Anesthetists debate has struck a nerve

A lawsuit in California has been the hottest topic on our Web site over the past week—and it’s easy to understand why.

The issue features two large physician groups, the California Medical Association and California Society of Anesthesiologists, who are alleging that California Gov. Arnold Schwarzenegger’s move to allow nurse anesthetists to administer anesthesia without physician supervision is a patient safety issue. The groups added that the governor “completely ignored” federal law, which requires a number of procedural steps and consultations with state licensing agencies before taking the action.

“Our concern is, no one has shown that there was ever the need to require doing something this drastic,” Francisco Silva, general counsel for the California Medical Association.

However, nurse anesthetists are defending their ability to administer anesthesia to Medicare patients without physician supervision, saying there’s never been a study showing the practice to be unsafe.

Instead, these groups are saying that certified registered nurse anesthetists perform the service with equal safety, or even more safely, than anesthesiologists.

California joins 14 other states, all with large rural populations, whose governors exercised the opt-out provision, which allows nurse anesthetists to administer anesthesia without physician supervision. One might not think of California as rural, but at least one county has an anesthesiologist and physician shortage.

According to a survey last year by the California Healthcare Foundation, Kings County had only two anesthesiologists. That survey said that 22 of the state’s 58 counties have five or fewer anesthesiologists.

Is this case simply a turf battle between docs and anesthetists? Is this a way for the state to save money by paying less for services delivered by anesthetists? Or is this a patient safety issue? A combined 18 readers have responded to the two articles so far. Let us know what you think. 

Do Sleepy Medical Residents Jeopardize Patient Care?

The issue of limiting allowable residents’ consecutive work hours is back as the health watchdog group Public Citizen is speaking out about how tired doctors are putting patients—and themselves—at risk.

Public Citizen is asking the feds to limit residents’ consecutive work hours to 16 rather than 30. The group and about 40 patient safety organizations are launching a Web site to both collect information about errors committed by tired medical students as well as push the feds to relax work rules.

“It is likely that there are more deaths in U.S. hospitals each year caused by sleep-deprived doctors than the total number of annual deaths from train and plane accidents in this country,” said Public Citizen Director Sidney Wolfe, MD. “The current limits are too lax.”

Those in support of shorter consecutive work hours point to a 2008 Institute of Medicine recommendation of no more than 16-hour work shifts.

“The science on sleep and human performance is clear that fatigue makes error more likely to occur,” according to the 400-page IOM report.

However, a December 2009 survey that was done by the American Academy of Family Physicians with family medicine residency program directors suggests otherwise. The groups charge that restricting resident duty hours will not improve safety.

They say limiting hours further will lead to more patient hand-offs, which could result in more serious medical errors. For instance, a departing caregiver may not effectively communicate a patient’s new medication order or need for a lab test to the one taking over.

This issue affects so many areas in healthcare: beginning with staffing and leading all the way to quality. There are strong arguments on both sides.

So, what do you think? How many consecutive hours are too many for residents?

Meaningful health reform is dead

Any question about whether comprehensive health reform is still possible in 2010 ended Wednesday night when President Obama buried the topic in his State of the Union.

His former number one domestic item (health reform) followed more than a half-hour on jobs (his new number one domestic item), bank reform, and energy policy. And what the president actually said about health reform was limited and didn’t shed any more light on what kind of reform he actually expects now.

Sure, Obama mentioned the need for health reform and that Congress is close to accomplishing the work. But he didn’t do what was needed. I wrote on this blog yesterday that the president needed to:

• Spark the Democratic leaders to action
• Provide a roadmap of his top health reform provisions
• Suggest whether to continue with a vast health reform package or target specific smaller projects, such as payment reform, additional insurance regulations, pilot projects, and expanding Medicaid and state Children’s Insurance Plans
• Offer an olive branch to Republicans

He accomplished none of those.

