In his testimony on March 24 to the health subcommittee of the House Energy and Commerce Committee, AANS President James R. Bean, MD, stressed the need to enfold medical liability reform into healthcare reform legislation.
“We will never be able to control costs—a critical component of any healthcare reform that works and is sustainable over time—if we don’t do something about the constantly overhanging fear of lawsuits that drive physicians and hospitals to increasingly practice defensive medicine,” he said.
Using the success of medical liability reform passed in Texas in 2003 as an example, Dr. Bean illustrated how the passage of similar legislation at the national level might reduce the number of medical liability case filings, reduce medical liability insurance rates, and encourage doctors to practice. He also expressed approbation for President Obama’s description of medical liability reform legislation in “Modern Health Care for All Americans,” which was published in the New England Journal of Medicine when he was a presidential candidate. However, Dr. Bean warned against a “one-size-fits-all” solution that would imply negligence whenever a healthcare provider, exercising judgment and expertise, offered a treatment outside of guidelines articulated by a medical society.
Frequency of Surgical Mistakes Is New Survey’s Subject
In a new study of medical errors in orthopedics, published in the Journal
of Bone and Joint Surgery, orthopedic surgeons were asked if they had observed
a medical error in the past six months. More than half, 53 percent, responded
affirmatively. Most errors involved equipment (29 percent) and communication
(24.7 percent). Errors that could cause serious patient harm included medication
errors (9.7 percent) and wrong-site surgery (5.6 percent). The reporting orthopedic
surgeon was involved in 60 percent of the errors, a nurse in 37 percent, another
orthopedic surgeon in 19 percent, other physicians in 16 percent, and house
staff in 13 percent. Author D.A. Wong and colleagues concluded that medical
errors continue to occur, representing a threat to patient safety, and called
for quality assurance measures and additional research in the areas of higher
error occurrence (equipment and communication) and high risk (medication and
wrong-site surgery).
www.ejbjs.org
Zero Industry Funding Proposed for Medical Societies
A proposal to ideally reduce industry funding of professional medical associations’
activities to zero was published in the April 1 issue of the Journal of the
American Medical Association. David Rothman and colleagues sought to address
what they termed a lack of uniformity and stringency among association policies
regarding industry funding of their activities. They identified and analyzed
conflicts of interest that could affect the activities, leadership, and members
of associations, and then formulated short- and long-term guidelines intended
to prevent the appearance or reality of undue industry influence. A short-term
recommendation was to reduce industry support to no more than 25 percent of
an association’s budget. Industry funding that was clearly recognizable as
“marketing,” such as exhibit hall and advertising income, was exempt from their
recommendations.
www.jama.com
Few U.S. Hospitals Have EHRs, Survey Finds
Although the American Recovery and Reinvestment Act of 2009 supports health
information technology through significant funding, a recent survey suggests
that there is a long way to go before achieving widespread adoption of electronic
health records, let alone software compatibility and interoperability. Of
nonfederal hospitals surveyed in a study published in the New England Journal
of Medicine, only 1.5 percent currently had a comprehensive electronic records
system, and 7.6 percent had a basic system. Author Ashish Jha and colleagues
used an expert panel to define “comprehensive” and “basic” systems. Computerized
provider-order entry for medications had been implemented in only 17 percent
of hospitals. Survey respondents cited capital requirements and high maintenance
costs as the primary barriers to implementation. The survey was sent to all
American Hospital Association-member acute care hospitals. A previous study
by the authors found that 17 percent of U.S physicians were using either
a basic or comprehensive EHR. Related article: “Considering an EMR?
www.nejm.org
Doctors’ Donations Help Close Hospital’s Budget Gap
When Beth Israel Deaconess Medical Center in March announced a $20 million
budget shortfall that would cause budget cuts and staff layoffs, 12 medical
department heads took unusual action. They voluntarily cut their individual
pay by about $27,000, a move that was expected to save about 10 jobs. They
then sent letters requesting donations from other doctors affiliated with the
hospital to “support job preservation among the hospital staff in order that
they can continue to provide great service to our patients.” Their action complemented
the hospital’s cost-cutting efforts, which included executive pay cuts and
staff pay freezes, and donations from other staff and the business community
to close the shortfall. The story, characterized as an example of innovative
leadership and teamwork, was widely reported.
www.amednews.org; www.boston.com