The Pharmacy Robot Doesn't Make Mistakes

http://www.hendersondispatch.com/

Best Care Pharmacy, one of two new businesses in the old First Citizens Bank building on Dabney Drive, has an employee who doesn't take coffee breaks, get a weekly salary, go to the restroom, eat lunch or take vacations.

The worker is a robot who receives prescription orders from a computer, and then fills them by counting pills, pouring the tablets and capsules into bottles, putting them on a conveyor belt and sticking on labels containing address and caution information.

A picture of the medication and processing data show up on a screen that the human pharmacist uses to check the mechanical druggist's work.

Utilization Review: The Future Trend

http://www.allhealth.org/

Utilization review/disease management—In an
attempt to keep costs under control, many
employers are using utilization review and disease
management programs. The Kaiser/HRET
study found that about eight in 10 covered workers
are in a health plan that uses case management
for high-cost claims. Three-fourths of covered
workers must obtain approval from a health
plan before receiving inpatient services and more
than half (55 percent) must get prior certification
for outpatient surgery.
Some 56 percent of covered workers are
enrolled in a plan with at least one disease management
program. These programs help those
with chronic conditions—typically, diabetes, asthma,
hypertension and high cholesterol—manage
and control their illnesses more effectively and
remain healthier longer.

The Essential Job Of Medical Coding

http://www.delawareonline.com/

Hundreds of regulations dictate how coding decisions are made. Once the coder has collected all the necessary codes, a computer program called a grouper is used to group the codes, establish which ones take precedence and determine which one will be billed as the primary diagnosis. This directly affects the amount of payment collected from insurance companies and Medicare.

Usually, coders are able to get the information they need from the patient's medical records. But sometimes the investigation can involve consulting with the doctor to get further insight. Being able to communicate on the same level as a physician is crucial, Rodriguez said.

"You can't infer anything," she said. "You have to follow the doctor's thought process through the entire chart."

A Typical Community Hospital Board Meeting

http://www.dailyitem.com/

It will still make decisions regarding physician credentialing and hiring and will determine the mission of Sunbury Community Hospital. The board will meet 10 times a year, with one public meeting held annually. The board also is responsible for evaluating the performance of Mr. Park and will step into the peer review process of the medical staff when necessary.

"It's going to be a working board," Mr. Carpenter said.

Community Health Systems has one thing that Sunbury Community Hospital hasn't had: access to capital. And Community Health Systems has pledged to invest $10 million in the hospital over five years. Accordingly, the board of trustees is now able to focus on capital improvements that were previously beyond its grasp. At the top of the list is a new emergency room, a feature Mr. Park says should be in place in 2007.

Major Backlog In Maryland Doctor Complaint Investigations

http://www.baltimoresun.com/

Hundreds of complaints against doctors are languishing because the state board set up to discipline physicians can't hire enough investigators to keep up with the caseload, according to the board's director.

Testifying before the House Health and Government Operations Committee yesterday, C. Irving Pinder Jr., executive director of the Maryland Board of Physicians, said there is a backlog of about 400 such cases.

Complaints about doctors "take too long to get through the process," Pinder told lawmakers. The health committee is considering a bill to continue the board, which oversees about 24,000 physicians licensed in the state. About 17,000 are believed to be practicing here.

URAC Revises Health Website Standards (Full Press Release)

http://biz.yahoo.com/

As consumers increase their dependence on the Internet for the latest medical information and entrust sites with personal information, the nation's only organization that accredits health web sites is tightening the requirements to earn its seal of approval.

URAC, an independent, non-profit accreditation organization, pioneered Health Web Site accreditation in 2001 to assess the quality and privacy practices of accredited sites.

Like the original standards, the Health Web Site version 2.0 standards were developed with the assistance of an expert committee of representatives of industry, accredited health web sites, the public and government.

"More than half of Internet users have surfed the web for medical information, and that information should be accurate and up-to-date," said Alan P. Spielman, URAC's president and CEO. "Consumer-directed health plans are now drawing consumers to the Internet for information on cost and quality. In this environment, the URAC accreditation provides a visible seal of approval that says a site can be trusted."

Changes in the standards include a requirement that health web site users "opt-in," or give consent, before providing any personally identifying information. The previous standards only required this consent before providing personal health information. The new standard adds an additional level of privacy protection for consumers.

Enhanced editorial standards require health content vendors to ensure site content is peer-reviewed before it is published online. The standards also enhance editorial transparency, requiring that the names of content team members be posted and that all editorial sources are noted on the site.

"Today's consumer is increasingly concerned about the practices of health web sites. With the emergence of online medical records, the quality and privacy practices of the sites are more important than ever before." Spielman said. "URAC accreditation shows consumers that health web sites have credibility and go the extra mile to protect their privacy."

