding of the problem the innovation aims to solve is paramount.”

As an example of what can come out of design thinking by clinical teams, Dr. Kalaichandran writes that:

“The leader of our trauma team  now wears an orange vest.

“The easy-to-spot garment, called the trauma team leader identification vest, clearly identifies who’s in charge. It’s a simple yet effective innovation created by a nurse after a hectic gunshot trauma simulation, in which a huddle of highly stressed emergency room staff members spoke over one another and there were no clear roles. In particular, no one knew who was leading the trauma code. The orange vest became routine part of emergency care at our hospital earlier this year, and the trauma team reports it has helped clarify who’s in charge and strengthened communication among members.”

To read more, please hit this link.

The more covered lives the better for America


Jonathan H. Burroughs, M.D.,  a fellow of the American College of Healthcare Executives and the American Association for Physician Leadership, discusses in Hospital Impact the importance of having as broad a patient base as possible in private- and public-sector insurance plans.

He poses the question:”Why are covered lives so important, and why should America pursue the ultimate goal of 100 percent healthcare insurance coverage rather than the ‘freedom from obligatory coverage’ that seems to have politicized the healthcare reform movement in the last decade?”

He answers:

  1. “Health insurance is more affordable if everyone participates.”

“In any population of covered lives—be it Medicare, Medicaid or commercial coverage—the rate of spending forms a pyramid, with the top 1% of people (with life-threatening diseases and injuries) making up 23% of the total spend and the top 5% (with multiple chronic diseases) making up almost 50% of the total spend. The healthy 50% of the population, which spends very little (less than 7%), makes up the base of the pyramid and provides the premium payments that enable the top 5% to receive care.”

  1. “Everyone pays for uncovered lives.”

“Next time you visit your local community hospital, you should ask healthcare administrators what their charity care and bad debt rate is and how they pay for it. If they are honest, they will tell you, you do that through cost shifting. What is cost shifting? It is paying $2,000 for a CT scan that costs the hospital $300 per unit volume to do. It is paying $500 for a medication that costs the hospital $25. It is paying an emergency medicine charge of $600 for a physician who gets paid $200/hour by the hospital, including benefits.”

“In other words, since any economic entity cannot afford the significant percentage of charity care (inability to pay) and bad debt (unwillingness to pay), it shifts that liability to the consumer through higher rates. Some organizations cost shift to the tune of more than 500%: Each individual who pays covers the costs of four other people who cannot.”

  1. “The average working American is one serious illness away from personal insolvency.”

“Healthcare is now the No. 1 cause of personal bankruptcy among working Americans. The average American family has approximately 90 days of cash on hand, which means that following removal of all paychecks, the average family would only have enough assets (including life savings, mortgage and retirement) to cover their costs for three months. An unexpected, life-threatening illness such as cancer can have a devastating impact on a family’s finances and place people in terrible conflict by having to choose between their family’s economic security and a person’s ability to survive.”

  1. “Health is the great economic stimulant.”

“You cannot work when you are unhealthy. Ask any large employer, and they will tell you that the costs of presenteeism (coming to work when ill and not being able to do your job) are even greater than the costs of absenteeism (not coming to work at all).”

“Meaningful healthcare reform will only be possible with more covered lives and more affordable coverage in a business model that is sustainable for all economic entities and stakeholders. The unfortunate trend of Democratic or Republican cabals negotiating secretly into the night is not a constructive model for change. It will only continue to divide the nation and fail to create the type of healthcare system that the country desperately needs.”

To read more, please hit this link.


An upbeat look at physician-owned practices


There are grounds for optimism about the future of physician-owned practices as seen in the AMA’s most recent Physician Practice Benchmark Survey, says Aledade co-founder and CEO Farzad Mostashari, M.D., in a post in Healthcare Dive. Among his remarks:

“First, probably the most interesting quantitative and qualitative points of the report came in a section on hospital ownership. In 2014, the survey found that about a third of physicians were either directly employed by a hospital or in a hospital-owned practice. In 2016, that share had not changed.”

“Not only had the proportion of physicians in hospital employment flatlined, but the rate at which hospitals were buying up practices had slowed. In 2014, 24.5% said that a hospital had purchased their practice in the past five years. In 2016, that dropped to 21%.”

“Hospital acquisitions have flatlined. Most physicians are working in small practices. Physician ownership is still the dominant model. And this is good news for our healthcare system’s movement to a value-based payment future.”

“Small, physician-owned practices offer more personalized care and are more responsive to patient needs. They have lower average costs per patient, fewer preventable hospital admissions, and lower readmission rates than large, hospital-owned practices. And primary care doctors can influence up to 85% of downstream costs in our nation’s healthcare system.”

“The simple fact is that the data from AMA shows that small, physician-owned practices are neither irrelevant nor are they going extinct. In fact, they’re in the best position for a new era of better healthcare at lower costs. ”

To read more, please hit this link.


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