NewNotables – Issue 73

Survey Finds Gap in Doctor-Patient Communication

USA Today December 6, 2010

Doctors and patients alike believe that when they communicate well, healing goes better, and it can even make a difference between life and death. A national survey of doctors and hospitalized patients found a different result — that effective communication often is sorely lacking.

The survey showed that only 48% of patients said they were always involved in decisions about their treatment, and 29% of patients didn’t know who was in charge of their case while they were in the hospital. Eighty-one percent of patients and 71% of doctors agreed communication made a difference in “whether a patient lives of dies,” according to the survey of 500 doctors and 800 patients. The commission was sponsored by Marttila Strategies in Boston.

Emphasis on better communication has increased in recent years as the medical community has become more aware of its effect on patient healing. Since 1995, U.S. medical students have been required to get training in communication skills. In 2005, the United States Medical Licensing Exam began to include testing on interpersonal and communication skills.

Communication skills and high patient-satisfaction scores can give hospitals a competitive edge as well as reduce malpractice claims, says Debra Roter, a professor at John Hopkins University in Baltimore.

Comment: It seems like it just makes common sense that good communication will improve results in medical issues and other areas of our life, whether professional or personal. The things we say are often heard differently by others. Kudos to the medical profession for placing better communication in their training and medical exams. Of course, I also like the positive effect on malpractice suits.

The Leapfrog Group Announces Top Hospitals of the Decade

The Associated Press, November 30, 2010

Virginia Mason Medical Center in Seattle and University of Maryland Medical Center in Baltimore were named as the top hospitals of the decade, citing their strong public commitments to and major achievements in reducing medical errors and other innovations in patient safety and quality.

The two hospitals are among 1,200 leading institutions that voluntarily participate in the annual Leapfrog survey, at extensive collection of nationally recognized standards that help ensure the safety and quality of hospital care. They were the only two hospitals in America to consistently perform in the top ranks of survey responders since Leapfrog began its Top Hospital awards program in 2006.

The Leapfrog Group is a coalition of public and private purchasers of employee health benefits founded a decade ago to work for improvements in health care safety, quality and affordability. Leapfrog Board Chair David Knowlton describes the efforts of the two hospitals as “extraordinary in every sense of the word.” Knowlton noted, “The new era of health care reform in our nation is going to require providers, insurers, employers and others to work together as never before to improve the quality and efficiency of care.” Knowlton added that, “Hospitals such as The University of Maryland Medical Center and Virginia Mason Medical Center chose to blaze that trail long ago by committing themselves to change, accountability and transparency. They have done the work that others must now undertake.”

Comment: Both hospitals earned these distinguished awards and should be a model to follow. These awards are tributes not only to the hospitals, but also to employers and health care purchasers, boards of trustees, and management teams at these hospitals and to their physicians, nurses, and employees working every day to improve the quality and efficiency of care.

Doctor Faces Suits Over Cardiac Stents

The New York Times, December 5, 2010

Word reached top executives at Abbott Laboratories that a Baltimore cardiologist, Dr. Mark Midei, had inserted 30 of Abbott’s cardiac stents in a single day in August 2008, “which is the biggest day I can remember hearing about,” an Abbott executive wrote in a celebratory e-mail two days later. An Abbott sales representative spent more than $2,000 to buy a whole, slow-smoked pig and other fixings for a barbecue dinner at Dr. Midei’s home, according to a Senate report. The dinner was a small part of millions in salary and perks showered on Dr. Midei for putting more stents in more patients than almost any other cardiologist in Baltimore.

The Senate finance committee, which oversees Medicare, started investigating Dr. Midei after a series of articles in The Baltimore Sun said that Dr. Midei at St. Joseph Medical Center had inserted stents in patients who did not need them, reaping high reimbursements from Medicare and private insurance.

The Senate report concludes that Dr. Midei “may have implanted 585 stents which were medically unnecessary” from 2007 to 2009. Medicaid paid $3.8 million of the $6.6 million charged for those procedures. The report also describes the close relationship between Dr. Midei and Abbott Labs, which paid consulting fees to the cardiologist after he left the hospital. After reports about Dr. Midei’s case and the wider state investigation, the number of stent procedures performed at St. Joesph and other area hospitals plunged, raising doubts about the appropriateness of much of the region’s cardiac care.

Dr. Steven Nissen, chief of cardiovascular medicine at the Cleveland Clinic, said, “What was going on in Baltimore is going on right now in every city in America. We’re spending a fortune as a country on procedures that people don’t need.”

Last month, St. Joseph agreed to pay a $22 million fine to settle charges that it paid illegal kickbacks to Dr. Midei’s medical practice, MidAtlantic Cardiovascular Associates, in exchange for patient referrals. The hospital did not admit any wrongdoing. St. Joseph said in a statement that it now conducts monthly random reviews of stent cases “to assure such a situation cannot occur again.”

Comment: Does it seem strange that both Abbott and St. Joseph celebrated Dr. Midei’s excessive use of stents rather than challenge the extremely high usage, and then showered benefits on him? Once again, greed blinds people to the obvious. Situations such as excessive use of stents and other procedures performed to avoid malpractice suits, costs billions in our health care system. A positive result of this case is that St. Joseph now conducts monthly random reviews of stent cases “to assure such a situation cannot occur again.” It’s better late than never, but they should be embarrassed that the high stent usage didn’t raise a red flag. Of course St. Joseph “did not admit to any wrongdoing,” but still paid a $22 million fine.

By Roger Eigsti
Board President,
Institute for Business, Technology, and Ethics