Document 6425002

St. Vincent Healthcare
Volume 7, Issue 3
March 2010
Medical Staff Officers:
Gregory McDowell, MD, President
Michael Bush, MD, President Elect
Kevin McCrea, MD, Immediate Past
President
A NOTE FROM THE PRESIDENT
OF THE MEDICAL STAFF
Gregory McDowell, MD
Department Chairs:
Anesthesia—Zeferino Arroyo, DO
Emergency Medicine – Jim Bentler,
MD
Family Med. -Vernon Johnson, MD
Medicine – Charles McClave, MD
OB/Gyn - Hal Forseth, MD
Orthopedics- Curtis Settergren, MD
Pathology – Paul Holley, MD
Pediatrics – David Standish, MD
Radiology – Kathleen Ryan, MD
Surgery - Eric Dringman, MD
Committee Chairs
Bylaws—Grace Kim, MD
Cancer – Martin Lucas, MD
Credentials – Lionel Tapia, MD
ICU – James McMeekin, MD
Infection Control – Fred Kahn, MD
MEC – Gregory McDowell, MD
MSQIC – Jeff Johnson, MD
OR - Benjamin Jagodzinski, MD
Perinatal Care-Kathleen Stevens,
MD
P & T – Michael Hagan, MD
Radiation Safety–John Hanson, MD
Transfusion – Paul Holley, MD
Trauma – Dennis Maier, MD
Utilization Management—
I would like to thank each of you for
taking some of your valuable time
to read these comments. I respect
each of you. I admire your high
academic achievements, professionalism and your focus on patients’ health enhancement as your
professional priority. I share your
commitment to your family, to the
larger community about us and to
your avocational interests. I applaud your passion for lifelong
learning and I respect the sacrifice
that you have made to pursue the
practice of medicine. The long
hours of work and the sleepless
nights on call are realities that persist from our training days. The
three foremost rules of residency
are still valid today as they were
then: If you see a chair, sit in it; if
you see a bed sleep in it; if you see
food, eat it. You are in a uniquely
qualified position to comment on
the strengths and weaknesses of
our healthcare environment and to
the challenges that confront both
those providing and benefitting
from the delivery of care today. You
find understandable frustration in
not being at the table and being
forced to the sideline.
The responsibilities that you bear
and the decisions that you make
have a great impact on human life
and health each day. Paperwork
requirements are enormous at
times and the degree of multitasking that is required to manage your
electronic lives sometimes stands
in your way of effective patient
care. Compliance and reporting
requirements are growing annually.
The ever present threat of litigation
or fraud and abuse investigation
exists. Your workforce seems to be
small in the face of the growing
demands and attrition is noted
among your peers. The population
is aging and growing and our patients are visiting more frequently
with worsening health each year.
The consumers of our healthcare
product are in general heavier with
more complex risk factors and more
co-morbidity and are also older on
average. Struggles with the growing
inequity between physicians and
facilities relative to reimbursement
schedules exist as well as great
frustration with working within an
industry where the value of what you
do is not determined by yourself but
rather by an independent third party
payer or payers. Heavy discounts on
fee schedules are typical and the
threat of these discounts growing in
magnitude is real and likely imminent. The free market around you
seems to be stifled and not at work.
Few remember the ten years of
training beyond college that is typical
for physicians and the four years of
additional cost that you bore for your
education beyond your collegiate
work. Further compounding your
roles early on are the low earning
potentials which you accepted during internship, residency and fellowships with the promise of better
years to come. Most of us spent ten
years after college without making
any retirement contributions whatsoever to qualified benefit plans. Ten
years out of college you are so far
behind in your savings for retirement
relative to your peers that there may
be no opportunity to catch up subsequently.
Nonetheless, each day you come to
work to be a role model, an educator, a leader and to treat human
suffering. You do no harm and take
care of the underprivileged, those in
great need and the sick and weary.
You are highly respected by your
patients and have always sought to
be part of the solution and not part of
a problem. You are committed to
meaningful solutions and to attempting to leave our house of national
healthcare in a good condition for
those who follow rather than in a
state of economic shambles. You
have not abandoned your charitable
or humanitarian agendas. You are a
role model and beacon for the
young individuals in training and
allied health professionals as well
as nurses that surround and support
you. As you act in the best interest
of your patient rather than in yourself,
you
define
the
word
“professional.”
