Archive for April 2008

Message to Medicare: Whoa, Nellie!

Last week, Medicare proposed nine additional “do not pay” conditions, several months before implementing the first eight. I like the concept of not paying for preventable adverse events, but this new list is a case of too far, too fast.In my previous review of the new policy (here and in this article), I described four conditions that should be met for an adverse event (AE) to be included on the “do not pay” list:Evidence demonstrates that the AE in question can largely be prevented by widespread adoption of achievable practices.The AE can be measured accurately, in a way that is auditable.The AE resulted in clinically significant patient harm.It is possible, through chart review, to differentiate an AE that began in the hospital from one that was “present on admission” (POA).Take, for example, catheter-related bloodstream infections (CR-BSI), one of the eight original AEs slated for “do not pay” implementation by the…

Snooping At Britney’s Chart: Why Should Docs and Nurses Have Different Rules?

Should doctors and nurses be subject to different penalties for precisely the same infraction? Of course not. Are they? Sure. Just ask Britney Spears.Britney was hospitalized at UCLA at least twice in the past few years – once when she gave birth to her first son in 2005, and again in early 2008 for psychiatric care. Both times, dozens of UCLA staff members peeked at her medical records, despite having no clinical reason to do so. This voyeurism, of course, is hard wired into our DNA, and we aren’t about to purge our inner paparazzis any time soon. But even celebs have a right to keep their medical records private. Although the Health Insurance Portability and Accountability Act (HIPAA) has caused some real mischief, one of its beneficial effects is that it put the issue of medical record snooping on our radar screen. Whether the victim is a Hollywood starlet…

Should Patient Satisfaction Scores Be Adjusted for Where Patients Shop?

Last week, Medicare added patient satisfaction data to its hospital reporting website. This is progress, but it raises an interesting question: should patient satisfaction scores be case-mix adjusted?The motivation to include patient satisfaction data comes from the Institute of Medicine’s inclusion of “patient-centeredness” as one key component of quality. And what could be simpler than asking patients a few questions, as the Center for Medicare & Medicaid Services (CMS) survey does. (A pdf of the survey, formally known as HCAHPS, or “H-CAPS”, for Hospital Consumer Assessment of Healthcare Providers and Systems, is here). I like the addition of the patient experience data and found the presentation on the CMS site to be fairly reader-friendly (as did US News & World Report’s Avery Comarow). For example, it only took a few seconds to find my hospital’s performance on the summary question, “Would you definitely recommend this hospital?”:UCSF Medical Center: 80% yesAverage…

A Quick Thanks for a Very Nice Honor

Today, Modern Healthcare released its yearly list of the 50 most influential physician-execs in the U.S. I have to believe that you, my readers, are at least partly responsible (along with my parents and their pals in Boca) for my #19 position, the highest rank of any full-time faculty physician. As nice as this is, I must admit that seeing myself on this list of movers and shakers is a bit odd. At number 19, I'm sandwiched between people like the leaders of the Mayo Clinic and HCA, and the heads of the Cleveland Clinic, CDC, NIH, FDA, AMA, and Robert Wood Johnson Foundation. In other words, people who control budgets of billions of dollars. In contrast, the biggest budgetary decision I’ve made in the last few months was whether to go for the one- or three-movie plan at Netflix. In any case, thanks much. I am humbled.

Notes from the Society of Hospital Medicine’s Annual Meeting

A few random observations from the Society of Hospital Medicine’s annual meeting in San Diego:There are about 1600 people here, most of whom I don’t know. How did this happen?People still seem pretty jazzed about their jobs and lives. The meeting has not lost its soul, nor its sense of wonderment or of family. That’s a very good thing, since these intangibles can be easily lost with time and size.Certain issues seem to bubble up in every hallway conversation:Are you co-managing surgical patients yet?What’s the core job description of your hospitalists?Are you having trouble recruiting?How do you say no to relentless demand for hospitalist coverage?Viz recruiting, in this morning’s panel discussion, John Nelson asked audience members to raise their hand if their program was recruiting for new people. About 90% of people did so. How many hospitalists hailed from places weren’t looking for new recruits? About 3 hands went up.…