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Patient Safety Watchdog Group Issues Latest Hospital Ratings

The Leapfrog Group, a national patient safety watchdog group has released their latest Hospital Safety Scores, assigning letter grades to hospitals nationwide based on a 30 measures of publicly-available safety data. The grades of A, B, C, D or F are assigned twice a year to 2,500 hospitals across the US.

Copyright Alberto G. https://www.flickr.com/photos/albertogp123/In Washington State, Overlake Medical Center, University of Washington Medical Center, and Virginia Mason Medical Center all received A grades for excellence in patient safety. These hospitals have earned “straight A’s” over the last three years, and are the only three in Washington State to do so (153 hospitals have earned this distinction nationwide).

The Hospital Safety Score was developed under the guidance of Leapfrog’s Blue Ribbon Expert Panel, which, for the first time, included five measures of patient-reported experience with the hospital as well as two of the most common infections, C.diff and MRSA.

“Avoidable deaths in hospitals should be the number one concern of our health care leaders,” said Leah Binder, president and CEO of The Leapfrog Group, “Hospitals that earn an ‘A’ from Leapfrog are leaders in saving lives, and we commend them and urge their continued vigilance.”

“We are so honored and proud to receive this ‘A’ grade from The Leapfrog Group for a third year in a row,” said Overlake CEO J. Michael Marsh. “Patient safety is our hospital’s top priority and this award demonstrates our commitment and consistency.”

Those who would like more information on how their local hospital ranks, or for information on the methodology behind the grade system, are encouraged to learn more at http://www.hospitalsafetyscore.org/

Medical errors revealed to be the third leading cause of death in America

An article published in The BMJ Journal by Martin Makary and Michael Daniel on May 3rd, 2016 identified that medical errors are the third most common killer in the United States. The Centers for Disease Control and Prevention do not report medical error on death certificates, resulting in public ignorance as to the scale of fatal mistakes during patient care. Death certificates rely on the International Classification of Diseases coding system, which does not include a classification for “medical error”.

According to the researchers, medical error was the cause of death in 251,000 cases in 2013, beating lung disease, suicide and motor vehicle deaths combined. The two leading causes of death in 2013 were heart disease (661,000) and cancer (585,000). Examples of such errors include patients being handed the incorrect medication, infections from improperly sterilized equipment, accidental cuts on the operating table, and many more.

“Although we cannot eliminate human error, we can better measure the problem to design safer systems mitigating its frequency, visibility, and consequences” say the authors. “Strategies to reduce death from medical care should include three steps: making errors more visible when they occur so their effects can be intercepted; having remedies at hand to rescue patients; and making errors less frequent by following principles that take human limitations into account”. Of course another major strategy should be educating practitioners on best practices for those procedures which most commonly result in accidental deaths.

Clearly this study has implications for healthcare recruiters and human resources managers as well. When hiring for open positions it is crucial that an employer has the opportunity to interview the most highly qualified candidate. That isn’t possible if only one or two applicants express interest and show up for a job interview. Strong recruiting platforms are necessary to empower employers to survey a range of would-be employees, and that’s where the quantity of applicants breeds quality in eventual employee performance.

Patients should also be empowered to make intelligent decisions about their care. By publishing more data about medical errors, and utilizing resources like Hospital Safety Score, patients can choose the medical teams which are more likely to provide incident-free care.

 

Martin A Makary, Michael Daniel. “Medical error—the third leading cause of death in the US”. BMJ 2016;353:i2139

Study Finds Most Successful Hospitals are Nonprofits

An article recently published in “Health Affairs” has identified that seven of the ten most profitable acute care hospitals in the United States are not-for-profit organizations. The data examined was retrieved from Medicare Cost Reports and Final Rule Data, and analysis considered the 2013 net income from patient care services per adjusted discharge.