Some thoughts on the current
healthcare debate:
At times all of us have felt that the
current healthcare debate has been
unsympathetic to the needs of the
physicians and to patients for whom
they provide care. Many physicians
sense that the proposed healthcare
reform agenda is frankly disrespectful to both physician and to the patients they serve. It has been stated
that we provide some of the most
inferior and expensive healthcare in
the developed world. I find that contention objectionable on a number
of levels although the financial data
speaks for itself. I still think that in
many regards we in the United
States are world leaders in healthcare. Many international guests
come to the United States for their
education and training and the English literature is a central repository
for the most credible peer-reviewed
medical literature in the world. We
are taking on some of the most
complex challenges in regards to
addressing the health of our consumers who have increasingly complex medical comorbidities. I ask
Continued on Page 8
Come and celebrate with a lunch in your honor!
Monday, March 29, 2010
Marillac Auditorium
11a.m.—1:30 p.m.
Page 2
Page 3
New in Town…. Welcome!!
Erich Garland, MD comes to us from Idaho Falls, ID and will be providing Locum coverage
for SVH Hospitalist Neurologist program. Dr. Garland received his medical degree and completed his internship from Texas Tech University School of Medicine, Lubbock, TX. He completed a residency in Neurology at University of New Mexico Medical Center, Albuquerque,
NM.
Change of Status.
The following providers have chosen to change their Medical Staff membership and / or privileges:
Provider Name
Department
Request
Bouldin, Anthony, MD
Pediatrics / Neurology / Telemedicine
OBGyn
Voluntary resignation .
Connor, G. Patrick, MD
Durden, Angela, MD
Pediatric / Neurology / Telemedicine
Pathology
Frewin, Curtis, MD
Surgery / Ophthalmology
Paul, Drake, MD
Schmidt, Guy, MD
Stears, Robert, MD
Pediatrics / Critical Care
Surgery, Orthopedic
Radiology
Swift, James, MD
Thompson, Tracey, MD
Pediatric / Critical Care
Pediatrics / neonatology locum
Davis, Bradley, MD
Additional privilege—Gynecological Oncology
Voluntary resignation
Transfer from Provisional to Active – provisional monitoring
complete
Transfer from Provisional to Courtesy – provisional monitoring
complete
Voluntary resignation
Voluntary Resignation
Transfer from Provisional to Active – provisional monitoring
complete
Voluntary Resignation
Voluntary resignation
Department and Committee Happenings
Committee
Meeting Date
Start Time
End Time
Requested location
Anesthesia Department
3/22/2010
700
800
Board Room- 4 Allard
DOCTORS DAY CELEBRATION
3/29/2010
1100
1330
MARILLAC AUDITORIUM
Credentials Committee
4/5/2010
645
745
Board Room- 4 Allard
Intensive Care Committee
4/8/2010
1200
1300
Board Room- 4 Allard
Emergency Medicine Department
4/9/2010
700
830
Mansfield #7
Surgical M&M
4/12/2010
700
800
Mansfield Burns W
Operating Room Committee
4/12/2010
700
800
Gallatin Room
Medical Executive Committee
4/12/2010
1730
1930
Board Room- 4 Allard
Medicine Department
4/13/2010
700
800
Mansfield 1 & 2
Trauma Committee
4/19/2010
645
830
Mansfield Burns W
Orthopedics Department
4/19/2010
700
800
Mansfield 1 & 2
Pediatrics Department
4/21/2010
1230
1330
Mansfield Burns W
Surgery Department
4/26/2010
700
800
Mansfield 1 & 2
Anesthesia Department
4/26/2010
700
800
Board Room- 4 Allard
Podiatry Subsection
4/27/2010
700
800
Stillwater room
Page 4
The SVH Medical Staff Bulletin Board
Welcome daVinci!
St Vincent Healthcare is pleased to announce the addition of da Vinci robotic
assisted surgery. A philanthropic project
of the St. Vincent Healthcare Foundation,
the da Vinci has been delivered and is
available for viewing in Surgical Services.
The da Vinci’s sophisticated robotic technology allows surgeons to perform minimally invasive procedures with unrivaled
precision.
