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MedPac Seeks SGR Alternatives
WASHINGTON - Multiple options exist to permanently fix the Medicare Sustainable Growth Rate formula, but each has its cost to physicians, patients, and the program, according to staff analysts for the Medicare Payment Advisory Commission.
Among the options MedPAC staff presented to commissioners at a recent MedPAC meeting were adjusting the SGR's spending targets so that they are no longer cumulative, but are calculated on an annual basis and allowing some flexibility in the target. Both of those options would forgive any excess over the target, removing the annual pay cut threat doctors have endured since 2002 under the SGR, according to Cristina Boccuti, a principal policy analyst for MedPAC. However, forgiving any overage will lead to higher costs for the Medicare program. Neither option would leave any room to offer incentives for improved quality and efficiency, she added.
In the past, MedPAC has recommended setting target growth rates - and payment rates - according to particular service categories; the commission is looking in this direction again. For example, separate categories could be established for primary care, imaging, minor procedures, and anesthesia, allowing rates to more closely track volume of services. But the system might also provide incentives for physicians to order higher-volume (and more highly paid) services, according to Kevin Hayes, another MedPAC principal policy analyst.
Two options that seemed to pique commissioners' interest: exempting certain providers (such as accountable care organizations) from the current SGR target but holding them accountable for other targets, and penalizing physicians who are outliers in resource use.
MedPAC has two contractors working on projects to better determine the valuation of providers' time and resource use; more information will be available at the next commission meeting, Ms. Boccuti said.
Every year since 2002, Medicare has failed to meet the SGR targets, causing physician pay, by law, to be reduced. However, every year, and more recently, two or three times a year, Congress has stepped in to legislate a way to avoid those cuts. Cumulatively, the avoided cuts are becoming an ever-growing debt on the federal ledger.
The White House, in its fiscal 2012 budget proposal, is proposing to reduce that debt over the next 10 years, at a cost of $370 billion.
But the administration has figured out only how to pay for that fix for the first 2 years. The reality is that there's a declining pool of Medicare-specific offsets - required by law - to pay for fixing the SGR, Glenn Hackbarth, MedPAC chairman, said at the meeting. "We're in a deteriorating situation here; we're spiraling down," said Mr. Hackbarth. "This isn't going to get better; it's going to get worse."
He envisions a future where lawmakers will have to take money from education or roads or some other non-health-related area of the budget to pay for the Medicare fix. "And that bothers me," he said.
MedPAC in 2001 saw trouble with the SGR and recommended that it be scrapped. Now, the commission is looking again at ways to overhaul the formula so that physicians do not have to face a constantly shifting landscape. The uncertainty is undermining physician confidence in Medicare and leading some to stop seeing beneficiaries, Mr. Hackbarth noted.
He said the time might be right to work out a "quid pro quo" with physicians: an end to the yearly exercise to avert the SGR cuts in exchange for a payment system that has volume constraints and rewards efficiency and improved quality, or, alternatively penalizes those who fail to meet such targets.
WASHINGTON - Multiple options exist to permanently fix the Medicare Sustainable Growth Rate formula, but each has its cost to physicians, patients, and the program, according to staff analysts for the Medicare Payment Advisory Commission.
Among the options MedPAC staff presented to commissioners at a recent MedPAC meeting were adjusting the SGR's spending targets so that they are no longer cumulative, but are calculated on an annual basis and allowing some flexibility in the target. Both of those options would forgive any excess over the target, removing the annual pay cut threat doctors have endured since 2002 under the SGR, according to Cristina Boccuti, a principal policy analyst for MedPAC. However, forgiving any overage will lead to higher costs for the Medicare program. Neither option would leave any room to offer incentives for improved quality and efficiency, she added.
In the past, MedPAC has recommended setting target growth rates - and payment rates - according to particular service categories; the commission is looking in this direction again. For example, separate categories could be established for primary care, imaging, minor procedures, and anesthesia, allowing rates to more closely track volume of services. But the system might also provide incentives for physicians to order higher-volume (and more highly paid) services, according to Kevin Hayes, another MedPAC principal policy analyst.
Two options that seemed to pique commissioners' interest: exempting certain providers (such as accountable care organizations) from the current SGR target but holding them accountable for other targets, and penalizing physicians who are outliers in resource use.
MedPAC has two contractors working on projects to better determine the valuation of providers' time and resource use; more information will be available at the next commission meeting, Ms. Boccuti said.
Every year since 2002, Medicare has failed to meet the SGR targets, causing physician pay, by law, to be reduced. However, every year, and more recently, two or three times a year, Congress has stepped in to legislate a way to avoid those cuts. Cumulatively, the avoided cuts are becoming an ever-growing debt on the federal ledger.
The White House, in its fiscal 2012 budget proposal, is proposing to reduce that debt over the next 10 years, at a cost of $370 billion.
But the administration has figured out only how to pay for that fix for the first 2 years. The reality is that there's a declining pool of Medicare-specific offsets - required by law - to pay for fixing the SGR, Glenn Hackbarth, MedPAC chairman, said at the meeting. "We're in a deteriorating situation here; we're spiraling down," said Mr. Hackbarth. "This isn't going to get better; it's going to get worse."
He envisions a future where lawmakers will have to take money from education or roads or some other non-health-related area of the budget to pay for the Medicare fix. "And that bothers me," he said.
MedPAC in 2001 saw trouble with the SGR and recommended that it be scrapped. Now, the commission is looking again at ways to overhaul the formula so that physicians do not have to face a constantly shifting landscape. The uncertainty is undermining physician confidence in Medicare and leading some to stop seeing beneficiaries, Mr. Hackbarth noted.
He said the time might be right to work out a "quid pro quo" with physicians: an end to the yearly exercise to avert the SGR cuts in exchange for a payment system that has volume constraints and rewards efficiency and improved quality, or, alternatively penalizes those who fail to meet such targets.
WASHINGTON - Multiple options exist to permanently fix the Medicare Sustainable Growth Rate formula, but each has its cost to physicians, patients, and the program, according to staff analysts for the Medicare Payment Advisory Commission.
Among the options MedPAC staff presented to commissioners at a recent MedPAC meeting were adjusting the SGR's spending targets so that they are no longer cumulative, but are calculated on an annual basis and allowing some flexibility in the target. Both of those options would forgive any excess over the target, removing the annual pay cut threat doctors have endured since 2002 under the SGR, according to Cristina Boccuti, a principal policy analyst for MedPAC. However, forgiving any overage will lead to higher costs for the Medicare program. Neither option would leave any room to offer incentives for improved quality and efficiency, she added.
In the past, MedPAC has recommended setting target growth rates - and payment rates - according to particular service categories; the commission is looking in this direction again. For example, separate categories could be established for primary care, imaging, minor procedures, and anesthesia, allowing rates to more closely track volume of services. But the system might also provide incentives for physicians to order higher-volume (and more highly paid) services, according to Kevin Hayes, another MedPAC principal policy analyst.
Two options that seemed to pique commissioners' interest: exempting certain providers (such as accountable care organizations) from the current SGR target but holding them accountable for other targets, and penalizing physicians who are outliers in resource use.
MedPAC has two contractors working on projects to better determine the valuation of providers' time and resource use; more information will be available at the next commission meeting, Ms. Boccuti said.
Every year since 2002, Medicare has failed to meet the SGR targets, causing physician pay, by law, to be reduced. However, every year, and more recently, two or three times a year, Congress has stepped in to legislate a way to avoid those cuts. Cumulatively, the avoided cuts are becoming an ever-growing debt on the federal ledger.
The White House, in its fiscal 2012 budget proposal, is proposing to reduce that debt over the next 10 years, at a cost of $370 billion.
But the administration has figured out only how to pay for that fix for the first 2 years. The reality is that there's a declining pool of Medicare-specific offsets - required by law - to pay for fixing the SGR, Glenn Hackbarth, MedPAC chairman, said at the meeting. "We're in a deteriorating situation here; we're spiraling down," said Mr. Hackbarth. "This isn't going to get better; it's going to get worse."
He envisions a future where lawmakers will have to take money from education or roads or some other non-health-related area of the budget to pay for the Medicare fix. "And that bothers me," he said.
MedPAC in 2001 saw trouble with the SGR and recommended that it be scrapped. Now, the commission is looking again at ways to overhaul the formula so that physicians do not have to face a constantly shifting landscape. The uncertainty is undermining physician confidence in Medicare and leading some to stop seeing beneficiaries, Mr. Hackbarth noted.
He said the time might be right to work out a "quid pro quo" with physicians: an end to the yearly exercise to avert the SGR cuts in exchange for a payment system that has volume constraints and rewards efficiency and improved quality, or, alternatively penalizes those who fail to meet such targets.
FDA Panel Voted to Expand Carotid Stent Approval
Earlier this year, the majority of a Food and Drug Administration advisory panel voted in favor of expanding the approved use of a carotid stent to include patients who are at standard surgical risk in addition to the previously approved indication for revascularization in patients at high surgical risk.
The FDA's Circulatory System Devices Panel voted 7-3 with 1 abstention that the benefits of the Acculink Carotid Stent, a self-expanding stent made of nickel and titanium manufactured by Abbott Vascular, outweigh the risks when used for the proposed population of patients, at standard surgical risk.
The indication under review is for the treatment of patients at standard risk for adverse events from carotid endarterectomy who require carotid revascularization and meet the following criteria: patients who have neurological symptoms and at least 70% stenosis of the common or internal carotid artery by ultrasound or at least 50% stenosis by angiogram; or patients without neurological symptoms and at least 70% stenosis of the internal carotid artery by ultrasound or at least 60% stenosis by angiogram. Patients must also have a reference vessel diameter within the range of 4.0 mm and 9.0 mm at the target lesion.
