Category Archives: Virginia Mason

Group Health ends 15-year relationship with Virginia Mason, switches to Swedish – Puget Sound Business Journal

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Group Health IconGroup 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.

via Group Health ends 15-year relationship with Virginia Mason, switches to Swedish – Puget Sound Business Journal.

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Hospital prices vary wildly for common treatments

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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

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Sign for an emergency room.

App tells how long you’re likely to wait in a hospital’s ER

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Sign for an emergency room.by Lena Groeger
ProPublica

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.

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Virginia Mason Medical Center had the longest wait times in Seattle, but 81% of patients said they would “Definitely Recommend” Virginia Mason, higher than the state average of 73%.

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.

Physician and Nurse Pushing GurneyIn 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.”

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Nearly 1,500 hospitals penalized under Medicare quality program

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hospital magnify 300By Jordan Rau
KHN Staff Writer

More hospitals are receiving penalties than bonuses in the second year of Medicare’s quality incentive program, and the average penalty is steeper than it was last year, government records show.

Medicare has raised payment rates to 1,231 hospitals based on two-dozen quality measurements, including surveys of patient satisfaction and—for the first time—death rates.

Another 1,451 hospitals are being paid less for each Medicare patient they treat.

For half the hospitals, the financial changes that started last month are negligible: they are gaining or losing less than a fifth of one percent what Medicare otherwise would have paid. Others are experiencing greater swings.

Gallup Indian Medical Center in New Mexico, a federal government hospital on the border of the Navajo Reservation, will be paid 1.14 percent less for each patient. Arkansas Heart Hospital in Little Rock, a physician-owned hospital that only handles cardiovascular cases, will get the largest bonus, 0.88 percent.

The bonuses and penalties are one piece of the health care law’s efforts to create financial incentives for doctors and hospitals to provide better care. They come at a tumultuous time as the technical problems of the healthcare.gov insurance portal and premium prices are stoking questions about the law’s viability. The incentives are among the law’s few cost-control provisions that have kicked in, but it is too early to tell how effective they will be in making hospitals operate more efficiently.

“This program is driving what we want in health care,” said Dr. Patrick Conway, Medicare’s chief medical officer. He said most hospitals have improved since the program began a year ago. However, even some hospitals that have gotten better are still losing money because they are not scoring as well as others or have not improved as much.

Across the country, hospital executives say they have put renewed focus on excellence in the areas that are judged. Some have clamped down on nighttime noise, one of the questions patients are asked about, by replacing squeaky wheels on food carts and discouraging nurses and workers from chatting on cell phones outside of rooms.

Others have scrambled to ensure heart attack patients always get an angioplasty within 90 minutes of arrival because that is part of the scoring. Some private insurers have adopted similar incentives.

“The thing about the government, if they start paying attention to it, we have to scramble around to pay attention to it,” said Dr. Leigh Hamby, chief medical officer at Piedmont Healthcare, a hospital system in Georgia. “It gets us moving.”

Hospitals in Maine, Massachusetts, Nebraska, New Hampshire, North Carolina, Utah and Wisconsin are faring the best, with 60 percent or more of hospitals getting higher payments, according to a Kaiser Health News analysis.

Medicare is reducing reimbursement rates for at least two-thirds of hospitals in 17 states, including California, Connecticut, Nevada, New Mexico, New York, North Dakota, Washington and Wyoming, as well as the District of Columbia.

How A Hospital Is Rated

Under the program, known as Hospital Value-Based Purchasing, Medicare reduced payment rates to all hospitals by 1.25 percent. It set the money aside in a $1.1 billion pot for incentives. While every hospital is getting something back, more than half are not recouping the 1.25 payment they initially forfeited, making them net losers.

The payment adjustments are applied to each Medicare patient stay over the federal fiscal year that started Oct. 1 and runs through September 2014. The potential bonuses and penalties were higher than they were last year, when the maximum at stake was 1 percent.

To assess quality, Medicare looked not only at how hospitals scored in comparison with each other, but also how much each improved from two years ago compared to other hospitals.

A hospital is judged on whichever score is higher, so some hospitals with subpar quality rankings are still getting more money because they showed vast improvement.

It won’t be clear how much any hospital’s bonuses and penalties amount to in dollar figures until next October because it depends on how much a hospital ultimately bills Medicare.

This year, 45 percent of a hospital’s score is based on how frequently it followed basic clinical standards of care, such as removing urinary catheters from surgery patients within two days to decrease the chance of infections. Thirty percent of the score is based on how patients rate the way they felt they were treated in the hospital, such as whether the doctors and nurses communicated well.

Medicare added its first measure of a medical outcome, looking at death rates of patients admitted for heart attacks, heart failure or pneumonia.Those mortality rates, calculated from the number of Medicare patients who died in the hospital or within a month of discharge, count for 25 percent of a hospital’s score.

The incentive program has received a mixed reception among hospital executives. Some complain that patients’ views sometimes are swayed by the swankiness of the hospital, and that hospitals that treat the very sickest patients often get the worst evaluations.

Physician-owned hospitals that focus on just a few specialties have tended to do particularly well in the program, as evidenced by the Arkansas Heart Hospital’s record bonus this year. Some leaders also object that even if they show improvements, their hospital can lose money if the improvements are not as great as others.

Will Penalties Bring Change?

Researchers are unsure whether the penalties are significant enough to trigger major improvements, especially in areas such as mortality, where there’s no definitive explanation for why some hospitals do such a better job than others in keeping patients alive.

“Shame and penalties, I don’t know if that’s the best way to get organizations to change,” said Leslie Curry, a researcher at the Yale School of Public Health.  Her work has found that hospitals with low mortality rates are the ones where it is a priority of executives and where there is a culture where front-line workers such as nurses and lab technicians feel comfortable raising concerns to doctors and devising better methods.

“The fiscal penalties are nominal, frankly, in the scheme of things,” she said.

Others say even small differences in payments provide strong encouragement for hospitals to improve. “Sometimes institutions may think they’re performing excellently until they see outside data that compares to your peers,” said Dr. Richard Bankowitz, the chief medical officer of Premier, a group that works with hospitals to improve quality. “People are motivated to excel. Nobody wants to be in the bottom quartile anymore.”

The addition of mortality rates into the scores provides hospitals with their biggest challenge yet. Amanda Berra, a consultant at The Advisory Board, a Washington health care consulting firm, interviewed 40 chief medical officers at hospitals about mortality rates.

“They were very split. About half of them said you could not have a more powerful measure. On the other side we heard people who were really unenthusiastic,” she said. “We heard that the data is not super meaningful. They felt they had drastically improved in recent years and have kind of gotten where they could go.”

