| Ascend News Digest |
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| News for Healthcare Administrators | Friday, September 6, 2002 |
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"We're all in favor of privacy, but there comes a point in time where you're so private you can't do anything." - Michael Evans, senior vice president and chief risk officer at Sutter Health
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Legal - Doctors, Hospitals Back New Privacy Laws Hospital and doctors' groups have supported the new regulations, backed by the Bush administration, governing computerized medical records that were approved last week, and they say that the new rules will maintain patients' privacy and could lead to better health care. The new rules became official on Wednesday, but were approved on Friday and will determine how hospital staff, doctors, pharmacists, insurers -- virtually anyone who has access to personal health information -- handle a patient's personal information. The regulations also give patients the right to scrutinize their own medical records and make corrections, as well as to locate who else has viewed them. According to hospital industry officials, the paperwork involved in such regulations might delay care in an emergency situation or prohibit someone from picking up a prescription for a sick friend or relative if the patient has not already signed a consent form at the pharmacy. The new rules, which take effect April 14, ease that requirement by permitting health care providers to release the information without written consent. However, medical professionals still require notifying patients about the policies and exerting a good faith effort in order to attain that consent. The vagueness in the rules has also troubled some hospital officials and medical providers. For example, they point out, doctors are allowed to give insurers the "minimum necessary" information they need on a patient's condition, but that interpretation can vary. Another worry of the doctors and hospitals is that patients, armed with the right to view and make corrections to their medical records, will start requesting their records or demanding to know who else has viewed them. Dr. Paul Tang, chief medical information officer with the Palo Alto Medical Foundation said the group of about 450 doctors will interpret the new rules as conservatively as possible, by gaining prior written consent from patients when it does not interfere with medical care. "We will live up to that spirit (of the earlier rules), but we will not let it get in the way of patient care,” he added. (Victoria Colliver, San Francisco Chronicle, 08/15) |
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Financial - Cincinnati Hospitals In Crisis, Area Leaders Told According to hospital leaders greater Cincinnati hospitals are in a crisis due to nursing shortages, physicians leaving for more money, aging facilities and a record number of emergency-room diversions. Chief executive officers of the region's three largest hospital companies set aside their competitiveness to gather about 200 business, civic and government leaders for an extraordinary breakfast meeting at the Gregory Center downtown. The CEOs informed the group that the basic problem was that Cincinnati-area hospitals were not being adequately reimbursed by insurance companies for the costs of providing health care. Lynn Olman, president of the Greater Cincinnati Health Council said that another reason is that, in the 1990s, most major Cincinnati-area employers began steering their employees to health- care plans with the lowest possible costs. Area hospitals are increasingly unable to staff emergency rooms with an adequate numbers of nurses and doctors, stated the CEOs. They asked the business, civic and government representatives to assist them in finding solutions to the problems. Ken Hanover of the Health Alliance, which includes University and Christ hospitals said, “The competitive atmosphere of the past can only create new problems now. It's time we work together to solve these problems.” (Howard Wilkinson, The Cincinnati Enquirer, 07/26) |
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Financial |
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Nyack Hospital Losing Less Money Experts, after examining new financial information, stated that although Nyack Hospital lost $3.6 million last year and still has a pile of debt, the institution is making progress in recovering from its fiscal crisis. The audited 2001 year-end results, as well as corrected results for 1999 and 2001, were released by the hospital to financial analysts and investors. The audit shows that in 2001, the hospital continued to lose money but not nearly as much as it did the year before when it racked up $34 million in losses. Stephen Majetich, Nyack's chief financial officer, said that the hospital lost money during the first five months of this year, but at a slower rate than last year, and hopes to be in the black by the end of December. But its auditor warned that Nyack is not yet on firm ground. A 25-page report prepared by the accounting firm Ernst and Young charts the finances and challenges the hospital still faces, including litigation and an investigation by the U.S. Securities and Exchange Commission. The auditors wrote that their findings "raise substantial doubt about the hospital's ability to continue as a going concern." (Jane Lerner, The Journal News, 07/25) |
