Should your doctor text you? Probably not.

What ethical and professional factors should be weighed in how a physician interacts with patients via internet or by texting are discussed in this detailed position statement prepared for the American College of Physicians and the Federation of State Medical Boards.  By and large, the guidelines can distilled into three words, “Caution, caution, caution!”  Physicians are exhorted repeatedly to comport themselves in a professional manner vis-a-vis the social media platforms.  E-mailing is somewhat less problematic than friending on Facebook or texting.  To interject a little real world context here, I have to say that my dentist’s office emails appointment reminder/RSVPs, and I find this service helpful.  However, this article is primarily about electronic interactions that have the potential to violate confidentiality or provide misleading information.

Source: Farnan, J.M., and others.  Online medical professionalism: patient and public relationships, policy statement from the American College of Physicians and the Federation of State Medical Boards.  Annals of Internal Medicine;158:620-627, 2013.  Click here for full text: http://annals.org/data/Journals/AIM/926759/0000605-201304160-00007.pdf  Posted by AHA Resource Center, 312.422.2003, rc@aha.org

Top 10 issues in health care for 2013: PwC

PricewaterhouseCoopers has identified the top ten issues in health care for 2013 in this white paper.  Here they are (paraphrased a little):

1. How will states implement the Affordable Care Act (ACA)?
2. How to provide care for dual eligibles (patients who qualify for both Medicare and Medicaid)?
3. Will employers continue to offer health insurance?
4. What role will consumers play?
5. How will consumer ratings affect providers?
6. How will providers transform care delivery?
7. Will population health management trend take off?
8. What role will mobile devices play?
9. How will cost-effectiveness play into treatment decisions, such as prescribing new drugs?
10. How will the excise tax affect medical devices?

Source: PricewaterhouseCoopers.  Top Health Industry Issues of 2013: Picking Up the Pace on Health Reform, Jan. 2013.  Click here for full text (you may have to complete a free registration on the site first): http://pwchealth.com/cgi-local/hregister.cgi/reg/pwc-hri-top-health-industry-issues-2013.pdf  Posted by AHA Resource Center (312) 422-2050, rc@aha.org

Freestanding emergency departments: benchmarks

Urgent Care Association of America, a trade group representing urgent care centers, has produced this brief white paper comparing the characteristics of freestanding emergency departments with hospital EDs and with urgent care centers.  Here are some of the observations:

• 35 to 40 patients/day: break even for a freestanding emergency department (FED)
• 3 to 5 percent of FED patients are admitted to a hospital
• 60 to 90 minutes: length of stay in FED
• $350 to $500: net revenue / patient in FED
• 5,000 to 20,000 square feet: FED size

One city that has been called a hotbed for FED development is Houston, which had 35 centers at the time this white paper was written.  A related article indicates that there are a total of 284 FEDs in operation nationally.

Sources: Ayers, A.A.  Emerging Business Models: Freestanding Emergency Rooms.  Urgent Care Association of America, (Feb. 2012?)  Click here for full text: http://www.ucaoa.org/docs/Article_Freestanding.pdf

Ter Maat, S.  Freestanding emergency department growth creates backlash.  American Medical News, Apr. 29, 2013.  Click here for full text: http://www.amednews.com/article/20130429/business/130429966/4/

Posted by AHA Resource Center (312) 422-2050, rc@aha.org

Catastrophic Medical Malpractice Payouts in the U.S.

An analysis of medical malpractice payouts of $1 million or more over a seven year period was recently published. It found that these catastrophic medical malpractice awards accounted for nearly 8% of all paid malpractice claims, and were most often associated with infants; quadriplegia, brain damage, or lifelong care; and anesthesia.

Annual catastrophic payouts averaged $1.4 billion, but this figure represented only 0.05% of total health expenditures in the U.S.  The study was based on the National Practitioner Data Bank that includes details on malpractice payouts on behalf of physicians or other individual providers; malpractice claims against hospitals or other institutions are not covered by the Data Bank. Consequently, total national payouts may be underestimated by about 20%, according to the researchers.