In 2004, the Acculink Carotid Stent was approved for use for carotid revascularization in patients at high risk for adverse events from carotid endarterectomy who require carotid revascularization and meet slightly different criteria.
The company filed for approval of the expanded indication to include the lower surgical risk population based on the results of the Carotid Revascularization Endarterectomy vs. Stenting Trial (CREST), a randomized multicenter noninferiority study conducted in the United States and Canada comparing the outcomes of carotid artery stenting to the preferred method, carotid endarterectomy in patients who met the criteria in the proposed indication. At 1 year, the primary safety and effectiveness end point ? death, stroke, and myocardial infarction within 30 days of having the procedure plus the rate of ipsilateral stroke from 31 to 365 days after the procedure, was 7.1% among those who received the stent (1,131 patients) and 6.6% among those who underwent endarterectomy (1,176 patients), a difference that met the prespecified criteria for noninferiority.
Different components of the composite end point - periprocedural MIs and strokes - were elevated among patients in the two arms: In the stent arm, the rate of strokes was 4.1%, compared with 1.9% in the surgical arm. MI at 30 days was 3.4% in the surgical arm, compared with 2% in the stent arm. Panelists varied on their opinions on the clinical significance of these differences.
The Acculink stent is approved in over 90 countries and more than 128,000 have been distributed worldwide, according to Abbott Vascular.
The CREST study was funded by Abbott Vascular, and was created by NIH and the New Jersey Medical School, Newark. The FDA usually follows the recommendations of its advisory panels.
The FDA usually follows the recommendations of its advisory panels. Panel members have been cleared of potential conflicts of interest by the FDA prior to the meeting. Occasionally, the FDA grants a waiver to a panelist with a conflict but not at this meeting.
Commenting on this story, Dr. Linda Harris, vice chair, faculty development, department of surgery, Millard Fillmore Gates Hospital-Kaleida, Buffalo, N.Y. , stated: "While FDA approval is important to allow use of the carotid stent for average risk patients, this does not guarantee that Medicare or other insurances will reimburse for patients at average risk. Further, it is important to closely dissect the CREST data, which clearly show a higher rate of stroke for stenting than for endarterectomy, with a higher MI rate for open surgery."
In addition, "the goal of the procedure is to prevent stroke, so a higher stroke rate is a significant issue. They also noted that in a quality of life evaluation, as part of the CREST study, stroke had significantly greater impact on patient wellness than did MI. There is clearly a role for carotid stenting; however, physicians must weigh the benefits and disadvantages of each treatment methodology for a given patient. The role for any interventional therapy for asymptomatic patients is currently also being reevaluated in the era of improved medical management, with statins, plavix, and b-blockers in addition to aspirin," Dr. Harris concluded.
Earlier this year, the majority of a Food and Drug Administration advisory panel voted in favor of expanding the approved use of a carotid stent to include patients who are at standard surgical risk in addition to the previously approved indication for revascularization in patients at high surgical risk.
The FDA's Circulatory System Devices Panel voted 7-3 with 1 abstention that the benefits of the Acculink Carotid Stent, a self-expanding stent made of nickel and titanium manufactured by Abbott Vascular, outweigh the risks when used for the proposed population of patients, at standard surgical risk.
The indication under review is for the treatment of patients at standard risk for adverse events from carotid endarterectomy who require carotid revascularization and meet the following criteria: patients who have neurological symptoms and at least 70% stenosis of the common or internal carotid artery by ultrasound or at least 50% stenosis by angiogram; or patients without neurological symptoms and at least 70% stenosis of the internal carotid artery by ultrasound or at least 60% stenosis by angiogram. Patients must also have a reference vessel diameter within the range of 4.0 mm and 9.0 mm at the target lesion.
In 2004, the Acculink Carotid Stent was approved for use for carotid revascularization in patients at high risk for adverse events from carotid endarterectomy who require carotid revascularization and meet slightly different criteria.
The company filed for approval of the expanded indication to include the lower surgical risk population based on the results of the Carotid Revascularization Endarterectomy vs. Stenting Trial (CREST), a randomized multicenter noninferiority study conducted in the United States and Canada comparing the outcomes of carotid artery stenting to the preferred method, carotid endarterectomy in patients who met the criteria in the proposed indication. At 1 year, the primary safety and effectiveness end point ? death, stroke, and myocardial infarction within 30 days of having the procedure plus the rate of ipsilateral stroke from 31 to 365 days after the procedure, was 7.1% among those who received the stent (1,131 patients) and 6.6% among those who underwent endarterectomy (1,176 patients), a difference that met the prespecified criteria for noninferiority.
Different components of the composite end point - periprocedural MIs and strokes - were elevated among patients in the two arms: In the stent arm, the rate of strokes was 4.1%, compared with 1.9% in the surgical arm. MI at 30 days was 3.4% in the surgical arm, compared with 2% in the stent arm. Panelists varied on their opinions on the clinical significance of these differences.
The Acculink stent is approved in over 90 countries and more than 128,000 have been distributed worldwide, according to Abbott Vascular.
The CREST study was funded by Abbott Vascular, and was created by NIH and the New Jersey Medical School, Newark. The FDA usually follows the recommendations of its advisory panels.
The FDA usually follows the recommendations of its advisory panels. Panel members have been cleared of potential conflicts of interest by the FDA prior to the meeting. Occasionally, the FDA grants a waiver to a panelist with a conflict but not at this meeting.
Commenting on this story, Dr. Linda Harris, vice chair, faculty development, department of surgery, Millard Fillmore Gates Hospital-Kaleida, Buffalo, N.Y. , stated: "While FDA approval is important to allow use of the carotid stent for average risk patients, this does not guarantee that Medicare or other insurances will reimburse for patients at average risk. Further, it is important to closely dissect the CREST data, which clearly show a higher rate of stroke for stenting than for endarterectomy, with a higher MI rate for open surgery."
In addition, "the goal of the procedure is to prevent stroke, so a higher stroke rate is a significant issue. They also noted that in a quality of life evaluation, as part of the CREST study, stroke had significantly greater impact on patient wellness than did MI. There is clearly a role for carotid stenting; however, physicians must weigh the benefits and disadvantages of each treatment methodology for a given patient. The role for any interventional therapy for asymptomatic patients is currently also being reevaluated in the era of improved medical management, with statins, plavix, and b-blockers in addition to aspirin," Dr. Harris concluded.
Earlier this year, the majority of a Food and Drug Administration advisory panel voted in favor of expanding the approved use of a carotid stent to include patients who are at standard surgical risk in addition to the previously approved indication for revascularization in patients at high surgical risk.
The FDA's Circulatory System Devices Panel voted 7-3 with 1 abstention that the benefits of the Acculink Carotid Stent, a self-expanding stent made of nickel and titanium manufactured by Abbott Vascular, outweigh the risks when used for the proposed population of patients, at standard surgical risk.
The indication under review is for the treatment of patients at standard risk for adverse events from carotid endarterectomy who require carotid revascularization and meet the following criteria: patients who have neurological symptoms and at least 70% stenosis of the common or internal carotid artery by ultrasound or at least 50% stenosis by angiogram; or patients without neurological symptoms and at least 70% stenosis of the internal carotid artery by ultrasound or at least 60% stenosis by angiogram. Patients must also have a reference vessel diameter within the range of 4.0 mm and 9.0 mm at the target lesion.
In 2004, the Acculink Carotid Stent was approved for use for carotid revascularization in patients at high risk for adverse events from carotid endarterectomy who require carotid revascularization and meet slightly different criteria.
The company filed for approval of the expanded indication to include the lower surgical risk population based on the results of the Carotid Revascularization Endarterectomy vs. Stenting Trial (CREST), a randomized multicenter noninferiority study conducted in the United States and Canada comparing the outcomes of carotid artery stenting to the preferred method, carotid endarterectomy in patients who met the criteria in the proposed indication. At 1 year, the primary safety and effectiveness end point ? death, stroke, and myocardial infarction within 30 days of having the procedure plus the rate of ipsilateral stroke from 31 to 365 days after the procedure, was 7.1% among those who received the stent (1,131 patients) and 6.6% among those who underwent endarterectomy (1,176 patients), a difference that met the prespecified criteria for noninferiority.
Different components of the composite end point - periprocedural MIs and strokes - were elevated among patients in the two arms: In the stent arm, the rate of strokes was 4.1%, compared with 1.9% in the surgical arm. MI at 30 days was 3.4% in the surgical arm, compared with 2% in the stent arm. Panelists varied on their opinions on the clinical significance of these differences.
The Acculink stent is approved in over 90 countries and more than 128,000 have been distributed worldwide, according to Abbott Vascular.
The CREST study was funded by Abbott Vascular, and was created by NIH and the New Jersey Medical School, Newark. The FDA usually follows the recommendations of its advisory panels.
The FDA usually follows the recommendations of its advisory panels. Panel members have been cleared of potential conflicts of interest by the FDA prior to the meeting. Occasionally, the FDA grants a waiver to a panelist with a conflict but not at this meeting.
Commenting on this story, Dr. Linda Harris, vice chair, faculty development, department of surgery, Millard Fillmore Gates Hospital-Kaleida, Buffalo, N.Y. , stated: "While FDA approval is important to allow use of the carotid stent for average risk patients, this does not guarantee that Medicare or other insurances will reimburse for patients at average risk. Further, it is important to closely dissect the CREST data, which clearly show a higher rate of stroke for stenting than for endarterectomy, with a higher MI rate for open surgery."
