Anger Management: A Potential Problem In Healthcare Organizations

http://counseling-apc.blogspot.com/

Health care organizations are especially vulnerable to aggressive disruptive behavior because they typically have not invested in communication and leadership skills for physicians and nurses. Hospital medical peer review panels find it painfully difficult to reprimand a colleague who may be behaving badly. Moreover, many organizations fail to deal with difficult physicians until they've crossed the line to "disruptive." It is unfortunate, but rare for a physician to recognize the need for help and voluntarily seek anger management/executive coach assistance

Texas Hospital Peer Review Decision

http://hollandhart.typepad.com/

Hospitals and their medical staffs frequently assert in post privileges termination legal proceedings that the only issue is whether the hearing panel could reasonably conclude that the physician practices substandard medicine justifying the restriction or elimination of his privileges. See Smith v. Ricks, 31 F.3d 1478 (9th Cir. 1994); Pamituan v. Nanticoke Memorial Hospital, 192 f. 3d 378 (3d Cir. 1999) and Morgan v. Peacehealth, 14 P 3d 773 (Wash. App. 2000). Notwithstanding, the lack of consistency and evenhandedness in the peer review of hospital physicians represents potentially compelling evidence of intent to commit an antitrust violation or to violate the civil rights of a physician. In Benson, the Court ordered the hospital to produce all of the underlying cases in the hospital peer review of other physicians in order to permit Dr. Benson to do a comparative analysis of peer review of others compared to his own.

More Physicians Opting Out of Managed Care

http://www.tmcnet.com/

"While physicians have not dropped out of managed care networks in large numbers, this small but statistically significant increase could signal a trend toward greater out-of-pocket costs for patients and a decline in patient access to physicians," said Paul B. Ginsburg, PhD, president of HSC, a nonpartisan policy research organization funded principally by The Robert Wood Johnson Foundation.

Options for physicians who do not contract with managed care plans range from seeing only patients covered by insurance products that do not include provider networks (including fee-for-service Medicare), establishing cash-only practices, and serving managed care patients as an out-of-network provider who can balance bill patients for charges beyond insurer reimbursements for out-of-network providers.

"Despite media reports about doctors dropping out of insurance networks because of payment and administrative hassles, the vast majority of physicians continue to contract with managed care plans," said HSC Senior Researcher Ann S. O'Malley, MD, coauthor of the study with HSC Senior Researcher James D. Reschovsky, PhD

Common Hospital Billing Errors

http://www.consumerreports.org/

Dates of service. Pamela Wilson, a nurse for American Medical Bill Review, a Redding, Calif., firm that works for insurers, says that most plans do not allow hospitals to charge for your discharge day, although hospitals frequently do so anyway. The day you entered the hospital can generally be billed as a full day, however, even if you were admitted late at night.

Duplicate or incorrect orders for medication, lab work, tests, or room fees. Compare the charges on your bill with the doctor's orders. Hospitals may bill a patient for a procedure even though the doctor cancelled it. Also, if you were charged several lab fees on one day, call your insurer to check whether the charges should be bundled. For example, you might be charged for a number of blood tests in one day that should be combined as one charge. Room fees may come with à la carte extras. "I often see charges for supplies like sheets, towels, and gloves that should be included in the room charge," says Pat Palmer, president of Medical Billing Advocates of America (MBAA), a Salem, Va., group that checks bills for consumers. Palmer is also coauthor of "The Medical Bill Survival Guide" (Warner Books).

Operating-room time. Your anesthesia record will state the times when your surgery began and ended. Operating-room use is billed either hourly or by the half- or quarter-hour. Rates vary from $500 to more than $2,000 per half-hour. You may find, for example, that you were billed for four hours for a procedure that actually took only three.

Fraudulent charges. By carefully reviewing basics such as your dates of service, you may be able to spot more-unscrupulous practices. Brennan, the fraud investigator, says he found one ophthalmologist's office manager who billed patients legitimately for surgery on one eye, and then routinely billed for surgery on the other eye two weeks later--even though no second surgery occurred. "Over six months, she stole over $45,000," Brennan says.

You may also spot charges for more expensive services or procedures than were performed. Commonly known as upcoding, the practice inflates the patient's diagnostic code to a more serious condition requiring more costly procedures. Although it will take some time and effort, you can double-check the doctor's orders against the diagnosis to make sure it is consistent with the procedures listed on your bill. You can check codes on the web at www.cdc.gov/nchs/icd9.htm.

U.S. Circuit Court Rules On Peer Review Case

http://www.law.com/

A federal statute requires the release of a medical facility's peer review records despite state law shielding their confidentiality, the 2nd U.S. Circuit Court of Appeals has ruled.

Clearing the way for the release of peer review records sought for investigations into the deaths of two mentally ill patients at state-administered hospitals, the circuit said the plain language of the Protection and Advocacy for Individuals with Mental Illness Act, 42 U.S.C. §§10801-10851, trumps state law.

