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Carolinas Healthcare System Pays Executives Even More

In May, 2012, we <a href="http://hcrenewal.blogspot.com/2012/05/from-serving-poor-to-pay-executives.html">discussed</a> the contrast between the outsize compensation given to top executives of Carolinas Healthcare System, a large tax-exempt public hospital authority, and the apparent failure of the system to fulfill it promise to provide community care.  Now we can update that story. 2012 Executive Compensation The Charlotte Observer <a href="http://www.charlotteobserver.com/2013/02/06/3835851/charlotte-hospital-pay.html">reported </a>on the compensation given to top executives at the Carolinas Health Care System in 2012: <blockquote class="tr_bq">The top executive at Carolinas HealthCare System received $4.76 million in 2012 compensation, a 12 percent increase over 2011, as the system celebrated a profitable year and met all of its systemwide performance goals, the system announced. CEO Michael Tarwater, 59, who has led the $7.5 billion nonprofit system for more than 10 years, received a salary of $1.1 million, two bonuses totaling $2.8 million, and other compensation, including retirement and health benefits, of $795,724. The top 10 executives at Carolinas HealthCare each received more than $1 million in total compensation. Most received increases of more than 8 percent.</blockquote> A more detailed list, which included the rate of increase since 2011:: <blockquote class="tr_bq">Michael Tarwater, CEO: $4,760,026 – 12.36 percent increase Joseph Piemont, president and chief operating officer: $2,880,926 – 13.57 percent increase Greg Gombar, chief financial officer: $1,898,027 – 8.35 percent increase Laurence Hinsdale, executive vice president: $1,844,413 – 8.92 percent increase Paul Franz, executive vice president: $1,704,671 – 8.17 percent increase Dennis Phillips, executive vice president: $1,420,521 – 5.14 percent increase Dr. Roger Ray, chief medical officer: $1,315,148 – 21.76 percent increase John Knox, chief administrative officer: $1,296,185 – 8.24 percent increase Debra Plousha Moore, executive vice president: $1.145,357 – increase not available Russell Guerin, executive vice president: $1,141,171 million – 7.56 percent increase </blockquote><div style="color: black; font: 10pt sans-serif; height: 1px; overflow: hidden; text-align: left; text-transform: none; width: 1px;"> Read more here: http://www.charlotteobserver.com/2013/02/06/3835851/charlotte-hospital-pay.html#storylink=cpy</div><div style="color: black; font: 10pt sans-serif; height: 1px; overflow: hidden; text-align: left; text-transform: none; width: 1px;"> Read more here: http://www.charlotteobserver.com/2013/02/06/3835851/charlotte-hospital-pay.html#storylink=cpy</div> Also here were the compensation figures for some leaders of individual hospitals within the system: <blockquote class="tr_bq">Others in Carolinas HealthCare System - 2012 • Spencer Lilly, president, Carolinas Medical Center: $633,326 • Robert Larrison, president, Carolinas Rehabilitation: $348,976 • Douglas Roush, president, CMC-Mercy: $262,745 • Christopher Hummer, president, CMC-Pineville: $549,616 • William Leonard, president, CMC-University: $378,369 • Phyllis Wingate-Jones, president, CMC-NorthEast: $761,160 • Peter Acker, president, CMC-Lincoln: $385,847 • Michael Lutes, president, CMC-Union: $488,427 </blockquote><div style="color: black; font: 10pt sans-serif; height: 1px; overflow: hidden; text-align: left; text-transform: none; width: 1px;"> Read more here: http://www.charlotteobserver.com/2013/02/06/3835851/charlotte-hospital-pay.html#storylink=cpy</div> The Context The context is that Carolinas Healthcare is a large tax-exempt public hospital system that claims that it "works to improve and enhance the overall health and wellbeing of its communities" according to <a href="http://www.carolinashealthcare.org/about-chs">its web-site</a>.  However, there have been accusations, for example here by "Jessica Curtis, director of the Hospital Accountability Project for Community Catalyst in Boston," that is has been <blockquote class="tr_bq">'...sending very low income patients to collections and suing them as well.' The Observer and The News & Observer reported last year that during the five years ending in 2010, North Carolina hospitals filed more than 40,000 lawsuits. Most of the suits were filed by Carolinas HealthCare.</blockquote> Note that we discussed the contrast between this hospital system's public nature and aspirational statements about serving the community on one had, and its oversize executive compensation on the other hand <a href="http://hcrenewal.blogspot.com/2012/05/from-serving-poor-to-pay-executives.html">here</a>.  Since then, executive compensation has only gone up. The Usual Talking Points for Justification Of course, when asked, defenders of the hospital system gave the stock justifications.  For example, <blockquote class="tr_bq">Carolinas HealthCare officials said executive compensation is 'performance based' and reflects the system’s growth. </blockquote> The Observer found a health care executive compensation consultant to make the usual arguments about the need to pay market rates to prevent supposedly talented executives from being recruited elsewhere: <blockquote class="tr_bq"> Consultants who assist hospitals in setting executive compensation say they compare peers at hospital systems of comparable size, complexity and performance. 'If , he’s going to get paid higher in the range. That individual is very vulnerable to being recruited away' said Bob Erra, president of Integrated Healthcare Strategies. 'The last thing a compensation committee wants to do is to lose a leader over pay,' said Erra, whose Minneapolis-based firm works with Novant Health but not Carolinas HealthCare.</blockquote>  Just as we mentioned in our <a href="http://hcrenewal.blogspot.com/2013/02/non-profit-hospital-executive-salaries.html">most recent post</a>, whenever anyone bothers to try to justify extravagant executive compensation at hospitals, and for that matter, most other health care organizations throughout the US, they seem to repeat the same set of talking points.    We first listed the talking points <a href="http://hcrenewal.blogspot.com/2011/09/talking-points-sans-original-thought-to.html">here</a>, and then provided additional examples of their use <a href="http://hcrenewal.blogspot.com/2011/09/more-repeats-of-talking-points.html">here</a>, <a href="http://hcrenewal.blogspot.com/2012/03/example-of-how-complex-takes-control.html">here</a> and <a href="http://hcrenewal.blogspot.com/2012/12/health-care-hired-managers-not-playing.html">here</a>.   The talking points are: -  we pay what everyone else pays -  CEOs work hard and are brilliant, and so deserve high pay -  high pay is needed to attract and retain competent, if not brilliant people. Note that without specific evidence to back them up, the first two talking points at least are logical fallacies.  The first is an <a href="http://www.nizkor.org/features/fallacies/appeal-to-common-practice.html">appeal to common practice</a>.  The second is an <a href="http://www.nizkor.org/features/fallacies/appeal-to-authority.html">appeal to authority</a>. None of the examples of these talking points we have seen so far explain why these apply to CEOs and other top hired managers, but not to other kinds of employees. So it should be no surprise that the justifications for the largess to hospital executives at Carolinas follow the talking points yet again. -  We Pay What Everyone Else Pays => "they compare peers at hospital systems of comparable size, complexity and performance."  Note further that it is hard to believe the comparisons were only to other public hospital systems, that is, hospital systems run by local government - CEOs Work Hard and Are Brilliant => "(the CEO) is a high performer...."  Note further that as usual no evidence of the CEO's specific performance was offered. - High Pay Needed for Retention => "That individual is very vulnerable to being recruited away."  Note that as we wrote recently, most CEOs are recruited from within the organization, and no specific evidence that this specific CEO was particularly likely to be recruited away was offered.  So as is usual, underlying these talking points there was no evidence, nor arguments that would make them more logical. Summary: the More Things Change The more they stay the same.  Thus this seems to be yet another example of how top managers almost always now seem able to personally profit from their positions of trust.  In this particular example, however, these were managers of a public organization, so it may be possible that public pressure could make them more accountable and hold them to more reasonable pay.   So to repeat my conclusions from 2012....  The governance of this organization, like that of many others we have discussed, needs to regain accountability, transparency, integrity, and ethics. It must insist that the leaders it hires uphold the mission ahead of other concerns, particularly personal enrichment. It must provide these leaders with realistic incentives based on how well they uphold this mission, not on revenue or operating margin. Until such changes are accomplished, expect this hospital system, like many other health care organizations, to contribute only to our ever rising prices, declining access, and stagnating health care quality.

Carolinas Healthcare System Pays Executives Even More

In May, 2012, we discussed the contrast between the outsize compensation given to top executives of Carolinas Healthcare System, a large ta...

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Bipartisan Policy Center's Health Innovation Initiative: Health IT Industry Officials Lying to Regulators With Impunity?

