AllMed Healthcare Management Blog: 06/23/06
Friday, June 23, 2006
Court Orders Comparative Hospital Peer Review Records Produced
In a recent discovery order of The United States District Court, the Southern District of Texas confirms the relevance and discoverability of patient records in credentialing disputes involving comparative peer review, i.e., the peer review disputes where the penalties imposed one physician are dissimilar or unequal to those imposed on others.
In Royal Benson, M.D. v. St. Joseph Regional Health Center, the District Court ordered the production of approximately 1300 patient charts, but divided the cost among the physician and the hospital to prevent undue hardship. Statements of the Court clearly indicate the importance of reviewing the peer review done upon other physicians in these disputes.
posted by Dr. Skip
Hospital Sues HMO Over Reimbursements
http://www.bakercountypress.com/
The not-for-profit corporation that operates Fraser Memorial Hospital in Macclenny has sued two large health insurance companies to force them to pay the hospital’s going rates for emergency room services. The outcome of the lawsuit filed May 30 against Aetna Health Management and Humana Medical Plan affects out-of-pocket expenses for hundreds of Baker County residents, most of them public employees.
Baker County Medical Services Inc., which manages the hospital and adjoining Wells Nursing Home, argues a Florida law that took effect in January 2005 allows it to decide “usual and customary” charges for the emergency room.
The law requires hospital reimbursement by HMOs using one of three criteria: the lesser of the amount billed or the “usual and customary” charges in the community; or, charges agreed upon beforehand by both the hospital and insurance provider.
posted by Dr. Skip
Flexibility Important In Managing Healthcare Facilities
http://www.hospitalconnect.com/
Flexibility has long been a recognized attribute of the most successful health care facilities. It is described in requests for proposals and project design criteria as a desired feature outcome of the programming, planning and design process.
It offers opportunities for increasing operational efficiency and cross utilization of space. It may also reduce total square footage because it minimizes space, equipment and staff redundancies. However, flexibility is also a subjective term that can translate to a wide range of meanings.
Flexibility must be measured as the physical ability to change to accommodate differing operational or functional requirements. Operational and space standards, such as space allocation rules and size for offices, exam rooms and consultation rooms, have been an accepted methodology for allowing functional change with minimal structural changes.
In most health care organizations, establishing guidelines is beneficial from an operational and construction cost point of view. Similarly, a process can be followed to establish flexibility design guidelines early in the functional space programming process—prior to facility planning and design.
posted by Dr. Skip
Company Sends Employees To India To Save On Healthcare Costs
The company’s most ambitious health management initiative is a plan to allow workers and dependents the option of traveling to India for certain medical procedures and sharing in up to 25 percent of the cost savings.
“The cost savings are tremendous, and we would be willing to share that with employees who are willing to do this,” he said.
Overseas treatment options are beginning to draw more attention, said health care consultant Steve Graybill of Mercer Health & Benefits’ Charlotte office, and on-site health clinics are proving increasingly popular with U.S. businesses. “Companies are looking at all options and being creative,” he said.
posted by Dr. Skip
Drug Utilization Review Implemented In Vermont
http://www.burlingtonfreepress.com/
Beginning today, Vermonters whose health care is paid by the state's Medicaid program won't be taking the much-advertised "little purple pill" -- properly called Nexium -- for gastric acid reflux unless their doctors show that no other medication meets the patients' medical needs.
The new restriction on this brand drug is an example of the state's strategy to curb the growth in the cost of prescription drugs in the Medicaid program. The Legislature and the Douglas administration have struggled in recent years to find enough money to pay the state's share of Medicaid. Overall costs continue to rise in this subsidized health care program for low-income and disabled Vermonters, with a $42 million deficit projected for state budget year beginning July 1, 2007.
About one-third of Medicaid spending in recent years went to pay for prescription drugs. That's a change from the early 1990s when spending for nursing home care ranked first, followed by inpatient hospital care, then pharmacy.
posted by Dr. Skip
Erectile Dysfunction Drugs Benefit The Rest Of The Body
http://www.medicalnewstoday.com/
When we look at all the different organ systems - the blood, the heart, the lungs, blood flow in the brain - there are hardly any negative side effects. In fact, just the opposite is true. There are beneficial effects for primary pulmonary hypertension, as well as for conditions such as heart failure and lack of oxygen in the heart," said Schwarz. "The only issue is that the data we have are from relatively short-term studies. Viagra has been on the market since 1998 and the other two PDE-5 inhibitors were approved by the FDA in 2003. Therefore, we do not have multi-year follow-up studies. On the other hand, the drugs have been on the market for several years now and there have been no reports of negative long-term effects."