The average penalty grew to 0.26 percent, up from 0.21 percent in the first year of the program. North Georgia Medical Center in Ellijay is the only hospital besides Gallup to lose more than 1 percent of its reimbursements: it will lose 1.04 percent.  Denver Health Medical Center, a highly respected safety-net hospital, is losing 0.71 percent of its reimbursements.

The hospital that was penalized the most last year, Auburn Community Hospital in upstate New York, reduced its 0.90 penalty, but will still lose 0.55 percent.

The average bonus was 0.24 percent, almost the same as last year’s 0.23 percent. Large bonuses are going to some major teaching hospitals, such as Thomas Jefferson University Hospital in Philadelphia and Duke University Hospital in Durham, N.C. Most are being distributed among smaller institutions, such as Pikeville Medical Center in Kentucky.

“The dollars are less important in terms of impact than the fact that the nation is sending a signal through the payment mechanism that there’s something to be worked on in the care we deliver,” said Nancy Foster, an executive at the American Hospital Association. “It’s a national symbol to health care providers that here is an area where you can do better.”

Many Past Winners Continue To Get Bonuses

Most winners from last year stayed winners and losers stayed losers. But there were some switches. Oaklawn Hospital in Marshall, Mich., improved its score the most from last year. In place of a 0.26 penalty, Oaklawn will receive a 0.65 percent bonus. A number of prominent academic medical centers also turned around their scores.

Vanderbilt University Medical Center in Nashville, Massachusetts General Hospital in Boston, New York-Presbyterian Hospital in Manhattan, Cedars-Sinai Medical Center and Ronald Reagan UCLA Medical Center, both in Los Angeles, and Yale-New Haven Hospital were among the 300 places that went from a penalty to a bonus.

A total of 416 hospitals that won bonuses last year will be penalized this year. Centura Health-St. Thomas More Hospital in Canon City, Colo., dropped from a 0.08 percent bonus to a 0.72 percent penalty, the largest decrease.

This program is one of several Medicare has launched to make hospitals and doctors pay more attention to how their treatments compare with other hospitals, and to be more careful with public money.

Medicare gives bonuses to the private Medicare Advantage insurance plans that score well on quality metrics. In 2015, the health law calls for the government to begin a quality payment program for physician groups of 100 professionals or more, and that is to be expanded to all doctors by 2017.

The goal of all these programs is to replace the current financial incentive in Medicare, in which the only way for a hospital to get paid more is to perform more procedures and take on more patients.

For hospitals, the quality payments come on top of Medicare’s penalties on 2,205 hospitals with higher than expected readmission rates. The agency is doling out a maximum punishment this year of 2 percent.

As a result two out of three hospitals are losing money starting last month from the combined effects of the quality and readmissions programs. Pineville Community Hospital in Kentucky is losing 2.57 percent of its reimbursements, the largest penalty in the country.

Twenty-one other hospitals are losing 2 percent or more. These cuts come on top of reductions in special payments that go to hospitals that treat large numbers of low-income people.

Only 729 hospitals will end up with an increase in payments from the combined readmissions and value-based programs. Maine Coast Memorial Hospital in Ellsworth fared the best, gaining 0.80 percent.

Hospitals that are designated as critical access facilities, certain cancer hospitals and places with too few cases to be accurately measured were excluded from both programs.

Maryland hospitals are exempt because that state has a unique payment arrangement with Medicare.

Medicare relies on information found on hospital bills to determine the quality of care. In judging death rates, Medicare looked at patients admitted from July 2011 through June 2012, and compared those rates with how the hospitals performed between July 2009 and June 2010.

For the clinical and patient satisfaction measures, Medicare assessed hospital performances from April 2012 through December 2012, and compared them with scores during the same months in 2010.

The amount of money at stake increases to 1.5 percent of payments in October 2014, and continues to grow by a quarter percent until it reaches 2 percent.

Medicare is planning to add new measures next year, including comparisons of how much patients cost Medicare at different hospitals and rates of medical mishaps and infections from catheters.

In addition, the maximum readmission penalties grow to 3 percent next year, and Medicare is launching a third incentive program that takes an additional 1 percent of payments away from hospitals with the most patients who suffered injury or infection during their stay.

Combined, these three quality programs have the potential to strip away as much as 5.5 percent of Medicare payments from the worst performing hospitals starting next October.

“We’re moving more toward outcomes measures,” Conway said. “We’re moving away from volume and toward quality.”

Read More:

jrau@kff.org

This article was produced by Kaiser Health News with support from The SCAN Foundation.

This article was reprinted from kaiserhealthnews.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.

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How much should hospital executives be paid? – Viewpoint

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H for hospitalBy Kathleen O’Connor
Publisher of the O’Connor Report

This year was the first year that hospitals in Washington State were required to report their executives’ compensation.  I did not conduct this research independently.

The figures below are what the hospitals themselves reported to the Department of Health.  The complete list of executive pay in not-for-profit hospitals can be found on The Department of Health website here.

For profit hospitals were not required to report their executive compensation, presumably for proprietary reasons. Some hospitals and hospital systems apparently chose not to report. See the list of non-responders at the end of this article.

These salaries raise more questions than answers.  The differences between hospitals are staggering and incomprehensible. I offer questions for Boards of Directors and consumers at the end of the article.

We have several millionaires. Some in places I would not have predicted. In order of magnitude:

  • Gary Kaplan, MDVirginia Mason Medical Center, Seattle                   $3,737,678
  • John Evans, Jr., Central Washington Medical Center, Wenatchee   $1,766,084
  • Rich Roodman, Valley Medical Center, Renton                                          $1,285,860
                                               
  • Elaine Couture, Providence Sacred Heart, Spokane                                $1,034,994
  • Medrice Caluccio, Providence St. Peter, Olympia                                     $1,010,027

 

Top Seattle Hospitals

The following is the compensation details only for the top administrator at the four top Seattle hospitals.  Swedish has several sites.

Details on other executives’ compensation are included in the compensation data on the DOH website referenced above.

