CMS Regs for Dialysis Centers Require Patient Grievance Response

The Centers for Medicare and Medicaid Services regulations for Dialysis centers, updated in 2008, serve as minimum standards that dialysis facilities must meet in order to meet to be certified under the Medicare program. 

The revised rule focuses on the importance of patient rights, patient safety and the patient’s participation in the development of his or her own plan of care. Among other enhancements to the regulation, Dialysis Centers are now required to have a facility-level grievance process that explains how a facility must respond to patient grievances.

Dialysis Centers looking to enhance their grievance process will find a useful resource in The Southern California Renal Disease Counsel's Patient Grievance Guidelines and Forms. Organizations wishing to improve their response and documentation to patient grievances will find an excellent, affordable, reporting tool at Simple Data

Monitoring and responding quickly to patient complaints and grievances improves both patient safety and patient satisfaction, reduces liability risk, and complies with CMS regulations.


Delaware Pediatrician Arrested on Multiple Child Rape Charges

As many as 100 children may have been sexually abused by Earl Bradley, M.D., a Lewes, Delaware pediatrician over the last 11 years, according to authorities.

Bradley has been the focus of a state police investigation involving several victims for about a year, state police spokesman Cpl. Thomas Guarini said.

Concerned parents of Dr. Bradley’s patients are urged to call the state victims’ hotline, 800-VICTIM-1.

Read more at Delaware Online

Update 2/23/2010

On Monday, the Attorney General’s Office made its suspicions official, with a grand jury indictment accusing Bradley of sexually assaulting 102 girls and one boy he treated – a more than tenfold increase in the number of victims originally alleged.

Attorney General Beau Biden expects even more victims to be found.

The indictment capped weeks of speculation about the extent of Bradley’s alleged crimes, which Biden said dated to at least 1998.

Physicians Co-Manage This Hospital

"These doctors think the hospital should cater to their every whim!" 

"All the hospital cares about is making money, not about quality patient care!"

If you've worked in healthcare long, you've probably heard those words from frustrated leadership on both sides of the table.

Animosity can build between hospital administrators and physician leaders if communication is poor. Each side may argue that the other doesn't understand or appreciate the real needs of the organization and its patients.  Any forward motion slows to a painful grind.

Hospital_physician Huntsville Memorial Hospital, a 123-bed hospital in Texas is trying something new to improve communication between physicians and administrators; a program that provides primary care doctors and all specialists a seat at the administration table of the hospital.

A comprehensive group of physicians from across all specialties and general practice created a management company that contracts with the hospital to provide clinical management services. The physician-owned company works with a team of hospital administrators as part of a Joint Operating Committee (JOC) to develop best practices and new ideas for the hospital.

All active physicians on the medical staff at the hospital are eligible to join the co-management company, and 95 percent have done so.

Price Waterhouse Coopers assisted Huntsville in establishing the co-management model.

Read the rest in The Huntsville Item

Virtual Doctor Visits on the Horizon

Americans could soon be able to see a doctor without getting out of bed, in a modern-day version of the house call that takes place over the Web.

OptumHealth, a division of UnitedHealth Group,the nation’s largest health insurer, plans to offer NowClinic, a service that connects patients and doctors using video chat, nationwide next year. It is introducing it state by state, starting with Texas, but not without resistance from state medical associations.

Read the rest in the New York Times (free registration required):
The Virtual Visit May Expand Access to Doctors

Must Physician Malpractice be Proven Before a Negligent Credentialing Claim Can Move Forward?

An ongoing Ohio issue has existed of whether a negligent credentialing claim can be pursued against a hospital without a prior finding that the plaintiff’s injury was caused by the negligence of a physician who had privileges at the hospital…

In response to this argument, a number of Ohio courts have agreed to bifurcation (having the claims presented and considered separately) i.e.

, (a) did the physician act negligently/willfully resulting in harm to the plaintiff; and (b) if the answer to the first question is “yes,” did the hospital act negligently in credentialing the physician thereby permitting him to treat the patient. If the answer to the first question is “no,” then the case is dismissed in its entirety

However, by decision dated August 26, 2009, the Ohio Supreme Court … based upon the “unusual circumstances of (Schelling v. Humphrey, Ohio Supreme Court Case No. 2009-Ohio-4175) permitted the plaintiff to go forward and attempt to prove the physician’s malpractice even though the physician was not (and would not be) a party to the lawsuit.

