In the Puget Sound region’s latest affiliation deal, Seattle-based nonprofit Virginia Mason Health System announced Wednesday that it will affiliate with Yakima-based Memorial Family of Services.
The Seattle-based medical enterprise, which has about 5,500 employees, has offered some workers voluntary severance packages before it decides whether layoffs will be necessary in 2016, said spokesman Gale Robinette.
Seattle’s Virginia Mason Medical Center has begun posting online star ratings for, and patients’ comments about, its clinic physicians and providers.
The ratings (up to five stars) and comments are based on patient satisfaction surveys and appear with providers’ biographies on the Virginia Mason website, VirginiaMason.org.
To find a specific provider, type his or her name in the “Search” field at the top of the homepage. Click here to see an example.
In satisfaction surveys, patients rate physicians and other providers (i.e., physician assistants, advanced registered nurse practitioners) as Very Poor, Poor, Fair, Good or Very Good on these topics:
- Friendliness/courtesy of the provider
- Explanations the care provider gave you about your problem/condition
- Concern the care provider showed for your questions or worries
- Care provider’s efforts to include you in decisions about your treatment
- Degree to which the provider talked with you, using words you could understand
- Amount of time the care provider spent with you
- Your confidence in the provider
- Likelihood of your recommending this care provider to others
Ratings and patients’ comments are verified by Press Ganey Associates, an independent company that conducts ongoing satisfaction surveys.
The Virginia Mason Patient Relations and Service Department also uses information from the satisfaction surveys to identify and address issues of importance to patients and their families.
Virginia Mason is among a few health systems across the U.S. that post ratings for, and patient comments about, its providers on the Internet. Others include Cleveland Clinic, University of Utah Healthcare, Stanford Healthcare and University of Pittsburgh Medical Center.
Virginia Mason has launched several other similar initiatives include: implementing the Patient Cost Estimator, which offers comprehensive estimates of out-of-pocket costs for numerous medical exams and procedures; posting online the estimated prices of the 100 most common outpatient surgical procedures; and enabling Virginia Mason patients to see clinical notes about their care on the secure, online patient portal, called MyVirginiaMason.org.
As a dermatologist, I often hear from patients that they don’t have time for intensive skin care.
However, people should still take care of their skin by doing the basics over their lifetimes.
Good skin care and healthy lifestyle choices can help delay the natural aging process and prevent various skin problems.
Protect yourself from the sun
One of the most important ways to care for your skin is to protect it from the damaging effects of overexposure to the sun’s harmful ultraviolet (UV) rays. A lifetime of sun exposure can cause wrinkles, age spots and other problems, like skin cancer.
For the most complete sun protection Continue reading
Having both knees replaced at the same time has advantages
By Dr. David Kieras
If someone you know has severe arthritis in both knees that greatly reduces their quality of life, they may be a candidate for bilateral simultaneous knee replacement surgery, where both joints are simultaneously operated on in one surgical procedure.
Although not an option for everyone, this approach is enticing to many people who dread the idea of recovering from two separate surgeries, which delays recovery and a return to normal activities for several months, if not years.
Bilateral ‘staged’ knee replacement – one knee surgery followed by another – is not uncommon. However, bilateral simultaneous knee replacement is more advanced and uncommon due to the special expertise and team coordination required.
It can be beneficial for people who have limited time off from work for rehabilitation and need to return to a more normal lifestyle as quickly as possible. Continue reading
The independent investigative journalism website ProPublica has created online “Surgeon Scorecard” that you can use to find out a surgeon’s complication rate for eight commonly performed operations.
To learn about the complication rates of surgeons working at hospitals in Washington state go here.
Theresa Bigler, of Woodway, is suing Virginia Mason Medical Center and a medical-device manufacturer after the death of her husband following a “superbug” infection. Hospital officials have reversed course to reach out to affected patients and families.
The Seattle Times reported this morning that there had been an outbreak of multidrug-resistant “superbug” infections spread by contaminated endoscopes between 2012 and 2014 in which at least 32 patients at Virginia Mason Medical Center were infected .
Neither the hospital nor health officials notified patients or the public, the Seattle Times reported.
In response to the paper’s report, Public Health – Seattle & King County has posted the following Q & A on its Public Health Insider blog:
Q & A about Public Health’s investigation of an endoscope associated outbreak
Voluntary reporting by Virginia Mason Medical Center led to identification of an outbreak of multidrug resistant bacterial infections in 2013. After months of investigative work, Public Health—working with Virginia Mason Medical Center, Washington State Department of Health and the Centers for Disease Control Prevention (CDC)—linked the outbreak to a procedure called endoscopic retrograde cholangiopancreatography (ERCP). Since discovering the risk from this procedure, our Communicable Disease Epidemiology staff has taken a leadership role in drawing national attention to this issue in the medical community. Dr. Jeff Duchin, Interim Health Officer and Chief of Communicable Disease Epidemiology answered questions about this outbreak.