On Wednesday, February 13, 2013, The <a href="https://bipartisanpolicy.org/" target="_blank">Bipartisan Policy Center's</a> Health Innovation Initiative held a discussion on its new report: An Oversight Framework for Assuring Patient Safety in Health Information Technology.  The announcement is here:  <a href="https://bipartisanpolicy.org/news/press-releases/2013/02/bipartisan-policy-center-releases-recommendations-oversight-framework-pa">https://bipartisanpolicy.org/news/press-releases/2013/02/bipartisan-policy-center-releases-recommendations-oversight-framework-pa</a> The report is here (PDF):  "<a href="http://bipartisanpolicy.org/sites/default/files/Patient%20Safety%20Health%20IT_0.pdf" target="_blank">An Oversight Framework for Assuring Patient Safety in Health Information Technology.</a>" The "who's" of the<a href="https://bipartisanpolicy.org/" target="_blank"> Bipartisan Policy Center's</a> Health Innovation Initiative included these people: <ul><li>Senator Tom Daschle, Former U.S. Senate Majority Leader; Co-founder, Bipartisan Policy Center (BPC); and Co-leader BPC Health Project Carolyn M. Clancy, M.D., Director, Agency for Healthcare Research and Quality, Department of Health and Human Services</li><li>Farzad Mostashari, M.D., ScM, National Coordinator for Health Information Technology, Department of Health and Human Services </li><li>Peter Angood, M.D., Chief Executive Officer, American College of Physician Executives</li><li>Russ Branzell, Chief Executive Officer, Colorado Health Medical Group, University of Colorado Health</li><li>John Glaser, Ph.D., Chief Executive Officer, Siemens Health Services </li><li>Douglas E. Henley, M.D., FAAFP, Executive Vice President and Chief Executive Officer, American Academy of Family Physicians</li><li>Jeffrey C. Lerner, Ph.D., President and Chief Executive Officer, ECRI Institute</li><li>Ed Park, Executive Vice President and Chief Operating Officer, athenahealth</li><li>Emad Rizk, M.D., President, McKesson Health Solutions</li><li>Janet Marchibroda, Moderator; Director, BPC Health Innovation Initiative </li></ul> Unfortunately, I was unable to attend.  I was at the <a href="http://www.justicewinterconvention.org/" target="_blank">2013 Annual Winter Convention of the American Association for Justice</a> (Trial Lawyer's Association) in Florida, as an invited speaker on health IT risk, its use in evidence tampering, and other legal issues. <table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh1kTtcFaa9AlR4ehFZ2saSVQIFGGXDXX0oj-i8Ak1HQVCSfth5AWUu_Z2XZr0dLHOklLh0MpDCA_dcNT35QiGkJfroeHJDohpj7zLVKul8fjan3Ob9p4DSsotj8f0vdTceuobxQiizwqFv/s1600/aaj.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="192" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh1kTtcFaa9AlR4ehFZ2saSVQIFGGXDXX0oj-i8Ak1HQVCSfth5AWUu_Z2XZr0dLHOklLh0MpDCA_dcNT35QiGkJfroeHJDohpj7zLVKul8fjan3Ob9p4DSsotj8f0vdTceuobxQiizwqFv/s400/aaj.jpg" width="400" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">"United for Justice" - click to enlarge</td><td class="tr-caption" style="text-align: center;"> </td><td class="tr-caption" style="text-align: center;"> </td><td class="tr-caption" style="text-align: center;"> </td></tr></tbody></table><div class="separator" style="clear: both; text-align: center;"></div> I found the following statement from the Bipartisan Policy Center's Health Innovation Initiative <a href="http://bipartisanpolicy.org/sites/default/files/Patient%20Safety%20Health%20IT_0.pdf" target="_blank">report</a> remarkable as a "framework for health IT safety": <blockquote class="tr_bq">The Bipartisan Policy Center today proposed an oversight framework for assuring patient safety in health information technology. Among other guiding principles, the framework should be risk-based, flexible and assure patient safety is a shared responsibility, the authors said. “Assuring safety in clinical software in particular is a shared responsibility among developers, implementers, and users across the various stages of the health IT life cycle, which include design and development; implementation and customization; upgrades, maintenance and operations; and risk identification, mitigation and remediation,” the report states. Among other recommendations, the center said clinical software such as electronic health records and software used to inform clinical decision making should be subject to a new oversight framework, rather than traditional regulatory approaches [e.g.,  FDA - ed.] applied to medical devices given its lower risk profile.</blockquote> I find it remarkable that the health IT industry and its supporters now feel they can lie to our government and regulatory agencies with impunity.  Stating that health IT has a "lower risk profile" is an example. One cannot know what is acknowledged to be unknown. From the Institute of Medicine in its 2012 report on health IT safety: <blockquote class="tr_bq">Institute of Medicine. 2012. <a href="http://www.ischool.drexel.edu/faculty/ssilverstein/Patient%20Safety%20and%20Health%20IT%20prepub.pdf" target="_blank">Health IT and Patient Safety: Building Safer Systems for Better Care</a> .  Washington, DC: The National Academies Press. ... While some studies suggest improvements in patient safety can be made, others have found no effect. Instances of health IT–associated harm have been reported. However, little published evidence could be found quantifying the magnitude of the risk. Several reasons health IT–related safety data are lacking include the absence of measures and a central repository (or linkages among decentralized repositories) to collect, analyze, and act on information related to safety of this technology. Another impediment to gathering safety data is contractual barriers (e.g., nondisclosure, confidentiality clauses) that can prevent users from sharing information about health IT–related adverse events. These barriers limit users’ abilities to share knowledge of risk-prone user interfaces, for instance through screenshots and descriptions of potentially unsafe processes. In addition, some vendors include language in their sales contracts and escape responsibility for errors or defects in their software (i.e., “hold harmless clauses”). The committee believes these types of contractual restrictions limit transparency, which significantly contributes to the gaps in knowledge of health IT–related patient safety risks. These barriers to generating evidence pose unacceptable risks to safety. ... More worrisome, some case reports suggest that poorly designed health IT can create new hazards in the already complex delivery of care. Although the magnitude of the risk associated with health IT is not known, some examples illustrate the concerns. Dosing errors, failure to detect life-threatening illnesses, and delaying treatment due to poor human–computer interactions or loss of data have led to serious injury and death.”  </blockquote> Even to those with particularly thick skulls, this statement seems easy to comprehend: "The magnitude of the risk associated with health IT is not known." I repeat once again: One cannot know what is acknowledged to be unknown. A statement that health IT has a "lower risk profile" compared to other regulated healthcare sectors such as devices or drugs, in order to seek continued and extraordinary regulatory accommodations, is remarkable.  It is either reckless regarding something that the statement's makers should know, or should have made it their business to know - or a deliberate prevarication with forethought. The report did attempt to shroud the declarative "lower risk profile" in a sugar coating through misdirection, citing the need to take into account "several factors" including: <blockquote class="tr_bq">"the level of risk of potential patient harm, the degree of direct clinical action on patients, the opportunity for clinician involvement, the nature and pace of its development, and the number of factors beyond the development stage that impact its level of safety in implementation and use." </blockquote> These "factors" speak to a higher level of potential risk, not lower, and are a justification for stronger regulatory oversight, not weaker.  I would opine that there is a possibility that health IT. through which almost all transactions of care need to pass (e.g., orders, results reporting, recording and review of observations, finding, diagnoses, prognoses, treatment plans, etc.), could have a higher risk profile than one-off devices or drugs.  Health IT affects every patient, not just those under a specific therapy or using a specific device or drug. Partial taxonomies developed from limited data themselves speak to the issue of a potentially huge risk profile of health IT, e.g., the FDA Internal Memo on HIT Risks (<a href="http://www.ischool.drexel.edu/faculty/ssilverstein/Internal-FDA-Report-on-Adverse-Events-Involving-Health-Information-IT.pdf" target="_blank">link</a>), the AHRQ Hazards Manager taxonomy (<a href="http://healthit.ahrq.gov/HealthITHazardManagerFinalReport" target="_blank">link</a>), and the sometimes hair-raising voluntary defects reports (largely from one vendor) in the FDA MAUDE database (<a href="http://hcrenewal.blogspot.com/2011/01/maude-and-hit-risk-mother-mary-what-in.html" target="_blank">link</a>).  Further, health IT can and does affect thousands or tens of thousands of patients en masse even due to one simple defect, such as happened in Rhode Island at Lifespan (<a href="http://hcrenewal.blogspot.com/2011/11/lifespan-rhode-island-yet-another.html" target="_blank">link</a>), or due to overall design and implementation problems such as at Contra Costa County, CA (<a href="http://hcrenewal.blogspot.com/2012/09/in-addition-to-nurses-doctors-now-air.html" target="_blank">link</a>) and San Francisco's Dept. of Public Health (<a href="http://hcrenewal.blogspot.com/2010/11/avatar-fails-no-not-cameron-movie-but.html" target="_blank">link</a>). We don't know the true levels of risk and harm - but we need to, and rapidly.  Industry self-policing is not the answer; it didn't work in drugs and devices, and even with regulation there are still significant problems in those sectors.  (Imagine how it would be if those sectors received the special accommodations that health IT receives, and wishes to continue to receive.) My other issue is with the "shared responsibility" including "users." The user's responsibility is patient care, not being a beta tester for bug-laden or grossly defective health IT products.  Their responsibility ends at reporting problems without retaliation, and ensuring patient safety. Their responsibility is to avoid carelessness - as it is when they drive their cars. In other words, the inclusion of "users" in the statement is superfluous. It is not a responsibility to be omniscient and be held accountable when bad health IT promotes "use error" (the NIST definition of "use error" I will not repeat again here; search the blog) -- as opposed to and as distinct from "user error" - note the final "r" - i.e., carelessness. Bad health IT (see <a href="http://www.ischool.drexel.edu/faculty/ssilverstein/cases/" target="_blank">here</a>): <blockquote class="tr_bq">Bad Health IT ("BHIT") is defined as IT that is ill-suited to purpose, hard to use, unreliable, loses data or provides incorrect data, causes cognitive overload, slows rather than facilitates users, lacks appropriate alerts, creates the need for hypervigilance (i.e., towards avoiding IT-related mishaps) that increases stress, is lacking in security, compromises patient privacy or otherwise demonstrates suboptimal design and/or implementation.  </blockquote> One special accommodation that the health IT industry has been afforded for far too long is to be able to "blame the user." "Blaming the victim" of bad health IT is a more appropriate description. -- SS

Bipartisan Policy Center's Health Innovation Initiative: Health IT Industry Officials Lying to Regulators With Impunity?

