The Daily Briefing

News for Health Care Executives

Will apologies prevent lawsuits? Mass. hospitals pledge to find out

Coalition aims to improve state's medical malpractice system

April 19, 2012

Seven Massachusetts hospitals will offer prompt apologies and financial settlements to patients harmed by medical errors as part of a statewide initiative to improve the state's medical malpractice system.

According to the Massachusetts Medical Association's Alan Woodward, the threat of legal action often leaves caregivers hesitant to apologize to patients for errors. It also encourages the practice of defensive medicine, which can unnecessarily drive up medical costs. In addition, Woodward says that legal action over medical errors in Massachusetts lasts an average of five and a half years.

The pilot program could represent "a fundamental transformation of the system," Woodward says, adding, "The whole system has created secrecy and denial. We are trying to turn things around." He says the new model will promote "honesty and transparency" and "stop driving unnecessary costs."

The program is inspired from a University of Michigan Health System model that cut the number of lawsuits filed against the system in half and reduced spending on legal defense by 60%, according to a 2010 study in the Annals of Internal Medicine.

How the pilot program will work
Under the Massachusetts program, any physician, nurse, patient, family member, or other individual may report a suspected medical error. The hospital will then conduct a root cause analysis to assess the situation and determine whether a health provider or the hospital made a mistake.

If a medical error is detected, the relevant caregivers will apologize and the hospital will work with malpractice insurers to offer compensation for the patient's injuries and follow-up care.

Hospitals will encourage patients to hire attorneys to evaluate offers. Patients who chose not to take a hospital's offer retain the right to sue.

For example, a patient harmed because surgeons failed to check that they were performing the correct procedure would be entitled to an apology and compensation. However, a patient who experiences an unforeseeable reaction to a medication would not qualify for a settlement, according to Kenneth Sands, a senior vice president at Beth Israel Deaconess Medical Center, one of the seven pilot program participants.

Three insurers and a medical group have donated about $1 million to launch the pilot program and Harvard School of Public Health researchers will assess its success, the Boston Globe reports.

Pilot program part of a state coalition
The pilot program is part of the "Roadmap to Reform" program, which brings together physician, hospital, and patient groups across the state in an effort to reduce time spent litigating malpractice lawsuits.

The coalition is pushing for legislative changes to help implement its "disclose, apology, and offer" approach. For example, the groups are asking lawmakers to implement a six-month "cooling-off period" after a medical error occurs before a lawsuit can be filed. They also are pushing to make caregiver apologies inadmissible in a lawsuit (Kowalczyk, Boston Globe, 4/18; Lee, Modern Healthcare, 4/18 [subscription required]).

Hospitals push back against proposed overpayment rules

AHA calls on CMS to entirely rewrite rule to reflect reform law's original intent

April 19, 2012

Hospital groups this week urged CMS to reconsider a proposed rule that would require hospitals to voluntarily return all overpayments within 60 days of detecting an erroneous payment.

The rule—which was broadly outlined in the federal health reform law—gives health care providers 60 days to return overpayments from the moment the organization has "actual knowledge" of an error, or when a staff member deliberately ignores an overpayment or recklessly disregards it.

The American Hospital Association (AHAs) and the Federation of American Hospitals (FAHs) in comment letters to CMS said the proposed rule distorts the original intent of repayment rules. Moreover, the rule could create retroactive liabilities for the past 10 years, which the groups consider unreasonable.

In its letter, AHA said the reform law "is being contorted by this proposed rule to create another confusing, onerous, and legally risk set of expectations for hospitals."

The group urged CMS to entirely rewrite the rules to reflect the reform law's intent to establish a "safe and reliable way in which hospitals can return payments mistakenly received from the government." Specifically, it said the rule should focus on "minimizing the unnecessary burden and assuring coordination with the many existing and varied reviews, reviewers, and processes already imposed on hospitals."

Meanwhile, FAH in its letter said it "cannot accept the premise that every improper Medicare hospital payment results from bad acts." The group called on CMS to "scale back the proposal to meet the statutory directive, which is to require reporting and returning an overpayment when a hospital has actual knowledge than an overpayment exists" (Carlson, Modern Healthcare, 4/17 [subscription required]; AHA News, 4/16).

Breast cancer patients underestimate care quality, study finds

Researchers find black women more likely to underestimate care quality

April 19, 2012

Cancer patients may judge their care by factors like their physician's communication style—and underestimate the actual quality of their care—according to a study in the Journal of Clinical Oncology.

