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PubMed2002

NFP Investor Conference. Growth is back in sight.

In a whirlwind of high-stakes meetings in New York City in mid-May, two dozen of the nation's largest hospitals and health systems strutted their stuff with a single goal: securing their future. Their message was clear: back-to-basics works, and now it's time to grow the business. Executives from 23 providers outlined their work on increasing revenue, boosting margins and shoring up balance sheets. They presented their market positions, strategic initiatives and financial results for investment analysts, credit raters and bond traders. The third annual Non-Profit Healthcare Investor Conference was co-sponsored by the American Hospital Association, Health Forum, the Healthcare Financial Management Association and Salomon Smith Barney. The focus on growth doesn't come without challenges Several common themes emerged from the presentations, among them pressure on reimbursement, workforce shortages, liability insurance issues and capacity constraints. Yet executives agree: it all comes down to the basics, and building the strength to keep their missions alive. As Thomas Meier, vice president and treasurer of Oakland, Calif.-based Kaiser Permanente, put it: "No margin, no mission, no más."

Capital Financing↗
PubMed1992

A courtroom lesson in physician-assisted suicide.

Physician participation in euthanasia and assisted suicide has been the subject of long-standing debate and is unlikely to be resolved easily or soon. The Pennsylvania Medical Society's Medical Student Section explored this topic recently in a second "mock trial" held in conjunction with the Temple University School of Law and co-sponsored by the Pennsylvania Medical Society Liability Insurance Company. This is an account and essay from that trial.

Ethics, Medical↗
PubMedDate not supplied

Multiple chemical sensitivity: treatment and followup with avoidance and control of chemical exposures.

Reducing unnecessary chemical exposures, particularly pesticides and other petrochemicals, shows promise for reducing illness episodes in the chemically sensitive. Because similar types of exposures have been associated with the onset of chemical sensitivity, such precautions could have wider preventive value for the rest of society as well. Many uses of chemicals have dubious social benefits, and reduced use should be achievable. The chemical industry will likely bitterly contest the reduced use of chemicals because it stands to lose substantial sales. Compensation and liability insurance carriers also stand to lose if the environment is found problematic, rather than individual psychology, for example. Professionals should also recognize conflicts of interest for the chemical and insurance industries by openly acknowledging funding sources for research. The author believes that research on chemical sensitivity that blames the psyche of the victim rather than the chemical will more likely be funded by the insurance or chemical industry than will other research. Study designs should be developed in an atmosphere removed from financial conflicts of interest. This means a substantially larger role for government funding of research on chemical sensitivity to avoid biasing the knowledge base by financially interested parties. The time is critical for government funding of research on chemical sensitivity because the illness is being defined and characterized. If preliminary research is flawed by improper design and focus, our understanding of the problem could be delayed for years.

Adult↗
PubMed2003

Coordination of benefits.

Figuring out who is supposed to "pay first" when your client has Medicare and other health benefits can be confusing both for you and your clients. In this brief we discuss how Medicare coordinates payment of claims with other health benefits.

Cost Sharing↗
PubMedDate not supplied

Family physicians' colposcopy practices.

BACKGROUND: The objectives of this study were to determine (1) the extent to which family physicians are performing colposcopy, (2) which colposcopic procedures are performed by these family physicians, (3) demographic characteristics of physicians who perform colposcopy, and (4) whether physicians who do not perform colposcopy plan to do so in the future. METHODS: A questionnaire was mailed to all 757 self-identified family practice physicians in Arizona. RESULTS: The return rate was 72 percent, and the response rate was 55.5 percent. Results indicated that 19.3 percent of respondents were trained to perform colposcopy, and 9.5 percent actually have performed it. For those performing colposcopy, the mean number of procedures performed during the previous 6 months was 25 (range 2-100). CONCLUSIONS: Certain barriers to performing colposcopy were identified: (1) lack of available training, (2) interspecialty "turf battles," (3) quality assurance, and (4) the cost of malpractice liability insurance. Nevertheless, there were no insurmountable reasons why family physicians could not perform colposcopy.

Arizona↗
PubMed2005

Informed consent to proposed course of medical treatment: recent case law stances.

