Eroding Doctor-Patient Relationships

The “Bed-Side Manner” Deterioration Continues
Staff Reporters
A growing chorus of discontent suggests that the once-revered doctor-patient relationship is on the rocks.
Results
About one in four patients feel that their physicians sometimes expose them to unnecessary risk, according to data from a Johns Hopkins University [JHU] study published in the journal, Medicine, while two recent studies show [...]

Medicare GAO Report on Radiology

Prior Imaging-Authorization Suggested
Staff Reporters
As reported in the Wall Street Journal, on July 14, 2008, Medicare may be soon requiring prior authorization to curtail unnecessary utilization of CT scans, MRIs and other forms of medical imaging, a new Government Accounting Office [GAO] report suggests.
The Medicare Report
To cut imaging costs, Medicare has been reducing certain physician [...]

CMS to Bonus Doctors for PQRI

July – December 2007 Reporting Period
Staff Reporters
According to Anne Zieger, of Fierce Health Finance, the Centers for Medicare and Medicaid Services [CMS] will pay out more than $36 million in monetary incentives to medical providers who reported data on quality of care delivered between July 2007 and December 2007; as part of its Physician Quality [...]

Prescription Quantity Survey

The IMS Health Data Study
Staff Reporters
Did you know that the number of prescriptions dispensed by pharmacies in the U.S. is growing at its worst rate in at least a decade, as consumers are squeezed by both a troubled economy and the growing burden of out-of-pocket health-care costs?
The IMS Report
Data from market researcher IMS Health and [...]

Culture Change in Nursing Homes

Commonwealth Fund Survey of Nursing Homes
Staff Reporters
The “medical culture change” movement is working to radically transform nursing home care, and help facilities transition from institutions to home.
Survey Highlights
The following highlights just a few of the findings from the Commonwealth Fund 2007 National Survey of Nursing Homes report, released in May 2008:

Fifty-eight percent of culture [...]

1/3 of Medical Procedures Fail to Improve Health

A Startling Congressional Budget Office Report!
Staff Writers
Almost one-third of the procedures that doctors perform fail to improve a patient’s health!
Of course, this may come as quite a surprise to most citizens, but not so to readers of the Executive-Post, or the books, white-papers and dictionaries of its sponsor, the Institute of Medical Business Advisors, Inc [...]

Consumer Health Plan Satisfaction Survey

New Deloitte Center for Health Solutions Survey
Staff Reporters
Nine out of 10 Americans are not completely satisfied with their health plans, according to “The Deloitte Center for Health Solutions 2008 Survey of Health Care Consumers.”
The Survey:
According to the survey of what more than 3,000 Americans thought about a variety of healthcare issues; these findings [...]

Medication Errors Persist

Bar Coding Not a Proven Technology
Staff Reporters
Bar coding has not yet been proven to reduce medication errors, and often the shortcuts that caregivers develop undermine its effectiveness, according to a study published in the Journal of the American Medical Informatics Association [JAMIA].
Hospital Settings
In hospitals that use bar codes, each patient gets a unique [...]

We’re Listening …

Executive-Post Collaborative Improvement Initiative
To provide you with the best possible communications forum that integrates medical practice management with personal financial planning and health economics, the editors of the Executive-Post would really appreciate hearing from you.
We want your honest opinion about the Executive-Post so that we can determine what we do right - and what [...]

Faux Healthcare 2.0 Collaboration for Terminal Patients?

American Society of Clinical Oncology Study
Staff Writers
Only one-third of terminally ill cancer patients said their doctors had discussed end-of-life care, according to a recent federally funded study presented at the American Society of Clinical Oncology conference in Chicago.
Study Results
According to the study, patients who had these talks were no more likely to become depressed [...]

The Cure for Claims Campaign [CCC]

Reducing Healthcare Administrative Burdens and Costs
Staff Writers
To help reduce the administrative burden of ensuring accurate insurance payments for physician services, the American Medical Association [AMA] recently launched the “Cure for Claims” Campaign [CCC] and unveiled the first AMA National Health Insurer Report Card on claims processing.
Goals
The goal of the AMA campaign is to hold [...]