Harborview Medical Center: 

Eileen Whalen, base salary $485,000, bonus incentive -0-, other $1,692, retirement/deferred compensation $61,550non-taxable benefits, $19, 268 Total:  $567,599

Swedish Medical Center: First Hill

Todd Strumwasser, base $435,848, bonus incentive $2500, other $71,000, retirement/deferred $76,928, nontaxable benefits $21,928 Total:  $607,702

Swedish Medical Center:  Cherry Hill

 Rayburn Lewis, base $303,584, bonus incentive $24, other $51,875, retire/deferred $51,194, non taxable $17,713 Total: $424,390

 Swedish Medical Center: Ballard

 Jennifer Graves, base $241,620, other -0-, bonus incentive $37,500 retire/deferred $12,882, nontaxable $11,245 Total: $303,187

 University of Washington Medical Center: 

 Stephen Zieniewicz, base $518,405, bonus -0-, other $1692, retire/deferred $61,793, non taxable $23,942, Total:  $605,832

 Virginia Mason Medical Center

Gary Kaplan, MD base $1,039,978, bonus incentive $449,871, other $17,788, retire/deferred $2,199,932, non-taxable $30,109 Total: $3,737,678

 Other State Hospitals and Medical Centers

Valley Medical Center, Renton, Washington

 Rich Roodman, base $706,575, bonus incentive $487,105, other $33,306, retire/deferred $32,201, nontaxable $26,471. Total:  $1,285,860

Evergreen Medical Center, Bellevue

Robert Malte, base $592,423, bonus incentive -0-, other $51,581, retire/deferred $194,960, nontaxable $4,272, Total:  $843,236

Providence Sacred Heart, Spokane

Elaine Couture, base $360,667, bonus incentive $592,708, other $17,901, retire/deferred $46,618, nontaxable $17,100 Total: $1,034,994

Providence St. Peter, Olympia

Medrice Caluccio base $417, bonus incentive $141,498, other $17,577, retire/deferred $419,464, non taxable $15,710 Total:  $1,010,027

Central Washington Medical Center, Wenatchee

John Evans, Jr. base $141,598, bonus incentive -0-, other $1,491,778, retire/deferred $127,110 nontaxable $5,597 Total:  $1,766,084

Smaller Hospitals: Top Administrators Total Salaries

Lake Chelan                                                       $177,242

Forks                                                                     $217,892

Lourdes Medical Center, Pasco                 $823,668

Skagit County Hospital, Anacortes           $378,386

Yakima Valley Memorial Hospital            $565,441

Kittitas Valley Hospital, Ellensburg         $277,674

Kadlac Medical Center, Richland              $879,058

Walla Walla General Hospital                   $393,221

Shriners’ Hospital for Children                  $144,910 (Spokane)

Mid-Valley Hospital, Omak                        $159,972

Hospitals Not Reporting

For profit hospitals were not required to report, presumably for proprietary reasons.  Other hospital and health systems apparently chose not to report.  All these hospitals accept public money in the form of Medicaid and Medicare money.

There were some health systems that were not abundantly clear about who made what at which hospital, such as Multicare Health System out of Tacoma.

It was not clear what was Multicare, Mary Bridge Children’s Hospital and their other hospitals, so they were not included here. You can check them online at the DOH website.

Not reporting: 

Overlake Medical Center, Bellevue

Seattle Children’s Hospital

Seattle Cancer Care Alliance

Peace Health Hospitals

Franciscan Health System Hospitals

It’s Time for Accountability

Each of these organizations has a Board of Directors, Trustees or Commissioners.  You can go to each hospital website. If you do not easily find the list of their Boards of Directors/Trustees/Commissioners, you can type in “Board of Directors” in the search function on their website and the information will come up.

For example, here is the list of the Board of Trustees for Virginia Mason.https://www.virginiamason.org/BoardMembers

Swedish:  http://www.swedish.org/About/Overview/Leadership—Governance/Community-Board#axzz2WpWdCSEa

University of Washington Medical Center: http://www.uwmedicine.org/Global/About/Pages/UWMedicineBoard.aspx

Harborview:  http://www.uwmedicine.org/Patient-Care/Locations/HMC/About/Pages/Board-of-Trustees.aspx

Central Washington Medical Center:  http://www.cwhs.com/Content.aspx?id=71&terms=board%20of%20directors

Valley Medical Center:  https://www.valleymed.org/About-Us/Meet-the-Board/

Providence Health System:  This is more difficult since it is a health system, and there is a system board, as well as a local board, but here is Spokane:http://washington.providence.org/donate/providence-health-care-foundation-eastern-wa/board-of-directors/

Mid Valley Medical Center, Omak http://www.mvhealth.org/leadership

Forks Community Hospital, Forks, http://www.forkshospital.org/board-minutes

What We Need to Do

As members of Boards of Trustees, Commissioners, you need to ask the hard questions:

  • What value and outcomes are you getting in your community for the salaries you are paying your executives?
  • Are they improving patient care?
  • What are patient outcomes?
  • How many readmissions do you have that may have been avoided?
  • How are you doing in managing hospital infections?
  • How much uncompensated care does the hospital provide as compared to other hospitals in the community?

This last question, of course, would not apply to communities such as Omak or Forks where they are the only hospital.

Certainly the choices in Omak and Forks are different than the ones in Tacoma and Seattle, but the question is, how do we hold our health care institutions accountable?

I believe, but I do not know for certain, that many Boards of Trustees are paid to serve on these Boards.  If you are paid to serve, who is going to ask the hard questions?  Who is going to ask about outcomes, readmission rates, infection control, necessary or unnecessary surgeries?

Certainly the problems in Forks, Omak and other disproportionate share rural hospitals are different from an urban Swedish or Evergreen.  But we all need to be smarter about health care.

I offer two sites in Washington State that are dealing with documented health care outcomes as determined voluntarily by community practicing doctors:  http://www.qualityhealth.org and its respective programs and the Bree collaborative:  http://www.hta.hca.wa.gov/bree.html

As patients and consumers, we need to hold the Boards of Directors/Trustees accountable.  Your doctor determines where you go, because of admitting privileges and insurance contracts.  Ask him or her why they chose to work with the hospital they use.  Talk to the hospital board of director members.  Look at the outcomes from facility to facility.

I don’t know how many states require hospitals to report their compensation.  But it is time we had community conversations about what we expect from these institutions in return for our community investments.

I am not the only person looking into this.  

Here is an article by Kaiser Health News: Hospitals reward CEOs for growth that increase costs.

Kathleen O’Connor, MA: O’Connor, publisher of the O’ConnorReport, has nearly 30 years experience in health care reform publishing and consulting, reform strategies, and consumer advocacy locally and nationally.  She is a member of the Association of Health Care Journalists.

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Healthcare’s ‘Dirty little secret’: No one may be coordinating care

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By Roni Caryn Rabin
This KHN story was produced in collaboration witwapo

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Illustration by Arthur Giron

Betsy Gabay saw a rotating cast of at least 14 doctors when she was hospitalized at New York Hospital Queens for almost four weeks last year for a flare-up of ulcerative colitis.

But the person she credits with saving her life is a spry, persistent 75-year-old with a vested interest — her mother.

Alarmed by her daughter’s rapid deterioration and then by her abrupt discharge from the hospital, Gabay’s mother contacted a physician friend who got her daughter admitted to Mount Sinai Medical Center in Manhattan.

By then, Gabay, 50, had a blood clot in her lung and a serious bacterial infection, C. difficile.