Training on the da Vinci is underway with
the first procedures slated for mid to late
April.
Providers please remember to PRINT you name
after your signatures! Thank you.
National Healthcare Decisions Day 2010
Friday, April 16
SVHC Ethics Committee invites Providers (MD’s, PA’s and
APRN’s) to a Provider Education Event
Topic: Montana POLST (Provider Orders for Life Sustaining Treatment)
Presenter: Jim Upchurch, MD (MT Board of Medical Examiners)
10:00 – 11:00 AM at MHEC, Burns Auditorium
Dr. Upchurch will address the Montana POLST: how it was developed /
adopted, how it is being implemented and how it interfaces with Comfort One, hospital DNR orders and Advance Directives.
A blessing of da Vinci was held proceeding the open house on March 16.
A community wide name the robot contest for grade school children will begin in
late March.
Physician Centricity Help Line
For those pesky problems!
237-3900
If you don’t get an answer PLEASE
LEAVE A MESSAGE with your call back
number!! The phone is checked CONSTANTLY. Charlie or Dan WILL RETURN YOUR CALL!!
NEW ISOLATION GOWN GO LIVE!!
Starting March 22nd SVH will be transitioning to Non-Disposable Yellow
Isolation Gowns at the Hospital. These gowns are used once and then
placed in the dirty laundry bag which should be inside the patient’s room.
Proper procedure includes gowning first and then gloves placed over the
white cuff, covering the white cuff completely. When removing isolation
gear, gloves are removed first followed by the gown and then mask if a
mask was used. Hand hygiene is preformed before and after isolation.
This new process has been instituted for two reasons, first during a pandemic event supplies are very limited and second during a natural disaster
or pandemic event if our supply chain is cut off we have only three days
worth of supplies on a routine basis at which point we would be unprotected. This new process will ensure the protection of our physicians and
staff going forward. If you have any questions please feel free to contact
Infection Prevention & Control at ex 3090.
SCIP Corner
In April there are some changes for SCIP (Surgical Care Improvement Project).
Addition to the list of what is accepted as documentation of infection, and “Reasons to extend antibiotics” past the 24h (48h for Open Hearts) time period to have the antibiotics discontinued.
New Reasons to Extend Antibiotics: Must be clearly documented as the reason
1. Erythromycin given postop for increasing gastric motility.
2. Hepatic encephalopathy
3. Pneumoscystis pneumonia in a pt with AIDS
4. Infection (Some new terms added to be considered as infection: Endometritis, free air in abd,
necrosis, penetrating abdominal trauma, perforation of bowel, purulence/pus)
5. Current malignancy of the lower extremity having a joint revision
6. Previous surgery on a joint that is now having a joint replacement (i.e. ORIF to THA)
7. Culture was taken after incision, prior to abx (will be considered suspected infection, and will also
exclude the abx prior to incision if clearly documented prior to surgery or during surgery as the
reason to hold abx until after the culture is taken)
HIPAA TIP
To be HIPAA
compliant make
sure to log out
of Centricity
when you leave
a workstation. Not
logging out
puts you at risk
for the next person sitting at
that workstation to access protected
health information (PHI) under
your password.
Page 5
CMO Corner Notes
My patient had an ADVERSE Event – What do I do?
Of course the first priority upon discovery of an unanticipated outcome is to ensure the
safety and care of the patient and any others who maybe at risk. Then what are the next
steps? Ask someone to look up SVH Guidelines in the Apology and Disclosure Policy.
Contact Risk Management or contact the Administrator on Call (pager 015) after hours.
Then disclose, apologize and document.
Mike Schweitzer, M.D.,
MBA
Regional Chief Medical
Officer
Holy Rosary/St. Vincent
Healthcare
VP Medical Affairs, St.
Vincent Healthcare
According to a February 1, 2010, American Medical News article, 35 states currently have
"apology laws" to prevent a physician's apology from being used as evidence in malpractice
cases. The article describes how some medical liability insurers offer a premium discount to
physicians who attend a seminar on disclosure and apology and some healthcare organizations have lowered costs associated with malpractice claims by adopting an "I'm sorry" policy. These policies require disclosure of facts related to adverse events, an appropriate physician apology, and financial compensation. (SVH has these policies.) The “I’m sorry” law
adopted in 2005 in Montana rules that providing a “statement, affirmation, gesture, or conduct expressing apology, sympathy, commiseration, condolence, compassion or benevolence relating to the pain, suffering, or death of a person that is made to the person, the person’s family, or a friend of the person or the person’s family is inadmissible for any purpose
in a civil action for medical malpractice”… It is recommended that you avoid using words
such as “wrong”, error”, “mishap”, “incorrect”, “inadvertent”, “mistake”, and
“accident”. What should be said is “I’m sorry that you (or a family member) had this
complication.”
