As small hospitals ally with big ones, do patients benefit?

https://www.washingtonpost.com/national/health-science/as-small-hospitals-ally-with-big-ones-do-patients-benefit/2019/01/25/ccd50f2c-0a14-11e9-88e3-989a3e456820_story.html?utm_term=.44da63db320e

After seven years of a vigorous fight, Jim Hart worried he was running out of options.

Diagnosed with prostate cancer at age 60, Hart had undergone virtually every treatment — surgery, radiation and hormones — to eradicate it. But a blood test showed that his level of prostate-specific antigen, which should have been undetectable, kept rising ominously. And doctors couldn’t determine where the residual cancer was lurking.

“I didn’t like the sound of that,” said Hart, a retired international oil specialist for the federal government. “I wanted it gone,” he added, especially after learning that he had inherited the BRCA2 gene, making him vulnerable to other cancers.

So when Andrew Joel, Hart’s longtime urologist at Virginia Hospital Center in Arlington, mentioned the hospital’s membership in the Mayo Clinic Care Network and suggested consulting specialists at the Rochester, Minn., hospital for a second opinion, Hart enthusiastically agreed.

A Mayo immunologist told Joel about a new PET scan, not then available in the Washington area, that can detect tiny cancer hot spots. Hart flew to Mayo for the scan, which found cancer cells in one lymph node in his pelvis. He underwent chemotherapy at Virginia Hospital Center and five weeks of radiation at the Mayo Clinic. Since September 2016, there has been no detectable cancer.

“This collaboration was sort of a magic process,” Hart said. “I feel very fortunate.”

‘Benefit by association’

Hart’s experience showcases the promise of a much-touted but little understood collaboration in health care: alliances between community hospitals and some of the nation’s biggest and most respected institutions.

For prospective patients, it can be hard to assess what these relationships actually mean — and whether they matter.

Leah Binder, president and chief executive of the Leapfrog Group, a Washington-based patient safety organization that grades hospitals based on data involving medical errors and best practices, cautions that affiliation with a famous name is not a guarantee of quality.

“Brand names don’t always signify the highest quality of care,” she said. “And hospitals are really complicated places.”

Affiliation agreements are “essentially benefit by association, ” said Gerard Anderson, a professor of health policy and management at the Johns Hopkins Bloomberg School of Public Health. “In some cases it’s purely branding and in other cases it’s a deep association.”

A key question is “how often does the community hospital interact with the flagship hospital? If it’s once a week, that’s one thing. If it’s almost never, that’s another,” Anderson said.

Feeling ‘plugged in’

To expand their reach, flagship hospitals including Mayo, the Cleveland Clinic and Houston’s MD Anderson Cancer Center have signed affiliation agreements with smaller hospitals around the country. These agreements, which can involve different levels of clinical integration, typically grant community hospitals access to experts and specialized services at the larger hospitals while allowing them to remain independently owned and operated. For community hospitals, a primary goal of the brand name affiliation is stemming the loss of patients to local competitors.

In return, large hospitals receive new sources of patients for clinical trials and for the highly specialized services that distinguish these “destination medicine” sites. Affiliations also boost their name recognition — all without having to establish a physical presence.

In some cases, large hospital systems have opted for a different approach, largely involving acquisition. Johns Hopkins acquired Sibley Memorial and Suburban hospitals in the Washington area, along with All Children’s Hospital in St. Petersburg, Fla. The latter was re-christened Johns Hopkins All Children’s Hospital in 2016.

New York’s Memorial Sloan Kettering Cancer Center has embraced a hybrid strategy. It operates a ring of facilities surrounding Manhattan and has forged alliances with three partners in Connecticut, Pennsylvania and Florida.

“Every one of these models is different,” said Ben Umansky, managing director for research at the Advisory Board, a Washington-based consulting firm.

Local hospitals, he said, particularly those operating “in the shadows of giants,” may be better able to retain patients “by getting a name brand on their door. . . . There is a sense that they are plugged in.” (Virginia Hospital Center, for example, competes with Hopkins, MedStar Washington Hospital Center, which has an alliance with the Cleveland Clinic, and the Northern Virginia-based Inova system.)

Doctors can obtain speedy second opinions for their patients and streamline visits for those with complex or unusual medical needs, processes that can be daunting and difficult without connections.

