Before everyone checks their family tree to see if they are 15th removed on the male side of these old global merchant families for access to health care remember this------that connection simply gets you a one-way ticket to ex-pat status in Upper Mongolia to develop markets and there is no health care there either. So, let's simply
GET RID OF THE WALL STREET 1% AND PLAYERS AND REBUILD WHAT WAS THE BEST IN THE WORLD'S HISTORY PUBLIC HEALTH SYSTEM FOR ALL.
“There is a great story waiting to be written about” dismal maternal death rates in the United States, which lags behind other Western countries. The increasing rate, as well as four states' recent actions to understand the reasons behind it, provide important space for reporting on the social, economic, and racial issues that are at play. The latest from Joy Victory-Walsh, patient adviser to the Preeclampsia Foundation, in our Member blog.
The answer is---we no longer have Federal public health agencies that monitor actual health statistics---we only have NGOs that manufacture health stats to make US citizens think these global Wall Street policies are helping main street. The land of progressive posing does not create REAL data.
Below you see what will be happening across all health care sectors for men and women. Wall Street identified OB-GYN as an expensive proposition for maximizing profits so they are now selling the idea of having babies at home with mid-wives. I love that process -----it is indeed empowering ----the problem is with no oversight and accountability these health procedures being performed by anyone with a certificate will end as we have today with AUTO MECHANICS----only with health care having a person in the business only to fleece you does not end with simply a car broken down on the side of the road. They say SOCIAL DARWINISM HEALTH CARE value-added for market-based maximized profits.
Keep in mind Tennessee is home of Al Gore and as such it has the same hyper-US International Economic Zone policies being installed especially in health care.
Children's Health Matters
Why isn’t the nation’s maternal mortality problem generating more headlines?
By Joy Victory
June 08, 2016
If anyone should know about a new Tennessee law that will help reduce preventable pregnancy-related deaths in her state, it’s Beth Lee Frazer.
In 2008, after nearly dying from HELLP syndrome (a severe form of preeclampsia) and losing her 20-week twins, the Tennessee resident and three-time mom became an outspoken advocate and fundraiser for preeclampsia research and improved pregnancy care.
Yet even though she knew there was pending legislation, Frazer still had no idea that on May 2, Tennessee passed the Maternal Mortality Review and Prevention Act of 2016. This law allows for the creation of an expert panel that will investigate how and why women are dying from pregnancy-related causes and complications in the state, and compile related data.
She found out about the vote through me, after I contacted her to ask if she had read any news about it.
“It’s hard to explain to someone who hasn’t faced a life-threatening pregnancy complication why this is so, so important,” she told me. “This makes me hugely proud of my state. Tennessee is standing up for the health of our mothers.”
Almost no news coverage of four new state laws addressing problem
Tennessee was one of four states that passed maternal mortality review board laws in the most recent round of legislative sessions, along with Washington, North Carolina and South Carolina.
This is an important trend — both on the state level and nationally — as it’s aimed straight at a vexing problem: The United States now has the highest maternal death rate among developed nations.
State-level maternal mortality review boards have been repeatedly pinpointed by the CDC and the Association of Maternal & Child Health Programs as a crucial way to get that statistic down, as explained in this Pew Stateline look at the issue.
Yet, this would be hard to know about from just reading the news. Based on a news search I conducted in those states in early May, I found meager coverage of the issue — both while it was a pending bill and after it passed and became law. For example:
In 2010, the Joint Commission — the nation’s top health care accrediting organization — issued a “sentinel event alert” about the increasing rate of U.S. women dying from pregnancy-related causes. “For every woman who dies, there are 50 who are very ill, suffering significant complications of pregnancy, labor and delivery,” Dr. William Callaghan, a senior CDC scientist, said in the alert.
Many of the commission’s sentinel events are considered failures in patient safety: rape in a hospital setting, surgery on the wrong limb, an abduction of a newborn. By adding maternal mortality to that list, the commission signaled it was time for the U.S. health care system as a whole to get serious about this problem. As the National Partnership for Maternal Safety notes, "a significant proportion of morbidity and mortality in these conditions has been found to be due to missed opportunities to improve outcomes."
With such a stern warning, one would expect that by now curious reporters would have extensively dug into the problem — and explored possible solutions, too, like these laws.
However, several journalists and public health experts I spoke to said this just hasn’t happened to any notable degree — and this is exemplified by the recent gap in coverage on the new state laws.
The reasons I heard ranged from straightforward, such as fewer statehouse reporters and journalists in general, to hard-to-prove, like the persistent myth that U.S. women no longer die in childbirth. Political controversy in other areas of women's health was often cited, too.
“Because of the political battles around access to abortion and contraception, it seems like maternal health (which people can generally agree on) gets pushed to the backburner,” said Elizabeth Dawes Gay, a writer and reproductive health advocate based in Washington, D.C., via email. “There are 'newsier' things happening and media may feel like they have to prioritize other important reproductive health and gender topics.”
'I didn’t realize we were last — absolute last — among Western countries'
A number of causes have been identified by the National Partnership for Maternal Safety, including both healthcare quality and safety problems, and more complicated patient demographics, such as older, heavier women having babies. Graphic courtesy Pew Charitable Trust
It’s not just state news that gets overlooked. I found Dawes Gay because she appears to be the only journalist who wrote about an April congressional briefing about this problem.
Trudy Lieberman, a 40-year veteran health care journalist and contributing editor to this site, also pointed out the lack of interest hospitals and doctors have in promoting awareness about this problem — especially given that the headlines can be far from complimentary.
“They’re interested in pushing the stuff they want you to write about,” she said. “If hospitals aren’t pushing it, is the local press going to write about it? They’re telling writers about a new cancer wing or kidney machine.”
One example: Although an entire day was devoted to the topic of maternal mortality during the just-held 2016 meeting of the American College of Obstetrics and Gynecology, this wasn't touted in their press materials.
Lack of PR for the problem means that many journalists simply have no idea there’s even a problem to report on. Michael Ollove, a Pew Stateline writer who was one of the few journalists to write about the recent CDC push for state-level maternal mortality review boards, says he stumbled upon the story idea while watching a presentation at a health journalism conference. He was stunned by what he saw.
“I didn’t realize we were last — absolute last — among Western countries,” he said.
'There is a great story out there waiting to be written about'
At least some of the silence might also be because it’s an issue that disproportionately affects the most disenfranchised women, Dawes Gay said.
While state maternal mortality review boards are only one part of the solution — as Gay points out, they aren’t likely to solve the social, economics and racial issues at play — experts say they can play a vitally important role in swinging the grim numbers back to something the U.S. can once again be proud of.
“There is a great story out there waiting to be written about strategies to accomplish that goal,” says Sharon Dunwoody, a science communication expert and professor emeritus in the School of Journalism and Mass Communication at the University of Wisconsin-Madison. “A reporter could spend some time in the historical weeds, offer comparative statistics that puts the U.S. to shame, reflect on the politics of focusing on women’s health issues, and look for evidence that these maternal mortality review boards actually do reduce death of women for pregnancy-related causes," Dunwoody said.
HELLP survivor Beth Lee Frazer couldn’t agree more.
“Women die, every day, bringing life into this world," she said. "But it has never been given the attention it deserves."
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We know that is law is passed AFTER it is found that citizens are struggling under third world health outcomes for decades-----that is not socially progressive legislation---that is progressive posing to PRETEND they are addressing a social issue when all other health policy advances major lack of health access.
SOCIAL DEMOCRATS PREVENT THESE ISSUES FROM HAPPENING WITH OVERSIGHT AND ACCOUNTABILITY----FAR-RIGHT WALL STREET GLOBAL CORPORATE CLINTON/OBAMA NEO-LIBERALS SIMPLY THROW A PROGRESSIVE BONE WITH NO INTENTION OF DOING ANYTHING.
Below is a quote from global health corporation Burwell:
'Through Healthy People 2020 and other initiatives, we will also track outcome measures that reflect changes in Americans' health and health care. To drive progress, we are focusing on three strategies.
The first is incentives: a major thrust of our efforts is to create an environment in which hospitals, physicians, and other providers are rewarded for delivering high-quality health care and have the resources and flexibility they need to do so'.
What Affordable Care Act does is simply install into Federal law what has been the conditions through CLINTON/BUSH/OBAMA. These Wall Street health leaders have no intentions of reversing the last few decades---they are simply codifying what was already in place and maximizing global health profits more by eliminating any oversight and accountability.
HAVING THE RESOURCES AND FLEXIBILITY TO DO SO.
The leading reason given by doctors for leaving is the failure of access to resources and absolutely no flexibility---their power as physicians has been co-opted. Just as with our teaching profession this same language is used---MAKING SURE THEY HAVE THE RESOURCES THEY NEED AND THE FLEXIBILITY TO DO SO. This as they install global education corporation policies of Common Core, testing and evaluation, watching every move a teacher makes with declining student achievement.
These policies are working to remove the people most connected to that very goal----providing quality care---or providing quality education because the goal is NOT QUALITY IT IS MAXIMIZING PROFITS BY NOT ALLOWING MORALS, ETHICS, AND LEGALITY TO INHIBIT BAD BUSINESS PRACTICES.
Bad Medicine04.14.14 5:45 AM ET
How Being a Doctor Became the Most Miserable Profession
Nine of 10 doctors discourage others from joining the profession, and 300 physicians commit suicide every year.
When did it get this bad?By the end of this year, it’s estimated that 300 physicians will commit suicide. While depression amongst physicians is not new—a few years back, it was named the second-most suicidal occupation—the level of sheer unhappiness amongst physicians is on the rise.
Simply put, being a doctor has become a miserable and humiliating undertaking. Indeed, many doctors feel that America has declared war on physicians—and both physicians and patients are the losers.
Not surprisingly, many doctors want out. Medical students opt for high-paying specialties so they can retire as quickly as possible. Physician MBA programs—that promise doctors a way into management—are flourishing. The website known as the Drop-Out-Club—which hooks doctors up with jobs at hedge funds and venture capital firms—has a solid following. In fact, physicians are so bummed out that 9 out of 10 doctors would discourage anyone from entering the profession.
It’s hard for anyone outside the profession to understand just how rotten the job has become—and what bad news that is for America’s health care system. Perhaps that’s why author Malcolm Gladwell recently implied that to fix the healthcare crisis, the public needs to understand what it’s like to be a physician. Imagine, for things to get better for patients, they need to empathize with physicians—that’s a tall order in our noxious and decidedly un-empathetic times.
