Cooperating for better care.

California Hospital Association

Tag Archives

‘We don’t live in patient-centered environment’

November 22, 2017by Robert Whitcomb in Uncategorized tagged , ,

By EMILY BAZAR

For Kaiser Health News

My dad was in excruciating pain over Labor Day weekend, so my mom rushed him to the emergency room of a renowned university hospital.

Doctors determined that he needed surgery that night, and luckily I was able to fly in and see him before he was wheeled away. “Take care of your mom if anything happens to me,” he said as my mom and I wept.

Thankfully, my dad made it through. But he had to spend 11 days recovering in the hospital, a place he now equates with prison.

One night, he suffered for five hours, desperately calling for help after his pain meds had run out. A nurse’s aide stationed in his room had fallen asleep.

“I called on the intercom so many times, and nobody showed up,” he recounts.

That was just one of the many failures in care that we encountered during my dad’s stay. Others included inconsistent nursing quality, waiting all day for doctors to respond to pages, insensitive communication of bad news, trying in vain to reduce noise levels so my dad could sleep, and so much more.

My job is to give you advice on health care and insurance issues. My mom is a registered nurse. Yet we both felt frustrated that we couldn’t make things better for my dad.

Unfortunately, this happens to a lot of people. “Everything you hear these days is about patient-centered care, this and that,” says Terry Bay, who owns a Casper, Wyo.-based business that provides advocacy services to older patients. But “we don’t live in a patient-centered healthcare environment.”

Today I’m going to offer advice for you in case you or a loved one lands in a hospital.

There are state and federal laws that cover, among other things, your rights to privacy, nondiscrimination, language interpretation and visitation, says Lois Richardson, vice president and legal counsel of the California Hospital Association.

But beyond legal protections, there are people you can talk to and steps you can take to improve your situation if you feel you’re not getting the care you deserve. And patients’ opinions do count.

“All hospitals increasingly are being scored and paid based on patient and family satisfaction scores,” says Rebecca Kirch, an executive vice president with the National Patient Advocate Foundation. “There is power in the people.”

That power starts with a few simple things.

First, make sure a spouse, child, family member or friend — anyone concerned for your well-being — can spend time with you in the hospital and be your advocate. You cannot do it by yourself while you’re in pain, medicated and not thinking clearly.

“It’s having someone else in your court, someone who can check in and make sure your questions are being answered,” says Dr. Rebecca Sudore, a geriatrician and palliative care physician at the University of California-San Francisco.

Before you or your advocate speaks to your nurse or doctor, write down your questions. Keep track of your glasses, hearing aids and dentures — the personal belongings that most often go missing in hospitals, Sudore says.

“How can someone speak up for themselves if they can’t see someone? Or can’t hear?” she asks.

When the time comes to ask questions — or express frustration — don’t be afraid to speak up. You have every right, even though it can feel intimidating to question your doctors or complain about your nurses.

“You can say, ‘No, I don’t want to go for that test. I want to speak to my daughter first,’” Bay says.

If you’re getting jostled out of sleep for a blood draw or blood-pressure check in the middle of the night, ask your doctor the next day if it’s really necessary. Often, it can wait till early morning, says Julianne Morath, president and CEO of the Hospital Quality Institute.

“It’s up to us to put our own humanity back into decisions,” Sudore says.

But here’s where speaking up can get thorny.

Let’s say you don’t feel you’re getting adequate care or you’re unhappy with how you’re being treated. You can start with your nurse, but if that’s uncomfortable — perhaps because that nurse is the source of the problem — approach the charge nurse, who manages the staff in your unit.

You can also ask to talk to a hospital-based social worker, who can intercede or help you figure out who to talk to, Kirch says.

If that doesn’t help, take your complaints to the next level.

Every hospital that participates in the Medicare program — which is most — must have an ombudsman or patient rights advocate, Richardson says. My mom and I eventually complained to the patient rights advocate. It helped, and we wish we had done it sooner.

