Archive for February 2011

Are Academic Medical Centers Toast in a Post-Healthcare Reform World?

My hospital, UCSF Medical Center, is thriving. Our profits this year will be nearly $200 million. We’re building a sparkling clinical complex – a combined women’s, children’s, and cancer hospital – adjacent to our new downtown biomedical research campus. We are installing a state-of-the-art computer system. US News & World Report calls us the 7th best hospital in the country. Our students, residents, and fellows have never been better. Yet angst is in the air, borne of a sense that the future is coming at us fast, and we are not prepared. We’re not alone, mind you. Every hospital enjoying a positive bottom line today is contemplating a bleaker future. Traditionally, hospitals planned to lose about 30% on every Medicaid patient and 5-10% on every Medicare patient, while banking enough profits from commercially insured patients to make the math work out. All of these payers – both governmental and private…


Like a UN cargo plane dropping a crate of rice into a Sudanese refugee camp, so goes the conundrum of the ARRA payment for EHR meaningful use. The rush to grab the dough will result in some casualties. For the ARRA program, those yet to be known casualties may result in rethinking whether dropping the crate was a good idea in the first place. (more…)

Improvements in stroke care by multi-center QI effort

In this report from the CDC, the results of a multi-state stroke registry were reported for 10 performance measures of stroke care (such as IV tpa use and smoking cessation counseling). The results over the course of years are substantial and sustained. This is another example that QI consortiums are a very effective way to standardize and improve evidence based care (abstract)

Med rec in the ED

In this single site study, med rec lists obtained by triage nurses was routinely inaccurate; although they were completed 92% of the time, 37% contained discrepancies, 38% were on nonprescription medications that were not listed, and 28% were on additional medications that were not listed. Accurate medication reconciliation is a time consuming process, that often requires multiple inputs (family, pharmacy, PCP) and is very challenging, especially in an ED triage setting (abstract)

Cost of contamination of blood cultures

In this single center case-control study of the detrimental effects of contaminated blood cultures, researchers found that patients with a false positive blood culture had a significantly longer length of stay (by 5 day) and higher hospital cost (almost $5,000) than those with a true negative blood culture. They estimated the cost of these false positive cultures to be almost $2million a year. While there are a number of assumptions in this study, and not all confounders were accounted for, there is no doubt that reducing the rate of false positive blood cultures in hospitals would reduce LOS and cost (abstract)