According to the study, ” Forty-five percent of hospitals were profitable, with 2.5 percent earning more than $2,475 per adjusted discharge. The ten most profitable hospitals, seven of which were nonprofit, each earned more than $163 million in total profits from patient care services.” (Bai G. Anderson G.) Caring for patients was a net loss for 55% of hospitals in 2013. Roughly one-third of hospitals which earned a profit made between $1 and $1,000 per patient discharged. Only 12% of hospitals fared better, at $1,000+ per patient discharged.

Study co-author Ge Bai believes that it is important to understand which hospitals are profitable and to what extent they are affected by various public policies. Bai believes that it is up to the general public to monitor hospital consolidation, and to consider its impact on operating expenses and insurance negotiating power.

Mayor Laurel Prussing of Urbana, IL. discussed the phenomenon in an article published in the Associated Press. Urbana lost 11% of its assessed tax value, $6.5 million annualy, when the Carle Foundation Hospital in her city was no longer responsible for property taxes. “We need to question this whole idea of what not-for-profit means,” Prussing said. “This is a highly profitable business that manages to not pay taxes.”

Others aren’t so sure that losing money should be a prerequisite to earning nonprofit status. Danny Chun of the Illinois Hospital Association makes the case that increased spending power tends to directly benefit future patients and the community at large. He claims that income earned each year is reinvested in ” the latest technology, newer equipment, modern facilities, highly-trained staff and other programs that ensure access to quality health care services and benefit the health of their community.”

One thing is for sure: when hospital care makes up almost one-third of national health care spending, nearing $1 trillion, the debate about the relationship between nonprofit hospitals and profit margins will continue to be a hot topic.

 


Ge Bai, Gerard F. Anderson Health Aff May 2016 vol. 35 no. 5 889-897 doi: 10.1377/hlthaff.2015.1193

Johnson, Carla “Study: 7 of 10 most profitable US hospitals are nonprofitsAssociated Press, May 2nd, 2016./sup>

New Report Predicts a National Physician Shortage

On April 5th 2016, IHS Inc. released a 2016 update to their report on behalf of the Association of American Medical Colleges about the projected supply and demand for physicians in American from 2014 – 2015.1

 

The updated report comes in at around 40 pages, and contains projections for many different scenarios that have an effect on demand for physicians services such as demographic changes like the aging of the baby boomer generation, or the ability of non-physician healthcare providers like ARNPs to provide services presently offered by physicians. The report also discusses the supply of physician services, which is impacted by the number of physicians retiring in the next decade and the number of physicians graduating from medical school who are expected to enter the workforce. The report is very detailed, and it is worth a read to anyone who faces the difficult task of recruiting physicians over the coming decades.

Empty Waiting Room

The key findings of the report are:

 

1. Even under the “brightest” of assumptions, there will be a physician shortfall in 2025, it’s just a matter of how large that shortfall is. The report projects there will be between 61K-94K fewer physicians than needed by 2025. For comparison, the US had about 1 million physicians in 2012.2

 

2. There will be a shortfall in both primary care physicians and non-primary care physicians by 2025.

 

3. The largest impact on supply will be the retirement of currently practicing physicians. Just as the aging of the baby boomers will have a drastic effect of the age diagram of the American population over the coming decade, many physicians are members of the baby boom generation, so we will see a similar demographic trends. Today 11% of the physician workforce is age 65-75. That fraction will increase to one-third by 2025. The exact percentage that will retire as they age is unknown, but the aggregate effect will push down the total supply of physicians.

 

4. The aging of the American population will be the primary cause of increased demand for physician services. The population under 18 is expected to grow by 5% and the population over 65 will grow by 41% – a factor of 8X.

 

5. The expansion of coverage under the Affordable Care Act (ACA) will push up demand for physicians. Depending on how many states expand medicaid, the ACA could contribute to the shortfall by 10,000 to 17,000 physicians.

What does this all mean for physician jobs around the country?