About URAC

URAC, an independent, nonprofit organization, is well-known as a leader in promoting health care quality through its accreditation and certification programs. URAC offers a wide range of quality benchmarking programs and services that keep pace with the rapid changes in the health care system, and provide a symbol of excellence for organizations to validate their commitment to quality and accountability. Through its broad-based governance structure and an inclusive standards development process, URAC ensures that all stakeholders are represented in establishing meaningful quality measures for the entire health care industry. For more information visit http://www.urac.org/

Hospital Peer Review & One Navy Hospital

http://www.navytimes.com/

"Bono said that the hospital conducts a “quality care review” of such incidents and that those deemed serious undergo peer review, which can result in restricting a doctor’s staff privileges. The hospital also asks the Bureau of Medicine and Surgery to review the case. That can result in a higher-level peer review and, if the Navy surgeon general chooses, the doctor is reported to the National Practitioner Data Bank, which maintains a permanent record of the malpractice, possibly impeding future employment. "

English Peer Review Study

http://news.ft.com/

"He suggested publishing individual doctors' performance and making the achievement of improvements in that part of the contract for NHS chief executives. "That would at least harness the natural competitiveness among doctors who would be faced with their activity levels compared with others. That in turn would lead to a conversation about the quality of their clinical outcomes," he said.

Professor Ham agreed: "Improving productivity involves getting into clinical practice and finding out why doctors take different decisions about similar patients. That can't be done from Whitehall, and chief executives find it hard to make an impact. It has to come from peer review and self-policing by the medical profession. But even where you have effective clinical leaders, they find it hard to persuade colleagues to change."

However, he suggested that the financial pressure that would be applied by payment by results, the new "money follows the patient" payment system for the NHS, "is likely to produce a one-off reduction in the length of stay and a one-off shift towards day surgery".

Peer Review Shows 62% Unnecessary Sugeries

http://www.newsinferno.com/

"As reported by The Charleston Gazette, an expert review of 21 spinal surgeries performed by Dr. John Anderson King in 2002 and 2003 at Putnam General Hospital found 13 of the operations to have been partly or completely unnecessary.

The analysis of King’s surgical records regarding those 21 operations was conducted by Dr. Edgar Dawson from the University of California at Los Angeles."

How Peer Review Is Done At One Medical Center

http://www.casperstartribune.net/

"Wyoming Medical Center would not be allowed to renew its hospital license without first providing a form of peer review," the commissioners responded.

A hospital's governing board determines whether peer review should be conducted by a state, local specialty medical society or other lawfully created group of physicians.

The Wyoming Medical Center conducts its peer review through the medical staff, which establishes standards which will trigger an initial review by a nurse auditor, and that review proceeds through a medical department.

If the department chairman determines the physician's performance fell short, the chairman will forward the information to the peer review committee.

The committee then reviews the information and patient chart and gives the physician recommendations to improve care or the medical environment.

If the process confirms a significant error or breach in care standards, the physician's privileges may become an issue. At this point, the physician's due process rights commence and a new set of rules and higher standards are applied, according to the answer."

Dental Insurance Claims & NICO

http://www.businessweek.com/

Aetna says it has discovered 429 claims improperly filed for NICO treatment -- none of which would have come to light had Cavitat not filed suit first against the insurer. In September, 2004, Cavitat alleged that Aetna interfered with its ability to do business by publishing an explanation of why it won't pay claims for NICO treatments. "They intend to put us out of business," Jones says. John B. Shely, an outside lawyer for the insurer, counters that "Aetna believes it is important that consumers, employers, and health-care professionals have information about what is covered, and Aetna is legally entitled to publish that information." When Aetna started investigating Cavitat's charges, it discovered the alleged wrongful claims and countersued.

The Aetna case blasts Cavitat customers such as Dr. Michael Margolis, a dentist in Mesa, Ariz., who has spoken at Cavitat seminars. Aetna alleges that Margolis advocates that his patients prepare for surgery with "'hydrocolon therapy,' or what he crudely calls 'a tube up the booty cleans things out."' Margolis confirms this but says Aetna is taking his comments out of context. "If they don't want to pay for it, that's their business, but they don't have the right to tell me I can't do something," he says. The Arizona State Board of Dental Examiners disciplined Margolis in April, 2004, for recommending that a Cavitat-scanned patient have five teeth removed. Margolis is suing the board. "I didn't do anything wrong," he says.

Aetna ended up paying for the claims it's now disputing because, like most other large insurers, it has become almost completely automated. Dentists and physicians submit claims that describe procedures using numeric codes assigned by outside agencies such as the American Medical Assn. There are no specific codes for NICO-related procedures. Aetna alleges that Cavitat's Jones coached dentists on how to use codes that describe treatments similar to those advocated for NICO so they would fly through the computer systems undetected. "We published [existing] insurance codes," says Jones. "There's nothing illegal, no misrepresentation, no insurance fraud."

