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NEWS BRIEFS

High Drug Error Rate Found in Hospital Radiology Departments

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JCAHO Issues Sentinel Event Alert for Medication Reconciliation

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New Indiana state law will require error reports from hospitals in 2006--State is second in nation to set up system on mistakes which will be publically reported. read more

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Deadly Hospital Germ Now Spreading in U.S. read more

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Cost of Hospital Acquired Infections Staggering read more

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Illinois Going Public with Hospital Errors in '08   read more

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20 Tips to Help Prevent Medical Errors to Your Children  read more

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Be Prepared for any Disaster--Natural or Man Made--in 3 Easy Steps; A Special Bulletin from Harvard Medical School 

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The Pennsylvania Department of Health Said It Would Start Fining Hospitals That Fail to Report Hospital Acquired Infections Click here to read full story.

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Are Our Hospitals Making Us Sick?

Care facilities across the nation should be focused on reducing infections inside their walls. In Texas, one critic says, lawmakers have 'punted' on the problem. So have many others. Click here to read full story.

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More than 11,600 Patients Acquired Hospital Infections in Pennsylvania Last Year

1500 additional deaths & 2 billion in extra hospital charges

July 13, 2005

Pennsylvania on Wednesday became the first state to publicly report the toll hospital infections take, saying that more than 11,600 patients got infections while in hospitals last year. Those infections led to an additional 1,500 deaths and $2 billion in hospital charges.

"The consequences clearly are huge," says Marc Volavka, executive director of the Pennsylvania Health Care Cost Containment Council, an independent state agency that published the data. "Everyone is paying the bill."

Pennsylvania is one of six states that require hospitals to report information on infections, and it is the first state to publicize its findings. "The deaths associated with those patients and the costs associated with those patients are astounding," said Volavka. "These numbers, even on their own, stand as a clarion cry to take action."

Officials at the council said they suspect the actual incidence of infection is higher because of seeming inconsistencies in the quarterly reports on four types of infections that Pa. hospitals were required to file last year and due to the fact that sixteen facilities, including several large hospitals, reported having no infections at all last year. The actual tally could be as high as 115,000 infections, based on billing claims the hospitals submitted to insurers. Read more on the Pa. infection scourge.

 

U.S. healthcare costs highest in the world; malpractice not a factor

By Kristen Gerencher; MarketWatch, Inc.
7/12/2005

SAN FRANCISCO (MarketWatch) -- Americans pay more for health care per person than citizens anywhere else in the world, doling out half again as much in medical expenses each year as the second-highest-cost country, according to a new study.

And contrary to popular belief and political rhetoric, malpractice lawsuits have little impact on those high costs in this country. Nor does the fact that people elsewhere end up on waiting lists for care that is in short supply do anything to hold costs down, according to the study published in the July/August edition of Health Affairs.

U.S. citizens paid $5,267 per person for health care in 2002, the study found, 53% more than any other industrialized country and $1,821 more than Switzerland, the nation with the second highest per-capita spending.

"What we said three years ago and still reiterate is, it's prices, stupid," said Dr. Gerard Anderson, lead author of the report and a professor at the Johns Hopkins Bloomberg School of Public Health.

"We pay for drugs, hospital stays and doctor visits 2 to 2 1/2 times as much as other countries pay."

While medical malpractice is a problem, its costs account for less than 1% of spending. And defensive medicine, where doctors run tests or do procedures to lower their chances of being sued, makes up no more than 9% of total spending, the study of spending in 30 nations found.

"The finding that litigation and waiting lists do not explain most of the higher U.S. health spending is perhaps not surprising considering previous research showing that the prices of care, not the amount of care delivered, are the primary difference between the United States and other countries," the authors wrote.

In 2001, the average malpractice award in the U.S. was $265,100. That was lower than Canada's $309,417 and the United Kingdom's $411,171 but higher than Australia's average payment per settlement or judgment of $97,014. All four nations had malpractice payments that represented less than 0.5% of total health spending.

But Canada, Australia and the U.K. are getting more litigious, and at a faster rate, Anderson said. Australia's average annual total malpractice payments from 1997 to 2001 increased by 28%, Canada's grew 20% and the U.K. rose 10% compared with a 5% increase for the U.S, the study said.

The presence of waiting lists for medical services didn't appear to account for much of the difference in spending either.

