patient care

Case study: MO hospital assigns hospitalists to specific units

Anne Zieger — Thu, 26 Jun 2008 01:43:16 -0400

In the past, hospitalist physicians have been forced to wander all around the hospitals where they practice, from floor to floor and unit to unit. Increasingly, however, hospitals are coming to see this as an inefficient arrangement--with many moving to assign hospitalists to a single unit instead. This way, hospitalists can focus on a smaller group of patients rather than shuttling from place to place or answering pages from other areas of the hospital.

One hospital that recently decided to try this approach is SSM St. Mary's Health Center of Richmond Heights, MO. To test the new program, St. Mary's worked with IPC The Hospitalist Company to set up a pilot--a dedicated 20-bed hospitalist unit including five physicians and two nurse practitioners. St. Mary's is carefully studying how the program works, particularly how patient care is impacted. If things work well, the unit may be kept long-term, and possibly implemented at other SSM-St. Louis hospitals.

In other settings, some hospitals have found that assigning hospitalists to units avoids wasted travel across the hospital, gives physicians more time with patients, families and staff, and allows patients to begin treatments sooner. Typically, unit-based hospitalists also participate in rounds, making it easier for them to work with other members of the care team and share insights. However, other hospitals have found that this approach forced the emergency department to spread patients evenly across units, which has proved too difficult to sustain.

To learn more about these programs:
- read this St. Louis Post-Dispatch article

Related Articles:
Study: Hospitalists cut hospital length of stay
Trend: Hospitalist ranks exploding
Hospitalist group predicts presences will double by end of decade
Study: Hospitalists cut stays for complex cases

PA hospitals' overall financial health improves

Thu, 12 Jun 2008 06:59:55 -0400

A new report from the Pennsylvania Health Care Cost Containment Council concluded that while the overall financial health of the state's hospitals improved, small community hospitals in rural areas didn't perform as well. The agency concluded that many of the state's 170 hospitals improved their performance in fiscal 2007, though the rising cost of uncompensated care was a big issue. Uncompensated care was up $74 million this year, or 12.2 percent, to $678 million.

Among the best performances were the University of Pennsylvania Health System, whose dominant hospital, Hospital of the University of Pennsylvania, made almost $215 million from patient care last year, along with another $55 million in investment and endowment income. The hospital's operating margin was a whopping 14.28 percent in an area where 4 to 5 percent margin is considered a reasonable result. At the other end, Tenet-owned Hahnemann University Hospital had an operating margin of 18 percent, a loss of $65 million.

To find out more about the state's hospital market:
- read this article from The Philadelphia Inquirer

Related Articles:
Pennsylvania hospital infection bill headed for approval
PA hospitals battle central-line infections
PA among first states to report hospital-specific infection rates.
Revenue growth slows at PA hospitals

OH plans, providers share pricing and quality information

Fri, 23 May 2008 06:59:55 -0400

This week seems to be a big one for transparency. Not only did Cigna roll out its nationwide physician and hospital rankings program nationwide, central Ohio got into the action, too. Anthem Blue Cross and Blue Shield in Ohio has published pricing information on medical procedures on a site accessible only to its members this week. Anthem's tool tells members what's paid to providers after contract discounts for 39 common elective procedures.

The move follows similar steps by providers, for example, local health system OhioHealth, which began publishing CMS data on patient care and satisfaction a couple of weeks ago. Also, OSU Medical Center published its data from CMS in late March, with Nationwide Children's Hospital planning to follow up with its own data this summer.

Aetna, meanwhile, has offered its members price information for physicians in central Ohio since 2006, along with a system rating doctors with stars, as well as by rates of patients readmitted to hospitals within 30 days after discharge.

To learn more about transparency in central Ohio:
- read this Business First of Columbus piece

Related Articles:
Critics doubt benefit of posting hospital prices online
Tennessee hospitals put prices online
MN group posts hospital prices to Web
Maryland adds pricing to hospital guide

ALSO NOTED: City of San Francisco sues McKesson; CMS regs put three-year moratorium on LTC hospital construction; and much more

Fri, 23 May 2008 06:59:50 -0400

> The city of San Francisco has sued McKesson Corp., arguing that the company manipulated prices on brand-name drugs. Article

> CMS has announced a regulation that places a three-year moratorium on the construction of new long-term care hospitals. Article

> Geisinger Health System should open its $35 million facility in August, which includes 70 exam rooms, 16 procedure rooms and six imaging suites. Article

> The Blue Shield of California Foundation has given out $12.3 million in grants to California nonprofits, largely to organizations providing improve patient care or better access. Article

And Finally... But what about highway muleage? Article

ALSO NOTED: S&P to rate non-profit hospitals' IT investments; Pharmas winning legal battle over pre-emption; and much more...

Wed, 14 May 2008 06:59:50 -0400

> Ratings firm Standard & Poor's has announced that it plans to track not-for-profit hospitals' IT investments and factor them in significantly in how they rate the hospitals' financial health. FierceHealthFinance

> It looks like pharmaceutical companies may be winning one of their key arguments--that since they're regulated by the FDA, plaintiffs are pre-empted from suing in state courts. Let's see what the Supremes think. FiercePharma

> Think your electronic medical record system is just for patient care? Think again, say policy makers and researchers. FierceHealthIT

> Stem cell researchers who managed to engineer a human embryo are now facing criticism that their work is a big step toward designing babies. FierceBioResearcher

And Finally... What includes Harry Truman's 1948 Democratic National Convention speech, Michael Jackson's "Thriller" and Fiorello LaGuardia reading comics? Article

When it comes to ED costs, nobody wins

Fri, 02 May 2008 06:59:59 -0400

As we all know, things can get pretty tense in the emergency department, particularly for patients who come in because they have no health insurance and can't go anywhere else.