Developments in ethics, deontology and case law, along with the related increasing demand for patient autonomy in decision-making in health care, led the President of SIAARTI in 2000 to request the Bioethics Commission to revise the documentation on informed content the Study Group on Anesthesia Safety had issued. In response to the request, a multidisciplinary study group was called to examine the ethical, psychological, clinical, legal and medicolegal issues related to informed consent and to draw up a document that would provide for the implementation of the procedure for information and consent proposed in the model of disclosed information and consent for anesthesia approved by the SIAARTI Advisory Board. The model is to be viewed as evidence for an established anesthetist-patient relationship and as a useful record in case of legal or insurance liability litigation. In Italy, failure to obtain consent to medical treatment has assumed growing legal implications. Since 1992, the failure to obtain consent has become part of case law, an exemplary instance of which is the case of a surgeon that was closed in 2002 with the judgment of the Corte di Cassazione (Italian Supreme Court), section I, of 29/05/2002. The judgment found that, in the absence of express implementation of the Oviedo Convention, a physician is always legitimated to performed therapeutic treatment deemed necessary for preserving the life of a patient in his or her care, even in the absence of explicit consent, with the sole but significant exception of unequivocal refusal of treatment.

Anesthesia↗
PubMedDate not supplied

Continuing decline in service delivery for family physicians: is the malpractice crisis playing a role?

PURPOSE: This study was conducted to monitor trends in the reduction and elimination of services offered by family physicians. In addition, we examined whether the malpractice situation may be influencing these trends. METHODS: We surveyed all family physicians in rural Florida and an equal number of randomly selected, urban, family physicians in the state. We examined changes in professional liability insurance (PLI) premiums, and changes in services offered, practice satisfaction, and future practice plans. RESULTS: Overall, 308 (42.1%) family physicians responded. Results suggest that 60.3% of them reduced or eliminated services in the last year. Specifically, almost two thirds of respondents had eliminated hospital-based surgeries (65.2%) and vaginal deliveries (64.5%). Furthermore, endoscopies were decreased or eliminated by 69% of survey participants, and coverage of emergency departments and nursing homes was reduced or eliminated by 64.1% and 56.4% of respondents, respectively. Increases in the PLI averaged 78.2%. Overall increases in the PLI were significantly related to a decrease or elimination of services offered by family physicians. Dissatisfaction with practice was relatively high (36.8%) and was associated with both the reduction of services and an intention to leave practice within 2 years. No major differences in these trends were noted between rural and urban family physicians. CONCLUSIONS: Access to care provided by rural and urban family physicians in Florida is being hampered by the malpractice situation and other factors. Policymakers may need to focus on these factors in an effort to relieve additional barriers to care for vulnerable populations.

Adult↗
PubMed2004

Avoid costly litigation: ten steps to implementing lawful hiring practices.

A malpractice claim or suit can have a devastating effect on a physician's practice and personal life. What is often overlooked is that an employment-related suit or EEOC charge also can extract a heavy toll, personally, professionally, and financially. The number of employment-related suits and claims has risen dramatically in the last few years. According to recent enforcement and litigation statistics released by the U.S. Equal Employment Opportunity Commission (EEOC) (1), the total discrimination charges filed by individuals against their employers increased last year to 80,840--the highest level since the mid-1990's. According to the EEOC data, in 2001, employers paid $248 million in connection with charges of discrimination filed with the EEOC by job applicants, employees, and former employees. Employers paid an additional $47 million to the EEOC in connection with lawsuits filed against employers by the EEOC (2). This does not include the millions of dollars employers were forced to pay in settlements, judgments, costs, and attorney's fees incurred in connection with employment-related lawsuits filed in state and federal courts during the same period of time. Employment-related litigation is on the rise, and the healthcare industry is not immune. Physicians as employers can be a target for a wide range of employment-related claims and suits, such as breach of contract, invasion of privacy, sex, race, age, religious and age discrimination, and negligent hiring, just to name a few. The number of jury verdicts rendered against employers is increasing and the verdict awards are often staggering. In addition, defending these suits can be as expensive as defending a complicated malpractice suit. Even worse, employment discrimination suits and charges are generally not covered by malpractice, D & O, or general liability insurance policies, leaving the physician to cope with the financial burden of judgments, settlements, attorney's fees and litigation costs. Most employment-related disputes that lead to costly litigation would never have arisen if the employer had implemented more effective employment practices. Hiring mistakes in particular cause many costly legal battles. This article identifies legal issues that precipitate litigation and suggests ten steps physicians can take to implement lawful hiring practices that will reduce the risk of costly employment suits while improving office efficiency, morale, and productivity. NOTE: This article is intended as an overview of lawful hiring strategies, and is not a substitute for legal advice from experienced employment counsel. Applicable laws vary from state to state and appropriate procedures may depend on specific factual situations. This article is not, and should not be construed as, legal advice.