Spending in 12 countries with waiting lists for elective surgery was $2,366 per person compared with $2,696 per person in seven nations, not including the U.S., that said they didn't have substantial waits -

Medical services that require waiting lists comprise only 3% of U.S. health spending.


Drug costs and hospital stays


Americans also pay twice as much for prescription drugs than other countries that benefit from collective bargaining, Anderson said.

"They have a more uniform approach where all the insurers or all the purchasers of care get together and negotiate with the hospitals, with the pharmaceutical industry or the physicians," he said. "They have one block that's the negotiator whereas in the U.S. every insurance company is negotiating individually. It's not as powerful a negotiation."

Despite a widespread belief that Americans make frequent use of some of the best medical care in the world, they see doctors less often and spend 20% fewer days in the hospital than most other countries, Anderson said.

Americans checked in for 4.8 hospital days on average in 2003, down from 5 days in 1999 and 7.3 days in 1980, according to the Centers for Disease Control and Prevention.

"Our whole policy focus for the past 10, 15 years has been trying to reduce encounters, especially hospitalizations," Anderson said. "Why we're still focused as a country on reducing hospital days makes no sense to me."

Doctors' economic expectations after attending medical school also are vastly different in the U.S. compared with other nations because they begin their careers with a much bigger financial burden.

"In virtually no other country do you leave with an average $100,000 of debt," Anderson said. "In most other countries the debt a medical student has is either zero or very small."

"It's both a real difference and a perceived difference," he said. "A doctor feels like he or she is entitled to a very high salary because of this debt, but the reality is doctors make anywhere from $150,000 to $200,000 on average.... In no other country do they make more than $100,000."

Economic impact

Most industrialized countries saw their health spending increase more quickly than their total economic activity. Health spending rose to 14.6% of gross domestic product in the U.S. in 2002 from 13% in 1992 even as analysts credited managed care and cost sharing with holding it down, according to the study.

The gain of 1.6 percentage points was twice the median increase of other developed nations during that time.

Only two other countries spent more than 10% of their GDP on health care in 2002: Switzerland spent 11.2% and Germany spent 10.9% on medical expenditures.


The Slow Pace of Quality Improvement: “A Deficiency of Will & Ambition.”

R. Galvin. Health Affairs (Web Exclusive; 2005).
A leading champion of health care quality, Donald Berwick, founder of the Institute for Healthcare Improvement, sees the slow pace of improvement as evidence of a failure of provider leadership and concludes that external pressure will be necessary to move the system toward meaningful change. Interview: 'A Deficiency Of Will And Ambition:' A Conversation With Donald Berwick.

 

Washington Post, Three Part Series

Disciplining Doctors: A Washington Post Investigation

This startling investigation, the results of which were published in April, 2005, reveals rampant problems with medical boards in the Washington, D.C. area and nationwide, including:

PART ONE--Medical Boards Let Physicians Practice Despite Drug Abuse:

  • Thousands of physicians in the Washington, D.C. area and across the nation have been given numerous chances to practice, despite evidence of well-documented drug and alcohol problems. With permission of state medical boards and hospitals, they have remained in business, even when many have relapsed multiple times and posed a clear danger to patients, medical board records show;
  •  74 doctors in the District, Maryland and Virginia were disciplined for substance abuse from 1999 through 2004. In five other cases, these state boards found that doctors violated the law by abusing drugs or alcohol but took no action. Of the 74 physicians, 53 percent have been disciplined more than once for alcohol or drug use during their medical careers. Nine were sanctioned at least three times by the same board.

PART TWO--D.C. Board Rarely Punishes its Physicians:

  • Between 1999 and 2004, the D.C. medical board disciplined 49 physicians, according to board records. Thirty-four of the physicians—nearly 70 percent—were punished based on action taken elsewhere. By comparison, that figure was 16 percent in Maryland and 12 percent in Virginia;
  •  Several D.C. doctors (including one internist who failed drug tests 5 years in a row) who have been charged with drug possession or misuse have never been disciplined or taken out of practice by the D.C. board;
  • In Maryland, about 3 percent of the more than 10,800 complaints the state board received between 1999 and 2004 led to discipline against doctors, according to its records. In Virginia, the amount was about 9 percent of its more than 8,725 complaints during that period. In the District, about 1 percent—four of roughly 318—led to discipline.