AEM Report on Drug History Errors

Annals of Emergency Medicine Drug-Report
Staff Writers 
Medication histories for trauma patients were inaccurate for a rural population due to communication lapses, according to a new study published on June 9 2008, by the Annals of Emergency Medicine [AEM].
The Report
Researchers studied 234 trauma patients in a rural setting, the majority of whom were moderately injured. Medication lists [...]

The Consumer-Patient Purchaser Disclosure Project

Advancing Healthcare Transparency and Advocacy
Staff Reporters
The Consumer-Purchaser Disclosure Project http://healthcaredisclosure.org, and various collaborating organizations, recently announced that a “comprehensive national agreement” has been reached with “leading physician groups and health insurers on principles to guide how health plans measure doctors’ performance and report the information to consumers.”
Stakeholders-on-Board
Stakeholders signing on to support the initiative include AARP, [...]

Crafting a Medical Practice Mission Statement

Solidifying Guiding Principles
By Dr. David Edward Marcinko; MBA, CMP™
Publisher-in-Chief
The mission statement is an important and fundamental document that reminds doctor’s why they are in medical practice. This document reflects the physician-executive’s beliefs about life, practice, patients, employees, reimbursement and medical vendors. It serves as a guide for him or her to make choices about how [...]

Hospitals Avoiding Non-Emergency Care

Reducing Emergency Department Workloads and Expenses
Staff Writers
As most Executive-Post readers know, hospitals are under more intense pressure than ever to avoid bad-debt expenses and reduce write-offs. For example, according to one study, total emergency room visits, classified as non-urgent conditions increased from 10 percent 1997 to 14 percent in 2006, according to research by the [...]

Survey on Convenient Care Medical Clinics

Possible Solution to the Healthcare Dilemma?
Staff Reporters
Another new survey suggests that convenient care medical clinics (CCMCs) could be a potential solution to health care issues, if fears can be alleviated; at least in the Keystone State.
The Survey
The survey by Widener University in Elder Pennsylvania, found that while baby-boomers aged 43 to 64 were most [...]

New Hospital Rating Service

Consumers Union
Staff Reporters 
The nonprofit Consumers Union is launching a new hospital ratings service, adding to the growing competition to provide online consumer information about health care, as reported in the Wall Street Journal.
A Consumer Reports Publication
The effort, by the publisher of Consumer Reports magazine, is a gamble that the credibility of the magazine’s [...]

The Dartmouth Atlas Project

Documenting Medical Resource Variations
Staff Reporters
For more than 20 years, the Dartmouth Atlas Project [DAP] has documented glaring variations in how medical resources are distributed and used in the United States.
Purpose

According to its website, the project uses Medicare data to provide comprehensive information and analysis about national, regional and local markets, as well as individual [...]

Nurses in e-Charge

Trends in Clinical Information Systems Technology 
Staff Reporters
Recently, iMBA Inc www.MedicalBusinessAdvisors.com and the Executive-Post participated in a Healthcare Informatics survey on nursing clinical information systems [CIS].
The top five CIS functions were:

Electronic documentation

PACS

EMR/EHRs

Automated alerts

Cross-continuum patient records

Assessment
The following link has a summary of white-paper results from that survey
http://survey.opinionresearch.com/surveys/J35584NOV2007/First_Look.pdf
Conclusion
You thoughts and comments are appreciated.
Related Information Sources:
Practice [...]

Patient Survey of Retail Health Clinics

One-Third Lack a Family Doctor
Staff Reporters
According to results of an online survey of 4,937 US adults conducted by Harris Interactive® between May 2 and 6, 2008 for the Wall Street Journal Online’s Health Industry Edition, 30% of patients who used retail-based health clinics do not have a primary care provider.
Other findings include:
 

The use of [...]