After all, the public sees ophthalmologists and radiologists making out like bandits and wonder why they should feel anything but scorn for such doctors—especially when Americans haven’t gotten a raise in decades. But being a primary care physician is not like being, say, a plastic surgeon—a profession that garners both respect and retirement savings. Given that primary care doctors do the work that no one else is willing to do, being a primary care physician is more like being a janitor—but without the social status or union protections.
Unfortunately, things are only getting worse for most doctors, especially those who still accept health insurance. Just processing the insurance forms costs $58 for every patient encounter, according to Dr. Stephen Schimpff, an internist and former CEO of University of Maryland Medical Center who is writing a book about the crisis in primary care. To make ends meet, physicians have had to increase the number of patients they see. The end result is that the average face-to-face clinic visit lasts about 12 minutes.
Neither patients nor doctors are happy about that. What worries many doctors, however, is that the Affordable Care Act has codified this broken system into law. While forcing everyone to buy health insurance, ACA might have mandated a uniform or streamlined claims procedure that would have gone a long way to improving access to care. As Malcolm Gladwell noted, “You don’t train someone for all of those years in [medicine]… and then have them run a claims processing operation for insurance companies.”
In fact, difficulty dealing with insurers has caused many physicians to close their practices and become employees. But for patients, seeing an employed doctor doesn’t give them more time with the doctor—since employed physicians also have high patient loads. “A panel size of 2,000 to 2,500 patients is too many,” says Dr. Schimpff. That’s the number of patients primary care doctors typically are forced to carry—and that means seeing 24 or more patients a day, and often these patients have 10 or more medical problems. As any seasoned physician knows, this is do-able, but it’s certainly not optimal.
Most patients have experienced the rushed clinic visit—and that’s where the breakdown in good medical care starts. “Doctors who are in a rush, don’t have the time to listen,” says Dr. Schimpff. “Often, patients get referred to specialists when the problem can be solved in the office visit.” It’s true that specialist referrals are on the rise, but the time crunch also causes doctors to rely on guidelines instead of personally tailoring medical care. Unfortunately, mindlessly following guidelines can result in bad outcomes.
Yet physicians have to go along, constantly trying to improve their “productivity” and patient satisfaction scores—or risk losing their jobs. Industry leaders are fixated on patient satisfaction, despite the fact that high scores are correlated with worse outcomes and higher costs. Indeed, trying to please whatever patient comes along destroys the integrity of our work. It’s a fact that doctors acquiesce to patient demands—for narcotics, X-rays, doctor’s notes—despite what survey advocates claim. And now that Medicare payments will be tied to patient satisfaction—this problem will get worse. Doctors need to have the ability to say no. If not, when patients go to see the doctor, they won’t actually have a physician—they’ll have a hostage.
But the primary care doctor doesn’t have the political power to say no to anything—so the “to-do” list continues to lengthen. A stunning and unmanageable number of forms—often illegible—show up daily on a physician’s desk needing to be signed. Reams of lab results, refill requests, emails, and callbacks pop up continually on the computer screen. Calls to plead with insurance companies are peppered throughout the day. Every decision carries with it an implied threat of malpractice litigation. Failing to attend to these things brings prompt disciplining or patient complaint. And mercilessly, all of these tasks have to be done on the exhausted doctor’s personal time.
Almost comically, the response of medical leadership—their solution— is to call for more physician testing. In fact, the American Board of Internal Medicine (ABIM)—in its own act of hostage-taking—has decided that in addition to being tested every ten years, doctors must comply with new, costly, "two year milestones." For many physicians, if they don't comply be the end of this month, the ABIM will advertise the doctor's "lack of compliance" on their website.
In an era when nurse practitioners and physician assistants have shown that they can provide excellent primary care, it’s nonsensical to raise the barriers for physicians to participate. In an era when you can call up guidelines on your smartphone, demanding more physician testing is a ludicrous and self-serving response.
It is tone deaf. It is punitive. It is wrong. And practicing doctors can’t do a damn thing about it. No wonder doctors are suicidal. No wonder young doctors want nothing to do with primary care.
But what is a bit of a wonder is how things got this bad.
Cheat Sheet
A speedy, smart summary of news and must-reads from The Daily Beast and across the Web
By clicking "Subscribe," you agree to have read the Terms of Use and Privacy PolicyCertainly, the relentlessly negative press coverage of physicians sets the tone. “There’s a media narrative that blames physicians for things the doctor has no control over,” says Kevin Pho, MD, an internist with a popular blog where physicians often vent their frustrations. Indeed, in the popular press recently doctors have been held responsible for everything from the wheelchair-unfriendly furniture to lab fees for pap smears.
The meme is that doctors are getting away with something and need constant training, watching and regulating. With this in mind, it’s almost a reflex for policy makers to pile on the regulations. Regulating the physician is an easy sell because it is a fantasy—a Freudian fever dream—the wish to diminish, punish and control a disappointing parent, give him a report card, and tell him to wash his hands.
To be sure many people with good intentions are working toward solving the healthcare crisis. But the answers they’ve come up with are driving up costs and driving out doctors. Maybe it’s too much to ask for empathy, and maybe physician lives don’t matter to most people.
But for America’s health to be safeguarded, the wellbeing of America’s caretakers is going to have to start mattering to someone.
_________________________________________________
'The first is incentives: a major thrust of our efforts is to create an environment in which hospitals, physicians, and other providers are rewarded for delivering high-quality health care and have the resources and flexibility they need to do so'.
As Burwell and Obama's Federal Health and Human Services pushes out data saying Affordable Care Act is really doing all it said it would when installed several years ago we see the same toll on medical workers down the hospital and health care line because VALUE-ADDED MARKET-BASED POLICY IS NOT ABOUT PATIENT QUALITY CARE---IT'S ABOUT DELIVERING CARE THE CHEAPEST WAY POSSIBLE.
Our US medical staff have these few decades been under attack and this transition from professional wages to bringing in immigrant labor for lower wages is well established. Obama and Clinton neo-liberals are simply using ACA to take these health systems and structures already in place globally and install them in the US.
YES, THESE HEALTH SYSTEMS CONGRESS IS PRETENDING TO CREATE THESE SEVERAL YEARS IN OUR STATE PRIVATE SYSTEMS ARE SIMPLY DEVELOPING NATION INTERNATIONAL ECONOMIC ZONE HEALTH STRUCTURES BEING BROUGHT TO THE US. NO NEW MARKETS BEING CREATED----SAME GLOBAL GROUPS OF CORPORATIONS.
We have already talked about how the ACA deregulated health care education such that our health care degree programs are no longer strong professional training---
Wall Street players will pretend to be addressing these issues when it has become far worse these few years.
Top 5 Reasons Why Good Nurses Leave the Profession
by Nachole Johnson | Nov 11, 2013 | Blog |
Some nurses are becoming frustrated with the profession and leaving altogether to pursue other careers. I’ve known a few well-seasoned nurses who have left after 10, 20, or 30 years in the profession. Some nurses leave after only a short time in the field. Why?
Here are the top 5 reasons why nurses leave the field:
1. Short staffing
Short staffing runs rampant in nursing. There never seems to be enough staff to care for patients on any given day. Staffing issues cause undue stress on the average nurse, especially when it’s an ongoing issue. The unit they work for will ask nurses to pick up an overtime shift or two and this then becomes the norm. The money for overtime shifts may be good, but nurses get tired of continually pulling more than their weight during any given shift. In addition, if your unit is fully staffed and other units in the hospital aren’t, you may be asked to float. Having to float to another unit is the bane of most nurses’ existence.
2. Too many tasks
It seems as if each time I report to work there’s a new piece of paper to fill out or a new task for nursing to do that another department used to handle. Sometimes it seems as if every other department in the hospital dumps on nursing. As a result, nurses end up doing someone else’s job (and well at that matter!) and soon the hospital is finding other ways to further cut costs and push even more on the nursing staff.
A prime example of this is Vanderbilt Medical Center. Nurses there are now taking over housekeeping duties! Can someone please tell me why management thought this was a good idea? This is wrong on so many levels; infection control, overworking nursing staff, disrespect for the nursing profession- I could go on and on. Most nurses barely have time to eat, let alone pee, so how can Vanderbilt feasibly add housekeeping to the list of things nurses have to do each day?
3. Lack of upward mobility
Let’s face it…it’s hard to move beyond the bedside without having an advanced degree. Many older nurses received either a diploma or associates degree to enter the field. When I received my associate’s in nursing 8 years ago, all it took to move beyond the bedside was a BSN. It’s getting more and more difficult to find a non-clinical nursing job without a master’s degree or higher. Because of this, many experienced nurses who want to try something non-clinical either have to go back to school for many more years of schooling or decide to leave the profession for non-nursing jobs when they get tired.
4. Poor management
I once read that nurses don’t leave specific floors, they leave poor management. This sentiment rang true for me as I reflected on previous jobs and the main reasons I left. I can honestly say my two worst jobs weren’t because of coworkers or the workload- it was because of poor management. Poor management can cause toxicity among coworkers and increased workload. There is a correlation! If management truly cared about the backbone of the hospital (nurses!) then maybe they wouldn’t lose so many.
5. Underpayment
A common misconception among the general public is that nurses are paid very well for the work we do. Although we hold a tremendous amount of responsibility, this couldn’t be further from the truth for many of us. Nursing salaries vary widely based on geographic location, but most nurses feel underpaid for the amount of responsibility we have on a daily basis. Another issue concerning underpayment is that nursing salaries are capped after so many years of experience. Even worse, some newer nurses make almost as much as experienced nurses because their starting salaries begin higher than the experienced nurses did oh-so many years ago.
There are many more reasons nurses end up leaving the profession, but these are the top 5 as I see them. What are the other reasons why nurses leave and what can be done to keep more nurses in the profession?
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Looking at the stats above----we do not believe the comment below in a USA Today article. Is this in-patient room technology REALLY creating more effectiveness?
'Doctors, too, are reacting well to changes, Ornish says: "It's a chance for doctors and other professionals to reclaim why we went into medicine — to be healers."'
Indeed, hospitals are claiming more and more funding by telling Health and Human Services they are meeting goals listed below when they are not. Raise your hand if you understand that hyper-global profit-driven health systems are not going to tell the truth? Raise your hand if you know these are the same health industries that committed $400 billion and higher of health fraud and profiteering these few decades so we only expect the fraud to get worse with less patient voice or access to justice as it does. THAT IS WHAT DEREGULATING PUBLIC HEALTH DOES----TAKES AWAY ALL AVENUES OF HEALTH JUSTICE. So, does a patient fight against bad hospital service when a health insurance policy identifies only one place for a particular disease vector to be treated? It's like having a slum landlord with no other options for housing. It will become SLUMDOG MILLIONAIRE in health care soon enough.
