California's Tracks Hospital Heart Surgery Performance And...

http://www.signonsandiego.com/

Yesterday's report is California's fourth on coronary artery bypass surgery. The project began in 1997 as an effort to compare hospitals' performance for common medical procedures. It is designed to enable health care consumers – including employers, insurance companies and patients – to make informed choices about where to get care.

Until 2003, the state couldn't require that hospitals submit their data on bypass surgeries. About 40 percent of the hospitals in California – including UCSD's two medical centers – refused to participate.

State legislation has made the information reporting compulsory. All 121 nonmilitary hospitals that perform bypass surgery contributed data for the latest analysis.

Among 21,272 coronary artery bypass graft procedures performed statewide in the absence of any other type of heart procedure, such as a valve replacement, 618 patients died.

Yesterday's report also was more complete in that the state included mortality rates not only for patients who died during or immediately after bypass surgery, as was done in previous reports, but also patients who died at home or at facilities other than the operating hospital within 30 days after their surgery.

This broader range of information provides a much more accurate picture of fatal surgical complications, Parker said. In addition, it takes into consideration many hospitals' practice of discharging patients who fared poorly to hospice facilities so they don't die at the hospital.

Controversy Over Specialty Hospitals

http://www.guardian.co.uk/

Specialty hospitals routinely focus on cardiac care, orthopedics and surgery. They are owned or partially owned by the physicians who work in them. In late 2003, Congress approved an 18-month moratorium designed to limit their numbers while the government analyzed their impact on health care.

Under the moratorium, physician investors in new hospitals may not refer Medicare or Medicaid patients to those hospitals, which essentially limits their funding.

Health and Human Services Secretary Mike Leavitt recently acknowledged that a Portland, Ore., hospital began operations and billed Medicare despite the moratorium. Focus on the hospital intensified after a patient's death.

Artificial Joints Becoming More Popular

http://www.spokesmanreview.com/

The huge increase in artificial joints is the result of two converging trends – more people suffering wear and tear on their joints in a condition called osteoarthritis, and improvements in artificial joint technology that dramatically relieves pain and disability, experts say.

Joints normally sustain wear over time. The cartilage cushion between bones gradually erodes, causing pain when the bones rub together. This process is exacerbated by vigorous exercise or sports activities, which may injure joints, and putting on excessive pounds, which places greater pressure on joints. Artificial replacements are made of metal and plastic.

The study projecting increased use of artificial joints is also seen as a harbinger of a looming health care crisis as medical technology eases the lives of more patients, but greatly increases costs. As costs escalate they could add to pressures to deny underserved patients the benefits of this technology, medical experts say.

British Medicare Chief Speaks

http://www.medicalnewstoday.com/

The Centers for Medicare & Medicaid Services (CMS) appreciates the Institute of Medicine 's (IOM) review of the Medicare Quality Improvement Organization (QIO) Program. Quality improvement is a very high priority across the Agency, and the QIOs play an important role in supporting the Agency's work in this area. CMS is pleased that the IOM has confirmed significant quality improvements in Medicare and strongly supports an effective QIO Program to achieve greater improvements. As the IOM noted, more can be done to increase the Program's impact on quality improvement. The IOM's report and recommendations complement the Agency's ongoing review of the QIO Program and will be carefully considered as CMS works to shape the future of this important program.

This is not the first time the IOM has reviewed the nation's QIO Program, which has led to dramatic changes in the role of these local peer review organizations. In 1990, a congressionally mandated IOM study of the QIO program was a catalyst for shifting to a quality improvement-focused archetype, which strengthened the program and redefined the QIO mission. In the 15-plus years since the release of that report, the quality improvement landscape in the nation's health care system has changed dramatically. During this time, the IOM issued additional landmark studies, including “To Err is Human” and “Crossing the Quality Chasm,” which point to system-wide process change - not individual provider sanctions - as the most effective way to improve healthcare quality. CMS and the organizations making up the QIO program have paid close attention to the IOM reports, and have made changes to the program that reflect their findings and recommendations.

In concluding that the quality of health care received by Medicare beneficiaries has improved, the IOM noted the difficulties of directly linking QIO contributions to that success. There is some recent evidence that the QIO Program is contributing to the improvements.

