Posted by CEP America on Thu, Apr 29, 2010 @ 08:55 AM
By Marty Ogle MD
What does an emergency physician do on his off hours? In my case, I sometimes like to read – and not just about emergency medicine. Recently an article in the April 2010 Annals of Internal Medicine caught my attention. The article examined the criteria that US News and World Report uses to determine the 50 best American hospitals – which, it seems, is based primarily on “reputation”.
After finishing the piece, I came to the conclusion that there’s apparently little or no objective criteria in the selection process such as mortality rates, size of a specific program, patient satisfaction, CMS Core measures, or the elements of the PQRI program. That, to me, is a real puzzler.
If you've read the U.S. News article, you may very well join me in asking if these are really the “Best” hospitals. Wouldn’t you expect part of the selection criterion to include how well they actually care for their patients?? Isn’t that what hospitals are supposed to do?
The Annals article concludes by stating that “The relative standings of the top 50 hospitals largely reflect the subjective reputations of those hospitals. Moreover, little relationship exists between subjective reputation and objective measures of hospital quality among the top 50 hospitals”. To which I say “Amen, brother”.
In an era of increasing scrutiny of outcomes and performance (for both providers and hospitals), I think this would somehow enter into the mix. Not only are objective criteria in the “real world” being looked at by payors, some performance metrics are being linked to reimbursement and I suspect this trend will only accelerate.
I know that US News and World Report needs to sell magazines and advertising space, and is skewed toward a “consumer” vs. medical industry audience. So the thinking among their editorial staff most likely is to portray the article as containing empirical content to increase curiosity and sales. Nothing wrong with that -- but let’s get real. Try labeling the selected facilities as the “50 Most Popular Hospitals in the US” for journalistic accuracy. They would likely still sell a lot of magazines. And at least their article would be accurate.
What are your thoughts on mislabeling hospital quality and performance?
Posted by CEP America on Tue, Mar 16, 2010 @ 06:20 PM
By Michael Harrington, CEO, MedAmerica
As the healthcare reform debate continues, the overall complexity of our country's healthcare system seems almost overwhelming. Many healthcare organizations, physician groups, administrators and physicians are frustrated and unsettled by the pending sea change in how the government will fund and support our myriad healthcare programs.
Navigating the healthcare maze is challenging enough. But with total healthcare spending predicted to reach a staggering 20% of the entire US economy by 2017, and with per person healthcare expenditures looking to double during the same period, physicians and medical professionals will be hard pressed to spend quality time with their patients - adding to increased concerns about healthcare quality and safety.
That's why I firmly believe that the importance of a qualified, third party practice management organization has never been greater. To illustrate my point, I've identified the top 5 benefits a practice management organization can offer to health administrators and physician groups:
- Deep understanding of your business - The strength of a practice management organization is that you are working with a team of experienced professionals who understand the healthcare industry. You'll work with people who truly know and understand your business, and will treat you like a partner.
- Efficient and cost effective - Because a group offers comprehensive management specialties under one roof, you'll be able to take advantage of an array of management solutions without having to shop around to several consultants or smaller firms. This "one-stop shopping" approach increases overall efficiency and cost effectiveness.
- Collaboration - Collaboration ensures open lines of communication and a healthy sharing of ideas that lead to high-performance solutions that work for your practice. A practice management organization should be completely in sync with your unique needs.
- Technology - The benefits of a larger practice management organization include Information Technology services that are right for your needs, vs. a cookie cutter approach that may not serve your best interests. Looking toward the future, technology will be playing an ever greater role in maintaining a successful practice.
- Financials - having access to a full scope of financial, billing, reporting, benefits administration, etc. enhances the profitability of your practice. The best practice management firms offer these capabilities and take the burden off of you and your practice to keep up with ever-changing State or Federal mandates.
The bottom line is the healthcare industry isn't going to get any less complicated. The right healthcare practice management organization can really make a difference in running a successful practice. And as I like to say, it allows doctors to do what they do best - practice medicine!
Have any opinions on practice management groups? I'd love to hear them!
Posted by Guest Blogger on Fri, Dec 04, 2009 @ 04:58 PM
By Christy Palombo, RN
Seems like every day there's a new challenge concerning H1N1. For those of us in emergency medicine, it's important to take note. Is the hysteria starting? Are ER's about to be hit by an onslaught? Are people listening to us and staying home if they're ill?
On Thursday, an article published in the Washington Post stated that people may be able to spread swine flu even after their symptoms have subsided.
This comes from a recent study of Air Force cadets who came down with the flu this summer. It was found that a large number of the cadets were still "shedding" the virus more than 24 hours after their fever and other symptoms had disappeared. You can read the full report here: American Journal of Preventive Medicine
These findings bring into question whether people are listening to what we've been telling them, most importantly, staying home if they have flu-like symptoms (such as fever, sore throat, cough, etc.) instead of going to work or school and spreading the virus to others. If transmission is still possible after symptoms have gone, it could be bad news if individuals are returning to work or school too soon.