PART THREE--Physicians Easily Outrun Poor Performance Records from State to State:

  • Nationally, 972 physicians between 1999 and 2004 were disciplined in one state, but then moved at least once more, and then were disciplined again for a separate infraction, according to federal statistics. Nineteen were disciplined in four or more states over five years;
  • Doctors who are disciplined can move around because many are never reported to the National Practitioner Data Bank, the national repository for doctor discipline records. The data bank is supposed to allow licensing boards and employers to check on doctors' records before they are hired and to prevent problem doctors from state-hopping;
  • However, almost 54 percent of all hospitals have never reported a disciplinary action to the data bank, according to the federal Department of Health and Human Services. Federal law requires that hospitals and medical boards be penalized if they don't report action to the data bank. Yet federal government officials acknowledge that no penalty or fine has ever been levied;
  • As part of a leave agreement, hospitals often agree not to report doctors they are forcing out. This mistakenly signals to other states and medical facilities that the doctor has a clean history. In some instances, doctors' names are removed from malpractice settlements to keep them off data bank records. Only those physicians named in the final settlement must be reported.

RELATED STORIES:()

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    Anesthesiologist Licensed to Practice in Several States
  • Despite Deaths, D.C. License Upheld (Read More)

    Board Chose Less Severe Penalties

  • Multiple State Licenses Helped Shield History (Read More)

  • Red Flags About Md. Doc Ignored (Read More)
    With Each New Job, More Accusations of Substance and Sex Abuse

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Commentary

New Study Finds That No Medical Malpractice Litigation "Crisis” Exists

The meticulous work of four scholars – three law professors and one professor of law and medicine –researched years of litigation in Texas, and found that neither jury verdicts nor payouts to patients were responsible for causing skyrocketing premiums for doctors. The study,  “Stability, Not Crisis: Medical Malpractice Claim Outcomes in Texas, 1988-2000,” was released by The Center on Lawyers, Civil Justice, and the Media at the University of Texas School of Law, and studied data from the Texas Department of Insurance from 1988-2002.

The Texas study, along with one done recently in Washington state together with many others done in past years, undermines one of the central assertions of those pursuing misdirected efforts to cap damages for patients as a way of bringing down doctors’ insurance rates.  Payments, total costs, and jury verdicts have all remained stable and have not driven recent premium increases.  The causes and solutions to that problem lie with a largely unregulated insurance industry.

We hope that state legislatures and Congress will be inspired by this latest study, as well as the recent actions by Washington State’s insurance commissioner to refund excessive premiums to doctors, to explore real reforms that will end the unfair price-gouging of doctors.  Lawmakers must stop blaming juries, lawyers and injured patients for a problem that is clearly not their fault – the price-gouging of doctors by insurers around the country.Read news reports on the Texas study here and here and read the full study here.

Viewpoint
The Importance and Paucity of Trust in Today's Healthcare System
By Donald Berwick, M.D., M.P.P.

As president and CEO of the Institute for Health Care Improvement (IHI), Cambridge, Mass., Don Berwick is one of today's true leaders in patient safety and quality improvement. This was excerpted from his acceptance speech for HRET's 2004 TRUST Award:

"Unfortunately, except for a minority of people in healthcare, improving American health lacks a sense of urgency. That puts each person's trust in our health care system at risk. The harm caused by defects in health care quality is real and its impact enormous. Yet, too many of us tolerate it." Click here to read entire speech.

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Save 100,000 Lives Campaign
The Institute for Healthcare Improvement launched a campaign to enlist up to 2,000 hospitals in an effort to reduce medication errors and avoidable injuries to patients. Participating hospitals will commit to implementing at least one of six quality improvement changes, a process estimated to result in 100,000 saved lives by July 2006. The six changes, which have been proven to prevent avoidable deaths, are to: deploy rapid response teams at the first sign of patient decline; deliver reliable, evidence-based care for acute myocardial infarction to prevent deaths from heart attack; prevent adverse drug events by implementing medication reconciliation; prevent central line infections by consistently delivering five interdependent, scientifically grounded steps collectively called the "Central Line Bundle"; prevent surgical site infections by delivering the correct perioperative antibiotics at the proper time; and prevent ventilator-associated pneumonia by implementing a series of interdependent, scientifically grounded steps called the "Ventilator Bundle."