On Wednesday, February 13, 2013, The Bipartisan Policy Center's Health Innovation Initiative held a discussion on its new report: An Ov...

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Non-Profit Hospital Executive Salaries Continue to Defy Gravity and Logic

The old saying is that nothing is certain except death and taxes.  In health care, the other near certainty seems to be that compensation for health care leaders is big and always getting bigger.  Over the past few weeks several reports about the compensation of top executives of US non-profit hospitals and hospital systems have appeared.  So it is time to do our latest round-up of incessantly buoyant hospital executive compensation, and argumentative hot air that seems to fuel it.  I will first summarize the latest cases in alphabetical order by state, and then examine some common justifications for the seemingly anti gravitational nature of executive compensation in this part of health care. Arizona On AZCentral.com was an <a href="http://www.azcentral.com/news/politics/articles/20130208maricopa-county-health-care-chief-big-raise.html">article</a> about the CEO of a single relatively small public hospital system: <blockquote class="tr_bq">The leaders of Maricopa County’s public health-care system agreed to raise chief executive Betsey Bayless’ pay by 33 percent, bringing her salary to $500,000.</blockquote> That may not seem like a lot of money as executive compensation goes, but consider the context: <blockquote class="tr_bq">The Maricopa Integrated Health System is a public hospital system that provides care for the Valley’s poor and uninsured. It is funded by federal and state health-care dollars and a special county levy paid by all county property-tax payers. MIHS budgeted $3.5 million for market adjustments and merit raises for its employees in fiscal 2013. Bayless’ salary increase alone will consume one-quarter of the $500,000 the board had allocated this fiscal year to bring all employees’ pay in line with similar positions elsewhere. The health-care system’s rank-and-file employees have received annual merit-based salary increases of no more than 2.9 percent since fiscal 2008.</blockquote> Nonetheless, the CEO did not exactly feel rich: <blockquote class="tr_bq">Bayless said she did not request the raise and was not expecting it. She said she believes MIHS employees will understand that her salary has been comparatively low and that her replacement likely will be brought in at an even higher salary.</blockquote> She justified her pay by comparing it to what she thought the market would bear. <blockquote class="tr_bq">'Any salary information will show you that my salary is always the lowest of any (hospital) CEO currently in the entire state, even the little-bitty hospitals,' Bayless said. 'On any measure, 375 (thousand dollars) is below market. So, do I feel undercompensated? I don’t know. But on any measure, it always comes in below market.'</blockquote> Members of the hospital system's board also justified the pay on the grounds that it was at the market rate: <blockquote class="tr_bq">[Board Members Mary] Harden and [Terence] McMahon said they voted for the pay raise because a national search firm hired to find Bayless’ replacement set $500,000 as a minimum competitive salary for qualified candidates.</blockquote> Another board member also noted how hard CEO Bayless works: <blockquote class="tr_bq">'The lady works 70-plus hours a week. She’s on call 24/7. So, I think the job warrants it. She works very, very hard,'  Dewane said.</blockquote>I am sure health care professionals who also work long hours, and are frequently on call, but unlike managers, have to make decisions with real life and death consequences would understand, or not. California In California a report focused in contrast on the bigger hospitals and hospital systems.  California Healthcare News <a href="http://www.payersandproviders.com/news-article.php?news_id=138&region=3">reported</a> on the best compensated hospital executives in the state.  In general, <blockquote class="tr_bq">More than one in five non-profit hospital chief executive officers in California received compensation totaling $1 million or more in 2010, according to a new pay survey by Payers & Providers. Altogether, 32 CEOs of the 154 surveyed received pay packages that ventured into the seven figures. That compares to 19 CEOs who received seven-figure pay packages in the only prior survey Payers & Providers conducted. That survey was published in June 2010, and relied primarily on data from 2007 and 2008.  </blockquote> Some specifics about the best paid executives: <blockquote class="tr_bq">Kaiser Permanente's George Halvorson is the most highly-compensated hospital system executive in California, receiving $7.74 million in 2010. That included more than $6 million in additional compensation. Halvorson is retiring as Kaiser's CEO in June. Thomas Priselac, the chief executive officer of Cedars-Sinai Medical Center in Los Angeles, was the highest-paid standalone hospital CEO, earning $2.77 million in 2010. That included additional compensation of $1.6 million.</blockquote> The article provided the justification for Priselac's seven-figure compensation: <blockquote class="tr_bq">According to an email response from Cedars-Sinai spokesperson Duke Helfand, Priselac's compensation 'reflects the top-tier clinical, research and educational performance the medical center consistently has delivered in his 19 years of leadership.'</blockquote> He did not offer how this performance was measured, how it compared to that of any other hospital, or whether anyone other than the CEO might have been responsible for that performance. The survey results included the best compensated CEO of a health-district <blockquote class="tr_bq">Michael Covert,  the CEO of the two hospital Palomar-Pomerado Health system in San Diego County, was the highest-paid district hospital CEO, earning $1.09 million in 2010. He was among two district hospital CEOs to earn seven-figure compensation. </blockquote> The survey results also included the best compensated CEO for academic medical centers run by the (state supported) University of California: <blockquote class="tr_bq">David T. Feinberg, M.D., is by far the highest-paid CEO among those who oversee the five research hospitals operated by the University of California. Feinberg, who runs Ronald Reagan UCLA Medical Center, earned $1.33 million in 2010 – the only seven-figure pay package among that cohort of CEOs, and nearly $450,000 more than the second-highest earner in that group, Mark Laret of UC San Francisco Medical Center.</blockquote>Connecticut Becker's Hospital Review <a href="http://www.beckershospitalreview.com/compensation-issues/9-connecticut-hospital-ceos-pay-tops-1m-in-fy-2011.html">provided information</a> on the highest paid Connecticut hospital CEOs: <blockquote class="tr_bq">Here are the nine CEOs who earned at least $1 million in 2011. •    Clarence Silvia, The Hospital of Central Connecticut: $2.76 million •    Marna Borgstrom, Yale-New Haven Hospital: $2.59 million •    Brian Grissler, Stamford Hospital: $2.24 million •    Elliot Joseph, Hartford Hospital: $1.74 million (*CEO is now Jeff Flaks) •    Frank Corvino, Greenwich Hospital: $1.71 million •    Susan Davis, RN, Saint Vincent's Medical Center: $1.48 million •    Chris Dadlez, Saint Francis Hospital and Medical Center: $1.42 million •    John Murphy, MD, Danbury Hospital: $1.08 million •    Christopher O'Connor, Hospital of Saint Raphael: $1.04 million</blockquote>  The report did not provide any justification for the pay levels, and I could find no further news coverage that was relevant. Massachusetts The Fitchburg (MA) Sentinel and Enterprise seemed to be the only media outlet which  <a href="http://www.sentinelandenterprise.com/local/ci_22266835/questions-raised-pay-mass-hospital-execs">noted</a> the compensation of hospital executives reported to the state attorney general.  It listed compensation of some regional hospital leaders, <blockquote class="tr_bq">Patrick Muldoon, president and CEO of HealthAlliance Hospital, a member of the UMass Memorial Health Care system, received a compensation package of $653,868 in 2010, the most recent year for which compensation data is publicly available. The HealthAlliance system includes a 135-bed community hospital with services on two campuses in Leominster and Fitchburg. Over that same period, Daniel P. Moen, former president and CEO of the 153-bed Heywood Hospital in Gardner, received a compensation package of $386,126. Christine Schuster, CEO of Emerson Hospital in Concord, earned a total compensation package of $669,844. Emerson has 179 beds. Lahey Clinic chief executive Howard Grant, who oversees a facility with 317 beds, was paid a total compensation package of $768,568 in 2010. </blockquote><div style="background-color: white; border: medium none; color: black; overflow: hidden; text-align: left; text-decoration: none;"> The article did not note the justification for the pay of any of these CEOs.  I was unable to find any other recent reporting that took advantage of the data supplied to the state Attorney General.</div><div style="background-color: white; border: medium none; color: black; overflow: hidden; text-align: left; text-decoration: none;"> </div><div style="background-color: white; border: medium none; color: black; overflow: hidden; text-align: left; text-decoration: none;">New York</div><div style="background-color: white; border: medium none; color: black; overflow: hidden; text-align: left; text-decoration: none;"> </div><div style="background-color: white; border: medium none; color: black; overflow: hidden; text-align: left; text-decoration: none;">SUNY - Downstate Medical Center The New York Daily News <a href="http://www.nydailynews.com/new-york/brooklyn/suny-downstate-bigs-earn-200k-lich-closing-moves-article-1.1257273">reported</a> on compensation given to executives at one state supported university medical center:</div><div style="background-color: white; border: medium none; color: black; overflow: hidden; text-align: left; text-decoration: none;"> </div><blockquote class="tr_bq"><div style="background-color: white; border: medium none; color: black; overflow: hidden; text-align: left; text-decoration: none;">15 SUNY Downstate Medical Center bigs are raking in $200,000-plus salaries even as plans move forward to shut down its Long Island College Hospital campus. Downstate president Dr. John Williams who’s leading the drive to close the Cobble Hill hospital gets the fattest pay of all. He’s paid $650,000 a year salary and gets an annual housing allowance of up to $80,000 and the use of a car.</div></blockquote>It listed the following compensation information for other executives: <blockquote class="tr_bq">Other big hospital administrators’ salaries, 2011 * $552,556.33 — Debra Carey, vice president * $357,379.26 - Grace Wong, vice president * $334,072.19 — Ivan Lisnitzer, vice president * $312,182.24 — Paul Davis, assistant vice president * $286,954.51 Renee Poncet, vice president</blockquote> This should be viewed in the context of the medical center's current dire straits: <blockquote class="tr_bq">SUNY Downstate — which has a hospital and medical school in East Flatbush — is in such bad financial shape it could go broke by March, SUNY chairman Carl McCall has said.</blockquote><div style="background-color: white; border: medium none; color: black; overflow: hidden; text-align: left; text-decoration: none;"> </div><div style="background-color: white; border: medium none; color: black; overflow: hidden; text-align: left; text-decoration: none;">Of course, despite these financial threats, a "spokesman" defended these payments again as market-based:</div><div style="background-color: white; border: medium none; color: black; overflow: hidden; text-align: left; text-decoration: none;"> </div><div style="background-color: white; border: medium none; color: black; overflow: hidden; text-align: left; text-decoration: none;"><blockquote class="tr_bq">[Robert] Bellafioire defended the brigade of big salaries — though the controller’s audit suggested Downstate should consider cutting the number of high-paid administrators. </blockquote><blockquote class="tr_bq">'We have to offer competitive compensation, particularly when we’re up against any number of the country’s best hospitals and medical schools just across the bridge and in the metropolitan area,' Bellafiore said.</blockquote><div style="background-color: white; border: medium none; color: black; overflow: hidden; text-align: left; text-decoration: none;">Rural Hospitals in Upstate New York On the other hand, the Plattsburgh (NY) Press-Republican <a href="http://pressrepublican.com/0100_news/x1303545809/Salaries-of-hospital-CEOs-detailed">reported</a> on the compensation given to hospital executives in rural northern New York state.  These included Alice Hyde Medical Center:</div><div style="background-color: white; border: medium none; color: black; overflow: hidden; text-align: left; text-decoration: none;"> </div><blockquote class="tr_bq"><div style="background-color: white; border: medium none; color: black; overflow: hidden; text-align: left; text-decoration: none;">John Johnson, president and chief executive officer, was paid $339,539 in 2010. He retired in the fall of 2012. He was replaced by Douglas DiVello, who is paid $246,682 in salary and benefits.</div></blockquote><div style="background-color: white; border: medium none; color: black; overflow: hidden; text-align: left; text-decoration: none;"></div><div style="background-color: white; border: medium none; color: black; overflow: hidden; text-align: left; text-decoration: none;"></div><div style="background-color: white; border: medium none; color: black; overflow: hidden; text-align: left; text-decoration: none;"></div><div style="background-color: white; border: medium none; color: black; overflow: hidden; text-align: left; text-decoration: none;"> Then there was CVPH Medical Center in Plattsburgh </div><div style="background-color: white; border: medium none; color: black; overflow: hidden; text-align: left; text-decoration: none;"> </div><blockquote class="tr_bq"><div style="background-color: white; border: medium none; color: black; overflow: hidden; text-align: left; text-decoration: none;">Hospital President Stephens Mundy has been at CVPH for 10 years and was paid $749,563 in salary, bonuses and other compensation in 2010. His base salary for 2013 is $478,421,...