If you can’t go to the patient rights advocate yourself, “you can call them or ask your nurse to call them and have them come up to your room,” Richardson says. Hospitals must acknowledge patient complaints immediately, she says, and must respond in writing once they are resolved.

As part of this process, no matter whom you talk to, there are some phrases that can spur quick action, Kirch explains. One is “This doesn’t feel like quality care to me.” Another is “I see my loved one suffering.”

If you have a serious illness and you’re suffering from symptoms that aren’t being managed correctly, you can also request a consultation with a palliative care team. Palliative care isn’t only about end-of-life issues, it’s about quality of life, Kirch says.

Most large hospitals have a multidisciplinary team of doctors, nurses, social workers, chaplains and others who can provide added support on top of the medical treatment you’re receiving, especially if you’re getting shuffled among medical specialties.

“They can help tremendously to fill in the blanks. … It can be pain management. It can be spiritual or psychological distress,” Kirch says. “The palliative care team treats the person beyond the disease.”

If you have done all that and still have concerns, Kirch’s organization has case managers who provide free, one-on-one support for patients. Call 800-532-5274 for more information or visit www.patientadvocate.org/help.php.

To be clear, I’m not suggesting you complain about every little thing. Be realistic. For instance, a hospital doctor may see up to 30 patients a day. So you might have to wait for your page to be answered unless you have a serious, potentially life-threatening problem, Sudore says.

“It may not be that you’re being ignored. It might be that someone has to figure out the competing priorities,” she says.

And don’t forget that your caregivers are human too, Morath advises. “They get tired, they get stressed,” she says. “Very often, just letting them know you’re not getting what you need and asking for their help … is a very powerful act.”

Calif. hospitals losing ground on quality

April 21, 2017by Robert Whitcomb in Uncategorized tagged , ,

chinese

Entrance to San Francisco Chinese Hospital, one of California’s top performers.

By CHAD TERHUNE

For Kaiser Health News

Nearly half of California hospitals received a grade of C or lower for patient safety on a national report card aimed at prodding medical centers to do more to prevent injuries and deaths.

The Leapfrog Group, an employer-backed nonprofit group focused on healthcare quality, issued its latest scores last week. The report card is part of an effort to make consumers and employers aware of how their hospitals perform on key quality measures, so they can make better-informed health care decisions. The scores are updated twice a year, in spring and fall.

After steady improvement in recent years, California hospitals lost ground in last week’s report card. Two years ago, 37 percent of California hospitals received a C, D or F grade. That increased to 46 percent of the 271 California hospitals rated in the most recent report.

Many California hospitals still struggle to reduce preventable medical errors and infections in patients, despite industrywide efforts to remedy those problems. California accounted for 6 of the 10 hospitals nationwide that received an F grade.

California public health officials track a wide assortment of patient infections that can be acquired during a hospital stay. A recent state report noted progress in some areas, while other issues have been harder to address.

From 2014 to 2015, 56 California hospitals achieved “significant improvement” in preventing certain infections, including ones in the blood and those resulting from surgery, according to the California Department of Public Health. But diarrheal infections in California hospitals have increased 8 percent above a national benchmark since 2011.

The state has created an interactive map where the public can check infection rates by hospital.

Leapfrog, which has issued hospital scores in California and nationwide since 2012, analyzes information it collects as well as data reported to Medicare. Erica Mobley, a Leapfrog spokeswoman, said the group’s methodology compares all hospitals to each other on a national scale, so a mix of factors could be responsible for the lower scores statewide.

“This could represent California hospitals’ performance slipping in comparison to their peers across the country or could also mean that they may be staying constant in their performance while other hospitals are progressing,” Mobley said.

The percentage of hospitals in the Golden State that got the top rating also decreased in Leapfrog’s latest analysis. Twenty-five percent of California hospitals, 68 facilities, earned an A grade this year, compared to 43 percent, or 104, in 2015.

California ranked 28th nationally in the percentage of A-rated hospitals. More than half of the hospitals in states such as Oregon, North Carolina and Massachusetts achieved the highest score.

