Boston health interviews: Spotlight on surgery, Lown and Berwick

You correspondent has been tooling around the city lately asking a lot of questions. Three recent Q&A column in Health Leaders with Boston, Brookline and Cambridge, Mass. links.

Also, the staff at the Brigham had a few questions when a VIP guest make some special requests. Check out the story from the Sunday Globe

When state investigators interviewed an employee identified as “nurse director #1’’ in the report, she said the patient interpreted the use of protective gowns as an indication they thought he was “dirty’’ and asked that staff not wear them. A physician told inspectors that he visited the patient five to seven times a week and did not wear protective gear because the patient “found it offensive.’’ And the hospital had no infection control policies in place for the patient’s personal staff, it told the state. 

sox win 07

Go Sox!

Concurrent Surgery Gets the Spotlight treatment: The editor of The Boston Globe’s investigative reporting unit discusses his team’s series raising questions about the practice of concurrent surgeries and patient safety.

 

Vikas Saini, MD, president of the Lown Institute:”There really needs to be an alliance among patients, families, and communities. At the end of the day, they get to decide what is the right care,”

 

Donald Berwick: The former head of CMS says “we will never solve the problem of cost and finance by focusing on cost and finance.” Instead, it will be resolved “by focusing on the design and redesign of healthcare and the improvement of its quality.”  Part 2

 

 

Guns in hospitals? MGH guards go with pepper spray

579 mill tower MGH

MGH 2010

Deep into a disturbing  New York Times story on hospital guards who shoot patients, find a passing reference to Massachusetts General Hospital’s security program.

(More on guns in hospitals here.  It has been about a year since the son of a patient walked into the Brigham and fatally shot a doctor. 

From the Times:

To protect their corridors, 52 percent of medical centers reported that their security personnel carried handguns and 47 percent said they used Tasers, according to a 2014 national survey, more than double estimates from studies just three years before. Institutions that prohibit them argue that such weapons — and security guards not adequately trained to work in medical settings — add a dangerous element in an already tense environment. They say many other steps can be taken to address problems, particularly with the mentally ill.

Massachusetts General Hospital in Boston, for example, sends some of its security officers through the state police academy, but the strongest weapon they carry is pepper spray, which has been used only 11 times in 10 years. In New York City’s public hospital system, which runs several of the 20 busiest emergency rooms in the country, security personnel carry nothing more than plastic wrist restraints. (Like many other hospitals, the system coordinates with the local police for crises its staff cannot handle.)

“Tasers and guns send a bad message in a health care facility,” said Antonio D. Martin, the system’s executive vice president for security. “I have some concerns about even having uniforms because I think that could agitate some patients.”

Surgeons, MGH react to to Globe story on surgery scheduling

ss2 (2)Reaction to the Globe’s Spotlight series on simultaneous surgeries — where a surgeon has two operations going at the same time — continues in the paper and beyond

In late December, the paper reported:

 

The American College of Surgeons plans for a roughly 10-member committee — which includes both critics and supporters of concurrent surgeries — to craft a consistent approach to keeping patients safe and informed when doctors run two operating rooms, according to Dr. David Hoyt, executive director of the organization.

“We are going to move as quickly as we can on this,” Hoyt said. “This is a priority.”
A Globe survey of 47 hospitals nationwide found that it is common for surgeons to start a second operation before the first is complete, often after the surgeries were deliberately scheduled to overlap briefly. However, some surgeons have operations that run simultaneously for longer periods. And few hospitals call on doctors to explicitly tell patients when their operations are double-booked.

The paper also ran an editorial cartoon — a surgeon on RollerBlades –with a super long disclosure statement.

MGH got a lot of space in the Sunday “Ideas” section to offer their unfiltered take on the matter, as did this doctor:

When I handle concurrent procedures, I have to carefully design the schedule around when I can and cannot be absent from an operating room. Surgical procedures have “critical” and “noncritical” portions, and this changes on a case-by-case basis depending on the patient and his or her unique problem as well as the team I’m working with. For instance, if I’m working with a brand-new intern, then every moment, from preparation to wake-up, is critical. If I’m working with a seasoned fellow with five years of operating experience, then the critical portions are much more focused.

From the Jan. 10 piece  by Dr. Peter L. Slavin –president of Massachusetts General Hospital  and Dr. Thomas J. Lynch chairman of the Massachusetts General Physicians Organization ran in the Sunday “Ideas” section of the paper

Overlapping surgery occurs at MGH and hospitals throughout the country for a variety of reasons. Overlapping surgery saves lives in certain clinical situations, such as after the Boston Marathon bombings and the Rhode Island Station nightclub fire, when multiple critically ill patients need rapid access to surgical care. Overlapping surgery enhances access to care, helping meet the high demand for certain specialties and specialists.

Partners has also posted detailed comments on its own web site.

