Question of the Week: Should Facilities Use Surveillance to Ensure Compliance?

An article in today's American Medical News highlights how Maryland is using $100,000 in federal stimulus funds to train volunteers who will secretly monitor hand washing in 45 of the state's 47 acute care hospitals.

Maryland isn't the only state turning to surveillance methods. Rhode Island Hospital requires surgeons to participate in at least two video-recorded surgeries a year after five wrong-site surgeries were reported in the past two years. In 2007, the Massachusetts Legislature considered mandating video recorded surgeries.

There are those who support the use of surveillance and those who don't. Dr. Mark Chassin, president of The Joint Commission says that if surveillance helps hospitals determine what is affecting performance, then it can be an aid. However, Chassin cautions against the improper use of surveillance data as ammunition against individuals in their personnel files.

Dr. Mark E. Rupp, professor of infectious diseases at the University of Nebraska Medical Center and president of the Society for Healthcare Epidemiology of America believes that some providers will not like the "Big Brother" feeling that this system may impose.

What do you think? Is surveillance an effective way to boost compliance and help facilities identify practices that need improvement? Or do you think that this oversight method will cause more provider stress and anxiety?

Let us know what you think by taking this week's poll and providing your comments below.


Source: amednews.com
http://www.ama-assn.org/amednews/2009/11/30/prl21130.htm

One in Ten Surgeons Believe They Made a "Major Error" Recently

A study published in the Annals of Surgery shows that one in ten surgeons believe that they made a major medical error in the past three months.

The survey showed that surgeons experiencing burnout as a result of exhaustion, depersonalization, and personal career dissatisfaction were more likely to report an error. 40 percent of respondents said that they were experiencing "burnout," and 30 percent reported experiencing symptoms of depression. The study did conclude whether the burnout was a result of the errors, or if the errors were a result of the burnout.

The results reflect the feedback of 7,905 surgeons who completed a survey by the American College of Surgeons.

If it turns out that burnout is a link to medical error, then it looks like hospitals will have to figure out ways to boost physician morale as a way to maintain patient safety.


Source: Wall Street Journal Health Blog
http://blogs.wsj.com/health/2009/11/23/nine-percent-of-surgeons-have-made-major-errors-recently/

Senate Democrats Propose $848 Billion Health Bill

Senate Majority Leader Harry Reid (D-NV) unveiled a healthcare proposal yesterday that would cover 94 percent of all Americans and cost $848 billion over 10 years. Estimates from the Congressional Budget Office predict that the bill will cut the federal deficit by $127 billion in its first year, and $650 billion over the next decade.

While the bill has wide Democratic support in the Senate, Republicans are hesitant to believe that the bill will be budget-neutral. The plan will be paid for by Medicare cuts and increased taxes, such as a tax on high-premium "Cadillac plans."

Some provisions of the bill include:

• A public health care plan, with an option to the states to opt out of the system if they want to;
• Employers under the House bill (except some small businesses) would be mandated to provide coverage to their employees; under the Senate bill, employers who do not offer coverage will only be fined $750 per employee;
• Individuals (except illegal immigrants) who do not have access to affordable coverage through their employers would be able to purchase it from a multi-state exchange;
• 5 percent excise tax on elective cosmetic surgery; and
• A firewall segregating private insurance funds used to cover abortion from public funds; the HHS Secretary will be given discretion to determine whether or not public funding will be available for abortions.

The Senate is expected to hold a vote this Saturday to introduce the bill for debate.

$54.2 Billion Spent on Medicare Fee-for-Service Errors in 2009

Peter Orszag, Director of the Office of Management and Budget, reported that Medicare and Medicaid spent $54.2 billion in improper payments in 2009. Orszag also reported that the rate of Medicare fee-for-service errors doubled in the past year.

Orszag attributes the doubled rate to a new system of counting errors, which counts incidents such as an illegible signature or submitting a claim without sufficient documentation as errors.

To address this problem, President Obama will issue an executive order requiring greater agency oversight, the creation of a website that allows the public to track and report improper payments, and penalties for those who do not return payments received in error.

This is another example of how billions of dollars are being spent with no contribution to improving healthcare. As healthcare reform continues to develop, let's hope that the government figures cost-effective ways to improve the administrative side of healthcare delivery and increase accountability for errors. $52.4 billion could go a long way toward patient-centered improvements.

Click here for the full article:
http://www.modernhealthcare.com/article/20091117/FREE/311179968.



Source: Modern Healthcare

DNV Releases First Annual Report

DNV has released its first annual report to the public on its hospital accreditation program.

The report includes comments from several hospitals that have switched to DNV accreditation. There are almost 100 hospitals accredited by DNV.

The report also includes new initiatives, including DNV's application for deeming authority to accredit critical access hospitals.

To view the report, click here:
http://www.ebookdnv.com/hcannualreport/.

Conn. Attorney General to Seek Legislation on Medical Mistake Disclosure

Connecticut Attorney General Richard Blumenthal has announced plans to seek legislation requiring hospitals to improve the disclosure of medical mistakes.

The legislation would also direct resources to the state Medical Examining Board and Department of Public Health to for the investigation of medical mistakes and complaints of errors.

Blumenthal believes that disclosure of medical mistakes will create transparency and increase hospital accountability for errors committed.