In Leapfrog’s report card, some performance measures are risk-adjusted for patient severity and income so hospitals aren’t penalized for admitting sicker, poorer patients.

Some hospital industry officials have criticized Leapfrog’s letter grades as too simplistic for a complex issue and as potentially misleading for patients.

Jan Emerson-Shea, a spokeswoman for the California Hospital Association, noted there are many different scorecards and said consumers shouldn’t put too much stock in any one ranking.

“While these scorecards often serve as a good starting point for patients to ask questions of their health-care provider, they should not be viewed as being a definitive source for determining the quality of care provided by any hospital,” Emerson-Shea said.

The Leapfrog data show that some of the top performers in California include San Francisco Chinese Hospital,  Mercy General Hospital, in Sacramento, Hoag Memorial Hospital Presbyterian, in Newport Beach, and Inglewood’s Centinela Hospital Medical Center.

Health giant Kaiser Permanente consistently posts some of the highest scores and shows little variation across its 35 hospitals in the state. Thirty-three Kaiser hospitals received A or B grades; two got C grades.

The University of California health system fared well across seven hospital campuses, with five A ratings and two B grades.

Some large institutions lagged further behind. Providence St. Joseph Medical Center, in Burbank, received a D, as did the Zuckerberg San Francisco General Hospital and Trauma Center.

Leapfrog cited San Francisco General, a public safety-net hospital, for being below average at preventing surgical site infections after colon surgery and for allowing dangerous objects to be left in a patient’s body, among other factors. Providence’s Burbank hospital had a higher-than-expected rate of patients who developed serious breathing problems and caught antibiotic-resistant infections, according to Leapfrog.

A spokesman for San Francisco General didn’t comment directly on the hospital’s results, other than to say it didn’t participate in Leapfrog’s optional survey on safety procedures and training.

Providence said in a statement it takes patient safety seriously and respects efforts to help consumers make an informed choice. However, “it is important to understand that health care data are extremely difficult to compare as each patient is unique,” the hospital said. “Often information is a few years old before it is analyzed and aggregated for the public.”

California’s Office of Statewide Health Planning and Development also offers data on hospital quality and patient outcomes. And Medicare posts star ratings for hospitals nationwide, which are another resource for patients and policymakers.

Will many Calif. hospitals opt out of assisted-suicide law?

May 6, 2016by Robert Whitcomb in Uncategorized tagged , , , ,

 

Will many California hospitals decide to opt out of the Golden State’s assisted-suicide law, which goes into effect June 9?

Gov. Jerry Brown calls the new law “a comfort” to anyone “dying in prolonged and excruciating pain.”

The End of Life Option Act lets physicians, medical groups and hospitals opt out of the law’s guidelines for assisting the terminally ill to do. Most, if not all, religious hospitals are expected to reject the law.

The Los Angeles Times reports that the California Hospital Association couldn’t  estimate  the number of hospitals that will opt out, although it’s expected that at Catholic-affiliated hospitals will.

Calif. exchange threatens to fire hospitals

March 21, 2016by Robert Whitcomb in Uncategorized tagged , , , , , , , ,

fired

By CHAD TERHUNE

For Kaiser Health News

California’s insurance exchange is threatening to cut hospitals from its networks for poor performance or high costs, a novel proposal that is drawing heavy fire from medical providers and insurers.

The goal is to boost the overall quality of patient care and make coverage more affordable, said Peter Lee, executive director of the Covered California exchange.

“The first few years were about getting people in the door for coverage,” said Lee, a key figure in the rollout of the Accountable Care Act. “We are now shifting our attention to changing the underlying delivery system to make it more cost effective and higher quality. We don’t want to throw anyone out, but we don’t want to pay for bad quality care either.”

It appears to be the first proposal of its kind in the country. The exchange’s five-member board is slated to vote on it next month. If approved, insurers would need to identify hospital “outliers” on cost and quality starting in 2018. Medical groups and doctors would be rated after that.

