Daily Archives: February 19, 2015

02.19.15
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Free Access to Journal

We invite non-members to view the Winter 2014 issue of PSNA’s peer-reviewed e-journal, Pennsylvania Nurse. Feel free to share it with your colleagues! Pennsylvania Nurse is published electronically four times a year. This issue contains three continuing education articles. PSNA members can take all of the tests and earn CE for FREE. Non-member pricing for each CE is $10 through PSNA’s Continuing Education Center.

 

02.19.15
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In The Medicare Bonus Round, The Winners Are…Small, Specialty Hospitals!

In Medical Park hospital in Winston-Salem, North Carolina, Angela Koons is still a little loopy and uncomfortable after wrist surgery. Nurse Suzanne Cammer jokes around with her. When Koons says she’s itchy under her cast, Cammer laughs and says, “Do not stick anything down there to scratch it!”  Koons smiles and says, “I know.”

Cammer is wearing charm-bracelets and jangly earrings, so she literally jingles as she works around Koons. Her enthusiasm for her job puts Koons at ease and is making her hospital stay more comfortable.

“They’ve been really nice, very efficient. Gave me plenty of blankets because it’s really cold in this place,” she says.

A reporter takes a quick informal poll, asking Koons and her stepfather, Raymond Zwack, to rate their satisfaction with the hospital on a 10-point scale.  They both give Medical Park the same rating: a perfect 10.

Other patients — Karen Siburt, George Stilphen and Emily Willard — all agreed. They would rate the hospital a 9 or a 10.

Hospitals take more formal surveys from Medicare very seriously because the Affordable Care Act ties some hospital payments each year to how patients rate the facilities. Medical Park received a $22,000 bonus from Medicare in part because of sterling patient satisfaction surveys.

Novant Health is Medical Park’s parent company, and none of their dozen or so other hospitals even come close to rating that high on patient satisfaction.  Figuring out why Medical Park did so well is complicated.

First, says staff surgeon Scott Berger, this isn’t your typical hospital.

“It kind of feels, almost like a mom-and-pop shop,” he says.

Medical Park is really small, only two floors. Doctors just do surgeries, like fixing shoulders and removing prostates, and mostly for people with insurance.

Another key is that no one at Medical Park was rushed to the hospital in an ambulance or waited a long time in the emergency room; in fact, the hospital doesn’t even have an emergency room. The vast majority of the surgeries done at Medical Park are elective.

“They’re choosing to come here,’’ says Chief Operating Officer Chad Setliff. “They’re choosing their physician.”

These are the built-in advantages small, specialty hospitals have on patient satisfaction, says Chas Roades, a consultant with The Advisory Board Company.

“A lot of these metrics that the hospitals are measured on, the game is sort of rigged against [large hospitals] in a sense just because of the kind of facility they are,” he says.

This is the third year hospitals can get bonuses or pay cuts from Medicare in part because of those scores. They can add up to hundreds of thousands of dollars.

Hospitals that handle many more patients – often massive, noisy and hectic places – are more likely to get penalized, says Roades.

“In particular, the big teaching hospitals, urban trauma centers, those kind of facilities don’t tend to do as well in patient satisfaction because they’re just busy, crowded, [and] there’s a lot of different caregivers that interact with the patients,” he says.

Roades says the patient surveys aren’t perfect, but they are fair: “In any other part of the economy, if you and I were getting bad service somewhere – if we weren’t happy with our auto mechanic or we weren’t happy with where we went to get our haircut – we’d go somewhere else.”.

In health care, patients rarely have that choice. So Roades says hospitals should be assessed in part by patients.

And Medical Park executives say there are ways big hospitals can seem smaller – and raise their scores.

Nurse Gennie Tedder is walking patient Jeremy Silkstone through a pre-surgical visit.  It’s a chance a week or two before surgery to connect with patients and prepare them for what can be a painful process.

“It’s very important that you have realistic expectations about pain after surgery. It’s realistic to expect some versus none,” she explains to Silkstone.

Medical Park now handles this part of surgery prep for some of its parent company’s other, bigger hospitals. Silkstone, for example, will have surgery at the huge hospital right across the street, Forsyth Medical Center.

Medical Park Nursing Director Carol Smith says when her staff took over pre-surgical, “Forsyth’s outpatient surgical scores increased by 10 percent.”