The researchers conclude that defensive medicine rather than ‘frivolous’ malpractice awards may be the more costly concern. According to Marty Makary, one of the Johns Hopkins researchers, “It is not the payouts that are bankrupting the system — it’s the fear of them.” He estimates defensive medicine costs $60 billion annually for too many tests and procedures.

Sources:

Bixenstine PJ and others. Catastrophic medical malpractice payouts in the United States. Journal for Healthcare Quality, published first online, Mar. 29, 2013, at http://onlinelibrary.wiley.com/doi/10.1111/jhq.12011/abstract

“Catastrophic malpractice payouts add little to health care’s rising costs. Johns Hopkins Medicine news release, May 1, 2013. http://www.hopkinsmedicine.org/news/media/releases/catastrophic_malpractice_payouts_add_little_to_health_cares_rising_costs

Posted by AHA Resource Center (312) 422-2050, rc@aha.org

30-day readmission rates for heart and pneumonia patients

This is the fifth year that Modern Healthcare has published a list of large, medium, and small health systems judged to be top performers on clinical and operational performance indicators.  The analysis is done by Truven Health Analytics.

Here are some of the benchmarks derived from this study for 30-day readmission rates (these are MEDIANS):

• 19.55% acute myocardial infarction patients
• 23.55% heart failure patients
• 18.13% pneumonia patients

These rates represent the performance of the top 15 health systems in the U.S.  The article also provides comparative rates for the entire universe of health systems.

Source: Establishing a culture focused on quality.  Modern Healthcare;43(15):28-29, Apr. 15, 2013.  Click here for publisher’s website: http://www.modernhealthcare.com/  Posted by AHA Resource Center (312) 422-2050, rc@aha.org

Operating room utilization benchmark: 75% suggested

If the operating room utilization rate is lower than 75 percent there is room for improvement, according to the authors.  This article discusses how to improve utilization by tightening up block scheduling rules.  One problem involves the commonly-used 4-hour block, which can be inefficient.  Another problem involves allowing surgeons to release blocks on short notice with no penalty.  How to design an efficient block scheduling system is described.

Source: The right strategies can help increase OR utilization.  OR Manager;29(5):21-22, May 2013.  Click here for the publisher’s website: http://www.ormanager.com/

Related information: Dexter, F., and others.  An operating room scheduling strategy to maximize the use of operating room block time: computer simulation of patient scheduling and survey of patients’ preferences for surgical waiting time.  Anesthesia & Analgesia;89:7-20, 1999.  Click here for full text free: http://www.internetgroup.ca/clientnet_new/docs/OR%20Scheduling%20Strategy.pdf

 

What is a specialty ACO? A disease-specific ACO?

Initial development of accountable care organizations (ACOs) was focused on primary care, but interest is now shifting to how to encompass care management for certain types of chronic care patients, such as those with cancer or end-stage renal disease.  In some cases, the ACOs are contracting care management for these patients out to specialty physician groups.  Examples of these specialty ACOs would be the relationship between Banner Health and the Southwest Kidney Institute or between Florida Blue and Moffitt Cancer Center.  A challenge with specialty ACOs is amassing a large enough patient base.  Another challenge is working out the referral relationships and possible turf issues between a primary care ACO and the specialty ACO(s) in a service area.

Source: Punke, H.  Specialty ACOs: the next step in accountable care.  Becker’s Hospital Review;2013(5):26-27, May 2013.  Click here for article: http://www.beckershospitalreview.com/hospital-physician-relationships/specialty-acos-the-next-step-in-accountable-care.html  Posted by AHA Resource Center (312) 422.2050, rc@aha.org

Other related information: Florida Blue launches oncology ACO.  HealthLeaders Media, May 14, 2012.  http://www.healthleadersmedia.com/page-2/LED-280059/Florida-Blue-Launches-Oncology-ACO

Centers for Medicare & Medicaid Services.  Details for: comprehensive ESRD care model.  Fact Sheets, Feb. 4, 2013.  http://www.cms.gov/apps/media/press/factsheet.asp?Counter=4529