Given the price of emergency services, it's hardly surprising that patients blanch--and possibly even check themselves out--when they find out just how expensive their care will be. Apparently, that's just what happened in one unnamed ED, where a patient with a serious hand injury walked out when a surgeon candidly shared the estimated cost of care (about $10,000 to $20,000). It's worth noting that despite the likelihood that the patient would never pay up, the surgeon didn't deny the patient care, and didn't insist on any form of upfront payment either. He only gave the patient bad news--the truth.

Still, when the patient went to a different emergency room, that hospital didn't discuss fees, but rather told the man that he'd work things out with the facility later. Now it seems the first surgeon is facing costly EMTALA charges. The second hospital has accused that surgeon of committing an EMTALA violation, arguing that quoting prices constituted a "barrier" to care.

Wow. Talk about a no-win situation. The surgeon, who may have merely been of a literal turn of mind, simply answered a question with the facts--which, realistically, were probably more than a sick, frightened patient could handle. The man, who probably wasn't uninsured for his own jollies, did what he felt he had to do. Meanwhile, the other hospital most likely absorbed the bill, which wasn't great for them, of course.

I'm not sure there's a big lesson here, other than that in the world of uninsured, injured patients, pretty much nobody wins. Until there's a nationally-implemented, reliable source of funding for people without coverage--perhaps even just those with catastrophic needs--otherwise well-meaning people will continue to be caught in this bind.

I'd love to think that the next election will be change on this front, but honestly, I doubt it. What do you think the solution is here? Have you come up with any middle ground on this front? - Anne

Trend: Young MDs seek new practice options

Tue, 29 Apr 2008 06:59:55 -0400

Historically, doctors in training have been encouraged to see medicine as their entire life, not just something they do--and to make themselves available around the clock for patient care. But this doesn't sit well with the emerging generation of new physicians, who are intent on balancing their work with family life and personal interests.

To address their concerns, newly-minted physicians are turning to options like being a hospitalist, offering a more predictable schedule and a fixed salary. Historically, hospitalists have largely been primary care physicians, but today other specialists, such as OB-GYN physicians, are going on staff at hospitals, too. They're also showing more interest in specialties, like dermatology, which don't force them to remain on call, notes The Wall Street Journal.

Meanwhile, group practices are being forced to change how they do business. For example, the OB-GYNs employed by Philadelphia's Albert Einstein Healthcare Network only deliver babies during three 24-hour shifts in the hospital each month, providing office care the rest of the time. Another example is San Francisco-based primary-care practice 1Life, whose physicians work four days a week for eight or nine hours a day and don't follow patients to the hospital.

To find out more about this trend:
- read this article in The Wall Street Journal

Related Articles:
Physician now have many choices
Trend: Hospitalist ranks exploding
Hospitalist group predicts presence will double by end of decade

Nevada ASC forced to stop doing procedures

Thu, 17 Apr 2008 06:59:55 -0400

Following the discovery that six cases of hepatitis C were linked to a Nevada ambulatory surgery center--the Endoscopy Center of Southern Nevada--the state responded by inspecting all of the its 48 ASCs. CMS then did follow-up inspections at 20 of the sites. Now, this inspection program has turned up another ASC with questionable practices.

The state health division's Bureau of Licensure and Certification has ordered the Lake Tahoe Surgery Center of Zephyr Cove, NV to stop doing all patient-care procedures, after CMS inspectors observed "unsafe infection control practices." According to the state, inspectors found similar problems during a March 13 inspection. Unlike the prior case, it doesn't appear that there have been any cases of disease transmission to patients.

Barton HealthCare System, which owns 67 percent of the ASC, sent out a press release noting that it had put a corrective action plan in place after an inspection by the Joint Commission a few years ago. However, the Joint Commission hasn't announced the results of its recent unscheduled visit in late February.

To learn more about the ASC investigation:
- read this Modern Healthcare article (reg. req.)

Related Articles:
Study: MDs refer profitable patients to their ASCs
Number of PA ASCs keeps growing, but profits level off
CMS updating rules for ASC Medicare participation
ASCs get boost in Georgia

Trend: Minority doctors scarce in California

Thu, 03 Apr 2008 07:59:54 -0400

A new study suggests that despite California's ethnically-diverse citizenry, there are comparatively fewer doctors of color to serve them. The study, which was conducted by the University of California San Francisco, concluded that of 62,000 practicing doctors in the state, only 5 percent are Latino, despite the fact that Latinos make up a whopping one-third of the state's total population. And only 3 percent of California physicians are black, compared with 7 percent of the state's overall population. In real number terms, fewer than 3,300 Latino physicians and about 2,000 African-American physicians are in active patient care, in a state with more than 35 million residents. Meanwhile, the state has a disproportionate number of Asian and white doctors, researchers found.

To learn more about the study:
- read this San Francisco Chronicle article

Related Articles:
Minorities seek aggressive end-of-life care. Report
Racial disparities persist in health outcomes. Report
AstraZeneca seeks minority MDs for trials. Report

ALSO NOTED: Sutter claims nurse strike won't affect operations; Wash. group pushes for patient care reporting; and much more...

Mon, 24 Mar 2008 07:59:50 -0400

> With thousands of its nurses poised to go on a 10-day strike, Sutter Health is telling the public that business will still go on as usual. Article

> The Puget Sound Health Alliance has been given access to Medicare information, which it plans to use to foster public reporting on patient care. Report

> The recent merger between health IT vendors Allscripts and Misys Healthcare could be a sign that the industry is due for consolidation. FierceHealthIT

> Here's a striking number: Apparently, almost one-third of New York City residents are enrolled in the state's Medicaid program. Article

And Finally... As if one batch of contaminated heparin wasn't enough... Article