</div></blockquote><div style="background-color: white; border: medium none; color: black; overflow: hidden; text-align: left; text-decoration: none;"></div><div style="background-color: white; border: medium none; color: black; overflow: hidden; text-align: left; text-decoration: none;">In addition, there was Elizabethtown Community:</div><div style="background-color: white; border: medium none; color: black; overflow: hidden; text-align: left; text-decoration: none;"></div><blockquote class="tr_bq"><div style="background-color: white; border: medium none; color: black; overflow: hidden; text-align: left; text-decoration: none;">Rodney Boula, president and chief executive officer at ECH, was paid $229,902 in 2010.</div></blockquote><div style="background-color: white; border: medium none; color: black; overflow: hidden; text-align: left; text-decoration: none;"></div><div style="background-color: white; border: medium none; color: black; overflow: hidden; text-align: left; text-decoration: none;">Note that later the article explained that this hospital has no more than 25 beds. However, the reporter was unable to find out the compensation of the CEO of the Adirondack Medical Center in Saranac Lake:</div><div style="background-color: white; border: medium none; color: black; overflow: hidden; text-align: left; text-decoration: none;"> </div><blockquote class="tr_bq"><div style="background-color: white; border: medium none; color: black; overflow: hidden; text-align: left; text-decoration: none;">Chandler Ralph, president and chief executive officer for 16 years, is not employed by the hospital or its umbrella organization, Adirondack Health. She is paid through a contract with a management company, Health Tech Management Services, said Joe Riccio, AMC communications director. Her salary is a confidential employment contract, 'just like any other vendor that does business' with the hospital, he said. Because of that, her salary was not available through IRS records. The Press-Republican pressed Ralph to release her salary, noting that it was publishing the pay of all other area hospital CEOs, but she refused, citing confidentiality.</div></blockquote><div style="background-color: white; border: medium none; color: black; overflow: hidden; text-align: left; text-decoration: none;"></div><div style="background-color: white; border: medium none; color: black; overflow: hidden; text-align: left; text-decoration: none;">Parenthetically, this seems to be an unusual case of the actual outsourcing of top leadership. This compensation information again should be considered in the context.  These are all relatively small hospitals in a rural area with low costs of living.  In addition, these hospitals were facing substantial financial challenges:</div><div style="background-color: white; border: medium none; color: black; overflow: hidden; text-align: left; text-decoration: none;"></div><blockquote class="tr_bq"><div style="background-color: white; border: medium none; color: black; overflow: hidden; text-align: left; text-decoration: none;">Numerous jobs were cut in 2012 at the area’s five hospitals, some the first substantial layoffs in decades. One hospital recorded an operating deficit, and at some, programs and services were reduced. Adirondack Health, parent company of Adirondack Medical Center in Saranac Lake, and CVPH Medical Center in Plattsburgh, each laid off 17 employees last fall and eliminated vacant positions. Alice Hyde Medical Center in Malone let 12 people go in September and had closed down more than a dozen vacancies.</div></blockquote> <div style="background-color: white; border: medium none; color: black; overflow: hidden; text-align: left; text-decoration: none;"></div><div style="background-color: white; border: medium none; color: black; overflow: hidden; text-align: left; text-decoration: none;">Nonetheless, the justifications for these compensation levels included the usual suspects.In an introductory discussion not specific to any hospital, we find:</div><div style="background-color: white; border: medium none; color: black; overflow: hidden; text-align: left; text-decoration: none;"> <blockquote class="tr_bq">'The responsibilities of a CEO have exploded in the last four years,' said William Van Slyke of the Healthcare Association of New York State, an organization that represents hospitals and health-care systems across the state.</blockquote>Similarly, <blockquote class="tr_bq">'Being a hospital CEO, you are ‘all in,’ all the time, every hour. It’s a tremendous responsibility.'</blockquote>  This is the familiar argument about how hard seemingly all hospital CEOs work.  As noted above, it is particularly incongruous in a health care setting in which numerous health professionals are also "all in," and these professionals bear the responsibility of making decisions and taking actions that can directly affect patients' health, safety, and even survival.  Following this were the equally familiar arguments that the compensation of CEOs is determined by the market, and so to retain CEOs one must pay at this market rate: <blockquote class="tr_bq">'Being a hospital CEO, especially in the state of New York, is complex and demanding job. There is an extraordinarily limited pool of candidates, and that increases their value.' 'I can’t speak for the hospitals in your area,' he told the Press-Republican, 'but a qualified and successful CEO can go anywhere in the country and make equal or higher salaries.'</blockquote> The Press Republican also elicited very similar articles justifying pay for individual hospital CEOs, for example, regarding the CEO of the Alice Hyde Medical Center, here is the "compensation is determined by the market" argument from "Dean Johnston, president of the Board of Trustees, and member of the hospital's Compensation Committee" <blockquote class="tr_bq">'It’s important that the salary is competitive with other institutions because it’s difficult to attract professional leaders who will improve the quality of care.'</blockquote> And from the same person, here is the "CEOs work very hard" argument <blockquote class="tr_bq"> 'It’s difficult being CEO,' Johnston continued, 'because you’re the head of a complex and multi-faceted institution.'</blockquote> Very similar arguments were made to justify the compensation of the CEO of CVPH Medical Center.  The Usual Talking Points and Logical Fallacies So, to summarize, hospital executive compensation, at least such compensation that gets noted in the media, seemingly never has been better.  CEOs at even the smallest, most rural, non-profit community hospitals can make well into the six figures.  CEOs at public hospitals can make over half a million dollars.  CEOs at larger hospitals, even those that are state supported, can make even more, up to millions a year for CEOs of moderate to large non-profit hospital systems.  Even hospitals that are facing financial challenges, or that are laying off employees still pay substantial amounts. In previous posts, we noted that whenever anyone bothers to try to justify extravagant executive compensation at hospitals, and for that matter, other health care organizations throughout the US, they seem to repeat the same set of talking points.    We first listed the talking points <a href="http://hcrenewal.blogspot.com/2011/09/talking-points-sans-original-thought-to.html">here</a>, and then provided additional examples of their use <a href="http://hcrenewal.blogspot.com/2011/09/more-repeats-of-talking-points.html">here</a>, <a href="http://hcrenewal.blogspot.com/2012/03/example-of-how-complex-takes-control.html">here</a> and <a href="http://hcrenewal.blogspot.com/2012/12/health-care-hired-managers-not-playing.html">here</a>.   The talking points are: -  we pay what everyone else pays -  CEOs work hard and are brilliant, and so deserve high pay -  high pay is needed to attract and retain competent, if not brilliant people. None of the examples of these talking points we have seen so far explain why these apply to CEOs and other top hired managers, but not to other kinds of employees.  So it should be no surprise that the justifications for the largesse to hospital executives found in the cases above follow the talking points yet again. We Pay What Everyone Else Pays  Another way to put this is that some market determines CEO pay.  We saw versions of this to support the compensation of the CEOs of Maricopa Integrated Health System in Arizona, and SUNY - Downstate Medical Center and Alice Hyde Medical Center in New York. Note that almost never is this argument supported by data about whether comparisons were actually made to a representative peer group.  In any case, as we <a href="http://hcrenewal.blogspot.com/2012/12/health-care-hired-managers-not-playing.html">asserted before</a>, this justification may be a logical fallacy, an <a href="http://www.nizkor.org/features/fallacies/appeal-to-common-practice.html">appeal to common practice</a>. CEOs Work Hard and Are Brilliant  This is an especially frequently used talking point.  I have yet to see an instance in which any hospital official would omit a CEO was anything other than supremely diligent and totally brilliant.  We saw versions of this to support the compensation of the CEOs of Maricopa (AZ), Cedars-Sinai Medical Center in California, the Alice Hyde Medical Center and CVPH Medical Center in New York, and generically to support all New York State hospital CEOs. As we noted above, this justification is almost never accompanied by any evidence that CEOs work harder or are more brilliant than the numerous health care professionals who actually make it possible for the hospital to operate.  I would guess it would be very hard to show that CEOs work longer hours, are under more stress, make more consequential decisions, are smarter or better trained than typical doctors, nurses and other health care professionals.  This justification thus appears to be another kind of logical fallacy, an <a href="http://www.nizkor.org/features/fallacies/appeal-to-authority.html">appeal to authority</a>. High Pay is Needed for Retention  We saw versions of this to support the CEOs of Maricopa, SUNY - Downstate, Alice Hyde, CVPH, and generically again to support all NY hospital CEOs.  </div><div style="background-color: white; border: medium none; color: black; overflow: hidden; text-align: left; text-decoration: none;"></div><div style="background-color: white; border: medium none; color: black; overflow: hidden; text-align: left; text-decoration: none;"> </div><div style="background-color: white; border: medium none; color: black; overflow: hidden; text-align: left; text-decoration: none;">Note that this justification is also almost never supported by any evidence.  As we noted <a href="http://hcrenewal.blogspot.com/2012/10/more-reasons-to-doubt-how-ceos-are.html">here</a>, while this argument, probably like the others, comes from the generic business management literature, there is little data in the larger business world to show that CEOs are very mobile, or likely to succeed when transplanted to a new environment.  In fact, a recent report looking at the mobility of CEOs worldwide called this a "self-serving myth."  (See <a href="http://www.huffingtonpost.com/2013/02/11/ceo-pay_n_2661438.html">this summary</a> for a link to it.) </div><div style="background-color: white; border: medium none; color: black; overflow: hidden; text-align: left; text-decoration: none;"></div><div style="background-color: white; border: medium none; color: black; overflow: hidden; text-align: left; text-decoration: none;"></div><div style="background-color: white; border: medium none; color: black; overflow: hidden; text-align: left; text-decoration: none;"> </div><div style="background-color: white; border: medium none; color: black; overflow: hidden; text-align: left; text-decoration: none;">It is too bad that no one ever seems to get the opportunity to challenge these talking points when they are offered as justifications for outlandish executive compensation.  <div style="color: black; font: 10pt sans-serif; height: 1px; overflow: hidden; text-align: left; text-transform: none; width: 1px;"> Read more here: http://www.charlotteobserver.com/2013/02/06/3835851/charlotte-hospital-pay.html#storylink=cpy</div><div style="color: black; font: 10pt sans-serif; height: 1px; overflow: hidden; text-align: left; text-transform: none; width: 1px;"> Read more here: http://www.charlotteobserver.com/2013/02/06/3835851/charlotte-hospital-pay.html#storylink=cpy</div> </div></div><div style="background-color: white; border: medium none; color: black; overflow: hidden; text-align: left; text-decoration: none;">Summary</div> As we have <a href="http://hcrenewal.blogspot.com/search/label/executive%20compensation">shown again and again</a>, the pay of top health care leaders seems to endlessly increase, without clear justification, regardless of the vicissitudes affecting the organizations they lead, their employees, their patients and society.  This suggests that health care organizations, like many other organizations, seem to be run primarily for the benefit of their executives and their cronies, regardless of what happens to anyone else.   As we have frequently said, current policies about paying hired health care managers leave the managers unaccountable for the effects of their actions on patients' and the public's health, and worse, fail to deter and may even encourage ignorance of the health care mission, frankly mission-hostile behavior, self-interest, conflicts of interest, and outright corruption.  Meanwhile, paying nearly all top managers as if they were brilliant, while setting much harsher standards for the employees who actually take care of patients, including health professionals, demoralizes those on whom patients actually depend for care. As we have said endlessly,....   Health care organizations need leaders that uphold the core values of health care, and focus on and are accountable for the mission, not on secondary responsibilities that conflict with these values and their mission, and not on self-enrichment. Leaders ought to be rewarded reasonably, but not lavishly, for doing what ultimately improves patient care, or when applicable, good education and good research. On the other hand, those who authorize, direct and implement bad behavior ought to suffer negative consequences sufficient to deter future bad behavior. If we do not fix the severe problems affecting the leadership and governance of health care, and do not increase accountability, integrity and transparency of health care leadership and governance, we will be as much to blame as the leaders when the system collapses.