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Children's Given Bond-Rating Boost Declaring that the facility "will continue to enhance its leading market position, both regionally and nationally," Moody's Investors Service has upgraded its long-term rating for Children's Hospital of Philadelphia. The raise to "AA2", which is near the top of Moody's financial ratings, gives Children's the highest long-term rating of any nonprofit Philadelphia based hospital and one of the highest in America. The West Philadelphia-based hospital received the upgrade as it prepares to sell $323 million in bonds this month to cover a $650 million expansion that will ultimately double the extent of its main campus and add as many as 70 rooms to its existing 374. Analyst Liz Sweeney of Standard & Poor's Corp., another rating agency, which this week maintained its "AA" rating for the hospital, was slightly concerned with the expansion's size. Steven M. Altschuler, Children's chief executive officer attributed the hospital's strong performance - it made $12 million over three quarters of fiscal 2002 - to a better contract with Aetna Inc. and Independence Blue Cross, the region's dominant health insurers, and a comprehensive regional network of pediatric offices. Howard Grant, chief executive officer of Temple University Children's Medical Center, a competitor that sends cardiac surgery patients to Children's, said, "They have successfully leveraged their market position, which allows them to enjoy higher rates from the insurance companies.” (Karl Stark, The Philadelphia Inquirer, 07/26) |
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Slidell Hospital Renews Quest For Bids Slidell Memorial Hospital's board is seeking proposals from others to buy or become a partner in operating the hospital in the wake of voter rejection of a plan to raise money through a bond issue. The board said it would consider any offers from seven entities it reviewed earlier this year and wants new proposals to be submitted within 30 days. After a closed session lasting nearly three hours, the hospital board, reeling from its close loss at the polls for a $35 million bond issue authorization, took the action by unanimous vote. In April, the board decided to ask voters in the 6th, 7th, 8th and 9th wards to approve bonds that would have required a property tax ranging from 4 mills to up to 12 mills. Initially, the board was leaning toward reviewing only the proposals it received earlier this year. However in a surprise move the Board stated that it would call the bond election instead. Commissioner Emile Lombard said he had received calls since Saturday from two hospital chains interested in being a part of the bidding. The call for proposals should be thrown open to any qualified medical entity, he suggested, and other commissioners eventually agreed. (Paul Bartels, The Times-Picayune, 07/26) |
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Ailing Medical Centers Swallow Bitter Pill A financial breakdown has forced the Browne-McHardy Clinic in Metairie, LA to shed its assets in a bankruptcy fire sale, compelling former patients to scramble for their medical records. The fall of many medical operations across America in recent years reflect the changes that have rolled across the healthcare industry, prompted by a major shift in the way insurance companies pay providers. The alterations have caused financial losses at area hospitals, imperiled the financial viability of doctors' practices and left patients dizzy from navigating the changing landscape. Insurance companies, starting in the late 1990s, abandoned contracts in which physicians were paid up front for taking care of patients. They shifted from paying providers a monthly fee for every insurance plan member on their rolls to a new plan that paid doctors only when a patient came into the office. Stephen Williamson, the bankruptcy lawyer representing Summit Health Group said, "This is not the first or the last bunch of healthcare providers who are going to have this problem. People see what difficulty they have as individuals trying to get their health insurance claims paid. Doctors face the same issues when they're trying to get paid. Multiply that by several hundred." (Ronette King, The Times-Picayune, 07/28) |
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Legal |
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UCSF Violated Patients' Rights, Feds Say Investigators found out that researchers studying experimental breathing support techniques on emergency room patients at the University of California, San Francisco, violated federal guidelines for obtaining their consent. According to two federal reports, in a study which involved patients too sick to give consent for themselves, the researchers illegally convinced relatives to approve their participation after a mere phone call, without first providing them any written description of the study and its risks. The findings were revealed by investigators from the Office for Human Research Protections, an agency within the U.S. Department of Health and Human Services, who were responding to an anonymous complaint made in 2000, after the UCSF study was completed. UCSF's practices have been exposed at a time when the University of California is pressing state lawmakers to pass legislation that address the larger issue of whether it is proper to obtain consent from relatives in the first place. Assemblywoman Dion Aroner, one of the co-authors of AB2328, said she did not know that a UC campus had long been using inappropriate permission from relatives who were not legally appointed conservators. State Sen. Ray Haynes, who was unaware of UC's history on proxy consent, said he opposes AB2328 because of his experience at a law firm that handled conservatorships. Relatives cannot always be trusted to make the right decision for a vulnerable person, stated Haynes. "I remember hearing family members complain they had to sell Mom's house to take care of Mom, they wanted to preserve their inheritance," he added. (Bernadette Tansey, San Francisco Chronicle, 07/28) |