It's likely that other insurance companies have been paying for NICO, too. "If Aetna lost millions, the loss to the entire industry could be in the tens of millions," estimates Evelyn Ireland, executive director of the National Association of Dental Plans. "When we pay claims that are miscoded, premiums go up," Ireland adds. "It ends up costing the consumer."

Journal of Hospital Medicine Launches

http://www.prnewswire.com/

"The Society of Hospital Medicine
(SHM), the premier medical society representing hospitalists, is launching a
new peer-reviewed medical journal, the Journal of Hospital Medicine, in
February 2006 to promote the science and practice of hospital medicine and the
enhancement of hospital care. The Journal of Hospital Medicine will be the
nation's first and only peer-reviewed journal devoted exclusively to the
publication of research and evidence-based reviews in the area of hospital
medicine. Included with the inaugural issue will be a special supplement,
"The Core Competencies in Hospital Medicine: A Framework for Curriculum
Development by the Society of Hospital Medicine."

Irvine Administrator Ignored Hospital Peer Review Recommendations

http://horus.vcsa.uci.edu/

According to the Orange County Register, in July 2003, a peer review of the hospital found several critical problems with the program, including lack of surgeons, problems in patient management and a structure that made performing these transplants financially unwise for the hospital. The peer review was initiated after the United Network for Organ Sharing recognized that survival data showed transplant patients at UCI were faring worse than those at other hospitals.

In 2004, with transplant and survival rates still below federal standards, Cygan convinced UNOS to keep the transplant program operating by promising that a transplant surgeon from UC San Diego would join the UCIMC staff full time. However, the surgeon never had any intentions of moving to UCI full time.

The findings from Medicare’s audit from July to August 2005 show that the UCIMC did little, if anything, to fix the problems that were identified in years past. Among other problems, Medicare stated that “there was no documentation of any discussion or development of specific action plans to actively recruit transplant surgeons.”

Although he recognized “deficiencies” in the transplant program, Cygan told Medicare on Oct. 31 that the Medical Center was in negotiation to hire another transplant surgeon to join the program by early 2006. But it was too little, too late. Medicare decided to stop funding liver transplants at the UCIMC and consequently the program was voluntarily shut down.

National Study Evaluates Electronic Reporting of Medical Errors and Adverse Events (Complete Press Release)

http://sev.prnewswire.com/

Results from a multi-year survey of reports from hospitals using electronic adverse event and error reporting systems indicate that an estimated 34,000 patients a year could be seriously or permanently injured, or die, during hospitalization due to medical errors and adverse events.

The findings, based on an extensive study designed and managed by Tufts- New England Medical Center in Boston, come from analyses of 2.5 million patient days at 26 acute care hospitals across the U.S. The research also found:

* Among the errors that reached patients, the majority (67 percent) caused
no harm, while the remaining third caused injury (32 percent temporary
harm, less than 1 percent permanent or life threatening harm, and less
than 0.5 percent contributing to patient death).

* Although computer reporting stations were easily accessible to all
hospital employees, doctors entered fewer than two percent of all
reported incidents, whereas registered nurses provided nearly half of
all medical error reports.

* A total of 92,547 medical error and adverse events were reported.
Although over half of these involved patients, more than one-quarter
were due to institutional safety issues or "near-misses" that did not
affect patients.

The full study, funded in part by grants from the Ruth Kirschstein Individual National Research Service Award and the Agency for Health Research and Quality, was posted online today by The Journal of General Internal Medicine at http://www.blackwellpublishing.com/. It will appear in the February 2006 print edition.

According to Tufts-New England Medical Center's Physician-in-Chief Deeb Salem, MD, this is the first time any extensive research had been conducted on electronic error reporting systems in the United States.

"The study provides conclusive evidence that voluntary, online electronic reporting systems are playing an increasingly vital role in the nation's hospitals," said Salem, who is also the senior author of the study.

"An electronic system for reporting adverse events and medical errors may allow for easier identification and analysis of clinical practices that lead to adverse events and errors," said study lead author and Tufts-NEMC physician Catherine E. Milch, MD. "Direct observation and chart review, two other commonly used methods, are time and labor intensive and impractical for rapid analysis. The next step is to determine if electronic reporting will decrease the incidence of severe injury and death to patients."

The researchers also emphasized that computer-based systems allow hospitals to collect four times more data than conventional methods; "near misses" are routinely recorded; and all data is peer-review protected on secure internal computer networks.