Read the rest in the Bricker & Eckler Health Care Bulletin at 

The Salahi’s in the White House – Sentinel Event or Near Miss?

Whitehouse_night_sm After last week’s news about Tareq and Michaele Salahi’s White House adventures I began to consider whether, if one were applying healthcare criteria, the event would be classified as Sentinel or Near Miss.

Some unanticipated healthcare outcomes are clearly Sentinel (an unexpected occurrence involving death or serious physical or psychological injury, or the risk thereof, per the Joint Commission).  Many times however, there is room for educated discussion as to whether an event should be classified as Sentinel or Near Miss

For a hospital the difference in classification can impact the course of action and level of leadership involvement that occurs following a particular event.  Event classification is usually performed in the Risk Management or Quality Department.

Consider the Salahis. 

Since someone who was apparently not entitled to be present in the White House was touching the President, Vice-President and other officials, the matter clearly seems to meet the criteria of “the risk thereof” for death or serious injury.  Therefore, I would classify this event as Sentinel.

Some might argue that because the Salahis, along with other guests, were screened for weapons prior to entry, a Near Miss classification would be sufficient.  I would agree had the Salahis made it through some levels of screening, but been “discovered” and stopped prior to final access to the state dinner. 

For example, unplanned retention of a foreign body (we’ll say a sponge) after surgery is a Sentinel Event. If however, before the site is closed and the patient leaves the OR, the count is reported as incorrect and the sponge is discovered through x-ray or re-inspection, the event becomes a Near Miss.  Initial screening methods (earlier count or surgical site inspection for example) may not have revealed the presence of a foreign body, but later screening methods did.  The patient did not enter the recovery area with a retained foreign body, therefore, the event is a Near Miss.

The White House and Secret Service appear to be treating the presence of uninvited guests at a state dinner as a Sentinel Event. There are no doubt various flow diagrams and root-cause analysis documents being reviewed by high-level leaders in order to assure this type of issue does not reoccur.  Healthcare must be as diligent.

Hospitals in the UK Under Attack for Poor Safety Record

The debate about improving US healthcare availability continues, but in the United Kingdom, where public healthcare is the standard, a firestorm over patient safety has erupted.  Headlines like these have been featured over the past several days in the British press:

The worst NHS wards … where safety is a lottery

Chief Executive of 'appalling care' hospital has affair with safety manager

Eleven more NHS hospitals at centre of safety scandal

"An explosive report reveals a terrifying picture of many English hospitals, with people dying after being admitted with 'low-risk' conditions…  Failures lead to thousands of deaths.  Government orders new investigation."

"Research that ranks every general hospital in England against a range of safety measures has named 12 NHS hospital trusts judged to be “significantly underperforming”.

"This is despite the fact that last month the Care Quality Commission, the health service regulator, judged overall care at eight of the trusts to be good or excellent. Today’s study by Dr Foster, an NHS partner organisation that collates and analyses healthcare data, also highlights 27 trusts with unusually high death rates. Almost 5,000 more patients in their care died in the past year than was expected."

Our neighbors "across the pond" seem to have many of the same patient safety issues as hospitals in the US.  Perhaps a collaborative improvement effort is in order.

How American Healthcare Killed My Father – by David Goldhill

Keeping Dad company in the hospital for five weeks had left me befuddled. How can a facility featuring state-of-the-art diagnostic equipment use less-sophisticated information technology than my local sushi bar? How can the ICU stress the importance of sterility when its trash is picked up once daily, and only after flowing onto the floor of a patient’s room? Considering the importance of a patient’s frame of mind to recovery, why are the rooms so cheerless and uncomfortable? In whose interest is the bizarre scheduling of hospital shifts, so that a five-week stay brings an endless string of new personnel assigned to a patient’s care? Why, in other words, has this technologically advanced hospital missed out on the revolution in quality control and customer service that has swept all other consumer-facing industries in the past two generations?

Read the rest from The Atlantic, September, 2009