Wednesday, February 21, 2007
DaVinci Surgical Robots. A Hospital CEO Asks Advice.
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Running a hospital: da Vinci Uncoded -- or, Surgical Robots Unite!
"Here you have it folks -- the problem facing every hospital, and especially every academic medical center. Do I spend over $1 million on a machine that has no proven incremental value for patients, so that our doctors can become adept at using it and stay up-to-date with the "state of the art", so that I can then spend more money marketing it, and so that I can protect profitable market share against similar moves by my competitors?"
I just discovered this blog today via Medgadget and am already impressed. The large health system our group works in purchased a DaVinci last year. I don't know outcomes yet but it was apparent to me before the purchase that it was largely driven by regional competition in Central Pennsylvania. I think it's telling that many of the institutions which were the early adopters no longer use the systems.
I'm hoping to pick one up cheap in a couple of years so I can do labor epidurals from home. ;-p
Monday, February 19, 2007
Is CRNA Independent Practice Coming to Pennsylvania?
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Governor Rendell's 2007 budget document includes a section titled Prescription for Pennsylvania on page A3.32. The first paragraph of that section states:
"Ensuring that all licensed health care providers – including nurses, advanced nurse practitioners, midwives, physician assistants, pharmacists and dental hygienists – can practice to the fullest extent of their training. Pennsylvania consistently lags behind other states in fully utilizing health care providers who are not physicians. Prescription for Pennsylvania will seek to eliminate the barriers in existing laws, regulations and insurance reimbursement policies that limit the ability of health care providers to practice to the fullest extent allowed by their training and education."
Sounds like independent practice to me. Rather than write a knee-jerk reaction right now, I'd like to take some time to educate myself and consider the ramifications...
Saturday, January 21, 2006
Can damage caps influence premium growth and physician supply?
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The Impact of Caps on Damages: How are Markets for Medical Liability Insurance and Medical Services Affected?
"[This report] provides a summary of research on the impact of caps including those on punitive and total damages in addition to those that apply only to non-economic damages. Our focus is on those papers that employ statistical techniques to control for potentially competing explanations of changes that are observed when simple descriptive statistics are used."
and concludes
"the body of research on the impacts of tort reform shows that caps have resulted in lower growth in medical liability losses in states that passed caps than in states that did not. The more recent literature on premium effects has found that caps result in lower premium growth. And, two very recent papers based on sufficiently many years of the AMAâs Masterfile data have found that non-economic caps and direct tort reforms more generally have a positive effect on the number of physicians per capita in a state."
Sunday, January 1, 2006
QA On New Medicare Part B Prescription Drug Plan
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Deconstructing drug plan
- Who is eligible for the new Medicare drug benefit?
- What does the basic Part D plan include?
- Do I have to enroll in a Medicare drug plan?
- Do I have to decide today?
- What if I miss the deadline?
- My drug costs are really low and I don't have any coverage. Do I really need this?
More at http://www.medicare.gov/pdphome.asp
Saturday, March 12, 2005
Consequences of Physician Report Cards
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The Medical Informatics Weblog: Consequences of Physician Report Cards:
"Reporting quality information publicly can promote quality improvement. However, according to an article in the current issue of the JAMA, the Journal of the American Medical Association, the value of publicly reporting quality information is essentially undemonstrated and may have unintended and negative consequences on health care. These unintended consequences include causing physicians to avoid sick patients in an attempt to improve their quality ranking, encouraging physicians to achieve “target rates” for health care interventions even when it may be inappropriate among some patients, and discounting patient preferences and clinical judgment."
This is a very timely JAMA article as the Pennsylvania Health Care Cost Containment Council has just published its Guide to Coronary Bypass Graft Surgery 2003 in which it assigns higher than expected adjusted mortality mortality scores to three surgeons that I feel are head and shoulders above the rest in the list. In other words, it dinged the surgeons I think are the best. (as an aside, none practice an Pennsylvania any longer)
Frist Indicates Willingness To Compromise With Democrats on Malpractice Legislation
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Kaisernetwork.org--Frist Indicates Willingness To Compromise With Democrats on Malpractice Legislation:
" Senate Majority Leader Bill Frist (R-Tenn.) on Thursday said he would again push for medical malpractice legislation this session and indicated that he would consider compromises with Democrats to examine the "elements of insurance reform" in addition to establishing caps on noneconomic damages awards, CongressDaily reports. Republicans have been unsuccessful in passing legislation that would impose a $250,000 cap on noneconomic damages because of Democratic filibusters. Democrats maintain that rising medical malpractice insurance premiums stem from problems within the insurance industry. Frist suggested that he might be willing to reconsider the $250,000 limit but added, "There absolutely should be a cap." According to Frist, medical malpractice reform will be considered in the Senate after bankruptcy and other tort reform legislation, including changes to the asbestos litigation system, are addressed (Heil, CongressDaily, 3/10). "
Senate Committee Approves Bill To Establish Medical Error Reporting Database
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Kaisernetwork.org--Capitol Hill Watch | Senate Committee Approves Bill To Establish Medical Error Reporting Database - :
" The Senate Health, Education, Labor and Pension Committee on Wednesday approved by voice vote a bill (S 544) that would create a database to allow care providers to report medical errors, CQ Today reports. The database would be used to track medical errors, examine trends and prevent reoccurring mistakes, CQ Today reports. Information included in the database would not be used in medical malpractice lawsuits, according to CQ Today. Before the full Senate considers the measure, committee Chair Michael Enzi (R-Wyo.) and Sen. Edward Kennedy (D-Mass.) are expected to insert language to clarify that the bill would not affect information already available to attorneys for use in malpractice suits. The committee last year approved similar legislation, which was unanimously approved by the Senate. The House approved a separate version of the legislation, but the issue died after conference committee members were not appointed. The new bill is expected to pass the Senate. The House Energy and Commerce Committee has not yet scheduled a review of the bill (Schuler, CQ Today, 3/9). "
Wednesday, February 2, 2005
FactCheck: MoveOn.org Social Security Ad
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FactCheck.org got its start during the presidential election cycle and aims to "reduce the level of deception and confusion in U.S. politics." A project of the Annenberg Public Policy Center of the University of Pennsylvania, it periodically published 'fact checks' when it feels facts need to be checked (obviously). Their latest analysis is titled 'MoveOn.org Social Security Ad: Liberal group's ad falsely claims Bush plan would cut benefits 46 percent'.