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White Plains Hospitals Object To Proposed Restrictions The restrictions placed by the White Plains Common Council on New York Presbyterian Hospital if it approves a proposed $250 million cancer treatment and biomedical research center there next month is being opposed by three other White Plains' hospitals. According to the center, White Plains would house one of the few proton-beam accelerators in America, which are used for treating cancers in particularly sensitive areas near the brain, spinal column and eyes. The heads of St. Agnes Hospital, White Plains Hospital Center and Burke Rehabilitation Hospital wrote letters opposing to two key restrictions contained in an 80-page environmental finding the council has been drafting for the past month. The proposed regulations limiting the amount of space and the type of research at a hospital facility would set a bad precedent that, if extended to all city hospitals, could threaten them financially and undermine their ability to provide medical services to patients, the representatives of the three hospitals said. Thomas Dee, president and chief executive officer of St. Agnes Hospital wrote in a letter to the council that "The city's proposed regulations, as amorphous as they may be in their current form, would seriously compromise the ability of St. Agnes and the Children's Center to implement programs, offer services and enter into affiliation agreements essential to their future operation." (Susan Elan, The Journal News, 06/28) |
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Nevada Legislators Consider Cap On Malpractice Awards State lawmakers plan to cap malpractice awards after being confronted with a medical insurance crisis that temporarily closed Nevada's top trauma center and has forced some doctors to limit how many babies they will deliver. The problems started in the state during December, when Minnesota-based St. Paul Cos., which had insured 60 percent of the state's doctors, began canceling its malpractice policies. Some doctors said that the remaining insurers quoted high policy prices that would force them to give up their practices. Nevada's only top-level trauma center, in Las Vegas, shut down for 10 days this month after 58 orthopedic doctors resigned temporarily because of increasing insurance costs. Capping pain-and-suffering jury awards, improving the reporting of disciplinary actions and limiting doctors' payments to a percentage based on responsibility, was proposed by Republican Gov. Kenny. (The Seattle Times, 07/29) |
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Staffing & Management |
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NUMC Exec's 'Job Is Not Safe' Nassau University Medical Center chief executive Richard Turan's job is under threat a year and a half after he took over. Hospital board members and county officials are questioning everything from his personnel decisions to his accounting skills. In recent months, Turan has given five-figure raises to at least two staff members, prompting criticism as to whether the center can afford them. Several GOP hospital board members are also angry with his dismissal of the hospital's lawyer who was a favorite of the Republican party. He is under investigation from the state's ethics watchdog for illegal business trips. At a time when it is debatable whether the hospital will close its $17-million budget hole, he also has invested in multimillion dollar renovations. Board members, displeased with Turan's performance, tried unsuccessfully to oust him at a meeting last month, but lost by a single vote. Despite such problems, Turan has some powerful supporters and Nassau's state-appointed fiscal watchdog for the most part agrees with Turan's contention that revenues are on target. Nassau Interim Finance Authority member Richard Kessel said, "But you have to keep everything in perspective for the hospital is losing $17 million this year." (Dionne Searcey, Newsday, 08/09) |
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Health Executive Leaves U-M In Good Shape Dr. Gilbert Omenn, head of the University of Michigan Health System, which has been in the black - no small feat in today's climate – throughout the five years of his tenure, gave his last speech recently. The reputations of the medical school, other health-related schools, the hospitals and health centers are good and getting better and plans are in place for a new cardiovascular center, a depression center and other major projects, while admissions and clinic visits are increasing steadily. However, Omenn’s five years were not smooth as U-M's highest-paid executive. At times his relationship with his boss, former President Lee Bollinger, was difficult and his leadership abilities were questioned. But his colleagues gave Omenn a standing ovation when he finished his hour-long speech at the hospital's Ford Auditorium thanking his co-workers and saying he looked forward to working with them as he steps down from the $573,682-a-year job to return to research. "Over these last five years, I've seen him on virtually a daily basis, and I have been struck by his unique ability to see the institution through the eyes of patients, and that unique contribution has been of tremendous value here in every way," said Dr. Lloyd Jacobs, Chief Operating Officer and Senior Associate Dean for Clinical Affairs. (Tracy Davis, The Ann Arbor News, 07/28) |