For example, by creating an environment and infrastructure that fosters quality and quality improvement, QIO leadership in the areas of nursing home and home health quality measurement and improvement, and hospital surgical infection prevention, is helping to make such improvement possible. To provide much clearer evidence on how QIOs can have the maximum impact, the QIO's current work plan (“8th Scope of Work”) includes a more rigorous and controlled evaluation of the impact of QIO activities.

In reaffirming the continued need for the QIO Program, the IOM also recommends a number of significant changes to the Program, including reforms to strengthen the beneficiary complaint and appeals process. We take our responsibilities for beneficiary appeals seriously and we are committed to taking all the steps we can under the law to make sure that beneficiaries are well informed about the complaint and appeals process, and that they are able to use it effectively when they need it. The IOM's recommendation to consolidate the review functions into a few regional or national competitive contracts is a promising approach that the Agency will evaluate promptly as part of its ongoing review of the Program.

QIOs are key resources to CMS, working to refine care delivery systems; investigate beneficiary complaints; safeguard the integrity of the Medicare Trust Funds; and build national partnerships with key provider organizations. QIOs also play an important role in developing quality measures that can be used to measure provider performance and spur quality improvement activities. QIOs also assist in the validation process for quality data that has been submitted and develop information about best practices and tools which support them. All of these activities contribute to the goal of creating an environment for quality improvement.

In short, the QIO program is doing important work and we are pleased that the IOM recognizes that QIOs are “a potentially valuable nationwide infrastructure dedicated to promoting quality health care.” Today's report is a central point in the national conversation about the future of American healthcare quality and CMS' quality improvement efforts. We look forward to working with Congress, the IOM, the Administration and stakeholders to continue to build on the success of QIO initiatives and shape the future of this important program.

New Doctor / Physician Review Standards In Ireland

http://www.irishhealth.com/

Concerns to be investigated under the new structures will be categorised on two levels.

Firstly, the less serious level which will lead to an initial review involving a questionnaire assessment, and interviewing colleagues and patients and the doctors concerned.

If the Performance Review Committee judges a concern to be more serious, a performance assessment team made up of trained assessors (two doctors and one non-medic) will carry out a more detailed investigation.

Dr Sisson said low level concerns would include doctors who are struggling with health problems, those with personality issues,or those not responding to call-outs.

Higher level concerns, she said, would include doctors who have a higher than normal adverse effect rate from their procedures or those with serious problems with alcohol and drug abuse.

Actions to be taken under the new procedures, where action is deemed necessary, include referring the doctor for counselling or personal development training; referring the doctor for remediation or retraining;referral to the Council's Health Committee if there is a health problem involved; referral to the Council's Fitness to Practise Committee (which can recommend striking off the doctor) where there is believed to be a serious issue involved;or a combination of the above.

Medical Peer Review Is Coming To Bermuda

http://www.theroyalgazette.com/

He spoke of a new Chargemaster cost accounting application project that should be implemented by April 2007, and added: “A peer review program for all physicians has been started to ensure that all doctors who work at the BHB meet comparable general standards set in North America. This will establish BHB as a centre of medical excellence.”

The hospitals’ board has also introduced telemedicine allowing medics on the Island to connect with health care providers around the world to share information and gain immediate access to leading specialists.

Spinal Manipulation Little Help For Back Pain

http://news.independent.co.uk/

Spinal manipulation practised by osteopaths and chiropractors for symptoms such as back and neck pain is of little help, a review of research published today claims.

Studies into spinal manipulation (SM) have failed to demonstrate that it is an effective intervention for a series of complaints, according to research to be published in next month's Journal of the Royal Society of Medicine.

Experts at the Peninsula Medical School in Exeter, Devon, looked at 16 academic papers on SM where it was practised for conditions such as back pain, neck pain, period pains, asthma and allergy.

They concluded that SM was only effective for back pain where it is superior to "sham" manipulation but not better than conventional treatments.

U.S. Patients Only Get Quality Medical Care 55% Of The Time

http://www.mercurynews.com

U.S. patients receive proper medical care from doctors and nurses only 55 percent of the time, regardless of their race, income, education or insurance status, according to a national study published Thursday in The New England Journal of Medicine.

A well-functioning health care system should provide recommended levels of care 80 to 90 percent of the time, the study's authors said.

In a performance review of preventive services and care for 30 chronic conditions, including hypertension, diabetes and heart disease, researchers found that it's almost a coin flip as to whether patients get the recommended care from doctors and nurses - even though the standard treatments are widely known.

The findings show that everyone is at roughly equal risk of inadequate care from medical professionals. However, small differences did occur in the care given male and female patients and those from different racial and ethnic groups.