In addition, "the goal of the procedure is to prevent stroke, so a higher stroke rate is a significant issue. They also noted that in a quality of life evaluation, as part of the CREST study, stroke had significantly greater impact on patient wellness than did MI. There is clearly a role for carotid stenting; however, physicians must weigh the benefits and disadvantages of each treatment methodology for a given patient. The role for any interventional therapy for asymptomatic patients is currently also being reevaluated in the era of improved medical management, with statins, plavix, and b-blockers in addition to aspirin," Dr. Harris concluded.
Texas Medical Center Ties Tort Reform to Lower Liability Costs
PALM BEACH, FLA. – Tort reform significantly decreased surgical malpractice lawsuits by nearly 80% in one Texas academic medical center.
The legislation, passed in 2003, also significantly reduced legal costs and malpractice insurance premiums for individual surgeons, Dr. Ronald Stewart said at the annual meeting of the Southern Surgical Association. In 2002, malpractice insurance premiums were $10,000 per surgeon. By 2010, the premium had dropped to $2,700, and it is projected to be $2,000 per surgeon in 2011.
“Obviously this is a complicated and potentially controversial issue,” Dr. Stewart said in an interview. “However, our study was aimed at a simple question: Did the risk of surgical lawsuit decrease following tort reform? There’s no question in my mind that the legislation was directly responsible for these changes” in the surgery department of the University of Texas Health Sciences Center, said Dr. Stewart, the department’s interim chair. “Limiting economic incentives really does decrease malpractice case load and cost.”
In 2003, Proposition 12 placed a $750,000 cap on noneconomic damages in medical malpractice lawsuits, and limited an individual physician’s liability to $250,000. “UTHSCSA physicians’ liability is capped at $100,000, I believe, under the provision of public servant,” Dr. Stewart said.
He and his colleagues compared prevalence, incidence, and risk and cost in general surgery and reviewed the frequency of lawsuits in the entire department (10 divisions) from 1992 to 2010. They used data from two hospital databases. One records all surgical procedures since 1979, and the other contains information on all malpractice claims filed since 1976.
Liability cost was defined as any monetary award to a plaintiff, legal cost as the cost incurred defending the suits, and total litigation as the sum of those costs.
From July 1992 to June 2010, 98,513 surgical procedures were performed and 28 lawsuits were filed. Most (25) were filed from 1992 to 2003 (the pre-reform period). About half (13) were decided in favor of the plaintiff, and the remainder in favor of the surgeon. The liability cost of the suits was $5.56 million and the legal cost $1.6 million – for a total litigation bill of $7.16 million. The annualized cost was almost $600,000.
Of the three suits filed since 2004, one is still pending, and there were no plaintiff payouts in the other two, according to Dr. Stewart. Total legal costs of $3,345 translate into about $500 per year.
Besides frequency and cost, prevalence also significantly decreased, he said. Before tort reform, malpractice suit prevalence was 40/100,000 surgeons. After tort reform, it was 8/100,000, for a relative reduction of almost 80% (risk reduction, 0.21).
These changes led directly to the significant reductions in malpractice insurance premiums, which dropped by $8,000 per surgeon, Dr. Stewart said.
His cost analysis didn’t control for any confounding factors, such as improved disclosure, decreased errors, or quality improvement practices. “These factors may have been responsible for some decreased malpractice lawsuits, but it is very likely that tort reform was the primary driver for the observed decrease,” he said.
The study did more than simply point out cost savings, said Dr. Benjamin Li, a discussant with Louisiana State University Health Sciences Center. “It does not even measure more indirect costs, such as the practice of defensive medicine, the cost of recruiting surgeons into a high-risk medical malpractice environment, and the loss of opportunity to correct systems errors due to the inhibition of open discussion of medical errors for fear of malpractice suits,” he said.
Tort reform can improve the physician/patient relationship, Dr. Stewart said in an interview. “I believe a major problem of the tort system was that it fostered an adversarial relationship between surgeon and patient, which, when present, is directly counter to good patient care.”
However, he noted, not everyone believes the law was – and remains – a good one. The Texas Trial Lawyers Association declined to comment on the issue, referring questions instead to Texas Watch, which defines itself as “a nonpartisan, advocacy organization working to improve consumer and insurance protections for Texas families … providing a counter to wealthy special interest lobby efforts,” (www.texaswatch.org).
The decrease in lawsuits, plaintiff payouts, and malpractice premiums is no surprise to Alex Winslow, executive director of Texas Watch. “The question is what that really means,” he said in an interview. “While insurance companies and physicians are shielded and make more money, patients continue to suffer the burden of crushing medical errors. This does not mean there are less medical errors; it just means that patients have no means to hold doctors accountable.”
There are no data showing that the quality of health care services or medical errors has decreased since tort reform passed, Mr. Winslow said. “Nationwide, this is still a real problem, and in Texas there is no evidence that the quality of care has gotten better.”
While the statewide statistics may not be in evidence, Dr. Stewart described his institution’s experience with quality improvement since tort reform. “At least within our system, these malpractice cost savings have translated directly into spending on patient quality and safety initiatives – hopefully, directly benefiting our patients and improving the quality of care.”
Proponents of the law say the more favorable legal climate has expanded health care services and drawn more physicians to the state – a claim Mr. Winslow contested. “Underserved areas continue to struggle to attract physicians to serve their population, and Texas ranks close to the bottom in terms of physicians per capita.” Doctors are coming, he said, but only to metropolitan areas that already have a good supply. “We continue to lag well behind the rest of the country in per capita physician supply. Physician supply is failing to keep up with population growth.”
However, the Texas Alliance for Patient Access (www.tapa.info) – a statewide coalition of doctors, hospitals, clinics, nursing homes, and physician liability insurers – asserts that physician supply and medical services have increased since 2003. “Overall, Texas has enjoyed a 62% greater growth rate in newly licensed physicians in the past 3 years, compared to 3 years preceding reform,” according to TAPA documents supplied by spokesman Jon Opelt.
Other statistics he provided support the claim that underserved areas are benefiting from the law:
--Twenty-four rural counties added at least one general surgeon, and 11 added their first general surgeon.
--Twelve rural counties added at least one orthopedic surgeon, and nine counties added their first orthopedic surgeon.
--Six Texas counties added their first neurosurgeon; two of those counties are rural.
--Fifteen rural counties added a cardiologist or cardiovascular surgeon, including 11 that added their first cardiologist.
--The ranks of rural obstetricians have grown by 27%. Twenty-two rural counties added an obstetrician, and 10 counties added their first OB.
--Twenty-three rural counties have added at least one emergency medicine physician, and 18 added their first emergency room doctor.
Texas voters seem to favor the law, according to a survey of 501 randomly selected registered voters conducted in September by the group, Texans Against Lawsuit Abuse. Most survey respondents (62%) thought recent legal reforms have been a good thing because they have helped bring thousands of new physician specialists to Texas, allowed hospitals to provide expanded medical care, and reduced questionable lawsuits so people with legitimate malpractice claims could have their cases heard, a press release stated.
Dr. Stewart said his study can’t address these complex political issues, but he believes that “tort reform in Texas sets the stage for improved access to surgical care, reduces cost, and allows more effective quality and performance improvement initiatives.”
Dr. Stewart had no relevant financial disclosures.
PALM BEACH, FLA. – Tort reform significantly decreased surgical malpractice lawsuits by nearly 80% in one Texas academic medical center.
The legislation, passed in 2003, also significantly reduced legal costs and malpractice insurance premiums for individual surgeons, Dr. Ronald Stewart said at the annual meeting of the Southern Surgical Association. In 2002, malpractice insurance premiums were $10,000 per surgeon. By 2010, the premium had dropped to $2,700, and it is projected to be $2,000 per surgeon in 2011.
“Obviously this is a complicated and potentially controversial issue,” Dr. Stewart said in an interview. “However, our study was aimed at a simple question: Did the risk of surgical lawsuit decrease following tort reform? There’s no question in my mind that the legislation was directly responsible for these changes” in the surgery department of the University of Texas Health Sciences Center, said Dr. Stewart, the department’s interim chair. “Limiting economic incentives really does decrease malpractice case load and cost.”
In 2003, Proposition 12 placed a $750,000 cap on noneconomic damages in medical malpractice lawsuits, and limited an individual physician’s liability to $250,000. “UTHSCSA physicians’ liability is capped at $100,000, I believe, under the provision of public servant,” Dr. Stewart said.
He and his colleagues compared prevalence, incidence, and risk and cost in general surgery and reviewed the frequency of lawsuits in the entire department (10 divisions) from 1992 to 2010. They used data from two hospital databases. One records all surgical procedures since 1979, and the other contains information on all malpractice claims filed since 1976.
Liability cost was defined as any monetary award to a plaintiff, legal cost as the cost incurred defending the suits, and total litigation as the sum of those costs.
From July 1992 to June 2010, 98,513 surgical procedures were performed and 28 lawsuits were filed. Most (25) were filed from 1992 to 2003 (the pre-reform period). About half (13) were decided in favor of the plaintiff, and the remainder in favor of the surgeon. The liability cost of the suits was $5.56 million and the legal cost $1.6 million – for a total litigation bill of $7.16 million. The annualized cost was almost $600,000.
Of the three suits filed since 2004, one is still pending, and there were no plaintiff payouts in the other two, according to Dr. Stewart. Total legal costs of $3,345 translate into about $500 per year.
Besides frequency and cost, prevalence also significantly decreased, he said. Before tort reform, malpractice suit prevalence was 40/100,000 surgeons. After tort reform, it was 8/100,000, for a relative reduction of almost 80% (risk reduction, 0.21).
