Posts Tagged ‘hospitals’

Healthcare providers struggle with violence-related risk management

Wednesday, March 23rd, 2016

There’s no question but that healthcare workers face a growing threat of violence from patients while going about their day-to-day jobs. In a 2015 survey, the International Healthcare Security and Safety Foundation reported a 40% increase in violent crime from 2012 to 2014, with more than 10,000 violent incidents mostly directed at employees. High stress, armed patients and visitors, drug and alcohol intoxication, mental health issues and more all contribute to an increasingly dangerous environment. OSHA reports that:

From 2002 to 2013, the rate of serious workplace violence incidents (those requiring days off for an injured worker to recuperate) was more than four times greater in healthcare than in private industry on average. In fact, healthcare accounts for nearly as many serious violent injuries as all other industries combined.

Recently, Susannah Levine reported on the challenge that healthcare facilities face in her Risk & Insurance article, Hospitals Struggle with Security Risks. The article discusses the pros and cons of an armed approach to healthcare security, as well as the insurance implications of various risk management and security measures. Liability insurance may be a determining factor as to whether healthcare facilities opt for armed security or rely on less lethal tools like Tasers and sprays.

“Barry Kramer, senior vice president, Chivaroli & Associates, a health care insurance broker, said that armed security in health care settings is more of a risk management concern than a coverage issue.

“It would be highly unusual for our clients’ liability policies to exclude claims involving security guards, whether or not they’re armed with guns,” he said.

He said many health care risk managers are not equipped to manage exposures associated with licensing and certifying guards or registering the facility’s own firearms.

For facilities that lack the bandwidth to manage, train and track certifications for in-house security staff, Kramer said,third-party vendors, such as local law enforcement or private security companies, can be contracted, since they have firearms experience as well as liability insurance coverage.”

In February, the New York Times discussed various approaches and philosophies that healthcare facilities employ to mitigate risk. The article by Elisabeth Rosenthal – When the Hospital Fires the Bullet – centers on the case of a 26-year-old mental health patient who was shot by police in a Houston hospital. In the course of the article, Roenthal presents various approaches to security:

To protect their corridors, 52 percent of medical centers reported that their security personnel carried handguns and 47 percent said they used Tasers, according to a 2014 national survey. That was more than double estimates from studies just three years before. Institutions that prohibit them argue that such weapons — and security guards not adequately trained to work in medical settings — add a dangerous element in an already tense environment. They say many other steps can be taken to address problems, particularly with people who have a mental illness.

Rosenthal contrasts the approach of Boston’s Massachusetts General Hospital, where the strongest weapons its security officers carry is pepper spray to that of the Cleveland Clinic, which has its own fully armed police force and also employs off-duty officers.

Guns in hospitals

Meanwhile, as risk managers struggle with the dilemma of whether to arm or not to arm, patients and visitors are often armed, enabled by state and local gun laws – just one more factor that healthcare facilities are coping with. At of the beginning of the year, Texas law allows for guns in state mental health hospitals. Campus Safety Magazine reports on how Kansas College Hospitals are preparing to allow guns on campus to comply with a new law. Gun laws in health systems vary by state – while a federal law bars guns from schools, there is no such law about firearms in hospitals.

Healthcare Violence Prevention Resources

OSHA: Worker Safety in Hospitals – Caring for our Caregivers

OSHA: Preventing Workplace Violence: A Road Map for Healthcare Facilities

OSHA: Guidelines for Preventing Workplace Violence for Healthcare and Social Service Workers

Mitigating Workplace Violence at Ambulatory Care Sites

Emergency Department Violence Fact Sheet

Healthcare Crime Survey 2015

Prior related posts

More perils for healthcare workers

Violence in healthcare: 61% of all workplace assaults are committed by healthcare patients

Report on violence & aggression to Maine’s caregivers; Injuries include bites, kicks, being hit