So, where are we now? I feel even less confident that meaningful health reform is possible in 2010. Instead, I expect piecemeal reform that attempts to tackle issues, such as added health insurance regulation, subsidies for small businesses to provide health insurance, Medicare/Medicaid/state Children’s Insurance Plans’ expansion, pilots projects, and minor attempts at payment reform.

These small attempts at reform will provide insurance to a small number of the 47 million uninsured while adding some protections for those with pre-existing conditions. The reform will not affect other important issues though, such as spiraling costs and quality.

Congress and Obama had an opportunity to bring about health system improvements, but that no longer seems possible this year. Meaningful health reform in 2010 is a goner.

Is health reform dead? We’ll find out tonight

Remember the days when health reform was President Barack Obama’s number one domestic agenda item. OK, you only have to think back nine days ago.

That was before Republican Scott Brown won the Senate seat once occupied by the late liberal lion Edward Kennedy. In the days since the special election in Massachusetts, comprehensive health reform has gone from probable to unlikely.

There are conflicting reports out of Washington about what the Democrats will do next, but most believe Democratic leaders will see a large health reform bill as a loser and move onto other domestic issues.

Obama heads to Capitol Hill tonight in a much different political climate than nine days ago. He not only faces a wounded Democratic party, but an emboldened GOP and dissatisfied public.

So, what should Obama say during his State of the Union speech tonight? If health reform is to happen this year, his speech will need to:

• Spark the Democratic leaders to action
• Provide a roadmap of his top health reform provisions
• Suggest whether to continue with a vast health reform package or target specific smaller projects, such as payment reform, additional insurance regulations, pilot projects, and expanding Medicaid and state Children’s Insurance Plans
• Offer an olive branch to Republicans

Tonight, we’ll see whether Obama still views health reform as his number one domestic agenda item or a political quagmire. If he spends more time on bank regulations, job creation, and energy policy, comprehensive healthcare reform isn’t happening this year—or probably during Obama’s presidency.

Five social media lessons for hospitals

We published an article yesterday about a Greystone.Net survey that reported nine in 10 hospitals use social media, but most of them are not having any luck attracting new patients with it.

“It is impossible to ignore the effect that social media is having on the Internet in general, and on hospitals and health systems specifically,” said Mike Schneider, executive vice president of Greystone.Net. “Organizations that have a formal plan to manage their social media interactions are more likely to be successful, and we expect more and more hospital Web departments to embrace this strategy moving forward.”

HealthLeaders Media senior editor Gienna Shaw has written extensively about the topic of hospitals using social media, such as Facebook and Twitter. Here are five articles that can teach your hospital how to best use social media:

• This article looks at how hospitals can get social media buy-in from CEOs.
• This column explores the trend of businesses communicating with their employees through social media.
• Should hospitals use Twitter to describe surgeries in real time? Gienna interviewed Marc Battaglia, associate creative director at Demi & Cooper Advertising in Elgin, IL, who said the benefits outweigh the negatives.
• The headline of this article says it all: OK, We’re on Facebook. Now What?
• Here is one of the most widely read articles on our site in 2009. Gienna describes ways in which hospitals can use social media effectively and a few examples of social media missteps.

Improve your hospital’s claims management

Hospital CFOs agree that there is always room for improvement in the areas of claims denials and underpayments. But often times a “quick fix” doesn’t lead to improvements, says senior editor Karen Munich-Pourshadi.

In this column, Karen suggests financial leaders work with their teams to identify, clarify, and quantify denials and underpayments in order to improve claims management.

How can hospitals improve their revenue stream? Karen spoke to Judith B. Suska, MBA, FHFMA, director at IMA Consulting, to discuss the key components to getting your denials in order.

Karen provides four tips for hospital CFOs. The first one: Build a denial recovery unit. “Members of the task force should include a representative from any function that deals with revenue cycle such as patient access, health information management, case management, finance and there also needs to be clinical representation,” she writes.