But some doctors and patients who’ve been to both hospitals agree that the smaller one is sure to have higher scores. It’s just warmer and fuzzier, one patient says.

This story is part of a reporting partnership between NPR, WFAE and Kaiser Health News.

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation.

02.19.15
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Trade Deals Should Come With Their Own Warnings for Public Health

 Second in a series

Last September, the small West African nation Togo launched a public health campaign about the hazards of smoking. First they put warning labels in three languages on cigarette packages. Since Togo is one of the poorest countries in the world with a high illiteracy rate, they then added graphic images, such as smokers’ diseased lungs, similar to a model used by Australia.

That’s when the roof fell in. As the brilliant comic John Oliver chronicled on his HBO show “Last Week Tonight” February 15, the government of Togo received a letter from Phillip Morris International (PMI), which owns seven of the top 15 best selling cigarette brands, threatening “an incalculable amount of international trade litigation.”

Noting that Phillip Morris’ $80 billion in annual revenues dwarfs Togo’s gross domestic product of $4.3 billion, Oliver explained that Togo, “justifiably terrified by the threat of billion dollar settlements, backed down from a public health law that many people wanted.”

Togo was not alone. PMI and other tobacco giants also cited global trade pacts to overturn packaging laws for tobacco in Australia (which ultimately won a court fight with PMI), Uruguay, Namibia and the Solomon Islands. “That’s right,” intoned Oliver, “a company was able to sue a country over a public health measure through an international court.”

Thus the problem with so many of the international trade deals signed at the behest of transnational corporations the past three decades. National sovereignty is overridden by the inexorable push for higher corporate profits, with public health frequently a first target.

President Obama and leaders of Congress are presently pushing the next set of trade deals, including the Trans-Pacific Partnership, and seeking fast track authority that would bar critics of the handouts to corporate interests from amending the deals and even limiting debate.

If there’s one sign of whose ox is likely to be gored, just note that much of the language was written by Wall Street lobbyists and that corporate executives have had an advance look at the language of the proposed deals that are still being kept secret from not only the public but even many members of Congress.

But based on past experience – and what leaks have emerged – it is evident that the deals pose a significant threat to public health, consumer protections, and the environment. As well as to the democratic rights of any nation’s people to enact laws that will not be overturned by legal action or multi-billion dollar bullying by corporations that, like Phillip Morris, are wealthier than many nations.

The TPP, for example, would grant much greater leverage to block access to lower priced life saving medications, as chronicled in the first part of this series.

Public Citizen has warned that the TPP would require the U.S. to allow food imports that fail to meet U.S. safety guidelines, and that any food safety rules on use of pesticides, additives, or labeling requirements could be challenged as a barrier to trade.

Another proposed trade agreement, the Trans Atlantic Trade and Investment Partnership, would provide further license for healthcare corporations to undermine national health systems.

Yet a third trade deal in the works, the equally secretive Trade in Services Agreement, would promote privatization of health services.

According to a leaked document analyzed by Public Services International, the TISA negotiators are salivating over a “huge untapped potential for the globalization of healthcare services” mainly because “health care services (are) funded and provided by state or welfare organizations and (with) virtually no interest for foreign competitors due to lack of market-orientated scope for activity.”

In addition to providing the legal recourse for corporations to use international courts to overturn national or local laws they don’t like, all three of the current draft agreements contain an “investor-state dispute settlements” provision, which establishes separate “corporate courts” to adjudicate complaints, because of supposed infringement on their marketing.

NAFTA, the North American Free Trade Agreement (NAFTA), has provided many examples of the land mines for the public interest.

Citing NAFTA, drug giant Eli Lilly sued the Canadian government after Canadian courts invalidated the company’s monopoly patents and a group of private investors led by an Arizona entrepreneur challenged Canadian restrictions on for-profit surgery centers.

In another prominent case, Lone Pine Resources, a big oil and gas company is suing the Canadian province Quebec, under the rules of NAFTA, over a moratorium on the environmentally dangerous process of hydraulic fracturing or fracking.  

Stewart Trew of the Council of Canadians in Ottawa has warned of more lawsuits if the TPP and similar trade deals are approved as they are likely to include investor protection provisions similar to NAFTA’s.