Becker's Hospital Review

93 FINANCE CMO / CARE DELIVERY Physician-hospital integration does not improve care quality, study says By Megan Knowles A s hospitals acquire physi- cian practices and physi- cian organizations grow, this physician-hospital integration did not improve care on several quality measures, according to a study published in Medical Care Research and Review. The researchers, from Hous- ton-based Rice University, analyzed information from the CMS Hospital Compare database for 2008 to 2015. They looked at readmission rates, patient satisfaction scores and process of care measurements that assess how well a hospital gives care to its patients. They used this information to test whether patient outcomes are influenced by greater hospital market concentration or vertical integration between hospitals and physicians. Before starting the study, the re- searchers hypothesized that de- creased fragmentation, or better coordination between a patient's primary care physician, special- ists and admitting and attending hospital physicians, may improve patient care. However, they found this vertical integration has a lim- ited effect on care quality. "The government requires that hospitals report on a wide vari- ety of quality measures, such as practice of preventive care for surgical patients, whether their doctor or nurse communicat- ed well, or whether the patient would recommend the hospital to others," said study author Viv- ian Ho, PhD. "Physician-hospital integration did not improve the quality of care for the overwhelming majority of these measures. If patient welfare doesn't improve after integration, there may be other reasons why physicians and hospitals are form- ing closer relationships — perhaps to raise profits." n 13 patients harmed by care at Johns Hopkins All Children's, system says By Megan Knowles A n internal review conducted by St. Petersburg, Fla.-based Johns Hop- kins All Children's Hospital found 13 cases in which patients in the facility's heart unit were harmed by care, according to the Tampa Bay Times. e cases should have been immediately re- ported to state officials, the hospital's interim president told staff during private town halls the week of Feb. 3. None of the cases were reported until recently. Additionally, former All Children's leaders failed to properly notify the board of trustees about safety concerns in the heart surgery department, which led to a declaration by CMS that the hospital endangered patients, the interim president said. "Leadership knew there were quality and safety issues and did not elevate it in appro- priate ways to the board," said Kevin Sowers, MSN, RN, president of the Johns Hopkins Health System, based in Baltimore. Mr. Sow- ers also has been the interim president at All Children's since December. Mr. Sowers said Johns Hopkins had "let [All Children's] down." "Some of the people we put here did not act in the best interest of the children we were caring for or this organization," he said. Mr. Sowers detailed several lapses by former hospital leaders, saying they were "people that we trusted that hid the Heart Institute's problems from the internal and external oversight designed to keep patients safe." ose issues were publicized in November 2018 aer a Times investigation revealed the unit's mortality had tripled in only two years. e investigation led to the resignation of CEO Jonathan Ellen, MD, two heart surgeons and the three vice presidents in charge of risk man- agement, patient safety and communications. It also led to inspections by state and federal regulators, who visited All Children's in Jan- uary and placed it in immediate jeopardy. CMS gave the hospital until Feb. 10 to submit a written plan to address the inspectors' find- ings. If Johns Hopkins All Children's does not correct these issues by Feb. 23, the agency will cut off federal funding. n Viewpoint: Why this nursing 'rite of passage' is bullying in disguise By Mackenzie Bean G iving new graduate nurses the busiest patient assignments as a "rite of pas- sage" is really just another form of nurse bullying, travel nurse Mariam Yazdi, BSN, RN, wrote in an op-ed for Nurse.org. "Being given admission after admission, with a patient load of seven and eight, while the charge nurse and his or her friends have four or five patients is how nurses eat their young," Ms. Yazdi wrote. She said this practice can create a toxic work culture in which nurses who lack seniority are discriminated against. Ms. Yazdi acknowledged it can be uncomfortable to speak up about this unfair treatment but said young nurses must do so to help create a better work culture for themselves and future nurses. "You can change the narrative. You have the ability to stop the cycle of bullying," she wrote in the op-ed. "Don't allow your pain to be passed on to another generation of nurses. Empower yourself to use your voice. Your patients, your career and your well-being ask it of you." n

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