Health Wonk Review: Stormy Weather

Thursday, February 3rd, 2011

This dramatic satellite shot from NOAA captures the scope of the blizzard that swept across the country in the last few days. Being snowbound offered our contributing bloggers lots of time to think about all things healthcare, and in that arena, the climate is almost as stormy as the weather. The Florida judge’s ruling against the Health Care Act was much on the mind of several of our bloggers, as was the State of the Union address — both of which occurred since our last compilation. We have a lot of good submissions this week – grab a cup of cocoa to take the chill off and dig in.
Managed Care Matters – Hosting has its privileges, so we kick off this issue with a nod to the blogger who did the heavy lifting last issue, Joe Paduda. One thing we love about Joe is that he is never one to mince words, as evident in this week’s submission, Paul Ryan’s blatant hypocrisy – and the abject failure of mainstream media. Joe takes the Wisconsin representative to task, along with most of his colleagues in the GOP and the mainstream media. He finds today’s hand-wringing over healthcare related debt insincere from the same players who ignored yesterday’s elephant in the room. Also see his related post: If health reform is overturned.
The Apothecary (posted at Forbes) – Avik Roy’s post Florida v. HHS: Why Vinson’s Ruling Might Stand offers a detailed discussion of the four components of Judge Vinson’s Monday ruling, with an emphasis on why the lack of a severability clause might be the key factor in overturning the entire law.
California Healthline – With talk of rolling back the Patient Protection and Affordable Care Act dominating the news, Dan Diamond reminds us that this isn’t the first time that Congress has considered overturning a major health law. He wonders if the battle over the 1988 Medicare Catastrophic Coverage Act and its repeal 17 months later mightn’t hold some lessons for today.
Colorado Health Insurance Insider – Louise Norris suggests that any debate on healthcare should be based first and foremost on facts rather than rumors. She puts on her detective hat in considering whether a Colorado Representative’s vote was swayed by debunked info from an E-mail forward. She thinks the public debate should be informed by a higher standard and offers some clues for spotting suspect chain-mail claims
Disease Management Care Blog – Jaan Sidorov considers Atul Gawande’s recent essay The Hot Spotters and asks if targeted care management is something new? Jann says that while The New Yorker article might garner the glitteratis’ attention, the practice of identifying and reaching out to patients at risk is a standard MO in many commercial insurance plans. “What’s next, Dr. Gawande,” he asks, “discovering that there are machines that use electromagnetic radiation to take pictures of people’s insides?”
Health Affairs Blog -Tim Jost offers an analysis of Judge Vinson’s decision invalidating the Affordable Care Act, while his co-bloggers opine about the implications of the Sate of the Union speech and its aftermath: Kavita Patel on health care and the State Of The Union; Len Nichols who suggests being honest for a change, and Joe Antos with a taste of budgets to come.
Health AGEnda – In his post on the the John A. Hartford Foundation’s blog, Chris Langston poses a good question: Why are Medicare’s innovations more secret than the Joint Strike Fighter?. He champions the idea that we should be more nimble, transparent and collaborative in sharing innovations and improvements in care, particularly in terms of knowledge that we as taxpayers have already purchased.
Health Beat Blog – Maggie Mahar suggests that when it comes to electronic health records, perhaps we should walk before we run. She likens the mad stampede of EHR implementation to a market bubble with too many sellers, too many buyers, and too little information. In light of this, she tackles the question of whether Congress should defund the conversion to EHRs as some are proposing.
Health Business Blog – What makes you sad? For David Williams, it comes down to three words: US biogenerics policy. David makes the case that the debate on biogenerics misses the point: There are better, safer, faster ways to bring down the cost of biotech drugs while preserving incentives for innovation.
Health Care Renewal – Roy Poses makes a strong contribution to this week’s roundup with his post Big Door Keeps On Turning. He lists examples of health care leaders going from government to industry and then back to government again. He asks if this revolving door, with its constant interchange among corporate and government health care leaders, is a sign of how corporatist health care has become and if we can we really expect a cozy corporate leadership class with no fixed loyalty to any organization to put the care of individuals and populations ahead of their personal interests and relationships?
