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Workplace Situations

Domestic Medical Tourism On The Rise

BridgeHealth negotiated $70,000 in savings for Stephens Media’s employees nationwide.

The high cost of American healthcare has been a growing issue for years, prompting thousands of patients to explore health care services outside of the U.S.

Partially a reaction to foreign medical tourism, some large employers such as Lowe’s, PepsiCo, and Wal-Mart, have turned to a concept known as “domestic medical tourism.” These companies pay for their employees to travel out-of-state to hospitals that have negotiated reduced rates for medical procedures. The article by American Medical News, “Wal-Mart Gives Major Boost to Domestic Medical Tourism,” shows that the number of companies joining this trend is growing quickly.

“We’re going to see a lot more of this… And if physicians cannot compete on price, then they are going to have to compete on quality and exceptional customer service if they are going to keep patients,” said Simon Hudson, PhD, director of the SC Center of Economic Excellence in Tourism and Economic Development at the University of South Carolina.

One company, BridgeHealth Medical, specializes in negotiating discount rates with hospitals and extends those rates to big businesses. In the future, it seems domestic medical tourism will reshape the way healthcare is delivered, making quality, cost, and efficiency crucial for hospitals and physicians to compete in the marketplace.

While companies have released limited information about how many employees have traveled for care and how much has actually been saved, the negotiations with hospitals and insurers is on the rise. Read More…

Rational Care Includes Economic Analysis of Value

By Brian L. Grant MD

The New York Times article “In Cancer Care, Cost Matters,” is written by oncologists who are attempting to engage in rational discourse about the cost-benefit of chemotherapy drugs. They note:

“Physician guideline-setting organizations likewise focus on whether or not a treatment is effective, and rarely factor in cost in their determinations. Ignoring the cost of care, though, is no longer tenable. Soaring spending has presented the medical community with a new obligation. When choosing treatments for a patient, we have to consider the financial strains they may cause alongside the benefits they might deliver.”

In the case of Medicare beneficiaries, they do share in the cost of medications, but generally insured individuals are frightfully blind to the cost of their care. Thus it falls upon payers and physicians to make rational decisions on behalf of patients, and the cost should be part of the equation. The cost may be relative to doing nothing, or as stated in this article, to an alternative treatment.

To suggest that price should not be part of the decision process in health care is naïve. A life is priceless, but the cost of maintaining life in a world of finite resources must include a realistic assessment of the impact of the intervention and the price associated with it. To do otherwise diverts these resources from other uses, that might include more impactful treatments for individuals and society.

And if and when companies devising such treatments understand that standards and judgment are being imposed, they may modify and adjust the costs of their products to gain more acceptance and access to the market. Read More…

 

The Controversy Behind Our Nation’s Meningitis Outbreak

Our nation’s current meningitis outbreak has many people talking about two things: compounding pharmacies and lawsuits.

As of today, the Center for Disease Control has reported that 14 people have died in 170 cases of the outbreak which was caused by a steroid injection used for back pain. The contaminated vials were made by the New England Compounding Center in Framingham, Massachusetts, who recently recalled the products and shut down all operations

With nearly 14,000 people who may have been exposed to the steroid, the controversy has already sparked an investigation by the U.S. Food and Drug Administration and scrutiny about whether compounding pharmaceutical products is even legal.

A Forbes article “The Meningitis Outbreak: What Can Compounding Pharmacies Do Next?”, addresses many of these concerns about why compounding may cause more risks than benefits.

The Food and Drug Administration (“FDA”) explains that compounding “is an age-old practice in which pharmacists combine ingredients to create unique medications that meet specific needs of individual patients.” While the FDA has recognized that “pharmacy compounding is a vital service that helps many people,” they give a very ambiguous definition as to whether this practice is safe.

One patient who had received the injection is suing the firm, saying she is experiencing symptoms of meningitis and this may just be the first wave of lawsuits over the deadly outbreak. The FDA has become  increasingly concerned about the dangers from compounding over the past few years for two reasons. First, some companies allegedly engage in the large-scale production of drugs under the guise of compounding. Such companies, in the FDA’s eyes, are acting like manufacturers, but often without complying with the regulations requiring good manufacturing practices.

Thousands of these pharmacies so play a critical role in providing custom drug mixtures and hard-to-find compounds that might otherwise be unavailable to doctors and their patients. But a proliferation of compounding operations and federal oversight of these manufacturing regulations has obviously created a major national scandal. The article’s author, Richard Levick states:

“In a debate where liberals like Markey simultaneously deplore “the magnitude of sales”by the New England Compounding Center, it’s hard to know if this industry, caught in an ideological cross-fire, has any friends left.