Non-Profit Hospital Executive Salaries Continue to Defy Gravity and Logic

The old saying is that nothing is certain except death and taxes. In health care, the other near certainty seems to be that compensation fo...

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Texas Medical Association slams ONC Healthcare IT safety plan

The Texas Medical Association offers views similar to the views I have been writing about for a decade and a half on healthcare IT quality and patient care risks: <blockquote class="tr_bq">FierceHealth IT today</blockquote><div style="border-collapse: collapse; color: #222222; font-family: arial, sans-serif; font-size: 13px;"><div class="gmail_quote"> <blockquote><a href="http://links.mkt1985.com/ctt?kn=167&ms=NDcyNDQxMAS2&r=MTg5MDYxNTI0MDQS1&b=0&j=MTQyMjg5MTEzS0&mt=1&rt=0" name="13cd3c696d1da2b0_13cd3c13f19db484_13cd3bf97a5f8ea4_13cd0586c68a10a9_fiercehealthit_com_story__S4c8UaRxIHMoxpErecFsKw" target="_blank">Texas Medical Association slams ONC safety plan</a></blockquote><blockquote><table border="0" cellpadding="0" cellspacing="0"><tbody><tr><td style="margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px;" width="31"></td><td style="margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px;" valign="bottom" width="150">By Dan Bowman</td><td style="color: #888888; font-family: Verdana, Arial; font-size: 9px; margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px;" valign="bottom"> </td></tr></tbody></table></blockquote><blockquote><table border="0" cellpadding="0" cellspacing="0"><tbody><tr><td style="font-family: arial, sans-serif; margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px;"><div><div>The <a href="http://links.mkt1985.com/ctt?kn=57&ms=NDcyNDQxMAS2&r=MTg5MDYxNTI0MDQS1&b=0&j=MTQyMjg5MTEzS0&mt=1&rt=0" name="13cd3c696d1da2b0_13cd3c13f19db484_13cd3bf97a5f8ea4_13cd0586c68a10a9_fiercehealthit_com_story__kdmrdIyd6sIcVcFLYphXQ" target="_blank">health IT safety action plan proposed by the Office of the National Coordinator for Health IT</a> in December is not specific enough to succeed, according to recent comments made by the Texas Medical Association. In its <a href="http://links.mkt1985.com/ctt?kn=92&ms=NDcyNDQxMAS2&r=MTg5MDYxNTI0MDQS1&b=0&j=MTQyMjg5MTEzS0&mt=1&rt=0" name="13cd3c696d1da2b0_13cd3c13f19db484_13cd3bf97a5f8ea4_13cd0586c68a10a9_assets_fiercemarkets_com__roPjbL4h6p1at3aX94znog" target="_blank">letter</a> to National Coordinator for Health IT Farzad Mostashari, TMA said that responsibility for the plan "lacks focus," and should be overseen by a "highly visible HIT Safety Czar.</div><div> </div><div>TMA also called setting mandatory deadlines and developing a "robust" reporting and learning system imperative to the success of the plan, saying that the plan's current reliance on voluntary reporting and funding represents a "fundamental weakness."</div><div> </div><div>"TMA believes that significant patient safety risks exist now, and new ones will emerge in the next one to two years as many [electronic health record] and other HIT vendors merge or go out of business," the letter said.</div><div> </div><div>Additionally, the group expressed doubts about a code of conduct proposed to keep vendors in line as far as ensuring cooperation with safety organizations for adverse event reporting. "TMA is concerned that this will not materially affect industry accountability and generate the changes that are needed," the letter said. "For example, what if a developer does not comply with said code of conduct? There is no penalty or impetus for change."</div><div> </div><div>The American Medical Association was a bit less harsh in its <a href="http://links.mkt1985.com/ctt?kn=190&ms=NDcyNDQxMAS2&r=MTg5MDYxNTI0MDQS1&b=0&j=MTQyMjg5MTEzS0&mt=1&rt=0" name="13cd3c696d1da2b0_13cd3c13f19db484_13cd3bf97a5f8ea4_13cd0586c68a10a9_ama_assn_org_resources_do_kLlOCnendmgZnkafWC36A" target="_blank">assessment</a> of ONC's plan. It supports most of the ideas outlined in the plan, although it called for more research to be done on the impact of electronic health record use regarding patient safety in the ambulatory setting.</div><div> </div><div>"Physicians are concerned about potential liabilities from EHR system design and software flaws, as well as lack of interoperability among EHR systems that could result in incomplete or missing information, which may lead to errors in patient diagnosis and treatment," the AMA letter said. "In addition, the impact that EHRs have on physician practice workflows can lead to unintended consequences. Those impacts are the result of how the software is developed."</div><div> </div><div><a href="http://links.mkt1985.com/ctt?kn=5&ms=NDcyNDQxMAS2&r=MTg5MDYxNTI0MDQS1&b=0&j=MTQyMjg5MTEzS0&mt=1&rt=0" name="13cd3c696d1da2b0_13cd3c13f19db484_13cd3bf97a5f8ea4_13cd0586c68a10a9_fiercehealthit_com_story__fdelaLMvtjHW1QKrOUvegg" target="_blank">HIMSS said in its letter to Mostashari</a> that it wants to see more provider-vendor cooperation when it comes to investigation of patient safety events, as well as usability, while the AHA said in its letter that its stakeholders would like to see more of a focus on a single, national approach to matching patients with their records with a goal of patient safety.</div><div> </div><div>The <a href="http://links.mkt1985.com/ctt?kn=146&ms=NDcyNDQxMAS2&r=MTg5MDYxNTI0MDQS1&b=0&j=MTQyMjg5MTEzS0&mt=1&rt=0" name="13cd3c696d1da2b0_13cd3c13f19db484_13cd3bf97a5f8ea4_13cd0586c68a10a9_fiercehealthit_com_story__Uy2fglIMzJM3HSXPTivQVg" target="_blank">College of Healthcare Information Management Executives, meanwhile, said that the plan needs to be facilitated</a> by stakeholders not directly under government control.</div><div> </div><div>To learn more: - here's the TMA <a href="http://links.mkt1985.com/ctt?kn=92&ms=NDcyNDQxMAS2&r=MTg5MDYxNTI0MDQS1&b=0&j=MTQyMjg5MTEzS0&mt=1&rt=0" name="13cd3c696d1da2b0_13cd3c13f19db484_13cd3bf97a5f8ea4_13cd0586c68a10a9_assets_fiercemarkets_com__roPjbL4h6p1at3aX94znog" target="_blank">letter</a> (.pdf) - read the AMA <a href="http://links.mkt1985.com/ctt?kn=190&ms=NDcyNDQxMAS2&r=MTg5MDYxNTI0MDQS1&b=0&j=MTQyMjg5MTEzS0&mt=1&rt=0" name="13cd3c696d1da2b0_13cd3c13f19db484_13cd3bf97a5f8ea4_13cd0586c68a10a9_ama_assn_org_resources_do_kLlOCnendmgZnkafWC36A" target="_blank">letter</a> (.pdf)</div><div> </div><div>Related Articles:<a href="http://links.mkt1985.com/ctt?kn=5&ms=NDcyNDQxMAS2&r=MTg5MDYxNTI0MDQS1&b=0&j=MTQyMjg5MTEzS0&mt=1&rt=0" name="13cd3c696d1da2b0_13cd3c13f19db484_13cd3bf97a5f8ea4_13cd0586c68a10a9_fiercehealthit_com_story__fdelaLMvtjHW1QKrOUvegg" target="_blank">HIMSS, AHA support ONC's patient safety plan</a> <a href="http://links.mkt1985.com/ctt?kn=146&ms=NDcyNDQxMAS2&r=MTg5MDYxNTI0MDQS1&b=0&j=MTQyMjg5MTEzS0&mt=1&rt=0" name="13cd3c696d1da2b0_13cd3c13f19db484_13cd3bf97a5f8ea4_13cd0586c68a10a9_fiercehealthit_com_story__Uy2fglIMzJM3HSXPTivQVg" target="_blank">CHIME: ONC's role in health IT safety plan 'overstated'</a> <a href="http://links.mkt1985.com/ctt?kn=57&ms=NDcyNDQxMAS2&r=MTg5MDYxNTI0MDQS1&b=0&j=MTQyMjg5MTEzS0&mt=1&rt=0" name="13cd3c696d1da2b0_13cd3c13f19db484_13cd3bf97a5f8ea4_13cd0586c68a10a9_fiercehealthit_com_story__kdmrdIyd6sIcVcFLYphXQ" target="_blank">HHS issues health IT safety action plan</a></div></div></td></tr></tbody></table></blockquote></div></div><div style="border-collapse: collapse; color: #222222; font-family: arial, sans-serif; font-size: 13px;"><div class="gmail_quote"> The TMA and AMA letters linked above are worth reading in their entirety. I note, with little surprise, the "softer" stances (e.g., self-policing vs. government oversight) taken by industry-dominated bodies such as HIMSS and CHIME. On the other hand, I find the AMA's "less harsh" views somewhat disappointing.  Their letter is welcome, and more research needs to be done as to risks in ambulatory settings (and inpatient settings as well).  However, the delays in action during the research are of concern. Where patient safety is concerned, fast action is a top priority.  Patients, needless to say, have more rights than computers and their sellers. -- SS </div></div>

Texas Medical Association slams ONC Healthcare IT safety plan

The Texas Medical Association offers views similar to the views I have been writing about for a decade and a half on healthcare IT quality a...

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Guest post by Dr. Jon Patrick, U. of Sydney: On the ECRI Institute's recommendations following a "deep-dive" study of HIT-related events

