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Teaching Hospital Update - April 16-20, 2012


Email Alert

April 20, 2012

By Amy Kaufman*

Thomson Reuters List of Top 100 Hospitals

Thomson Reuters has released its top 100 U.S. hospitals based on overall performance.

The hospitals were ranked on ten key areas: mortality, medical complications, patient safety, average patient stay, expenses, profitability, patient satisfaction, adherence to clinical standards of care, post-discharge mortality and readmission rates for acute myocardial infarction (heart attack), heart failure, and pneumonia. The study has been conducted annually since 1993.

Thomson Reuters researchers evaluated 2,886 short-term, acute-care, non-federal hospitals. They used public informationMedicare cost reports and Medicare provider analysis and review data, among other sources.

Hospitals do not apply to appear on the list or pay to market a spot on the list.

Here are some of the top honors:

Major Teaching Hospitals

University of California San Diego Medical Center-HillcrestSan Diego, CA
Advocate Illinois Masonic Medical CenterChicago, IL
Advocate Christ Medical CenterOak Lawn, IL
Ochsner Medical CenterNew Orleans, LA
Baystate Medical CenterSpringfield, MA
Beth Israel Deaconess Medical CenterBoston, MA

Andrea K. Walker, Thomson Reuters List of Top 100 Hospitals, Baltimore Sun (April 16, 2012).

Patterns: Doctor's Stake in Lab Affects Biopsy Rate

Urologists with a financial interest in a laboratory send more prostate biopsies for analysis and have a lower rate of cancer detection than those who use independent labs, according to a new study.

Jean Mitchell, a professor of public policy at Georgetown University, analyzed Medicare claims from 2005 to 2007 in nine states. She compared 9,927 prostate biopsies performed by self-referring doctors with 26,334 done by doctors with no financial interest. Her report appears in the April issue of Health Affairs.

Medicare pays for prostate biopsies by the jar, and a jar can contain one or more specimens. Self-referring doctors billed Medicare for an average of 4.3 more jars per biopsy, a difference of almost 72% that persisted despite controlling factors.

"The results suggest that financial incentives prompt self-referring urologists to perform prostate biopsies on equivocal cases," Mitchell said.

More tests did not seem to raise the detection rate. In 2007, the rate of positive biopsies among self-referrers was 20.9%, compared with 35.4% among the others.

The study was paid for in part by the American Clinical Laboratory Association. The Large Urology Group Practices Association, which represents about one-fifth of the nation's urologists, questioned the study's methods and said it used "small numbers of hand-selected groups."

Nicholas Bakalar, Patterns: Doctor's Stake in Lab Affects Biopsy Rate, The New York Times (April 16, 2012).

University of Louisville Delays University Hospital Plan

The University of Louisville said Monday it will delay its selection of a new healthcare partner for University Hospital to allow time for additional "discussions and negotiations." The decision was to be announced this week but spokesman Gary Mans said it has been postponed until "on or before June 30" because of the "complexity of the venture."

The university launched its search for a partner after Kentucky Governor Steve Beshear (D) rejected a merger plan that would have handed over control of Louisville's only public hospital to a Catholic healthcare company, which the governor said might violate the principle of separation of church and state.

Mans declined to say Monday how many entities had submitted proposals for a partnership with University of Louisville or to identify them. But he said the university has not extended the deadline for applications, which passed last month. The university has said it needs a partner with deep pockets that can inject cash required to expand the hospital and attract new patients.

Kerri Richardson, a spokeswoman for Beshear, said he remains hopeful that University Hospital will find "a suitable path forward to preserve its public mission and continue to successfully serve citizens in the region."

Allison Gardner, a spokeswoman for Attorney General Jack Conway, declined to comment, saying it would be inappropriate because "we may have to weigh in on the legality of any proposals."

Auditor Adam Edelen, whose staff is auditing the university's indigent care fund, hadn't been informed about the delay, said spokeswoman Stephenie Steitzer. But she said the audit is expected to be completed by mid-May, which would allow it to be finished before the announcement.

Andrew Wolfson, University of Louisville Delays University Hospital Plan, Hospital Partner on Hold, Courier Journal (April 16, 2012).

Markey Fails to Get Movement on New Medical Device Regulations

Last month, Representative Edward Markey (D-MA) held a press conference at the U.S. Capitol to push for tighter regulation of medical devices and the process by which they're approved by the U.S. Food and Drug Administration (FDA). His bill would have fixed a loophole that currently requires FDA to approve new devices automatically if they're designed based on older deviceseven if these older devices have safety issues that led them to be pulled from the market years earlier.