She also needed to have her diseased colon removed, according to the doctors at Mount Sinai. Had the problems been left unaddressed, any one of them might have killed her.

Coordinated care is touted as the key to better and more cost-effective care, and is being encouraged with financial rewards and penalties under the 2010 federal health care overhaul, as well as by private insurers. But experts say the communication failures that landed Gabay in a rehab center, rather than in surgery, remain disturbingly common.

“Nobody is responsible for coordinating care,” said Dr. Lucian Leape, a Harvard health policy analyst and a nationally recognized patient safety leader. “That’s the dirty little secret about health care.”

Advocates for hospital patients and their families say confusion about who is managing a patient’s care — and lack of coordination among those caregivers — are endemic, contributing to the estimated 44,000 to 98,000 deaths from medical errors each year.

A landmark report by the Institute of Medicine in 1999 cited the fragmented health-care system and patients’ reliance on multiple providers as a leading cause of medical mistakes. Leape, who helped author that report, says there have been improvements since, but “we have not done enough.”

Subsequent studies suggest the toll may be even higher than the Institute of Medicine estimated. A 2010 federal report projected that 15,000 Medicare patients every month suffered such serious harm in the hospital that it contributed to their deaths.

Gabay experienced such shortcomings firsthand. During her 26 days in the Queens hospital, she said doctors would do rounds and “I couldn’t tell one name from the next. I didn’t know whether it was the gastroenterologist, or the nutritionist, or the physical therapist.”

When she was discharged to a rehab center, she was suffering from acute abdominal pain and bloody diarrhea, and was too weak to get out of bed.

“I thought I was being sent there to die,” said Gabay, who made a complete recovery once she was treated at Mount Sinai for the infection and blood clot and her colon was removed. Officials at New York Hospital Queens declined numerous requests for comment, citing patient confidentiality.

A New Set Of Doctors

Patients such as Gabay are often surprised to discover that the primary-care physician with whom they have an ongoing relationship isn’t the doctor overseeing their hospital care and is unlikely to be informed about their progress.

Instead, hospitals have staff doctors called hospitalists who are supposed to manage a patient’s care, coordinating the various specialists, managing medications and then overseeing the transition back home.

“I see my job as an orchestra conductor pulling it all together,” said Robert M. Wachter, chief of hospital service at UCSF Medical Center in San Francisco, who coined the term “hospitalist” in 1996. “I may only spend a few minutes in the [patient's] room, but the other subspecialists are communicating to me, and I’ll integrate it so we give the patient one uniform message.”

But that system is vulnerable to breakdowns. Patients and family members meet hospitalists, along with many other medical specialists, when they’re in crisis.

Even when hospitalists explain their role, patients may be too overwhelmed – or ill, medicated, or disoriented — to absorb the information. As a result, they often don’t distinguish the hospitalist from the dozens of other caregivers they see.

“Unless the patient has written it down, they will say, ‘Someone was here, but I don’t remember what they said,’” said Ilene Corina, founder of PULSE, a nonprofit organization in New York that works to improve patient safety.

For families, the sense that no one is on top of their loved one’s care can be one of the most harrowing experiences related to a hospital admission.

Miscommunications are also more likely to occur under the strain of heavy workloads and the routine transfer of responsibility from one hospitalist to another during a patient’s stay. Hospitalists routinely work seven to 15 days in a row on shifts that each last 10 to 12 hours to provide patient continuity.

But many doctors report juggling too many patients to do their jobs well. Nearly four in 10 hospitalists responding to a survey from Johns Hopkins University School of Medicine said they struggle with unsafe workloads at least once a week.

Almost a quarter believed their workload “likely contributed” to patient complications and even deaths. Most of them defined a safe workload as up to 15 patients per shift.

Workload issues are “the elephant in the room that cannot be ignored,” said Henry Michtalik, lead author of the journal article about the survey. “We have to find that balance between safety, quality and efficiency.”

Communication Snafus

Retired Washington D.C. internist Marsha Wallace had heard plenty of horror stories about hospital patients falling through the cracks. Still, she was troubled last fall during her own stay at a local hospital when she overheard doctors delivering entirely conflicting messages to the elderly cancer patient who was her roommate.

“First the surgeon came in and told her he hadn’t found anything,” Wallace recalled. “Then the gastroenterologist came in and said, ‘I just did a CT scan; you have an obstructed kidney.’ Then the internist came in and said, ‘We don’t know what’s wrong, so we may send you to [Johns] Hopkins.’ Then the social worker came in and said, ‘We’re going to discharge you to a rehab hospital.’”

The caregivers didn’t appear to be talking to one another, Wallace said.

Sharon Flank, chief executive of an anti-counterfeiting company in Silver Spring, Md., saw her mother suffer from one complication after another following lung surgery: a bad reaction to a painkiller, a hernia that required surgery, a serious cardiac problem and a blood clot.

When Flank’s mother went back to the lung surgeon for a postoperative appointment, “she was in miserable shape because all these other horrible things had happened,” Flank said. “But her incision looked good, and the surgeon looks at her and says, ‘I did a beautiful job.’ ”

Patients are most vulnerable to coordination problems when their recovery doesn’t go as planned or a medical mistake has occurred, say advocates, patients and others.  That’s when complications — and potential liabilities – develop.

Karen Curtiss, a Lake Forest, Ill., writer, witnessed what she said were so many mistakes in her father’s hospital care that she founded an advocacy group, Campaign Zero, in response.

Shortly after Curtiss’s father had a lung transplant in 2005, he fell as he tried to make it from the bathroom to his bed without waiting for a nurse.

Hospital staff put him in horizontal traction until a neurologist could examine him, even though that position can cause fluid to pool in the lungs.

The fall occurred on a Friday, and the neurologist didn’t come until Sunday evening; by then, Curtiss’s father had developed pneumonia, which compromised the newly transplanted lung.

Other complications followed, including a blood clot to his lung and a staph infection. He died soon afterward.

“His death certificate said he died of complications of pulmonary fibrosis,” said Curtiss, who has written a handbook for families with loved ones in the hospital. “I think it should have listed every single thing: the complications, the blood clot, a fall, infections, pneumonia.”

Fixing the System

Although hospitals, the federal government, nonprofit groups and insurers want to improve the system, efforts to boost coordination and teamwork still have a long way to go.

Last summer, the Joint Commission, the nation’s hospital accrediting group, developed a tool for hospitals to help guide communication when a patient is transferred from one hospital setting to another – for instance, from an intensive care unit to a regular floor.

Some medical centers have taken steps to improve communication, assigning color-coded ID tags or scrubs to staff members so patients know who’s a nurse and who’s a doctor, and installing white boards in patient rooms, where a nurse starting a shift can jot down his or her name.

At some facilities, hospitalists write their names on those boards, and hand patients and their relatives business cards or sticky notes with their photos.

