Detroit Medical Center's Children's Hospital of Michigan has established new agreements with Henry Ford West Bloomfield Hospital and Hurley Medical Center in Flint to expand pediatric surgical expertise at these two hospitals.
DMC has also established a new Children's Hospital of Michigan Specialty Center in West Bloomfield to house pediatric surgery services for patients, the hospital announced.
Over the past several years, Children's has established outpatient specialty centers in several surrounding towns.
"As the state's busiest hospital and referral center for pediatric medical and surgical specialty care, we understand how important it is to provide this care in locations and facilities that are convenient and easily accessible to area pediatricians and their patients," said Herman B. Gray, MD, president of Children's, in a media release. "Partnerships like these provide unique opportunities to efficiently and economically expand patient access, while maintaining the highest quality care for children and adolescents in surrounding communities and throughout the state."
A recent survey found that employers are frustrated that employees aren't taking advantage of their work-based wellness programs to rid themselves of unhealthy habits such as smoking and excess weight.
This frustration is understandable. The primary motive for the wellness movement, however well-intentioned, is to reduce healthcare costs, which are growing at unsustainable rates.
There is nothing wrong with looking at the bottom line, except that your business might fall into that reliably flawed expectation within the personal fitness movement that if you simply spend money, you will get good results.
Years ago, I read an essay which argued that our goal attainment processes are out of order. As best as I can recall with my graying memory, the essayist argued that the normal process of reaching a goal was: "want, work, get." In other words: "If I want to lose weight, I will exercise and eat right, and I will get the results."
Now, in the age of advertising, credit cards, and instant gratification, Americans have skewed the process into: "want, get, work." In other words: "If I want to lose weight, I will get the home gym, buy the $125 running shoes, or join the health club, and then I will lose weight."
Of course, what is left out of the second equation is the actual exercise–the work—that will result in the weight loss. We lace up the running shoes for grocery shopping. We join the health club but interest wanes. We see the guy with the six-pack abs on late-night TV. We see the five-easy-payments plans. We buy the exercise equipment, use it a few times—-or not—and tuck it under a bed. Don't believe me? Ask a fitness trainer how much health club attendance drops off –right about now—when New Year's resolutions get fuzzy. Do an eBay or Craig's List search for "Bowflex," "like new," or "still in box," and count the hits.
The evil twin of the "want, get, work" dynamic is instant gratification—best exemplified by the wonder diets that promise to shed 20 pounds in one week. The diets may work. But, the weight loss is almost always temporary. That is because the people who undertake these dramatic regimens may be prepared for short-term deprivation, but they haven't made the long-term lifestyle adjustments needed to keep the weight off.
I'm sensing that these mischievous twins have wangled their way into the boardroom. The suits in the C-Suite have listened to HR, they bought into the wellness movement as cost-effective, they built the on-site gym, they paid for the weight-loss or smoking cessation classes. So, where are the savings for the next quarterly report?
This is the tricky part. As I said earlier, the wellness movement's primary motivation is saving money. However, any employer, or employee, who embraces the wellness movement has to look at a return on investment that might not materialize in the next few quarters. Wellness is not a penny stock. It's more like a 30-year T-note. This is an evolutionary process.
After all, Americans didn't just wake up one morning and discover they were overweight, or getting older, or addicted to nicotine. These health issues are the result of years, if not decades, of unhealthy choices that people have made. To expect that an employee is going to lose 30 pounds in the next six months because you're paying half of his gym fee is not realistic.
That doesn't mean that we should give up on the wellness movement. The fact is, we are seeing progress in societal wellness. The "obesity epidemic" has flattened—not fattened—over the last 10 years.
Fewer than one in five Americans now smoke—down from more than 42% of the population in 1965. That's taken more than 40 years, and a lot of money, but I don't believe anyone would argue that the effort wasn't worth it—or that more needs to be done.
The employer-sponsored wellness movement is still quite young. As the movement matures, it will become more effective as it finds the right combination of incentives and benefits that will nudge employees to adopt healthier lifestyles. Now is not the time to get discouraged. Now is the time to take the long view.
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The Nashville, TN, Metro Council is set to consider a measure next month asking gubernatorial candidates to deliver nearly $20 million per year in federal funding for Nashville General Hospital that advocates say is being withheld by the state. The federal government reimburses Tennessee for most of the costs incurred by public hospitals to provide uncompensated healthcare to patients who are uninsured or underinsured. But most of that money doesn't make it back to care providers like Nashville General Hospital, which is facing shaky finances and an uncertain future, The Tennessean reports.