What is an ERCP used for?
The ERCP procedure uses a scope, or tube, that goes through a patient’s mouth and throat to reach their upper small bowel and bile duct system. ERCP is used in persons with serious medical problems including cancers and other diseases that cause obstruction or narrowing of the bile ducts.
What kind of bacteria caused the infections?
Infections were caused by two closely-related types of bacteria that are resistant to many antibiotics. In some cases, the bacteria were also resistant to powerful antibiotics called carbapenems. These bacteria are referred to as CRE (carbapenem resistant Enterobacteriaceae).
Was the outbreak caused by a CRE “superbug?”
No. The type of CRE that has caused outbreaks in other healthcare facilities has been referred to as a “CRE superbug.” It usually produces an enzyme that inactivates carbapenem antibiotics. The outbreak we investigated was not caused by this type of CRE, which did not have a carbapenemase enzyme.
What is the role of Public Health in this investigation? Continue reading
Seattle’s big companies have pushed local hospitals and doctors to meet the kinds of rigorous standards they use to build airplanes or brew coffee, reports The Los Angeles Times. Also in the news are a look at the SHOP exchanges for small businesses and the rate increases some of those employers are facing.
Although all hospitals in the state are making plans to rapidly identify, isolate and safely evaluate people with suspected Ebola, eight hospitals are preparing to care for a person with Ebola for the duration of the illness.
- CHI Franciscan Health (Harrison Medical Center – Bremerton campus),
- MultiCare Tacoma General Hospital,
- Providence Regional Medical Center Everett,
- Providence Sacred Heart Medical Center and Children’s Hospital in Spokane,
- Seattle Children’s Hospital,
- Swedish Medical Center (Issaquah),
- Virginia Mason Hospital, and
- UW Medicine (Harborview Medical Center, UW Medical Center, Valley Medical Center)
“The chance of a confirmed case of Ebola in Washington is very low, but in the event it happens we want to be sure we have the capacity to provide ongoing care to a patient,” said Dr. Kathy Lofy, state Health Officer. “Patients with Ebola can become critically ill and require intensive care therapy. Care needs to be delivered using strict infection control practices. We are working with each of the committed hospitals to ensure we are coordinated and thorough in our response.” Continue reading
The Patient Cost Estimator is available to Virginia Mason patients as well as others who are just shopping around to find out where to find the most affordable medical procedures. Some health care facilities might provide estimated prices or charges for a procedure, but those can be a much different amount than the cost the patient actually ends up with because there are a variety of bills that might come from hospitals, labs, physicians and elsewhere.
Seattle’s Virginia Mason is offering surgical warranties for hip and knee replacements that would cover the additional costs of any avoidable, surgery-related complications.
Group Health has signed an agreement with Swedish Health Services to provide Group Health’s Seattle-based hospital services, a decision that will end a 15-year-long acute-care relationship with Virginia Mason.
Some heart surgeries have become so common — the angioplasty, for example, to open clogged arteries — you might think the charge for it wouldn’t vary much from hospital to hospital.
You might assume the same about hip or knee replacements, which now hold the top spot in this country as the reason for overnight hospital stays by Medicare patients.
You would be so wrong. Continue reading
by Lena Groeger
Some medical conditions require and receive immediate care. People who are having heart attacks or who have suffered life-threatening injuries are typically seen by doctors as soon as they arrive at the hospital.
But in less urgent cases, patients arriving at the emergency room can wait for hours before seeing a doctor, receiving pain medication, having tests, or being admitted to the hospital.
And unless you had the foresight to call ahead, there is little way to know how long your visit will take.
Today ProPublica launching an interactive news application called ER Wait Watcher, which gives you a little more information to work with.
The app, which uses nationwide data recently released by the federal government, shows you how long it takes, on average, to see a doctor or other licensed professional at hospitals near you, plus the time it takes to drive there.
In many cases, the hospital closest to you may not be your best bet, because of long waiting times. Traveling farther may get you in front of a doctor sooner.
If you think you’re having a heart attack, or if you’ve suffered a serious injury, you should not use ER Wait Watcher. Please call 911. The ambulance will take you to the closest hospital, and won’t be as affected by traffic because it can speed and run red lights.
The app uses data from the Centers for Medicare and Medicaid Services on measures of “Timely and Effective Care.” These measures are based on a year’s worth of data that CMS updates quarterly (the last update was Dec. 12, 2013).
It includes averages for:
- How long patients tend to wait before seeing a doctor,
- how long they spend in the emergency department before being sent home or admitted to the hospital,
- and how many leave without being seen at all.
All data is reported voluntarily by hospitals, which have a financial incentive to participate.
