The Documentation Game

Our hospital finished the last year with an inpatient mortality index of 0.54, a fantastic accomplishment. That means that we provide great care and we play the documentation game well. If the hospital mortality index is 1.0, that means that you had exactly the number of inpatient deaths that other hospitals have on average, after […]

Reducing COPD Readmissions

On average, about 1 out of 5 patients admitted to the hospital with COPD in the U.S. get readmitted within 30 days. There is a wealth of medical literature analyzing COPD readmissions. For example, we know that patients at risk for readmission include: Patients without physician follow-up within 30 days of discharge African Americans Older […]

PrEP Your Hospital To Prevent HIV

I’ve been waiting for 35 years but finally, we have a way to prevent HIV infection. HIV and AIDS has been the defining illness in world health over the course of my career. June 1981: I had just finished my first year of medical school the month that the CDC first reported an outbreak of a rare […]

Variability Creates Vulnerability

As I mentioned in a previous post, we just had our every-3-year JCAHO site survey. One of the surveyors made a comment that “variability creates vulnerability” and that phrase really stuck with me. So what does this mean? Let me give you an example. If you get on a plane, the pilot is going to […]

The JCAHO Site Survey

We just went through our Joint Commission site survey and I have a few thoughts after doing this as a medical director. The Joint Commission for the Accreditation of Healthcare Organization (JCAHO or just “Joint Commission”) is the largest of several organizations that review and accredit hospitals in the United States. Hospitals pay the Joint […]

Pain, The Most Regulated Vital Sign

In 1996, the American Pain Society introduced the concept of “pain as the 5th vital sign” in order to increase awareness of insufficiently treated pain. As a consequence, in 2001, the Joint Commission for the Accreditation of Healthcare Organizations (JCAHO) added a requirement for healthcare providers to ask every patient about their pain in order […]

Medicare’s Stars Don’t Shine Brightly

This week, Medicare released its new hospital rating system, The Hospital Compare Overall Hospital Quality Star Ratings. Using this system, Medicare rates hospitals by their quality using a 5 star system with 1 representing the lowest quality hospital and 5 representing the highest quality hospital. In reviewing the methodology, I believe that Medicare has failed […]