Without comment, here are excerpts from Modern Healthcare that illustrate poor standards, lack of standardization, or lack of enforcement. Healthcare is in the unfortunate position of being one of the least compliant industries with modern management's dictum to insist on the highest standards (which produces quality and absence of litigation), and absolute standardization (which produces lower costs and greater vendor control)

• Clinical IT limited reality in doc offices: survey Despite a national emphasis on using information technology to improve patient care, the vast majority of America's physicians don't possess the technology to perform basic functions such as writing electronic prescriptions, the Center for Studying Health System Change said. According to a survey by the nonpartisan research group, less than 25% of U.S. physicians were able to generate treatment reminders for use during patient visits in 2001, and only about 10% could write electronic prescriptions. The survey, described as the first nationally representative snapshot of the IT available in physician offices, examined whether doctors were using computers or other IT for five clinical functions: obtaining treatment guidelines, exchanging clinical data with colleagues, accessing patient notes, generating treatment reminders and writing prescriptions. About 60% of practices reported using IT for no more than one of the functions. —9/29/04
• Two-thirds of ERs say on-call coverage inadequate  About two-thirds of emergency departments report inadequate on-call coverage from key specialists like orthopedic surgeons, neurosurgeons and obstetricians, according to a survey by the American College of Emergency Physicians. The ACEP said the survey, conducted from April to August with researchers from Johns Hopkins University, is the largest study ever to evaluate problems with on-call coverage. Medical directors from 1,427 emergency rooms participated. According to the survey, the ACEP said, a lack of specialist backup is creating risks for patients by delaying treatment and increasing patient transfers between hospitals. "The decrease in the number of medical specialists willing to be on-call in the nation's emergency departments is a looming national healthcare crisis," ACEP President Brian Hancock said. About one-third of respondents attributed the problems to a change this year in the Emergency Medical Treatment and Active Labor Act that narrowed definitions about what is and is not an ER and limited the regulation from being applied once patients are admitted to the hospital. Hancock said on-call problems are further exacerbated by medical liability insurance costs. —9/28/04
• System still 'routinely' falls short on care: NCQA   Between 42,000 and 79,400 Americans die unnecessarily annually because they receive less than optimal healthcare, according to the National Committee for Quality Assurance's eighth annual State of Health Care Quality report. The healthcare system's "routine failure to provide needed care" also results in $1.8 billion in excess medical costs and nearly 66.5 million potential sick days, including days in which sick employees work but below normal capacity, the NCQA said. Health plans that publicly report quality data made significant improvements in 2003 on 22 quality measures, including screening for breast cancer, treating high blood pressure and prescribing beta blockers for patients after heart attacks, the report said. But the healthcare system appears to be "deeply polarized," with many Americans receiving generally poor care, the NCQA said. The report is based on quality data from 563 health plans covering 69 million Americans. Harvard Pilgrim Health Care, Wellesley, Mass., was rated the top plan in terms of quality and customer satisfaction. 9/23/04
• Quality issues may persist at many nursing homes   Consumers Union said 10% of 1,717 nursing homes for which it has data have appeared on all four of the organization's annual Consumer Reports Nursing Home Watch List. The list names facilities located in the U.S. or its territories that the consumers group has judged as having quality-of-care issues based on state inspections and enforcement actions. More than 40%, or 715, of the homes on the 2004 watch list have appeared on the list for at least three years. About 6% of those listed were cited for deficiencies that placed residents at immediate risk of harm, the group said. 9/22/04
• Calif. hospitals' scores fall on patient survey  The latest results of a prominent survey on how Californians feel about their hospital care show dwindling satisfaction among patients and continued reluctance among hospitals to participate in the voluntary project. The third annual survey, formerly known as Patients' Evaluation of Performance in California, was co-sponsored by the California HealthCare Foundation and the California Institute for Health Systems Performance. It drew responses from more than 36,000 patients admitted for at least one night to any of 200 participating hospitals between March and June. Hospitals were rated on eight quality measures and their overall performance. Statewide, 25% of participants scored below average; 51%, average; and 24%, above average. In last year's survey, in which 181 hospitals participated, 18% scored below average; 57%, average; and 25% above average. The sponsors said the survey is the largest scientifically valid survey of its kind. Patients gave hospitals high marks for providing physical comfort, coordinating care and respecting personal preferences but believe hospitals could do better at providing emotional support, involving family and friends, and helping patients' transition to home. About 49% of the state's 389 eligible hospitals did not participate in the voluntary project. While 63 hospitals joined for the first time in 2003, 44 of the 2002 participants dropped out. 9/14/04