This is definitely a good strategy toward improving the delivery of health care services and preventing further medical mishaps. Better investigation of mistakes and complaints at all hospitals will be a huge undertaking for the state government, but may be an effective step toward preventing unnecessary patient harm. It will be interesting to see where the resources for this improved oversight will come from, whether or not this initiative is successful at improving care, and whether or not other states will seek similar legislation.

Source: BNA

Question of the Week: Online Doctor's Visits

A post on the blog, Hospital Impact, highlights a new subscription service called Hello Health, which allows patients to schedule an appointment and meet with a doctor online.

The service is aimed at providing both patients and doctors with a convenient forum where they meet in less time than a traditional office visit.

Currently the service is not covered by any insurance companies, so patients must pay out-of-pocket for all services, but may be able to receive a reimbursement depending on their health plan.

It will be interesting to see if Hello Health picks up steam and helps to improve patient-provider communication. It will also be interesting to see if Hello Health and any other similar services eventually seek to have the time spent on online patient visits covered by insurers. If so, this could raise interesting challenges on how to credential and privilege providers working in an "online practice."

The question of the week is, what do you think of the online doctor's visit? Is it a good strategy for improving the delivery of care, or will it have little impact?



Source: Hospital Impact

http://www.hospitalimpact.org/index.php/2009/11/11/innovation_in_healthcare_a_look_at_onlin?utm_source=feedburner&utm_medium=feed&utm_campaign=Feed%3A+Hospitalimpactorg+%28hospitalimpact.org%29.

Changing Landscape of the Medical School Curriculum

The following article from The Washington Post illustrates changes in the way medical schools are training doctors. Instead of focusing only on anatomy, students are learning more about patient communication and political advocacy.

Some schools have also adopted a different way of studying the human body, focusing on a multi-system approach, rather than focusing on the functions of individual organs.

These changes are intended to train doctors who can offer preventative care and greater patient interaction.

For the full article, click here:
http://www.washingtonpost.com/wp-dyn/content/article/2009/11/06/AR2009110603471.html.


Source: The Washington Post

Question of the Week: Health Reform

The House passed its bill over the weekend, and the Senate is expected to start debate on the issue on November 16.

There are several issues that are expected to cause controversy, including the inclusion of a public-run health plan, and whether those who receive federal subsidies to purchase health coverage should be allowed to select plans that cover selective abortion.

This week's question is, what do you think is the most difficult issue for our lawmakers to tackle as they debate our nation's healthcare system? Vote in the poll on the right of the NAMSS Blog page and let us know your thoughts in the comment field below.

House Passes Health Reform Bill

After a late Saturday session, the House passed H.R. 3962, the Affordable Health Care for America Act.

The bill includes a public-run health plan, which is expected to cause controversy in the Senate.

Below are a few highlights of the bill:

• Estimated cost: $1.05 trillion
• Includes a government-run health plan option that will compete with private insurers in a health care exchange
• Prohibits insurance companies from denying coverage or increasing premiums based on pre-existing conditions
• Provides subsidies to individuals and families receiving income at up to 400% of the poverty level
• Provides tax credits to some small businesses that provide coverage to their employees
• Prohibits lifetime caps on insurance coverage
• Expands Medicaid eligibility
• Prohibits the use of federal funds for abortions, except in the cases of rape, incest, or danger to the mother's life

Question of the Week: Registered Dietitians

This month's issue of HCPro's Briefings on Credentialing reports the movement toward Registered Dietitians (RDs) seeking clinical privileges so that they can write diet orders at their facilities. Currently, only licensed independent practitioners are required to write orders according to CMS regulations.

The American Dietetic Association supports the movement toward granting RDs clinical privileges. The ADA believes that allowing RDs to write diet orders on their own allows them to practice within the full scope for which they are trained. They acknowledge one issue, and that is that the physician in charge of a patient's care can still be liable in a malpractice suit, even if the patient's injury is a result of the dietitian's order.

The credentialing of RDs is a practice that facilities have handled in different ways. Some facilities delegate it to their human resources offices, while medical staff offices take care of it in other facilities. If the movement toward granting RDs clinical privileges picks up steam, it is likely that credentialing of RDs will become a function of the medical staff office.

The question of the week is, who currently performs the credentialing of Registered Dietitians in your facility? Take the poll on the right side of the NAMSS Blog page, and leave any comments or thoughts on this topic in the comment field below.

Happy Medical Staff Services Awareness Week!

In 1992, President George Bush signed Congressional House Joint Resolution #399 proclaiming the first week in November as National Medical Staff Services Awareness Week. Since then, NAMSS has partnered with hospitals, MCOs, doctor’s offices, university health systems, and government agencies to promote awareness of the medical services professionals (MSPs).

Don't forget to visit the NAMSS website to find a toolkit that you can use to teach your facility more about the importance of medical staff services. Invite colleagues to visit your office this week to learn more about what MSPs do on a daily basis. This is our week!

Use the comment field to share stories and ideas on how your facility is celebrating National Medical Staff Services Week.

Click here to access the National Medical Staff Services Awareness Week toolkit:
http://www.namss.org/MemberCenter/NationalMedicalStaffAwarenessWeek/tabid/157/Default.aspx.