The best way out of any such reputational cul-de-sac is to hit hard on the value that your company or industry provides even as you fully cooperate in efforts to remediate the problems you’ve caused. If you deserve to survive, the public benefits will palpably outweigh the liabilities in the court of public opinion.

The compounding pharmacy industry knows what those benefits are and what they’ll continue to be for quite some time to come. The industry has duly pointed out that drug companies cannot manufacture every medication that’s needed; that the compounders are filling a critical gap in our healthcare system; and that compounding pharmacists are steadfastly working with hospitals and doctors to help meet a prescription drug shortage of near-crisis dimension.” Read More…

More Doctors Frustrated with New Regulations & Health Policy

With an excess of new regulations, pressure from the new health care model, and a decline in clinical independence, nearly three-quarters of physicians are pessimistic about the future of the healthcare profession.

According to a new report by The Physicians Foundation, nearly half of the 14,000 doctors who were surveyed say they plan to cut back on hours, retire, see fewer patients, work part-time, transition to a concierge model or seek a non-clinical job in health care. Sixty percent would retire today if they could, compared with 45% in 2008. And if this trend continues, by 2016, it would equate to the loss of 44,250 full-time physicians.  Read More…

The American Medical News article, “Will a ‘Silent Exodus’ from Medicine Worsen Doctor Shortage?” explains that changes in the health industry have doctors feeling overrun, overburdened, and overtaxed.

The vice president of The Physicians Foundations said:

“It is clear that the introduction of nearly 30 million new patients into the U.S. health care system through health care reform, added to the already growing physician shortage, will have profound implications for patient access to medical care.”

The survey also showed the top reasons why doctors say the profession is in decline:

  • 79.2%: Too much regulation/paperwork
  • 64.5%: Loss of clinical autonomy
  • 58.6%: Physicians not compensated for quality
  • 54.4%: Erosion of physician-patient relationship
  • 45.9%: Money trumps patient care
  • 43.7%: Scope of practice encroachment
  • 6.9%: Too many part-time doctors

Data from “A Survey of America’s Physicians: Practice Patterns and Perspectives,” Physicians Foundation, Sept. 21 (See site)

Unfortunately, these results are not surprising. Another recent study published in the Archives of Internal Medicine surveyed 7,288 physicians in June 2011 and found that nearly 1 in 2 U.S. physicians report at least one symptom of burnout, with doctors at the front line of care (family medicine, general internal medicine, and emergency medicine) particularly vulnerable.

The findings showed that the doctors burnout rate is significantly higher than the general working population. Although physicians agree the current system is in trouble, the survey showed they were divided as to how to fix it. For the sake of both the future of the medical professionals and our nations patients, it’s clear that radical change is needed.

Five Ways Hospitals Could Prevent Deadly Mistakes

By Vanessa Radatus

The article, “How to Stop Hospitals from Killing Us” in The Wall Street Journal  provides a shockingly honest perspective into the health care industry and business of saving lives.

The author of the article, Dr. Marty Makery, a surgeon at Johns Hopkins Hospital, explains that 1 in 4 patients are harmed by a medical mistake that are almost always preventable. He asks a key question: Shouldn’t our healthcare system be held to the same safety standards as any other industry?

The comparison Makery uses is perfect. When there is a plane crash, it makes national headlines. Without question, a thorough investigation is done to find out what error was made, how it could have been avoided, and ultimately who is held accountable. It seems harsh, but then again, lives were lost because of a preventable error and you can be certain the aviation industry learns from their mistake.

However, the number of patients killed annually by medical errors is equivalent to four planes crashing every week, yet their stories are all too often unnoticed and forgotten. In the article, Makery states:

“If medical errors were a disease, they would be the sixth leading cause of death in America—just behind accidents and ahead of Alzheimer’s. The human toll aside, medical errors cost the U.S. health-care system tens of billions a year. Some 20% to 30% of all medications, tests and procedures are unnecessary, according to research done by medical specialists, surveying their own fields. What other industry misses the mark this often?” Read more…

Makery makes an excellent argument and explains a career defining moment when he learned the truth about our broken health care system. Few hospitals are actually held accountable for poor performance rates and bad outcomes and therefore, best-practices are lost in everyday procedures.

After years of witnessing this lack of accountability throughout his career, Makery published the book “Unaccountable: What Hospitals Won’t Tell You and How Transparency Can Revolutionize Health Care.”