Michael Kupferman, senior vice president of the MD Anderson Cancer Network, said it seeks to “elevate the quality of cancer care” by forming partnerships with “high-quality [hospitals] to keep patients at home and provide the imprimatur of MD Anderson.”

Virginia Hospital Center’s association with Mayo is “not just a branding affiliation, it’s a deep clinical affiliation,” said Jeffrey DiLisi, senior vice president and chief medical officer at the Arlington facility.

Despite extensive marketing, many patients seem unaware of the linkage. “We still think a lot about ‘How do we communicate this?’ ” DiLisi said.

Although affiliation agreements differ, many involve payment of an annual fee by smaller hospitals. Officials at Mayo and MD Anderson declined to reveal the amount, as did executives at several affiliates. Contracts with Mayo must be renewed annually, while some with MD Anderson exceed five years.

Acceptance is preceded by site visits and vetting of the community hospitals’ staff and operations. Strict guidelines control use of the flagship name.

“It is not the Mayo Clinic,” said David Hayes, medical director of the Mayo Clinic Care Network, which was launched in 2011. “It is a Mayo clinic affiliate.”

Of the 250 U.S. hospitals or health systems that have expressed serious interest in joining Mayo’s network, 34 have become members.

For patients considering a hospital that has such an affiliation, Binder advises checking ratings from a variety of sources, among them Leapfrog, Medicare, and Consumer Reports, and not just relying on reputation.

“In theory, it can be very helpful,” Binder said of such alliances. “The problem is that theory and reality don’t always come together in health care.”

Case in point: Hopkins’s All Children’s has been besieged by recent reports of catastrophic surgical injuries and errors and a spike in deaths among pediatric heart patients since Hopkins took over. Hopkins’s chief executive has apologized, more than a half-dozen top executives have resigned and Hopkins recently hired a former federal prosecutor to conduct a review of what went wrong.

“For me and my family, I always look at the data,” Binder said. “Nothing else matters if you’re not taken care of in a hospital, or you have the best surgeon in the world and die from an infection.”

 

 

 

Medicine Must Start Caring for the Caregivers

http://www.realclearhealth.com/articles/2017/12/18/medicine_must_start_caring_for_the_caregivers_110757.html?utm_source=morning-scan&utm_medium=email&utm_campaign=mailchimp-newsletter&utm_source=RC+Health+Morning+Scan&utm_campaign=2ee2060ff3-MAILCHIMP_RSS_EMAIL_CAMPAIGN&utm_medium=email&utm_term=0_b4baf6b587-2ee2060ff3-84752421

Image result for Medicine Must Start Caring for the Caregivers

Practicing medicine is bad for your health. Mounting evidence shows that stress-related burnout is a significant and growing threat to doctors – and their patients. If there is a silver lining, it is that the medical community is beginning to acknowledge and address the complex factors at play, recognizing that good health care must include caring for the caregivers.

Numerous studies reveal that physician burnout – generally defined as a loss of enthusiasm for work, feelings of cynicism and a low sense of personal accomplishment – is a major problem.

A Medscape survey found that 51 percentof doctors surveyed in 2016 said they suffered from burnout, an increase of more than 25 percent since 2013. This dovetails with a 2015 paper published in Mayo Clinic Proceedings, which reported a burnout rate of 54.4 percent in 2014, compared with a 45.5 percent rate in 2011. These burnout rates are almost twice as high as those found in the general population.

A 2015 Mayo Clinic study reported that roughly 40 percent of physicians suffer depression each year and almost 7 percent had considered suicide within the prior 12 months. It is estimated that 300 to 400 doctors take their lives every year.

The pain and suffering those statistics only hint at is bad enough. They are compounded by findings that burnout corrodes the doctor-patient relationship, resulting in lower levels of patient satisfaction, job satisfaction and productivity as well as higher levels of medical errors and disruptive behavior.

Burnout is also connected to the decision to switch jobs or leave medicine altogether – an ominous trend as the U.S. experiences a growing doctor shortage.

Many forces are driving this trend: long work days (doctors work an average of 50 hours per work, 10 more than other Americans), the demands of juggling busy careers with family obligations and the pressures caused by student debt (the average medical school graduate with student loans owes about $190,000 upon graduation).

These and other factors – especially the challenges of balancing work-home obligations – take a special toll on female doctors, whose burnout rates as twice as high as their colleagues, making them more likely to leave the profession.

