March 9, 2012
By Adam Mingal*
Tufts Adds Physician Assistant Program
The Tufts University School of Medicine has announced a new physician assistant (PA) program that will welcome its first class in January, according to School of Medicine Assistant Professor Richard Murphy.
The School of Medicine has developed the PA program for more than a year and a half, and the proposal for the program was submitted last fall, the Dean of the Public Health and Professional Degree Programs and Chair of the Department of Public Health and Community Medicine Aviva Must said. The program is currently undergoing an accreditation process that should be completed by September, according to Murphy.
The application portal for the program will be open this May and the first class, comprised of thirty students, will matriculate next January, Murphy said. In the next three years, Murphy said that the program hopes to increase its class size to fifty students.
The program duration is twenty-five months—the first twelve months being dedicated to classroom training in areas such as advanced anatomy and physiology, surgery, psychiatry, women's health, and behavioral medicine, and the final thirteen months including clinical rotations among affiliated hospitals, private practices, and clinics under the supervision of physicians and other graduate PAs, according to Murphy.
Patrick McGrath, Tufts Adds Physician Assistant Program, The Tufts Daily (March 7, 2012).
Harvard Hospitals Revise Physician Pay Structure
In an effort to respond to what one hospital executive termed a "primary care crisis," two Harvard-affiliated teaching hospitals will shift their pay structure so that doctors are paid in part based on the number of patients they treat and the complexity of those patients' conditions.
About 10% of doctors' salaries at Brigham and Women's Hospital and Massachusetts General Hospital (MGH) will be allocated based on the size of their practices, rather than the 2% based on practice size at MGH last year.
The new pay policy springs from an increasing demand for primary care, according to Joseph Frolkis, vice chair of primary care at Brigham and Women's Hospital. Frolkis said in an email that as baby boomers age, the population has become older and sicker, requiring more time and attention from doctors.
Armaghan N. Behlum, HMS Revises Pay Structure, The Harvard Crimson (March 8, 2012).
Transparency in the Physician/Patient Relationship
In question-and-answer format, Dr. Robert Truog, executive director of the Institute for Professionalism and Ethical Practice, addresses issues such as transparency between patients and doctors, the challenges to this ideal, and the future of the patient-doctor relationship.
A recent article by Truog explores the social forces that have affected the patient-doctor relationship over the last hundred years. Writing in The New England Journal of Medicine, Truog, who also teaches medical ethics at Harvard Medical School and practices intensive care medicine at Children's Hospital Boston, explains that despite the apparent widespread embrace of honesty and openness, both doctors and patients have remained resistant to full transparency—especially when it comes to discussions about costs and the inevitable need to allocate limited healthcare resources.
"Overcoming our inability to muster the political will and courage to acknowledge the necessity of rationing," Truog writes, "and to grapple with the best way to use the tremendous resources currently being devoted to healthcare is likely to be the greatest challenge in the evolving relationship between physicians and patients in the decades to come."
Pauline W. Chen, MD, What Doctors and Patients Don't Want to Talk About, The New York Times (March 8, 2012).
To Stay Fiscally Healthy, California Hospitals Want Fewer Patients
To survive the unprecedented challenges coming with federal healthcare reform, California hospitals are upending their bedrock financial model: they are trying to keep some patients out of their beds. Hospital executives must adapt rapidly to a new way of doing business that will link finances to maintaining patients' health and impose penalties for less-efficient and lower-quality care.
It's too soon to know precisely how the changes will affect patients. But experts say more will be treated in clinics and doctors' offices than in hospitals. And when they are admitted, their hospital stays could be shorter.
"How can we change our mindset from how many patients we have in the beds to how many patients we are keeping healthy and out of the hospital?" asked the president and chief executive of Hollywood Presbyterian Medical Center. "We haven't figured out how to do that yet."
The federal healthcare reform law changes the way hospitals and doctors will be paid. Going forward, fees will be based on patient outcome rather than on how long patients stay in the hospital or how many services they receive. And hospitals will be penalized for preventable readmissions and hospital-acquired infections.
Anna Gorman, To Stay Fiscally Healthy, State's Hospitals Want Fewer Patients, The Los Angeles Times (March 4, 2012).
Tufts Medical Center Designated as "Level One" Trauma Center
State health officials have designated Tufts Medical Center a level one trauma center, an elite designation that could bring more prestige and potentially more patients to the Boston teaching hospital.
Tufts won approval despite opposition from other Boston teaching hospitals. Surgery chiefs at four of Tufts' competitors questioned whether the city needs another top trauma center and asked public health officials to delay their decision until a comprehensive review of the state's trauma system is complete.
The American College of Surgeons gave initial approval, which was endorsed by the Department of Public Health. To become a level one trauma center, a hospital must prove it treats more than 1,200 trauma patients a year or about 250 severely injured patients, and conduct top-flight research.
"This designation is an important landmark for our trauma center and Medical Center, as it reflects the expertise of our highly-experienced medical staff and the comprehensive, state-of-the-art medical care we provide to our trauma patients," said the chief of the division of trauma and acute care surgery. "Injuries are the leading cause of death for people ages 1 to 44 and receiving care at a Level 1 trauma center can decrease the likelihood of fatality from trauma by 25%. Earning the highest level of certification by the American College of Surgeons affirms our ability to care for patients suffering from all levels of injuries, including those that are most life-threatening."
Liz Kowalczyk, Tufts Medical Center Designated as 'Level One' Trauma Center, The Boston Globe (March 3, 2012).
*We would like to thank Adam Mingal, Esquire (U.S. Department of Justice, Civil Rights Division, 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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