WSJ.com - California Hospitals Open Books, Showing Huge Price Differences

Link: WSJ.com - California Hospitals Open Books, Showing Huge Price Differences. (subscription required)

A new law in California mandates that hospitals there do what few hospitals in America will: open up their "chargemasters," books that show thousands of list prices for medical goods and services. An examination of chargemasters at several hospitals shows that pricing strategies fluctuate wildly -- on everything from brain scans to painkillers to leeches. Depending on a hospital's pricing method, the charge for the same commodity or service, such as a blood test, can vary by as much as 17-fold from one institution to another.

Horrors! People will now learn that the respected institution in their community, "their hospital" behaves entirely irrationally in order to make a buck. There's merit to exposing this and other practices to daylight, but the real irrationality derives from the continuing skirmishes and overall lack of coherent information about what it takes to make a successful hospital work and serve its community. (I'll leave the justification for what it takes to serve hospital company investors for others to explain.

VA Chief, Prinipi, Quits with Budget Cuts Looming

So the VA Chief, Prinipi, is quitting. It probably doesn't have much to do with the $900 Million plus cut anticipated in the DVA budget which will mostly fall on healthcare since that's the largest part of the DVA budget. This at the time when our military men and women will be returning from Iraq. Just a small precursor of the coming cuts in Medicare. Stay tuned.

Bloomberg Dec 9 2004 1:24AM GMT [Moreover - moreover...]

iHealthBeat.org

I don't know why they picked this one article out of the entire November 2004 issue of Academic Emergency Medicine devoted to Healthcare Technology and IT in the ED, but  it's very cool that we made the California Healthcare Foundation's iHealthBeat.

Link: iHealthBeat.org.

Recommended Reading: Suggestions for ED Clinical Documentation Systems

November 10, 2004

An article in the current issue of Academic Emergency Medicine outlined eight recommendations for improving emergency department clinical documentation systems.

. . .

"As technology is implemented, standards and requirements for documentation systems need to be established," according to the article. Electronic clinical documentation eventually will "improve immediate care, promote efficiency, and permit ready communication of critical patient information" (Davidson, Academic Emergency Medicine, November 2004).

Lower Nurse Staffing Proposed

Link: Lower Nurse Staffing Proposed. Well it appears as though California is re-thinking nurse staffing. I like the comment from Sandra Shewry, California's director of health services, "These changes provide common-sense flexibility for hospital emergency departments and clarify language in current regulations."

British hospitals' cellphone ban really manages behavior

So the British are banning cellphones. Hospital cellphone ban under the stethoscope - Engadget - www.engadget.com. At Maimonides we just went the other way and removed the prohibition.

The data on close reading has become increasingly persuasive that we were merely managing behavior with the ban, not a true technical problem. A thoughtful nursing leader commented to me,

"Another myth that drove policy? I believe our challenge is one of enforcing civility; the myth that it may interfere with the patient's electromechanical well-being was easier to convey than a request for good judgement and respect for a manageable environment. My nephew is a pilot and the manager of a private airport in DC, I asked him about the airline requirement; interesting response and he admits, it is more about managing the environment than the threat of real electromechanical interference! I guess the only good news for nursing is one less rule to enforce, as for the workplace, another example of who is really in charge."

Since the radio frequency (RF) environment in hospitals is increasingly a challenge and will only become more so, you might want to review the current data and opinion before you act. For the primary sources view the FDA's site which though it hasn't been updated since October 2002 is still the place to start. The recent publication of the Mobile Healthcare Alliance updates the older information and helped us decide to allow cellphones throughout the hospital.

Emergency room recovery

Don Berwick and IHI are touting this article Boston.com / News / Local / Emergency room recovery in the Boston Globe about operations research and its effectiveness at improving ED throughput. A great piece.

Can VoIP survive Congress?

So should emergency physicians hope that VoIP does not survive Congress so that California could better fund its emergency services? Yesterday I pointed to the California Medical Socieity's President's proposal. Today, Congress wants to preserve the subsidy for rural and low income "plain old telephone service" (POTS).

The Wednesday, July 7 hearing, "VoIP: Will the Technology Disrupt the Industry or Will Regulation Disrupt the Technology?" should open a small window on this policy making process.
It seems intuitively more reasonable for subsidy to accrue to the same business rather than across businesses. Not that telephone taxes haven't funded wars, but at least the present subsidy goes to deliver telephone services to more users, not EMS.

California Medical Association President Supports Emergency Services Ballot Initiative

The initiative would add a 3% surcharge to residential and mobile phone bills (free registration required)

Much as I'd like to see support to "help bail out" emergency departments, trauma centers and emergency doctors I don't think taxing communication services is a good approach, particularly as Vonnage Wins One suggests that we may not have plain old telephone service (POTS) to kick around for much longer as a tax base, or at least that is if we want a modern communication infrastructure; a social good at least as important to our society as emergency health care.

Mobile Lawyer arrives at the ER

I arrived at work Tuesday, May 4 for an early meeting and found this truck parked outside of my ER in physician only parking.

Our security staff chased him from the physician parking, but he spent the rest of the day camped on the corner diagonally opposite the ED. I guess it must work or they wouldn't be doing it.

So this is what has happened to two grand professions in a world where capitalism has triumphed over common sense.

Health Affairs on California EDs

"Contrary to popular belief, EDs in California are holding their own, even contributing to hospitals’ bottom lines."

Maybe someday, health services researchers will get a clue. They don't have one as yet. Be sure to read Art Kellerman's rebuttal.

Thanks to Mike Williams of the Abaris Group for the pointer.

I have no association with Mike or the Abaris Group.

Certified Physician Executive Tutorial

So I'm sitting at my sister's in Palmetto after four days at the American College of Physician Executives' Certified Physician Executive Tutorial. I have to admit I was reticent to even tell colleagues what I was off for this week. It seemed like a silly waste of time. Friends and colleagues had queried me, "What are you, a 'Wharton MBA' doing taking this ridiculous course. When held to account I spoke about "getting my ticket punched" but this week turned out to be a wonderful experience. I should have known it would.

The key is the variety of people at the program. Learning from peers has been wonderful and revitalizing. My cohort group of eight with our varied personalities and styles was a substantial contributor to the value of the week and one of our cohort's teaching fellows, Bob Hodge gave plenary presentations on informatics and mentoring that I could/would/wanted to have done . . . maybe someday.

The formal program varied as do most. I found our cohort a wonderful experience and the Meyer-Briggs a useful tool on which to organize a presentation. I'm going to do a little more reading about it and maybe develop a column around it.

Meanwhile, A few photos from the week are here.

So I begin again

Today, January 26, 2004 I'm starting my website again in this Blog. Emerging Medical Concepts and I look to support your own leadership efforts in medicine. Please feel free to email or contact me through any of the means noted on my "About Me" page.

Does puffery get you anywhere?

HealthLeaders Magazine says I'm an "Innovator in Action" (2001 October)

An Emergency Physician Connects to the Wireless Web (2000 August 4)