Hospitals

This commentary appeared on Health Affairs Blog on June 10, 2013.

In the past 12 years, several of our nation's most storied public hospitals have closed, including DC General (2001), New Orleans's Charity Hospital (2005), and Martin Luther King, Jr. hospital in Los Angeles (2007). When Atlanta's Grady Memorial Hospital was featured on the front page of The New York Times on Jan 8, 2008, it was widely assumed it would be the next to go. However, at its darkest hour, Grady received help from an unexpected quarter.

In the June issue of Health Affairs, a young physician, Dr. Kate Neuhausen, describes how she and other leaders of a little-known student organization mobilized hundreds of health professions students from around the state of Georgia to join the fight for Grady's survival. It is difficult to overstate how perilous the hospital's situation was at the time. Because Grady provides such a disproportionate share of uncompensated care in the state of Georgia, it would have been impossible for metro Atlanta's hospitals and private health care providers to absorb the sudden loss of more than 900 inpatient beds; the highly specialized trauma, burn and psychiatric services Grady provides; or the displacement of tens of thousands of inpatient days and hundreds of thousands of outpatient visits. The resulting social, medical and financial upheaval would have sent shockwaves throughout the region—the economic engine for the state and a vital financial, commercial and transportation hub for the Southeastern United States.

This commentary appeared in New England Journal of Medicine on April 24, 2013.

At 2:50 p.m. on April 15, nearly 3 hours after the first runner completed the Boston Marathon, two blasts ripped through the crowd that was gathered along the approach to the finish line, killing 3 people and injuring more than 260. Within moments, the crowd's initial panic was replaced by purposeful action, as bystanders ran to, rather than from, the horror to help the injured. Law-enforcement and emergency medical services (EMS) personnel swiftly converged on the scene. Within minutes, ambulances began transporting the most critically injured to nearby hospitals....

The remainder of this op-ed can be found at nejm.org.

Former Treasury Secretary Paul H. O'Neill, a RAND Trustee and Health Advisory Board member, published an open letter to President Obama in the Pittsburgh Post-Gazette this week in which he asks the president to use his executive power to address the problem of medical errors. In his letter, Secretary O'Neill calls on the president to order veterans' hospitals and U.S.-based military hospitals to post medical errors such as falls and hospital-acquired infections on the Internet each day. The effect of the policy, Secretary O'Neill, argues, would be to “enable individuals to choose where they go for service, based on the absence of error, not on the basis of proximity or advertising claims. And [it] would allow care-giving institutions to identify the best performers across the nation and learn how to improve their practices.”

When Hurricane Katrina roared into the Gulf of Mexico in August 2005, New Orleans was ill prepared for what followed. When storm-weakened levees failed the following day, the ensuing flood inundated large parts of the city, including several hospitals. Charity Hospital, a massive 2,680-bed facility, quickly lost power because its backup generator drowned in the hospital's basement.

Fast forward seven years. As Hurricane Sandy bore down on coastal New Jersey and New York City, officials thought they were ready. NYC Mayor Michael Bloomberg had received assurances from the city's hospitals that they could function on their own in the event of a power outage. But when storm surge swept through areas of lower Manhattan, two of the city's most vital hospitals—NYU-Langone and Bellevue—shut down. The reason? Critical components of both hospitals' backup power supplies—including a generator and fuel tanks at NYU-Langone, and fuel pumps that fed Bellevue's generators 13 floors up—were submerged in their basements. Ultimately, more than 700 patients had to be evacuated from the two facilities.

A "patient safety event" is any event or action that could lead to a worse outcome for a patient—bedsores, post-operative respiratory failure, post-operative deep vein thrombosis, etc. How often do hospital patients experience multiple patient safety events (MPSEs)?

• 1 in 1000 hospitalizations result in MPSEs.
• An MPSE increases the hospital stay by 400% and increases costs by 800%.
• The patient most likely to experience MPSEs is an older black man on Medicare living in a low median-income ZIP code.

This Letter to the Editor appeared in The New York Times on March 22, 2012.

Theresa Brown's critique of patient experience surveys notes the value of multiple measures of patient care. We agree. Unfortunately, she also repeats two common misconceptions about the Hospital Consumer Assessments of Healthcare Providers and Systems survey, which we helped develop.

One is that there are necessarily tradeoffs between good patient experiences and good clinical care. The preponderance of the evidence (at least four recent studies) suggests the opposite: hospitals that perform better on the survey tend to do better on clinical measures, have fewer readmissions within 30 days and have lower risk-adjusted mortality.

The issue of provider consolidation and its impact on price competition is perhaps the most important factor that will determine whether Californians will be able to afford health insurance in the future.

Our recent national study—which looked at the competitiveness of health plan markets and hospital markets—found that hospital markets are much less competitive than health plan markets nationally and, importantly for consumers, that hospitals operating with little competition are able to charge health plans much higher prices, which are passed on to consumers in the form of higher insurance premiums.