• Disruptive physicians need a timeout: survey  Almost one-third of physician executives say serious problems with disruptive behavior by doctors erupt in their organization on either a monthly or a weekly basis, a pattern that underscores a growing concern within the profession, according to a new national survey. What's more, the survey, conducted by the American College of Physician Executives, shows that about 70% of respondents reported that problems with physician behavior nearly always involves the same doctors, over and over again. "This has been a chronic problem that is acutely getting much worse," according to a comment from one of 1,627 physician executives who responded to the survey. "The stress of our jobs is increasing due to the decrease in reimbursement for professional activities, increasing regulatory requirements and severe financial constraints placed upon hospitals." The results of the survey are included in a special series of articles in the September/October issue of The Physician Executive, a medical-management journal published by the 10,000-member ACPE, based in Tampa, Fla. The authors of the study said executives must take firm disciplinary measures against disruptive or abusive doctors, coach physicians on appropriate behavior and mediate problems between doctors, nurses and other staff. About 57% of the respondents said problem behavior among doctors involved nurses or physician assistants. 8/27/04
• Study supports value of hospitalist physicians  A study comparing the inpatient care provided by hospitalists with that of other internal-medicine physicians found that hospitalists discharged their patients an average of one day earlier and ordered an average of $917 less in hospital services for each patient in their care. The greatest savings was in the cost of nursing services, likely directly related to the shorter length of stay, according to researchers at the Veterans Affairs Iowa City Health Care System and the University of Iowa. The researchers analyzed 1,700 admissions to four general internal medicine services at University of Iowa Hospitals and Clinics during 2000 and 2001. One service was staffed entirely by hospitalists and three by nonhospitalist physicians in internal medicine. Patients cared for by the hospitalists had an average stay of 5.5 days compared with 6.5 for patients of nonhospitalist physicians. The study appears in the August issue of the American Journal of Managed Care. A 10% overall reduction in hospital costs for hospitalists' patients was recorded, despite a higher average cost per day of $122, said Peter Kaboli, the study's lead author and a hospitalist. The results suggest that hospitalists may be more efficient in patient evaluation and treatment, allowing for earlier discharges, Kaboli said. The researchers also found a significant reduction in laboratory costs but no reduction in costs associated with radiology tests or pharmacy services. 8/16/04
• Group to push industry toward e-prescribing  A new coalition for speeding adoption of electronic prescribing will work to get the industry to embrace practice models that reward physicians for maximum use of e-prescribing and don't favor one vendor's technology over another's. The coalition, CafeRx, was announced at the National Council for Prescription Drug Programs' educational forum in San Francisco. The importance of e-prescribing in reducing costs and medical errors was highlighted in the recently unveiled government plan to expedite adoption of electronic medical records. Membership in the coalition is open to all information technology companies that agree to support the group's guiding principles. Nine founding "advisers" include the council, two vendors of e-prescribing products, Allscripts Healthcare Solutions and SureScripts; IT giants Microsoft Corp., Cisco Systems and Hewlett-Packard Co.; electronic prescription exchange companies NDCHealth and RxHub; and consulting firm Capgemini. Read about the coalition and its guiding principles at http://www.caferx.org/CafeRx.htm 8/10/04
• JCAHO drops mandatory bedside bar-coding   The Joint Commission on Accreditation of Healthcare Organizations has dropped from consideration a proposal to require bedside bar-coding systems in hospitals to ensure that correct medications are matched to patients. The proposal was among several recommended in April by an expert panel charged with advising the JCAHO on additions and revisions to its list of National Patient Safety Goals. But the JCAHO Board of Commissioners voted down the proposal, a spokeswoman said. An April 30 letter from the American Hospital Association petitioned the JCAHO not to specify the use of bar-code technology as the sole method of implementing the larger goal of "matching patients to medications, tests and treatments that are ordered for them." The AHA contended that such a requirement "locks accredited hospitals into adoption of a single technology solution that may not be the one most efficacious in improving the safety of the patients they serve." The proposal called for hospitals to develop a bedside bar-code medication management capability by Jan. 1, 2007. Meanwhile, U.S. Rep. Pete Stark (D-Calif.) has called a 1 p.m. news conference Tuesday to issue results of a government report expected to be critical of the JCAHO's accreditation practices and approach. An aide to Stark did not give details but said the report by the Government Accountability Office (formerly the General Accounting Office) will pertain to issues of quality. Also attending the conference will be U.S. Sen. Chuck Grassley (R-Iowa). 7/19/04