Depending upon how well they are organized, board meetings can provide vital monthly or quarterly face-to-face time among the decision-makers to keep your physician practice running smoothly.
Or, they can devolve into a cat rodeo; a huge waste of time and energy, where very well educated, very opinionated, highly trained professionals find themselves arguing over the everyday and trivial issues that should be solved on the middle-management level.
At Radiological Associates of Sacramento (RAS), the monthly practice board meeting is a model of efficiency. It is no small feat to get the 64 physician-owners of the practice to sit down for some two to four-and-a-half hours every month to review critical governance issues. But the efficiencies built into the meetings, which might seem effortless to the casual observer, are actually the result of constant streamlining and review, says Fred Gaschen, executive vice president at RAS.
"I'm proud of the way they have organized this," Gaschen says. "I've been here more than 13 years and I inherited a good structure. But I'd like to think that in that time we have streamlined and improved the structure."
RAS has been around since 1917, and Gaschen says the physicians in the practice know enough to let the business people they've hired to run the business, run the business. The business side takes care of the minutia, and helps the physicians organize the subcommittee and board meetings.
"We support the decision-making process by the physicians at the board level through our infrastructure," Gaschen says.
This all seems perfectly logical and simple. Don't waste everybody's time squabbling for hours about lower-level management issues that prolong meetings, force you to skim through more important issues, and leave practice partners irritated by the sense that important issues are not being addressed. But it's surprising how many physician practices run their meetings exactly that way, says Ken Hertz, principal, MGMA HealthCare Consulting Group, based in Monroe, LA.
What's on the agenda?
"I don't think you want to spend a half-hour at a board meeting deciding what kind of chairs you are going to put in the reception area. I don't think you want to spend a half hour at the board meeting or partner meeting deciding whether Dr. Jones' nurse Mary should get a bigger raise than the other nurses, because she has been here longer and, after all, she does three times the work everybody else does," Hertz says.
Instead, he says, the board should focus on governance. "We are talking about strategic issues—mergers, acquisitions, integration, recruitment, strategic decisions to develop a marketing plan," Hertz says. "Sitting at the board meeting is not where you read the copy for the ads and Dr. Jones says 'I don't like the way that paragraph is written.' It is your right to question, but there are certain things you need to entrust to a manager or a subcommittee."
To run an efficient meeting, Gaschen says, what is not on the agenda is almost as important as what is on the agenda.
"Small operational issues are not discussed at the board level. The board is responsible for overseeing corporation setting policy and directions. That is their role," he says. "The day-to-day operations are handled by the respective administrative staff hired in the divisions and each division."
For example, RAS has several subcommittees that meet weekly to vet and prepare issues for the larger board to act upon.
"It is at the divisional level they will look at new offices, new equipment, new services, or new medical ways of doing things, and there will be a lot more debate at the division level and the sub-groupings that happen between the monthly board meetings," Gaschen says.
"So the division will arrive at a consensus within its membership and that division will take it forward to the executive committee for informational purposes and the board of directors for final approval. By the time it gets to the board of directors, it has been vetted in multiple stages along the way. Rarely do we bring something up to the board level and there is a big brouhaha."
Meeting parameters
The agenda, the structure, the frequency, and length of the meeting may vary from practice to practice, depending on what works for the practice, Hertz says, but there are also some fundamental, common sense rules that should apply, regardless of whether you've got two or 200 physicians in your practice.
"Meetings need to start and end on time," Hertz says. "The people who show up on time shouldn't be penalized for the people who don't. It's disrespectful not to start on time and end on time. The more you don't start on time, the more people say 'why should I show up on time?' and then it becomes a downward spiral."
Meetings need to have a structured agenda and a facilitator to ensure that the agenda advances. "What we really want is the meeting to move forward. I've sat through many meetings where nobody moves. Somebody introduces a topic and it just meanders. There has to be some leadership," Hertz says. In most physician practices, the president of the board or a managing partner should lead the meeting. "I've seen a lot of practices where the administrator or manager chairs the meeting, but I'm not a big fan of that," Hertz says. "They are an employee. It's your practice. You're the governance. The manager can meet with the chair or the president, review the agenda and the material, point out any landmines or other things they need to be aware of, but, ultimately, a board needs to do the board's work."