A few hospitals have gone further. At the Mayo Clinic in Rochester, Minn., patients having surgery attend a pre-admission education class so they know “almost to the hour, let alone to the day, what’s going to happen,” said Chief Medical Officer Michael Rock.

In Pennsylvania, Geisinger Health System has developed a checklist on laminated cards that fit in caregivers’ pockets. It includes questions that doctors and nurses need to keep uppermost when reviewing cases, such as: “Is the patient taking high-risk medications? When is the patient going home? Does the patient have any catheters or lines that should come out?”

Virginia Mason Health System in Seattle completely overhauled how they did things after sending representatives to Japan to learn from Toyota. Now nurses spend 90 percent of their time near the patient “so the shift handoffs don’t happen at the nurses’ station anymore,” said Dr. Gary Kaplan, Virginia Mason’s chairman and CEO.  “Patients don’t have to use the call button.”

Consumer advocacy organizations, meanwhile, advise patients entering the hospital to have a relative or close friend, or even a hired hand, who can communicate on their behalf and be at their side through the hospitalization. [See sidebar]

But not all patients have such advocates, and even when they do, playing that role can place a difficult burden on families or make second-class citizens of those who do not, said Wachter, the hospitalist.

When his own mother had lung surgery in Miami several months ago, “I went down there and didn’t leave her bedside,” he said.

This article was reprinted from kaiserhealthnews.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.

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New online database reveals thousands of hospital violation reports

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Sign for an emergency room.By Christine Vestal
Stateline Staff Writer

Hospitals make mistakes, sometimes deadly mistakes.  A patient may get the wrong medication or even undergo surgery intended for another person.  When errors like these are reported, state and federal officials inspect the hospital in question and file a detailed report.

Now, for the first time, this vital information on the quality and safety of the nation’s hospitals has been made available to the public online.

A new website, www.hospitalinspections.org, includes detailed reports of hospital violations dating back to January 2011, searchable by city, state, name of the hospital and key word.

Previously, these reports were filed with the U.S. Department of Health and Human Services, Centers for Medicare and Medicaid (CMS), and released only through a Freedom of Information Act request, an arduous, time-consuming process.

Even then, the reports were provided in paper format only, making them cumbersome to analyze.

Release of this critical electronic information by CMS is the result of years of advocacy by the Association of Health Care Journalists, with funding from the Ethics and Excellence in Journalism Foundation.

The new database makes full inspection reports for acute care hospitals and rural critical access hospitals instantly available to journalists and consumers interested in the quality of their local hospitals.

The database also reveals national trends in hospital errors. For example, key word searches yield the incidence of certain violations across all hospitals.  A search on the word “abuse,” for example, yields 862 violations at 204 hospitals since 2011.

Once they receive a complaint, federal and state inspectors attempt to discover the cause of a hospital error or violation. For example, poor safety procedures result in thousands of patients slipping and falling each year in U.S. hospitals, and poor sterilization methods cause thousands more to contract infections. Poor administrative procedures can result in patients receiving wrong treatments.

Once the causes of specific problems are determined, federal and state authorities require hospitals to file a plan to correct them.  These plans still remain under wraps, as do inspection reports on psychiatric hospitals and long-term care hospitals.

Also unavailable are the results of complaint-based and routine inspections by the nation’s largest private hospital accreditation organization, The Joint Commission.

Because the commission is a private entity, it is not subject to the Freedom of Information Act.  For this reason, the health care journalism association has launched a new effort to gain the release of these reports on hospital quality and safety.

The commission has rejected two previous requests by the journalism group saying disclosure of the information would hamper its efforts to improve hospital quality.

Stateline is a nonpartisan, nonprofit news service of the Pew Center on the States that provides daily reporting and analysis on trends in state policy.

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My doctor is taking payments from drug companies – what should I do?

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Dollars for Docs: How to Evaluate Drug Payment Data

by Nicholas Kusnetz
ProPublica

Update: This story has been revised to reflect updated Dollars for Docs data on March 11, 2013.

Drug companies have long kept secret details of the payments they make to doctors for promoting their drugs. But 15 companies have now made some of that information public.

pills-spill-out-of-bottle

ProPublica’s Dollars for Docs pulls their disclosures into a single database so patients can easily search for their doctor. We created Dollars for Docs database partly as an educational tool. How can patients use it? Here are some suggestions.

Q. My doctor is on this list. Should I care?

A. If your doctor is listed, it’s because he or she received money from one of the drug companies for promotional activities or consulting.

Payments are legal, so it doesn’t mean your doctor has done anything wrong. But research has shown that drug company marketing can influence what a doctor prescribes, and some experts say it is cause for concern.

Others say the information should carry less weight. They say the amount of money a doctor receives is less important than personal recommendations and the doctor’s training and experience.

One word of caution: Some doctors in our database have the same or similar names, so be sure to confirm with your doctor that he or she is actually the one on the list. Names and addresses on the data are as disclosed by the companies, and they sometimes use variations.

Q. My doctor is not on the list. What does that mean?

A. ProPublica included payments only from the drug companies that have made these relationships public so far. Many doctors do not do promotional work or consulting for drug companies.

Others may receive such payments from companies that haven’t yet disclosed them. So even if your doctor isn’t on the list, experts say it’s worth asking about the issue.

Q. What’s the best way to bring up the issue with my doctor?

A. Although it can feel awkward, some experts say it’s important to ask about potential conflicts of interest. Others say patients should trust their doctors to do what’s right for them.

If you do raise the issue, tell your doctor you want to feel confident the drugs he is prescribing for you are best for the job.

According to a 2010 national survey by Consumer Reports, conducted for this project, 70 percent of adults say doctors should tell their patients about payments they’ve taken from a drug company whose drugs they are about to prescribe.

Ask first if your doctor has any financial relationships with drug companies. If so, ask about what companies are involved, the nature of each relationship and the duration.

Most often, doctors are paid for promotional activities, such as speaking to other doctors about a drug, or for consulting or research.

It’s important to ask whether medications you are taking are made by the companies. If the answer is yes, it’s not necessarily a problem but is worth discussing further.

Q. How can I be sure my doctor is offering unbiased advice about a drug?

A. If your doctor has prescribed you medication made by a company he or she receives payments from, you should ask whether there are any cheaper generic alternatives. How does the drug compare to others in its class? What are the side effects? Are there alternatives with fewer side effects? And importantly, are there non-drug alternatives, such as diet, watchful waiting or physical therapy?

It may be that the drug you are on is the best option. But sometimes a drug company will market a new, more expensive version of an established drug even when the older one is cheaper and effective.

Asking these questions will show your doctor you’re aware of these issues.

