JCAHO Accrediting "Tourism" Hospitals

http://www.newsday.com/

A number of major hospitals involved in medical tourism have been accredited by the Joint Commission International, affiliated with the Joint Commission on Accreditation of Healthcare Organizations, or JCAHO. JCAHO accredits U.S. hospitals. However, hospitals that don't seek accreditation from the Joint Commission International might be accredited by different organizations in their own countries.

Anne Rooney, executive director for international services at the Joint Commission International in Oak Brook, Ill., said the program is "heavily modeled on the JCAHO standards but there are differences to allow for differences" in medical practices and customs in other countries.

"The organization that is accredited has gone through a rigorous external evaluation process," Rooney said, noting that the commission's imprimatur is "the gold standard around the the world."

But worldwide, Rooney said, the Joint Commission International has accredited fewer than 100 hospitals. Bumrungrad International Hospital in Bangkok, Thailand, and the Apollo Hospital in Chennai, India - both known for rolling out the red carpet and arranging lavish accommodations for medical tourists - are among them.

Hospital Peer Review Process Puts San Diego Hospital On Probation

http://www.mercurynews.com/

A San Diego hospital was placed on probation on Wednesday after a review found its pancreas center failed to perform a sufficient number of transplants, making it the latest in a string of transplant centers facing scrutiny in California.

Sharp Memorial Hospital can still perform pancreas transplants and receive organs during its probationary period, hospital officials said.

The action came after a confidential peer review by a committee of the United Network of Organ Sharing, which runs the nation's transplant system under a federal contract.

A July meeting with hospital staff uncovered deficiencies in the pancreas program including a period of inactivity when no transplants were performed for more than six months, UNOS said.

Sharp Memorial transplanted only one pancreas patient last year despite having 12 people on the waiting list. Other pancreas transplant programs in the United States performed between one to eight operations during the same period.

Malpractice Reporting Controversy In Guam

http://www.kuam.com/

Additionally Dr. Landstrom says the board cannot verify if a physician is completely truthful in his or her application for licensure or renewal. After requesting the information from the hospital, the board is pursuing legal action with its attorney. "He's working on a subpoena so we can get that information. We shouldn't have to do that," stated the physician. "We should be able to share information back and forth equally and it just looks like another stumbling block for us to do our job."

GMH quality management administrator/risk manager Ray Vega, however, has a different take on federal reporting requirements. He maintains the agency is not required to report to the Guam Board of Medical Examiners unless a physician has had his/her hospital privileges suspended or taken away for more than thirty days or if the restriction, suspension, or termination of privileges is a result of peer review. Vega added that GMH does not report to the NPDB because the hospital believes that medical settlements made on behalf of GMH are not considered reportable under the system's requirements.

Additionally GMH administrator Peter John Camacho tells KUAM News the hospital is willing to provide the information requested by the board, but he has an obligation to ensure the privacy of physicians to prevent the hospital from being sued for releasing information.

Managed Health Care In South Africa

http://free.financialmail.co.za/

Under managed care, savings are generated by ensuring that only necessary, cost-effective treatment is prescribed in line with clinical protocols and drug formularies. To ensure these rules are adhered to, schemes contract doctor networks that agree to play by MHC rules in exchange for patient volumes and/or a premium on the standard consultation fee and/or a share in down-the-line savings to the scheme.

McLeod says schemes in SA have introduced all the easy MHC tools such as hospital pre-authorisation and chronic medicine programmes, but there is still little contracting and risk-sharing between funders and provider networks.

In the US, MHC includes the use of selective networks of contracted providers; ways of encouraging members to use the networks; and some risk-sharing with those networks. "This is the crucial and missing part of MHC in SA, because it is only through developing MHC programmes, which give doctors a stake in the outcome and force them to weigh up their decisions clinically and cost-effectively that you get the change in behaviour that brings the real win," she argues.

By US standards, SA still has a fee-for-service environment that is loosely managed. A study by US consulting actuaries Milliman USA found that in such an environment funds could expect to pay R100 for a claim compared with R80 in a moderately managed environment where there was some risk-sharing. The real win comes in a vertically integrated environment (where doctors, hospitals and a funder are located within one organisation such as some of SA's mine hospitals). There the cost falls to R50.

This explains why cost escalation persists in SA in the face of rapidly rising managed-care costs.

Verdict Against Hospital Over Peer Review Affirmed

http://www.prnewswire.com

In early 1998, Dr. Poliner's competitors began raising "concerns" about
some of Dr. Poliner's cases, ultimately resulting in a suspension of his
cardiac catheterization privileges-effectively denying him the ability to
treat his patients or attract new ones, the lawsuit claims. The peer review
committee charged with considering the complaints against Dr. Poliner
consisted primarily of his competitors.