FDA Investigates ADHD Drugs

http://www.yubanet.com/

The FDA's Drug Safety & Risk Management Advisory Committee held a two-day meeting last month on February 9th and 10th to review adverse events linked to the widely prescribed ADHD drugs that included reports of sudden death, high blood pressure, heart attacks and strokes among adults and children taking the medications.

In the US, between 1999 through 2003, the FDA had reports of 24 deaths among patients who took the amphetamine, Adderall, the staff report said. Eleven more deaths were reported among patients using other drugs in the amphetamine class, it noted.

During the same time frame, another 16 deaths were reported in patients who took Ritalin or other drugs known as methylphenidates, the report stated.

Thirty additional deaths of methylphenidate patients were recorded but they were either non-US cases or occurred outside the review period, the FDA said. The agency also excluded cases that appeared linked to intoxication from multiple drugs or other causes.

Former USC Heisman Trophy Winner Gets Gastric Bypass (Bariatric) Surgery

http://www.genengnews.com/

Davis, or A.D. as he is fondly referred to by friends and fans, left Scripps Memorial Hospital in La Jolla, California, where he had the surgery, just two days after his operation. "I've been feeling great since my surgery. I've experienced little to no pain -- this little ON-Q pump is amazing. After having gone through this, I'd never have surgery without it and I'd definitely recommend that others who want or need surgery ask for ON-Q," boasted Davis.

Davis chose nationally renowned surgeon Dr. Alan Wittgrove, Medical Director of the Wittgrove Bariatric Center at Scripps Memorial Hospital, to do his gastric bypass surgery and agreed for the procedure to be broadcast live and archived on the Lite and Hope website (www.liteandhope.com). Singer Carnie Wilson, who had gastric bypass surgery in 1999, narrated Davis' surgical cybercast. Davis' goal is to spread the word to others suffering from morbid obesity and its related problems like diabetes and sleep apnea. "I want people who are suffering like I was to know there is hope -- and that the surgery doesn't have to hurt if you get ON-Q," said Davis.

A pioneer, Dr. Wittgrove performed the first laparoscopic bypass surgery in the world in 1993 and currently he leads the team at the Wittgrove Bariatric Center, an American Society for Bariatric Surgery (ASBS) Center of Excellence. Having successfully performed 5,000 laparoscopic surgeries, Dr. Wittgrove underscores the significance of patient ambulation (getting up and moving around) after surgery. Ambulation is paramount to speed recovery and rehabilitation and to prevent problems.

Large Scale Medical Chart Review Study

http://buffalo.bizjournals.com/

The conditions -- asthma, diabetes, congestive heart failure, coronary artery disease and depression -- involve the largest portion of the doctors' caseload and utilize the most medical resources, said Dr. Cary Vastola, medical director of the Catholic Independent Practice Association, who developed the program with other doctors.

"By focusing our attention on these major health categories, we hope to see a measurable impact on the care and treatment of patients within our system, as well as better management of valuable healthcare resources," he said.

More than 20,000 patients will be involved initially, and will be representative of each of the three major health insurers.

Utilization Review Causing Problems For Medicaid Patients

http://pn.psychiatryonline.org

Clinically inappropriate utilization review (UR) requirements by prescription drug plans (PDPs) appear to be the most pervasive—but by no means the only—complaint. In some cases, it appears that UR requirements have been backed up by CMS in defiance of the agency's stated transition policies requiring continuity of medications for people moving from Medicaid into the new program.

Muszynski described the case of one clinician seeking prior authorization to prescribe Zyprexa for a patient previously stabilized on that drug. The clinician was told by a physician reviewer to treat the patient with Clozaril—despite the potential problems associated with that drug and the requirements for regular blood testing.

"In some cases it appears that CMS is just not serious about its own transition policies," Muszynski said. "Another serious concern we are having is that the exceptions and appeals process is one sided and in disarray."

Hospital Peer Review Court Decision In Tennessee

http://www.chattanoogan.com/

The Tennessee Court of Appeals has ruled that Dr. Alexander Stratienko has a right to examine credentialing papers of Dr. Van Stephen Monroe.

The ruling overturns a decision by Circuit Court Judge Sam Payne, who said the documents were confidential and not available for inspection.

Erlanger Medical Center suspended Dr. Stratienko from practice at the hospital after he was involved in a physical altercation with Dr. Monroe in a cath lab.