These changes led directly to the significant reductions in malpractice insurance premiums, which dropped by $8,000 per surgeon, Dr. Stewart said.
His cost analysis didn’t control for any confounding factors, such as improved disclosure, decreased errors, or quality improvement practices. “These factors may have been responsible for some decreased malpractice lawsuits, but it is very likely that tort reform was the primary driver for the observed decrease,” he said.
The study did more than simply point out cost savings, said Dr. Benjamin Li, a discussant with Louisiana State University Health Sciences Center. “It does not even measure more indirect costs, such as the practice of defensive medicine, the cost of recruiting surgeons into a high-risk medical malpractice environment, and the loss of opportunity to correct systems errors due to the inhibition of open discussion of medical errors for fear of malpractice suits,” he said.
Tort reform can improve the physician/patient relationship, Dr. Stewart said in an interview. “I believe a major problem of the tort system was that it fostered an adversarial relationship between surgeon and patient, which, when present, is directly counter to good patient care.”
However, he noted, not everyone believes the law was – and remains – a good one. The Texas Trial Lawyers Association declined to comment on the issue, referring questions instead to Texas Watch, which defines itself as “a nonpartisan, advocacy organization working to improve consumer and insurance protections for Texas families … providing a counter to wealthy special interest lobby efforts,” (www.texaswatch.org).
The decrease in lawsuits, plaintiff payouts, and malpractice premiums is no surprise to Alex Winslow, executive director of Texas Watch. “The question is what that really means,” he said in an interview. “While insurance companies and physicians are shielded and make more money, patients continue to suffer the burden of crushing medical errors. This does not mean there are less medical errors; it just means that patients have no means to hold doctors accountable.”
There are no data showing that the quality of health care services or medical errors has decreased since tort reform passed, Mr. Winslow said. “Nationwide, this is still a real problem, and in Texas there is no evidence that the quality of care has gotten better.”
While the statewide statistics may not be in evidence, Dr. Stewart described his institution’s experience with quality improvement since tort reform. “At least within our system, these malpractice cost savings have translated directly into spending on patient quality and safety initiatives – hopefully, directly benefiting our patients and improving the quality of care.”
Proponents of the law say the more favorable legal climate has expanded health care services and drawn more physicians to the state – a claim Mr. Winslow contested. “Underserved areas continue to struggle to attract physicians to serve their population, and Texas ranks close to the bottom in terms of physicians per capita.” Doctors are coming, he said, but only to metropolitan areas that already have a good supply. “We continue to lag well behind the rest of the country in per capita physician supply. Physician supply is failing to keep up with population growth.”
However, the Texas Alliance for Patient Access (www.tapa.info) – a statewide coalition of doctors, hospitals, clinics, nursing homes, and physician liability insurers – asserts that physician supply and medical services have increased since 2003. “Overall, Texas has enjoyed a 62% greater growth rate in newly licensed physicians in the past 3 years, compared to 3 years preceding reform,” according to TAPA documents supplied by spokesman Jon Opelt.
Other statistics he provided support the claim that underserved areas are benefiting from the law:
--Twenty-four rural counties added at least one general surgeon, and 11 added their first general surgeon.
--Twelve rural counties added at least one orthopedic surgeon, and nine counties added their first orthopedic surgeon.
--Six Texas counties added their first neurosurgeon; two of those counties are rural.
--Fifteen rural counties added a cardiologist or cardiovascular surgeon, including 11 that added their first cardiologist.
--The ranks of rural obstetricians have grown by 27%. Twenty-two rural counties added an obstetrician, and 10 counties added their first OB.
--Twenty-three rural counties have added at least one emergency medicine physician, and 18 added their first emergency room doctor.
Texas voters seem to favor the law, according to a survey of 501 randomly selected registered voters conducted in September by the group, Texans Against Lawsuit Abuse. Most survey respondents (62%) thought recent legal reforms have been a good thing because they have helped bring thousands of new physician specialists to Texas, allowed hospitals to provide expanded medical care, and reduced questionable lawsuits so people with legitimate malpractice claims could have their cases heard, a press release stated.
Dr. Stewart said his study can’t address these complex political issues, but he believes that “tort reform in Texas sets the stage for improved access to surgical care, reduces cost, and allows more effective quality and performance improvement initiatives.”
Dr. Stewart had no relevant financial disclosures.
PALM BEACH, FLA. – Tort reform significantly decreased surgical malpractice lawsuits by nearly 80% in one Texas academic medical center.
The legislation, passed in 2003, also significantly reduced legal costs and malpractice insurance premiums for individual surgeons, Dr. Ronald Stewart said at the annual meeting of the Southern Surgical Association. In 2002, malpractice insurance premiums were $10,000 per surgeon. By 2010, the premium had dropped to $2,700, and it is projected to be $2,000 per surgeon in 2011.
“Obviously this is a complicated and potentially controversial issue,” Dr. Stewart said in an interview. “However, our study was aimed at a simple question: Did the risk of surgical lawsuit decrease following tort reform? There’s no question in my mind that the legislation was directly responsible for these changes” in the surgery department of the University of Texas Health Sciences Center, said Dr. Stewart, the department’s interim chair. “Limiting economic incentives really does decrease malpractice case load and cost.”
In 2003, Proposition 12 placed a $750,000 cap on noneconomic damages in medical malpractice lawsuits, and limited an individual physician’s liability to $250,000. “UTHSCSA physicians’ liability is capped at $100,000, I believe, under the provision of public servant,” Dr. Stewart said.
He and his colleagues compared prevalence, incidence, and risk and cost in general surgery and reviewed the frequency of lawsuits in the entire department (10 divisions) from 1992 to 2010. They used data from two hospital databases. One records all surgical procedures since 1979, and the other contains information on all malpractice claims filed since 1976.
Liability cost was defined as any monetary award to a plaintiff, legal cost as the cost incurred defending the suits, and total litigation as the sum of those costs.
From July 1992 to June 2010, 98,513 surgical procedures were performed and 28 lawsuits were filed. Most (25) were filed from 1992 to 2003 (the pre-reform period). About half (13) were decided in favor of the plaintiff, and the remainder in favor of the surgeon. The liability cost of the suits was $5.56 million and the legal cost $1.6 million – for a total litigation bill of $7.16 million. The annualized cost was almost $600,000.
Of the three suits filed since 2004, one is still pending, and there were no plaintiff payouts in the other two, according to Dr. Stewart. Total legal costs of $3,345 translate into about $500 per year.
Besides frequency and cost, prevalence also significantly decreased, he said. Before tort reform, malpractice suit prevalence was 40/100,000 surgeons. After tort reform, it was 8/100,000, for a relative reduction of almost 80% (risk reduction, 0.21).
These changes led directly to the significant reductions in malpractice insurance premiums, which dropped by $8,000 per surgeon, Dr. Stewart said.
His cost analysis didn’t control for any confounding factors, such as improved disclosure, decreased errors, or quality improvement practices. “These factors may have been responsible for some decreased malpractice lawsuits, but it is very likely that tort reform was the primary driver for the observed decrease,” he said.
The study did more than simply point out cost savings, said Dr. Benjamin Li, a discussant with Louisiana State University Health Sciences Center. “It does not even measure more indirect costs, such as the practice of defensive medicine, the cost of recruiting surgeons into a high-risk medical malpractice environment, and the loss of opportunity to correct systems errors due to the inhibition of open discussion of medical errors for fear of malpractice suits,” he said.
Tort reform can improve the physician/patient relationship, Dr. Stewart said in an interview. “I believe a major problem of the tort system was that it fostered an adversarial relationship between surgeon and patient, which, when present, is directly counter to good patient care.”
However, he noted, not everyone believes the law was – and remains – a good one. The Texas Trial Lawyers Association declined to comment on the issue, referring questions instead to Texas Watch, which defines itself as “a nonpartisan, advocacy organization working to improve consumer and insurance protections for Texas families … providing a counter to wealthy special interest lobby efforts,” (www.texaswatch.org).
The decrease in lawsuits, plaintiff payouts, and malpractice premiums is no surprise to Alex Winslow, executive director of Texas Watch. “The question is what that really means,” he said in an interview. “While insurance companies and physicians are shielded and make more money, patients continue to suffer the burden of crushing medical errors. This does not mean there are less medical errors; it just means that patients have no means to hold doctors accountable.”
There are no data showing that the quality of health care services or medical errors has decreased since tort reform passed, Mr. Winslow said. “Nationwide, this is still a real problem, and in Texas there is no evidence that the quality of care has gotten better.”
While the statewide statistics may not be in evidence, Dr. Stewart described his institution’s experience with quality improvement since tort reform. “At least within our system, these malpractice cost savings have translated directly into spending on patient quality and safety initiatives – hopefully, directly benefiting our patients and improving the quality of care.”
Proponents of the law say the more favorable legal climate has expanded health care services and drawn more physicians to the state – a claim Mr. Winslow contested. “Underserved areas continue to struggle to attract physicians to serve their population, and Texas ranks close to the bottom in terms of physicians per capita.” Doctors are coming, he said, but only to metropolitan areas that already have a good supply. “We continue to lag well behind the rest of the country in per capita physician supply. Physician supply is failing to keep up with population growth.”
However, the Texas Alliance for Patient Access (www.tapa.info) – a statewide coalition of doctors, hospitals, clinics, nursing homes, and physician liability insurers – asserts that physician supply and medical services have increased since 2003. “Overall, Texas has enjoyed a 62% greater growth rate in newly licensed physicians in the past 3 years, compared to 3 years preceding reform,” according to TAPA documents supplied by spokesman Jon Opelt.