Providers who don’t measure up stand to lose insured patients and suffer a black eye that could sully their reputations with employers and other big customers.

By 2019, health plans would be expected to expel poor performers from their exchange networks.

The idea has already sparked fierce opposition. Doctors and hospitals accuse the exchange of overstepping its authority and failing to spell out the specific measures they would be judged on.

Health insurers, normally at odds with providers, have joined them in the fight. The insurers are balking at the prospect of disclosing their negotiated rates with providers. Health plans have long resisted efforts that would let competitors or the public see the deals they make with doctors and hospitals.

But scrutinizing the negotiated rates would help the exchange identify high-cost providers and allow policyholders with high deductibles to see the differences in price before undergoing a surgery or imaging test.

Lee said it’s time for the exchange to move beyond enrollment and flex its market power on behalf of its 1.5 million members. He said insurers haven’t been tough enough on hospitals and doctors.

Other public exchanges or large employers could try to replicate the idea, putting more pressure on providers and insurers. Lee has shared his proposal with other state marketplaces, government officials and employer groups to promote similar efforts.

Still, there are limits to the strategy. Exceptions would be granted if excluding a hospital or doctor from a network meant an area wouldn’t have a sufficient number of providers. Insurers could appeal and offer other reasons for keeping a provider in the network.

“California is definitely ahead of the pack when it comes to taking an active purchasing role, and exclusion is a pretty big threat,” said Sabrina Corlette, a research professor at Georgetown University’s Center on Health Insurance Reforms. “There may be a dominant hospital system that’s charging through the nose, but without them you don’t have an adequate network. It will be interesting to see how Covered California threads that needle.”

The composition of networks has typically been left up to insurers. Until now, most of the discussion has centered on the proliferation of narrow networks, with a limited range of providers, sold under the Affordable Care Act as a way to hold down rates. A study last year found that 75 percent of Covered California plans had narrow physician networks, with more restricted choices than all but three other states.

“I don’t know of anyone even close to trying this,” said Dan Polsky, the study’s author and executive director of the Leonard Davis Institute of Health Economics at the University of Pennsylvania. “I applaud Covered California for being bold to improve quality and reduce costs, but I worry about the implementation.”

Polsky said measuring quality can be complicated, and steps must be taken to ensure hospitals and doctors aren’t penalized for treating sicker patients or serving lower-income areas. Most quality-boosting efforts use financial bonuses and penalties rather than exclusion.

Under the Covered California plan, hospitals would be judged on a wide range of performance and safety measures, from rates of readmission and hospital-acquired infections to adverse drug events. The exchange said it will draw on existing measures already tracked by Medicare and other groups, and it will work with hospitals, consumer advocates and other experts over the next 18 months to finalize the details.

The California Hospital Association said the exchange is moving too fast and acting too much like a regulator.

“The devil is in the details, and the rapidity of this concerns us,” said Dr. David Perrott, chief medical officer at the state hospital trade group. “We understand value-based purchasing is here in some form and we do not oppose that. But Covered California is charging ahead with this assessment and trying to figure out the answers when it hasn’t been worked out.”

California physicians warn that the exchange’s proposal could further reduce networks that are already too thin for patients.

“Right now, one of the biggest problems in health care is limited access to specialty care. This allows more narrowing of the networks under spurious guidelines,” said Dr. Ted Mazer, a board member of the California Medical Association and a head and neck surgeon in San Diego.

Charles Bacchi, chief executive of the California Association of Health Plans, predicted that Covered California’s idea will backfire, discouraging hospitals and doctors from participating in the exchange and driving up premiums as a result.

“It’s the right goal but the wrong approach,” Bacchi said. “Covered California is proposing a top-down, arbitrary measurement system that carries a big stick. This can make it difficult for health plans and providers to work together constructively.”

Wide north-south divide in Calif. health costs

October 7, 2015by Robert Whitcomb in Uncategorized tagged , , , , , , , ,

goldendayte

The Golden Gate Bridge, serving a high medical-cost kingdom.