His book sheds light on the issue of bad doctors, botched surgeries, and the key changes that could change how hospitals treat patients. His book advocates that all hospitals should have data and statistics that are publicly accessible for patients to make best choices when it comes to treatment. Without that, patients are walking in to hospitals blind. Read more…

He believes five simple changes to the industry could make hospitals a safer place:

  1. Online Dashboards: Providing the public with the hospitals rates for infection, readmission, surgical complications and errors that should never occur. The dashboard should also list the hospital’s annual volume for each type of surgery that it performs and patient satisfaction scores so that a patient can choose a hospital that specializes in the procedure needed.
  2. Safety Culture Scores: Creating an environment where teamwork is encouraged and anyone from an intern to a nurse feels confident to speak up about a potential issue.
  3. Cameras: Cameras are already being used in health care, but usually no video is made. Reviewing tapes of cardiac catheterizations, arthroscopic surgery and other procedures could be used for peer-based quality improvement. Video would also serve as a more substantive record for future doctors and make doctors more compliant to perform best practices in their field.
  4. Open Notes: Giving patients the ability to review their doctors notes gives them access to explain all their symptoms and help prevent issues in the future.
  5. No More Gagging: Patients are increasingly being asked to sign a gag order, promising never to say anything negative about their physician online or publicly. In addition, if you are the victim of a medical mistake, hospital lawyers ensure that you will never speak publicly about the error as part of the settlement.

It is apparent that there needs to be more transparency in hospitals and medical procedures in order to create a safer and more reliable health care system. If an industry puts a person’s life at risk, like the aviation, automobile or drug industry, they are held accountable when they have made an error. Why should health care be any different?

A Global Health Issue: America’s Health Workforce & Countries Without Doctors

By Vanessa Radatus

The New York Times issued an Op-ed article last week that brings both good and bad news about our current healthcare employment dilemma. While jobs in the health care sector have increased by more than 1.2 million this year, there seems to be an imbalance in our medical education model and the number of foreign physicians we import.

The article “America’s Health Worker Mismatch” addresses the fact that despite increased demand for their graduates, medical schools have done little to expand their output and therefore must turn away hundreds of thousands of qualified medical school applicants. What’s more, our medical school tuition costs have increased by 312 percent in the past 20 years and some health specialties have raised the bar for education credentials – meaning more years of school, higher attrition rates, higher debt, higher wage demands and fewer workers from low-income areas.

The author of the op-ed, Kate Tulenko, is the senior director of health system innovation at IntraHealth International and author of “Insourced: How Importing Jobs Impacts the Healthcare Crisis Here and Abroad.” She explains that the United States dependence on foreign-trained health-care workers is creating a mismatch in our health care work force.

“It’s no surprise, then, that the response to this self-made labor shortage has been to recruit inexpensive workers from abroad, including the 57 poor countries defined by the World Health Organization as having significant shortages of their own. Among them is India, America’s largest source of foreign-trained doctors. A special visa program has made hiring these workers even easier… Today about 12 percent of the health work force is foreign-born and trained, including a quarter of all physicians…That’s bad for American workers, but even worse for the foreign workers’ home countries, including some of the world’s poorest and sickest, which could use these professionals at home.” Read More…

This trend is worrisome as most foreign-trained physicians applying to U.S. residency programs come from countries that are suffering a severe health service shortage. It raises the question: Does recruiting an imported physician workforce create more problems than solutions?

 

Are Our Nation’s Doctors Burned Out?

While job burnout can affect workers in any field, the medical profession is at special risk. The New York Times article, “The Widespread Problem of Doctor Burnout,” addresses a frightening issue that has become a trend among our nations doctors. With 8 years of education beyond high school, 3-8 years of internship and residency, and a long work hours day and night, it’s not all that shocking.

A new study published in the Archives of Internal Medicine surveyed 7,288 physicians in June 2011 and found that nearly 1 in 2 U.S. physicians report at least one symptom of burnout, with doctors at the front line of care (family medicine, general internal medicine, and emergency medicine) particularly vulnerable. The findings showed that the doctors burnout rate is significantly higher than the general working population.

“We’re not talking about a few individuals who are disorganized or not functioning well under pressure; we’re talking about one out of every two doctors who have already survived rigorous training,” said Dr. Tait D. Shanafelt, the lead author of the study and a professor of medicine at the Mayo Clinic in Rochester, Minn. “These numbers speak to bigger problems in the larger health care environment.”