Journal Article↗
PubMed2006

Malpractice in ophthalmology: guidelines for preventing pitfalls.

PURPOSE: To provide ophthamologists with guidelines with which to prevent common errors of malpractice and suggest ways to reduce the risk of liability claims by improving the quality of care. METHODS: Interview of a vitreoretinal surgeon (AW) and search of the current relevant literature. RESULTS: Some of the most common errors leading to ophthalmic malpractice litigation are: 1) failed diagnosis or progression of disease, 2) missing pathology, 3) failed surgery, 4) inadequate patient care, 5) lack of communication, 6) holding back information, 7) no signed informed consent, 8) lack of correct documentation/poor records, 9) poor doctor-patient relationship, 10) no ethical responsibilities, 11) no professional liability insurance coverage, 12) highly pressured hospital set-up, 13) insufficient understanding of law. CONCLUSION: The risk for malpractice litigation for ophthalmologists may be reduced by preventing common causes of malpractice and improving the quality of care.

Humans↗
PubMedDate not supplied

Academia and the medical group practice interface: the 2003 Institute of Medicine quality report and medication management.

University Physicians, Inc., has been impacted by the rising cost of professional liability insurance in recent years. Our internal risk management program needed to be enhanced to heighten provider sensitivity to the challenges certain practice processes (e.g., paper medical records) posed, and to tie this information to new patient and risk management strategies. The Institute of Medicine's 2003 report Priority Areas for National Action: Transforming Health Care Quality and the Agency for Healthcare Research and Quality's 2004 report Closing the Quality Gap: A Critical Analysis of Quality Improvement Strategies were used to establish priorities and develop indicators for measurement. A case study is presented on how these reports, combined with the Joint Commission on Accreditation of Healthcare Organization's 2006 National Patient Safety Goals for ambulatory care, were used to assess the group's risk profile and to implement practice changes to minimize risk.

Academic Medical Centers↗
PubMed2006

Serious complications after radiosynoviorthesis. Survey on frequency and treatment modalities.

AIM: Radiosynoviorthesis using intraarticular injection of beta-emitting radiocolloids is increasingly performed throughout Europe in patients with inflammatory joint disease. It is a cost-effective and safe treatment, local complications are very rare with only eight cases mentioned in the literature so far. No recommendations for therapy of tissue necrosis, infection or thromboembolism after radiosynoviorthesis are available. METHODS: Using a standardized questionary, 260 nuclear medicine physicians and 20 medical liability insurances were asked for the kind and frequency of complications after radiosynoviorthesis between 1998 and 2003. The survey was terminated after nine months with a response of only 25.7%. RESULTS: A total of 53 severe complications were documented (28 necroses, 12 thromboses, 13 joint infections). Eight other complications were seen but difficult to correlate directly with radiosynoviorthesis. Tissue necroses from yttrium-90 were successfully treated by surgical excision and closure of the defect. Rhenium-186-induced ulcers healed by hyperbaric oxygen therapy in two cases. Lesions from erbium-169 showed restoration by conservative treatment. Thromboembolic events happened after radiosynoviorthesis in joints of the lower limb only, mostly treated by conventional anticoagulation. Intraarticular infections showed restoration after intraarticular antibiotics in the majority of cases. CONCLUSION: Severe complications after radiosynoviorthesis seem to be rare. However, because of the low return rate, a reliable frequency cannot be calculated. Nevertheless, important advices regarding treatment concepts can be taken from our data.

Humans↗
PubMed1990

Risk management--a pediatric dentist's view.

The term "risk management" is a relatively new one for most practicing dentists. The concept of risk management comes from hospitals, where programs targeted at reducing or preventing financial awards and settlements have been implemented over the last ten years in response to trends in litigation. For hospitals and professional liability insurers, it is the financial risk or exposure that is of primary importance. To individual practitioners, the emotional stress and potential damage to professional reputation that may accompany charges of malpractice are also substantial risks worthy of "management."

Adolescent↗