Online Ratings For Hospital CEO, CFO’s, etc.

This week's NEJM features an article on hospital-sponsored online rating sites for docs.  The author, Vivian S. Lee, M.D., Ph.D., MBA, a prominent health services researcher discusses the adoption and success of her program at the University of Utah and how the system uses a portal open to patients to evaluate staff. In the piece, she covers familiar ground. Early renunciation and eventual acceptance by faculty in a manner you can predict: initial fears of reputation and prestige loss give way to a stable system allowing docs to obtain feedback in real time to improve their game.  It is not all wine and roses in her telling, but like all things, the apocalypse never materializes, and the once unthinkable becomes business as usual. Docs adjust.  Life moves on. Also in her viewpoint, she cites a recent study of interest that continues to get a lot of attention whenever inquiring minds consider provider ratings.…

Should Hospitalists Unionize?

  If you have given any thought to corporatized medicine and its impact on medical practice, I advise you to read this extended New York Times piece:           The story concerns the contentious relationship between a hospitalist group and their employer, PeaceHealth Sacred Heart Medical Center in Springfield, Oregon.  The group alleges the hospital made advances to replace them on account of their suboptimal performance--both financial and professional.  Sacred Heart put out bids to national companies to outsource their inpatient line of business.  However, their plan did not move forward due to significant physician backlash. Feeling vulnerable, the docs chose to join a union and hitched with the American Federation of Teachers, which already represented nurses at Sacred Heart.  (more…)

If you were paying you, when would you time your bonus and how?

  We all walk into the supermarket and see an abundance of goods. Every item has a place under alluring lighting and come-hither ads. The displays move you and your wagon, despite your beliefs, through the aisles in a deliberate way. The Walmart Supercenter manager wishes to steer your senses so as to induce the transfer of maximal amounts of merchandise from the shelf to your basket (and money out of your wallet). You don't think Whole Foods places huge reams of flowers at the entrance to their stores just to remind you of Mother's Day, do you? (more…)

Have we hit peak hospitalist?

I have detected something unusual.  Take a look at the cited quotes below and see if you can spot what I am referring to.  Both come from a national newspaper.  Here's the first: On arrival, Larson was put in a room and examined by a physician assistant. He didn’t stop at the admissions office because his information and treatment orders already had been placed into the hospital computer system. Larson was subsequently seen by an internal medicine hospitalist, an infectious-disease doctor and an orthopedic surgeon, who conferred regularly about his care over the next four days. He required 12 days of intravenous antibiotics after discharge; medical supplies were delivered within an hour of his arrival home. A nurse followed shortly to teach him how to administer the medication and give him a 24-hour phone number for a nurse and pharmacist. And here is the second: The hospitalist treating Albright told her that…

If Your Hospital was The Ritz-Carlton, How High Would Your Patients Rate You?

  I am a skeptic of the physician evaluation component of HCAHPS.  I suspect patients respond to hospital amenities, and better food, bigger TVs, and swankier lobbies have a halo effect—affecting how they assess not just the structural aspects of their care, but how they perceive their caregivers. You probably share my bias.  On an individual level, we can explain stellar assessments easily, because we all have a natural inclination to attribute good report cards to whatever brilliant skills we bring to the bedside.  However, if we receive an appraisal mom would not want to pin to the refrigerator door, we activate our deflector shields and point towards the patient's leaky sink, broken bed, and roommate with the earsplitting screams. When our crosstown rivals reinforce those impressions by citing say,  increased foot traffic post an upgrade ("build it and they will come"), we might be lulled into thinking designer labels…