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PubMed1991

Malpractice and the National Practitioner Data Bank: what OR nurses need to know.

The National Practitioner Data Bank will record any payments made for any reason related to a malpractice suit in a central data bank available to a number of designated parties. Hospitals will be required to request this information to screen applicants and at least every 2 years for appointment renewals. The data bank may also be consulted by hospitals and state licensing boards as they deem necessary and by professional societies when reviewing membership applications. It is in the best interests of all malpractice defendants to insist on adequate representation of their personal, professional, and financial interests, which may necessitate insurance carriers providing each defendant with individual counsel.

Databases, Factual↗
PubMed1991

Gaming the system. Dodging the rules, ruling the dodgers.

Although traditional obligations of fidelity require physicians to deliver quality care to their patients, including to utilize costly technologies, physicians are steadily losing their accustomed control over the necessary resources. The "economic agents" who own the medical and monetary resources of care now impose a wide array of rules and restrictions in order to contain their costs of operation. However, physicians can still control resources indirectly through "gaming the system," employing tactics such as "fudging" that exploit resource rules' ambiguity and flexibility to bypass the rules while ostensibly honoring them. Physicians may be especially inclined to game the system where resource rules seriously underserve patients' needs, where economic agents seem to be "gaming the patient," with needless obstacles to care, or where others, such as hospitals or even physicians themselves, may be denied needed reimbursements. Though tempting, gaming is morally and medically hazardous. It can harm patients and society, offend honesty, and violate basic principles of contractual and distributive justice. It is also, in fact, usually unnecessary in securing needed resources for patients. More fundamentally, we must reconsider what physicians owe their patients. They owe what is theirs to give: their competence, care and loyalty. In light of medicine's changing economics, two new duties emerge: economic advising, whereby physicians explicitly discuss the economic as well as medical aspects of each treatment option; and economic advocacy, whereby physicians intercede actively on their patients' behalf with the economic agents who control the resources.

Beneficence↗
PubMed1991

Placenta within the medicolegal imperative.

Bad pregnancy outcome includes abortion, stillbirth, neonatal death, morbidity, malformation, cerebral palsy, and mental retardation. These afflictions cause devastating personal impact. In the United States, almost 10% of all school-aged children are handicapped. Neurologic and communicative disorders affect 42 million people and cost $114 billion each year. The cause of cerebral palsy is known in less than 10% of these cases. Enormous litigations have threatened clinicians, paramedical personnel, hospitals, and insurance carriers. The placenta is an important potential means of establishing that fetal damage causes bad pregnancy outcome independently of clinical care. All pathologists serve an important role in the documentation of gross placental features and in the procurement of appropriate light microscopic slides. Pathologic placentas are common. Only an expert can determine whether an abnormal placenta represents the probable cause of bad pregnancy outcome.

Chorioamnionitis↗
PubMed1990

Outcomes measurement: a report from the front.

In August of last year, a group of individuals representing providers, employers, insurers, government agencies, researchers, and policymakers gathered for two days at a study center in Woods Hole, Massachusetts to share information on current programs, explore the obstacles, and consider the possibilities for the application and use of outcomes measurement. Several reports on actual use of outcomes measures by purchasers of health care, hospitals, clinics, and third-party payers formed the basis for discussion on the systems in use and their purposes, and also on the strengths and weaknesses of outcomes measures and how they might be improved. The group also addressed how purchasers, providers, and patients might work together to develop the most effective and useful measures.

Employment↗
PubMed1990

Multiple choice health insurance: the lessons and challenge to private insurers.

A health policy consultant with 20 years of experience in public and private health insurance, and particularly multiple choice systems, suggests the evidence is in on our national effort to contain costs through competition, HMOs, and multiple choice health plans. Specifically, we have learned that 1) multiple choice plans are not containing costs for employers, 2) while group and staff model HMOs contain costs, few have cut employers' costs in multiple choice health plans, and 3) group and staff model HMOs' capacity to contain costs has not been matched by insurers' managed care plans. Three options for insurers and HMOs to offer employers are outlined. The options are aimed at changing the behavior of providers so they offer lower cost health care.

Community Participation↗
PubMed1990

Institutes of Quality experience uneven volume.

The Prudential Insurance Company's plan to shuttle patients needing high-tech care to designated Institutes of Quality was announced with great fanfare and has been under way for more than a year now. Yet the prestige of the designation has been greater than any increases in patient volume for all but a few hospitals involved in the program. Still, according to Prudential, the program has saved the Newark-based company close to $1 million.

Bone Marrow Transplantation↗
PubMed1990

Reasons for exceeding average length of stay in the terminal patient: one center's experience.

1. LOS was not significantly influenced by the type of insurance carrier. 2. Age was not a factor in LOS of the terminal patient. However, Medicare patients averaged the greatest number of days lost/patient. 3. Terminal Medicare cancer patients whose physician was an oncologist had a shorter LOS. 4. The growing commitment to home hospice will result in a decreasing number of patients coming into the hospital to die. 5. The decreasing number of terminal cancer patients who expire within 72 hours of admission will result in an increase in the average LOS of those remaining hospitalized cancer patients.

Female↗