The article illustrates the story of a patient who may have been misdiagnosed for a pinched nerve  in his arm by a potentially burnt out senior doctor. Two weeks later, a younger doctor diagnosed him with cancer. Dr. Shaneflt explains that feelings of exhaustion or burnout can result in medical errors by doctors, or at the very least, lack of compassion for the patients they treat.

While the root of the problem could come from any number of things: the extensive schooling, long work hours, work vs. life balance, or the pressures of our new health care model, it is a critical issue that needs immediate attention.

“If people work in an environment where they believe there is meaning, they will put up with a lot,” Dr. Shanafelt observed. “It goes beyond the significant personal consequences for an individual physician. It affects whom patients can see when they are sick, the quality of care they receive and their safety. Read More…

 

 

How Do You Call In Sick As A Soldier?

Given the economic meltdown, the highest unemployment rate in years, and layoffs around every corner, workers are more likely to drag themselves into the office even when they really are sick with a fever or the flu. While most companies encourage sick employees to stay home, there is one government entity that hardly ever allows their members a sick day off without serious assessment. The military.

Last month, a Navy submarine worker, Casey James Fury, 24, set fire aboard the USS Miami in order to get out of work early. Faced with life in prison if convicted of two counts of arson in the fire aboard the USS Miami attack submarine, many wonder if his desperate attempt to get out of work may be warranted by the military’s impossible “sick day” policies. In the  Slate article, “Sir, Do I Really Have To  Work Today, Sir?” soldiers, airmen, sailors and Marines explain the various hoops they must jump through to get a day off due to illness.

“In most branches of the military, a service member who wakes up under the weather is expected to, well, suck it up. In extreme cases, though, he or she can inform the commanding officer of an ailing condition when reporting to first formation—a daily physical-training session at 6 or 6:30 a.m. that might include four-mile runs, push-ups, and sit-ups. It’s up to the commanding officer to decide whether to force the sick person to participate in the dawn routine or allow him or her to kill time with some stretching until sick call begins. Sick call, “a daily lineup of military personnel requiring medical attention,” takes place at the aid clinic, or infirmary. Enlisted medics assess the gathered troops, treat minor complaints, and issue further recommendations. An ailing service member might be assigned to “indoor” or “light” duty, which would exempt him from physical training and perhaps have him cleaning the barracks.”

In Casey James Fury’s case, setting fire aboard the submarine was simply an act of anxiety and desperation as civilian workers typically have the same leave policy as most workplaces do. The general procedures described above typically apply to members of the Army, Navy, Air Force, and Marines, both in training stateside and in combat overseas, according to the article. What’s more? If any service member tries to fake illness or  is perceived to exploit his unit’s leave policies (most branches cap sick leave at 13 workdays per year), he faces charges of malingering, dishonorable discharge, forfeiture of all pay and allowances, and confinement for one to three years.  Read More…

 

Health Care and Cheesecake Factory: Can the former learn from the latter?

By Vanessa Radatus

Illustration by Harry Campbell for The New Yorker

This week, The New Yorker presents a fascinating article that delves into heart of what our health care system needs. Using The Cheesecake Factory as a model, American physician and journalist, Atul Gawande, provides refreshing insight as to how hospitals could learn a thing or two from this service savvy business. After all, who wouldn’t want a healthcare model that guarantees 100% satisfaction with quality and service, all at an affordable price?

Atul Gawande says it nicely: “In medicine, too, we are trying to deliver a range of services to millions of people at a reasonable cost and with a consistent level of quality. Unlike the Cheesecake Factory, we haven’t figured out how. Our costs are soaring, the service is typically mediocre, and the quality is unreliable. Every clinician has his or her own way of doing things, and the rates of failure and complication (not to mention the costs) for a given service routinely vary by a factor of two or three, even within the same hospital.”

So, what can we learn from these flourishing businesses that continue to serve millions while managing efficiency, quality, and cost? For one, we must accept that whether we agree with recent health laws or not, our system needs a new model and fast.  With trillion-dollar healthcare costs only getting higher and a shortage of doctors to treat 30 million newly insured Americans, utilizing key business strategies from successful chains like The Cheesecake Factory may not be a bad idea.