California state officials and Consumer Reports magazine report very wide differences in  the costs of common procedures between the northern and southern parts of the state, with patients in the north  generally paying a lot more than ones in the south.

“Northern California shoppers are in for some unhappiness and some surprise,” Dr. R. Adams Dudley, director of the UC San Francisco Center for Healthcare Value and a professor of medicine and health policy, told The Sacramento Bee. “They live in an expensive part of the state, health-care-wise.”

The Bee reported that when “new 2016 rates for Covered California health care plans were announced, Northern California consumers faced additional sticker shock: Those who stay with their existing plan can expect their average premiums to jump 7 percent, compared with only 1.8 percent in Southern California. (Those rates cover individuals who purchase health care under the Affordable Care Act, not those with employer-sponsored health benefits.)”

The Bee went on:

“What accounts for the price difference between north and south? It’s simple, some experts say: lack of competition. Northern California tends to be dominated by larger hospital chains such as Sutter Health and Dignity Health, while Southern California has smaller hospital alliances and more independent doctor groups.”

“But blaming hospitals for high-priced healthcare is unfair, said Jan Emerson-Shea, vice president of external affairs for the California Hospital Association, based in Sacramento. Hospitals face economic pressures of all sorts, from spending billions on mandatory seismic retrofits to unionized labor contracts to costly medical technology, she said. And those costs have to be absorbed into their billing rates, ” she told the paper.

 

 

It’s tough to return to medicine

June 16, 2015by Robert Whitcomb in Uncategorized tagged , , , , , , , ,

redsea

 

 

By ANNA GORMAN,  for Kaiser Health News

 

After taking a 10-year break from practicing medicine to raise four sons, Kate Gibson was ready to go back to work.

The family practitioner had been reading about a shortage of primary-care doctors and knew she could help. But when Gibson, 51, applied to work at her former hospital near Los Angeles, she was turned away. She’d been out of clinical practice too long.

“I really thought it was not going to be that hard,” she said.

Like many professionals, physicians take time off to raise children, care for sick family members or to recover from their own illnesses. Some want to return from retirement or switch from non-clinical jobs back to seeing patients. But picking up where they left off is more difficult in medicine than in most careers.

In medicine, change occurs quickly. Drugs, devices and surgical techniques that were standard a decade ago may now be obsolete. Or a returning doctor’s skills may simply be rusty.

“My hands feel like those of an intern,” said Molly Carey, 36, an Ivy-League educated doctor who recently enrolled in a Texas retraining program after four years away from patients.

 

After extended leaves, doctors must convince medical boards to reissue their licenses, hospitals to grant admitting privileges and malpractice insurers to provide coverage. Only a handful of programs around the country are set up to help physicians brush up on their skills, and they can cost doctors thousands of dollars.

“Medical schools do a fantastic job graduating brand new medical students,” said Humayun J. Chaudhry, president of the Federation of State Medical Boards. “But what about people who have already graduated and need to get some retraining? There is a clearly a dearth of those kind of training programs.”

Policymakers and professional organizations are pushing to make the process less burdensome and costly – in part because it may help ease shortages of primary care doctors.

Getting experienced doctors to dust off their white coats is cheaper than starting from scratch, said Robert Steele, director of KSTAR physician programs at Texas A&M Health Science Center. He oversees a mini-residency program at the University of Texas Medical Branch, Galveston, in which returning doctors divide their time between seeing patients and attending classes. The three-month training includes the latest on medications, procedures, disease management and treatments.

“They just need polishing up to practice safely and competently,” Steele said.

Patient safety advocates argue that minimum standards should be set to ensure that doctors coming back after a hiatus are providing the best care possible. As it stands, no nationwide standards or requirements exist, and states have different requirements.

“Patients would like to think that any doctor who is seeing them or doing procedures on them is at the height of their career,” said Joe Kiani, founder of the Patient Safety Movement Foundation. “If a doctor has been out for a while, they are not.”