Q. Where can I learn more about drugs my doctor prescribes?

A. Searching the Web will bring up a wealth of links and literature. One site that has comprehensive drug and supplement information is MedlinePlus.

Want to know more? Follow ProPublica on Facebook and Twitter, and get ProPublica headlines delivered by e-mail every day.

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Hospitals get new grades on safety

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By Jordan Rau

The Leapfrog Group is out with its second round of hospital safety ratings, and what a difference a few months has made.

In the results released Wednesday, 103 hospitals that Leapfrog had given a “C” or lower in its first round of ratings in June got an “A” in the updated Hospital Safety Score, based on more recent data and a slightly tweaked methodology.

Here are the ratings for hospitals in Seattle:

 Northwest Hospital – View the full Score

 Virginia Mason Medical Center – View the full Score

 Swedish/Ballard Campus - View the full Score

 Swedish/First Hill Campus - View the full Score

 UW Medical Center - View the full Score

 Swedish/Cherry HIll - View the full Score

 Harborview Medical Center - View the full Score

For the rankings of all Washington hospitals go here.

These included New York-Presbyterian Hospital, the Hospital of the University of Pennsylvania and Geisinger Medical Center.

Two hospitals awarded an “A” in the first round, Leonard J. Chabert Medical Center in Houma, La., and Lawrence General Hospital in Lawrence, Mass., both slipped to a “D.”

Altogether, 8 percent of the 2,619 hospitals that Leapfrog rated changed by two or more grades, like an “A” to a “C,” according to Leapfrog, a patient safety nonprofit based in Washington, D.C.

Thirty-four percent changed one grade, like a “C” to a “B,” and 58 percent kept the same grade, Leapfrog said.

Leapfrog’s effort to provide a single letter grade based on 26 different measures of safety is part of a burgeoning effort to help consumers evaluate medical providers.

Consumer Reports this year also started boiling down  hospital metrics into its signature circular symbols, known as “Harvey Balls.”

In its first effort, Leapfrog gave a break to hospitals with poor showings, giving them a “Grade Pending.” This time, Leapfrog pulled out its red pen, giving 25 hospitals an “F,” including the Ronald Reagan UCLA Medical Center in Los Angeles.

Another 122 hospitals got a “D.”  Leapfrog gave 790 hospitals an “A,” and 678  received a “B.” Leapfrog gave 1,004 hospitals a “C.”

Leapfrog calculated its grades using publicly-available data, including the frequency of blood line infections, falls in the hospital, bedsores and the consistency that hospitals follow recommended methods of care, such as discontinuing an antibiotic within 24 hours of surgery.

Leapfrog’s effort has earned grumbles from hospitals, which note that much of the data is old, with some of it dating to events from as far back as July 2009.

Hospitals also have complained Leapfrog incorporates its own survey in its evaluations, although the organization says that doesn’t disadvantage hospitals that don’t fill them out.

Dr. Shannon Phillips, patient safety officer at The Cleveland Clinic—which saw its grade slip from a “C” to a “D”—said the Clinic “has seen measurable improvement month after month,” so Leapfrog’s evaluation is now outdated.

Phillips said the grades are of no help to hospitals since they are already aware of the underlying measures, which Medicare calculates and publishes. “It’s repackaging of data the public and we already have,” she said.

Leah Binder, Leapfrog’s chief executive officer, said the ratings will help companies and other health care purchasers as they try to educate their employees to select services with the highest value.

“When a person or employee looks at comparative pricing information, they assume the highest price is the highest quality,” she said. Leapfrog’s grade is “something that can be incorporated pretty easily into pricing transparency,” she said.

The individual hospital scores can be looked up on Leapfrog’s web site. A breakdown of how hospitals in each state did as tabulated by Kaiser Health News is below.

Maryland hospitals are not listed, because Medicare does not collect the same data from that state’s hospitals due to a unique arrangement with the federal government.

Number of Hospitals Receiving Each Grade for Patient Safety
State A B C D F
AK 1 2 1 2
AL 12 13 25 4 1
AR 3 5 22
AZ 11 10 14 5
CA 92 56 80 14 4
CO 13 11 15
CT 6 9 13
DC 1 4 2
DE 3 2 1
FL 61 38 49 8
GA 11 27 32 4 1
HI 1 4 4 1
IA 10 8 11 1
ID 1 2 5 1 1
IL 51 31 28 3 5
IN 15 31 16 1
KS 3 11 14 5
KY 12 20 21 1
LA 8 13 29 3 1
MA 50 4 5 1
ME 16 3 1
MI 37 25 22 1
MN 20 14 12 1
MO 18 11 30 3 1
MS 8 8 18
MT 3 4 3
NC 20 29 26 2
ND 3 1 1 1
NE 3 3 11
NH 2 5 6
NJ 23 22 24 1
NM 1 5 7 1
NV 2 5 12 1
NY 33 38 70 16
OH 35 23 45 8
OK 3 12 22 3
OR 4 10 14 2 1
PA 37 29 59 1
RI 2 4 3
SC 14 11 19 1 2
SD 2 1 5 1
TN 25 18 21 3
TX 52 44 91 16 5
UT 3 4 11 1
VA 30 16 21 2 1
VT 3 1 2
WA 13 15 14 1
WI 10 12 24
WV 2 5 17 2
WY 1 3 4
Grand Total 790 678 1004 122 25
Source: Leapfrog Group

This article was reprinted from kaiserhealthnews.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.

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Blank checklist on clipboard, with large red ticks, and room for text.

A checklist for health CEOs seeking to improve care, cut costs

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Virginia Mason President and CEO Dr. Gary Kaplan is one of eleven health system executives who helped draw up a checklist for health-care CEOs seeking to control costs and improve the quality of care that was published this week by the Institute of Medicine .

All the executives come from health systems that have established national reputations for their quality improvement initiatives, including executives from the Cleveland Clinic, Kaiser Permanente, and the Department of Veterans Affairs (see full list below).

The 10-item “Checklist for High-value Health Care” identifies strategies that these health-care executives have found to be “effective and essential” in their efforts to reform their health systems.

“Taken together, the Checklist provides a blueprint for improving quality and reducing cost,” the contributors write.

The items are grouped under four headings:

  • Foundational elements
  • Infrastructure fundamentals
  • Care delivery priorities.

To learn more: read the the full document “Checklist for High-value Health Care” available for free on the Instute of Medicine’s website.

