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Hopkins study names Texas’s most expensive hospital


The Johns Hopkins School of Public Health, in Baltimore, has named Texas General Hospital in Grand Prairie the most expensive hospital in the state. That may mean that the hospital will  henceforth have to struggle to attract patients for elective services, reports the Dallas Observer.

Last year, Johns Hopkins used Medicare data from 2012 to rank the 50 hospitals in America that charge commercial insurers the greatest markups above Medicare rates. Texas General came in at No. 11, making it the hospital with the greatest mark-up price in the state, according to the report.

The report found U.S. hospitals on average charged 3.4 times the Medicare-allowable cost in 2012. The top 50 hospitals named in Johns Hopkins’s report charged an average of more than 10 times the allowable cost.

The high insurance rates are passed onto patients that receive out-of-network treatment at the hospital, known as “balance billing”.

A hospital spokesman said that  Texas General’s rates were so high because the hospital does not take  adequate steps to collect payment from patients.

To read a Becker’s Hospital Review story on this, please hit this link.

Text/video: Baltimore hospitals seek to regain trust

Text and video: See/hear how Baltimore hospitals, including world-famous Johns Hopkins, are working t0 regain the trust and confidence of the city’s black community.

Rationale for regionalizing high-risk surgery



An operation in 1753, painted by Gaspare Traversi.

In this JAMA piece, Karan R. Chhabra and Justin B. Dimick argue that hospital networks and value-based payment comprise “fertile ground for regionalizing high-risk surgery.”

They describe “the shifts made by hospital networks toward a new type of surgical regionalization to improve surgical outcomes and overall clinical quality.”

“Recently, 3 major medical centers—Dartmouth, Johns Hopkins, and the University of Michigan—declared a ‘volume pledge’ that restricts performance of 10 selected procedures to surgeons and hospitals that meet volume criteria. This followed an announcement by US News & World Report of a new analysis demonstrating poorer outcomes at low-volume hospitals.  Both of these are derived from decades of research showing that high surgical volumes are associated with better outcomes, especially in high-risk procedures.


How to get high patient-satisfaction scores


Hanan Aboumatar, M.D., an assistant professor of medicine at Johns Hopkins  and member of the Johns Hopkins Armstrong Institute for Patient Safety and Quality, says there are various ways for a hospital to get high scores in the Consumer Assessment of Healthcare Providers and Systems  (HCAHPS).

She notes that such simple practices as proactive rounds by nurses and hospital leaders can have major positive effects on their patient-satisfaction scores.

She told Becker’s Hospital Review that most hospitals have prioritized patient experience  have taken different routes to get there, to varied results.

“People used different strategies,” she says. “There was no formula [and] some did better than others.”

However, the survey did find some things in common.

Becker’s reports that “One of the most-reported strategies from respondents involved their organization’s culture. A majority — 77 percent — of hospitals reported that a commitment to patients and their families is integrated into their culture, and they attributed their high patient safety scores in part to this mindset.”

“‘The organizations [that] are high-performing were ones [that] did not think of the patient experience as an add-on,”’ Dr. Aboumatar  told Becker’s “‘They thought of it as much more integral to the type of mission that they have. [It’s] what they’re all about.”‘

The importance of staff engagement  in improving patient experience also stood out to Dr. Aboumatar from the survey.

“The survey responses showed 83 percent of surveyed hospitals had proactive nurse rounds in place, and 62 percent reported that leaders from all levels of the organization also rounded on patients,” Becker’s reported.

“Some respondents indicated that leaders blocked out time in their calendars to round on patients and staff, asking patients how their stay is and asking staff what, if anything, they need to help them do their job to the best of their ability, according to Dr. Aboumatar.”


Population-health-wise, are second opinions useful?

By MICHELLE ANDREWS, for Kaiser Health News

Actress Rita Wilson, who was diagnosed with breast cancer and underwent a double mastectomy recently, told People magazine last month that she expects to make a full recovery “because I caught this early, have excellent doctors and because I got a second opinion.”

When confronted with the diagnosis of a serious illness or confusing treatment options, everyone agrees  that it can be useful to seek out another perspective. Even if the second physician agrees with the first one, knowing that can provide clarity and peace of mind.


A second set of eyes, however, may identify information that was missed or misinterpreted the first time. A study that reviewed existing published research found that 10 to 62 percent of second opinions resulted in major changes to diagnoses or recommended treatments.

