AHA Leadership Summit: Referral Relationships

We've got more from Kirk Mathews on the AHA Leadership Summit last weekend. Kirk was impressed by a session about managing the referral process--ie, ensuring a patient ends up at your hospital--led by Marc D. Halley, MBA. Key points from Mr. Halley, via Kirk:

• "Physician integration" these days = hospitals employing physicians...a strategy that became popular in the early '90s. Unfortunately, many hospitals are making the same mistakes as in the '90s, including:

--overpaying for physicians
--removing ancillary services from the physicians' offices and putting them all in the hospital
--adding to employment costs by providing benefits the doctors didn't provide to themselves
--adding occupancy costs by taking doctors from a $14 space and moving them to a $20 space
--disengaging doctors from the governance and business performance of the practice
--inadequately managing talent
--misunderstanding the "retail" side of the business

• The CEO should function as a market manager who understands medical practices (the needs, desires and priorities), has a market plan and has great customer contact. He or she needs to know where, precisely, the market is; who holds the market (is it PCPs?); and what the market holders are doing with it.
• Cultivating relationships is key, because referrals follow relationships. Relationships will atrophy over time, unless they are actively maintained.
  

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posted by Jessica Berthold at 12:42 PM   0 Comments

AHA Leadership Summit: How CEOs can avoid getting fired

Kirk Mathews, CEO of Inpatient Management, Inc. of St. Louis, Mo., attended the AHA Leadership Summit this past weekend, and graciously agreed to share what he learned at various sessions. Here's a paraphrase from Kirk about a session entitled "'How to Avoid the 'Pink Slip'," which covered different hospital CEO leadership styles, and how CEOs can avoid getting fired:

The session started by listing the four main reasons a CEO gets fired: failure to understand or respond to physicians' needs, failure to recognize one's own shortcomings, failure to recognize early warning signs of organizational unrest, and failure to anticipate and manage board issues.

Warnings signs of medical staff unrest might include physicians meeting off-site, a lowering of surgeon satisfaction, a lack of dialogue with medical staff, an increase in doctor-owned competing entities, and a decrease in market share. On a related note, CEOs who harbor a distrust of physicians--and who give off that impression--can expect the election of medical staff who are anti-administration.

Physician CEOs aren't necessarily better at medical staff relations than non-physician CEOs. Physician CEOs must know enough to surround themselves with good business people, and be prepared for the possibility that some of their physician colleagues will view them as traitors when they become CEOs. It's also important for CEOs to personally do outreach with those "medical staff" who aren't physically in the hospital but are still integral to its success: the primary care doctors who make referrals.

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posted by Jessica Berthold at 11:24 AM   0 Comments

Primary care internist objects to hospitalist's "provider"

I am ashamed to admit that I actually felt annoyed tonight over being referred to as a "primary care provider." It is hard to explain that after 21 years of education and another 23 years of practice as a specialist in Internal Medicine, I would be bothered by this.

One of my patients that I have cared for for 20 years was admitted to the hospital after going to the ER with abdominal pain. I was not informed of his admission and the hospitalist became the attending physician. The patient called me today from his hospital bed to inform me. He actually had a previously scheduled appointment with me in the office today and, good patient that he is, was calling to say he couldn't make it. He assumed I already knew he was admitted to the hospital. I asked him to have the attending doctor call me as soon as he/she made rounds.

I got the call from a young-sounding hospitalist who did not know my name and wondered if I was the "primary care provider." When I replied that I was his physician, she then said, "Oh, I don't usually call the primary care provider." That phrase just stopped me cold. It is so "insurance" sounding. So contrived and replaceable. Primary care provider ... delivery man ... vacuum cleaner salesman ... Roto-Rooter man. It's the doctor you can dismiss if you are a hospitalist, one or two years out of training.

"I don't usually call the primary care provider."

Guess I better get thicker skin.