The appeal of Protection & Advocacy for Persons with Disabilities v. Mental Health & Addiction Services, 05-1457-cv, was decided by Judges Sonia Sotomayor and Reena Raggi, with Southern District of New York Judge Miriam Goldman Cedarbaum, sitting by designation. Sotomayor wrote for the panel.

One Blogger's View of the Hospital / Physician Relationship

http://www.hospitalimpact.org/

The first is the relationship between physicians and hospitals. In many cases across the country, this is not a marriage made in heaven and it is easy to see why. The relationship between hospitals and physicians is not only fraught with legal peril, it is a relationship between parties with differing interests and financial incentives. It takes exceptional leadership, patience, and business savvy on the hospital side to make these relationship work. And even then, changes in the market and/or physician behavior can break the relationship (that is not to say that hospitals are never at fault). The main issue here is that the relationship between physicians and the hospital can make or break a hospital and my guess is that the overall state of hospital/physician relations is not good. I don't mean to stir the pot, but I haven't seen any indicators that the case is otherwise. The challenge for hospitals is how to build a mutually beneficial relationship that, in the end, serves the best interest of the patient as well.

Hospital Peer Review At Issue In Connecticut Court Decision

http://hollandhart.typepad.com/

A judge of the Superior Court of Connecticut, held last January that the hospital could not use a favorable peer review determination that an anesthesiologist on its staff had performed in accordance with the standard of care in its own defense of a negligent supervision and negligent credentialing case. The court, in Halley v. Norwalk Hospital Association, Conn. Super. Ct., No. CV-04-4017092-S, was responding to a motion by the plaintiffs in limine to prevent the hospital and the anesthesiologist’s professional corporation from disclosing the favorable peer review evaluation of the anesthesiologist. The court held that the plain meaning of the statute does not directly or by inference permit disclosure of the fact that privileges were not terminated or restricted.

No More Advance Notice for JCAHO Hospital Inspections

http://www.journalnow.com/

For the first time in its 55-year history, the Joint Commission on the Accreditation of Healthcare Organizations, which inspects most of the nation's hospitals, is no longer alerting institutions weeks before a routine visit.

The change, aimed at improving the quality of patient care, took effect Jan. 1 and applies to most of the 15,000 institutions that JCAHO accredits, including nursing homes and clinics.

Prisons and facilities run by the Department of Defense will receive five days' warning, which Joseph Cappiello, JCAHO's vice president, said is necessary to obtain security clearances.

Sentinel Event Leads To Elective C-Section Suspension At Canadian Hospital

http://www.thegoldenstar.net/

Dr. Kotlarz had suspended elective C-sections on April 10, citing unspecified risk management issues relating to the effectiveness of the practice in Golden. He offered no further details on the reasons, only describing his action as a "pre-emptive strike" in response to a "sentinel event".

The issue was to have been resolved following an April 26 peer review meeting in Cranbrook between IHA and several Golden physicians - pending the local doctors' acceptance of a list of recommendations subsequently issued by Dr. Kotlarz.

Independent Medical Review Welcomed In Australia

http://www.medicalnewstoday.com/

Medicines Australia is delighted that the Federal Government has established a process that allows an independent review of decisions made by the Pharmaceutical Benefits Advisory Committee (PBAC).

"The Free Trade Agreement was signed by Australia and the United States in May 2004 and in February last year the Federal Government announced details on how the Independent Review process would work," said the Chief Executive Officer of Medicines Australia, Kieran Schneemann.

Interqual Algorithms & The Consequences Of Not Following Them

http://www.democratandchronicle.com/

Few physicians are aware that a book called Interqual may dictate whether a patient is admitted or discharged from the emergency room. Interqual lists signs, symptoms and laboratory findings that the nurse case manager uses to opt for a 23-hour observation admission, full admission or discharge home from the emergency room. If the Interqual algorithms are not followed, the patient will not be admitted or the hospital is not paid.

The same issues arise with the length of stay in a hospital. Should the attending physician or nurse care manager decide when a patient should be discharged from the hospital or transferred to a lower level of care? Who knows more about the patient — the nurse care manager or the physician? Yet, if the nurse care manager's decision is not followed, the hospital will not be paid.

In our doctor's case, he was penalized financially for not following the algorithm of care for a particular medical condition. While community guidelines may have some relevance, they are no substitute for the decision-making that occurs in the doctor-patient relationship.

Being rich in computers and staff, insurance companies generate massive amounts of paperwork that allegedly help doctors practice better medicine. Lists of patients who should have certain tests performed are sent to physicians. These lists add to the depth and weight of the medical record but do not result in improved medical care by physicians trying to keep up with demands of the insurance companies and the independent practice associations associated with the insurance companies.

RFID And Its Utilization In Healthcare

http://www.sdcexec.com/

RFID is an enabling technology that saves lives, prevents errors, saves costs and increases security. It removers tedious procedures and provides patients with more freedom and dignity. For example, it reduces the amount of personal intervention by staff because it automates procedures such as protecting the disoriented elderly from danger and matching patient to treatment.

