July 15, 2010
3:32 pm
Two news stories this week raise serious concerns about the effectiveness of systems intended to act upon physicians and nurses who don’t meet adequate standards for providing patient care.
• A Massachusetts General Hospital survey of more than 3,000 physicians across multiple specialties found that one of every three doctors rejected the idea that they should report colleagues who are incompetent or impaired by substance abuse or mental health problems. The survey found that 17 percent of doctors had encountered a physician who was either incompetent or impaired, but only two-thirds of those doctors turned in their colleague.
• In today’s USA Today, it was reported that nurses who have committed acts of misconduct in some states can easily get jobs in other states that are part of a multi-state compact aimed at getting nurses into regions that need them the most. The news article cited a nurse in Wisconsin who was fired for stealing narcotics, but still maintained a clean record in the eyes of the multi-state compact and was able to easily get another nursing job in North Carolina.
I don’t want to oversimplify these issues. Certainly, it is difficult for physicians, in order to maintain open lines of communication and collaboration, to “snitch” on a colleague who has an addiction problem or who may even be suffering early signs of dementia. And, for nurses, the idea of multi-state cooperation is a good one because innovative steps need to be taken to address the nursing shortages that exist in so many parts of the country.
In the end, though, the patient has to come first, and patients can’t be put at risk by any lessening of standards when it comes to the quality of physicians and nurses. There is a need here for associations representing both professions to be proactive in ensuring that all members in their ranks meet the highest standards.
July 13, 2010
3:57 pm
An organization of health industry chief executives today applauded federal regulators for being responsive to the concerns of hospitals and physicians in constructing the final “meaningful use” regulations that will determine the allocation of health information technology (HIT) incentive funds. But, said the president of the Healthcare Leadership Council (HLC), the newly-released rules leave some critical issues still unaddressed.
HLC president Mary R. Grealy said that, even though her organization was still analyzing the regulations, “it’s clear that federal regulators paid close attention to the more than 2,000 comments they received on the proposed rule, and that they have been responsive to concerns that the initial regulations placed the “meaningful use” bar so unrealistically high that the health technology revolution would have been slowed instead of accelerated.”
The “meaningful use” regulations establish standards that health providers must meet in order to qualify for a share of the more than $27 billion authorized by Congress in last year’s economic stimulus legislation.
The Healthcare Leadership Council is a coalition of chief executives from all sectors of American healthcare.
Ms. Grealy said, “An example of this responsiveness is seen in the fact that the rules no longer require that, in the initial stage of implementation, all of a health provider’s administrative transactions must be included in an electronic health record. That simply wasn’t realistic. Those requirements are now in Phase 2 of implementation, which is achievable.”
She said, though, that legitimate concerns remain. For example, the regulations should consider each campus of a multi-campus hospital system as a separate entity in qualifying for HIT incentive payments. And, she said, health providers who have built and succeeded with their own information technology systems should be grandfathered into the universe of successful “meaningful use” qualifiers, but that doesn’t appear to be the case based on an initial review of the rules released today.
Nonetheless, Ms. Grealy said, “we’re seeing important progress with these regulations. Clearly, the administration saw there was a gap between the theoretical standards they initially wanted to apply and the real-world challenges that physicians and hospitals face in achieving HIT advancement. We all want the benefits that come from information technology – enhanced patient safety, more cost-efficient operations, greater use of evidence-based medicine – but to make strides forward, regulators and providers need to be moving at a coordinated pace.”
June 02, 2010
11:03 am
It’s so ironic that it could almost pass for satire. Some in Congress want to use a food safety bill currently making its way through the legislative process as a vehicle to press for prescription drug importation. Using a measure to protect the safety of what we eat as a means to make ourselves more vulnerable to dangerous counterfeit medications? To say the least, it defies logic.
Congressman John Dingell (D-MI) doesn’t find it the least bit amusing. He’s the sponsor of the House food safety bill and, according to an article in The Hill newspaper, he is extremely concerned that a drug importation amendment being pushed by some of his counterparts in the Senate could derail the whole measure.
Not only that, but Congressman Dingell believes, correctly, that drug importation is simply a bad idea.
“It will allow this country to be flooded with unsafe, counterfeit drugs, drugs that will not do what they should, drugs that are unsafe, drugs that will kill the American people,” he said, during a 2003 debate on the issue, according to The Hill article.