Physicians need time to prepare for the meeting. Hertz says one of the most common complaints he hears from physicians is that they aren't given a chance to plan for the meeting. He recommends publishing agendas as far in advance as possible. "You come to the meeting and somebody gives you a 15-page report and expects you to comment on it. That is not right," Hertz says. "I also hear 'I came to the meeting and all I heard was reports and I left.' Well, then why have a meeting? Put it in writing and e-mail it to me." Hertz says some practices don't issue the agenda because they say their physicians won't bother to read it. "I say 'I don't really care.' The right thing to do is give it to the docs in advance and they read it or they don't. It's their choice, but that is the proper way to do it."
Don't rehash the same issue in meeting after meeting. "Some practices allow that. Some practices say 'We made the decision. We are moving on.' If it is a major decision that the board is going to make and the board isn't made up of all the partners in the group, it is incumbent on the part of the board to get the shareholders input before the meeting and before the decision is made."
In the end, the board can't allow itself to get bogged down on one issue. Make a decision. It all comes back to leadership.
It is common for patients 65 and older to get potentially inappropriate medications when treated in emergency departments, a new University of Michigan Health System study has found.
Nearly 19.5 million older patients, or 16.8% of eligible emergency visits from 2000-2006, received one or more potentially inappropriate medications—or PIMs. The large sample of approximately 470,000 ED and outpatient clinic visits, corresponding to a national estimate of about 1.5 billion total visits, allowed the researchers to determine the extent of the problem nationwide, according to the study published in Academic Emergency Medicine.
Researchers looked at a nationwide sample of ED visits using data from the National Hospital Ambulatory Medical Care Survey to see how many patients aged 65 and older sent home from the ED were prescribed potentially inappropriate medications. The study found that 10 medications accounted for 86.5% of PIMs in the ED.
The five most common ones were promethazine, ketorolac, propoxyphene, meperidine, and diphenhydramine; and two of these—promethazine and ketorolac—accounted for nearly 40% of PIMs.
William J. Meurer, MD, the lead author of the study, and an assistant professor at U-M’s departments of Emergency Medicine and Neurology, said doctors need more education about the suitability of certain medications for older adults. The study also found that prescribing inappropriate medications was less likely to occur if a resident or intern was involved in the treatment, probably because younger doctors have had recent training about medications.
There was substantial regional and hospital type (teaching vs. non-teaching) variability. PIMs were less likely to occur in visits to hospitals in the Northeast and twice as likely in other parts of the country. And receiving a potentially inappropriate medication was more likely to occur at for-profit hospitals.
The study did not explore the possibility of medication interactions, so it is possible that the potential harm by medications is underestimated.
Connecticut Attorney General Richard Blumenthal said this week that his office has uncovered a potentially anticompetitive practice by health insurance companies that could raise healthcare costs and lower competition.
In a letter to HHS Secretary Kathleen Sebelius, Blumenthal called for an investigation of these practices at the national level.
Blumenthal said his office has been conducting an antitrust investigation of Anthem Blue Cross and Blue Shield of Connecticut, which is owned by WellPoint, Inc., and has found contractual Anthem clauses—commonly referred to as Most Favored Nation clauses—requiring hospitals and other providers to allow Anthem to pay the lowest reimbursement rates in the industry.
Despite apparently having the best reimbursement deals, Blumenthal said Anthem won't pass on its savings to policyholders. Instead, he said the company has sought and received premium increases on Connecticut health insurance consumers, and possibly elsewhere in the country, of at least 13% to 20%.
"Our investigation remains ongoing, but federal officials deserve immediate warning about these practices—potentially having national implications and warranting federal investigation," Blumenthal said in a media release. "Small businesses, individuals—and our entire economy—have a direct and immediate stake in practices that straitjacket hospitals and raise healthcare costs."
"WellPoint and Anthem—among the most powerful players in the health insurance industry—may be exploiting its strength to force hospitals into giving them the best deal in the market. As a result of Anthem's practices, competitors are forced to pay more, hospitals are forced to accept less from Anthem—and consumers are the ones paying," Blumenthal said.
Blumenthal added that less than a year ago, Anthem received approval for premium increases between 13% and 20% on individual health insurance policies in Connecticut, even as the company acknowledged paying at least 39 executives a minimum of $1 million each.
Anthem said its premium hikes were owing to the trouble economy, because "younger, healthier policyholders who lose their job are canceling their health coverage. This means there are fewer policyholders, resulting in those who are left having to pay more."
Anthem issued a statement saying it is working with Blumenthal's office, but the health insurer insisted it has done nothing wrong.
"We have no reason to believe that any provision in our hospital contracts is in violation of applicable law," Anthem said. "When negotiating contracts with hospitals, Anthem makes every effort to obtain fair market reimbursement rates for our customers.