At my Feb. 9, 2013 post "<a href="http://hcrenewal.blogspot.com/2013/02/ecri-institute-pso-uncovers-health.html" target="_blank">ECRI Institute PSO Uncovers Health Information Technology-Related Events in Deep Dive Analysis</a>", I wrote about an ECRI Institute study of well-defined client data submitted over a 9-week period (a "deep dive" study) on EHR problems.  Risk-creating events at a level that should be a significant concern to patients and clinicians fell into the following categories:  <ul><li>inadequate data transfer from one HIT system to another </li><li>data entry in the wrong patient record</li><li>incorrect data entry in the patient record</li><li>failure of the HIT system to function as intended </li><li>configuration of the system in a way that can lead to mistakes </li></ul> Dr. Jon Patrick at U. Sydney, a scientist and medical informatician who sees the issues from a number of unique perspectives (<a href="http://rp-www.cs.usyd.edu.au/~jonpat/CV/CV_brief.html" target="_blank">link to bio</a>), has offered the following critique of the key recommendations made by the ECRI Institute as a result of this study of health IT events (see aforementioned post for the text of those recommendations).  One caveat is that neither he nor I have the full report as of this writing in part due to expense: <blockquote class="tr_bq">The ECRI has produced a report on HIT errors. I was concerned about the manner in which the Key Recommendations minimised, generalised or failed to concretise important issues that I offer these comments. On ECRI Key Recommendations: 1. Enlist leaders’ commitment and support for the organization’s health IT projects. JP: This is clearly a comment from one level of  management to those levels above it. It doesn't seem to be a comment about the nature of the HIT itself but more about the internal processes to getting it established. There is really not much to say here because if upper management don't want to do anything about the introduction of HIT then engaging in the task is probably futile, hence it was difficult to understand why it was included. 2. Involve health IT users in system planning, design, and selection. JP: yes, this is crucial to successful solutions. 3. Conduct a review of workflow and processes to determine how they must be modified. JP: the missing clause at the end of this sentence is "to fit the introduced HIT system". This is putting the cart before the horse. The notion that a piece of software designed by engineers should have priority over the team of clinicians who are experts in their business is highly naive. Also this statement is in contradiction to point 2 above. The privileging of the functioning of  the IT system as the expert over that of the clinical team, AND making a recommendation in contradiction to an earlier recommendation is absurd enough by itself  to undermine the credibility of  the report. 4. Evaluate the ability of existing IT systems within the organization to reliably exchange data with any health IT system under consideration. JP: And after the evaluation what should be done. This is hardly an informative recommendation. It is of the form "Do Something, it doesn't matter what you do, just do something."  A more compelling statement that would have enhanced the credibility of the authors and demonstrate their knowledge of the industry would have been: " Establish unambiguously and conclusively that any health IT system under consideration has the ability to reliably exchange data with existing IT systems within the organization". Note the focus needs to be on the incoming system being the object of conformity not the incumbent systems. 5. Conduct extensive tests before full implementation to ensure that the health IT system operates as expected. JP: this is a clearly a desirable goal and applies to point 4 above as well as all other aspects of the system functions. 6. Provide user training and ongoing support; educate users about the capabilities and limitations of the system. JP: This is a motherhood statement that does nothing to contribute to the nub of training issues in the use of HIT. Training is an ongoing issue for two reasons: staff change and new staff come on to the roster and need to be trained, and, these systems are complex and expert advice and skill needs to be available to staff as an ongoing service so that work is not delayed due to confusion on how to use the IT. An alternative proposal to reduce training costs and investment would be to design the system so that it matches current best practice of the clinical team so that learning the system is minimised because it fits seamlessly into their work processes. Surely the issue of educating users about the capabilities and limitations of the system is independent of the training topic. The users will discover on their own bat the limitations of the system as they try to use it. 7. Closely monitor the system’s ease of use and promptly address problems encountered by users. JP:This is a quite inadequate description of the action that needs to be taken. The real consideration is for them to have an effective avenue for expressing the limitations in a manner that is acceptable and they are NOT chastised as malcontents [or Luddites or technophobes - ed.] AND that the unnecessary or dangerous limitations are addressed promptly. 8. Introduce alterations to a health IT system in a controlled manner. JP: It is hard to understand what is meant by this statement. Firstly I would have said "introduce alterations to the clinical processes  in a controlled manner". Secondly, alterations to the HIT system need to be done promptly  when it is defective. Once again, as in point 3 above the technology is being preferenced over the clinical processes which I argue is back-to-front. 9. Monitor the system’s effectiveness with metrics established by the organization. JP: This is definitely something that should be done but it also needs a more directed purpose. It is easy to say to assess patient safety but most systems don't readily capture relevant data or supply analytical devises to easily draw a picture of patient  safety. However there is an equally important factor in care that is often overlooked and that is staff productivity and by implication morale. There is a need to understand better ways of assessing staff productivity in positive ways and the effect a CIS has on staff morale.  Typical comments about CISs is that they cost staff  up to 20% more time to maintain the patient record. Staff wouldn't mind giving up that time if it was returned in some other form, but it isn't, so they feel the time is stolen from them or from their patients. 10. Require reporting of health IT- related events and near misses. JP: This is poorly stated and is probably meant to read "health IT - related adverse events". This is a positive recommendation but does not go far enough. A more comprehensive statement would be "Install a process and technology for reporting adverse events and establish methods for evaluating the reports and recommending changes to clinical practice, or technology functionality and implementing them. 11. Conduct thorough event analysis and investigation to identify corrective measures. JP: This  goes some way to dealing with my point in item 10 above. Its weakness is in not identifying the types of problems and taking a firm stance on completing the correct action. SOME of the Items that have been OVERLOOKED 1. The system needs to be alterable at any time by the clinical leadership so as to immediately emplace revised work practices when they are approved. 2. The system needs to have native analytics so that the clinical leadership can monitor the activities of their teams and provide evidenced based feedback to support continuous process improvement. 3. The system needs highly accurate natural language processing so that the search for required content though the clinical record can be fast, efficient and reliable. Professor Jon Patrick Chair of Language Technology School of Information Technologies Faculty of Engineering University of Sydney Health Information Technologies Research Laboratory <a href="http://www.it.usyd.edu.au/~hitru">http://www.it.usyd.edu.au/~hitru</a></blockquote> This is excellent advice coming from perhaps the only computing expert in the world who's conducted a forensic analysis of a major commercial EHR product, one intended for high-risk ED's.  His analysis of that product, intended for government-mandated rollout in public hospitals in Dr. Patrick's Australian state of New South Wales, is at this link. This work has largely been ignored by the health IT industry and the academic Medical Informatics community.  However, I can assure the industry and the academic community that the report will not be ignored by those in the legal community if (perhaps I should say when) patients are injured or killed by the system's deficiencies. -- SS