In his article, “Restaurant Chains have Managed to Combine Quality Control, Cost Control and Innovation. Can Health Care?” Gawande takes a close look inside of The Cheesecake Factory’s  strategies to see how the business makes $1.2 billion in yearly revenue while maintaining affordable, high-quality products that always leave customers smiling. He explains that the success secrets behind the business is that instructions are precise, objectives are clear and oversight is tight. “The formula was Business 101: Use the right amount of goods and labor to deliver what customers want and no more. Anything more is waste, and waste is lost profit,” Awande stated.

If our hospitals aimed to reach the same amount of quality, efficiency and positive outcomes as these enterprises do, our healthcare system would not be in its current crisis. Awande proves a good point when he asked Dave Luz, Regional Manager of eight L.A. Cheesecake Factory’s, what he would do if he were manager of a neurology or cardiology unit in a hospital:

“This is pretty obvious. I’m sure you already do it. But I’d study what the best people are doing, figure out how to standardize it, and then bring it to everyone to execute.”

Unfortunately, this is not how medical care works. But new health-care chains are now hoping to do this on a mass scale, Awande says.

“They want to create Cheesecake Factories for health care. The question is whether the clinicians in the operating rooms, in the medical offices, in the intensive-care units—will go along with the plan. Fixing a nice piece of steak is hardly of the same complexity as diagnosing the cause of an elderly patient’s loss of consciousness. Doctors and patients have not had a positive experience with outsiders second-guessing decisions. How will they feel about managers trying to tell them what the “best practices” are?”

After a lengthy yet intriguing look into both the medical and food industry, Awande ends with this final thought for readers: ”

“The critical question is how soon that sort of quality and cost control will be available to patients everywhere across the country. We’ve let health-care systems provide us with the equivalent of greasy-spoon fare at four-star prices, and the results have been ruinous. The Cheesecake Factory model represents our best prospect for change. Some will see danger in this. Many will see hope. And that’s probably the way it should be.”  Read More…

Atul Awande is a highly respected physician and journalist. His writings on the process and practice of healthcare are important. His book “The Checklist Manifesto” is a must read for anyone concerned about health care and hospital quality.

Risk Management: Why a Chef’s Job is Among the Riskiest

 By Vanessa Radatus

Photo credit: Food Network Kitchens/ Wiley, John & Sons, Incorporates

It may not be ranked among the most dangerous profession in U.S, but recent headlines about celebrity chefs and Food Network personalities have got us thinking that being a top chef should be ranked among the riskiest jobs.

Here’s some food for thought. Just this year, celebrity chef and cooking show host, Paula Dean, reluctantly announced that she was diagnosed with type 2 diabetes. Known for her Southern-style, often deep-fried, high calorie recipes, it came as no surprise to those who watch her show.

According to experts, a chef’s lifestyle poses many safety and health risks. Not only is a busy kitchen a dangerous place in general- with sharp knives, hot pans, slippery floors and sanitation issues- but a chef must also constantly taste the food they make leading to high-caloric intake, which can cause obesity, heart disease and diabetes like Paula Deen.

We often hear about high risk jobs like firefighters, police officers, and construction workers, but what if a celebrity chef or TV food host is injured, seriously ill and can no longer perform? How does that affect his or her income? And how does it affect the overall “brand” and the businesses that rely on their name? In a

 recent Risk Management article, “Chopped Chef,” they explain how insurance works for these high profile food connoisseurs.

The article lays it out pretty clearly, proving that a chef’s job is worth protecting, especially if a million dollar brand is involved: “Investors and corporate risk managers generally recognize how dependent these franchises are on the brand of their celebrity chefs. Their response is often to secure large blocks of key person life insurance to protect against an untimely death. But many often ignore the greater risk of injury and forgo disability coverage, which may be a mistake if you realize that replacing these individuals is not as easy as calling up a recruiting agency.”

For this reason, large corporations dependent on personalities such as Martha Stewart, Gordon Ramsay, Rachel Ray, etc, procure key person life and key person disability insurance  in order to protect the wide array of people invested: the company, the employees, the shareholders, the board of directors, production and merchandising partners, etc.

“Chefs also can obtain coverage as a form of personal protection. This was the case for one high-profile celebrity chef in his mid-40s who was updating his financial plan when his new wealth adviser noticed that he failed to maintain disability income protection. With an annual income north of $2 million, the chef wanted to be able to maintain his lifestyle in the event of a disability. A policy was structured with a 90-day waiting period, followed by $100,000 per month of tax-free disability benefits. Coverage was underwritten protecting losses from both accident and illness utilizing a specific occupation policy form that covered the insured if he could not be an “on-air” personality. In all, nearly $15 million of future income was protected at a cost of around $40,000 annually.” Read More…