Other statistics he provided support the claim that underserved areas are benefiting from the law:
--Twenty-four rural counties added at least one general surgeon, and 11 added their first general surgeon.
--Twelve rural counties added at least one orthopedic surgeon, and nine counties added their first orthopedic surgeon.
--Six Texas counties added their first neurosurgeon; two of those counties are rural.
--Fifteen rural counties added a cardiologist or cardiovascular surgeon, including 11 that added their first cardiologist.
--The ranks of rural obstetricians have grown by 27%. Twenty-two rural counties added an obstetrician, and 10 counties added their first OB.
--Twenty-three rural counties have added at least one emergency medicine physician, and 18 added their first emergency room doctor.
Texas voters seem to favor the law, according to a survey of 501 randomly selected registered voters conducted in September by the group, Texans Against Lawsuit Abuse. Most survey respondents (62%) thought recent legal reforms have been a good thing because they have helped bring thousands of new physician specialists to Texas, allowed hospitals to provide expanded medical care, and reduced questionable lawsuits so people with legitimate malpractice claims could have their cases heard, a press release stated.
Dr. Stewart said his study can’t address these complex political issues, but he believes that “tort reform in Texas sets the stage for improved access to surgical care, reduces cost, and allows more effective quality and performance improvement initiatives.”
Dr. Stewart had no relevant financial disclosures.
Supreme Court Ensures Fair VA Appeals Process
Amputations Among Soldiers Increase Sharply in Afghanistan
Minivan, Major Lesson
I recently visited my parents in my ancestral home of Wisconsin. As parents of a certain age, they inexplicably are genetically predisposed to owning a minivan. Another quirk of their DNA is that they must own a new minivan. No sooner has the last wisp of new-car smell osmosed from the burled walnut interior than they are trading up to the newest, tricked-out minivan. Perhaps more puzzling is the manner of pride they display in their minivan.
Now, my dad, as if not readily apparent, is not cool. And to see him folded into the driver’s seat, his furry-ear-to-furry-ear grin signaling a self-satisfaction customarily reserved for his grandchildren, painstakingly recounting glory-day stories and 4:30 p.m. dinner buffets, further solidifies his place in the Annals of Uncool.
When I’m home, they tend to employ my chauffeur services (most likely in retribution for my peri-pubescent years), and on the first day back home, I stopped their newest ride near the back door of the house, foot idling on the brake while this exchange occurred: “That’s a fascinating story about how much more challenging the world was when you were my age, Dad. You are a true American hero. Would you like to get out here or in the garage?”
“Here,” he replied.
“OK, then get out,” I countered.
“I can’t,” he responded knowingly.
“Why not?” I queried, the patience seeping from my voice.
“Because the door’s not open,” he answered, seemingly mocking me.
“Then open it,” I replied, silently recounting the evidence for his institutionalization.
“I can’t,” he responded.
“Why not?” I replied again, this time calculating the likelihood that I was adopted.
“Because it’s locked,” came his retort.
“Then unlock it,” I answered, reconfirming my decision to move away for college.
“I can’t,” he replied, ostensibly encouraging parenticide.
“Why not?” I queried, strongly contemplating parenticide.
“Because you haven’t put the car in park,” he responded triumphantly.
A System So Safe
As a safety feature, the minivan needed to be in park before you could open the door to exit. I’ve never heard of anyone actually falling out of a moving car, but recollecting high school, I can fathom the right mix, type, and number of teenagers where possibility would meet inevitability. But, apparently, enough people are falling out of moving vehicles that car engineers have built a system that is so safe, this can’t happen. So no matter how hard someone tries, it just isn’t possible to fall out of a moving car (believe me, toward the end of a week of my father’s car stories, my mind had worked every possible angle).
Likewise, newer vehicles employ occupant-sensitive sensors that detect the weight, size, and position of the passenger to determine if the airbag should deploy. Rather than depending on the driver to turn the passenger-side airbag on or off, the car does it for you: heavy enough to trigger the sensor, and the airbag will deploy; too light, and the car assumes you are a child and doesn’t deploy. It’s a system that is so safe because it doesn’t depend on the operator to get it right.
Ditto motion sensors that detect objects behind the car while reversing (avoiding accidental back-overs), antilock brakes (to maintain control during panicked braking), traction control (improves stability during acceleration), electronic stability control (foils spinouts), tire-pressure-monitoring systems (avoids blowouts), daytime running lights (ensures others see you), rollover airbags (they stay inflated to keep you in the car), lane-departure warning (alerts you if you stray from your lane), and doors that automatically lock after the car starts (again, falling out of cars).
For all the negative press of late, car manufacturers understand safety.
A System Not So Safe
Contrast this to healthcare, in which 10% of patients will suffer a serious, preventable, adverse event during their hospital stay.1 Read that sentence again. That’s 10%; that’s preventable; that’s a number that has largely remained unchanged in the past decade. If 1 in 10 drivers suffered a serious adverse preventable auto accident, Congress would do nothing but hold automotive safety hearings.
In medicine, we still largely employ unsafe systems in which even the best doctors can, and do, hurt patients. Sure, we have made strides in this arena (oxygen tubing that only works if hooked up properly, smart pumps that avert IV dosing errors, CO2 monitors to detect proper endotracheal tube placement), but remarkably, in this era of patient safety, we still utilize systems that largely depend on the heroism of the individual.
As physicians, we are famously autonomous and value our professional independence, even to the degree that it might harm patients. We generally eschew standardization, believing that each patient is inherently different. In fact, the thrill of the improvisational theater that follows every patient’s chief compliant is one of the great satisfiers in medicine. We love that feeling that comes from sleuthing each case, deftly enacting a plan of action to shepherd the patient to health.
To suggest following protocols, guidelines, and checklists is derisively dismissed as “cookbook medicine.” To work in teams in which certain tasks are delegated to others is seen as weakness—we don’t need a system that utilizes a pharmacist; rather, we should know the doses of all medicines, their interactions, and the effect of renal and liver impairment on their clearance. To suggest otherwise is an insult to our Oslerian roots. To examine our errors, our system breakdowns, our patient harms is anathema to our practice, an admission of failure.
The result is that most of us continue to toil in systems that have become exponentially unsafe as healthcare has become more complex. Today, we still have a system that will more or less allow us to kill a patient by doing nothing more than forgetting the letter “g.” I can go to my hospital today and intend to write “4 grams of magnesium sulfate (MgSO4)” and inadvertently forget the “g” in “Mg.” This could result in an order for a lethal dose of morphine sulfate (MSO4). It’s that easy to hurt a patient. Now, you might say that would never happen, because the pharmacy would catch it. And this is likely. But is it guaranteed? Can you 100% ensure it wouldn’t happen? Consider that nearly 20% of medication doses administered in a hospital are done so incorrectly.2 Nearly 1 in 5. This is the type of system we are employing to stop this lethal overdose. Is this system, which depends on another human to prevent an error, foolproof, or just a snare waiting to prove you the fool?
This represents our opportunity. As hospitalists, the hospital is our tapestry, our system of care, our responsibility. Few others are as well-positioned to ensure that the systems that envelop our patients are highly functional, reliable, and safe. This will take work—work that will feel burdensome, underappreciated, undercompensated. And, fully recognizing that none of us went into medicine to become systems engineers, this will be hard.
However, if not us, who? Who will ensure that our fathers, our mothers, our children will be as safe in the hospital as they are on the drive to the hospital? TH
Dr. Glasheen is associate professor of medicine at the University of Colorado Denver, where he serves as director of the Hospital Medicine Program and the Hospitalist Training Program, and as associate program director of the Internal Medicine Residency Program.
References
- Global health leaders join the World Health Organization to announce accelerated efforts to improve patient safety. World Health Organization website. Available at: www.who.int/mediacentre/news/releases/2004/pr74/en/. Accessed Feb. 14, 2011.
- Barker KN, Flynn EA, Pepper GA, Bates DW, Mikeal RL. Medication errors observed in 36 health care facilities. Arch Intern Med. 2002;162(16):1897-1903.
I recently visited my parents in my ancestral home of Wisconsin. As parents of a certain age, they inexplicably are genetically predisposed to owning a minivan. Another quirk of their DNA is that they must own a new minivan. No sooner has the last wisp of new-car smell osmosed from the burled walnut interior than they are trading up to the newest, tricked-out minivan. Perhaps more puzzling is the manner of pride they display in their minivan.
Now, my dad, as if not readily apparent, is not cool. And to see him folded into the driver’s seat, his furry-ear-to-furry-ear grin signaling a self-satisfaction customarily reserved for his grandchildren, painstakingly recounting glory-day stories and 4:30 p.m. dinner buffets, further solidifies his place in the Annals of Uncool.
When I’m home, they tend to employ my chauffeur services (most likely in retribution for my peri-pubescent years), and on the first day back home, I stopped their newest ride near the back door of the house, foot idling on the brake while this exchange occurred: “That’s a fascinating story about how much more challenging the world was when you were my age, Dad. You are a true American hero. Would you like to get out here or in the garage?”
“Here,” he replied.
“OK, then get out,” I countered.
“I can’t,” he responded knowingly.
“Why not?” I queried, the patience seeping from my voice.
“Because the door’s not open,” he answered, seemingly mocking me.
“Then open it,” I replied, silently recounting the evidence for his institutionalization.
“I can’t,” he responded.
“Why not?” I replied again, this time calculating the likelihood that I was adopted.
“Because it’s locked,” came his retort.
“Then unlock it,” I answered, reconfirming my decision to move away for college.