 

It’s good news for physicians. The shortfall should push up wages for physicians as employers compete to hire the best talent. This is also good news for non-physician providers who may be able to perform services once restricted to physicians as states change their regulations in order to help address this shortfall. Medical schools are also likely to see an increase in enrollment, so new programs around the country are essential. New MD and DO programs like the CUNY Medical School in New York and the University of Nevada’s Las Vegas School of Medicine are popping up all around the country. One thing this report makes clear is that churning out qualified practitioners should be a major priority for the healthcare industry.

 

All signs indicate that physician recruiters will have an increasingly challenging task ahead in the coming decade. While the exact magnitude of the shortfall is unknown, its impending presence is rather certain according to this report. Employers will need to continue to innovate and improve their recruiting practices to stay competitive with the hospital down the road. Tools like FindHealthcareCareers.com can be a big asset for recruiters within this competitive demographic.

Team-Centered Wound Care Provides Improved Outcomes, Patient Comfort and Job Satisfaction

This post was written by guest blogger, Ryan Dirks, PA. Ryan is a Physician Assistant and founder of Ryan DirksUnited Wound Healing located in Puyallup, Washington. Ryan’s team of Nurse Practitioners, specializing in wound care, partner with skilled nursing and rehab centers throughout Washington to provide “Team-Centered Wound Care.” Through weekly wound rounds, these Nurse Practitioners lead multi-disciplinary teams of skilled nursing home caregivers resulting in extraordinary clinical outcomes, education, prevention and great job satisfaction. United Wound Healing is seeking ARNPs skilled in leadership and a desire to transform their patients’ care through a team approach.

 

Have you become discouraged about your role as a health care provider? Have changes in documentation, Meaningful Use, and quality measures left you feeling dissatisfied and disconnected from what you find meaningful in your career? Well, you are not alone. In fact, the solution you may need may also be the best thing for your patients and our healthcare system.

“The strength of the team is each individual member and the strength of each member is the team.” –Phil Jackson former coaching legend of the Chicago Bulls

 

Perhaps the solution we all need is not found in regulations and quality measures. A transformation of health care that includes strengthening and building teams may prove not only to improve your career satisfaction, but improve patient outcomes, quality measures, and cost savings.

I founded United Wound Healing after years of working in medicine only to find that the team environment I wanted to practice in was not truly a team, it was just as broken as our national health care system. We created “Team-Centered Wound Care”™ in response to a dire need in local skilled nursing and rehabilitation centers. Patients with chronic wounds were being transported weekly to remote wound care centers creating uncomfortable and expensive traveling, often to receive basic wound care services that could have easily been performed where the patients were residing. The communication between the patients’ caregivers and wound care providers was less than adequate. Team work was non-existent.

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Research has validated the value of team-centered wound care. In 2012, a review of retrospective cohort data was conducted to compare Medicare expenditures between two groups of skilled nursing facility residents with a diagnosis of pressure, venous, ischemic, or diabetic ulcers whose wounds healed during the 10-month study period. A rough population prevalence rate for chronic non-healing wounds in the United States is 2% of the general population and caring for these wounds exceeds $50 billion per year.

The study group included 372 residents who were managed using a structured, comprehensive wound management protocol provided by an externally-led wound management team. The matched comparison group consisted of 311 skilled nursing facility residents who did not receive care from the wound management team. The study group residents experienced lower rates of wound-related hospitalization per day and shorter wound episodes than comparison group patients. Total Medicare costs were $21,449.64 for the study group and $40,678.83 for the comparison group.

This study supports the cost savings and quality outcomes patients and our health care system need. However, instead of resulting from rules, regulations, and EMR’s, the outcomes are a result of teamwork, synergy, and collaboration. I would venture to say these virtues are also the very characteristics we all crave as health care providers and what is lacking in our own job satisfaction.

References

Caroline E. Fife, MD, CWS; Marissa J. Carter, PhD, MA; David Walker, CHT; Brett Thomson, BS

Wounds, Volume 24 – Issue 1 – January 2012