Tag: University of Washington Medical Center

Devilsih Dealings in Hospital Mergers

devilish latte
devilish latte (Photo credit: strikeseason)

Hospital mergers between faith-based (mainly Catholic) and secular healthcare systems are picking up speed and setting off more alarm bells across the country. Here in my home state of Washington–one of our nation’s most secular and socially progressive states–we are quickly becoming the state with the largest percentage of Catholic hospitals. If all of the pending hospital mergers go through, more than half of all hospital beds in Washington State will be in Catholic hospitals. How can this be?

In my previous blog post “God and Mary and Jesus are back….and Coming to a Hospital Near You” (February 27, 2012) I wrote about the concerns raised by the merger of Seattle-based secular Swedish Hospital with Seattle-based (Catholic) Providence Health and Services. As part of the merger deal Swedish Hospital dropped its abortion services. Since the merger, employees have reported they are not allowed to talk with or refer patients for pregnancy termination or give patients resources about our state’s Death with Dignity Act. There are also concerns voiced about the merger’s effect on access to and quality of health care for LGBTQ individuals.

My own physician is part of Swedish and I’ve had conversations with her about whether or not my end-of-life wishes/Advance Directives would be honored if I ended up in a Providence/Swedish hospital. I considered switching health care providers, but now most all in the Seattle area are affiliated with Catholic hospital systems. Even the University of Washington Medical Center is merging/affiliating with PeaceHealth, a large Catholic healthcare system. You have to wonder about these names. Who can argue (especially all of us Pacific Northwest hippies) with a name like PeaceHealth?

As I stated in my previous post– I am all for religious freedom. But I also believe that the separation of church and state goes both ways—not only protecting the
church/religion from the bully-power of the state, but also the state
(government and civil society) from the bully-power of the church.

The ACLU of Washington has taken up the issue of hospital mergers and hosted an excellent panel discussion last week on this topic at Town Hall, Seattle. You can hear a full recording of it here. The audience Q&A session was the most interesting part of it for me. Someone asked why no hospital administrators were on the panel. The answer from the organizers was that they wanted an educational forum and not a public debate–and that hospital administrators had ample resources and platforms already for voicing ‘their side’ of the issue. A woman asked what the ramifications will be for health science student education at University of Washington with the merger/affiliation with PeaceHealth. Two of the panelists were UW faculty members and one replied, laughingly, that they weren’t authorized to answer that question. How sad and how telling and oh how political health care is in our country.

Hospital and Doctor Compare: Patient Beware

Patient Recognition Month Poster
Patient Recognition Month Poster (Photo credit: Army Medicine)

Nurse and NYT’s Well Blog contributor Theresa Brown has a NYT Op-ed piece today entitled “Hospitals Aren’t Hotels,” in which she states “…the growing focus on measuring ‘patient satisfaction’ as a way to judge the quality of a hospital’s care is worrisomely off the mark.” She points to the patient satisfaction section of The Centers for Medicare and Medicaid’s Hospital Compare website, where consumers can look up individual hospital quality of care information. Based on Medicare patient data and hospital reporting mechanisms, Hospital Compare includes process and outcome of medical care measures, use of medical imaging, patient safety measures, Medicare payment/volume, as well as a 10-item survey of patient’s hospital experiences.

It is instructive to note that patient satisfaction is only one of six categories of quality of care data on Hospital Compare from which consumers can make more informed medical care decisions. Obviously it is only useful for planned procedures and hospitalizations, since patients having a heart attack aren’t likely to stop and look up Hospital Compare data on their iPads. I used Hospital Compare several years ago when my sister asked my advice as to Seattle-area hospital choices for her planned abdominal hernia repair. At the time, Swedish Hospital had the highest volumes and best patient outcomes (including patient safety) for this surgical procedure, so my sister then picked a surgeon from their list. She had a decent hospital experience. Today for grins I pretended I needed to have laparoscopic gallbladder removal (I don’t) and ‘shopped’ for Seattle-area hospitals based on this specific procedure. Of the three geographically closest hospitals—Group Health Central, Northwest, and University of Washington Medical Center (UWMC), Group Health came out the clear winner overall for quality of care measures that are most meaningful to me: patient safety (UWMC is worse than national average for hospital acquired conditions such as infections and things besides vital organs left in after surgery—and for the ominous sounding “accidental cuts and tears from medical treatment”), having medications explained to me before they are given, nurses and doctors who communicate with patients well, and the area around patient rooms being quiet at night.

It can be and is argued that patient satisfaction with care is not a valid measure of outcome of medical care. I know from teaching that I can make my students happy and get high ‘student satisfaction’ with teaching scores, and still not have done my job of actually teaching them anything of importance. In her NYT Op-ed piece today, Ms. Brown uses an example of an elderly cancer patient who was told by the hospital oncologist that he was basically too old to qualify for treatment and was sent home. He may have not scored that hospital very high on his Medicare hospital survey, since he didn’t get what he wanted. Ms. Brown links to a recent study by Joshua Fenton at UC Davis showing that higher patient satisfaction scores with individual doctors was linked with greater use of hospital services (higher medical cost) and increased mortality. To me that’s a no-brainer and points to the danger of overuse of health care—more health care is not better health care, and health care can be dangerous to your health.

US doctors have been fighting consumer ratings of individual doctors. (see Ron Lieber’s “The Web is awash in reviews, but not for doctors. Here’s why.” NYT, 3-9-12) The developer of the online RateMyProfessors.com site created RateMDs.com. RateMDs.com now includes ratings of close to 1.4 million physicians in the US and Canada. The founder of RateMDs.com gets at least one lawsuit threat a week from physicians who don’t like what’s been posted about them. A physician reputation management service, Medical Justice, set up a system whereby physicians had patients sign a “no web posting opinions of the doctor” agreement in exchange for enhanced patient privacy protections. That’s almost like a restaurant owner asking you to sign an agreement not to post a review on Yelp in exchange for not putting flies in your soup. The Medical Justice system collapsed after a complaint was filed with the Federal Trade Commission.

Insurance companies and health plans collect consumer ratings and medical outcomes data for individual doctors and other providers, but they don’t make these data available to consumers. With the Affordable Care Act/health care reform, starting January 1, 2013, Medicare will be required to provide consumers more information on doctors as well as on hospitals. (As of this writing, they have a “Physician Compare” site, but it only allows searches to find physicians who accept Medicare.) I disagree with Theresa Brown on this issue. I think that patient satisfaction as one aspect of judging the quality of hospital or other medical care is essential for improving our health care system. It is an essential component of patient-centered care.