"Electronic error reporting systems will allow clinicians to gather real- life data, both now and as safer systems are implemented. Such data are central to causing and sustaining change," said Stephen Pauker, MD, Tufts- NEMC's Associate Physician-in-Chief and study co-author. "Gathering accurate data about medical errors is a necessary step toward making medical care safer."

Study Methodology

The study evaluated all reported events from 26 acute care non-profit, non-federal hospitals that had voluntarily implemented a system for at least three months (median range of usage was 21 months).

Hospitals ranged in size from 120 to 582 beds. Twenty-four were adult or adult/pediatric care; two were exclusively pediatric; nine were academic medical centers; 11 were in urban, 13 in suburban, and two in rural settings.

The reporting system consisted of a secure, web-based portal available on all hospital PCs. Any employee could submit a report after a secure login. The reporting process took an average of 10 minutes to complete. Collected data was only accessible to pre-specified hospital personnel, mostly chief medical officers and quality improvement executives.

Of the total 92,457 reports, 34 percent were non-medication related clinical events, 33 percent were medication related events, 13 percent were falls, 13 percent were administrative and six percent "other." Of all error incidents, registered nurses reported 47 percent; pharmacists and pharmacy technicians 16 percent; lab technicians 10 percent; unit clerks/secretarial staff 10 percent; LPNs and nursing assistants three percent; and physicians 1.4 percent. Other reports came from medical assistants, security personnel, social workers, and risk case managers.

Other physician-researchers participating in the study were Dr. Thomas G. Lundquist, Dr. Sanjaya Kumar, and Mr. Jack Chen. The error reporting system is a product of Quantros, Inc., Milpitas, Calif.

URAC Revises Standards (Complete Press Release)

http://www.prnewswire.com

Today URAC announced the rollout of
comprehensive revisions of its clinical accreditation standards, including new
requirements for ongoing patient safety initiatives, effective Jan. 1, 2006.
The changes affect Health Utilization Management, Workers' Compensation
Utilization Management, Case Management, Disease Management, Health Call
Center, Independent Review Organization, Credentials Verification
Organization, Provider Credentialing, Health Plan, and Health Network
accreditation programs.

"These Standards revisions represent a next generation of accreditation
standards. Standards enhancements have been applied across eleven programs
simultaneously," said Douglas Metz, DC, chairman of URAC's Standards Committee
and chief health services officer for American Specialty Health. "The changes
improve consistency and efficiency between the Core standards and each of the
accreditation program modules."

"Establishing viable standards in today's environment requires both an
understanding of current practice and the evolving trends in the market," said
Alan P. Spielman, URAC's president and chief executive officer. "The Standards
Committee includes representatives from many different stakeholder
perspectives, who worked for two years discussing and debating the most
appropriate quality standards for these revisions."

Metz said the Standards Committee sought input from various and diverse
stakeholders through the revision process. Stakeholders who provided input
into the process included URAC's Health Web Site Advisory Committee, its
Disease Management Advisory Committee, and hundreds of other volunteers who
peer-reviewed and commented on draft versions of the standards. A critical and
essential part of the revision process, URAC released draft standards to the
public so that all industry stakeholders and interested parties had an
opportunity to comment.

"The Committee reviewed each and every comment we received," Metz said.
"Although the revised standards are consistent with and similar to the initial
drafts released for public comment, the Committee added many clarifications
and enhancements to the standards based on that public input."

Focused efforts to enhance patient safety is a specific area of emphasis
in the new standards, which now include a Consumer Safety Quality Improvement
Project as one requirement for organizations seeking accreditation.

Other changes to the standards include:

-- A single accreditation glossary of terminology for all of URAC's
clinical standards modules. This standardizes terminology and
definitions across the clinical accreditation programs.

-- An updated description of the URAC scoring/weighting system. This
clarification does not change the current system, but it does more
effectively communicate the scoring/weighting process for
organizations seeking accreditation.

-- The Credentialing chapters of the Health Plan and Health Network
Standards have been synchronized to the extent possible in order to
promote more efficiency in the credentialing process.

"Rapid changes and innovation in health care raise a number of pivotal
challenges to ensure health care delivery remains focused on care, rather than
cost alone," Spielman said. "URAC accreditation gives organizations the
ability to translate the complexity of health care operations and activities
into a well-recognized seal of approval that embodies high standards and
industry best practices for all."

About URAC

URAC, an independent, nonprofit organization, is well known as a leader in
promoting health care quality through its accreditation and certification
programs. URAC offers a wide range of quality benchmarking programs and
services that keep pace with the rapid changes in the health care system, and
provide a symbol of excellence for organizations to validate their commitment
to quality and accountability. Through its broad-based governance structure
and an inclusive standards development process, URAC ensures that all
stakeholders are represented in establishing meaningful quality measures for
the entire health care industry. For more information, visit
http://www.urac.org