Health News Review Blog – Gary Schwitzer enlists the help of Harry Demonaco, director of the Mass. General Hospital’s Innovation Support Center in turning a critical eye on health screening advice issued by Prevention magazine, which advised readers, “If you haven’t had these cutting-edge screenings, put this magazine down and call your doctor. Now.” This is cited as another bad example of screening madness in US health care journalism, which promotes and fosters screening outside the boundaries of the best evidence.
Healthcare Economist – Jason Shafrin informs us that home health services are among the fastest growing services that Medicare provides. In thinking of reform to control this rise in spending, he turns to MedPAC’s 2011 Home Health Reform Recommendations.
Healthcare Technology News – Rich Elmore and Paul Tuten discuss the launch of pilot projects enabling secure direct messages among healthcare stakeholders in their post about Direct Project implementations taking flight. They offer project details and note that this is a very big deal, as reflected in the related briefing by David Blumenthal (National Coordinator for Health IT), Aneesh Chopra (US CTO) and Glen Tullman (CEO Allscripts) among other federal and industry participants.
healthyimagination – In December, scientists and healthcare professionals shared groundbreaking research an NIH symposium focused on health disparities. Lisa Cappelloni shares some of the novel approaches aimed at eliminating health inequities in her post Advancing Minority Health: New Minds, New Methods.
The Hospitalist Leader – Bradley Flansbaum offers A Hospitalist’s Lament, a thoughtful essay on the issue of end of life care and advance directives. In the light of controversies like death panels and care rationing, he states that our country may be at least a decade or two away from having a sophisticated discussion on this subject. He illustrates the complexity of the surrounding issues through an intriguing exercise conducted with his colleagues.
Improving Population Health – David Kindig is another contributor who listened closely to the State of the Union address, and asks if one could find any mention of population health, public health, or prevention in the speech. While he didn’t hear those phrases directly, he was heartened by the speech addressing two major drivers of health — education and jobs.
The Incidental Economist – Austin Frakt says that cost shifting is not well understood and has become a political football. He sheds light on the topic in the first of a series of posts: Hospital cost shifting: Brief history and possible future.
Insure Blog – As the oft-quoted Andy Warhol line goes, we will all have our 15 minutes of fame. But in the world of insurance, fame may be measured in cents rather than minutes, if Hank Stern’s post about Ceridian’s 2-cent Moment is any measure. In this case, the company made headlines when a cancer patient was denied coverage over a 2 cent shortchange. Or was there more to this story than the headlines? Hank digs a little deeper and offers his two cents on the matter. (Oh, and kudos to Hank & crew for Insure Blog’s 6 year blogiversary – quite the landmark!)
John Goodman’s Health Policy Blog – In his post The Case For Health Insurance, John states that everyone should have access to health insurance, and notes that real insurance involves a pooling of risks. “The insurer must make sure each new entrant to the pool pays a premium that reflects the expected costs that entrant brings to the pool. Otherwise, the insurer won’t be able to pay claims. The business of insurance is the business of pricing and managing risk.”
The Notwithstanding Blog – Genomic medicine, end-of-life care, and rationing are three “hot” areas of medicine and health policy in which much stock is given to the opinion of bioethicists. Our blogger at the Notwithstanding Blog (written by a first-year medical student) says that he has a bad feeling in observing the near-uniformity with which the bioethics establishment has opposed medical advancement and patient empowerment, and uses the lens of public-choice analysis to argue that the deference shown to their prescriptions is at least partially misplaced.
Pizaazz – In his post about how early career physicians use Facebook, Glenn Laffel reviews a study that should give some comfort to those who worry that physicians will misuse the social networking site by failing to protect patients’ protected health information.
Workers Comp Insider – In the niche area of occupational illnesses and injuries, Jon Coppelman demonstrates that some villains contributing to skyrocketing health care costs might lie entirely outside the delivery system. He examines the curious spike in carpal tunnel injuries reported by guards at an Illinois correctional facility in his post John T. Dibble’s Sympathetic Ear.
That wraps up this issue! Next up to bat: Louise Norris at Colorado Long Term Care Insider on February 16!