Dr. Stratienko filed suit and obtained a restraining order blocking the suspension from going into effect.

The case has been on hold while an appeal was made on the issue of whether the credentialing papers of Dr. Monroe could be inspected.

Major Hospital Peer Review Situation In Guam

http://www.kuam.com/

Hospital administrator Peter John Camacho says forty-nine cases were submitted to the peer review organization. Of those, twenty-three were reviewed.

"Thus far the care that had been rendered and everything associated with the care of those patients has been deemed appropriate," Camacho explained. "We want to reassure the community that we do take care of people here and despite some of the limitations we face, they do good things here."

Camacho adds that in a two-year period there were 109 deaths that took place in the Hospital. Officials are working to forward the remaining cases to the Mountain Pacific Group in the next two weeks.

Hospital Responds To Outside Audit

http://www.mendocinobeacon.com/

MCDH staff presented the public with a verbal summary of the key points raised by the Rural Health Management Corporation's (RHMC) independent study financed by the Hospital Resource Council and the hospital's responses.

The Hospital Resource Council is a group of four concerned citizensMike Dell'Ara, Vince Taylor, Tom Birdsell and Richard Miller, M.D., who financed the study to help resolve the current hospital financial crisis.

The well-documented hospital staff report is available to the public on request. The complete RHMC report is available on the Resource Council's Website, www.savethehospital.org

"It is difficult and certainly presumptuous to attempt to draw any definitive conclusions from a brief two-day exposure to a situation," the RHMC report states in its opening remarks on "Conclusions and Recommendations."

"A more in-depth review of relevant financial, planning and operational documentation together with additional interviews and the opportunity to observe the various interest groups in action would be required before the survey team could comfortably develop defensible final conclusions and offer relevant recommendations."

Medicare Payment Advisory Commission Report Recommends Revision of Reimbursement System

http://www.kaisernetwork.org/

The Medicare Payment Advisory Commission on Wednesday released to Congress a report that recommends CMS revise the system used to determine Medicare reimbursements for different forms of medical services, CQ HealthBeat reports. Under the current system, CMS assigns "Relative Value Units" to different forms of medical services based on the amount of resources required to provide the services, with higher reimbursements provided for services with higher RVU values. CMS reviews the RVU values for different medical services every five years, based in large part on the recommendations of a private sector advisory committee formed by the American Medical Association called the RVS Update Committee. In the report, MedPAC maintains that the five-year review system "does not do a good job of identifying services that may be overvalued" and that CMS has "relied too heavily on physician specialty societies to identify services that are misvalued." The update committee in most cases recommends higher RVU values for specialty care, which has led to decreased reimbursements for primary care, MedPAC said. MedPAC Chair Glenn Hackbarth said that the disparity raises concerns about the future supply of primary care physicians. He added that the number of medical students in primary care residencies has experienced "a pretty precipitous drop-off." The MedPAC report recommends the establishment of "a standing panel of experts to help CMS identify overvalued services and to review recommendations from the [update committee]," adding, "The group should include members with expertise in health economics and physician payment as well as members with clinical expertise." Hackbarth said that CMS can establish such a committee independently but added that Congress likely will have to provide financial support.

Medical Review Audits In Ireland

http://www.irishmedicalnews.ie/

“Currently, what we have been planning will be funded on our own resources. In the long term, there will be more in-depth procedures in the tried approach we have outlined. It will be expensive in time and/or money, and maybe time is the more difficult to replace.”

Dr Hillery believed that a “multifaceted approach” to funding and facilitating review will be necessary, either through contractual designations or the way posts are structured, in addition to routine audit.

He said routine audit and publication was needed in all facets of medicine throughout the country – “It is essential rather than the ideal.”

Could The United States & Canada Do Joint Drug Reviews?

http://www.canada.com/

Health Canada is looking at the idea of conducting joint reviews of new drugs with the American government, an idea long promoted by the pharmaceutical industry as a way to get their products on the market more quickly.

Officials stressed plans are in the early stages. But hooking up with the U.S. Food and Drug Administration (FDA) could result in new medications reaching the Canadian market an average of almost a year earlier than is the case now.

Manufacturers submit their applications for approval sooner in the much larger U.S. market and the American regulator reviews those requests in about half the time it takes Health Canada.

The first stage could be pilot projects involving "parallel" reviews by the Canadian agency and the FDA, Health Canada officials indicated at a recent meeting with the brand-name drug-industry association.