In 2002, the University of Michigan Health System (UMHS) adopted a disclosure, apology and compensation policy, cutting litigation costs by $2 million a year and new
claims by more than 40%. Rick Boothman, chief risk officer at the UMHS, is one of the
early adopters and said the reason other doctors and hospitals have been slow to say
"I'm sorry" is simple. "What holds us back is fear, and you can't quantify it," Boothman
said. "Those fears are not the result of bad experiences -- they're the result of people
who've never tried it." Dr. Gerald Hickson, a recognized expert on physician behavior,
found that 24% of the patients he surveyed filed suit when they found that “the physician
had failed to be completely honest with them about what happened, allowed them to believe
things that were not true, or intentionally misled them.”
The Institute of Medicine report in 1999 that popularized the statistic that 44,000 to 98,000
Americans die each year as a result of medical errors unleashed a variety of pressures to
improve patient safety. Some medical liability insurers are open to the idea of doctors
apologizing. COPIC Insurance Co., a medical liability carrier in Colorado, started
openly communicating about medical errors in 2000 and reimburses patients for costs
of up to $30,000. The American Medical Association ethical opinion states that when a
doctor errs, "the physician is ethically required to inform the patient of all the facts necessary to ensure understanding of what has occurred" and that liability concerns
should not impede disclosure.
Our Risk Department coordinates an event determination or root cause analysis on near
misses, adverse events, or unexpected outcomes. Our focus is fixing the process or system
so it does not happen again. About 66% of the time, poor communication is a major contributor. The Department of Defense developed a class to train people to have better communication and perform better as a team. We have started training physicians and staff in
that TeamSTEPPS (Strategies & Tools to Enhance Performance & Patient Safety) program.
This is designed for health care professionals and strives to improve patient safety through
an evidence-based teamwork system. It is designed around improving communicating and
teamwork skills. TeamSTEPPS provides a source for ready-to-use tools to integrate teamwork principles into all areas of a health care system. It aims to produce highly effective
medical teams that optimize the use of information, people, and resources to achieve the
best clinical outcomes for patients. We are first targeting the high risk areas in our hospital.
L&D training is nearly finished. The teams in OR, ED, and ICU are next.
Page 6
Documentation Team says….
quested by the Recovery Audit Contractors to be reviewed for possible
overpayment to the hospital. One of
the main areas auditors across the
country are looking at, is medical
necessity for the patients’ admission.
They are focusing a lot of their energy on patients admitted with symptom codes as their main diagnosis.
THE
DOCUMENTATION
TEAM
Mary Harmon –7788-378
Tena Pegar– 7788-521
Julie Skagen-7788-991
Den’Ette Boyer-7788-138
Henri Jenkins 7788-439
Dana Rutan-7788-762
Michael DeBar-7788-479
RAC and Medical Necessity Documentation
Saint Vincent has received our
first request for RAC audit charts.
These are charts that have been re-
Symptom code admits can include unspecified chest pain, abdominal pain, and back pain, they
can also include altered mental
status, shortness of breath and other
symptoms. If at all possible, symptom code admits should be linked to
a diagnosis such as, “Patient admitted with abdominal pain, possible
gastroenteritis.”
Please remember
for CMS (Center for Medicare and
Medicaid Services) and hospital
coding purposes words such as:
likely, possible, probable, suspicious for, are perfectly acceptable.
Thorough documentation of your
patients’ status, possible diagnoses
and treatment plans is even more
important now to show the medical
necessity of your patients’ admission. The CDMP team will be glad
to assist you as needed.
This is great news for Montana!
HealthShare MT (HSM) received today $5.76 million in Federal ARRA grant for expanding meaningful use health information exchange in MT. We previously received $1.4 million in combined state and federal startup money last fall.
