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the
Grace Report Provides Important Private Intelligence,
Gathered Exclusively
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Headlines-
December 19, 2005
Headlines- December 19, 2005 Commentary
and Opinion by Robert L. Michel: TODAY, I’D LIKE TO MAKE A PREDICTION that will personally affect every ob-gyn. I predict that campaigns to reduce medical errors and improve clinical outcomes will have another, oft-unmentioned consequence. The day is fast-approaching when physicians will be expected to practice medicine within tight boundaries. Variability between physicians in basic care will be greatly reduced. Traditionally, physicians have been the “masters and commanders” over the care provided to their patients. It has been their prerogative to decide how their patients will be treated. The healthcare system has respected this situation. Colleagues and other clinicians have traditionally not been invited to criticize, second-guess, or suggest “better” ways to treat another’s patient. Physicians have been generally free to practice within a wide boundary that allows for lots of independence. That era of medicine is drawing to a close. Increasingly, physicians will find themselves working with clinical decision support systems designed to guide them to consistently do the “right” thing for the patient. Employers, payers, and patients will have access to data which reveals how consistently individual physicians follow recommended guidelines. Reimbursement for clinical services will be increasingly tied to whether or not a physician followed the accepted protocols in treating the patient. Physician pay-for-performance programs are both a sign of this trend and an agent of change. The error-reduction initiative by ob-gyns at Beth Israel Deaconess Medical Center is a real-world example. As you will read on pages 3-9, in recent years, ob-gyns in the obstetrics department sought out the advice of the aviation industry. After all, airplane pilots are well-trained and highly-educated professionals. To reduce aviation errors and plane crashes, pilots in the same cockpit have had to learn how to communicate effectively. This means one colleague may have to challenge another in flight—but using methods designed to produce the right answer and the right action with the goal of maintaining air safety. It’s the same reason why ob-gyns at BIDMC are learning how to communicate, in different ways, to the benefit of the patient. In fact, they define their new clinical approach to be a team-based system. By definition, this is collaborative medicine and gives us a look at how things will be in the near future. -------------------------------------------------------------------------------------------------------- Boston’s Beth Israel Tackles Errors in Labor & Delivery Lessons from airline and military pilots help Beth Israel improve patient safety CEO Summary: When one of the nation’s flagship teaching hospitals turned to the Department of Defense for lessons in how to reduce errors, many ob-gyns were skeptical. However, after adopting resource management and communication techniques from the U.S. military, ob-gyns at Beth Israel Deaconess Medical Center in Boston,Massachusetts, have used them to cut both the number of malpractice claims and adverse events in its labor and delivery unit. Now in its third year, the program has reduced the amount of money reserved for claims, from $8.7 million in 2001 to $3.8 million for all of 2004. -------------------------------------------------------------------------------------------------------- Study of OB Claims Triggers Move to Team-Based Care Boston’s Beth Israel Deaconess Medical Center blazes innovative path encouraging team care CEO Summary: In response to a particularly tragic case involving medical errors in 2000, Beth Israel Deaconess Medical Center in Boston, Massachusetts, took a radical course of action. It decided to explore how the decision-making processes used in aviation to reduce errors and accidents could be used in its labor and delivery unit. After studying 10 years of malpractice claims, the hospital began training its ob-gyns and staff on these techniques in 2001. Since then, there has been a noticeable reduction in cases involving errors. -------------------------------------------------------------------------------------------------------- Two Specific Legal Threats Need Response from Ob-Gyns Unwary ob-gyns may be snared by recent tax code changes CEO
Summary: Congress
passed IRS Section 409A last year. IRS guidance on this new law, which
affects medical groups with Nonqualified -------------------------------------------------------------------------------------------------------- Ob-Gyn Practice Update: Solo Ob-Gyn Shares Lessons from Start-up New practice steadily gaining more patients, but local hospital closes its OB department -------------------------------------------------------------------------------------------------------- OB-GYN Briefs: US. ATTORNEY ACCUSES MARYLAND OB-GYN OF FRAUDULENT CODING MORE MOMENTUM IN DRIVE TO APPROVE VACCINE FOR HPV ANTI-AGING IS BASIS FOR MEDICAL PRACTICE OF BODYLOGICMD ------------------------------------------------------------------------------------------------------- INTELLIGENCE: Late and Latent INSTITUTE OF MEDICINE CALLS FOR UNIVERSAL PAY-FOR-PERFORMANCE STANDARDS Hospitals
Leaving the HMO Business
Look for the next briefing on Monday, January 9, 2005.
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