The lighter side: medical people having fun

Friday, August 13th, 2010

Friday afternoon in August – who wants to be too serious? We think it’s the perfect time to deploy the secret stash of medical-humor related videos we’ve been collecting,
The first is a feel-good clip performed by staff at Providence St. Vincent Medical Center in Portland, Oregon to raise awareness for breast cancer.

The next clip is a Gilbert & Sullivan parody created by the Neuroscience Education Institute to be a little video played at the beginning of lectures presented by Dr. Stephen Stahl.
The Model of a Psychopharmacologist

The third clip is performed by the Laryngospasms, a group of practicing Certified Registered Nurse Anesthetists who create and perform medical parodies for audiences throughout the United States.

Other gems
The Colorectal Surgeon Song – OK, this is not performed by actual medical folk, but well worth a listen anyway!
UAB Emergency Room Tap – created by ER nurses for a National Nurses’ Week contest and celebration. UAB nurses and other staff members are featured in the video.
Breathe – another ditty by the Laryngospasms. More can be found at
Footloose: Nursing School Style – Baylor Louis Herrington School of Nursing cuts footloose.

New Cavalcade of Risk; other news briefs

Thursday, July 30th, 2009

Nancy Germond is hosting this week’s Cavalcade of Risk at her blog, Insurance Copywriter. She should get hazardous duty pay – she tells us that it is 113 degrees by noon on any given day in Phoenix – yikes. Nancy’s post covers topics as diverse as damaged guitars, dog health, and – of course – the health care debate. By the way, you can find more risk-related articles authored by Nancy at AllBusiness.
Other news notes
As we noted previously, Roberto Ceniceros has been attending the Disability Management Employer Coalition annual meeting and has been posting about the meeting on his blog. We found one item that he wrote about in Business Insurance of particular interest: his report that Harley Davidson is using functional assessments to reduce workers comp and disability claims among new hires and in its return-to-work programs. Hanover, Md.-based BTE Technologies Inc. provides the electronic functional assessment testing system and accompanying software and evaluates worksites to perform physical-demand analyses. The “…system evaluates attributes such as range of motion, dexterity, grip strength, lifting ability and tolerance of certain positions. Employees are measured by pushing against a column, lifting weights and other efforts matched to specific job requirements that are recorded electronically.” The company estimates savings of nearly $260,000 in workers comp claims costs by preventing new hire injuries alone, which doesn’t encompass the other benefits and savings from the disability and RTW components.
In Risk and Insurance, Peter Rousmaniere launches a three-part series on health issues facing veterans as they return to the workplace. His first post tells the story of one Sgt. Stephen Kinney of New Hampshire, ho was the victim of an IED explosion on the outskirts of Camp Anaconda in Iraq. Among injuries, Kinney sustained brain injuries and post-traumatic stress disorder (PTSD) that left him unable to resume his prior job as mail carrier.
NIOSH Science Blog posts about safe and health green jobs and tells us that, with its partners, NIOSH has launched a Going Green: Safe and Healthy Jobs initiative. The note that as America moves towards energy efficiency and more environmentally-friendly practices, it is likely that there will be changes to traditional jobs and the creation of new kinds of occupations. The purpose of the initiative is to eliminate hazards in the green jobs through planning, organization, and engineering – a concept known at NIOSH as Prevention through Design (PtD).
Supporting Safer Healthcare posts that U.S. News & Word report has issued its 2009 list of best hospitals.
The Ohio Department of Insurance has a new web address – update your bookmarks accordingly: (Please note – we had previously said that it was the Ohio Bureau of Workers Comp that had a new web address but we were wrong – that stays the same: – sorry for any confusion!)

Health Wonk Review: the biweekly smorgasbord of the best fare in the health care policy blogs

Thursday, May 14th, 2009

smorgasbord.jpg Welcome to Health Wonk Review, our bi-weekly smorgasbord of the best that the policy wonks have dished out on some of the most noteworthy healthcare blogs over the prior fortnight. We have an extensive sampling of tasty and nutritious treats, with lots of brain food among the fare – so without further ado, we offer this week’s buffet.

  • The love fest at the White House with health care providers generated great headlines, but, where’s the beef? Merrill Goozner at GoozNews points out that the promises made by the trade associations and physicians held not a few ironies: Just Don’t Ask CBO To Score It.
  • To say that Joe Paduda of Managed Care Matters is skeptical about said love fest is an understatement. He is shocked and blown away that the politicians in Washington actually believe the health care-insurance industry’s self regulation will reduce the nation’s health care costs.
  • Will the consortium of private sector stakeholders be able to cut $2 trillion in healthcare costs as they claim? Jason Shafrin of Healthcare Economist casts a critical eye on this in his post Letter to Obama: We’re gonna save $2 trillion .
  • When it comes to financing health care reform, Anthony Wright of Health Access WeBlog suggests that policymakers take a two birds with one stone approach by seeking options that not only raise funds but also help the health system.