Contributors to the CEO Checklist

  • Delos Cosgrove, MD, President and CEO, Cleveland Clinic
  • Michael Fisher, President and CEO, Cincinnati Children’s Hospital Medical Center
  • Patricia Gabow, MD, CEO, Denver Health and Hospital Authority
  • Gary Gottlieb, MD, MBA, President and CEO, Partners HealthCare System, Inc.
  • George Halvorson, Chairman and CEO, Kaiser Permanente
  • Brent James, MD, MStat, Executive Director Intermountain Institute for Care Delivery Research
  • Gary Kaplan, MD, Chairman and CEO, Virginia Mason Health System
  • Jonathan Perlin, MD, PhD, President, Clinical and Physician Services HCA, Inc.
  • Robert Petzel, MD, Undersecretary for Health Department of Veterans Affairs
  • Glenn Steele, MD, PhD, President and CEO Geisinger Health System
  • John Toussaint, MD, CEO, ThedaCare Center for Healthcare Value

 

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VM’s Kaplan elected chair of the Institute for Healthcare Improvement’s board of directors

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Dr. Gary S. Kaplan, chairman and CEO of Virginia Mason Medical Center, has been elected chair of the board of directors of the Institute for Healthcare Improvement (IHI). Dr. Kaplan has served on the board since 2007.

IHI is an independent not-for-profit organization based in Cambridge, Mass., that focuses on improving patient safety and quality of care by promoting the adoption of best practices and effective innovations.

The Institute was founded by Dr. Donald Berwick, a leading proponent of evidence-based medicine who recently served as administrator of the Centers for Medicare and Medicaid Services for the Obama Administrations.

The Institute has become known as a leader in health-care quality improvement.

Virginia Mason Medical Center’s involvement with IHI began in 1989 – two years before it was formally incorporated as IHI

Over the years, Virginia Mason has participated in a number of IHI projects, including:

Dr. Kaplan has served as chairman and CEO of Virginia Mason Medical Center and the Virginia Mason Health System since 2000. He received a medical degree from the University of Michigan and is board certified in internal medicine.

 

 

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Virginia Mason launches quality improvement blog

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Virginia Mason Medical Center has launched a blog that will focus on quality improvement processes aimed at improving patient safety and cutting costs.

The Seattle hospital established a national reputation for quality improvement by adapting “lean” manufacturing techniques to medicine.

These techniques were first developed by the Japanese car maker Toyota and have been credited for making Toyotas some of the most reliable cars made.

The Toyota approach seeks to eliminate all waste in its production system and to “mistake-proof” its processes, cutting costs and reducing errors.

Virginia Mason started its adaptation of the Toyota approach, developing an approach the hospital calls the Virginia Mason Production System, 12 years ago.

In large part as result of that effort, Virginia Mason was named “Top Hospital of the Decade” by The Leapfrog Group, a national organization of insurers, employers, and other groups dedicated to improving health-care quality.

Kenney

The new blog will be written by  Charles Kenney. Kenney is a former Boston Globe reporter who has written three books on  improving quality in health care, including a book about the Virginia Mason initiative: Transforming Health Care: Virginia Mason Medical Center’s Pursuit of the Perfect Patient Experience.

Kenney says he hopes the blog will provide a forum for anyone who is interested in making health care safer, more efficient and cost-effective.

The site’s first blog post features Kim Pittenger, MD, a family physician at Virginia Mason Kirkland, who discusses on how primary care doctors can organize their work “in flow” to do a better job taking care of more patients in less time, and get home for dinner with no open charts or left over paperwork.

Kenney writes:

Dr. Pittenger and his VM colleagues “have not only reduced the blizzard of paper, email and phone messages, they have created a system that enables more doctors to go home by 6 o’clock more often with no open charts and no left over paper work.

“How have they accomplished this seeming miracle? In a word, flow. They have created flow stations – and a flow production system – where a doctor works in close partnership with a medical assistant who breaks down the indirect care paper, phone calls and email into small lots that can be handled throughout the course of the day rather than in a batch at the end of the day.”

“We will have a lot of these straightforward, things-I-can-do-right-now kinds of posts, and we want our readers to comment, add links, and contribute their knowledge,” says Kenney. “And we’ll post thoughts on books, conferences and articles – anything we think can be helpful to clinicians and administrators working to improve the quality and efficiency of care delivery.’’

To learn more:

 

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Employers, health-care providers team up to cut costs, improve care

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By Harris Meyer
This story was produced in collaboration with 

HILLSBORO, Ore. — Peter Cady, who works 12-hour shifts on his feet at Intel’s plant here, occasionally suffers severe lower back spasms.

But he nearly gave up seeking medical help because in the weeks it took to get a doctor’s appointment and a referral to physical therapy, the pain usually subsided.

These days, however, Cady is much happier with his care.

Rather than waiting to see a doctor, Cady and other patients with routine back pain now see a physical therapist within 48 hours of calling, compared with about 19 days previously, Intel says.

They complete their treatment in 21 days, compared with 52 days in the past. The cost per patient has dropped 10 percent to 30 percent due to fewer unnecessary doctor visits and diagnostic imaging tests.

And patients are more satisfied and return to work faster.

“It’s a real bureaucracy buster that gets you right straight to someone who can take care of the problem,” says Cady, 47. “Before, the doctor wasn’t helping me or explaining anything. But the physical therapist educated me, gave me stretches and exercises to do, and cleared it up.”

The change came about through an unusual collaboration between Intel, two local health care systems, and a health insurer. Based on that success, the partners have developed similar improvements for hip, knee, shoulder and headache treatment.

Intel and its partners say the result has been $2 million in administrative savings this year, from reduced costs for patient scheduling and registration, for example.

The Hillsboro collaboration is one of a small but growing number of voluntary partnerships around the country to tackle the twin problems of unsatisfactory quality and rising health-care costs.

Similar programs are underway in Atlantic City, N.J.; Lewiston, Maine; Muskegon, Mich.; Sacramento, Calif.; San Francisco and Seattle. One is budding in Orlando.

All the efforts draw on quality improvement models developed in manufacturing and other industries. Physicians and hospitals share cost savings with the employers and insurers, and in some cases share losses if savings targets aren’t met.

Medicare has launched a similar program under the 2010 health reform law aimed at developing so-called accountable care organizations.

Tackling a cost crisis

Health care was the only area where we weren’t setting standards and managing our suppliers.

Experts say employers, hospitals, physicians and health plans increasingly are willing to work together because cost and quality problems have reached crisis levels.

The goal is to carve out health-care spending that’s wasteful and doesn’t help patients. Sometimes there’s an implicit threat that if a provider or health plan doesn’t participate, the large employer will buy health care from someone else.

“It all starts when leaders in a community say the current system is not sustainable and we’ve got to find a different model,” says Joe Damore, a vice president at Premier, a national alliance of 200 health systems focused on performance improvement. “Major employers are jumping on board because they see it as an opportunity to improve their employees’ health and reduce costs.”

Intel asked Providence Health & Services, Tuality Healthcare and Cigna to collaborate in 2009 because its employee health costs were rising by more than 10 percent a year, with costs projected to hit $1 billion companywide.