“I can’t,” he replied, ostensibly encouraging parenticide.
“Why not?” I queried, strongly contemplating parenticide.
“Because you haven’t put the car in park,” he responded triumphantly.
A System So Safe
As a safety feature, the minivan needed to be in park before you could open the door to exit. I’ve never heard of anyone actually falling out of a moving car, but recollecting high school, I can fathom the right mix, type, and number of teenagers where possibility would meet inevitability. But, apparently, enough people are falling out of moving vehicles that car engineers have built a system that is so safe, this can’t happen. So no matter how hard someone tries, it just isn’t possible to fall out of a moving car (believe me, toward the end of a week of my father’s car stories, my mind had worked every possible angle).
Likewise, newer vehicles employ occupant-sensitive sensors that detect the weight, size, and position of the passenger to determine if the airbag should deploy. Rather than depending on the driver to turn the passenger-side airbag on or off, the car does it for you: heavy enough to trigger the sensor, and the airbag will deploy; too light, and the car assumes you are a child and doesn’t deploy. It’s a system that is so safe because it doesn’t depend on the operator to get it right.
Ditto motion sensors that detect objects behind the car while reversing (avoiding accidental back-overs), antilock brakes (to maintain control during panicked braking), traction control (improves stability during acceleration), electronic stability control (foils spinouts), tire-pressure-monitoring systems (avoids blowouts), daytime running lights (ensures others see you), rollover airbags (they stay inflated to keep you in the car), lane-departure warning (alerts you if you stray from your lane), and doors that automatically lock after the car starts (again, falling out of cars).
For all the negative press of late, car manufacturers understand safety.
A System Not So Safe
Contrast this to healthcare, in which 10% of patients will suffer a serious, preventable, adverse event during their hospital stay.1 Read that sentence again. That’s 10%; that’s preventable; that’s a number that has largely remained unchanged in the past decade. If 1 in 10 drivers suffered a serious adverse preventable auto accident, Congress would do nothing but hold automotive safety hearings.
In medicine, we still largely employ unsafe systems in which even the best doctors can, and do, hurt patients. Sure, we have made strides in this arena (oxygen tubing that only works if hooked up properly, smart pumps that avert IV dosing errors, CO2 monitors to detect proper endotracheal tube placement), but remarkably, in this era of patient safety, we still utilize systems that largely depend on the heroism of the individual.
As physicians, we are famously autonomous and value our professional independence, even to the degree that it might harm patients. We generally eschew standardization, believing that each patient is inherently different. In fact, the thrill of the improvisational theater that follows every patient’s chief compliant is one of the great satisfiers in medicine. We love that feeling that comes from sleuthing each case, deftly enacting a plan of action to shepherd the patient to health.
To suggest following protocols, guidelines, and checklists is derisively dismissed as “cookbook medicine.” To work in teams in which certain tasks are delegated to others is seen as weakness—we don’t need a system that utilizes a pharmacist; rather, we should know the doses of all medicines, their interactions, and the effect of renal and liver impairment on their clearance. To suggest otherwise is an insult to our Oslerian roots. To examine our errors, our system breakdowns, our patient harms is anathema to our practice, an admission of failure.
The result is that most of us continue to toil in systems that have become exponentially unsafe as healthcare has become more complex. Today, we still have a system that will more or less allow us to kill a patient by doing nothing more than forgetting the letter “g.” I can go to my hospital today and intend to write “4 grams of magnesium sulfate (MgSO4)” and inadvertently forget the “g” in “Mg.” This could result in an order for a lethal dose of morphine sulfate (MSO4). It’s that easy to hurt a patient. Now, you might say that would never happen, because the pharmacy would catch it. And this is likely. But is it guaranteed? Can you 100% ensure it wouldn’t happen? Consider that nearly 20% of medication doses administered in a hospital are done so incorrectly.2 Nearly 1 in 5. This is the type of system we are employing to stop this lethal overdose. Is this system, which depends on another human to prevent an error, foolproof, or just a snare waiting to prove you the fool?
This represents our opportunity. As hospitalists, the hospital is our tapestry, our system of care, our responsibility. Few others are as well-positioned to ensure that the systems that envelop our patients are highly functional, reliable, and safe. This will take work—work that will feel burdensome, underappreciated, undercompensated. And, fully recognizing that none of us went into medicine to become systems engineers, this will be hard.
However, if not us, who? Who will ensure that our fathers, our mothers, our children will be as safe in the hospital as they are on the drive to the hospital? TH
Dr. Glasheen is associate professor of medicine at the University of Colorado Denver, where he serves as director of the Hospital Medicine Program and the Hospitalist Training Program, and as associate program director of the Internal Medicine Residency Program.
References
- Global health leaders join the World Health Organization to announce accelerated efforts to improve patient safety. World Health Organization website. Available at: www.who.int/mediacentre/news/releases/2004/pr74/en/. Accessed Feb. 14, 2011.
- Barker KN, Flynn EA, Pepper GA, Bates DW, Mikeal RL. Medication errors observed in 36 health care facilities. Arch Intern Med. 2002;162(16):1897-1903.
I recently visited my parents in my ancestral home of Wisconsin. As parents of a certain age, they inexplicably are genetically predisposed to owning a minivan. Another quirk of their DNA is that they must own a new minivan. No sooner has the last wisp of new-car smell osmosed from the burled walnut interior than they are trading up to the newest, tricked-out minivan. Perhaps more puzzling is the manner of pride they display in their minivan.
Now, my dad, as if not readily apparent, is not cool. And to see him folded into the driver’s seat, his furry-ear-to-furry-ear grin signaling a self-satisfaction customarily reserved for his grandchildren, painstakingly recounting glory-day stories and 4:30 p.m. dinner buffets, further solidifies his place in the Annals of Uncool.
When I’m home, they tend to employ my chauffeur services (most likely in retribution for my peri-pubescent years), and on the first day back home, I stopped their newest ride near the back door of the house, foot idling on the brake while this exchange occurred: “That’s a fascinating story about how much more challenging the world was when you were my age, Dad. You are a true American hero. Would you like to get out here or in the garage?”
“Here,” he replied.
“OK, then get out,” I countered.
“I can’t,” he responded knowingly.
“Why not?” I queried, the patience seeping from my voice.
“Because the door’s not open,” he answered, seemingly mocking me.
“Then open it,” I replied, silently recounting the evidence for his institutionalization.
“I can’t,” he responded.
“Why not?” I replied again, this time calculating the likelihood that I was adopted.
“Because it’s locked,” came his retort.
“Then unlock it,” I answered, reconfirming my decision to move away for college.
“I can’t,” he replied, ostensibly encouraging parenticide.
“Why not?” I queried, strongly contemplating parenticide.
“Because you haven’t put the car in park,” he responded triumphantly.
A System So Safe
As a safety feature, the minivan needed to be in park before you could open the door to exit. I’ve never heard of anyone actually falling out of a moving car, but recollecting high school, I can fathom the right mix, type, and number of teenagers where possibility would meet inevitability. But, apparently, enough people are falling out of moving vehicles that car engineers have built a system that is so safe, this can’t happen. So no matter how hard someone tries, it just isn’t possible to fall out of a moving car (believe me, toward the end of a week of my father’s car stories, my mind had worked every possible angle).
Likewise, newer vehicles employ occupant-sensitive sensors that detect the weight, size, and position of the passenger to determine if the airbag should deploy. Rather than depending on the driver to turn the passenger-side airbag on or off, the car does it for you: heavy enough to trigger the sensor, and the airbag will deploy; too light, and the car assumes you are a child and doesn’t deploy. It’s a system that is so safe because it doesn’t depend on the operator to get it right.
Ditto motion sensors that detect objects behind the car while reversing (avoiding accidental back-overs), antilock brakes (to maintain control during panicked braking), traction control (improves stability during acceleration), electronic stability control (foils spinouts), tire-pressure-monitoring systems (avoids blowouts), daytime running lights (ensures others see you), rollover airbags (they stay inflated to keep you in the car), lane-departure warning (alerts you if you stray from your lane), and doors that automatically lock after the car starts (again, falling out of cars).
For all the negative press of late, car manufacturers understand safety.
A System Not So Safe
Contrast this to healthcare, in which 10% of patients will suffer a serious, preventable, adverse event during their hospital stay.1 Read that sentence again. That’s 10%; that’s preventable; that’s a number that has largely remained unchanged in the past decade. If 1 in 10 drivers suffered a serious adverse preventable auto accident, Congress would do nothing but hold automotive safety hearings.
In medicine, we still largely employ unsafe systems in which even the best doctors can, and do, hurt patients. Sure, we have made strides in this arena (oxygen tubing that only works if hooked up properly, smart pumps that avert IV dosing errors, CO2 monitors to detect proper endotracheal tube placement), but remarkably, in this era of patient safety, we still utilize systems that largely depend on the heroism of the individual.
As physicians, we are famously autonomous and value our professional independence, even to the degree that it might harm patients. We generally eschew standardization, believing that each patient is inherently different. In fact, the thrill of the improvisational theater that follows every patient’s chief compliant is one of the great satisfiers in medicine. We love that feeling that comes from sleuthing each case, deftly enacting a plan of action to shepherd the patient to health.
To suggest following protocols, guidelines, and checklists is derisively dismissed as “cookbook medicine.” To work in teams in which certain tasks are delegated to others is seen as weakness—we don’t need a system that utilizes a pharmacist; rather, we should know the doses of all medicines, their interactions, and the effect of renal and liver impairment on their clearance. To suggest otherwise is an insult to our Oslerian roots. To examine our errors, our system breakdowns, our patient harms is anathema to our practice, an admission of failure.