ER Wait Watcher also estimates in real time how long it would take to drive to nearby hospitals based on current traffic conditions. It fetches this data directly from Google, so travel times will change throughout the day.
While minutes matter when you’re having a medical emergency, longer wait times are not always an indicator of worse care. For example, emergency rooms that see more patients with behavioral health problems like alcohol abuse may have much longer wait times; it may take hours for a patient to sober up enough to be safely discharged.
And time is not the only important factor, of course, so the app also includes patient satisfaction scores and other hospital quality measures to help you make an informed decision about which emergency room to go to.
The federal data includes what researchers say are important quality metrics for the nation’s emergency departments. According to Dr. Jeremiah Schuur, an emergency physician at Brigham and Women’s Hospital in Boston, the most useful measure from a patient’s perspective is waiting time — the time from when a patient walks in the door to when he sees a doctor.
Other emergency room measures, such as total length of stay at the hospital, may vary more depending on condition (a head fracture may take longer than a dislocated elbow) or on other patients (some hospitals treat sicker patients).
But whether or not a patient is seen quickly is a measure that can be compared across hospitals, says Schuur.
CMS’s move to standardize how to measure the quality of emergency care is especially needed now. In the last two decades an increase in ER patients, many of them older and sicker, has led to overcrowding.
Nationwide, ambulances are now turned away once a minute from overcrowded ERs and hospitals have difficulties in finding specialists to take emergency calls.
Some patients leave in frustration without being seen at all, while others can wait many hours for a hospital bed to become available. This confluence of problems led the Institute of Medicine to warn that emergency rooms in the United States are “at a breaking point.”
Overcrowding is not just an annoyance, and doesn’t just affect the people who come in complaining of a headache. A study of almost a million admissions to 187 California hospitals found that patients who were admitted after going through a very crowded emergency room were at 5 percent greater odds of dying than those admitted after passing through a less-crowded emergency room.
To tackle the problem, some experts advocate more measurement. Publicly releasing quality metrics can drive meaningful improvements in emergency care, according to a recent article in Health Affairs, a health policy journal. And the strategy has had some success in the past.
In 2004 hospitals began to publicly report a quality measure called “door-to-balloon time.” It refers to the time between a heart attack patient’s arrival at the emergency room and the moment of surgical intervention (which can sometimes involve inflating a thin balloon inside a heart artery).
CMS used door-to-balloon time to determine a portion of a hospital’s Medicare payment. Since then, emergency departments have focused a great deal of effort and money on identifying patients with heart attacks by screening them at triage. This has led to improvements in care for heart attack patients.
But not all measurements have had the same success. In 2005, England tried implementing another measure — a “four-hour rule” for the length of time a patient could stay in the emergency room before being sent home or admitted to the hospital. The country’s health service mandated that hospitals reach this four-hour time limit for 98 percent of their patients.
While nearly all hospitals met the goal, many also found ways to game the system, for example transferring patients to another doctor right before the clock ran out.
Since 2010, England has relaxed this measure and introduced new ones such as time to triage and percentage of patients who left without being seen.
Some U.S. emergency departments advertise their own quality care metrics, for example by posting waiting times on their websites, on billboards or on smartphone apps.
For people with conditions that are not life-threatening, this information allows them to postpone their trip or avoid a busy hospital altogether.
Theoretically this could help distribute patients more effectively and avoid pockets of crowding, improve patient satisfaction and serve as an incentive for hospitals to speed up their services.
But that information may not be reliable, or useful for comparing hospitals. On their own websites, hospitals are free to advertise any definition of “waiting time” they choose.
While one hospital could choose to count the time from when a patient arrives to when she is evaluated by a doctor, another could decide it’s when a patient is seen by a triage nurse, or receives a welcome from the hospital greeter.
In order to solve these discrepancies, CMS established standard definitions and a common metric with which to accurately compare different hospitals.
The agency defines its own “waiting time” measure as the time from when a patient walks in the door to when he is evaluated by a licensed provider (a doctor, physician assistant or nurse practitioner). CMS says its specifications state clearly who qualifies, to avoid confusion.
A caveat: Hospitals may record these times inaccurately. In most cases someone must manually write down the time a patient was seen, so the times are not always precise. To combat this, some emergency rooms outfit doctors and nurses with electronic badges that wirelessly record exact times.
According to CMS, hospitals have 30 days to review their data before submitting it to the government. The agency places most of the responsibility on hospitals for making sure their data is correct before doing so.
Instead of emphasizing timeliness, future measures could look at effectiveness of care or how well emergency departments utilize resources, according to Dr. Schuur. While the newly released data is extremely important to enable individual hospitals to improve their operations, he said, “consumers should be aware that there is much more to the quality of an emergency room than how quickly they see you.”