Baltimore has been tied to the ACA for three decades as it was exempted from Medicare illegally to create these pools of funding that should go to health care but are sent to expand global health systems instead. I literally refused to complete this patient checklist for my last hospital stay in Baltimore because the patient treatment was so bad. They can simply fill it out themselves for goodness sake. If you have medical staff who for decades committed medical coding fraud to have a job---they will be filling in these patient surveys as well.
As it says below----the use of telemedicine---tracking the patient after they leave is the way they stop readmittance. If you have a problem that requires re-admittance then you end losing your doctor and are pushed to another hospital and health plan most likely more and more expensive.
Hospitals chart ways to boost care, funding under ACA
Alicia McElhaney, USATODAY 11:49 a.m. EDT March 28, 2014
Patient satisfaction is high on the checklist.
(Photo: Erik Butler)
Hospitals are getting creative when it comes to meeting tough new mandates in the Affordable Care Act to improve care and increase patient satisfaction — and they're getting paid more as a result.
Getwellnetwork's technology allows patients -- or their parents -- to access records and instant-message staff through hospital room TVs. (Photo: Getwellnetwork)
Under an ACA program, the federal government gives money to hospitals that deliver better care, rather than just paying them for procedures covered by Medicare and Medicaid. Called the Hospital Value-Based Purchasing program, it aims to increase quality care and shrink the number of patients who die from mistakes.
As part of the program, the Center for Medicare and Medicaid Services (CMS) pays hospitals for infection prevention, successful surgeries, low readmission rates and patient satisfaction scores. The CMS bases funding on both achievement and yearly improvement.
Hospitals across the country are taking steps to improve and claim the extra funds.
•Mayo Clinic branches in Rochester, Minn., Jacksonville and at the Scottsdale/Phoenix campus use iPads for cardiac surgery patients to help them track progress and to give them to-do lists for the day, says Douglas Wood, a cardiologist and director of Mayo's Center for Innovation.
•New York City's Beth Israel Medical Center and the Charleston Area Medical Center in West Virginia are among the hospitals that use the Ornish Spectrum, a 72-hour program for heart disease patients that helps them make lifestyle changes in nutrition, fitness and stress management. It was founded by physician and author Dean Ornish.
•Virginia hospitals in the Sentara Healthcare network allow patients to see their medical records on an app called MyChart. The app lets patients e-mail their doctors with questions, says Tim Jennings, Sentara's vice president of pharmacy services.
Medical technology companies are coming up with innovations that can help hospitals improve care. For instance, GetWellNetwork in Bethesda, Md., has developed a program that uses in-room televisions to instant-message patients between shows. The messages educate patients about care and help track recovery progress, says CEO and founder Michael O'Neil. Patients can instant-message doctors and nurses and give feedback during their hospitalization. The information is also available through smart phones and tablets after patients return home.
Quality care doesn't have to be high-tech. Staffers at Saint Elizabeth Hospital in Lincoln, Neb., removed regular soda from vending machines and moved diet soda and sugary drinks to the bottom rows to promote healthier choices, which can lower readmission, says Libby Raetz, vice president of nursing,
Hospitals aren't changing only because there's a financial reward but because the government tells them how to make improvements, says Nancy Foster, vice president of quality and patient safety at the American Hospital Association.
"They are responding to that signal that says, 'Here is an important opportunity to do something that will make a difference,' " Foster says.
Every year, 210,000 to 440,000 people die from avoidable hospital mistakes, according to a 2013 study published in the Journal of Patient Safety.
Such mistakes cost the health care system nearly $7.3 billion in two years, according to a 2013 study by quality awareness company HealthGrades.
"We may not be able to eliminate all of the errors, but we may be able to prevent the error from reaching the patient and causing harm," Foster says.
Doctors, too, are reacting well to changes, Ornish says: "It's a chance for doctors and other professionals to reclaim why we went into medicine — to be healers."
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As someone with hospital administration and medical management background for decades I know the conditions and attitudes over time. Doctors have always been a pain in the neck with their superiority complex of thinking they know all and not wanting to hear other opinions, especially from a patient. I think all Americans would want to change that dynamic. What this article below states is true though. This PROGRESSIVE POSING POLICY OF PATIENT SATISFACTION is almost worthless in the field of health care.
We have just finished a few decades of being fleeced by the health industry for providing TOO MUCH HEALTH CARE for profiteering and here we see an article in 2014----AFTER AFFORDABLE CARE ACT----with doctors shouting all of this is getting worse.
I'M SORRY PATIENTS---WE DON'T KNOW WHAT IS BETTER. THE PROBLEM NOW BECOMES WITH FOR-PROFIT MAXIMIZATION HEALTH CARE CAN WE TRUST THAT THESE DOCTORS DO WHAT IS BEST?
'The first is incentives: a major thrust of our efforts is to create an environment in which hospitals, physicians, and other providers are rewarded for delivering high-quality health care and have the resources and flexibility they need to do so'.
'A physician came up to me afterwards and agreed with me but said that he had no choice. He works in one of those venues and is subject to surveys to measure "quality." For him, quality is measured in 2 ways: The first is by getting the patient door-to-door in 45 minutes, and the second is by a Press Ganey survey to see if the patient was happy. Because of these measures, he is forced to abandon his role as a responsible steward of antibiotic use to keep his job and get a bonus'.
From Keystone Physician
Patient Satisfaction Is Overrated
William Sonnenberg, MD
Disclosures | March 06, 2014
Editors' Recommendations
Related Drugs & DiseasesEditor's Note:
This article first appeared in the Fall 2013 issue of Keystone Physician, a publication of the Pennsylvania Academy of Family Physicians.
I recently was at the Scientific Assembly of the American Academy of Family Physicians (AAFP) in San Diego, giving a lecture to a large audience of Academy members on respiratory syncytial virus (RSV) bronchiolitis. I mentioned why I thought identifying the RSV virus was important. I stated that if you tell the family the infant has RSV and that there is the expectation that cough will last 1-2 months, this may forestall them going to the ER or urgent care center. In those assembly lines of healthcare, they will be told that their child has "bronchitis" and will receive the inevitable azithromycin script. This will make the parents happy, free the healthcare provider of the need for further explanations, and result in a satisfying visit for the administrators of that facility. The trouble, of course, is that an antibiotic has again been used to treat a self-limited viral infection.
A physician came up to me afterwards and agreed with me but said that he had no choice. He works in one of those venues and is subject to surveys to measure "quality." For him, quality is measured in 2 ways: The first is by getting the patient door-to-door in 45 minutes, and the second is by a Press Ganey survey to see if the patient was happy. Because of these measures, he is forced to abandon his role as a responsible steward of antibiotic use to keep his job and get a bonus.
Another physician in the audience told the crowd that he was able to increase his satisfaction score by 7% simply by prescribing an antibiotic to all patients who call with a complaint of cough, sore throat, or sinus headache. One doctor reported to the media that he had to give Dilaudid® for minor pain because his Press Ganey score was low the previous month.
I believe that this little-known company, Press Ganey, from South Bend, Indiana, has become a bigger threat to the practice of good medicine than trial lawyers. They are the leading provider of patient satisfaction surveys for hospitals and physicians. For the past decade, the government and healthcare administrators have embraced the "patient is always right" model and will punish providers that fail to rate well in these surveys. Press Ganey's CEO, Patrick Ryan, said, "Nobody wants to be evaluated; it's a tough thing to see a bad score, but when I meet with physician groups I tell them the train has left the station. Measurement is going to occur."[1] Obamacare has budgeted $850 million in reduced Medicare reimbursement for hospitals with lower scores.
The mandate is simple: Never deny a request for an antibiotic, an opioid pain medication, a scan, or an admission. One emergency room with poor survey scores started offering hydrocodone "goody bags" to discharged patients in order to improve their ratings. And doctors face the reality that uncomfortable discussions on behavioral topics -- say, smoking or obesity -- come with the risk of a pay cut. If you tell a patient that their knee pain is related to weight, that their smoking is worsening their child's asthma, or that they can't lose weight because of French fries and not a glandular problem, your ratings and pay will take a hit.
Satisfied patients are not healthy patients. In a paper published in 2012, researchers at the University of California, Davis, using data from nearly 52,000 adults, found that the most satisfied patients spent the most on healthcare and prescription drugs.[2] They were 12% more likely to be admitted to the hospital and accounted for 9% more in total healthcare costs. Strikingly, they were also the ones more likely to die.
Overtreatment is a silent killer. We can overtreat and overprescribe. The patients will be happy, give us good ratings, yet be worse off. We must have the ability to deny treatment for a patient's own good. Patients aren't the best judge of what is best for them. Several years ago, an elderly female patient wanted me to write a prescription for tamsulosin because she got a coupon in the mail. It did not matter that she lacked a prostate.
We should try to be kind to our patients and take time to understand them, but we must resist these misguided pressures and do the right thing. Sometimes patients have to be told "no," and the leadership in healthcare must understand this.
Take heart in the words of Mark Twain: "Always do what is right. It will gratify half of mankind and astound the other."
______________________________________________
So, Burwell's first objective with ACA:
'The first is incentives: a major thrust of our efforts is to create an environment in which hospitals, physicians, and other providers are rewarded for delivering high-quality health care and have the resources and flexibility they need to do so'.
We want to look at what will be the goal----this article shows preventing death which if you are an older adult with chronic illness or an end-of-life senior re-admittance, bad outcomes, cost of patient care all rub against these goals. We are watching as a tiered system of global predatory health care builds health systems designed SPECIFICALLY TO REMOVE THESE MORE COSTLY PEOPLE WHILE LOOKING AS THEY ARE BEING INCLUSIVE. Whether it is done through selective locations for specialized treatment taking patients across the state or out of state to get that treatment or whether as in Baltimore where they PRETEND there are sources of care for seniors and low-income but there are not. Population redistribution to US International Economic Zones are no place for the chronically ill, seniors, or disabled so they WILL BE PUSHED OUT OF WHAT USED TO BE THE BEST OPPORTUNITIES FOR QUALITY CARE.
It looks like OPERANT CONDITIONING ----make that patient feel satisfied as cheaply as you can and you will get more money.
Remember, the term 'worst performing' under market-based value means PROFIT and not quality and satisfaction no matter how Wall Street 1% global corporate neo-liberals want to package it
'Combined, these three quality programs have the potential to strip away as much as 5.5 percent of Medicare payments from the worst performing hospitals starting next October'.