• Pay-for-performance standards urged   HCA Chairman and Chief Executive Officer Jack Bovender Jr. called on Congress to create a special board to come up with a standard set of quality measures for the pay-for-performance programs mushrooming nationwide. Speaking at the Healthcare Financial Management Association's 2004 Annual National Institute in Nashville, Bovender said that absent such an organized approach, healthcare providers would face higher administrative costs as they try to comply with the differing data requirements of myriad pay-for-performance programs. "It would be entirely appropriate and productive for Congress to step in and form a board to say here's how we're going to come up with measurements and here's how we can equally apply them across all providers," he said. Bovender was part of an expert panel on the pros and cons of pay-for-performance programs, which reward providers that achieve better clinical outcomes with bonuses or higher reimbursement and sometimes reduce reimbursement for providers with worse outcomes. Panelist Karen Ignagni, president and CEO of America's Health Insurance Plans, agreed that the industry needs a consensus on the appropriate structure for such programs. "We have all these silos going up -- Leapfrog, individual consulting companies, government agencies, employer groups -- all are starting down different paths," Ignagni said. While supporting a public-private partnership to address the issues involved, Ignagni stopped short of endorsing a congressionally mandated task force. She did not indicate whether AHIP had the power or intent to push insurers to agree on parameters for programs. 6/29/04
• Study: Pediatric-care errors common in hospitals  Thousands of children die unnecessarily in hospitals because of medical errors stemming from patient-safety lapses, and the extra cost of care for pediatric patients exposed to 20 types of safety problems exceeds $1 billion annually, according to a study in the June Pediatrics. The study confirmed that medical errors are a significant problem for children as well as adults, and it identified the very young and the very poor as more vulnerable than children in general. Researchers from the department of pediatrics at Johns Hopkins University, Baltimore, said the figures on patient deaths were conservative. The methods used to identify 4,483 unnecessary deaths from an analysis of 5.7 million records in 2000 "can detect only a small portion of the types of patient safety events that actually happen in hospitals," according to the article. More than 51,000 cases of medical error were discovered, and four of the 20 types of treatment failure occurred at a rate exceeding 100 per 10,000 discharges. Those were failure to rescue a patient suffering from a threatening event, postoperative sepsis, and obstetric trauma with and without the use of instrumentation. The study also recorded the financial cost of each of the 20 types of treatment failure. For example, each case of sepsis resulted in an average of 26 extra hospital days and $118,000 in extra charges. 6/7/04
• Bill would tie Medicare payments to IT system use   Sen. Edward Kennedy (D-Mass.) introduced legislation that would reward hospitals using electronic medical records and automated bill payment systems with higher Medicare payments. Over a period of time, payments to large healthcare facilities that fail to use such systems would be reduced. Specifics of the bill were not available at deadline, and a Kennedy spokesman said he did not have details about how the incentives would work. The legislation would set the goal of broadly implementing electronic medical records by 2011, he said. Kennedy's bill follows several like it in both the House and Senate, but it is the first to specifically propose tying Medicare payments to the use of information technology, the spokesman said. 5/14/04
• Standard e-record proposed, HHS names IT czar  Electronic health records advanced as a high-profile issue on two fronts. A standards group called Health Level 7 unveiled a consensus document defining the essential functions of such systems. Also, HHS named David Brailer, a senior fellow at the Health Technology Center in San Francisco, to fill a newly created position to coordinate the nation's healthcare IT efforts. Health Level 7 said it had obtained overwhelming industry approval of a draft "functional model" for electronic health records that will be tested over a two-year period. The model, which now contains 130 identified functions, would then become an officially accredited standard. HHS has expressed keen interest in defining the functions of an electronic record as part of its effort to promote technology in healthcare. At a hastily organized IT summit of prominent healthcare representatives in Washington, HHS Secretary Tommy Thompson announced Brailer's appointment as national health information technology coordinator. President Bush created the position last week to help achieve his goal of ensuring every American has an electronic health record in 10 years. Brailer served 10 years as chairman and chief executive officer of Care Science, a company that developed software for detecting and resolving clinical problems in hospitals. He also was instrumental in developing and overseeing a regional health information coordination project in Santa Barbara County, Calif. 5/6/04