The result is that most of us continue to toil in systems that have become exponentially unsafe as healthcare has become more complex. Today, we still have a system that will more or less allow us to kill a patient by doing nothing more than forgetting the letter “g.” I can go to my hospital today and intend to write “4 grams of magnesium sulfate (MgSO4)” and inadvertently forget the “g” in “Mg.” This could result in an order for a lethal dose of morphine sulfate (MSO4). It’s that easy to hurt a patient. Now, you might say that would never happen, because the pharmacy would catch it. And this is likely. But is it guaranteed? Can you 100% ensure it wouldn’t happen? Consider that nearly 20% of medication doses administered in a hospital are done so incorrectly.2 Nearly 1 in 5. This is the type of system we are employing to stop this lethal overdose. Is this system, which depends on another human to prevent an error, foolproof, or just a snare waiting to prove you the fool?
This represents our opportunity. As hospitalists, the hospital is our tapestry, our system of care, our responsibility. Few others are as well-positioned to ensure that the systems that envelop our patients are highly functional, reliable, and safe. This will take work—work that will feel burdensome, underappreciated, undercompensated. And, fully recognizing that none of us went into medicine to become systems engineers, this will be hard.
However, if not us, who? Who will ensure that our fathers, our mothers, our children will be as safe in the hospital as they are on the drive to the hospital? TH
Dr. Glasheen is associate professor of medicine at the University of Colorado Denver, where he serves as director of the Hospital Medicine Program and the Hospitalist Training Program, and as associate program director of the Internal Medicine Residency Program.
References
- Global health leaders join the World Health Organization to announce accelerated efforts to improve patient safety. World Health Organization website. Available at: www.who.int/mediacentre/news/releases/2004/pr74/en/. Accessed Feb. 14, 2011.
- Barker KN, Flynn EA, Pepper GA, Bates DW, Mikeal RL. Medication errors observed in 36 health care facilities. Arch Intern Med. 2002;162(16):1897-1903.
Simple Protocol Improved Handwashing in the ICU
SAN DIEGO - Adding a simple question to the daily ICU checklist about handwashing before touching patients significantly improved handwashing compliance and was associated with a decreased rate of central line-associated bloodstream infections in a surgical intensive care unit over the course of 6 months, according to a presentation at the annual congress of the Society of Critical Care Medicine.
"If you look at how people address hand hygiene compliance overall, most of the time it's with fairly elaborate and expensive educational and marketing campaigns," Dr. Jeremy Pamplin said in an interview after the study was presented during a poster session at the congress. "Inevitably, you improve hand hygiene compliance for a while. Then the campaign goes away and you start to have fading of the compliance."
As part of a process improvement project, Dr. Pamplin, medical codirector of the 20-bed surgical/trauma ICU at Brooke Army Medical Center, Fort Sam Houston, Tex., and his associates added the following question to their daily ICU checklist: "Has anyone seen anyone else touch the patient without washing their hands in the past 24 hours?" The question was asked during multidisciplinary ICU rounds for every patient, and only "yes" or "no" answers were allowed.
If respondents answered "yes," they were asked to provide the name of the offender, which was recorded. Compliance was measured by a third-party observer and was defined as washing hands or using hand sanitizer prior to touching a patient or the patient's immediate surroundings.
Dr. Pamplin and his associates collected data for 3 months before and 3 months after this question was added to the ICU checklist. Over that period, the rate of handwashing compliance significantly increased from 69% to 89%, while the rate of central line-associated bloodstream infections decreased from 13.7/1,000 central line days to 2.7/1,000 central line days, an improvement that did not reach statistical significance.
"Before we introduced this question to our checklist, it was very rare for a provider to tell another provider, 'Hey, I didn't see you wash your hands," Dr. Pamplin said. "After we introduced this question, people started doing it because we gave leadership and emphasis to it."
This resulted in a change of culture, he continued, "so if nurses, residents, or technicians saw someone walk into the room without washing their hands, they would stop them and say, 'Hang on a second; you didn't wash your hands.' Everyone knows that hand hygiene is an important part of infection control. The hard part is remembering to do it. It's a rare circumstance that someone gets upset by another health care provider who says, 'Hey, you forgot to wash your hands.' Because we have talked about hand hygiene compliance on rounds as a team, it has elevated that component of infection control so that everyone recognizes it as being important."
Dr. Pamplin said that he had no relevant financial disclosures to make.
SAN DIEGO - Adding a simple question to the daily ICU checklist about handwashing before touching patients significantly improved handwashing compliance and was associated with a decreased rate of central line-associated bloodstream infections in a surgical intensive care unit over the course of 6 months, according to a presentation at the annual congress of the Society of Critical Care Medicine.
"If you look at how people address hand hygiene compliance overall, most of the time it's with fairly elaborate and expensive educational and marketing campaigns," Dr. Jeremy Pamplin said in an interview after the study was presented during a poster session at the congress. "Inevitably, you improve hand hygiene compliance for a while. Then the campaign goes away and you start to have fading of the compliance."
As part of a process improvement project, Dr. Pamplin, medical codirector of the 20-bed surgical/trauma ICU at Brooke Army Medical Center, Fort Sam Houston, Tex., and his associates added the following question to their daily ICU checklist: "Has anyone seen anyone else touch the patient without washing their hands in the past 24 hours?" The question was asked during multidisciplinary ICU rounds for every patient, and only "yes" or "no" answers were allowed.
If respondents answered "yes," they were asked to provide the name of the offender, which was recorded. Compliance was measured by a third-party observer and was defined as washing hands or using hand sanitizer prior to touching a patient or the patient's immediate surroundings.
Dr. Pamplin and his associates collected data for 3 months before and 3 months after this question was added to the ICU checklist. Over that period, the rate of handwashing compliance significantly increased from 69% to 89%, while the rate of central line-associated bloodstream infections decreased from 13.7/1,000 central line days to 2.7/1,000 central line days, an improvement that did not reach statistical significance.
"Before we introduced this question to our checklist, it was very rare for a provider to tell another provider, 'Hey, I didn't see you wash your hands," Dr. Pamplin said. "After we introduced this question, people started doing it because we gave leadership and emphasis to it."
This resulted in a change of culture, he continued, "so if nurses, residents, or technicians saw someone walk into the room without washing their hands, they would stop them and say, 'Hang on a second; you didn't wash your hands.' Everyone knows that hand hygiene is an important part of infection control. The hard part is remembering to do it. It's a rare circumstance that someone gets upset by another health care provider who says, 'Hey, you forgot to wash your hands.' Because we have talked about hand hygiene compliance on rounds as a team, it has elevated that component of infection control so that everyone recognizes it as being important."
Dr. Pamplin said that he had no relevant financial disclosures to make.
SAN DIEGO - Adding a simple question to the daily ICU checklist about handwashing before touching patients significantly improved handwashing compliance and was associated with a decreased rate of central line-associated bloodstream infections in a surgical intensive care unit over the course of 6 months, according to a presentation at the annual congress of the Society of Critical Care Medicine.
"If you look at how people address hand hygiene compliance overall, most of the time it's with fairly elaborate and expensive educational and marketing campaigns," Dr. Jeremy Pamplin said in an interview after the study was presented during a poster session at the congress. "Inevitably, you improve hand hygiene compliance for a while. Then the campaign goes away and you start to have fading of the compliance."
As part of a process improvement project, Dr. Pamplin, medical codirector of the 20-bed surgical/trauma ICU at Brooke Army Medical Center, Fort Sam Houston, Tex., and his associates added the following question to their daily ICU checklist: "Has anyone seen anyone else touch the patient without washing their hands in the past 24 hours?" The question was asked during multidisciplinary ICU rounds for every patient, and only "yes" or "no" answers were allowed.
If respondents answered "yes," they were asked to provide the name of the offender, which was recorded. Compliance was measured by a third-party observer and was defined as washing hands or using hand sanitizer prior to touching a patient or the patient's immediate surroundings.
Dr. Pamplin and his associates collected data for 3 months before and 3 months after this question was added to the ICU checklist. Over that period, the rate of handwashing compliance significantly increased from 69% to 89%, while the rate of central line-associated bloodstream infections decreased from 13.7/1,000 central line days to 2.7/1,000 central line days, an improvement that did not reach statistical significance.
"Before we introduced this question to our checklist, it was very rare for a provider to tell another provider, 'Hey, I didn't see you wash your hands," Dr. Pamplin said. "After we introduced this question, people started doing it because we gave leadership and emphasis to it."
This resulted in a change of culture, he continued, "so if nurses, residents, or technicians saw someone walk into the room without washing their hands, they would stop them and say, 'Hang on a second; you didn't wash your hands.' Everyone knows that hand hygiene is an important part of infection control. The hard part is remembering to do it. It's a rare circumstance that someone gets upset by another health care provider who says, 'Hey, you forgot to wash your hands.' Because we have talked about hand hygiene compliance on rounds as a team, it has elevated that component of infection control so that everyone recognizes it as being important."
Dr. Pamplin said that he had no relevant financial disclosures to make.
Web Site Seeks to Improve OR Safety
It's a simple idea, but it could help save millions of lives: a Web site helping hospitals and surgeons worldwide improve surgical outcomes by making a commitment to implement proven protocols in their operating rooms, to share ideas, and to receive feedback on what works best.
Called ORReady, the grass roots project is the brainchild of Dr. Paul Alan Wetter, founder and chairman of the Society of Laparoendoscopic Surgeons. Inspired by the humble beginnings of Facebook, and the power of collaboration in the Human Genome Project, Dr. Wetter decided that his idea - a global effort to improve surgical outcomes - would be just as feasible because "smart doctors around the world can get together and do it." No bureaucracy. No big dollar budget.