Loren Schrag, previously IT director for RMHN, is our new executive director. The state office will be in Billings.
John Middleton joined the Board last fall after Mike Foster rotated off. John also is on the tech committee. I serve on the executive
committee and also as Chair of Finance.
HealthShare MT http://www.healthsharemontana.org/ is a grassroots statewide organization that we started about five years ago to
create a statewide electronic health information exchange or Regional Health Information Organization (RHIO). We recently chose
Doc Site to be our vendor for HIE.
Elimination of “Self-Authorization” in Centricity
We have found a solution for eliminating the “self-auth” requirement in Centricity that preserves our ability to protect patient privacy,
while allowing easier access for physicians. The first part of the solution is new software that makes it easier to detect, track and
report unauthorized access to patient records. The second part of the solution is an updated confidentiality agreement outlining accountability and responsibility associated with the privilege of accessing protected health information.
We plan to disable the “self-auth” feature as soon as the majority of the medical staff has returned the updated signed agreement,
with a target of two weeks from now. Anyone who does not return an updated agreement will still be required to “self-auth” according
to the current process.
Protecting the privacy and security of patient information has become critical in this age of electronic records and the Internet. At a
minimum, physicians who are found to have failed to respect patient privacy will see their access privileges curtailed.
Please contact the Medical Staff Office for a Self Authorization Removal form if you have not already received one via email.
Please do not hesitate to contact me directly if you have questions, suggestions, or concerns.
Sincerely,
John Middleton, MD, FACS
Chief Medical Information Officer
St. Vincent Healthcare
[email protected]
(406) 237-3994
Office
Page 7
Pharmacy Update
Enoxaparin Dosing in Special Populations
The Joint Commission National Patient Safety Goal 3E on improved anticoagulation management recommends individualizing anticoagulant dosage needs on a patient-specific basis. Recommendations for appropriate dosing of enoxaparin include dose adjustment for special populations, such as obese patients and those with renal failure. To meet this objective, pharmacists will be monitoring patients receiving enoxaparin to ensure appropriate dosage adjustments are being made. Pharmacists will contact providers if changes in dose or
increased monitoring are recommended. They will also be available to assist with any dosing questions or needs. The following information summarizes recommendations in the literature for adjusting doses of enoxaparin based on renal function and obesity and provides
monitoring guidelines.
Enoxaparin Dosing in Renal Impairment
•
•
Although no dose adjustment is recommended in patients with moderate (CrCl 30-50 mL/min.) and mild (CrCl 50-80 mL/min.)
renal impairment, all such patients should be observed carefully for signs and symptoms of bleeding.
The recommended prophylaxis and treatment dosage regimens for patients with severe renal impairment (CrCl < 30 mL/min.)
are described below.
Indication
Dosage Regimen
Prophylaxis in abdominal surgery
30 mg SC ONCE daily
Prophylaxis in hip or knee surgery
30 mg SC ONCE daily
Prophylaxis in medical patients during acute illness
30 mg SC ONCE daily
Prophylaxis of ischemic complications of unstable angina & non-Q-wave
myocardial infarction, when concurrently administered with warfarin
Inpatient or Outpatient treatment of acute DVT with/without PE, when
administered with warfarin
1 mg/kg SC ONCE daily
•
•
1 mg/kg SC ONCE daily
Pharmacokinetic and clinical data on the use of enoxaparin in patients with renal impairment demonstrate that the half-life of anti
-Xa activity is prolonged and increases with decreasing renal function, and that bleeding risk is increased in patients with renal
impairment compared to those with normal renal function.
It is recommended that anti-Xa monitoring be used in monitoring safety of enoxparin use in patients with severe renal impairment
(CrCl < 30 mL/min.) It is recommended that the initial enoxaparin dose be reduced by 30-40% and further adjustments of 2040% are recommended as necessary.
Enoxaparin Dosing in Obesity
•
•
•
•
Patients of extreme body weight rarely have been included in clinical trials involving LMWHs.
In controlled trials using weight-adjusted dosing regimens, the enoxaparin dose was based on patients’ actual body weight.
Available evidence supports the use of TBW as the appropriate marker for LMWH dosing, and also cautions against underdosing
in obese and morbidly obese patients.