"The increases in premium costs, however, are driven by much more than the increase in hospital rates. An aging population, higher patient utilization, the increase of chronic disease, new high-cost technologies, and cost shifting from Medicare and Medicaid all contribute to rising insurance premiums."
Hospital nurses spend three hours of a typical 12-hour shift away from the patients' bedside to complete regulatory requirements, redundant paperwork, and other non-direct care, a recent online survey of more than 1,600 nurses shows.
Some of the biggest distractions and time eaters include documenting patient care information in multiple locations, and completing logs, checklists, and other "redundant" paperwork, the nurses said. They also reported wasted time trying to secure equipment and supplies.
The nationwide survey, conducted last fall for Jackson Healthcare, the Alpharetta, GA-based healthcare staffing and management company, targeted nurses, nursing managers, and CNOs. It was conducted with StatCom and Travel Nurse Solutions, and was based upon the online responses from 1,663 hospital nurses.
"Nurses are being taken away from the patient's bedside by non-patient activities. Unfortunately, due to the regulatory nature of healthcare, we know that some of these redundancies won't go away," said Jackson Healthcare CMO Bob Schlotman.
"However, the good news is methodology, in the form of process improvements, and adaptive technology now exists to help minimize and manage these frustrations for our nurses."
The survey found a number of differences between CNOs and front-line nurses. CNOs were more concerned with the coordination of patient care, whereas nurses felt overworked and in need of additional staff support, the survey showed.
The front-line nurses said ancillary staff support, hospital-wide communications technology, and reductions in redundant regulatory requirements could alleviate the distractions and time away from patient, the survey showed.
A new study found that patients admitted to full or near-full hospitals increased their risk of dying by 5.6%.
University of Michigan Health System researchers evaluated four factors that can affect hospital deaths: occupancy, nurse staffing levels, weekend admissions, and seasonal flu.
Having more nurses made patients safer, decreasing risk by 6%. But weekend admission raised the risk by 7.5% and admission during seasonal flu had the greatest impact by increasing the risk of death by 11.7%, according to the study, which was published today in Medical Care.
"The study establishes that there is indeed a connection between hospital occupancy and death rates in U.S. hospitals," said lead author Peter L. Schilling, MD, a resident in orthopedic surgery at UMHS, and Robert Wood Johnson clinical scholar. "It's important to emphasize though that this study does not identify a specific occupancy level above in which patient care suffers and deaths abruptly become more common. The key occupancy level may differ for each hospital."
The study included 166,920 adult patients admitted to 39 Michigan hospitals over three years, and can be generalized to hospitals nationwide, Schilling said.
The study—the first to compare all four factors at once—found that each factor had a significant impact even while evaluated in a model simultaneously. "The good news is that each can be modified in some way," says co-author Darrell A. Campbell Jr., MD, chief of clinical affairs at the UMHS.
For example, during peak flu season, hospitals can reinforce the importance of hand washing and covering coughs and sneezes. The impact of seasonal flu may also be diminished by improving vaccination rates in the community and among healthcare workers.
Researchers calculated the occupancy of the hospitals every day for the years 2003-2006. On average, patients in the study were admitted while hospital occupancy was 73% of full capacity. One-third of patients were admitted on high occupancy days, at average levels of 80% or more.
Study patients were admitted after being seen in the ED for heart attack, congestive heart failure, stroke, pneumonia, hip fracture or gastrointestinal bleeding.
"Hospital occupancy changes from day to day, so patients shouldn't try to choose a hospital based on its occupancy level," said co-author Matthew M. Davis, MD, co-director of the Robert Wood Johnson Foundation Clinical Scholars Program at the UMHS. "But these kinds of study findings should prompt hospitals to look at the flow of patients and processes of their care teams during high occupancy times. Those are more challenging moments when more things can go wrong."
The UMHS study also examined the impact of "access block" when a full hospital prevents ED patients from accessing an inpatient hospital bed. While a wave of accident victims to the ED is impossible to predict, hospital administrators can control occupancy by managing the number of elective surgical cases scheduled for admission.
The authors said restricting these profitable procedures can cost hospitals money since they've become increasingly important to hospital finances in recent years. "However if access block is a true phenomenon, a hospital full of elective surgical admissions may be limited in its ability to safely handle an influx of urgent admissions through the ED," Schilling said.
Healthcare network VHA Inc. has signed a five-year strategic agreement with Omnicare Inc. subsidiary Tidewater GPO, a group purchasing organization for long-term care providers.