 

Carey, 36, had a great education, graduating from medical school at the University of Pennsylvania and completing a residency in 2011 in obstetrics and gynecology at Brown University and a Providence hospital. But after taking just four years off to care for a sick grandmother and another relative, she felt she needed to freshen her clinical skills. So she moved from Rhode Island to Texas to take part in the KSTAR program, hoping to gain more confidence as a surgeon and become more marketable.

Setting Standards and Removing Obstacles

Reliable numbers of how many doctors suspend their practices aren’t available, but the American Medical Association estimated in 2011 that 10,000 doctors could reenter practice each year.

The Federation of State Medical Boards wants states to create a standard process for physicians to show they have the skills to return to medicine. It is asking licensing agencies to track whether doctors are still practicing and whether it is in their area of training.

The American Academy of Pediatrics and the AMA also are trying to remove obstacles for doctors who want to return to work after taking time off. And John Sarbanes, a Maryland congressman, has proposed legislation to help expand re-entry programs for primary care doctors and help cover physicians’ costs if they agree to practice in high-need areas.

After hitting a wall with her former employer and others, Gibson enrolled in an online retraining program in San Diego, which cost her $7,000. She spent four months completing the courses last year and a week shadowing a family physician. Then she took a written exam and was evaluated during mock visits with “patients” played by actors.

In the end, she received two certificates — one from the program and one from UC San Diego School of Medicine for 180 hours of continuing medical education.

“I definitely felt more confident,” Gibson said. But she still wanted more hands-on clinical training. So she recently started a paid fellowship at the USC Department of Family Medicine, seeing patients under the oversight of other doctors.

Former medical school professor Leonard Glass created the San Diego program, called the Physician Retraining & Reentry Program, in 2013. Besides retraining primary care doctors, the online program has attracted specialists who wanted to switch to primary care and restless retirees.

“Some are simply tired of being retired,” he said. “It’s sort of an itch to go back to taking care of people.”

‘Expensive And Time-Consuming’

Several retraining programs are run by hospitals, including Cedars Sinai Medical Center. There, participants spend between six weeks and three months seeing patients under the supervision of other physicians, then discuss their cases in an exit interview to demonstrate what they learned. They leave with a letter that can be submitted to employers or hospitals.

The Cedars program costs $5,000 a month. Leo A. Gordon, who runs it, said some doctors who call to inquire are angry about having to spend the time and money when they already have so much education and experience. But he said others are simply appreciative that “there is a way to get back in the game.”

One of the Cedars graduates, Maria DiMeglio, decided she wanted to return to practice as an OB/GYN after taking off almost six years to care for her children and her ill mother.

“I thought I was retiring, said DiMeglio, “but I kept my options open.”

 

She had retained her medical license and kept up with continuing-education courses. But she needed to persuade her old hospital, Cedars-Sinai, to give her privileges so she could perform surgeries. The Cedars retraining program, she said, “wasn’t difficult, but it was expensive and time-consuming. Not everyone can do that.”

Hospitals set their own requirements for doctors to get credentials and privileges, but doctors who have been out of practice for more than two years generally must show that they are competent to see patients. Having a certificate from a reentry program helps, said David Perrott, chief medical officer of the California Hospital Association.

Jeff Petrozzino, a 50-year old doctor who trained in pediatrics and neonatology, knows all about that. He ran into difficulty returning to clinical practice after spending several years doing health economics research.

“I was a double board-certified physician licensed in several states,” he said. “You would think I would be able to get a job.”

When he finally did get an offer at a medical center in New Jersey, he said both the job and the state medical license were contingent on him getting retrained. He completed a three-month program at Drexel University College of Medicine in 2013, where he was surprised to discover many other doctors in a similar situation.

Petrozzino said he was grateful for the program — but given the hassles of re-entry he would advise doctors to plan carefully before taking breaks from their practice.

“Careers are interrupted or derailed for various reasons,” he said. “The system does not readily allow for re-entry.”

 

Contact Info

info@cmg625.com

(617) 230-4965

Wellesley, MA