" Summary
MoveOn.org launched a false TV ad in the districts of several House members, claiming through images and words that President Bush plans to cut Social Security benefits nearly in half. Showing white-haired workers lifting boxes, mopping floors, shoveling and laundering, the ad says "it won't be long before America introduces the working retirement."
Actually, Bush has said repeatedly he won't propose any cuts for those already retired, or near retirement. What MoveOn.org calls "Bush's planned Social Security benefit cuts" is actually a plan that would hold starting Social Security benefits steady in purchasing power, rather than allowing them to nearly double over the next 75 years as they are projected to do under the current benefit formula. The White House has discussed such a proposal, and may or may not adopt it when the President puts forth a detailed plan expected in late February. "
As physicians I think we need to be familiar with the facts about such major policy changes and FactCheck helps. If you like, you may sign up to receive future reports automatically.
Friday, January 7, 2005
Does Race-based Affirmative Action Help Professional Students?
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An article is about to be published in the Stanford Law Review that is already creating a great deal of buzz in the law community. UCLA Law School professor Rick Sanders has written "Systematic Analysis of Affirmative Action in American Law Schools" which argues that African American students have been materially and tangibly harmed by law school affirmative action policies (a summary is here).
" "In the case of blacks, at least, the objective costs of preferential admissions appear to substantially outweigh the benefits. The basic theory driving many of these findings is known as the “academic mismatch” mechanism; attending an advanced school where one’s credentials are far below those of one’s peers has a variety of negative effects on learning, motivation, and goals that harm the beneficiary of the preference. Over the past several years, a wide range of scholars have documented the operation of the mismatch mechanism in a number of fields of higher education. " "
Based on my experience as a medical student and then as a member of medical school admissions committees, these finding resonate with me. I hope that a similar analysis can be done for medical school admissions. More importantly, I hope we can have an open discussion focussed on what's best for the individual students.
Sunday, December 19, 2004
Ambulatory Care, Procedures Requiring Surgical Site Marking
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JCAHO: Ambulatory Care, Procedures Requiring Surgical Site Marking:
" "marking the site is required for procedures involving right/left distinction, multiple structures (such as fingers and toes), or levels (as in spinal procedures). Site marking is not required (nor is it prohibited) for other procedures." "
Thursday, December 9, 2004
Unreliable System Fails Doctors and Patients
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" "The Washington Post takes a detailed look at a single medical malpractice case--one that began when Dr. Kevin Kearney of Maryland's Eastern Shore urged an 18-year-old mother to have her baby without a Caesarean section. What followed was a complicated delivery resulting in permanent injuries to the child, and a multi-year legal battle, filled with dramatic moments that illustrate how an unreliable system can fail both doctors and patients." "
[Via MedWatch]
Tuesday, December 7, 2004
Laparoscopy and Ambulatory Surgery Centers in PA
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The Pennsylvania Department of Health sent a letter to all Ambulatory Surgery Centers in Pennsylvania reminding them that they are not to perform laparoscopic surgeries which:
" 'require major or prolonged invasion of body cavities.' "
Noting that:
" 'the risk of injury to abdominal and other internal organs and structures is not lessened. In fact, there are some reports that the risk of injury may be increased. (Peter D. Jacobson, Medical Liability and the Culture of Technology, PEW Project on Medical Liability, released 9/22/04). ' "
My reading of the Pew report turns up no data implicating ambulatory surgery centers (ASC's) specifically in injuries from laparoscopic procedures. Nothing to suggest that eliminating most laparoscopic procedures from ASC's will improve patients safety. In an era when 'evidence based medicine' is the watchword for practitioners, this kind of blanket policy by the government is difficult for me to swallow.
I suspect (though cannot prove) that hospitals have brought political pressure to bear on the Governor and/or Department of Health to make this policy change in order to bring a very profitable class of surgery back to the hospital setting. The facility fees collected for laparoscopic surgery are considerable, and hospitals feel they've been missing out.
Another example to suggest hospitals have been active in this area is the requirement by some payors that orthopedic implant surgeries be performed in hospitals rather than free standing ASC's. For example, we used to perform rotator cuff repairs (which use an anchor suture) in the ASC, but they can no longer be done here because the insurance company will only pay for the anchors if placed in a hospital. There is just no reason I can think of for this requirement other than to force surgeries back into hospitals and away from ASC's.
12/8/04 update: it is on the state servers at: http://app2.health.state.pa.us/commonpoc/content/facilityweb/FacMsgBoardDetails.asp?msgid=819&msgindex=2&Selection=ALL
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