Because of swine flu vaccine production delays, the government has backed off initial estimates that as many as 120 million vaccine doses would be available by mid-October. As of last week, only 11 million doses had been shipped to health departments, doctor's offices and other providers across the country, according to the CDC.
All of which means, unless current behavior patterns change, there will be a lot of sick people heading for their local ER. My view is that medical professionals and the media need to get the word out to individuals and employers that staying home if you feel sick is the best medicine. It's clear that there will always be those who try to power through whatever illness they have, but it's also clear that the H1N1 pandemic is not business as usual. Behaviors need to be modified, and we need to make sure that message is getting out to the public. That's what I'm attempting to do here.
I welcome your thoughts and ideas on the topic - please ensure that your voice is heard!
Posted by Guest Blogger on Thu, Dec 03, 2009 @ 05:08 PM
By Nancy Burghart-Hall
With the ever-increasing demands put upon this nation's emergency departments, the challenge of implementing information technology has never been greater. And the challenges will continue to grow if the H1N1 pandemic comes to pass.
During "normal times", IT is touted to enable an ED's administrative and managerial systems to function more efficiently. In addition, software vendors tell us how clinical applications can lead to systems that more quickly capture patients' data into an electronic medical record - including the diagnosis coding, medications, and discharge summary. However, practical experience is showing us different, and the administrative overhead added to the workload by information technology often times slows down a productive ED.
Taken a step further, what will happen during extraordinary circumstances like a natural disaster or the predicted H1N1 pandemic - both of which create an onslaught of new patients?
Will our information technologies prove themselves as useful tools to help keep emergency rooms from being overwhelmed, or will our systems be even more disruptive and clog the ED during times of stress? Will your ED be able to effectively manage a pandemic using your current IT infrastructure?
The answer is "probably not". In which case, I have a couple of suggestions that are not necessarily "high tech" but have been shown to be helpful in expediting the online documentation and EDIS systems process.
Scribe programs:
A scribe is "a physician collaborator who fulfills the primary secretarial and non-medical functions of the busy emergency physician." Scribe programs have been shown to benefit ED doctors and their patients tremendously, expediting the ED process by as much as 30%-40%. During times of high stress, having a scribe program in place can be beneficial. For a thorough overview of how scribe programs work, visit: http://bit.ly/30wWLi
Voice Activation:
Medical records serve many crucial purposes. Besides a description of the clinical scenario and therapy, they serve to justify care to insurance companies and managed care organizations. It's important to note that hospitals and physicians are paid not by what they do for the patient, but how well what they do is documented. Voice Activation can support the documentation process, creating a higher quality chart.
So during a pandemic, how can an emergency physician quickly generate a comprehensive, accurate and legible medical record? Both Scribes and Voice Activation are tools to help you do this.
Is your ED's IT infrastructure up to the task? I'd love to hear your thoughts and learn about the systems you have in place. I'm also happy to share more information - just ask!
Posted by Guest Blogger on Thu, Dec 03, 2009 @ 05:05 PM
By Dan Culhane, M.D.
Is your emergency department ready for the H1N1 pandemic? It's back in the news and for most ED physicians and nurses it's most likely back in our minds. If the numbers are correct and your ED isn't prepared, this could be a very trying flu season in America.
According to a recently released presidential advisory report, The H1N1 virus could cause up to 90,000 U.S. deaths this fall - mainly among children and young adults.
The report states that the H1N1 virus, commonly known as swine flu virus, could infect between 30% and 50% of the American population during the fall and winter. They're saying 60 million to 120 million Americans could be infected, 30 million people infected but without symptoms, and up to 1.8 million Americans may be hospitalized. Visit http://www.ostp.gov/cs/hometo read the complete report.
H1N1 resurgence may happen as early as September at the beginning of the school year, and infections may peak in mid-October. However, the H1N1 vaccine isn't expected to be available until mid-October, and even then it will take several weeks for vaccinated individuals to develop immunity, the report says.
Infections may increase as early as August as some pupils return to school, according to the Centers for Disease Control and Prevention in Atlanta.
So what does it all mean to emergency rooms across the country? We could well be seeing a huge influx of sick or "think they're sick" people. And though the report urges speedier production of the H1N1 vaccine and the availability of some doses by September, the virus will likely get to a lot of people before the vaccine does. In fact, hospitals could suffer "severe disruptions", the White House warned.
While the focus on H1N1 prevention is good, the problem is, once the media frenzy gets into high gear, it's going to cause panic - when in fact people need to exercise common sense and go to the emergency room only if they need that level of care. Otherwise, it's going to overload a system that's already overloaded.
So prepare yourself and your emergency department. Perhaps doctors need to create their own campaign around avoiding the ER - "if you're not sick, it's a lot easier to catch germs in a waiting room than if you stayed home".
Please let me know your thoughts
Posted by Guest Blogger on Thu, Dec 03, 2009 @ 04:55 PM
By Ellis Weeker MD.
As an Emergency Physician, I'm always looking for interesting articles about my profession. Recently, I came upon a study published by the California Healthcare Foundation. It raises the question about California's hospital-based ED system - and whether it's keeping up with the increased pressures placed upon it. For those of us in emergency medicine, I think its great food for thought.