Still, there is one significant new development that seems to be driving the recent increase in burnout: electronic health records (EHRs). It is no coincidence that the spike in burnout rates has come at the same time as the broad adoption of EHRs. Someday, EHRs may revolutionize health care by dramatically increasing our ability to share and review patient information. But today, EHRs are turning many physicians into clerks. It can take 32 clicks to order and record a single flu shot. Some studies show that doctors now spend about two hours on paper and desk work for every hour they devote to deliver direct patient care.

It is hard to overstate how much this dispiriting lack of personal contact, which is the major reason people choose careers in medicine, leads to the depersonalization and depression that are the hallmarks of burnout.

Perhaps the best evidence that practicing medicine is bad for one’s health is studies showing that medical students begin their training with stronger mental health profiles than their fellow college graduates. This advantage vanishes and a deficit emerges as they progress through their schooling, residency and professional practice.

As in medicine, we must identify the problem before we can treat it. A crucial step was taken in July when the National Academy of Medicine called on researchers to identify interventions that ease burnout. Many universities and academic hospitals have already been exploring ways to address the problem.

At the University of Michigan we established two groups earlier this year – one to look at burnout among our doctors, the other among our younger residents. It is still too early to say what might work. But ideas to help physicians achieve a better work-life balance, including more flexible scheduling that recognizes family commitments as well as better child care assistance, seem promising. So, too, does the use of “scribes” to handle some paperwork chores and drawing a sharper distinction between the care only doctors can deliver and that which can be provided effectively by physician’s assistants and other trained personnel.

Above all, we must allow doctors to ask for help and provide them with the care they need without penalty. Medicine has long been hampered by the ancient myth of invincibility – the notion that physicians must never show weakness, every embodying grace under pressure. This is not only wrong, it’s dangerous.

Physician burnout is a national crisis. Unfortunately, it does not offer a quick fix. Medicine will always be a uniquely demanding profession, requiring years of training and long hours of service to be ready to make life and death decisions.

Fortunately, a broad consensus has emerged in the medical community that doctors cannot provide the best care for their patients if we don’t figure out how to take care of them.

 

A new public health crisis: Preventable harm in healthcare

http://www.fiercehealthcare.com/healthcare/a-new-public-health-crisis-preventable-harm-healthcare?utm_medium=nl&utm_source=internal&mrkid=959610&mkt_tok=eyJpIjoiTlRrd09UVTNNMlEyWlRkayIsInQiOiJNUWd0R2JcL0hydzN1TUp5N3I3eFpjaGtST1wvNzk5bWdBU1JmdWl1WFwvSzNWYk1XUmdoOWhBaHBpRE0xMzFLdGFUaUljcWVwNjdjVE80N3RVWkZnckFucVVzeDhpdk9GazBsXC9SXC9GSmI1bUtuRGdnd3AwazBQRWNlY1NQcERvcEF6In0%3D

Doctor and nurses wheeling patient in gurney through hospital corridor

Photographer: Getty Images Hospitals That Mess Up Are Urged to Confess

http://www.bloomberg.com/news/articles/2016-06-10/hospitals-that-mess-up-are-urged-to-confess

Transparency is touted as better for patients, families, and the bottom line. Some malpractice lawyers are skeptical.

http://www.bloomberg.com/view/articles/2016-07-05/make-hospitals-come-clean-about-errors?_hsenc=p2ANqtz-8ZpJHzsW6ezhTNDzhthaaXe6weEgaxabXDhTr3Tnr4tY83AkIxknJyohj6Vu-VhfX2tS0Xo3ep8RxBlqIckVnwVBZmPQ&_hsmi=31344233&utm_campaign=KHN%3A+Daily+Health+Policy+Report&utm_content=31344233&utm_medium=email&utm_source=hs_email

Why Hospitals Are Now Much Less Likely to Kill You

http://www.thefiscaltimes.com/2016/06/15/Why-Hospitals-Are-Now-Much-Less-Likely-Kill-You?utm_campaign=541c47950e351dbe08037e5f&utm_source=boomtrain&utm_medium=email&bt_alias=eyJ1c2VySWQiOiJlYTVkYTNmYi1jYzljLTQzYTMtOGQ0ZS00NTc0NWNlNWFiN2QifQ%3D%3D

For decades, checking into a hospital was a high-risk venture. Patients were as likely to die from a doctor’s error, a bad drug reaction or serious infection picked up from a catheter than from major scheduled surgery or medical treatment.