  • Are hospitals really taking a hit from the current health care system? That’s a question posed by InsureBlog’s Henry Stern, who deconstructs the latest survey results from the American Hospital Association in his post, Economy Tanks; Hospitals, Patients Hardest Hit.
  • Brady Augustine of MedicaidFrontPage posts about Wellcare being taken to the woodshed for the sins of its prior executives who lived high on the hog while shortchanging vulnerable citizens. He discusses lessons learned, offering his thoughts on how to avoid such a scenario in the future.
  • How Hard Can It Be To Coordinate Care? Rich Elmore of Health Technology News interviews Dr. Mai Pham, who turned up some startling results in a study of the number of physicians and practices that are linked to a primary care provider for coordination of care.
  • Jeffrey Seguritan looks at a study of Medicare’s unplanned hospital readmissions at nuts for healthcare, noting that readmissions seem to indicate low quality of hospital care and drive health spending. He suggests that hospitals should be incentivized to cut readmissions, but current
    policy proposals should be wary of system-gaming and should consider illness severity.
  • Yikes. David Harlow of HealthBlawg posts about the Virginia prescription record security breach, in which millions of prescription records were lifted from a state government website and replaced with a $10m ransom note. He suggests that organizations that hold electronic protected health information should use this incident as a learning experience for planning and executing programs yo increase data security, as well as preparing for communications both to prevent breaches and to respond to any breaches that do occur.
  • Roy M. Poses of Health Care Renewal has frequently tackled the topic of conflicts of interest in health care, offering examples of published defenses based on logical fallacies. Most examples were written by people who had their own ties to health care corporations and appeared mainly in the op-ed pages of newspapers, but in his post Attacking “Crusaders” Against Conflicts of Interest with Logical Fallacies, he offers an example in a scholarly journal, published as an anonymous editorial. He says we can expect to see more accusations of witch-hunting, prudery, moralism, lack of realism, and the like leveled against those who oppose such lucrative financial
  • Louise of Colorado Health Insurance Insider posts about how Reid is absent in Sick Around America, apparently fallout with Frontline after last year’s acclaimed Sick Around the World. Louise offers the scoop on the controversy.
  • At Disease Management Care Blog, Jaan Sidorov examines the ugly politics that emerged around the issue of using gender in health insurance underwriting in his post Snatching Humiliation From the Jaws of Compromise.
  • President Obama recently spoke about his grandmother’s death and the questions it raises about end of life care in an interview published in the New York Times Magazine. Joanne Kenen of New Health Dialogue discusses Obama’s Grandmother and the National Conversation on Healthcare, adding her own patient-centric questions that need to be part of the dialogue.
  • Jocelyn Guyer of Say Ahhh! tells us that there was mostly good news for children in the Senate Finance Committee’s Health Reform Proposal.
  • Glenn Laffel of Pizaazz discusses a particularly vexing clinical and policy problem involving a defective defibrillator produced by Medtronic, that is currently in the bodies of a quarter of a million people. Leaving the failing device in place may kill patients, but removing it may do the same.
  • Pop goes the health care bubble? At the Health Care Blog, George Lundberg looks at Enron, the era, and the real estate-financial collapse, all recent examples of growth and expectations far exceeding substance, and makes the case that the health care bubble will be soon to follow.
  • David Williams of Health Business Blog asks why employees should be penalized for smoking or being overweight but not for having unprotected sex with multiple partners in his post on the ethical considerations of financial penalties for unhealthy behaviors.
  • Eric Turkewitz of New York Personal Injury Law Blog notes that doctors still top our the pay charts, but complain about malpractice premiums anyway. He cites a survey which states that out of the ten top paying jobs, nine go to medical professionals.
  • Tinker Ready of Boston Health News posts about a new Partners/Harvard HIT blog on clinical informatics. Incidentally, Tinker will host the next issue of Health Wonk Review.
  • In his post Even more ‘Fierce’, Neil Versel of Healthcare IT Blog discusses a new publication FierceEMR, which includes one of his articles about live video links from ambulances to a trauma center in Tucson, Arizona.
  • Although the influenza A (H1N1) or swine flu outbreak is gradually falling out of U.S. news headlines, Kara Rogers of Britannica Blog notes that the full extent of the outbreak may not be known for some time because other countries are only now experiencing their first cases or are experiencing an increase in confirmed cases as their backlogs of samples are tested.
  • Is our food policy behind the current swine flu pandemic? Eric Michael Johnson discusses how we can best promote national health by changing how our food production policies at The Primate Diaries.
  • And here at Workers Comp Insider, we’ve noted that there’s a new OSHA sheriff in town. Long-time worker safety advocate and former safety blogger extraordinaire Jordan Barab is serving as Acting OSHA Administrator.