Launched in early 2010, the project is still in its infancy, and the Web site (www.orready.com) is still maturing. But the power of it all, he said in an interview, lies in the number of people who know about it and use it.
"There are many examples of people who have really improved outcomes in surgery with increased use of safety measures," said Dr. Wetter, who is an ob.gyn. in South Miami, Fla., and an internationally recognized leader in the field of minimally invasive surgery.
He hopes that by sharing OR safety information, there will be at least a 2%-3% improvement in outcomes. That's six million lives saved worldwide each year. He hopes that hospitals, medical societies, and surgical centers worldwide sign onto this effort within the coming years.
He admits that it's a lofty goal. But he also believes that the increasing emphasis on improving patient safety will help the initiative take off. Add to that the power of technology and collaboration: "[The] world is becoming a small place and information is disseminated quickly," said Dr. Wetter, who is also clinical professor emeritus at the University of Miami.
ORReady is a nonprofit project run by members and institutions that have volunteered their time and resources. The Web site follows the Creative Commons guidelines. "We encourage you to copy and use any materials that will help improve surgical outcome and create Centers of Merit in Surgery and MIS [minimally invasive surgery]." It encourages hospitals and departments to download and sign an "Outcome Commitment Letter"; to choose from a set of protocols on the Web site that suit their operating rooms; and register as an ORReady Center of Merit.
The guidelines suggest three main steps for surgeons and their teams: "Slow Down for Warm Up and Check Lists; Stop for Time Out before you Go." A stoplight on the site sums up the message.
Soon, participants can register with an open-access database that can be used for research to improve outcomes and to provide feedback. The school of biological and health systems engineering at Arizona State University, Tempe, has offered to help create the database. Dr. Wetter said that with the rapidly changing technology and arrival of new procedures, ORReady can be the tool through which surgeons and institutions can quickly share their data and receive feedback on what works best.
Dr. Wetter said that so far he has approached a handful of institutions in the United States and abroad and has received a unanimously positive response.
The project also recently won its first award. The Society of Laparoendoscopic Surgeons won the 2011 Alliance for Continuing Medical Education Great Idea Award in the Medical Specialty Societies Member section for introducing ORReady as a way to encourage surgical facilities to improve CME for improved surgical outcomes.
"We're looking for things that are best practices, are innovative, and that other people may want to replicate, adapt, [and] consider using," Jann Balmer, Ph.D., president of the Alliance, said in an interview.
"It's very exciting to do this and see this great enthusiasm," said Dr. Wetter. "For almost any doctor, the main concern is the safety of their patients."
Dr. Wetter is now focusing on spreading the word and making more surgeons and hospitals aware of and involved in ORReady. "The more people that know about this, the more successful it's going to be."
He hopes to see his project make an impact within the next few years.
It's a simple idea, but it could help save millions of lives: a Web site helping hospitals and surgeons worldwide improve surgical outcomes by making a commitment to implement proven protocols in their operating rooms, to share ideas, and to receive feedback on what works best.
Called ORReady, the grass roots project is the brainchild of Dr. Paul Alan Wetter, founder and chairman of the Society of Laparoendoscopic Surgeons. Inspired by the humble beginnings of Facebook, and the power of collaboration in the Human Genome Project, Dr. Wetter decided that his idea - a global effort to improve surgical outcomes - would be just as feasible because "smart doctors around the world can get together and do it." No bureaucracy. No big dollar budget.
Launched in early 2010, the project is still in its infancy, and the Web site (www.orready.com) is still maturing. But the power of it all, he said in an interview, lies in the number of people who know about it and use it.
"There are many examples of people who have really improved outcomes in surgery with increased use of safety measures," said Dr. Wetter, who is an ob.gyn. in South Miami, Fla., and an internationally recognized leader in the field of minimally invasive surgery.
He hopes that by sharing OR safety information, there will be at least a 2%-3% improvement in outcomes. That's six million lives saved worldwide each year. He hopes that hospitals, medical societies, and surgical centers worldwide sign onto this effort within the coming years.
He admits that it's a lofty goal. But he also believes that the increasing emphasis on improving patient safety will help the initiative take off. Add to that the power of technology and collaboration: "[The] world is becoming a small place and information is disseminated quickly," said Dr. Wetter, who is also clinical professor emeritus at the University of Miami.
ORReady is a nonprofit project run by members and institutions that have volunteered their time and resources. The Web site follows the Creative Commons guidelines. "We encourage you to copy and use any materials that will help improve surgical outcome and create Centers of Merit in Surgery and MIS [minimally invasive surgery]." It encourages hospitals and departments to download and sign an "Outcome Commitment Letter"; to choose from a set of protocols on the Web site that suit their operating rooms; and register as an ORReady Center of Merit.
The guidelines suggest three main steps for surgeons and their teams: "Slow Down for Warm Up and Check Lists; Stop for Time Out before you Go." A stoplight on the site sums up the message.
Soon, participants can register with an open-access database that can be used for research to improve outcomes and to provide feedback. The school of biological and health systems engineering at Arizona State University, Tempe, has offered to help create the database. Dr. Wetter said that with the rapidly changing technology and arrival of new procedures, ORReady can be the tool through which surgeons and institutions can quickly share their data and receive feedback on what works best.
Dr. Wetter said that so far he has approached a handful of institutions in the United States and abroad and has received a unanimously positive response.
The project also recently won its first award. The Society of Laparoendoscopic Surgeons won the 2011 Alliance for Continuing Medical Education Great Idea Award in the Medical Specialty Societies Member section for introducing ORReady as a way to encourage surgical facilities to improve CME for improved surgical outcomes.
"We're looking for things that are best practices, are innovative, and that other people may want to replicate, adapt, [and] consider using," Jann Balmer, Ph.D., president of the Alliance, said in an interview.
"It's very exciting to do this and see this great enthusiasm," said Dr. Wetter. "For almost any doctor, the main concern is the safety of their patients."
Dr. Wetter is now focusing on spreading the word and making more surgeons and hospitals aware of and involved in ORReady. "The more people that know about this, the more successful it's going to be."
He hopes to see his project make an impact within the next few years.
It's a simple idea, but it could help save millions of lives: a Web site helping hospitals and surgeons worldwide improve surgical outcomes by making a commitment to implement proven protocols in their operating rooms, to share ideas, and to receive feedback on what works best.
Called ORReady, the grass roots project is the brainchild of Dr. Paul Alan Wetter, founder and chairman of the Society of Laparoendoscopic Surgeons. Inspired by the humble beginnings of Facebook, and the power of collaboration in the Human Genome Project, Dr. Wetter decided that his idea - a global effort to improve surgical outcomes - would be just as feasible because "smart doctors around the world can get together and do it." No bureaucracy. No big dollar budget.
Launched in early 2010, the project is still in its infancy, and the Web site (www.orready.com) is still maturing. But the power of it all, he said in an interview, lies in the number of people who know about it and use it.
"There are many examples of people who have really improved outcomes in surgery with increased use of safety measures," said Dr. Wetter, who is an ob.gyn. in South Miami, Fla., and an internationally recognized leader in the field of minimally invasive surgery.
He hopes that by sharing OR safety information, there will be at least a 2%-3% improvement in outcomes. That's six million lives saved worldwide each year. He hopes that hospitals, medical societies, and surgical centers worldwide sign onto this effort within the coming years.
He admits that it's a lofty goal. But he also believes that the increasing emphasis on improving patient safety will help the initiative take off. Add to that the power of technology and collaboration: "[The] world is becoming a small place and information is disseminated quickly," said Dr. Wetter, who is also clinical professor emeritus at the University of Miami.
ORReady is a nonprofit project run by members and institutions that have volunteered their time and resources. The Web site follows the Creative Commons guidelines. "We encourage you to copy and use any materials that will help improve surgical outcome and create Centers of Merit in Surgery and MIS [minimally invasive surgery]." It encourages hospitals and departments to download and sign an "Outcome Commitment Letter"; to choose from a set of protocols on the Web site that suit their operating rooms; and register as an ORReady Center of Merit.
The guidelines suggest three main steps for surgeons and their teams: "Slow Down for Warm Up and Check Lists; Stop for Time Out before you Go." A stoplight on the site sums up the message.
Soon, participants can register with an open-access database that can be used for research to improve outcomes and to provide feedback. The school of biological and health systems engineering at Arizona State University, Tempe, has offered to help create the database. Dr. Wetter said that with the rapidly changing technology and arrival of new procedures, ORReady can be the tool through which surgeons and institutions can quickly share their data and receive feedback on what works best.
Dr. Wetter said that so far he has approached a handful of institutions in the United States and abroad and has received a unanimously positive response.
The project also recently won its first award. The Society of Laparoendoscopic Surgeons won the 2011 Alliance for Continuing Medical Education Great Idea Award in the Medical Specialty Societies Member section for introducing ORReady as a way to encourage surgical facilities to improve CME for improved surgical outcomes.
"We're looking for things that are best practices, are innovative, and that other people may want to replicate, adapt, [and] consider using," Jann Balmer, Ph.D., president of the Alliance, said in an interview.
"It's very exciting to do this and see this great enthusiasm," said Dr. Wetter. "For almost any doctor, the main concern is the safety of their patients."
Dr. Wetter is now focusing on spreading the word and making more surgeons and hospitals aware of and involved in ORReady. "The more people that know about this, the more successful it's going to be."
He hopes to see his project make an impact within the next few years.