Nearly 1,500 Hospitals Penalized Under Medicare Program Rating Quality
By Jordan Rau November 14, 2013
This KHN story was produced in collaboration with
More hospitals are receiving penalties than bonuses in the second year of Medicare’s quality incentive program, and the average penalty is steeper than it was last year, government records show.
Medicare has raised payment rates to 1,231 hospitals based on two-dozen quality measurements, including surveys of patient satisfaction and—for the first time—death rates. Another 1,451 hospitals are being paid less for each Medicare patient they treat.
For half the hospitals, the financial changes that started last month are negligible: they are gaining or losing less than a fifth of one percent what Medicare otherwise would have paid. Others are experiencing greater swings. Gallup Indian Medical Center in New Mexico, a federal government hospital on the border of the Navajo Reservation, will be paid 1.14 percent less for each patient. Arkansas Heart Hospital in Little Rock, a physician-owned hospital that only handles cardiovascular cases, will get the largest bonus, 0.88 percent.
The bonuses and penalties are one piece of the health care law’s efforts to create financial incentives for doctors and hospitals to provide better care. They come at a tumultuous time as the technical problems of the healthcare.gov insurance portal and premium prices are stoking questions about the law’s viability. The incentives are among the law’s few cost-control provisions that have kicked in, but it is too early to tell how effective they will be in making hospitals operate more efficiently.
“This program is driving what we want in health care,” said Dr. Patrick Conway, Medicare’s chief medical officer. He said most hospitals have improved since the program began a year ago. However, even some hospitals that have gotten better are still losing money because they are not scoring as well as others or have not improved as much.
Across the country, hospital executives say they have put renewed focus on excellence in the areas that are judged. Some have clamped down on nighttime noise, one of the questions patients are asked about, by replacing squeaky wheels on food carts and discouraging nurses and workers from chatting on cell phones outside of rooms. Others have scrambled to ensure heart attack patients always get an angioplasty within 90 minutes of arrival because that is part of the scoring. Some private insurers have adopted similar incentives.
“The thing about the government, if they start paying attention to it, we have to scramble around to pay attention to it,” said Dr. Leigh Hamby, chief medical officer at Piedmont Healthcare, a hospital system in Georgia. “It gets us moving.”
Hospitals in Maine, Massachusetts, Nebraska, New Hampshire, North Carolina, Utah and Wisconsin are faring the best, with 60 percent or more of hospitals getting higher payments, according to a Kaiser Health News analysis. Medicare is reducing reimbursement rates for at least two-thirds of hospitals in 17 states, including California, Connecticut, Nevada, New Mexico, New York, North Dakota, Washington and Wyoming, as well as the District of Columbia.
How A Hospital Is Rated
Under the program, known as Hospital Value-Based Purchasing, Medicare reduced payment rates to all hospitals by 1.25 percent. It set the money aside in a $1.1 billion pot for incentives. While every hospital is getting something back, more than half are not recouping the 1.25 payment they initially forfeited, making them net losers. The payment adjustments are applied to each Medicare patient stay over the federal fiscal year that started Oct. 1 and runs through September 2014. The potential bonuses and penalties were higher than they were last year, when the maximum at stake was 1 percent.
To assess quality, Medicare looked not only at how hospitals scored in comparison with each other, but also how much each improved from two years ago compared to other hospitals. A hospital is judged on whichever score is higher, so some hospitals with subpar quality rankings are still getting more money because they showed vast improvement. It won’t be clear how much any hospital’s bonuses and penalties amount to in dollar figures until next October because it depends on how much a hospital ultimately bills Medicare.
This year, 45 percent of a hospital’s score is based on how frequently it followed basic clinical standards of care, such as removing urinary catheters from surgery patients within two days to decrease the chance of infections. Thirty percent of the score is based on how patients rate the way they felt they were treated in the hospital, such as whether the doctors and nurses communicated well.
Medicare added its first measure of a medical outcome, looking at death rates of patients admitted for heart attacks, heart failure or pneumonia.Those mortality rates, calculated from the number of Medicare patients who died in the hospital or within a month of discharge, count for 25 percent of a hospital’s score.
The incentive program has received a mixed reception among hospital executives. Some complain that patients’ views sometimes are swayed by the swankiness of the hospital, and that hospitals that treat the very sickest patients often get the worst evaluations. Physician-owned hospitals that focus on just a few specialties have tended to do particularly well in the program, as evidenced by the Arkansas Heart Hospital’s record bonus this year. Some leaders also object that even if they show improvements, their hospital can lose money if the improvements are not as great as others.
Will Penalties Bring Change?
Researchers are unsure whether the penalties are significant enough to trigger major improvements, especially in areas such as mortality, where there’s no definitive explanation for why some hospitals do such a better job than others in keeping patients alive.
“Shame and penalties, I don’t know if that’s the best way to get organizations to change,” said Leslie Curry, a researcher at the Yale School of Public Health. Her work has found that hospitals with low mortality rates are the ones where it is a priority of executives and where there is a culture where front-line workers such as nurses and lab technicians feel comfortable raising concerns to doctors and devising better methods. “The fiscal penalties are nominal, frankly, in the scheme of things,” she said.
Others say even small differences in payments provide strong encouragement for hospitals to improve. “Sometimes institutions may think they’re performing excellently until they see outside data that compares to your peers,” said Dr. Richard Bankowitz, the chief medical officer of Premier, a group that works with hospitals to improve quality. “People are motivated to excel. Nobody wants to be in the bottom quartile anymore.”
The addition of mortality rates into the scores provides hospitals with their biggest challenge yet. Amanda Berra, a consultant at The Advisory Board, a Washington health care consulting firm, interviewed 40 chief medical officers at hospitals about mortality rates. “They were very split. About half of them said you could not have a more powerful measure. On the other side we heard people who were really unenthusiastic,” she said. “We heard that the data is not super meaningful. They felt they had drastically improved in recent years and have kind of gotten where they could go.”
The average penalty grew to 0.26 percent, up from 0.21 percent in the first year of the program. North Georgia Medical Center in Ellijay is the only hospital besides Gallup to lose more than 1 percent of its reimbursements: it will lose 1.04 percent. Denver Health Medical Center, a highly respected safety-net hospital, is losing 0.71 percent of its reimbursements. The hospital that was penalized the most last year, Auburn Community Hospital in upstate New York, reduced its 0.90 penalty, but will still lose 0.55 percent.
The average bonus was 0.24 percent, almost the same as last year’s 0.23 percent. Large bonuses are going to some major teaching hospitals, such as Thomas Jefferson University Hospital in Philadelphia and Duke University Hospital in Durham, N.C. Most are being distributed among smaller institutions, such as Pikeville Medical Center in Kentucky.
“The dollars are less important in terms of impact than the fact that the nation is sending a signal through the payment mechanism that there’s something to be worked on in the care we deliver,” said Nancy Foster, an executive at the American Hospital Association. “It’s a national symbol to health care providers that here is an area where you can do better.”
Many Past Winners Continue To Get Bonuses
Most winners from last year stayed winners and losers stayed losers. But there were some switches. Oaklawn Hospital in Marshall, Mich., improved its score the most from last year. In place of a 0.26 penalty, Oaklawn will receive a 0.65 percent bonus. A number of prominent academic medical centers also turned around their scores. Vanderbilt University Medical Center in Nashville, Massachusetts General Hospital in Boston, New York-Presbyterian Hospital in Manhattan, Cedars-Sinai Medical Center and Ronald Reagan UCLA Medical Center, both in Los Angeles, and Yale-New Haven Hospital were among the 300 places that went from a penalty to a bonus.
A total of 416 hospitals that won bonuses last year will be penalized this year. Centura Health-St. Thomas More Hospital in Canon City, Colo., dropped from a 0.08 percent bonus to a 0.72 percent penalty, the largest decrease.
This program is one of several Medicare has launched to make hospitals and doctors pay more attention to how their treatments compare with other hospitals, and to be more careful with public money. Medicare gives bonuses to the private Medicare Advantage insurance plans that score well on quality metrics. In 2015, the health law calls for the government to begin a quality payment program for physician groups of 100 professionals or more, and that is to be expanded to all doctors by 2017. The goal of all these programs is to replace the current financial incentive in Medicare, in which the only way for a hospital to get paid more is to perform more procedures and take on more patients.
For hospitals, the quality payments come on top of Medicare’s penalties on 2,205 hospitals with higher than expected readmission rates. The agency is doling out a maximum punishment this year of 2 percent. As a result two out of three hospitals are losing money starting last month from the combined effects of the quality and readmissions programs. Pineville Community Hospital in Kentucky is losing 2.57 percent of its reimbursements, the largest penalty in the country. Twenty-one other hospitals are losing 2 percent or more. These cuts come on top of reductions in special payments that go to hospitals that treat large numbers of low-income people.
Only 729 hospitals will end up with an increase in payments from the combined readmissions and value-based programs. Maine Coast Memorial Hospital in Ellsworth fared the best, gaining 0.80 percent.
Hospitals that are designated as critical access facilities, certain cancer hospitals and places with too few cases to be accurately measured were excluded from both programs.
Maryland hospitals are exempt because that state has a unique payment arrangement with Medicare.
Medicare relies on information found on hospital bills to determine the quality of care. In judging death rates, Medicare looked at patients admitted from July 2011 through June 2012, and compared those rates with how the hospitals performed between July 2009 and June 2010. For the clinical and patient satisfaction measures, Medicare assessed hospital performances from April 2012 through December 2012, and compared them with scores during the same months in 2010.
The amount of money at stake increases to 1.5 percent of payments in October 2014, and continues to grow by a quarter percent until it reaches 2 percent.
Medicare is planning to add new measures next year, including comparisons of how much patients cost Medicare at different hospitals and rates of medical mishaps and infections from catheters.
In addition, the maximum readmission penalties grow to 3 percent next year, and Medicare is launching a third incentive program that takes an additional 1 percent of payments away from hospitals with the most patients who suffered injury or infection during their stay.
Combined, these three quality programs have the potential to strip away as much as 5.5 percent of Medicare payments from the worst performing hospitals starting next October.
“We’re moving more toward outcomes measures,” Conway said. “We’re moving away from volume and toward quality.”
GET RID OF THE WALL STREET 1% AND PLAYERS AND REBUILD WHAT WAS THE BEST IN THE WORLD'S HISTORY PUBLIC HEALTH SYSTEM FOR ALL.