The Oregon Public Employees’ Benefit Board recently joined the effort, having its members participate in the redesigned Providence and Tuality care models, sharing its data with the collaborative, and working with the partners to come up with new ways of improving quality and reducing costs.

“Health care was the only area where we weren’t setting standards and managing our suppliers,” says Patricia McDonald, an Intel vice president who spearheaded the project. “Our employees were waiting for care and the quality was questionable.”

In Atlantic City, Unite Here Health, a hotel workers’ union health plan, persuaded AtlantiCare, a local health care system, to open a special, jointly funded clinic in 2007 to provide intensive outpatient care to high-cost patients with chronic conditions such as diabetes, obesity and heart disease.

The program, which the union is replicating in Las Vegas, achieved steep drops in patient smoking, blood pressure and diabetic blood sugar levels, according to AtlantiCare.

By keeping patients healthier, it has reduced hospital admissions by 41 percent and emergency department visits by 48 percent.

Collaboratives help physicians and hospital leaders see employers and patients as customers whose expectations, such as rapid access to care, must be met.

“I practiced for 30 years without knowing how long patients waited to see me,” says Dr. Robert Mecklenburg, who led the development of a collaborative effort at Virginia Mason Medical Center in Seattle, which started working with Starbucks and other employers in 2004.

After meeting with employers, he adds, “you realize how important it is to see patients when they need to be seen. Any wait is not OK.”

Roadblocks to collaboration

One man’s waste is another man’s income.

There are still many obstacles to such partnerships. It’s often difficult to get traditional competitors and antagonists to collaborate, including sharing proprietary medical and financial data.

Some employers are reluctant to get directly involved in how health care is delivered. Critics warn about rationing of care.

And some physicians complain about interference with their professional autonomy, although Mecklenburg says most come around when they see better results for patients.

Perhaps the biggest roadblock is the predominant fee-for-service system, which pays providers to deliver more services, rather than better, more efficient care. Health-care payers, including private insurers and Medicare, have been slow to change their payment models to reward outcomes rather than volume of care. That sometimes puts providers in the position of losing revenue by doing the right thing for patients.

Dr. Donald Storey, who worked on the Seattle collaborative as an Aetna medical director and now is a vice president at Premera Blue Cross, blames insurers’ reluctance to change on their having many different contracts with employers and providers. In addition, not everyone wants a more efficient system. “One man’s waste is another man’s income,” he says.

Some insurers have embraced collaboration. In Sacramento, Blue Shield of California, Catholic Healthcare West and Hill Physicians Medical Group have worked with CalPERS, the state public employee benefit system, to redesign care after they identified quality problems and high costs for 42,000 plan members.

Key areas were obesity-reduction surgery, hip and knee care, hysterectomies, and preventable emergency department visits and hospital readmissions. For example, Hill Physicians persuaded its OB/GYNs to perform more minimally invasive hysterectomies, which are safer and cheaper than open hysterectomies, when appropriate. Catholic Healthcare West hospital staff worked closely with patients on their medication instructions before discharge, to make readmissions less likely.

Redesigning care through a collaborative is “not easy to do. There’s a lot of investment of human resources, and we didn’t know if it would work or not,” says John Wray, senior vice president for managed care at Catholic Healthcare West. “But this was something we thought was important to try to learn from.”

It worked. Hospital length of stay and readmissions both declined 15 percent in 2010. That helped save more than $20 million, exceeding the $15.5 million target and allowing Blue Shield to keep CalPERS’ premiums flat in Sacramento for 2011.

The remaining savings were split among the three partners, who would have lost money if the target hadn’t been hit.

Now Blue Shield is working with its current partners and several additional provider organizations to improve care for 26,000 members of the San Francisco public employee plan.

It’s also starting partnerships in January for 38,000 plan members in California’s Orange and Stanislaus counties.

Mecklenburg hopes this partnership model will spread widely across the country. “We are creating a marketplace based on quality, where employers can use their purchasing power to bring out the best in both providers and health plans,” he says. “But up to now it hasn’t usually worked that way.”


This article was reprinted from kaiserhealthnews.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.

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VM to launch health services research center

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Seattle’s Virginia Mason Medical Center announced today that it is creating a new Center for Health Services Research. The new center will open January 1st.

Virginia Mason has established a national reputation for its efforts to apply the super-efficient “lean production” system, developed by the car manufacturer Toyota, to health-care delivery.

The hospital says its application of the Toyota Production System’s approach to health care has significantly improved the quality of its care and the morale of its staff.

Treatment is more timely, delays are fewer and quality has improved, the hospital says.

At the same, time it “has meant less rework and frustration for staff” and helped control the cost of care, the hospital says.

The purpose of the new center is to evaluate the effectiveness of hospital’s improvement initiatives more rigorously and publish the results in medical journals and other publications.

Craig Blackmore, MD, MPH, will serve as director of the Center for Health Services Research.

“The role of the center will be to collect that data, apply the rigor of science and academic peer review, and publish it so that it can be scrutinized and applied by health care providers around the globe,” Dr. Blackmore said.

The Center for Health Services Research will also support the scholarly and publication efforts of Virginia Mason’s education programs that train medical residents, nurses, pharmacists and other health care professionals.

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Two Seattle hospitals make “Top Hospital” list

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Overall Patient Safety Ratings for Seattle hospitalsSwedish Medical Center’s First Hill Hospital and Virginia Mason Medical Center both make the “Top Hospital” list put out each year by The Leapfrog Group, a coalition of public and private purchasers of employee health coverage that works to improve healthcare safety, quality, and affordability.

This is the sixth year in a row that Virginia Mason has made the Top Hospital List, and the second year in a row for Swedish First Hill.

This year sixty-five hospitals have earned The Leapfrog Group’s annual “Top Hospital” designation for delivering the highest quality care:

  • by preventing medical errors,
  • reducing mortality for high-risk procedures like heart bypass surgery,
  • and reducing hospital readmissions for patients being treated for conditions like pneumonia and heart attack.

The 2011 Top Hospital list was culled from a field of nearly 1200 hospitals that voluntarily and publicly report their performance by participating in the Leapfrog Hospital Survey, which focuses on three critical areas of hospital care:

  1. How patients fare
  2. Resources used to care for patients
  3. Management practices that promote safety and quality

In each of the three areas, Leapfrog asks hospitals to report on nationally standardized measures so healthcare consumers can compare hospitals in their community and across the country.

University and other teaching hospitals, children’s hospitals, and community hospitals in rural, suburban, and urban settings were all represented in the 2011 rankings.

To learn more:

  • A complete list of 2011 Leapfrog Top Hospitals and the survey results for all participating hospitals are posted on a website at www.leapfroggroup.org.
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