Later that year, the hospital's medical board voted to restore Dr.
Poliner's privileges after several nationally known cardiology experts
testified that Dr. Poliner's care of his patients met or exceeded the
standard of care, and that his suspension was unwarranted. Despite the
return of privileges, the board upheld the original suspension "based on
the evidence available to him [Dr. Knochel] at the time."

"Judge Solis has ratified jurors' very strong feelings that their
verdict should send a very strong message to Presbyterian and other
hospitals that this type of conduct should stop," says Mr. Lynn.

"This has been a long and difficult process for Dr. Poliner," says
original lead trial counsel Charla Aldous. "Not many people would have had
his determination and resolve. Hopefully, the jury and court's decision
will have a positive impact on the peer review process throughout the
country."

One Trillion Dollars Of Healthcare Waste

http://www.pittsburghlive.com/

Half of all health care dollars spent -- $1 trillion -- is wasted on poor quality care, safety issues and a perverse incentive plan that rewards mistakes, a leading reformer said Wednesday.

"The problem with health care is that it has become unaffordable -- and passively or actively you, employers, have the system you paid for," said Robert Mecklinburg, whose 86-year-old Virginia Mason Medical Center in Seattle was forced earlier this decade to closely examine its operations when health insurer Aetna told the provider it was too expensive.

Mecklinburg, chief of medicine at Virginia Mason, spoke at the Pittsburgh Business Group on Health's seventh annual health care symposium at the Marriott Pittsburgh City Center Hotel, Downtown.

The only way for the health care system to be fixed is for employers, those paying the bill, to stand up and say "we're not paying," said Richard P. Shannon, chairman of Allegheny General Hospital's Department of Medicine.

URAC Summit To Be Held In San Diego

http://biz.yahoo.com/

Health care management executives, quality leaders and medical professionals from across the nation will share innovative practices and address the evolving role of health care organizations at URAC's 7th Annual Quality Summit, Oct. 11-13 in San Diego. The Annual Summit attracts the country's industry pioneers and top thought leaders to examine issues at the forefront of quality and health care today.

The theme of the national Summit is "Discover New Ways to Focus on Quality." Through keynote speakers, expert panel discussions and breakout sessions, the Summit will focus attention on three critical topics in health care: consumer empowerment and protection; leadership in care coordination; and best practices in quality and accreditation initiatives.

"The consumer is taking on a more independent, responsible role in health care, and the corresponding role of health care management organizations is changing as well," said Alan P. Spielman, URAC's president and chief executive officer. "URAC's focus is to bring together the recognized leaders in quality health care to inspire ideas and lead in-depth discussion, so participants will walk away with solid business solutions that address issues in consumerism, care coordination and best practices in accreditation initiatives."

The rise of consumerism is attracting more emphasis in the health care environment. On day one of the Summit, URAC will host a general session panel discussion, led by nationally respected experts and leaders in health care to discuss the changing role of the consumer. The presentation, entitled "The Role of Consumerism in Redesigning Health Care Delivery," will offer insight from the perspectives of health plans, purchasers, and consumers. Panel speakers are Vicky Gregg, CEO, BlueCross BlueShield of Tennessee; Arnold Milstein, MD, U.S. thought leader, Mercer Health & Benefits; and Grace-Marie Turner, president, Galen Institute.

"Consumerism as we know it today is going to change over time," Gregg said. "But as far as health plans are concerned, I think the two words that are going to be tied to consumerism, regardless of products and features that may be developed, are transparent and supportive."

Many South African Deaths Due To Hospital Negligence

http://www.iol.co.za/

The committee found that 1 059 of the total number of deaths for the period under review were "directly" avoidable. These preventable deaths were linked mainly to hypertension (331), postpartum haemorrhage (261), pregnancy-related sepsis (158) and antepartum haemorrhage (100). A further 91 deaths were "anaesthetic related".

'Aids is the leading killer of women - that is clear in the report'
At district hospitals, 53,8 percent of deaths were attributed to negligent health officials, while the proportion at regional and provincial hospitals was 48,3 percent and 36,5 percent respectively. These statistics related to 3 079 of the total number of deaths that were assessed for administrative problems.

Unsuccessful resuscitation accounted for 22,3 percent of deaths, while HIV and Aids accounted for 36 percent, or 1 226, of all deaths. It is important to note, however, that the HIV status of more than 1 800 mothers was not known.

A third of all deaths was attributed to "administrative factors" such as a lack of ambulances to transport women between hospitals (9,7 percent), a lack of appropriately trained staff (12,8 percent), insufficient intensive care beds or emergency laboratory services (11,2 percent) and inadequate supplies of blood for transfusions (9,2 percent).

JCAHO Hospital Study At Odds With U.S. News Hospital Report

http://www.modernhealthcare.com/

Results of a recently published hospital quality study by the Joint Commission on Accreditation of Healthcare Organizations showed its ratings of hospitals based on treatment of heart patients was at odds with the rankings of hospitals appearing in the popular U.S. News & World Report best hospitals list, reopening the debate about whether process or outcomes measures are the better gauge of performance.