“There is a great story waiting to be written about” dismal maternal death rates in the United States, which lags behind other Western countries. The increasing rate, as well as four states' recent actions to understand the reasons behind it, provide important space for reporting on the social, economic, and racial issues that are at play. The latest from Joy Victory-Walsh, patient adviser to the Preeclampsia Foundation, in our Member blog.
The answer is---we no longer have Federal public health agencies that monitor actual health statistics---we only have NGOs that manufacture health stats to make US citizens think these global Wall Street policies are helping main street. The land of progressive posing does not create REAL data.
Below you see what will be happening across all health care sectors for men and women. Wall Street identified OB-GYN as an expensive proposition for maximizing profits so they are now selling the idea of having babies at home with mid-wives. I love that process -----it is indeed empowering ----the problem is with no oversight and accountability these health procedures being performed by anyone with a certificate will end as we have today with AUTO MECHANICS----only with health care having a person in the business only to fleece you does not end with simply a car broken down on the side of the road. They say SOCIAL DARWINISM HEALTH CARE value-added for market-based maximized profits.
Keep in mind Tennessee is home of Al Gore and as such it has the same hyper-US International Economic Zone policies being installed especially in health care.
Children's Health Matters
Why isn’t the nation’s maternal mortality problem generating more headlines?
By Joy Victory
June 08, 2016
If anyone should know about a new Tennessee law that will help reduce preventable pregnancy-related deaths in her state, it’s Beth Lee Frazer.
In 2008, after nearly dying from HELLP syndrome (a severe form of preeclampsia) and losing her 20-week twins, the Tennessee resident and three-time mom became an outspoken advocate and fundraiser for preeclampsia research and improved pregnancy care.
Yet even though she knew there was pending legislation, Frazer still had no idea that on May 2, Tennessee passed the Maternal Mortality Review and Prevention Act of 2016. This law allows for the creation of an expert panel that will investigate how and why women are dying from pregnancy-related causes and complications in the state, and compile related data.
She found out about the vote through me, after I contacted her to ask if she had read any news about it.
“It’s hard to explain to someone who hasn’t faced a life-threatening pregnancy complication why this is so, so important,” she told me. “This makes me hugely proud of my state. Tennessee is standing up for the health of our mothers.”
Almost no news coverage of four new state laws addressing problem
Tennessee was one of four states that passed maternal mortality review board laws in the most recent round of legislative sessions, along with Washington, North Carolina and South Carolina.
This is an important trend — both on the state level and nationally — as it’s aimed straight at a vexing problem: The United States now has the highest maternal death rate among developed nations.
State-level maternal mortality review boards have been repeatedly pinpointed by the CDC and the Association of Maternal & Child Health Programs as a crucial way to get that statistic down, as explained in this Pew Stateline look at the issue.
Yet, this would be hard to know about from just reading the news. Based on a news search I conducted in those states in early May, I found meager coverage of the issue — both while it was a pending bill and after it passed and became law. For example:
- In February, The Tennessean wrote a five-paragraph story about the pending bill. I could find no other examples of coverage from any Tennessee news outlet.
- Last year, South Carolina’s The Post and Courier wrote a well-reported, thorough piece about the alarming maternal death rates in the state, but hasn’t appeared to follow up on the news of the state law. No other outlets in South Carolina appear to have written about the bill or law either.
- I could find no news about the bill or the law in North Carolina, except for a tiny mention in a state health care policy news site. (The majority of the article was devoted to the portion of the bill establishing a 72-hour waiting period for abortions, a policy topic that did make state and national news.)
- In Washington, the new law got one brief mention in a larger statehouse round up of women’s health issues by a nonprofit news service, and the bill did garner a small segment on local public radio.
In 2010, the Joint Commission — the nation’s top health care accrediting organization — issued a “sentinel event alert” about the increasing rate of U.S. women dying from pregnancy-related causes. “For every woman who dies, there are 50 who are very ill, suffering significant complications of pregnancy, labor and delivery,” Dr. William Callaghan, a senior CDC scientist, said in the alert.
Many of the commission’s sentinel events are considered failures in patient safety: rape in a hospital setting, surgery on the wrong limb, an abduction of a newborn. By adding maternal mortality to that list, the commission signaled it was time for the U.S. health care system as a whole to get serious about this problem. As the National Partnership for Maternal Safety notes, "a significant proportion of morbidity and mortality in these conditions has been found to be due to missed opportunities to improve outcomes."
With such a stern warning, one would expect that by now curious reporters would have extensively dug into the problem — and explored possible solutions, too, like these laws.
However, several journalists and public health experts I spoke to said this just hasn’t happened to any notable degree — and this is exemplified by the recent gap in coverage on the new state laws.
The reasons I heard ranged from straightforward, such as fewer statehouse reporters and journalists in general, to hard-to-prove, like the persistent myth that U.S. women no longer die in childbirth. Political controversy in other areas of women's health was often cited, too.
“Because of the political battles around access to abortion and contraception, it seems like maternal health (which people can generally agree on) gets pushed to the backburner,” said Elizabeth Dawes Gay, a writer and reproductive health advocate based in Washington, D.C., via email. “There are 'newsier' things happening and media may feel like they have to prioritize other important reproductive health and gender topics.”
'I didn’t realize we were last — absolute last — among Western countries'
A number of causes have been identified by the National Partnership for Maternal Safety, including both healthcare quality and safety problems, and more complicated patient demographics, such as older, heavier women having babies. Graphic courtesy Pew Charitable Trust
It’s not just state news that gets overlooked. I found Dawes Gay because she appears to be the only journalist who wrote about an April congressional briefing about this problem.
Trudy Lieberman, a 40-year veteran health care journalist and contributing editor to this site, also pointed out the lack of interest hospitals and doctors have in promoting awareness about this problem — especially given that the headlines can be far from complimentary.
“They’re interested in pushing the stuff they want you to write about,” she said. “If hospitals aren’t pushing it, is the local press going to write about it? They’re telling writers about a new cancer wing or kidney machine.”
One example: Although an entire day was devoted to the topic of maternal mortality during the just-held 2016 meeting of the American College of Obstetrics and Gynecology, this wasn't touted in their press materials.
Lack of PR for the problem means that many journalists simply have no idea there’s even a problem to report on. Michael Ollove, a Pew Stateline writer who was one of the few journalists to write about the recent CDC push for state-level maternal mortality review boards, says he stumbled upon the story idea while watching a presentation at a health journalism conference. He was stunned by what he saw.
“I didn’t realize we were last — absolute last — among Western countries,” he said.
'There is a great story out there waiting to be written about'
At least some of the silence might also be because it’s an issue that disproportionately affects the most disenfranchised women, Dawes Gay said.
While state maternal mortality review boards are only one part of the solution — as Gay points out, they aren’t likely to solve the social, economics and racial issues at play — experts say they can play a vitally important role in swinging the grim numbers back to something the U.S. can once again be proud of.
“There is a great story out there waiting to be written about strategies to accomplish that goal,” says Sharon Dunwoody, a science communication expert and professor emeritus in the School of Journalism and Mass Communication at the University of Wisconsin-Madison. “A reporter could spend some time in the historical weeds, offer comparative statistics that puts the U.S. to shame, reflect on the politics of focusing on women’s health issues, and look for evidence that these maternal mortality review boards actually do reduce death of women for pregnancy-related causes," Dunwoody said.
HELLP survivor Beth Lee Frazer couldn’t agree more.
“Women die, every day, bringing life into this world," she said. "But it has never been given the attention it deserves."
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We know that is law is passed AFTER it is found that citizens are struggling under third world health outcomes for decades-----that is not socially progressive legislation---that is progressive posing to PRETEND they are addressing a social issue when all other health policy advances major lack of health access.
SOCIAL DEMOCRATS PREVENT THESE ISSUES FROM HAPPENING WITH OVERSIGHT AND ACCOUNTABILITY----FAR-RIGHT WALL STREET GLOBAL CORPORATE CLINTON/OBAMA NEO-LIBERALS SIMPLY THROW A PROGRESSIVE BONE WITH NO INTENTION OF DOING ANYTHING.
Below is a quote from global health corporation Burwell:
'Through Healthy People 2020 and other initiatives, we will also track outcome measures that reflect changes in Americans' health and health care. To drive progress, we are focusing on three strategies.
The first is incentives: a major thrust of our efforts is to create an environment in which hospitals, physicians, and other providers are rewarded for delivering high-quality health care and have the resources and flexibility they need to do so'.
What Affordable Care Act does is simply install into Federal law what has been the conditions through CLINTON/BUSH/OBAMA. These Wall Street health leaders have no intentions of reversing the last few decades---they are simply codifying what was already in place and maximizing global health profits more by eliminating any oversight and accountability.
HAVING THE RESOURCES AND FLEXIBILITY TO DO SO.
The leading reason given by doctors for leaving is the failure of access to resources and absolutely no flexibility---their power as physicians has been co-opted. Just as with our teaching profession this same language is used---MAKING SURE THEY HAVE THE RESOURCES THEY NEED AND THE FLEXIBILITY TO DO SO. This as they install global education corporation policies of Common Core, testing and evaluation, watching every move a teacher makes with declining student achievement.
These policies are working to remove the people most connected to that very goal----providing quality care---or providing quality education because the goal is NOT QUALITY IT IS MAXIMIZING PROFITS BY NOT ALLOWING MORALS, ETHICS, AND LEGALITY TO INHIBIT BAD BUSINESS PRACTICES.
Bad Medicine04.14.14 5:45 AM ET
How Being a Doctor Became the Most Miserable Profession
Nine of 10 doctors discourage others from joining the profession, and 300 physicians commit suicide every year.
When did it get this bad?By the end of this year, it’s estimated that 300 physicians will commit suicide. While depression amongst physicians is not new—a few years back, it was named the second-most suicidal occupation—the level of sheer unhappiness amongst physicians is on the rise.
Simply put, being a doctor has become a miserable and humiliating undertaking. Indeed, many doctors feel that America has declared war on physicians—and both physicians and patients are the losers.
Not surprisingly, many doctors want out. Medical students opt for high-paying specialties so they can retire as quickly as possible. Physician MBA programs—that promise doctors a way into management—are flourishing. The website known as the Drop-Out-Club—which hooks doctors up with jobs at hedge funds and venture capital firms—has a solid following. In fact, physicians are so bummed out that 9 out of 10 doctors would discourage anyone from entering the profession.