Guest post by Dr. Jon Patrick, U. of Sydney: On the ECRI Institute's recommendations following a "deep-dive" study of HIT-related events

At my Feb. 9, 2013 post " ECRI Institute PSO Uncovers Health Information Technology-Related Events in Deep Dive Analysis ", I wrot...

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A New ECRI Institute Study On Health Information Technology-Related Events

As I wrote <a href="http://hcrenewal.blogspot.com/2012/12/pennsylvania-patient-safety-authority.html" target="_blank">here</a>, I was a reviewer of the report in the PA-based, ECRI Institute-conducted study "The Role of the Electronic Health Record in Patient Safety Events."  ECRI studied the Pennsylvania Patient Safety Reporting System database for HIT-related errors.    <blockquote class="tr_bq">The <a href="http://www.ecri.org/" target="_blank">ECRI Institute</a> is an independent organization renowned for its safety testing of medical technologies and reporting on same, and that "researches the best approaches to improving the safety, quality, and cost-effectiveness of patient care."  I've mentioned it and its bylaws in this blog in the past as a model for independent, unbiased testing and reporting of healthcare technologies. </blockquote> The full report in PDF is <a href="http://www.patientsafetyauthority.org/ADVISORIES/AdvisoryLibrary/2012/Dec;9%284%29/documents/113.pdf" target="_blank">at this link</a>.  In the report, the Pennsylvania Patient Safety Authority analyzed reports of EHR-related events from a state database (the Pennsylvania Patient Safety Reporting System or PA-PSRS, pronounced "PAY-sirs") of reported medical errors and identified several major themes. My review input led to a discrete "limitations" section.  Also, my invited July 2012 presentation to the PA Patient Safety Authority "Asking the Right Questions: Using Known HIT Safety Issues to Improve Risk Reporting and Analysis" with ECRI in attendance (<a href="http://www.ischool.drexel.edu/faculty/ssilverstein/PA_patient_safety_Jul2012.ppt" target="_blank">link to PPT here</a>) on the danger of limited datasets due to systematic impediments to information diffusion was apparently taken seriously.  ECRI decided to do something about the knowledge gap, and they asked the right questions. They've just released this summary of a new study they conducted.  I have a few comments which follow:    <blockquote class="tr_bq"><a href="http://www.prnewswire.com/news-releases/ecri-institute-pso-uncovers-health-information-technology-related-events-in-deep-dive-analysis-190064661.html" target="_blank">ECRI Institute PSO Uncovers Health Information Technology-Related Events in Deep Dive Analysis</a> Data transfer, data entry, system configurations, and more identified as serious problem areas   PLYMOUTH MEETING, Pa., Feb. 6, 2013 /PRNewswire-USNewswire/ -- The federal government is spending about $19 billion to encourage hospitals, physician practices, and other healthcare organizations to invest in their health information technology (HIT) infrastructure with the goal of improving patient safety and quality through the Health Information Technology for Economic and Clinical Health (HITECH) Act. Concerned about the unintended consequences of HIT and the potential for errors to cause patient harm, <a href="https://www.ecri.org/PatientSafetyOrganization/Pages/default.aspx" target="_blank">ECRI Institute Patient Safety Organization</a> (PSO) recently conducted a PSO Deep Dive™ analysis on HIT-related safety events. Their just-released 48-page report identified five potential problem areas, which can be assessed with the accompanying toolkit. The <a href="https://eshop.ecri.org/p-140-pso-deep-dive-health-information-technology.aspx" target="_blank">report and toolkit are available for purchase</a> [appx. $350 U.S. - ed.] without membership in ECRI Institute PSO. "Minimizing the unintended consequences of HIT systems and maximizing the potential of HIT to improve patient safety should be an ongoing focus of every healthcare organization," says Karen P. Zimmer , MD, MPH, FAAP, medical director, ECRI Institute PSO. Based on [voluntary - ed.] reports submitted to the PSO from participating organizations, ECRI Institute PSO experts identified the following key HIT-related problems: <ul type="disc"><li>inadequate data transfer from one HIT system to another </li><li>data entry in the wrong patient record </li><li>incorrect data entry in the patient record </li><li>failure of the HIT system to function as intended </li><li>configuration of the system in a way that can lead to mistakes </li></ul> To collect enough reports for meaningful evaluation, ECRI Institute PSO asked participating organizations to submit standardized data about HIT events during a nine-week period. This enabled ECRI Institute PSO to identify patterns and trends from the aggregated data and share the findings, as well as its recommendations. The data in the PSO Deep Dive represents only that collected using the Agency for Healthcare Research and Quality (AHRQ) HIT Common Formats.  [Not the improved formats developed by AHRQ in their <a href="http://healthit.ahrq.gov/HealthITHazardManagerFinalReport" target="_blank">IT Hazards Manager project</a>, still in development - ed.]  ECRI Institute PSO data encompasses over 800 HIT-related events. According to the report, HIT must be considered in the context of the environment in which it operates during the three phases of any HIT project: planning for new or replacement systems, system implementation, and ongoing use and evaluation of the system. "Shortsighted approaches to HIT can lead to adverse consequences," caution the authors. "Healthcare organizations should consider the findings and recommendations in the PSO Deep Dive as part of their effort to achieve those goals," adds Zimmer. The HIT PSO Deep Dive findings were published in a 48-page report and toolkit with self-assessment questionnaire and action plan form available to all ECRI Institute PSO Members and its partner PSO members. The table of contents of the report is available for <a href="https://www.ecri.org/EmailResources/PSRQ/ECRI_Institute_PSO_Deep%20Dive_HIT_TOC.pdf" target="_blank">free viewing/download</a>. Additional information will be presented in ECRI Institute PSO's Monthly Brief free e-newsletter March edition; go to <a href="https://www.ecri.org/psobrief" target="_blank">www.ecri.org/psobrief</a> to sign up. The full report and toolkit are also <a href="https://eshop.ecri.org/p-140-pso-deep-dive-health-information-technology.aspx" target="_blank">available for purchase</a>. For questions about this topic, or for information about purchasing the report, please contact ECRI Institute PSO by telephone at (610) 825-6000, ext. 5558; by e-mail at <a href="mailto:pso@ecri.org" target="_blank">pso@ecri.org</a>; by fax at <a href="tel:%28610%29%20834-1275" target="_blank" value="+16108341275">(610) 834-1275</a>, or by mail at 5200 Butler Pike, Plymouth Meeting, PA 19462-1298, USA.</blockquote> From the free linked TOC document: Key Recommendations <ul><li>Enlist leaders’ commitment and support for the organization’s health IT projects.</li></ul><ul><li>Involve health IT users in system planning, design, and selection.</li></ul><ul><li>Conduct a review of workflow and processes to determine how they must be modified.</li></ul><ul><li>Evaluate the ability of existing IT systems within the organization to reliably exchange data with any health IT system under consideration.</li></ul><ul><li>Conduct extensive tests before full implementation to ensure that the health IT system operates as expected.</li></ul><ul><li>Provide user training and ongoing support; educate users about the capabilities and limitations of the system.</li></ul><ul><li>Closely monitor the system’s ease of use and promptly address problems encountered by users.</li></ul><ul><li>Introduce alterations to a health IT system in a controlled manner.</li></ul><ul><li>Monitor the system’s effectiveness with metrics established by the organization.</li></ul><ul><li>Require reporting of health IT-related events and near misses.</li></ul><ul><li>Conduct thorough event analysis and investigation to identify corrective measures.</li></ul> My comments are these: <ul><li>The ECRI study, report and recommendations are quite welcome. </li></ul><ul><li>The case reports received were apparently voluntary and probably "conservative" and understated as hospitals are not happy to release data on problems and harms that can lead to, or support, litigation.   </li></ul><ul><li>The study was just 9 weeks long, and with a limited set of healthcare organizations participating.  800 HIT-related events were identified. </li></ul><ul><li> The relevant issues discovered in the events, as summarized in the bullet points above, are capable of causing clinician distraction, incorrect decisions, "use error" (as opposed to "user error", see <a href="http://hcrenewal.blogspot.com/2011/10/nist-on-ehr-mission-hostile-user.html" target="_blank">here</a>), patient harm, and death.  (I am aware of such issues in the press including harms and deaths, as readers here have read at links such as <a href="http://hcrenewal.blogspot.com/search/label/glitch" target="_blank">these</a> and <a href="http://hcrenewal.blogspot.com/2011/01/maude-and-hit-risk-mother-mary-what-in.html" target="_blank">these</a> and <a href="http://hcrenewal.blogspot.com/2011/09/sweet-death-that-wasnt-very-sweet-how_24.html" target="_blank">these</a> and <a href="http://hcrenewal.blogspot.com/2011/06/babys-death-spotlights-safety-risks.html" target="_blank">these</a>, and others about which I am providing expert-witness consultation and cannot share.) </li></ul><ul><li>I believe ECRI has now begun to peer below the water level, through the muck of industry control of the narrative, of what FDA CDRH leader Jeffrey Shuren MD JD referred to as "<a href="http://hcrenewal.blogspot.com/2010/02/fda-on-health-it-adverse-consequences.html" target="_blank">the tip of the iceberg</a>" - i.e., the current level of knowledge of health IT difficulties, defects and harms. </li></ul><ul><li>The report is yet another red flag for a far more robust (and mandatory, in my view) post-marketing surveillance of health IT.   </li></ul><ul><li>Those who claim these findings are "anecdotes" (as <a href="http://hcrenewal.blogspot.com/2013/02/ama-news-ehr-sloppy-and-paste-and-why.html" target="_blank">here</a>) are looking increasingly foolish and cavalier. </li></ul> Finally, readers of this blog have been reading about these issues for years.  You heard it here first. -- SS