The Best Health Care in the World: Part Two – What does it cost?

Thursday, March 13th, 2008

In 1992 I became a Trustee of a major, tertiary care, teaching hospital in Massachusetts. For Trustee indoctrination, new Trustees spent a week in a classroom learning about every facet of hospital life. One morning we were briefed by the hospital’s CFO. I was astonished to learn that the hospital had 27 different billing systems, one for each insurer and HMO with which it did business. To me, this was Kafkaesque. I mention it now, because in the intervening years, the situation has become worse, much worse.
At 31% of total US health care expenditures, the administrative costs of healthcare providers are double those in Canada (Woolhandler et al, New England Journal of Medicine, August 21, 2003, page 768), and, with the exception of tiny Luxembourg (population 425,000), America’s health administration and insurance costs are the highest of any of the world’s developed democracies.
We spend more, far more, than any other country in the world on health care. Do we get what we pay for? In Parts Two and Three of this series on health care, we examine that question. In Parts Four and Five we relate it all to workers’ compensation, at 3% to 4%, a tiny room in the American health care house that Jack built.
The US compared with other developed countries: The cost explosion.
The United States has been a member of the Organization for Economic Cooperation and Development since the OECD’s founding in 1961 (the forerunner of the OECD was the Organization for European Economic Cooperation, set up under the Marshall Plan in 1947). There are 30 member-countries of the OECD, all democracies, most of which are thought to be the most economically advanced nations in the world.
In September, 2007, the US Congressional Research Service, the best research group you’ve never heard of, published a report for Congress titled, “U.S. Health Care Spending: Comparison with Other OECD Countries.” (Abstract , including downloadable full report in PDF.) This 60-page, well sourced report paints a grim, if occasionally confusing picture.
Until 1980, US spending on health care, as measured as a percentage of gross domestic product (GDP) ranked at the high end of OECD countries, but not excessively so. In 1980, US spending as a share of GDP was 8.8%, which compared favorably to Sweden’s 9.0%, Denmark’s 8.9%, Ireland’s 8.3% and the Netherlands 7.2%. True, spending in the United Kingdom, at 5.6%, France and Norway, at 7.0%, each, and Canada, at 7.1%, was lower, but no one could claim that the US spending was out of control.
Then something happened. By 1990, our spending as a share of GDP had grown to 11.9%, while the rest of the OECD countries remained fairly static – Sweden’s and Denmark’s declined to 8.3%, the UK’s rose to 6.0%, and so on. And by 2003, the US share had ballooned to 15.3%, nearly three percentage points higher than Switzerland, at the time our closest competitor. In fact, in 2004, the OECD average spending as a percentage share of GDP, excluding the US, was 8.6%, just over half of the US share.
In the average OECD country nearly 74% of healthcare costs are publicly financed; in the US, less than 45 %. Moreover, per capita health care spending in OECD countries, excluding the US is $2,438; in the US, per capita spending is 250% higher, at $6,102.
When analyzing why the US spends so much more on health care, one hardly knows where to begin, because in nearly every category we dwarf the field.
Take prescription drugs, for example. Average per capita spending on pharmaceuticals among all OECD countries, including the US is $383, but in the US it is $752, which is $153 dollars per person more than the second largest spender, France. Despite this, because the US spends so much on all of health care, pharmaceuticals account for only 12.3% of total spending, which is near the bottom of the pack among all OECD countries where average spending on pharmaceuticals is 17.8%.
One would think, perhaps, that spending is so much higher in the US because we have more hospitalization, or doctor visits per capita, but one would be wrong. Hospital discharges per 1,000 people in the US are 25% lower than the average for all OECD countries, and doctor visits are 42% lower.
Well, maybe people have significantly more intense and aggressive service while they are hospitalized in the US? One indicator of intensity is the average length of acute care hospital stay. In the US, the length of acute hospital stay is 5.6 days, which is less than all but eight of the other 29 OECD countries. But shorter stays could mean higher efficiency. A better way to look at it is to look at specific causes for hospital stays, like heart attacks, for instance. The US average hospital stay following acute myocardial infarction is 5.5 days, the lowest in the OECD.
Consider childbirth. Here the US has the third-lowest rate of stay, 1.9 days – much shorter than the OECD average of 3.6 days.
Another reason for high costs in the US is our aggressive testing. Only Japan has more CT scanners and MRI units per million people.
And, although doctors will roll their eyes when they read this, still another reason for our higher costs is physician compensation. At an average of $230,000 and $161,000 for specialist and general practitioner pay, respectively, each of these groups earns more than double their OECD counterparts.
Clearly then, there is no denying that, for whatever reasons, the US outspends its OECD partners by a long shot. The question that has to be asked is: Are we getting what we are paying for? All of us, taxpayers, employers, employees and individuals – the collective “we.”
That will be the subject of Part Three in this series.
Prior posts in this series:
Part 1: The best health care plan in America

Washington passes “Safe Patient Handling” legislation

Thursday, March 23rd, 2006

Few think of health care as one of the nation’s most hazardous professions, but there you have it: nurses, nursing home attendants, and other health care workers are among the nation’s most frequently injured work population, suffering from a high incidence of musculoskeletal injuries. Patient care calls for frequent lifting and moving, and this wreaks havoc with the back and shoulders. It’s estimated that as many as 12 to 18% of all nurses stop practicing due to chronic back pain. The nursing shortage means that many health care workers have to do more with less, increasing the likelihood of injury; ironically, these injuries may be a primary culprit in exacerbating the nursing shortage.
Not to mention the hazards to the patient. When you are at your most vulnerable, do you really want a single nurse to be heaving you about? Bill Cosby used to have a stand-up routine about how you never wanted to hear a doctor say “oops.” Similarly, When you are taking your first steps after major surgery, you don’t really want the nurse who is helping you to say “ouch” – a helper who is writhing in pain may not be in your best interests.
Legislators in Washington – prompted by the Washington State Nurses Association, United Food and Commercial Workers Local 141 and Service Employees International Union 1199NW – just passed a Safe Patient Handling law that requires hospitals to provide mechanical lift equipment for the safe lifting and movement of patients. According to Occupational Hazards:

“On a timeline between Feb. 1, 2007, and Jan. 30, 2010, Washington hospitals must take measures including implementation of a safe patient handling policy and acquisition of their choice of either one readily available lift per acute-care unit on the same floor, one lift for every 10 acute-care inpatient beds or lift equipment for use by specially trained lift teams.”

In August, we reported on Texas legislation that required nursing homes and hospitals to implement safe patient handling and movement programs. Most importantly, both laws have provisions that protect health care workers from reprisals should they refuse to perform patient handling that they deem potentially harmful to themselves or their patients.