Toni Brayer, FACP, is an ACP Internist editorial board member who blogs at EverythingHealth, designed to address the rapid changes in science, medicine, health and healing in the 21st Century.

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posted by Ryan DuBosar at 9:35 AM   1 Comments

Apologizing for errors halves malpractice suits

University of Michigan Health System reports that admitting medical errors and offering compensation before being sued resulted in malpractice claims falling from 121 in 2001 to 61 in 2006, with corresponding savings in costs per claim.

The Associated Press profiled the hospital system's efforts not only as a business decision but also an ethical one that benefits patients, while not exposing the system to further litigation.

Apologies aren't easy, but ACP's news publications have offered advice to make them easier:
--"Internist searches for answers when test results go missing," ACP Internist, April 2009.
--"Apologize like a pro," ACP Hospitalist, January 2008.
--"To err is human ... to not plan for it is trouble," ACP Hospitalist, December 2008.
--"Owning up to a mistake takes courage--and practice," ACP Internist, April 2009.

Also, PIER offers an entire module on disclosing medical errors, and Annals of Internal Medicine looked at the state-by-state efforts to implement shield laws for physicians who disclose errors.

Labels: ethics, malpractice, patient communication

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posted by Ryan DuBosar at 11:03 AM   0 Comments

Nursing shortage turns into a glut

For years we have heard there is a shortage of nurses and as recently as today, the California Senate Education Committee approved a bill (AB867) to "address a severe nursing shortage in California." The Health Resources and Services Administration (HRSA) projects that 90% more RNs must be produced in order to meet the predicted need for one million new nurses in the American health care system by 2020.

So if there is such a shortage ... why can't new nurse graduates find a position? I was pleased to pass on the name of a new RN school graduate who had great references from previous allied health care work and was told by the hospital:

"Virtually no one is doing a new grad training program at this time. We have made the commitment to "trickle in" some new grads this fall and received over 1,000 applications for five positions. I might suggest this individual get their foot in the door as a nurse's aide, phlebotomist or some other non-nursing job. Unfortunately, the economy has turned our profound nursing shortage into a glut, virtually overnight."

Upon investigation I find that there is actually an overabundance of nurses in Canada, the Philippines as well as across the United States. There may be openings for experienced critical care nurses, but medical-surgical nurses are pounding the pavement looking for work and finding few or no jobs available. There are hundreds of nurses vying for every opening. The jobs just aren't there.

The downturn in the economy means more older nurses are keeping their jobs and delaying retirement. Hospital census is down and staffing is lean. Is that enough to turn a shortage into a glut? Apparently it is, or the prior predictions just weren't true.

Experts are still saying there will be a shortage after the recession is over that will only get worse in coming years. But for now, it looks like nurses are not in demand and there are thousands of unemployed RNs looking for work.

Toni Brayer, FACP, blogs at EverythingHealth, designed to address the rapid changes in science, medicine, health and healing in the 21st Century.

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posted by Ryan DuBosar at 9:30 AM   0 Comments

Hospital Compare site adds 30-day mortality, readmissions data

CMS has added information on mortality rates and readmissions to its Hospital Compare Web site, according to a news release.

Specifically, the site has added 30-day mortality rates for patients admitted to the hospital for heart failure, acute myocardial infarction and pneumonia, as well as 30-day readmissions measures for patients who were originally admitted to the hospital for one of these 3 conditions.


Using three years of claims data, CMS estimates that the national 30-day mortality rate is 16.6% for patients originally admitted for heart attack, 11.1% for heart failure patients, and 11.5% for pneumonia patients. The Hospital Compare site shows whether a hospital's mortality or readmissions rate is "better than," "no different from," or "worse than" these U.S. national rates.


The data also show that, on average, 19.9% of patients admitted to a hospital for heart attack treatment will return within 30 days, compared to 24.5% of patients admitted for heart failure and 18.2% of patients admitted for pneumonia.

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posted by Jessica Berthold at 4:54 PM   0 Comments