The JCAHO, which uses process evaluation, found in its study of U.S. News' rankings that 13 hospitals in the country performed better than more than 80% of the hospitals on the magazine's list of the 50 best heart and heart-surgery hospitals. U.S. News relies on hospital outcomes, such as mortality rates, and other methods in creating its rankings.

The JCAHO's effort follows a different study published earlier this year that said process-based quality evaluation methods such as the JCAHO's aren't a good predictor of mortality rates for certain conditions (July 3/10, p. 16).

And the JCAHO study, evaluating what is arguably the most established and widely read series of consumer-oriented reports on hospital performance, also comes as the JCAHO is pushing for a higher profile with the general public as a source of data on hospital performance and quality.

URAC's 3 Consumer Benefit Briefs (Press Release)

http://biz.yahoo.com/

URAC, the independent, nonprofit leader in promoting health care quality through its accreditation and certification programs, is expanding its emphasis on ways to further protect and empower consumers in an increasingly more consumer-driven health care benefits and management environment. The three issue briefs tap into the expertise of nationally recognized thought leaders to examine the issues from the perspectives of purchasers, consumers and health plans.

Consumer protection and empowerment have become a leading focus of the accreditation agency. In June 2005, URAC released its Consumer Education and Support (CES) standards, the nation's first accreditation standards to address quality within health plan products with consumer-directed features. In 2006, URAC released its next generation of accreditation standards across 11 of its accreditation programs, including new requirements for Consumer Safety Quality Improvement Projects for medical management programs. Through its accreditation programs, URAC is promoting consumer empowerment by establishing benchmarks for appropriate practices in engaging consumers as they purchase and use health plans, whether traditional or consumer-directed plans.

The issue brief released today, entitled "Health Plans Partner with Purchasers in Consumerism Drive," features observations and insights from Vicky Gregg, chief executive officer of BlueCross BlueShield of Tennessee, and John P. Weis, co-founder and chief executive officer of Quest Analytics, the software company that has linked with Health Grades, Inc. to provide a standardized method to measure and report quality outcome information on hospitals nationwide.

While consumerism is on the rise, consumer empowerment has not yet arrived. The market is still transitioning from one in which purchasers and health plans make most decisions on behalf of consumers. And the tools consumers need to make the best choices, based on both cost and quality, are still evolving.

"In the marketplace today, there's receptivity on the part of employers that consumers should have more skin in the game," Gregg said. "Health plans see increasing demand from purchasers for ways to move in this direction. Most large groups we work with view this period as a transition and are asking us, 'what are the steps that take us towards a more consumer-directed plan?' But one of the key challenges we still face is the receptivity of the actual consumer."

The second issue brief, "Consumerism Takes Center Stage As Newest Solution to Health Care's High Costs" takes the purchaser's perspective on the rapid rise of consumer-directed health care plans. The issue brief features the voices of Jerry Burgess, president and chief executive officer of the Knoxville, Tenn.-based HealthCare 21 Coalition, and Arnold Milstein, MD, MPH, medical director of the Pacific Business Group on Health and U.S. Thought Leader for Mercer Health & Benefits.

The third issue brief, "Transforming Health Care: A Consumer-Centered Model Takes Hold in the Information Age" is positioned from the consumer perspective. It features the voices of Grace-Marie Turner, founder and president of the Galen Institute, the Washington, D.C.-based public policy research organization, and Craig Froude, executive vice president and general manager of WebMD Health Services, a part of WebMD.

Consumer-directed health plans -- high-deductible plans combined with a health reimbursement arrangement (HRA) or health savings account (HSA) -- are a small but rapidly-growing segment of the health care market. Between January 2005 to January 2006, the number of enrollees and dependents covered by these plans increased from about 3 million to between about 5 and 6 million, according to an April 2006 report from the Government Accountability Office(1). Traditional health plans are also taking steps to better educate and inform consumers in the new consumer-oriented environment.

"Consumerism has experienced rapid growth, but overcoming some of these barriers will take ongoing innovation in the marketplace to ensure consumers get the information and tools they need to be comfortable as champions of their own health," said Alan P. Spielman, URAC's president and chief executive officer. "URAC is uniquely positioned to provide leadership through education and accreditation to ensure quality initiatives enhance consumerism. We are already seeing leadership emerging from health plans that are transforming their practices in ways that are measurable through URAC's Consumer Education and Support accreditation."

Study Says Physicians Unable To Self-Evaluate

http://www.forbes.com/

In fact, physicians who were judged by outsiders to be the worst performers in a given area often gave themselves especially high marks, researchers report.

"There is a subset of clinicians who appear, either by training or personality, unable to judge themselves," said study lead researcher Dr. David Davis, a professor of health policy management and evaluation at the University of Toronto, in Canada.

The findings suggest that outside evaluators might be better equipped to review a physician's performance, then direct him or her to areas that need improvement with continuing medical education.