FDA unofficially supported the bill, but with no Republican co-sponsors, Markey was hoping to get its provisions folded into a larger piece of legislation to renew the FDA's user fee program. That hope, however, was dashed late Tuesday when the Subcommittee on Health declined to add Markey's medical device provisions into the draft user fee bill that could move in its current form to the House floor for a vote by early summer.

"I am disappointed," said Markey in a statement issued today. "The FDA has made clear that it does not have the legal authority to reject a new medical device outright as long [as] the device proves it is similar to the earlier model, even if the earlier product was recalled for harming patients."

Patient advocacy groups reacted angrily to the omission. Public Citizen, a watchdog group based in Washington, DC, sent a letter to members of Congress saying it opposes the draft legislation because many of its provisions would "weaken the oversight" of medical devices "endangering the health and lives of patients."

Deborah Kotz, Markey Fails to Get Movement on New Medical Device Regulations, Boston Globe (April 18, 2012).

Doctor-Supported ED Access Plan Gains Ground in Washington State

After a long legislative and legal battle with emergency physicians, lawmakers in Washington state have turned their attention to an alternative plan supported by emergency department (ED) doctors to prevent overutilization of emergency services by Medicaid patients.

Governor Chris Gregoire (D) announced that she was suspending a policy to restrict Medicaid payments to emergency departments for more than 400 patient conditions, which would have included treatment for certain burns, strains, and other injuries that were deemed not medically necessary in an emergency setting. The policy was set to go into effect April 1. The state was intending to push Medicaid patients to seek treatment for such injuries in a doctor's office by denying payment for care if it were received in the ED, where costs to the state are higher.

In conjunction with Gregoire's decision, the legislature was considering at this article's deadline an amendment to the state's "zero visit policy." State officials expected the amendment, which the American College of Emergency Physicians (ACEP) and local doctors support, to pass and receive the governor's approval.

The alternative approach to discourage unnecessary ED use is written by physicians and seeks to decrease utilization without limiting access to needed emergency care for patients, said Nathan Schlicher, MD, the Washington ACEP's legislative chair. "We need to get back to solving these problems and not just pass the buck."

The Washington Health Care Authority, which runs the state's Medicaid program, spent nearly $98 million on more than 325,000 fee-for-service Medicaid emergency department visits in 2010. The legislature had estimated that the state could save $35 million a year by limiting what was considered non-emergency care under the zero-tolerance policy.

Charles Fiegl, Doctor-Supported ED Access Plan Gains Ground in Washington State, American Medical News (April 16, 2012).

Reinventing the Third-Year Medical Student

A year ahead in medical school, my friend had been a constant source of support and inspiration, offering study tips for courses and warnings about professors and, when he had neither, hilarious spot-on imitations of classmates and teachers. Patients he was beginning to see in his introductory course on the physical exam seemed to adore him, too; a few even wanted to set him up with their daughters.

"When we're done with medical school and residency," he always said, "we'll be the doctors we've always dreamed of being."

He stopped saying that during his third year of medical school.

One evening that year, I ran into him in the hospital cafeteria. The third-year schedule of rotating every few weeks among teams of doctors, trainees, and real patients had left him gaunt. He showed me a stack of index cards, one for each patient he had been assigned in the last week.

"I got an 'appy,' a gallbladder, and a breast biopsy," he said, referring to patients with appendicitis, a gallbladder infection, and breast cancer. He pulled out one card highlighted in yellow and smiled. "I also got a Whipple," he said, referring to a patient with pancreatic cancer who needed that potentially complicated surgery.

"That," he continued without flinching, "was awesome."

My friend wasn't the same. The patients had been reduced to their diseases.

For nearly a century, the third year of medical school has been a pivotal point in training, a crucial step in the development of professional skills and attitudes toward patients. Recently, however, the tradition of month-long "rotations"a speed-dating introduction to the major disciplines of medicine and the issues patients facehas come under fire.

During their third year, medical students are under constant pressure to perform for an ever-changing group of senior physicians, who in turn must evaluate the students based on brief interactions. Sailing through as many as six disciplines in just under a year, students have opportunities for only transient relationships, garnering mere snapshots of their patients' illnesses and lives.

Not surprisingly, studies have shown that these experiences result in "ethical erosion." Students' sense of empathy and bedside manner deteriorate, and many begin to refer to their patients not as people but as diseases, that dehumanizing shorthand of the wards.

Pauline W. Chen, MD, Reinventing the Third-Year Medical Student, The New York Times (April 19, 2012).

*We would like to thank Amy E. Kaufman, Esquire (Patton Boggs LLP, Washington, DC), for providing this week's update.

AHLA Teaching Hospital Updates are intended to provide quick summaries of cutting-edge issues of interest to teaching hospitals and their counsel. Additional information and more in-depth coverage on these topics may be available from AHLA Health Lawyers Weekly and appropriate AHLA Practice Groups.

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