Some small studies show that in morbidly obese patients undergoing bariatric surgery, enoxaparin 40 mg SQ BID may be more
effective in preventing VTE than lower doses.
General Recommendations on the Use of LMWHs in Obese patients
1.
2.
3.
4.
Capping the LMWH dosage is not routinely recommended.
Avoid once-a-day dosing schedules in obese patients requiring treatment for DVT or PE
Anti-Xa monitoring is recommended for patients with a TBW of <45 kg or >150 kg.
Increasing the prophylactic LMWH dosage by 30% may be appropriate in morbidly obese patients or consider Lovenox 0.5 mg/
kg based on TBW ONCE daily for prophylaxis.
Measure anti-Xa level within 3-7 days of therapy initiation.
5.
Anti-Xa Monitoring Recommendations – Enoxaparin
•
•
•
•
Desired therapeutic range (Prophylaxis) – 0.2-0.4 IU/mL
Desired therapeutic range (Treatment) – 0.5-1.2 IU/mL
It is recommended that the sample for testing be collected 4 hours after the 2nd or 3rd SC dose. Maximum peak anti-Xa activity
occurs 3-5 hours after SC injection.
Recommended for high risk groups.
For more information on enoxaparin dosing, please contact Stephanie Longin, PharmD (237-8119) or Brett Stubson, RPh, MS (237-8112).
References
Hirsch J, et. al. Parenteral Anticoagulants. In: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines
(8th edition). Chest Supplement 2008;133: 141S-159S.
Sanofi-Aventis. Lovenox® package insert. Bridgewater, NJ:2007 October.
Page 8
Page 9
Presidential notes…continued from page 1
you today who is more dissatisfied, the average patient with his
physician or the average citizen
with his member of congress? I
would like to see healthcare
reform come full circle to address first and foremost the concerns of the frontline providers in
medicine and their patients’ best
interests. Healthcare at its simplest level is physicians and
other healthcare providers taking
care of patients. In the current
debate we are overwhelmed with
the big business of medicine and
have lost some focus on what
medicine has historically been
and how its core relationships
are best defined between provider and consumer.
I find several areas of overwhelming concern with the current reform agenda. Clearly, the
agenda is cumbersome. Two
thousand pages of new amendments and resolutions are hard
to integrate into our already busy
lives. Our system needs to be
simplified and is already excessive in its complexity. I find it
very objectionable that there is a
current threat to expand the
fraud and abuse investigations
through the use of plain-clothed
Department of Justice operatives
that impersonate patients in your
offices. Are you thinking about
this now and ready for this intrusion and entrapment? I’ll bet you
are as resistant to this concept
as I am. This past week I was at
a meeting of 104 Board of Counselors for the American Academy of Orthopaedic Surgeons
and I posed the question as to
whether or not there was any
support from the Board members, who are all physicians, for
implementing this fraud and
abuse strategy. There was not a
single member assembled that
was in support of this proposal
that President Obama states has
Republican support. The current
reform plan calls for more taxation across the board, and for the
incomes of families with high
earning potential as well as for a
reduction in reimbursement to
physicians. Additional penalties
of course are proposed to entitlement reimbursements for failure
to comply with the growing number of measures of compliance
initiatives. As an example of an
intrusive and sometimes less
than valuable compliance initiative that has been adopted, I will
reference the “Marking Your
Surgical Site” initiative. While
marking one’s surgical site
makes sense in the case of a
lateralizing or hidden lesion, it
strikes me as absurd when the
policy is applied to an obvious
lesion or a midline structure. Just
today I took an additional ten
minutes out of an already full
schedule to run to Surgery Plus
from my office to remark a midline lumbar incision that had been
previously marked 48 hours earlier after the mark was washed
off. Apparently your legislators
have in the past been convinced
that a fellowship trained spine
surgeon does not know where the
lumbar spine is and needs to
mark the midline lumbar region to
assure the safety of the patient.
These imposed initiatives are
frankly ridiculous but are we to
not comply we simply cannot do
our work in federally supported
institutions. The documentation
required to address compliance
has grown in scope and now
provide additional frustration and
loss of efficiency for us in our
systems. The insistence on more
use of electronic media and automated health information systems
will likely move us in a direction
that we need to be evolving; however, the contention that information technological changes will
reduce medical error rates and
will reduce costs has lacked evidence-based support. Some of
these systems have a net effect
of reduction in efficiency and
increasing our cost basis. The
mere purchasing of electronic
health record software systems,
not to mention the hardware support and the required hiring of
multiple individuals with IT backgrounds to support those systems
will be a significant expenditure.