Don’t let medical providers “discount” your injured workers

Wednesday, August 24th, 2005

We talked a bit about “framing” on Monday – the depersonalization that can occur when people are lumped into broad categories or stereotypes, and how that pigeonholing can set the trajectory for future behaviors and events. Thus, an injured worker can make the leap from being your best employee to a rather suspicious “claimant” in one fell swoop. So it was of some interest when, in doing our weekly medical blog rounds, we came upon a post that related to the transformation and depersonalization that often occurs when one becomes “a patient.”
Rita Schwab at MSSPNexus points us to a story in The New York Times about the degrading shift from person to patient* that often occurs when one crosses the threshold into a hospital. Rita comments that, often, ” … the courtesies that help lubricate and dignify civil society are neglected precisely when they are needed most, when people are feeling acutely cut off from others and betrayed by their own bodies.”
She excerpts this incident from the article:
“Mary Duffy was lying in bed half-asleep on the morning after her breast cancer surgery in February when a group of white-coated strangers filed into her hospital room.
Without a word, one of them – a man – leaned over Ms. Duffy, pulled back her blanket, and stripped her nightgown from her shoulders.
Weak from the surgery, Ms. Duffy, 55, still managed to exclaim, “Well, good morning,” a quiver of sarcasm in her voice.
But the doctor ignored her. He talked about carcinomas and circled her bed like a presenter at a lawnmower trade show, while his audience, a half-dozen medical students in their 20’s, stared at Ms. Duffy’s naked body with detached curiosity, she said. “

If you or a family member has been hospitalized recently, you may identify with some of the stories and issues discussed in the article. It made me recall The Doctor, an old film in which William Hurt played a successful but brusque surgeon who learned what it feels like to have the tables turned after he gets cancer.
(* If the NYT article is archived, you may be able to access it from here with free registration.)
What happens when your injured workers visit the doctor?
Employers need to give some thought to what happens when their injured workers become patients. As Rita points out, this is a very vulnerable point for your employee and the medical milieu can be a highly confusing and frustrating labyrinth. In addition to all the regular depersonalization inherent in encounters with the medical world, employees who seek care under the banner of workers comp can be made to feel like they are somehow less worthy, second-class patients. And in a sense, they are – workers comp rates are generally discounted by fee schedules and network negotiations; further, some providers are reluctant to be involved in what they see as a potentially contentious case.
Employers that truly care about the recovery of their injured workers would do well to assume the role of patient advocate. This entails advance planning by seeking out and meeting the quality medical providers near your facilities and making these doctors familiar with your organization and your return-to-work programs. In representing your work force, you have more buying power and more influence to ensure timely service and priority care than any one individual walking in off the street would. If an employee is experiencing frustration or confusion during the course of treatment, you want to know that and be in a position to help resolve those issues whenever possible. If you don’t pay attention to those frustrations, an attorney would be glad to!
Hands-on advocacy
Often, employers think that managing the relationship with providers is the job of the insurer or the contracted network, but we would argue that this is not a relationship that can be “outsourced” on the day-to-day managerial level. Employers need to be an active participant in this relationship, and to ensure that injured employees get top quality care and service. And we would add that a good place to begin is to be more concerned with quality than with discounts when seeking out a network or a doctor — in fact, we often encourage employers to pay more to ensure good service. Cheap medical care is no bargain; a few extra dollars spent early might be the best bargain of all.

Google New Hires!