For the complete study, click on the link:
Is California's Hospital-Based ED System Eroding?
The study states that worsening severity of illness may be a greater factor in ED overcrowding than the growing volume of patients. My thoughts regarding their assertions include:
The supply of California ED beds grew by 17% between 2001 and 2007, while population rose 6% and ED visits increased 2%.
The supply of beds in CA EDs has risen to accommodate the increased need of an aging population as well as the increased and unmet needs for urgent and primary care. Seniors require more procedures and our system currently rewards utilization, in particular procedures. So this is not a surprise. For many hospitals, increased ED beds mean more revenue for inpatients as well as outpatients. An increase of 17% in the supply of CA ED beds can be easily explained.
A higher proportion of ED patients are more severely ill, and a greater share of visits results in hospital admission.
The higher number of critically ill and older patients greatly impacts the efficiency of an ED. More testing and therapy are required. Even after a diagnosis is made, it takes longer to admit these patients. The average percent of patients admitted to hospitals from their EDs is now 51%. So that's another reason for more ED beds.
The numbers of ED visits considered non-emergency have increased.
Lack of urgent and primary care availability to underinsured patients remains a stressor for all EDs. While non-emergency visits have increased, many insured patients have also begun to use EDs as urgent care centers.
The study reports a large variance in the percentages of increased ED visits, hospital closings and construction throughout the state. This is because our system has little or no central planning and largely responds to the local circumstances of an area, i.e. the affluence of the patients. Hospitals and their EDs close where there's poor reimbursement for patients. New hospitals and EDs are built where there's money to support them.
As always, I welcome your comments.
Posted by Guest Blogger on Thu, Dec 03, 2009 @ 11:16 AM
By Nancy Carlson, RN, MBA.
One more thing this recession has done is to temporarily mask the symptoms of a problem that's two decades old. That is, with older nurses staying in the work force longer and delaying retirement - and other nurses who left and then came back due to recessionary times - the trend toward nursing vacancies appears to have been reversed.
But there's still a nursing shortage. In fact, CINHC projects California will have a shortfall of 108,000 nurses in California alone by 2020. So even with fewer openings, there's a real need to increase capacity to educate and prepare new nurses.
Today, the positions are being filled by experienced nurses back in the market due to the economy. The average age of an RN in California is over 47, so when they start retiring, the statewide shortage will jump. According to the California Institute for Nursing & Health Care (CINHC) 90% of RN's under the age of 55 are working, which tightens the market for new grads more than usual.
The good news is that educational capacity for RNs statewide has increased 55% since 2004, bringing younger nurses - including men - into the workforce. But despite these successes, we can't pull back in our efforts to overcome the nursing shortage.
Increasing funding for nursing-education programs is still very important. And we can't become complacent when looking at recent economic data that indicate we've solved the nursing shortage. With an aging population and continued growth in the demand for caregivers, the need for new nurse graduates is as great as ever.
So where can new graduates get the needed "first job" experience if hospitals are not hiring them? (At least until the economic tide shifts and baby boomer nurses retire).
There are nursing jobs available. Opportunities are growing in ambulatory and non-acute settings as care shifts away from hospitals. Apply for any open position, be persistent in calling employers and consider moving to states such as Texas or the Midwest with more demand. New graduates may not get their first choice of a job or location, but there are still openings.
What ideas do you have to encourage our new nurses? Should hospitals hire more staff than they really need (or can afford to have on the payroll)? What has YOUR hospital done to keep graduate nurses in the employment pipeline?
Posted by Guest Blogger on Wed, Dec 02, 2009 @ 01:17 PM
By Marty Ogle, M.D.
Last week, I was reading TIME magazine's online version and came across a short piece on US Emergency Departments and how overcrowded they are. "Dog bites man", right? We all know EDs are crowded. This is NOT breaking news.
But when they spoke of the causes of ED crowding, I was impressed to see they were at least partially right about the causes: insured patients not able to get into their Primary Care Physician and sick ED patients being "boarded" in the ED for hours or days due to insufficient in-patient bed capacity.
Where the author went off track, unfortunately, was the conclusion that hospital administrators do not want to invest in the ED and instead invest in tools for high margin elective surgeries. In fact, most hospital administrators I speak with agree that Emergency Services is a profitable part of their operations. In addition, at many hospitals, the ED accounts for 50% or more of all in-patient admissions.
I am reminded that 75-90% of the patients seen in the ED are sent home. So a savvy administrator who invests in ED capacity is probably getting the most bang for the buck. The other piece to this ED capacity/crowding is what some refer to as "virtual capacity." In essence, real capacity can be altered depending upon how smoothly the place runs. Clearly, a well-functioning ED can contribute to the financial success of the hospital overall.
Finally, the author goes on to say that the impending Health Care Reform - and the possibility that healthcare coverage would be universal - will have negative effects on EDs by throwing more patients into an already overburdened Emergency Care system. I would argue that with broader coverage, patients should have greater choices and might look to other sources of care than the ED. As always, the devil is in the details. It should be quite a ride. Please let me know your thoughts.