 

Partners’ Kvedar’s new book on “The Internet of Health Things”

Joseph  Kvedar, the VP of Partners’ Connected Health Program was on to  “The Internet of Healthy Things” way before any of the rest of us.  Now he’s collected his thoughts — aimed a “business executives” — in a new book.

More video from this year’s connected health conference here.

 

Health care in Massachusetts: Affordable or not?

Not affordable: From this week’s paper

Rising health care costs have outpaced the incomes of Massachusetts families over the past decade, despite efforts by the state to control medical expenses, according to a report released Wednesday.

Affordable: Two weeks ago.

Despite concerns about rising health care costs, the head of the state’s largest and most expensive network of doctors and hospitals said Thursday that health care is “very affordable” in Massachusetts.partners

Partners HealthCare chief executive Dr. David Torchiana, in remarks to the Greater Boston Chamber of Commerce, acknowledged that health care costs are higher here than in other parts of the country, largely because Massachusetts is home to several large teaching hospitals whose training and research programs make them expensive to run.

But considering the high incomes in Massachusetts, it’s not so bad, Torchiana said: “Health care is very affordable in Massachusetts.”

To help make sense of this and other health policy debates, check out the latest Health Wonk Review.

Federal prosecutors investigate double-booked #surgeries identified in Globe Spotlight series #MGH #qualityofcare

Note that the Globe’s story on double book has instigated some scrutiny from outside the world of medicine and journalism. ss2 (2)

Federal prosecutors have subpoenaed 10 years of internal records from Massachusetts General Hospital and have interviewed several physicians as part of an investigation into surgeons running two operating rooms at the same time, according to individuals with direct knowledge of the probe.

Some MGH staff members have raised concerns for years about double-booked operations in the renowned hospital’s orthopedics department, a dispute little known to the public until a Globe Spotlight Team report last month. Hospital officials say concurrent surgery is safe and improves efficiency, but critics say the practice is risky and that, too often, patients are not told their surgeon plans to manage a second, simultaneous case.

Also note that MGH feels the article treated the institution unfairly.

MGH 2010

MGH 2010

MGH set up a website for patients in response to the Spotlight report and sent out e-mails to employees defending double-booking.

“There is no quality and safety issue that the MGH has scrutinized more carefully in recent years than overlapping surgery,’’ Dr. Peter Slavin, the hospital president, and Dr. Thomas Lynch, head of the Massachusetts General Physicians Organization, wrote employees on Oct. 30. “We do not believe that the Globe article provided a fair and balanced description of surgical practices at MGH.’’

A hospital spokeswoman said MGH has had no cancellations or postponements of surgeries and only a handful of questions from patients.

 

Looking for Boston Globe health reporting? Try the business section

ssUPDATE: Props to Beta Boston, another source of Globe health reporting.

Since the Globe currently has no full-time health and science editor, no science writer and a hard-to-find, often dated health site, we turn to the business section for news on health, or at least health finance and pharma. Perhaps things will pick up in the fall.

In terms of Globe-ish  health-sci-ish  reporting, we see STAT continuing to pop up in the paper and the paper’s website but not the STAT website. The business section of the print version of today’s paper premieres a weekly column called Kendall Squared. Today, Andrew Joseph reports on the rebranding of the square-less square, the sale of dishes at the closed Hungry Mother restaurant, a Forsyth Institute dentist who runs a children’s clinic in Kuwait and a non-profit dispute resolution group that is being prices out of the Square.

In the meantime, best to follow individual members of the Globe‘s shrinking but solid Metro sci-health team:

Kay Lazar @GlobeKayLazar

Liz Kowalcyk @GlobeLizK

Felice J. Freyer @felicejfreyer

And, check the business page. The state Center for Health Information and Analysis has come out with it’s latest hospital profits report and today, The Globe helps sort it out for us.

The state’s biggest hospitals were the most profitable in 2014, with Massachusetts General Hospital, the largest academic medical center, earning $200 million, up 34 percent from the previous year, and Brigham and Women’s Hospital earning $152 million, up 9 percent. Both are owned by Partners HealthCare of Boston.

Other big earners were Baystate Medical Center of Springfield, Lahey Hospital and Medical Center in Burlington, Saint Vincent Hospital in Worcester, and Beth Israel Deaconess Medical Center in Boston. The results are for fiscal year 2014, which for most hospitals ended last September.

The profits overall, however, mask some of the struggles in the changing field. Quincy Medical Center lost $39 million last year, the most in the state. Its owner, Steward Health Care System, closed the hospital at the end of the year. North Adams Regional Hospital in the Berkshires closed several months earlier. The push to cut costs has, in part, prompted several hospitals to consider mergers or acquisitions.

Earlier this week, the paper reported that the advent of ACOs has cut Medicare spending at five major health systems in the state

New figures show five Massachusetts health systems saved a combined $141 million during that period as part of the program, which aims to rein in costs by better coordinating care for Medicare patients and cutting unnecessary hospital stays and medical services. Doctors manage care for these patients in pools known as Pioneer accountable care organizations.

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