It’s hard for anyone outside the profession to understand just how rotten the job has become—and what bad news that is for America’s health care system. Perhaps that’s why author Malcolm Gladwell recently implied that to fix the healthcare crisis, the public needs to understand what it’s like to be a physician. Imagine, for things to get better for patients, they need to empathize with physicians—that’s a tall order in our noxious and decidedly un-empathetic times.
After all, the public sees ophthalmologists and radiologists making out like bandits and wonder why they should feel anything but scorn for such doctors—especially when Americans haven’t gotten a raise in decades. But being a primary care physician is not like being, say, a plastic surgeon—a profession that garners both respect and retirement savings. Given that primary care doctors do the work that no one else is willing to do, being a primary care physician is more like being a janitor—but without the social status or union protections.
Unfortunately, things are only getting worse for most doctors, especially those who still accept health insurance. Just processing the insurance forms costs $58 for every patient encounter, according to Dr. Stephen Schimpff, an internist and former CEO of University of Maryland Medical Center who is writing a book about the crisis in primary care. To make ends meet, physicians have had to increase the number of patients they see. The end result is that the average face-to-face clinic visit lasts about 12 minutes.
Neither patients nor doctors are happy about that. What worries many doctors, however, is that the Affordable Care Act has codified this broken system into law. While forcing everyone to buy health insurance, ACA might have mandated a uniform or streamlined claims procedure that would have gone a long way to improving access to care. As Malcolm Gladwell noted, “You don’t train someone for all of those years in [medicine]… and then have them run a claims processing operation for insurance companies.”
In fact, difficulty dealing with insurers has caused many physicians to close their practices and become employees. But for patients, seeing an employed doctor doesn’t give them more time with the doctor—since employed physicians also have high patient loads. “A panel size of 2,000 to 2,500 patients is too many,” says Dr. Schimpff. That’s the number of patients primary care doctors typically are forced to carry—and that means seeing 24 or more patients a day, and often these patients have 10 or more medical problems. As any seasoned physician knows, this is do-able, but it’s certainly not optimal.
Most patients have experienced the rushed clinic visit—and that’s where the breakdown in good medical care starts. “Doctors who are in a rush, don’t have the time to listen,” says Dr. Schimpff. “Often, patients get referred to specialists when the problem can be solved in the office visit.” It’s true that specialist referrals are on the rise, but the time crunch also causes doctors to rely on guidelines instead of personally tailoring medical care. Unfortunately, mindlessly following guidelines can result in bad outcomes.
Yet physicians have to go along, constantly trying to improve their “productivity” and patient satisfaction scores—or risk losing their jobs. Industry leaders are fixated on patient satisfaction, despite the fact that high scores are correlated with worse outcomes and higher costs. Indeed, trying to please whatever patient comes along destroys the integrity of our work. It’s a fact that doctors acquiesce to patient demands—for narcotics, X-rays, doctor’s notes—despite what survey advocates claim. And now that Medicare payments will be tied to patient satisfaction—this problem will get worse. Doctors need to have the ability to say no. If not, when patients go to see the doctor, they won’t actually have a physician—they’ll have a hostage.
But the primary care doctor doesn’t have the political power to say no to anything—so the “to-do” list continues to lengthen. A stunning and unmanageable number of forms—often illegible—show up daily on a physician’s desk needing to be signed. Reams of lab results, refill requests, emails, and callbacks pop up continually on the computer screen. Calls to plead with insurance companies are peppered throughout the day. Every decision carries with it an implied threat of malpractice litigation. Failing to attend to these things brings prompt disciplining or patient complaint. And mercilessly, all of these tasks have to be done on the exhausted doctor’s personal time.
Almost comically, the response of medical leadership—their solution— is to call for more physician testing. In fact, the American Board of Internal Medicine (ABIM)—in its own act of hostage-taking—has decided that in addition to being tested every ten years, doctors must comply with new, costly, "two year milestones." For many physicians, if they don't comply be the end of this month, the ABIM will advertise the doctor's "lack of compliance" on their website.
In an era when nurse practitioners and physician assistants have shown that they can provide excellent primary care, it’s nonsensical to raise the barriers for physicians to participate. In an era when you can call up guidelines on your smartphone, demanding more physician testing is a ludicrous and self-serving response.
It is tone deaf. It is punitive. It is wrong. And practicing doctors can’t do a damn thing about it. No wonder doctors are suicidal. No wonder young doctors want nothing to do with primary care.
But what is a bit of a wonder is how things got this bad.
Cheat Sheet
A speedy, smart summary of news and must-reads from The Daily Beast and across the Web
By clicking "Subscribe," you agree to have read the Terms of Use and Privacy PolicyCertainly, the relentlessly negative press coverage of physicians sets the tone. “There’s a media narrative that blames physicians for things the doctor has no control over,” says Kevin Pho, MD, an internist with a popular blog where physicians often vent their frustrations. Indeed, in the popular press recently doctors have been held responsible for everything from the wheelchair-unfriendly furniture to lab fees for pap smears.
The meme is that doctors are getting away with something and need constant training, watching and regulating. With this in mind, it’s almost a reflex for policy makers to pile on the regulations. Regulating the physician is an easy sell because it is a fantasy—a Freudian fever dream—the wish to diminish, punish and control a disappointing parent, give him a report card, and tell him to wash his hands.
To be sure many people with good intentions are working toward solving the healthcare crisis. But the answers they’ve come up with are driving up costs and driving out doctors. Maybe it’s too much to ask for empathy, and maybe physician lives don’t matter to most people.
But for America’s health to be safeguarded, the wellbeing of America’s caretakers is going to have to start mattering to someone.
_________________________________________________
'The first is incentives: a major thrust of our efforts is to create an environment in which hospitals, physicians, and other providers are rewarded for delivering high-quality health care and have the resources and flexibility they need to do so'.
As Burwell and Obama's Federal Health and Human Services pushes out data saying Affordable Care Act is really doing all it said it would when installed several years ago we see the same toll on medical workers down the hospital and health care line because VALUE-ADDED MARKET-BASED POLICY IS NOT ABOUT PATIENT QUALITY CARE---IT'S ABOUT DELIVERING CARE THE CHEAPEST WAY POSSIBLE.
Our US medical staff have these few decades been under attack and this transition from professional wages to bringing in immigrant labor for lower wages is well established. Obama and Clinton neo-liberals are simply using ACA to take these health systems and structures already in place globally and install them in the US.
YES, THESE HEALTH SYSTEMS CONGRESS IS PRETENDING TO CREATE THESE SEVERAL YEARS IN OUR STATE PRIVATE SYSTEMS ARE SIMPLY DEVELOPING NATION INTERNATIONAL ECONOMIC ZONE HEALTH STRUCTURES BEING BROUGHT TO THE US. NO NEW MARKETS BEING CREATED----SAME GLOBAL GROUPS OF CORPORATIONS.
We have already talked about how the ACA deregulated health care education such that our health care degree programs are no longer strong professional training---
Wall Street players will pretend to be addressing these issues when it has become far worse these few years.
Top 5 Reasons Why Good Nurses Leave the Profession
by Nachole Johnson | Nov 11, 2013 | Blog |
Some nurses are becoming frustrated with the profession and leaving altogether to pursue other careers. I’ve known a few well-seasoned nurses who have left after 10, 20, or 30 years in the profession. Some nurses leave after only a short time in the field. Why?
Here are the top 5 reasons why nurses leave the field:
1. Short staffing
Short staffing runs rampant in nursing. There never seems to be enough staff to care for patients on any given day. Staffing issues cause undue stress on the average nurse, especially when it’s an ongoing issue. The unit they work for will ask nurses to pick up an overtime shift or two and this then becomes the norm. The money for overtime shifts may be good, but nurses get tired of continually pulling more than their weight during any given shift. In addition, if your unit is fully staffed and other units in the hospital aren’t, you may be asked to float. Having to float to another unit is the bane of most nurses’ existence.
2. Too many tasks
It seems as if each time I report to work there’s a new piece of paper to fill out or a new task for nursing to do that another department used to handle. Sometimes it seems as if every other department in the hospital dumps on nursing. As a result, nurses end up doing someone else’s job (and well at that matter!) and soon the hospital is finding other ways to further cut costs and push even more on the nursing staff.
A prime example of this is Vanderbilt Medical Center. Nurses there are now taking over housekeeping duties! Can someone please tell me why management thought this was a good idea? This is wrong on so many levels; infection control, overworking nursing staff, disrespect for the nursing profession- I could go on and on. Most nurses barely have time to eat, let alone pee, so how can Vanderbilt feasibly add housekeeping to the list of things nurses have to do each day?
3. Lack of upward mobility
Let’s face it…it’s hard to move beyond the bedside without having an advanced degree. Many older nurses received either a diploma or associates degree to enter the field. When I received my associate’s in nursing 8 years ago, all it took to move beyond the bedside was a BSN. It’s getting more and more difficult to find a non-clinical nursing job without a master’s degree or higher. Because of this, many experienced nurses who want to try something non-clinical either have to go back to school for many more years of schooling or decide to leave the profession for non-nursing jobs when they get tired.
4. Poor management
I once read that nurses don’t leave specific floors, they leave poor management. This sentiment rang true for me as I reflected on previous jobs and the main reasons I left. I can honestly say my two worst jobs weren’t because of coworkers or the workload- it was because of poor management. Poor management can cause toxicity among coworkers and increased workload. There is a correlation! If management truly cared about the backbone of the hospital (nurses!) then maybe they wouldn’t lose so many.
5. Underpayment
A common misconception among the general public is that nurses are paid very well for the work we do. Although we hold a tremendous amount of responsibility, this couldn’t be further from the truth for many of us. Nursing salaries vary widely based on geographic location, but most nurses feel underpaid for the amount of responsibility we have on a daily basis. Another issue concerning underpayment is that nursing salaries are capped after so many years of experience. Even worse, some newer nurses make almost as much as experienced nurses because their starting salaries begin higher than the experienced nurses did oh-so many years ago.
There are many more reasons nurses end up leaving the profession, but these are the top 5 as I see them. What are the other reasons why nurses leave and what can be done to keep more nurses in the profession?
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Looking at the stats above----we do not believe the comment below in a USA Today article. Is this in-patient room technology REALLY creating more effectiveness?
'Doctors, too, are reacting well to changes, Ornish says: "It's a chance for doctors and other professionals to reclaim why we went into medicine — to be healers."'