The agreement gives Covington, KY-based Tidewater's approximately 4,000 members access to VHA's non-acute care portfolio for food and food distribution services with U.S. Foodservice.
"With the power of VHA's key contracts, Tidewater enhances its ability to bring significant value to its membership in a highly competitive and reimbursement sensitive marketplace, while remaining independent and committed exclusively to serving our senior care providers," said Tom Ludeke, president of Tidewater GPO, in a media release.
The agreement expands Irving, TX-based VHA's reach into the non-acute market of non-hospital healthcare providers, such as surgery centers, physician practices, home health agencies, and cancer centers.
VHA now serves more than 1,400 nonprofit hospitals and more than 28,000 non-acute care organizations nationwide.
VHA's contracting company, Novation, manages more than $35 billion in contract purchasing annually, including purchases through its agreement with U.S. Foodservice.
"Tidewater has a deep understanding of the long-term care market, which is growing rapidly as the baby boom generation approaches retirement age," said Amy Anthony, senior vice president of Supply Chain Programs for VHA, in a media release.
News that Martin Memorial Medical Center in Stuart, FL, disciplined several employees for taking cell phone pictures of the victim of a Feb. 3 shark attack who later died has generated a lot of interest on our HealthLeaders Media Web site.
The Martin Memorial incident was a clear violation of HIPAA privacy laws. What happens, though, when the shutterbug is not an employee, but a relative or a friend of the patient or even someone walking through the emergency department who otherwise has no connection with the patient or the hospital?
Digital cameras are standard equipment on most cell phones. This could make anyone walking into your hospital a potential photojournalist.
An emergency clinician—who is not connected to Martin Memorial or the shark attack incident—sent me an email asking that question. He writes:
"I am a provider working in the ER and have often had a case where either family or friends are taking pictures of the patient that is getting a splint after breaking something or in the process of getting stitched up. I often don't know this is happening until the cameral flash is going off and next thing you know, I am on someone's Facebook page stitching up their friend in the ER (my patient)."
"I realize we can't stop the interest of family and friends and their uncontrolled urges to capture every moment with the advances of technology and a camera on everyone's phone. The question that I raise is how does this work with HIPAA? Should we be banning camera phones in the ER/hospitals/clinics? Good luck with that one. Are the medical providers or the facilities at risk for violations?"
"Obviously a provider or other medical employee would face violation if these were taken and released, but what about something coming back to us that originated from a non-medical providers phone camera and the patient that agreed to have the picture taken due to peer pressure only to regret it later?"
I asked the Department of Health and Human Services' Office of Civil Rights about it. They replied: "Entities subject to the HIPAA Privacy and Security Rules are covered entities: health plans, healthcare providers, and healthcare clearinghouses. Generally speaking, a covered entity would not be responsible for the actions by a patient's friends or family."
So it appears that you and your hospital are off the hook if family or friends are taking the pictures. We live in a very litigious society, however. Can a patient sue his hospital for failing to protect his privacy when a stranger–someone not connected to the provider or the patient—takes a quick cell phone photo of the patient waiting in a hallway, or lying on a gurney?
John C. Parmigiani, president of John C. Parmigiani & Associates, LLC, says hospitals should post signs at the entrance to the ED or near ED examining rooms stating that picture taking is not permitted. That way, if a visitor ignores the rules, takes a picture and posts it online, the hospital can at least demonstrate that it was exercising reasonable measures to protect patient privacy. "To me, the posting prohibiting picture taking would represent another example/level of ‘due diligence' on the part of the hospital," Parmigiani says.
Kate Borten, CISSP, CISM, president of The Marblehead Group, says HIPAA expects healthcare providers to take "reasonable" measures to protect patient privacy, but also "accepts situations such as waiting rooms where patients can be seen by the public or a family member accompanying a patient to a bed in the ER. As long as the hospital wasn't doing something out of the norm, then it shouldn't have any liability when a member of the public snaps a picture."
HIPAA makes an "absolute distinction" between the hospital's workforce (a term defined in the regulations) and everybody else. "Organizations are responsible for the actions of their workforce, but not for the rest of the world," Borten says.
Given the frivolous or groundless nature of some lawsuits, it's understandable if hospitals and their employees are skittish about patient privacy violations. In the case of the shark attack victim at Martin Memorial, they should be skittish. They screwed up. However, if you exercise common sense and simply recognize that the person you're treating deserves the same respect and confidence that you'd want for yourself or your family, you shouldn't have anything to worry about.
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