A New ECRI Institute Study On Health Information Technology-Related Events

As I wrote here , I was a reviewer of the report in the PA-based, ECRI Institute-conducted study " The Role of the Electronic Health Re...

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New York Mayor Bloomberg: Gun Control - Yes, Bad Health IT Control - No?

The Mayor of New York, Bloomberg, calls for anti-gun legislation because accidents and unexpected events such as theft or use by a child can happen, even with legally owned guns (I don't think he believes law-abiding citizens who own them for defense or for sport would break the law with them). Yet the selfsame Mayor uncritically calls for spread of another technology that in its present state is prone to accidents and unintended consequences, and unlike guns, at a level that even the Institute of Medicine has admitted in unknown due to systematic impediments to transparency (see the middle of <a href="http://hcrenewal.blogspot.com/2012/03/doctors-and-ehrs-reframing-modernists-v.html" target="_blank">this post</a> for source). From a release at <a href="http://mikebloomberg.com/">MikeBloomberg.com</a>: <blockquote class="tr_bq"><a href="http://www.mikebloomberg.com/index.cfm?objectid=B530DDFC-C29C-7CA2-FF25BD11B52E6F7E" target="_blank">Mayor Bloomberg Announces Expansion of Electronic Health Records Result in Major Health Care Improvements</a> Feb 07, 2013 | NYC.gov Mayor Bloomberg, Deputy for Health and Human Services Linda I. Gibbs, Health Commissioner Thomas A. Farley today announced that the use of electronic health records has led to better health outcomes for tens of thousands New Yorkers in the critical areas of high blood pressure management, diabetes and tobacco control. New York City's introduction of electronic health records, which has become a national model, was a result of the Primary Care Information Project, a program that began in 2005 to help medical providers, particularly those with underserved patients, use technology to improve the quality and efficiency of health care. The prompts that electronic health records give doctors, such as signaling a daily dose of aspirin to prevent heart disease or follow up questions for someone who smokes, make a dramatic difference in how aggressively they treat the chronic health conditions of their patients. Through 3,200 primary care providers serving more than three million New Yorkers with electronic health records, over 96,000 additional patients reduced their high blood pressure, 81,000 patients improved their diabetes management and an additional 58,000 smokers were given assistance and successfully quit. The Mayor made the announcement at the “NYC Celebrates Improved Health Through Technology” event at the New York Institute of Technology where he was joined by Centers for Disease Control and Prevention Director Dr. Thomas Frieden, National Coordinator for Health Information Technology Dr. Farzad Mostashari and Director of Health Services Andrea Cohen.</blockquote> There is no doubt the technology can accomplish such goals.  The IT I authored or spearheaded at major hospitals improved quality of care in areas such as diabetes and asthma care, invasive cardiology, and others. The release, however, is missing the most important points. The issue is not whether benefits can accrue from health IT. The issues are ... at what level of harms in its present state, since the technology is unregulated and unvetted for potential risks, and also - are there simpler and cheaper ways to accomplish these ends, e.g., so that the underserved can get more access to care. There is no mention of unintended harms, or even concern about harms, in the release - the very same harms mentioned by Joint Commission, FDA, Institute of Medicine (for example see <a href="http://hcrenewal.blogspot.com/2008/12/joint-commission-sentinel-events-alert.html" target="_blank">JC</a>, <a href="http://hcrenewal.blogspot.com/2010/08/smoking-gun-internal-fda-memorandum-of.html" target="_blank">FDA</a>, <a href="http://hcrenewal.blogspot.com/2011/11/iom-report-on-health-it-safety-nix-fda.html" target="_blank">IOM</a>) and many others. That qualifies the press release as propaganda.  It is not balanced, almost like an ad for, say, VIOXX. Apparently, for the Mayor it's OK to have increased risk and innocent victims due to bad health IT (like <a href="http://hcrenewal.blogspot.com/search/label/glitch" target="_blank">these</a> and <a href="http://hcrenewal.blogspot.com/2011/01/maude-and-hit-risk-mother-mary-what-in.html" target="_blank">these</a> and <a href="http://hcrenewal.blogspot.com/2011/09/sweet-death-that-wasnt-very-sweet-how_24.html" target="_blank">these</a> and <a href="http://hcrenewal.blogspot.com/2011/06/babys-death-spotlights-safety-risks.html" target="_blank">these</a>, and others I cannot talk about due to case settlements), but not innocent victims of legally owned but stolen guns. Medicine's tradition for centuries has been "first, do no harm", not "when you have benefits to the many, it's OK to overlook the risks and the roadkill." We don't tolerate that any more from the likes of Merck, Pfizer, or Medtronic (to name a few examples). Why does health IT always get special accommodation, as I have frequently asked? <blockquote class="tr_bq">With new federal funding for 2013, NYC REACH is now working to help behavioral health professionals and specialists with high numbers of Medicaid patients adopt and implement electronic health records to continue to improve care across the City. </blockquote> Let's hope they don't have an Avatar rerun (<a href="http://hcrenewal.blogspot.com/2010/11/avatar-fails-no-not-cameron-movie-but.html" target="_blank">link</a>) or Contra Costa meltdown (<a href="http://hcrenewal.blogspot.com/2012/08/contra-costas-45-million-computer.html" target="_blank">link</a>, <a href="http://hcrenewal.blogspot.com/2012/09/in-addition-to-nurses-doctors-now-air.html" target="_blank">link</a>). Note: this post is not about gun control, a complex issue unto itself, but about medical ethics and hypocrisy.  -- SS Feb. 8, 2013 Addendum:  Prof. Jon Patrick of U. Sydney opines: I can only say the story is a well crated ANECDOTE. The pertinent text is this: <blockquote class="tr_bq">Between 2008 and 2011, the number of preventive care services participating doctors provided grew, on average, by about 290%, from 39 services per 100 patients to 113 services per 100 patients – nearly a threefold increase.</blockquote> Which tells us the only tangible piece of information in that services are increased - where are the figures from the EDs or hospital intakes that show the number of visits for these diseases have gone down? The other interesting point is the valid claim of better analytics - but they don't say how they were used, if at all: <blockquote class="tr_bq">"Patients served by doctors participating in the program were, for example, reminded to take daily aspirin doses to prevent heart disease or counseled to quit smoking. Electronic Health Records also permit doctors to view data on their entire population of patients, which helps them modify their routine office practices to help all of their patients and then evaluate how well those changes work."</blockquote> -- SS

New York Mayor Bloomberg: Gun Control - Yes, Bad Health IT Control - No?

The Mayor of New York, Bloomberg, calls for anti-gun legislation because accidents and unexpected events such as theft or use by a child can...

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