Indeed, hospitals are claiming more and more funding by telling Health and Human Services they are meeting goals listed below when they are not. Raise your hand if you understand that hyper-global profit-driven health systems are not going to tell the truth? Raise your hand if you know these are the same health industries that committed $400 billion and higher of health fraud and profiteering these few decades so we only expect the fraud to get worse with less patient voice or access to justice as it does. THAT IS WHAT DEREGULATING PUBLIC HEALTH DOES----TAKES AWAY ALL AVENUES OF HEALTH JUSTICE. So, does a patient fight against bad hospital service when a health insurance policy identifies only one place for a particular disease vector to be treated? It's like having a slum landlord with no other options for housing. It will become SLUMDOG MILLIONAIRE in health care soon enough.
Baltimore has been tied to the ACA for three decades as it was exempted from Medicare illegally to create these pools of funding that should go to health care but are sent to expand global health systems instead. I literally refused to complete this patient checklist for my last hospital stay in Baltimore because the patient treatment was so bad. They can simply fill it out themselves for goodness sake. If you have medical staff who for decades committed medical coding fraud to have a job---they will be filling in these patient surveys as well.
As it says below----the use of telemedicine---tracking the patient after they leave is the way they stop readmittance. If you have a problem that requires re-admittance then you end losing your doctor and are pushed to another hospital and health plan most likely more and more expensive.
Hospitals chart ways to boost care, funding under ACA
Alicia McElhaney, USATODAY 11:49 a.m. EDT March 28, 2014
Patient satisfaction is high on the checklist.
(Photo: Erik Butler)
Hospitals are getting creative when it comes to meeting tough new mandates in the Affordable Care Act to improve care and increase patient satisfaction — and they're getting paid more as a result.
Getwellnetwork's technology allows patients -- or their parents -- to access records and instant-message staff through hospital room TVs. (Photo: Getwellnetwork)
Under an ACA program, the federal government gives money to hospitals that deliver better care, rather than just paying them for procedures covered by Medicare and Medicaid. Called the Hospital Value-Based Purchasing program, it aims to increase quality care and shrink the number of patients who die from mistakes.
As part of the program, the Center for Medicare and Medicaid Services (CMS) pays hospitals for infection prevention, successful surgeries, low readmission rates and patient satisfaction scores. The CMS bases funding on both achievement and yearly improvement.
Hospitals across the country are taking steps to improve and claim the extra funds.
•Mayo Clinic branches in Rochester, Minn., Jacksonville and at the Scottsdale/Phoenix campus use iPads for cardiac surgery patients to help them track progress and to give them to-do lists for the day, says Douglas Wood, a cardiologist and director of Mayo's Center for Innovation.
•New York City's Beth Israel Medical Center and the Charleston Area Medical Center in West Virginia are among the hospitals that use the Ornish Spectrum, a 72-hour program for heart disease patients that helps them make lifestyle changes in nutrition, fitness and stress management. It was founded by physician and author Dean Ornish.
•Virginia hospitals in the Sentara Healthcare network allow patients to see their medical records on an app called MyChart. The app lets patients e-mail their doctors with questions, says Tim Jennings, Sentara's vice president of pharmacy services.
Medical technology companies are coming up with innovations that can help hospitals improve care. For instance, GetWellNetwork in Bethesda, Md., has developed a program that uses in-room televisions to instant-message patients between shows. The messages educate patients about care and help track recovery progress, says CEO and founder Michael O'Neil. Patients can instant-message doctors and nurses and give feedback during their hospitalization. The information is also available through smart phones and tablets after patients return home.
Quality care doesn't have to be high-tech. Staffers at Saint Elizabeth Hospital in Lincoln, Neb., removed regular soda from vending machines and moved diet soda and sugary drinks to the bottom rows to promote healthier choices, which can lower readmission, says Libby Raetz, vice president of nursing,
Hospitals aren't changing only because there's a financial reward but because the government tells them how to make improvements, says Nancy Foster, vice president of quality and patient safety at the American Hospital Association.
"They are responding to that signal that says, 'Here is an important opportunity to do something that will make a difference,' " Foster says.
Every year, 210,000 to 440,000 people die from avoidable hospital mistakes, according to a 2013 study published in the Journal of Patient Safety.
Such mistakes cost the health care system nearly $7.3 billion in two years, according to a 2013 study by quality awareness company HealthGrades.
"We may not be able to eliminate all of the errors, but we may be able to prevent the error from reaching the patient and causing harm," Foster says.
Doctors, too, are reacting well to changes, Ornish says: "It's a chance for doctors and other professionals to reclaim why we went into medicine — to be healers."
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As someone with hospital administration and medical management background for decades I know the conditions and attitudes over time. Doctors have always been a pain in the neck with their superiority complex of thinking they know all and not wanting to hear other opinions, especially from a patient. I think all Americans would want to change that dynamic. What this article below states is true though. This PROGRESSIVE POSING POLICY OF PATIENT SATISFACTION is almost worthless in the field of health care.
We have just finished a few decades of being fleeced by the health industry for providing TOO MUCH HEALTH CARE for profiteering and here we see an article in 2014----AFTER AFFORDABLE CARE ACT----with doctors shouting all of this is getting worse.
I'M SORRY PATIENTS---WE DON'T KNOW WHAT IS BETTER. THE PROBLEM NOW BECOMES WITH FOR-PROFIT MAXIMIZATION HEALTH CARE CAN WE TRUST THAT THESE DOCTORS DO WHAT IS BEST?
'The first is incentives: a major thrust of our efforts is to create an environment in which hospitals, physicians, and other providers are rewarded for delivering high-quality health care and have the resources and flexibility they need to do so'.
'A physician came up to me afterwards and agreed with me but said that he had no choice. He works in one of those venues and is subject to surveys to measure "quality." For him, quality is measured in 2 ways: The first is by getting the patient door-to-door in 45 minutes, and the second is by a Press Ganey survey to see if the patient was happy. Because of these measures, he is forced to abandon his role as a responsible steward of antibiotic use to keep his job and get a bonus'.
From Keystone Physician
Patient Satisfaction Is Overrated
William Sonnenberg, MD
Disclosures | March 06, 2014
Editors' Recommendations
Related Drugs & DiseasesEditor's Note:
This article first appeared in the Fall 2013 issue of Keystone Physician, a publication of the Pennsylvania Academy of Family Physicians.
I recently was at the Scientific Assembly of the American Academy of Family Physicians (AAFP) in San Diego, giving a lecture to a large audience of Academy members on respiratory syncytial virus (RSV) bronchiolitis. I mentioned why I thought identifying the RSV virus was important. I stated that if you tell the family the infant has RSV and that there is the expectation that cough will last 1-2 months, this may forestall them going to the ER or urgent care center. In those assembly lines of healthcare, they will be told that their child has "bronchitis" and will receive the inevitable azithromycin script. This will make the parents happy, free the healthcare provider of the need for further explanations, and result in a satisfying visit for the administrators of that facility. The trouble, of course, is that an antibiotic has again been used to treat a self-limited viral infection.
A physician came up to me afterwards and agreed with me but said that he had no choice. He works in one of those venues and is subject to surveys to measure "quality." For him, quality is measured in 2 ways: The first is by getting the patient door-to-door in 45 minutes, and the second is by a Press Ganey survey to see if the patient was happy. Because of these measures, he is forced to abandon his role as a responsible steward of antibiotic use to keep his job and get a bonus.
Another physician in the audience told the crowd that he was able to increase his satisfaction score by 7% simply by prescribing an antibiotic to all patients who call with a complaint of cough, sore throat, or sinus headache. One doctor reported to the media that he had to give Dilaudid® for minor pain because his Press Ganey score was low the previous month.
I believe that this little-known company, Press Ganey, from South Bend, Indiana, has become a bigger threat to the practice of good medicine than trial lawyers. They are the leading provider of patient satisfaction surveys for hospitals and physicians. For the past decade, the government and healthcare administrators have embraced the "patient is always right" model and will punish providers that fail to rate well in these surveys. Press Ganey's CEO, Patrick Ryan, said, "Nobody wants to be evaluated; it's a tough thing to see a bad score, but when I meet with physician groups I tell them the train has left the station. Measurement is going to occur."[1] Obamacare has budgeted $850 million in reduced Medicare reimbursement for hospitals with lower scores.
The mandate is simple: Never deny a request for an antibiotic, an opioid pain medication, a scan, or an admission. One emergency room with poor survey scores started offering hydrocodone "goody bags" to discharged patients in order to improve their ratings. And doctors face the reality that uncomfortable discussions on behavioral topics -- say, smoking or obesity -- come with the risk of a pay cut. If you tell a patient that their knee pain is related to weight, that their smoking is worsening their child's asthma, or that they can't lose weight because of French fries and not a glandular problem, your ratings and pay will take a hit.
Satisfied patients are not healthy patients. In a paper published in 2012, researchers at the University of California, Davis, using data from nearly 52,000 adults, found that the most satisfied patients spent the most on healthcare and prescription drugs.[2] They were 12% more likely to be admitted to the hospital and accounted for 9% more in total healthcare costs. Strikingly, they were also the ones more likely to die.
Overtreatment is a silent killer. We can overtreat and overprescribe. The patients will be happy, give us good ratings, yet be worse off. We must have the ability to deny treatment for a patient's own good. Patients aren't the best judge of what is best for them. Several years ago, an elderly female patient wanted me to write a prescription for tamsulosin because she got a coupon in the mail. It did not matter that she lacked a prostate.
We should try to be kind to our patients and take time to understand them, but we must resist these misguided pressures and do the right thing. Sometimes patients have to be told "no," and the leadership in healthcare must understand this.
Take heart in the words of Mark Twain: "Always do what is right. It will gratify half of mankind and astound the other."
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So, Burwell's first objective with ACA:
'The first is incentives: a major thrust of our efforts is to create an environment in which hospitals, physicians, and other providers are rewarded for delivering high-quality health care and have the resources and flexibility they need to do so'.
We want to look at what will be the goal----this article shows preventing death which if you are an older adult with chronic illness or an end-of-life senior re-admittance, bad outcomes, cost of patient care all rub against these goals. We are watching as a tiered system of global predatory health care builds health systems designed SPECIFICALLY TO REMOVE THESE MORE COSTLY PEOPLE WHILE LOOKING AS THEY ARE BEING INCLUSIVE. Whether it is done through selective locations for specialized treatment taking patients across the state or out of state to get that treatment or whether as in Baltimore where they PRETEND there are sources of care for seniors and low-income but there are not. Population redistribution to US International Economic Zones are no place for the chronically ill, seniors, or disabled so they WILL BE PUSHED OUT OF WHAT USED TO BE THE BEST OPPORTUNITIES FOR QUALITY CARE.