Evolutionary Shifts in the Primacy of Medical Ethical Principles

Philosophic Ruminations and Personal Interviews
By Render S. Davis; MHA, CHE
Crawford Long Hospital at Emory University
Atlanta Georgia USA
For more than 2000 years, the principle of beneficence, the profession’s obligation to be of service to others, was the foundation of the practice of medicine.
In taking the Hippocratic Oath, physicians swore that they would “perform their art [...]

Medical Conflicts of Interest

Emerging Ethical Issues of Trust
By Render S. Davis; MHA, CHE
Crawford Long Hospital at Emory University
Conflicts of interest are not a new phenomenon in medicine.
In the older fee-for-service system [FFS], physicians controlled access to medical facilities and technology, and they potentially benefited financially with every order, test, procedure, surgery or prescription they wrote.
Temptation to [...]

Stemming the Primary Care Exodus with DNPs

Doctor of Nurse Practice – Filling the Void
Dr. David Edward Marcinko; FACFAS, MBA, CMP™
Publisher-in-Chief
As the shortage of family doctors and primary-care physicians mount, and the domestic uninsured problem exacerbates to > 40 million uninsured Americans, the nursing profession is stepping up-to-the-plate by offering one possible solution to healthcare reform.
Cause and Effect
And, it is not [...]

Evidence Based Medicine

Emerging EBM Trends
Hope Rachel Hetico; RN, MHA, CMP™
The next emerging trend in healthcare is evidence-based medicine. EBM offers the promise of improving the quality of clinical services and reducing costs.
Definition
Evidence Based Medicine may be defined as the use of any techniques from science, engineering, risk-management and meta-statistics analysis - to medical literature reviews [...]

Medical Quality Drill-Down Analysis

Finding Sources of Treatment Variation 
By Brent A. Metfessel MD, MS, CMP™ (Hon)
If a medical provider or healthcare facility is found to have a significant variance from the norm on a measure, such as economic cost, drill-down analysis is important to find the reason behind the variance. 
Episodes of care case-mix adjustment is naturally suited [...]

Case-Mix Severity Methods

Measures and Benchmarks
By Brent A. Metfessel MD, MS, CMP™ (Hon)
In a previous Executive-Post, we asked readers if they knew of any case-mix severity measures other than those utilizing expected values.
The Black-Box
When an MCO or HMO analyzes provider practice patterns, it is imperative that the organization educate providers on the methodology and validation of the adjuster, [...]

Case-Mix Indices and Expected Value

Quality Measurements, Benchmarks and Ratios
By Brent A. Metfessel MD, MS, CMP™ (Hon)
Once an expected case mix index value is calculated for a medical provider or facility, comparison of the provider’s actual practice patterns to the expected value can take place.
Benchmarks
In medical severity case-mix reporting, there are three basic measures that utilize expected values: 

Ratio of actual [...]

Case-Mix Medical Adjustments

The Centerpiece of Quality Practice Patterns
By Brent A. Metfessel MD, MS, CMP™ (Hon)
It is difficult to construct an adequate medical practice pattern profile without case-mix or risk adjustments. There needs to be an algorithm that adjusts for the medical severity of patient mix. 
For example, a tertiary care center in New York City cannot be [...]

Non-Claims Data Outcomes Analytics

A Costly and Resource Intense Proxy
By Brent A. Metfessel MD, MS, CMP™ (Hon)
In a previous Executive-Post, medical claims outcomes analysis was discussed as an indirect proxy for care quality. And, we asked if anyone could comment on other ways [direct or indirect] to ascertain medical care outcomes using claims, or other data?
Non-Medical Claims Data Analysis [...]

Six-Sigma Healthcare Primer

six-sigma
Physicians, Hospital Administrators, Consultants and Executives
Staff Writers
Read this special report on improving medical care quality and related healthcare delivery initiatives thru manufacturing concepts of six-sigma, by a leading physician-executive and senior six-sigma practitioner from Creative Health, USA.
This feature was prompted by the many inquires after an original post on the same topic.
Our author is Daniel [...]