Senator Byron Dorgan (D-ND), one of the most ardent proponents of importation, argues that the food safety bill may present the last opportunity in this Congress to enact wholesale drug importation into law.
The real question, though, is why do it at all?
Importation proponents argue that it will bring Americans cheaper drugs. And yet, the nation’s wholesale distribution companies have testified before Congress that the storage, relabeling, transportation, inspection and liability protection costs involved in bringing prescription medicines into the country would wipe out any savings. So, with incidences of counterfeit drugs on the rise globally, we would be incurring greater risk without reaping any meaningful benefits.
Instead of clamoring to import other countries’ price controls into the U.S., wouldn’t it make more sense to make this an international trade issue and push price-controlling nations to pay their fair share for American pharmaceutical innovation?
Congress would do well to listen to John Dingell on this issue.
March 25, 2010
4:02 pm
The op-ed piece by Deborah Peel, who heads the Coalition for Patient Privacy, that appeared in The Wall Street Journal this week received an inordinate amount of attention. That’s because Matt Drudge of the popular Drudge Report website seized upon the Journal’s headline, “Your Medical Records Aren’t Secure” and listed it among several other stories critical of President Obama’s healthcare plan.
But Dr. Peel’s op-ed wasn’t criticizing the President. The targets of her op-ed included hospitals, pharmacies, employers and a litany of others who are out to plunder our personal medical records for financial gain. And, she alleges, these violations of confidentiality are even easier and more likely when health records are maintained electronically instead of on paper. She insists that the answer lies in giving patients the responsibility to decide what information they choose to share with medical professionals and what to keep secret.
Dr. Peel’s logic train goes off the tracks rather quickly. First of all, it’s simply not true that electronic records are less secure than paper ones. In her op-ed, she chooses to not acknowledge the role HIPAA privacy laws have played in keeping health information confidential. She ignores the new laws adopted earlier this year that strongly encourage encryption of electronic data and that impose new criminal and civil penalties for privacy violations. And you would never know from the op-ed in the Journal that hospitals, insurers and physicians throughout the country have taken extraordinary steps to safeguard patient data.
So we can see that any privacy “crisis” is overblown. The greater problem lies in the proposed solutions.
Giving patients the responsibility to decide which portions of their medical records should be open to healthcare professionals is, at best, unreasonable and, at worst, potentially deadly. It is highly unlikely that a patient without a medical background can make a sound decision on what information a physician might need to provide quality treatment.
But an even greater potential harm lies in the society-wide impact of ill-advised patient consent proposals. Enabling system-wide picking and choosing of what data enters the flow of essential information will have an impact on the many beneficial actions that are dependent upon information collection and analysis, such as:
• Reporting and tracking incidences of disease for public health purposes
• Monitoring the quality and safety of medical products
• Carrying out product recalls
• Medical research into lifesaving cures and treatments.
Our health system has dual objectives in this regard. We need to protect patient confidentiality while, at the same time, preserving the vital flow of information that protects, extends and saves lives. Some, as Dr. Peel’s op-ed demonstrates, lose sight of the need to maintain that balance. The fact is, though, that you should never have to choose between privacy and excellent healthcare, and we don’t have to.
March 09, 2010
1:37 pm
In order to boost public support for its health reform push, the White House added a new wrinkle to the Senate-passed reform bill it has, by and large, embraced. The White House proposes to create a new federal agency with the power to review, regulate and, if it so wishes, block health insurance rate increases.
It’s not difficult to see the political strategy involved here. With health insurance premium increases in the news as of late, the health reform debate has been cast as a heroes-versus-villains morality play. A new federal rate commission will save vulnerable Americans from the health insurance industry and its, as one Administration spokesman termed them, “wildly excessive rate increases.”
But, as veteran health policy journalist Robert Pear writes in today’s New York Times, there are serious flaws with this populist initiative.
For one, health insurance premiums are already regulated by the states. As Sean Dilweg, Wisconsin’s insurance commissioner, said, “The federal proposal would be a huge pre-emption of decisions that states have made over their history.”
It’s important to note here the difference between what states actually do and the new federal responsibilities being proposed. When states analyze proposed insurance rate increases, they look at the entire picture. What are overall healthcare costs? How much of an increase can consumers reasonably absorb? What is essential to keep health insurers solvent? Read more
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