Patients' perceptions and evaluations are of increasing importance to health care providers as pay-for-performance systems are adopted by the government and insurers.

For the study, researchers surveyed 374 women who had surgery for early-stage breast cancer at eight New York City hospitals between October 2006 and September 2009. Researchers compared data from phone interviews with the women to their medical records.

  • About 55% of the women said their care was "excellent," while 88% actually received good-quality care that was in line with medical guidelines.
  • More than half of those who said their care was "excellent" also considered their process of obtaining care to be "excellent."
  • Only 28 of 169 women who rated their care as "less-than-excellent" said the process of obtaining care was "excellent."

Patients who said they received "excellent" care also were more likely to say they received excellent treatment by staff, to say they knew which physician to ask questions or share concerns and to say they had a good level of trust and communication with their physician.

Just 39% of black women said they received "excellent" care, compared to 60% of whites and 62% of Hispanics. Black women also were less likely to trust physicians and to perceive racism in the process of receiving care. Researchers found no difference in the actual care quality when comparing black women with whites and Hispanics.

According to lead study author and Mount Sinai School of Medicine associate professor Nina Bickell, the findings reinforce that many organizations need to change their approach to patient care. Bickell called for making it easier for patients to schedule appointments, receive referrals and test results, and understanding next steps (Seaman, Reuters, 4/13).

Having a translator in ED may halve potential errors

Potential for error doubles without translator

April 19, 2012

Having a professional translator available in EDs for non-English speakers could help avoid potentially dangerous miscommunications between patients and their physicians, according to a recent study in the Annals of Emergency Medicine.

The study was based on 57 encounters with Spanish-speaking families at two Massachusetts pediatric EDs. Researchers recorded the families' interactions with their ED doctor. They compared the exchanges that took place with 20 participants that had help from a trained interpreter, 27 families that were aided by a non-professional, and 10 others that had no additional help.

The results showed that when a professional interpreter was on staff, 12% of translational slips—errors that occur when certain words are added or omitted—could have had "clinical consequences," such as administering a drug incorrectly. The potential for error doubled when no interpreter was present or if the translator was an amateur, such as a family member or a bilingual member of the hospital staff. Errors were least likely when interpreters had at least 100 hours of training, according to the study.

"The findings document that interpreter errors of potential clinical consequence are significantly more likely to occur when there is an ‘ad hoc' or no interpreter, compared with a professional interpreter," said lead study author and  University of Texas Southwestern Medical Center physician Glenn Flores.

Flores says that studies are still needed to compare which approach patients prefer and what is the most cost-effective. Under federal law, hospitals that receive public funds must have a professional interpreter or telephone- or video-based translation services for non-English speaking patients. However, neither must be paid for by the government or private insurance. As a result, in most states "the hospitals and clinics, and ultimately the taxpayers (because of uncompensated/charity care), are left covering the costs" (Norton, Reuters, 4/18).

Study: More advanced IT at Thomson Reuters' 'Top Hospitals'

HIMSS: Study findings highlight benefits of advanced EHR systems

April 19, 2012

Hospitals listed in Thomson Reuters' "100 Top Hospitals" have more advanced levels of electronic health record (EHR) adoption than average U.S. hospitals, according to a report by HIMSS Analytics.

For the report, HIMSS Analytics—the research arm of the Healthcare Information and Management Systems Society (HIMSS)—examined hospitals included on the Thomson Reuters "100 Top Hospitals" list in 2009 or 2010. Researchers then used the HIMSS Analytics Electronic Medical Record Adoption Model (EMRAM) scores from November 2011 to determine the top hospitals' level of EHR adoption.

Overall, they found that 21% of hospitals on the 2010 Thomson Reuters list were at Stage 5 or higher of EMRAM that year. In comparison, just 9% of all U.S. hospitals in 2010 had reached that level of EHR adoption.

The researcher also found that 14% of of hospitals on the 2009 Thomson Reuters list were in Stages 5 to 7 of EMRAM. At the time, just 6% of all U.S. hospitals had reached that level of EHR adoption.

HIMSS Analytics EVP John Hoyt in a statement said, "The very strong correlation between Thomson Reuters' 100 Top Hospitals and hospitals at higher levels on the EMRAM model shows the benefits of deploying advanced clinical applications in the delivery of health care in the U.S. hospitals."

According to HIMSS Analytics, hospitals with high EMRAM scores are more likely to achieve high levels of clinical and business performance (Lee, Modern Healthcare, 4/18; Monegain, Healthcare IT News, 4/18).