While there are some differences among the three medications, they have many properties in common and work by limiting the activity of the enzyme phosphodiesterase-5, which is found in tissues and vessels of the penis, blood platelets, and smooth muscle of blood vessels. For the treatment of erectile dysfunction, the drugs' constraint of the enzyme's action results in increased levels of cyclic guanosine monophosphate (cGMP) and nitric oxide (NO), biochemicals that promote smooth muscle relaxation and increased blood flow in erectile tissue.
According to the article, PDE-5 inhibitors can be effective in treating erectile dysfunction even for many men who also have diabetes, those who are older, and those who have co-existing ischemic heart disease (reduced blood flow to the heart caused by plaque buildup in the arteries). Furthermore, say the authors, "since PDE-5 is found in smooth muscles of the systemic arteries and veins throughout the body, use
posted by Dr. Skip
Do Physicians Follow Practice Guidelines? The Study.
http://www.psychiatrictimes.com/
These and other studies demonstrate that there are still many questions about how to develop useful guidelines, how to introduce them into clinical practice, and how to measure their effectiveness. Several authors have examined the process and made useful suggestions about how to resolve these barriers.
CPGs are more likely to be accepted by physicians if they are endorsed by respected professional organizations and colleagues rather than companies and institutions that have a major investment in reducing the cost of care. CPG developers need to test various formats for the guidelines (eg, summaries of recommendations, algorithms, manuals of collected guidelines) before releasing them because physicians apparently prefer some formats over others.4
Mailings of CPGs and formal continuing medical education programs have been reported to be minimally effective in changing clinical practice, perhaps because they are too impersonal. This conclusion is supported by reports that some of the more effective methods of ensuring compliance with CPGs are those that involve guideline monitoring, feedback about compliance, and multiple interactions between experts and clinicians using the guidelines.3,5,8,14 It is worth noting, however, that the successful implementation of an effective CPG does not necessarily guarantee continued clinician compliance with the guideline. 15 This means that there must be some ongoing system that reinforces compliance with the CPG.
Not surprisingly, the clinical habits that physicians develop over years of practice are resistant to significant change without a generous amount of one-to-one contact with experts who are supportive and mentoring rather than critical. Unfortunately, this is a timeintensive and expensive process. Medicine must therefore develop innovative and effective, but less expensive methods of monitoring guideline adherence and providing reasonable feedback to practitioners.
posted by Dr. Skip
JCAHO Aligns With NFID Standards
http://www.infectioncontroltoday.com
The National Foundation for Infectious Diseases (NFID) applauds the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) for announcing its new infection control policy that requires accredited organizations to offer influenza vaccination to staff, including volunteers and licensed practitioners with close patient contact. JCAHO's standard aligns with NFID's ongoing efforts to encourage healthcare institutions to implement policies and programs to increase vaccination rates among health care workers.
"This is an important first step toward improving influenza vaccination rates within the health care community, which will enhance the health and safety of patients in their care and healthcare workers themselves," said William Schaffner, MD, NFID vice president and professor and chair of the Department of Preventive Medicine at Vanderbilt University School of Medicine. "We hope in the future this standard will be expanded to encompass various strategies to increase healthcare worker vaccine uptake, such as signed declination."
JCAHO's standard, set to take effect beginning Jan. 1, 2007, aims to establish an annual influenza vaccination program and improve access to vaccinations on-site. The standard applies to its Critical Access Hospital, Hospital and Long Term Care accreditation programs.
posted by Dr. Skip
Naval Hospital Passes JCAHO Inspection
The Portsmouth Naval Medical Center has again been fully accredited by the Joint Commission on Accreditation of Healthcare Organizations following an unannounced, weeklong review of its practices and procedures last spring.
The surprise inspection was a first for a naval hospital.
Accreditation is for three years and means patients can be assured the center complies with the highest national standards for safety and quality of care, said Rear Adm. Thomas Cullison, the center's commander.
JCAHO, an independent, not-for-profit organization, is the nation's largest and oldest health care accrediting body whose mission is to improve the safety and quality of care, center spokeswoman Deborah Kallgren said in a release
posted by Dr. Skip