The goal initially would be just to share information and views, focusing collective brain-power on the process instead of performing the same task completely independently, said Jirina Vlk, a Health Canada spokeswoman.

NCQA Updates Physician Practice Standards

http://www.tmcnet.com/

The National Committee for Quality Assurance (NCQA) released updated standards for Physician Practice Connections, a program that recognizes medical practices that make systematic use of clinical information to deliver excellent patient care.

The American Board of Internal Medicine (ABIM) will incorporate PPC standards into its Maintenance of Certification program for 180,000 Diplomates.

The collaboration promises to introduce the program, and provide consistent guidance for quality improvement efforts using a harmonized set of measures, to a significant number of doctors over the next several years.

Maternity Programs Show Excellent ROI

http://www.marketwire.com/

American Health Holding, Inc., a multi URAC accredited medical management company, today announced that their Tomorrow's Child maternity management and high-risk maternity Case Management programs saved clients an average of $13.6 million on every 100 maternity cases opened in 2005. The goals of these programs are to decrease the number of premature and complicated births and to promote optimal delivery outcomes, resulting in minimized costs and reduced hospital readmission.

The Tomorrow's Child program addresses the needs of all expectant mothers -- from the most complicated pregnancies to those with no complications. Enrolled members are provided with education and support from their maternity nurse specialists. Additionally, they receive special mailings each trimester, including a copy of "The Good Housekeeping Illustrated Book of Pregnancy and Baby Care," pregnancy calendars, brochures and pamphlets, magazines, product samples and coupons. Higher risk pregnancies may be referred to the high-risk maternity Case Management program for closer monitoring.

According to the March of Dimes, one in every 13 pregnancies (or about 8%) results in low birth weight babies. Expectant mothers enrolled in American Health's high-risk maternity Case Management program experienced better than average results, with about one in every 14 pregnancies (or about 7%) resulting in low birth weight babies.

Recent surveys conducted with members showed that participants were overwhelmingly satisfied with the services they received through the programs -- on a scale of 1 to 4, with 4 being highly satisfied, the average score was 3.6. When given the opportunity to comment on her experience, one member wrote, "I would deeply like to express my gratitude for assisting me in bringing my beautiful baby girl into this world."

"As you can see, our Tomorrow's Child and high-risk maternity Case Management programs not only make an impact on our clients' bottom line," states Michael Reidelbach, President and CEO, "but they also enrich the experience of the mothers-to-be."

Why Do So Many Arizona Asthma Sufferers Get Treated In Emergency Rooms?

http://knowledge.wpcarey.asu.edu/

Asthma sufferers in Maricopa County, Ariz., who are on private health insurance plans are more likely to visit hospital emergency rooms for treatment than those on public insurance plans.

"Unfortunately today, people on private insurance often are switched from one private plan to another from year to year as their companies switch contractors in an attempt to save money, and that often means changing doctors and changing asthma medications due to the different doctor panels and drug formularies of different plans," Rimsza says. "That could certainly be one of the reasons why we saw another very surprising finding that people who were continuously insured but switched from private to public and visa versa within the course of one year had some of the highest rates of health care utilization."

That's one of the surprising findings in a new report, "Asthma in Maricopa County," by Arizona HealthQuery, a community health data system that houses comprehensive health information for Arizona residents. Located at the W. P. Carey School of Business and managed by the Center for Health Information and Research, AZHQ collects health-care information voluntarily provided by state agencies, hospitals, health-care systems, insurers, physician groups, community health centers, and other care centers.

Tracking Systems In Operating Rooms

http://www.infectioncontroltoday.com/

While using a tracking system may seem like a drastic departure from some hospitals’ standard procedures, it can be implemented with a simple, phased approach, Myers explains. “Our approach is really a phased and scalable one. We have facilities using our system at various levels of detail. We have customers who start by just managing their count sheets. From there, it’s an easy transition to tracking and managing at the tray level, and finally we have the customers who manage their instruments on an individual basis with unique bar codes. Implementation and training can last from two weeks to two months depending on the scope of the install.”

Once successfully instituted, a good tracking system can demonstrate its value in many other areas as well. “Our system isn’t just for sterile processing,” Myers says. “We refer to it as a comprehensive solution that can be deployed and deliver benefit in sterile processing, the surgical services suite, materials management, and the area of infection control. There is value in using our system in all of those areas.”