Monday, June 20th, 2005

If you were to Google the name “Dr. Jayant Patel,” you would find over 20,000 references going back a number of years. The more recent entries are undoubtedly the most alarming. “Dr. Death” has been implicated in the demise of 87 patients at a municipal hospital in Bundaberg, Australia. He has become infamous for not washing his hands between surgeries, for failing to use anesthesia during surgery and perhaps most famously, for performing a colostomy backwards (I’m not sure what that would look like, and I don’t really want to know). If you do take a few moments to google his name, you would be more diligent in researching the doctor than were his previous employer and the executive recruitment firm that brought him to Australia. Therein lies our tale.
Bundaberg is a farming community on the eastern coast of Australia, just south of the Great Barrier Reef. They are famous for “Bundy Rum” — an alcoholic beverage that presumably bears no relationship to the star of the dubious sitcom, “Married with Children.” The local municipal hospital was delighted to find a former professor of surgery at the State University of New York who was willing to relocate to Australia. Unfortunately, his tenure down under was not unlike his work in Oregon and New York. He had been suspended in New York and his license had been revoked in Oregon, where he had once worked for Kaiser Permanente.
Whistleblower Blown Off
One of the striking aspects of the story as presented in the New York Times (registration required) involves the head nurse at the hospital, Toni Ellen Hoffman. She continuously raised her concerns about Dr. Patel’s performance with hospital administrators, only to be told that she had a “personality problem.” After a particularly shocking incident, where a 9 year old girl watched her father die through Patel’s neglect, the nurse requested an inquiry. The administration’s response? They named Patel as the employee of the month!
Finally, as the result of a legislative inquiry, Dr. Patel’s name was published in a paper. An enterprising reporter Googled the name and the scandal finally exploded. Dr. Patel fled the country, returning to Oregon where he lives in a mansion and appears to be unenthusiastic about returning to Australia, where he could face charges of homicide.
Management Lessons
We often talk about the potential negligence involved in hiring and entrusting incompetent or dangerous people to carry out their responsibilities. Here we certainly have a case of negligence in hiring: the hospital in Bundaberg was so excited to find a credentialed foreigner willing to join their staff, they did not look beyond the documents he presented about himself. As we have seen, a simple Google search would have exposed Patel as both incompetent and dangerous.
In addition, Patel carried letters of reference from several of his Oregon colleagues. These letters were provided after his termination for cause; the doctors who wrote them are likely to find themselves involved in the many lawsuits that are going to come out of this situation, under the legal concept of “negligent reference.” Then again, perhaps the colleague who described Patel as “above average” has a very low opinion of the average doctor!
Beyond these examples of negligence, hospital administrators really messed up when they failed to respond to the alarms raised by a trusted member of the staff. The administration went into a denial mode that will severely compound their negligence in hiring: it’s bad enough to drop the ball on reference checking, but far more serious to ignore the evidence right in front of your eyes. The lawyers will have a field day.
Some are calling Patel a psychopath. Others think he is simply incompetent. The bottom line is that he did not belong in any operating room, anywhere in the world, including one in a relatively remote town on the shores of Australia. With the advent of the internet, the HR folks in Australia had access to the same data available in New York City. So here’s our advice: google new hires. It doesn’t cost anything, it only takes a few moments, and it might save you a whole lot of pain, suffering and trouble.

Docs and Jocks: Exclusive Remedy for a Pro Football Player

Wednesday, April 13th, 2005

I set out this morning to blog the general status of “exclusive remedy” in the workers comp system, but I’ve been distracted by a specific case which involves an injury to a professional athlete. I will return to the more general ramifications of “exclusive remedy” in a few days.
Greg Lotysz was a lineman for the New York Jets. In July of 2000 he sustained an injury to the anterior ligament of his left knee while blocking another player during pre-season practice . Pursuant to his NFL Player contract and the players’s Collective Bargaining Agreement, he received care from the Jets’ Medical Department. Lotysz underwent surgery and post-surgery rehabilitation under the care of the Jets’ physicians. A post-surgical infection resulted in permanent damage to his knee, which in turn brought a premature end to his football career.
No Malpractice Here
Lotysz tried to sue the team doctors for $10 million in damages, but in December of 2002 an appeals court in New York ruled against him. The court found that the doctors were employees of the Jets, that their medical services were made available to plaintiff as a consequence of his employment and that their services were not available to members of the general public. In other words, the court viewed the team doctors as co-workers of the same employer, so tort liability was not available as a remedy. You cannot sue your employer and you cannot sue co-workers for work-related injuries. Comp was the “exclusive remedy” for the injured player. It’s interesting to note that the unions for all the major pro-sports leagues (NFL, NBA, NHL and MLB) filed a friends-of-the-court brief in Lotysz’s behalf, arguing that team doctors are actually independent contractors. (You can view a detailed case study of Lotysz’s story here.)
The fact that Lotysz’s claim falls under the workers compensation system is not all bad. While he cannot sue the doctors for malpractice, he is eligible for indemnity benefits (admittedly chump change compared to a professional lineman’s salary) and for lifetime medical benefits for any treatments related to the injury (given the apparent permanency of his disability, this could turn out to be a significant benefit).
It is important to note that hospitals and similar medical facilities that treat both the public and their own employees may not find the courts so receptive to the “exclusive remedy” approach. For the most part, when hospitals treat their own employees for work related injuries, they become a third party vendor. If employees are unhappy with the treatment, they usually have the option of pursuing tort remedies. The main difference, I would guess, is that the hospitals routinely treat the public, while the “team doctors” have a more limited practice.
Docs and Jocks
The Lotysz opinion is binding only in New York. It’s possible that under similar circumstances other states will conclude that team doctors are indeed third parties and thus liable to lawsuits for malpractice. In the world of professional athletics, the medical profession is intricately involved in what from time to time may be ambiguous circumstances. With such enormous sums of money at stake, owners may pressure doctors to rush star athletes back onto the field. Permanent damage may result. Under these circumstances the player will certainly want to pursue a tort remedy. Whether this option is available to the athlete remains a state by state situation.