It looks like OPERANT CONDITIONING ----make that patient feel satisfied as cheaply as you can and you will get more money.
Remember, the term 'worst performing' under market-based value means PROFIT and not quality and satisfaction no matter how Wall Street 1% global corporate neo-liberals want to package it
'Combined, these three quality programs have the potential to strip away as much as 5.5 percent of Medicare payments from the worst performing hospitals starting next October'.
Nearly 1,500 Hospitals Penalized Under Medicare Program Rating Quality
By Jordan Rau November 14, 2013
This KHN story was produced in collaboration with
More hospitals are receiving penalties than bonuses in the second year of Medicare’s quality incentive program, and the average penalty is steeper than it was last year, government records show.
Medicare has raised payment rates to 1,231 hospitals based on two-dozen quality measurements, including surveys of patient satisfaction and—for the first time—death rates. Another 1,451 hospitals are being paid less for each Medicare patient they treat.
For half the hospitals, the financial changes that started last month are negligible: they are gaining or losing less than a fifth of one percent what Medicare otherwise would have paid. Others are experiencing greater swings. Gallup Indian Medical Center in New Mexico, a federal government hospital on the border of the Navajo Reservation, will be paid 1.14 percent less for each patient. Arkansas Heart Hospital in Little Rock, a physician-owned hospital that only handles cardiovascular cases, will get the largest bonus, 0.88 percent.
The bonuses and penalties are one piece of the health care law’s efforts to create financial incentives for doctors and hospitals to provide better care. They come at a tumultuous time as the technical problems of the healthcare.gov insurance portal and premium prices are stoking questions about the law’s viability. The incentives are among the law’s few cost-control provisions that have kicked in, but it is too early to tell how effective they will be in making hospitals operate more efficiently.
“This program is driving what we want in health care,” said Dr. Patrick Conway, Medicare’s chief medical officer. He said most hospitals have improved since the program began a year ago. However, even some hospitals that have gotten better are still losing money because they are not scoring as well as others or have not improved as much.
Across the country, hospital executives say they have put renewed focus on excellence in the areas that are judged. Some have clamped down on nighttime noise, one of the questions patients are asked about, by replacing squeaky wheels on food carts and discouraging nurses and workers from chatting on cell phones outside of rooms. Others have scrambled to ensure heart attack patients always get an angioplasty within 90 minutes of arrival because that is part of the scoring. Some private insurers have adopted similar incentives.
“The thing about the government, if they start paying attention to it, we have to scramble around to pay attention to it,” said Dr. Leigh Hamby, chief medical officer at Piedmont Healthcare, a hospital system in Georgia. “It gets us moving.”
Hospitals in Maine, Massachusetts, Nebraska, New Hampshire, North Carolina, Utah and Wisconsin are faring the best, with 60 percent or more of hospitals getting higher payments, according to a Kaiser Health News analysis. Medicare is reducing reimbursement rates for at least two-thirds of hospitals in 17 states, including California, Connecticut, Nevada, New Mexico, New York, North Dakota, Washington and Wyoming, as well as the District of Columbia.
How A Hospital Is Rated
Under the program, known as Hospital Value-Based Purchasing, Medicare reduced payment rates to all hospitals by 1.25 percent. It set the money aside in a $1.1 billion pot for incentives. While every hospital is getting something back, more than half are not recouping the 1.25 payment they initially forfeited, making them net losers. The payment adjustments are applied to each Medicare patient stay over the federal fiscal year that started Oct. 1 and runs through September 2014. The potential bonuses and penalties were higher than they were last year, when the maximum at stake was 1 percent.
To assess quality, Medicare looked not only at how hospitals scored in comparison with each other, but also how much each improved from two years ago compared to other hospitals. A hospital is judged on whichever score is higher, so some hospitals with subpar quality rankings are still getting more money because they showed vast improvement. It won’t be clear how much any hospital’s bonuses and penalties amount to in dollar figures until next October because it depends on how much a hospital ultimately bills Medicare.
This year, 45 percent of a hospital’s score is based on how frequently it followed basic clinical standards of care, such as removing urinary catheters from surgery patients within two days to decrease the chance of infections. Thirty percent of the score is based on how patients rate the way they felt they were treated in the hospital, such as whether the doctors and nurses communicated well.
Medicare added its first measure of a medical outcome, looking at death rates of patients admitted for heart attacks, heart failure or pneumonia.Those mortality rates, calculated from the number of Medicare patients who died in the hospital or within a month of discharge, count for 25 percent of a hospital’s score.
The incentive program has received a mixed reception among hospital executives. Some complain that patients’ views sometimes are swayed by the swankiness of the hospital, and that hospitals that treat the very sickest patients often get the worst evaluations. Physician-owned hospitals that focus on just a few specialties have tended to do particularly well in the program, as evidenced by the Arkansas Heart Hospital’s record bonus this year. Some leaders also object that even if they show improvements, their hospital can lose money if the improvements are not as great as others.
Will Penalties Bring Change?
Researchers are unsure whether the penalties are significant enough to trigger major improvements, especially in areas such as mortality, where there’s no definitive explanation for why some hospitals do such a better job than others in keeping patients alive.
“Shame and penalties, I don’t know if that’s the best way to get organizations to change,” said Leslie Curry, a researcher at the Yale School of Public Health. Her work has found that hospitals with low mortality rates are the ones where it is a priority of executives and where there is a culture where front-line workers such as nurses and lab technicians feel comfortable raising concerns to doctors and devising better methods. “The fiscal penalties are nominal, frankly, in the scheme of things,” she said.
Others say even small differences in payments provide strong encouragement for hospitals to improve. “Sometimes institutions may think they’re performing excellently until they see outside data that compares to your peers,” said Dr. Richard Bankowitz, the chief medical officer of Premier, a group that works with hospitals to improve quality. “People are motivated to excel. Nobody wants to be in the bottom quartile anymore.”
The addition of mortality rates into the scores provides hospitals with their biggest challenge yet. Amanda Berra, a consultant at The Advisory Board, a Washington health care consulting firm, interviewed 40 chief medical officers at hospitals about mortality rates. “They were very split. About half of them said you could not have a more powerful measure. On the other side we heard people who were really unenthusiastic,” she said. “We heard that the data is not super meaningful. They felt they had drastically improved in recent years and have kind of gotten where they could go.”
The average penalty grew to 0.26 percent, up from 0.21 percent in the first year of the program. North Georgia Medical Center in Ellijay is the only hospital besides Gallup to lose more than 1 percent of its reimbursements: it will lose 1.04 percent. Denver Health Medical Center, a highly respected safety-net hospital, is losing 0.71 percent of its reimbursements. The hospital that was penalized the most last year, Auburn Community Hospital in upstate New York, reduced its 0.90 penalty, but will still lose 0.55 percent.
The average bonus was 0.24 percent, almost the same as last year’s 0.23 percent. Large bonuses are going to some major teaching hospitals, such as Thomas Jefferson University Hospital in Philadelphia and Duke University Hospital in Durham, N.C. Most are being distributed among smaller institutions, such as Pikeville Medical Center in Kentucky.
“The dollars are less important in terms of impact than the fact that the nation is sending a signal through the payment mechanism that there’s something to be worked on in the care we deliver,” said Nancy Foster, an executive at the American Hospital Association. “It’s a national symbol to health care providers that here is an area where you can do better.”
Many Past Winners Continue To Get Bonuses
Most winners from last year stayed winners and losers stayed losers. But there were some switches. Oaklawn Hospital in Marshall, Mich., improved its score the most from last year. In place of a 0.26 penalty, Oaklawn will receive a 0.65 percent bonus. A number of prominent academic medical centers also turned around their scores. Vanderbilt University Medical Center in Nashville, Massachusetts General Hospital in Boston, New York-Presbyterian Hospital in Manhattan, Cedars-Sinai Medical Center and Ronald Reagan UCLA Medical Center, both in Los Angeles, and Yale-New Haven Hospital were among the 300 places that went from a penalty to a bonus.
A total of 416 hospitals that won bonuses last year will be penalized this year. Centura Health-St. Thomas More Hospital in Canon City, Colo., dropped from a 0.08 percent bonus to a 0.72 percent penalty, the largest decrease.
This program is one of several Medicare has launched to make hospitals and doctors pay more attention to how their treatments compare with other hospitals, and to be more careful with public money. Medicare gives bonuses to the private Medicare Advantage insurance plans that score well on quality metrics. In 2015, the health law calls for the government to begin a quality payment program for physician groups of 100 professionals or more, and that is to be expanded to all doctors by 2017. The goal of all these programs is to replace the current financial incentive in Medicare, in which the only way for a hospital to get paid more is to perform more procedures and take on more patients.
For hospitals, the quality payments come on top of Medicare’s penalties on 2,205 hospitals with higher than expected readmission rates. The agency is doling out a maximum punishment this year of 2 percent. As a result two out of three hospitals are losing money starting last month from the combined effects of the quality and readmissions programs. Pineville Community Hospital in Kentucky is losing 2.57 percent of its reimbursements, the largest penalty in the country. Twenty-one other hospitals are losing 2 percent or more. These cuts come on top of reductions in special payments that go to hospitals that treat large numbers of low-income people.
Only 729 hospitals will end up with an increase in payments from the combined readmissions and value-based programs. Maine Coast Memorial Hospital in Ellsworth fared the best, gaining 0.80 percent.
Hospitals that are designated as critical access facilities, certain cancer hospitals and places with too few cases to be accurately measured were excluded from both programs.
Maryland hospitals are exempt because that state has a unique payment arrangement with Medicare.
Medicare relies on information found on hospital bills to determine the quality of care. In judging death rates, Medicare looked at patients admitted from July 2011 through June 2012, and compared those rates with how the hospitals performed between July 2009 and June 2010. For the clinical and patient satisfaction measures, Medicare assessed hospital performances from April 2012 through December 2012, and compared them with scores during the same months in 2010.
The amount of money at stake increases to 1.5 percent of payments in October 2014, and continues to grow by a quarter percent until it reaches 2 percent.
Medicare is planning to add new measures next year, including comparisons of how much patients cost Medicare at different hospitals and rates of medical mishaps and infections from catheters.
In addition, the maximum readmission penalties grow to 3 percent next year, and Medicare is launching a third incentive program that takes an additional 1 percent of payments away from hospitals with the most patients who suffered injury or infection during their stay.
Combined, these three quality programs have the potential to strip away as much as 5.5 percent of Medicare payments from the worst performing hospitals starting next October.
“We’re moving more toward outcomes measures,” Conway said. “We’re moving away from volume and toward quality.”
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