 

Pay-for-Performance Expanding
There are more than 85 pay-for-performance programs nationwide—up from 35 in 2003—according to a recent survey by San Francisco–based Med-Vantage Inc. Although most programs continue to target primary care physicians, 42 percent included specialists in 2004. Public reporting of this data remains limited. But recent growth in these programs led the American Medical Association to hold an educational session, titled "Pay-for-Performance: The Good, The Bad, and The Ugly," at its annual interim meeting.

 

Hospital Comparative Data Now Online
Medicare launched a Web-based database last month that gives consumers access to information comparing their hospitals with other hospitals locally and nationally on 17 widely accepted quality measures. Access to Hospital Compare is free, and users can select information according to state, country, city, ZIP code, or institution. The database currently focuses on measures for the treatment of heart attacks, heart failure, and pneumonia, but it will eventually include data on other ailments and procedures. Cost comparisons and mortality rates are not provided. All but 60 of the nation's 4,200 general hospitals voluntarily submitted their data, though many chose to participate only after a 0.4 percent payment boost was offered under the Medicare Modernization Act of 2003.

 

NQF Calls Hospital Trustees to Action
The National Quality Forum (NQF) recently released a set of principles aimed at encouraging hospital governing boards to actively engage in quality improvement at their institutions. Titled "A Call to Responsibility," the principles grew out of a NQF Workshop on Hospital Governance and Quality Improvement and were approved by nearly 300 consumer, health care provider, health care payer, and other organizations. They call on hospital boards to ensure the quality of health care provided at their institutions; enable effective evaluation of their own role in enhancing quality; educate themselves in patient safety, clinical care, and performance measurement; and oversee and be accountable for their institutions' participation and performance in national quality measurement efforts and subsequent quality improvement activities. The document also classifies other stakeholders that influence hospital governance, specifically policymaking organizations, consumers, and payers, and defines principles for each group.

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O'Neill: Total Reform of Health System Necessary

Former U.S. Treasury Secretary Paul H. O'Neill continues to call on president Bush to appoint a commission to redesign the American health care reimbursement system. "[W]e still pay clinicians and facilities for activity, not for the quality of the job they did for the patient," he wrote in one Washington Post opinion piece.

 

Be Careful With Commercially Produced Quality Measures

Vida Foubister

Consumers need to critically evaluate all sources of information about their health care, including the ranking systems that are increasingly being offered through their health plans and employers. Health care leaders and physicians, too, need to be sure they understand "what's under the hood" when it comes to these commercially produced measures. Click here to read full story.

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Medicine's fastest-growing new specialty:

"Hospitalists"

Most patients won't learn about hospitalists until they end up in the care of one. But these specialists — whose sole responsibility is the care of hospitalized patients, from admission through discharge — constitute the fastest-growing field in medicine. Hospitalists coordinate care by all staffers from nurses to specialists, order up tests, make treatment decisions in consultation with primary care doctors, and are trained to recognize and respond quickly to changes in a patient's condition.

As a growing number of hospitals hire these staff physicians, hospitalists are fast supplanting the role of primary-care doctors in hospital care. The field's growth reflects efforts by hospitals to cut costs, reduce the alarming number of medical errors, and improve the general quality of care. Studies show patients cared for by hospitalists have a better chance of going home alive, with fewer complications that require readmission. Click here to read full story.


Employers' Push for Change

R. S. Galvin et al. Health Affairs 24, 228–233 (2005).
The Leapfrog Group has grown rapidly and achieved national recognition, and there is evidence that it is having direct and indirect effects on the health care market. For example, there is greater public reporting of quality data and more widespread use of computerized physician order entry for drug ordering. Yet, this employer-based initiative has struggled to create widespread changes in health care. Has The Leapfrog Group Had An Impact On The Health Care Market?

 

Hospital care for elderly with chronic conditions varies markedly in U.S.

Levels of medical care for Medicare patients with similar chronic conditions vary widely, even among hospitals identified as among the nation's best for geriatric care, according to studies conducted by Dartmouth Medical School. The report, published by the journal Health Affairs, found that the frequency of physician visits, the number of diagnostic tests and the rate of hospital and intensive care unit stays vary markedly among hospitals identified as "best" for geriatric care by the magazine U.S. News & World Report. Click here to read full story.

 

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Last update on: 12/20/05

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