ACO roundup

Key news from April 13-April 19

April 19, 2012

The Daily Briefing editorial team rounds up the top accountable care stories of the week.

  • Oregon: Three Portland counties and 11 health care organizations last week presented a plan for the implementation of the new state health reform law's coordinated care organizations (CCOs). Under the new law, each CCO will adopt the patient-centered medical home model and be charged with caring for Medicaid patients in a given area. Using a global Medicaid budget, each CCO will determine the best way to provide comprehensive health care for their patients—including dental and mental health care—with a particular focus on patients with chronic conditions, addiction problems, and mental illnesses (Giegerich, Portland Business Journal, 4/12).

  • Wyoming: Cheyenne Regional Medical Center (CRMC) and Wyoming Medical Center this week announced that they have agreed to consider forming a not-for-profit partnership, called "The Wyoming Solution." A CRMC said the partnership would be a step toward creating an ACO. "Now is the time to explore how we can align our health systems so we can achieve scale and continue to serve our communities," said CRMC board chair Jean Halpern (Selvam, Modern Healthcare, 4/17 [subscription required]).

How to drive breakthrough improvements in engagement

April 19, 2012

As you think about your employee engagement strategy, join Lola Brysz from Elkhart General Healthcare System as she shares her experiences in driving breakthrough improvements in engagement through collaboration, communication, and accountability. Learn more.


Daily roundup: April 19, 2012

Bite-sized hospital and health industry news

April 19, 2012

  • California: State Insurance Commissioner Dave Jones (D) on Monday announced a settlement agreement with UnitedHealthcare in which the insurer agreed to immediately cover specialized therapy for people with autism. The agreement follows similar settlements with Blue Shield of California, Cigna and Health Net. The settlements stem from a dispute over the insurers' compliance with the state's Mental Health Parity Law, which mandates coverage of medically necessary behavioral therapies (Robertson, Sacramento Business Journal, 4/17).
  • Connecticut: Eight of the state's 30 acute care hospitals end fiscal year (FY) 2011 at a financial loss, twice as many as in FY 2010, according to a state Office of Health Care Access report. The report also found that the average hospital profit margin was 3.62%, down from 4.27% the year before (Chedekel, Hartford Courant, 4/17).
  • Florida: Gov. Rick Scott (R) has vetoed health care funding cuts passed by the state legislature. The vetoed items include $3.4 million to provide exemptions from reimbursement ceilings for sole community hospitals and funding for children's hospital construction projects (Kutscher, Modern Healthcare, 4/17 [subscription required]).
  • Ohio: Ohio University (OU) and OhioHealth on Tuesday announced plans to expand a partnership that trains primary care physicians who agreed to stay in central Ohio after completing their training. The university is opening a new campus in Dublin in 2014 where, with OhioHealth's help, it hopes to enroll 50 medical students, in addition to the 140 currently enrolled at OU's Athens campus (Zachariah, Columbus Dispatch, 4/18).

In-home telemonitoring may not reduce hospitalizations

Telemonitoring may have little effect on the rates of hospitalizations and ED visits among seniors with heart, lung, or kidney disease, according to a study published in the Archives of Internal Medicine.

Study details

Over a one-year period, Mayo Clinic researchers studied 205 elderly patients in Minnesota who were found to be at high risk for hospitalization based on their age and current medical conditions, which included heart failure, lung disease, diabetes, and kidney disease.

Half of the patients received at-home telemonitoring systems that took health measurements, such as blood pressure and weight, for five to 10 minutes daily. The telemonitoring group also could talk with nurses over the phone or through videoconferencing technology.

The other half of the patients continued receiving their usual treatment, which included primary care and specialist visits.

Study findings

The study found that both groups had similar rates of hospitalizations and ED visits. About 64% of the patients in the telemonitoring group were hospitalized or visited the ED, compared with 57% of the control group.

Researchers also found that about 15% of the patients in the telemonitoring group died during the course of the study, compared with 4% of the patients in the control group. The researchers did not have an explanation for this finding but suggested that the two patient populations could have been different in unmeasured ways, such as support they received from caregivers.


Study author Paul Takahashi said the study findings suggest a need for further research so physicians can learn how to manage the constant flow of data from telemonitoring systems.

Researchers said the study does not indicate that telemonitoring will never be effective. However, they noted that the findings suggest that the in-home technology might not be useful for all patients (Pittman, Reuters, 4/16).