Another study that examined nearly 6,800 second opinions provided by Best Doctors, a second-opinion service available as an employee benefit at some companies, found that more than 40 percent of second opinions resulted in diagnostic or treatment changes.

But here’s the rub: While it’s clear that second opinions can help individual patients make better medical decisions, there’s little hard data showing that second opinions lead to better health results overall.

“What we don’t know is the outcomes,” says Dr. Hardeep Singh, a patient safety researcher at the Michael E. DeBakey VA Medical Center and Baylor College of Medicine, in Houston, who co-authored both those studies. “What is the real diagnosis at the end? The first one or the second one? Or maybe both are wrong.”

That doesn’t mean second opinions are a bad idea. Experts estimate that diagnostic errors occur in 10 to 15 percent of cases.

“There’s no getting away from it, diagnosis is an imprecise thing,” says Dr. Mark Graber, a senior fellow at RTI International who also co-authored the studies. Graber is the founder and president of the Society to Improve Diagnosis in Medicine.

Second-opinion requests were related to diagnosis questions in 34.8 percent of cases in the Best Doctors study. These included 22.5 percent of patients whose symptoms hadn’t improved, 6.3 percent who hadn’t gotten a diagnosis and 6 percent who had questions about their diagnosis.

In Wilson’s case, she wrote that after two breast biopsies she was relieved to learn that the pathology analysis didn’t find any cancer. But on the advice of a friend, she decided to get a second opinion, and that pathologist diagnosed invasive lobular carcinoma. Wilson then got a third opinion that confirmed the second pathologist’s diagnosis.

Getting a second opinion may not involve a face-to-face meeting with a new specialist, but it will certainly involve a close examination of the patient’s medical record, including clinical notes, imaging, pathology and lab test results, and any procedures that have been performed. Some people choose to have that second look done by physicians in their community, but other patients look for help elsewhere.

In addition to employer-based services like Best Doctors or Grand Rounds, medical centers such as the Cleveland Clinic and Johns Hopkins in Baltimore also offer individual patients online second opinions.

“It really does give people relatively easy access to expertise,” says Dr. C. Martin Harris, chief information officer for the Cleveland Clinic.

The medical center’s MyConsult service doesn’t accept insurance. A medical second opinion costs $565, while a consultation with a pathology review costs $745.

Face-to-face meetings with specialists who provide a second opinion and review a patient’s medical record are more likely to be covered by insurance than an online consult, but nothing is guaranteed.

“Usually it’s not the second opinion where the hiccup is,” says Erin Singleton, chief of mission delivery at the Patient Advocate Foundation, which helps people with appeals related to second opinions. “It may be that the MRI that they want to do again won’t be approved.”  Many insurers won’t pay for diagnostic or other tests to be redone, she notes.

Patients seeing an out-of-network specialist for a second opinion may encounter significantly higher out-of-pocket costs, particularly if they want to subsequently receive treatment from that provider. In those instances, the foundation can sometimes work with patients to make the case that no specialist in their network is equally experienced at treating their condition.

Of course, asking for a second opinion doesn’t necessarily mean accepting the advice. In the Best Doctors survey, 94.7 percent of patients said they were satisfied with their experience. But only 61.2 percent said they either agreed or strongly agreed that they would follow the recommendations that they received in the second opinion.


Touting the Kaiser model for cutting costs


“Where does the high cost of American healthcare really come from? Mostly it comes from our futile attempts to fend off death. Everyone knows that a disproportionately high percent of your life expenditure on healthcare comes in the last few years of life. ”

“One thing we do know is that people will make better choices when we communicate with them effectively. The C4 Project out of’ Johns Hopkins looked at structured communication with family members of ICU patients involving the entire treatment team. They found that patients and families made their own quality of life decisions when properly informed.”

“The project concluded that a little communication went a long way to reduce futile, unwanted, and costly care.”

“{T]here is  the fact that Americans just get too much medicine. They see doctors when they don’t need to. They get tests and procedures that aren’t necessary. ”

“As always, the best answer to a complex problem draws from many sources. But there are some guiding principles that emerge. First, we need to line up the incentives. Right now, the hospitals, providers, and insurers make money when the patients are sick or perceive themselves to be so. Let’s turn that around. We make money when the patient is not sick. And I don’t mean that we refuse care. Let insurance, providers, and hospitals work together for a common fee. When the patient is healthy the system spends less and we make more.”

“{L]et providers run the system, including the insurance companies, and compete with other providers who are doing the same. Without any wish to canonize Kaiser, they have created an impressive model for this kind of unified care. ”


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