Many legislators seem not to
recognize this. One wonders
whether providers can fully comply with the 26 meaningful use
criteria that will be necessary to
receive the 44-thousand dollars
of stimulus money.
Additionally, healthcare reform
seems to contain no meaningful
support for tort reform. There
does not seem to be anything in
healthcare reform that would
reduce the large class action
suits, some of which are supported by the federal government
against drug manufactures or
device manufacturers. Some of
these settlements are exorbitant.
I would give you as examples Eli
Lilly’s settlement, the Pfizer settlement the DePuy AcroMed’s
settlement on pedicle screws.
Were meaningful reform to exist
in the case of personal injuries,
such as has been enacted in Canada, we would likely spend a lot less
money litigating and supporting the
health care needs of those with
minimal injuries following low speed
vehicular accidents. Additionally, it
would be very helpful to have substantial reform within the workmen’s
compensation system to allow some
reasonable limits to be set on workplace injuries that simply are aggravations of underlying degenerative
conditions. A lot of money is wasted
in each of these areas in healthcare
and certainly a lot of time.
What would be very useful in healthcare reform would be to develop
true measures assessing the value
of the product that is received by the
consumer. By that I mean what is
the quality of the product and the
outcome that they benefit from as a
function of the cost of that benefit?
We here at St. Vincent Healthcare
acknowledge that being able to
assess and track value is one of our
highest priorities in the coming
years. We need a great deal of
professional input from our physicians to help us understand what
are our true measures of success
and a good deal of transparency
and compliance from all of us and
from our facility to assess the cost
piece. Without this, free market
forces will not be able to overcome
the current confused and complex
arm’s length relationship that exists
between the consumer and the
provider.
What can we do?
I know each and every one of us
wants to be part of the solution and
are committed to weighing in on
what is of vital importance to us. We
will use our position of leadership
and our central insights to slowly
influence the swing of the pendulum. We must use our powerful
combined voices to create a symphony and to avoid a singular
agenda. We will insist on market
forces defining our boundaries
through consumer choice and preference and we will support transparency in our quality and reporting of
price. We will not continue to passively accept unreasonable escalations in workplace demands without
responding to the challenge. We will
not leave our house of national
healthcare in economic shambles.
Enhancements in preventative care
and wellness and promotion of aggressive measures supporting
healthy nutrition, regular physical
exercise programs in the schools
and fast food labeling reform will
probably be very helpful. Our
aggressive efforts to reduce the
epidemic of obesity in this country
will see great benefits downstream in addressing our problems with diabetes, hypertension,
vascular diseases and diseases
that are the result of obesity including degenerative conditions
of the spine and of the extremities. Unless we address this root
cause of many of our health comorbidities the downstream disease prevalence will continue to
spiral out of control. It is already
unmanageable in my opinion and
many of us feel like we are swimming upstream against a very
strong current that eventually will
wash us away.
I sense that we may need to
support initiatives that decrease
the use of costly prescription
drugs. Reasonable limits on endof-life care are controversial but
most of us support hospice and
home healthcare models being
expanded. I think it would be
helpful to consider placing a reasonable cap on the markups that
facilities charge for devices and
drugs. Meaningful reform of workmen’s comp, medical liability and
insurance of the Food and Drug
Administration policies regarding
new devices may need to be
considered, in part to avoid stifling the free market. We need to
encourage rather than discourage
physicians from being central to
the process of focusing our
healthcare reform agendas. Who
is more familiar with the patients’
need and the best interest of the
patients, their physicians or others who are at arm’s length from
the process and seek to influence
it from outside? We need to reaffirm the high position of esteem
that we have for physicians and
treat the profession again with
deserving respect. This will mean
less micromanagement and compliance initiatives, not more. If we
improve our workplace performance internally we will regain and
enhance our professional satisfaction and retain physicians in
the workforce.
Thank you for taking the time to
read these comments and opinions which are an expression of
my own thoughts and not necessarily of those around me or of
the institution within which I work.