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Volume Figures Can Be Linked To Quality Patients have a better chance of surviving with limited complications if they choose a hospital that has plenty of practice, according to some experts. However, patients had no way to learn the volume of surgeries or other procedures being performed at their hospitals in Texas as the public's access to information on Texas hospitals has been very limited. Those numbers were made available for the first time, and the differences among hospitals are significant. Researchers and physicians stated that small programs can still have low death rates and other positive results, but when no other information is available, learning the volume of surgeries and other procedures at a hospital can give Texans a sense of how they might fare. Because of the connection between volume and better results, some groups have suggested benchmarks for the number of times a hospital should perform a certain procedure. Hospitals have pointed out that the figures present an incomplete and incorrect picture of quality because some small programs have fetched good results. But consumer advocates complimented any information that sheds light on the practice of medicine. A New England Journal of Medicine study of Medicare patients in April found that for 14 types of cancer and heart surgeries, patients were more likely to survive at a facility that met certain benchmarks for the number of procedures performed. Dr. John Birkmeyer, associate professor of surgery at Dartmouth Medical School in New Hampshire said that more than 20,000 Medicare patients die each year undergoing the surgeries. "Approximately 2,500 of those deaths could be averted if all hospitals were achieving the same level of performance as very high volume hospitals," he added. (Trebor Banstetter, Jeff Claassen And Charlotte Huff, Star-Telegram, 07/28) |
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Programs |
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Doctors Criticize Patient Safety Recommendations For Not Including Common-Sense Methods A government-appointed report on diminishing medical errors neglects simple, common sense ideas such as using checklists and counting surgical sponges to make sure none are left inside the patient, stated experts. The U.S. Agency for Healthcare Research and Quality sent the 600-plus-page report to doctors nationwide. It was commissioned by the health care agency in response to concerns about medical loopholes, and highlights only practices that have been rigorously studied, such as using ultrasound to help guide the insertion of intravenous tubes. In a critique in the Journal of the American Medical Association, Drs. Lucian Leape and Donald Berwick of Harvard University's School of Public Health and Dr. David Bates of Harvard Medical School called the report a "superb and groundbreaking compendium of what is known about the evidence of effectiveness" of certain methods of preventing complications. But the critique pointed out various simple methods used by doctors to stop mistakes — including checklists, sponge counts and techniques to ensure surgeons operate on the right spot — that had been excluded from the report. "It would be tragic if these omissions were interpreted as reasons to discontinue these practices," said the critique. (Lindsey Tanner, Associated Press, 07/28) |
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No Joke, No Jell-O: Hospital Food Goes Gourmet Hospitals are reporting a rise in their patient satisfaction ratings across the country as a result of installing room-service programs, which offer patients more healthy food like salads and fresh fruit and entrees reminiscent of what they would order at a fine restaurant. The new room-service concept also has permitted greater flexibility in scheduling, giving patients much more control over when they eat. Now, hospital images are actually being boosted by food. According to experts, the upgrade in food is a part of the continuing effort of hospitals for the betterment of the overall experience for patients and serves as a nice complement to other hospitality measures, like putting greeters at the hospital's front door. Bob Ashe, president of the Greater New Jersey Society for Health Care Food Administrators stated that although patients are being offered cold sandwiches and microwaveable meals on an around-the-clock basis by most hospitals, the fiscal bottom-line of many hospitals would rule out something like room service. (Angela Stewart, The Star-Ledger, 07/29) |
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Medical Research, Advancements, & Announcements |
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Study: Stem Cells May Save Limbs New research shows that injecting patients' own stem cells into their leg muscles could create new blood vessels, eliminating pain from bad circulation and helping to prevent gangrene or amputations. Scientists at Kansai Medical University in Osaka, Kurume University School of Medicine in Kurume and Jichi Medical School in Tochigi, conducted the study in what was the first demonstration that showed implanting stem cells into humans can result in new blood vessel networks, a process termed as angiogenesis. Experts state that the findings give hope to millions of people globally who suffer pain in their limbs because of plugged arteries but are unable to have an operation. The most impressive findings came from leg specimens of one patient who got stem cells in one leg and saline in the other but died half way through the trial of an unrelated heart attack, said Ira Herman, a professor of physiology at Tufts University who was not involved in the research. The examination found a significant increase in blood vessel numbers in the leg injected with stem cells. "It's just remarkable, You can't help but be impressed by the collection of data,” he said. (Emma Ross, Associated Press, 08/08) |
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Services |
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