In addition, RFID is now used in smart packaging that records when patients take medication and how much they take and provides prompts to help them comply with instructions. All this has been pulled together in a major new report "RFID in Healthcare 2006-2016" by IDTechEx. It gives 72 case studies, extensive supplier profiles, technology analysis and detailed ten year forecasts.

Over the next ten years, the largest use of RFID in healthcare will be labels on drugs at the item level and the infrastructure and services to support this throughout the supply chain and in healthcare facilities. The primary purpose of this will be anti-counterfeiting by establishing the full history of that package at all times — called pedigree. This will be underpinned by scientific analysis of the drugs inside the package.

RFID is already extensively used in hospitals and it is starting to be used in other healthcare environments, including care homes and self-help. In all these locations there is considerable scope for further use of RFID. In the IDTechEx RFID Knowledgebase, a collection of more than 2,000 RFID case studies, 8 percent are healthcare applications, and we do not expect that to increase greatly despite the very rapid adoption of RFID in healthcare. The relative importance of different applications within the healthcare sector is shown in the tables below. When we set this against the value of the different market sectors, we see that pharmaceuticals are involved in a relatively small number of high volume projects, whereas other applications largely consist of many small initiatives, often disproportionately profitable for suppliers because of the specialist knowledge and products required.

Rise of Antipsychotic Drug Use In Children

http://www.yubanet.com/

While the use of atypical antipsychotic drugs in children is not approved by the Food and Drug Administration (FDA), Medco's analysis of over 2 million insured Americans found that the number of children taking these medications has risen continuously over the past 4 years. This differs from trends seen in utilization of other behavioral medications including ADHD medications -- where use among children remained flat from 2004 to 2005 and antidepressants -- which saw a significant drop in use among children in that one-year period.

Children are receiving the latest generation of antipsychotics - known as atypical antipsychotics, including risperidone, olanzapine, clozapine, ziprasidone and quetiapine - at a much higher rate than adults. Of the patients prescribed antipsychotics, children received the newer atypical drugs 97 percent of the time rather than the older treatments. Adults received the newer antipsychotics 88 percent of the time. These drugs have been used as treatments for bipolar disorder, conduct disorder, ADHD, depression, Tourette's syndrome and other conditions.

"Children are receiving antipsychotics with greater frequency and that may be because they are viewed as less dangerous than the older medications and can be helpful for conditions that were previously treated with other medications," said Medco's chief medical officer, Dr. Robert Epstein. "However, these drugs are not without their risks. There is evidence that the risk of diabetes and metabolic disorders from using atypical antipsychotics could be much more severe for pediatric patients than adults, and there is a need for more studies to understand the long-term effects of these drugs on children."

Wireless Tracking of Patients In Hospitals

http://www.wirelesshealthcare.co.uk/

The automatic tracking software provides real-time tracking of patients and mobile medical equipment in the emergency department and ancillary areas using wireless badges worn by patients and staff. Unlike all other forms of computer-based patient tracking, the software requires virtually no manual updating by department staff to maintain real-time and complete communication on patient location and care status. The software incorporates a rules-based intelligence that translates interactions between patients, medical staff and equipment into time-stamped stages of a patient's treatment. This information is continuously updated on an electronic tracking map which is configured to an emergency department's layout. The elimination of data entry and the ability to generate detailed reports of all patient flow history assists emergency departments to efficiently match resources as patient flow fluctuates and to further analyze department utilization.

How Is The Teamwork In The Operating Room?

http://www.forbes.com/forbeslife

"Nurses are generally trained to work in teams with each other, and with the other disciplines," she explained. The teamwork begins even before the surgeon walks into the room, "whereas the surgeons are trained to be sort of the captain of the ship."

As a result, she added, "If the personality of the surgeon is not one where he or she naturally invites people to talk, those people are going to feel intimidated about speaking up if they have a question or they're concerned about something."

Communications mishaps are the most common cause of deaths and serious injuries reported by U.S. hospitals, according to the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), which tracks these so-called "sentinel events." In the most egregious, headline-grabbing cases, poor communication often is to blame for surgeries on the wrong patient or the wrong part of the body. But it can also be the culprit behind minor injuries and "near misses," Makary said.

To assess OR teamwork, the authors first adapted a survey originally designed to measure flight safety attitudes in the cockpit. "What the aviation industry learned was that crashes had been directly attributable to a co-pilot knowing that something was wrong but not feeling comfortable speaking up," Makary noted.

What Can Be Learned From The Patel Case

http://www.abc.net.au/

The review found that there were a number of deficiencies in the Queensland health system that contributed to the Patel situation. These included inadequate funding, defective administration, the absence of adequate peer review and a culture of concealment.

“(Patel) was not adequately assessed,” says Woodruff. “The College of Surgeons in fact has a very stringent and effective process for assessing overseas trained doctors. Dr Patel did not go through that process because there is such a workforce crisis that there is this area of need (and it was) imperative to short circuit the system.”

Woodruff says we will continue to rely on international medical graduates but says we “must ensure that they’re properly enculturated – introduced into our system”.