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• Are Hospitalists Recession-Proof?

  Hospitals aren’t the first businesses hurt when the economy sours, but they get hurt nonetheless, as an article in last week’s NY Times points out. But hospitalists have never lived through a massive downturn. What happens to them when the economy tanks?Let’s Read More... Posted Fri, Nov 14 2008 8:13 AM by Bob Wachter | 1 Comments Filed under: Hospital Care, Transparency and Reporting, Efficiency, Hospitalists/Hospital Medicine, Health Policy

• Can a Hospital Afford to Share Its Warts With the Public?

  Paul Levy, the blogging CEO at Boston’s Beth Israel Deaconess Medical Center, has staked his – and his hospital’s – reputation on a culture of transparency. Although no doubt partly driven by Paul’s ethical compass, he must also hope that his unique brand Read More... Posted Sun, Nov 02 2008 4:56 PM by Bob Wachter | 1 Comments Filed under: Hospital Care, Transparency and Reporting, Health Policy, Media/Press Coverage

• How the Newly Vigorous Patient Safety Regulatory Environment May Be Harming the Cause of Safety

  In responding to dysfunctional systems, America instinctively turns to “more regulation” (Exhibit A: today’s Wall Street). But regulation can, and often does, go too far, and – in patient safety – I believe that it now has.Note that this comes from someone Read More... Posted Sun, Oct 19 2008 8:34 PM by Bob Wachter | 6 Comments Filed under: Quality Improvement, Hospital Care, Transparency and Reporting, Quality Measurement, Patient Safety/Medical Errors, Health Policy

• NPR’s “Talk of the Nation,” Featuring Don Berwick and Yours Truly

  Medicare is now reporting actual risk-adjusted mortality rates for pneumonia, MI, and heart failure. The topic must be important, since "Talk of the Nation" spent 30 minutes yesterday interviewing Don Berwick and me about it… on the day of Hillary’s speech! Read More... Posted Wed, Aug 27 2008 7:08 PM by Bob Wachter | 2 Comments Filed under: Quality Improvement, Hospital Care, Transparency and Reporting, Quality Measurement, Information Technology, Health Policy, Media/Press Coverage

• Post-Vacation Potpourri: Items Interesting, International, and Ineffably Sad

  Just returning from a work-acation, including a talk in Buenos Aires. Today I’ll briefly cover a few items: Medicare’s final “no pay” list; patient safety in Argentina; a great post on hospital finances; and one of the saddest things I’ve ever experienced. Read More... Posted Thu, Aug 14 2008 3:07 AM by Bob Wachter | 0 Comments Filed under: Quality Improvement, Hospital Care, Transparency and Reporting, Quality Measurement, Patient Safety/Medical Errors, Health Policy, Media/Press Coverage

• Is “Patient-Centeredness” a Healthcare MacGuffin?

  Last week’s ABIM Foundation Summer Forum focused on patient-centered care… and who could be against that? But is patient-centered care just a healthcare MacGuffin? What’s a MacGuffin, you ask? In a spectacular talk at the Forum, Michael Richardson of Read More... Posted Mon, Aug 04 2008 4:16 AM by Bob Wachter | 8 Comments Filed under: Hospital Care, Transparency and Reporting, Ambulatory/Primary Care, Health Policy, Medical Ethics

• Door to Antibiotics Time in Pneumonia: Lessons from a Flawed Quality Measure

  In today’s Annals of Internal Medicine, my colleagues and I describe the saga of the four-hour measure of door-to-antibiotics time for pneumonia – the first truly dangerous measure in the era of public quality reporting. It is an important cautionary Read More... Posted Wed, Jul 02 2008 8:09 AM by Bob Wachter | 4 Comments Filed under: Hospital Care, Pay-for-performance, Transparency and Reporting, Quality Measurement, Patient Safety/Medical Errors, Health Policy

• How Infection Prevention Came to Dominate the Patient Safety Movement

  The Joint Commission just released its 2009 National Patient Safety Goals, and – no surprise – they focus on infection prevention. While this seems natural today, it wasn’t always so. In fact, the conflation of infection control and patient safety is Read More... Posted Sun, Jun 22 2008 1:10 AM by Bob Wachter | 2 Comments Filed under: Hospital Care, Transparency and Reporting, Quality Measurement, Patient Safety/Medical Errors, Nurses/Nursing, Health Policy

• Message to Medicare: Whoa, Nellie!

  Last week, Medicare proposed nine additional “do not pay” conditions, several months before implementing the first eight. I like the concept of not paying for preventable adverse events, but this new list is a case of too far, too fast. In my previous Read More... Posted Mon, Apr 28 2008 7:37 AM by Bob Wachter | 7 Comments Filed under: Hospital Care, Transparency and Reporting, Quality Measurement, Patient Safety/Medical Errors, Health Policy

• Should Patient Satisfaction Scores Be Adjusted for Where Patients Shop?

  Last week, Medicare added patient satisfaction data to its hospital reporting website. This is progress, but it raises an interesting question: should patient satisfaction scores be case-mix adjusted? The motivation to include patient satisfaction data Read More... Posted Sun, Apr 13 2008 4:03 AM by Bob Wachter | 1 Comments Filed under: Hospital Care, Pay-for-performance, Transparency and Reporting, Quality Measurement, Hospitalists/Hospital Medicine, Information Technology, Health Policy, Media/Press Coverage

• The Great Quality Debate: Berwick’s Plea for Action vs. Evidence-Based Medicine

  In this week’s JAMA, Dr. Don Berwick, CEO of the Institute for Healthcare Improvement, argues that evidence-based standards should be relaxed for quality improvement practices. Ironically, a few pages away, a Swiss study finds than an IHI-endorsed MRSA Read More... Posted Mon, Mar 17 2008 11:59 PM by Bob Wachter | 4 Comments Filed under: Quality Improvement, Hospital Care, Transparency and Reporting, Quality Measurement, Medical Education/Academia, Patient Safety/Medical Errors, Health Policy

• Fixing Fumbled Handoffs

  I recently participated in a meeting whose aim was to develop safety measures for hospital units (ie, med-surg, ED, L&D). As various measures were being ticked off, I muttered that we should also try to capture errors that occur as patients move between Read More... Posted Tue, Dec 25 2007 2:24 PM by Bob Wachter | 4 Comments Filed under: Quality Improvement, Hospital Care, Transparency and Reporting, Quality Measurement, Ambulatory/Primary Care, Patient Safety/Medical Errors, Health Policy

• More on Quality Reports: Lessons From SAT Scores

  My older son is gearing up to apply to college (:-\ and so I bought him one of the Bibles, the Fiske Guide. The book is cleverly written – enough academic factoids to get parents to spring for it, leavened with enough social scene skinny to get kids to Read More... Posted Fri, Dec 14 2007 2:42 AM by Bob Wachter | 1 Comments Filed under: Transparency and Reporting, Quality Measurement, Medical Education/Academia, Health Policy

• The Weekly Roundup…

  Stuff this week that caught my eye: Does medical tourism harm the natives? Are all those CT scans destroying more than our budgets? Are nocturnalists at risk for more than decubs? Will Medicare need to cut hospital payments to fuel P4P? Answers: yes, Read More... Posted Fri, Nov 30 2007 9:45 PM by Bob Wachter | 0 Comments Filed under: Hospital Care, Pay-for-performance, Transparency and Reporting, Quality Measurement, Hospitalists/Hospital Medicine, Diagnosis/Clinical Reasoning, Information Technology, Ambulatory/Primary Care, Nurses/Nursing, Health Policy, Outsourcing/Medical Tourism

• Three Remarkable Articles Last Week

  As I mentioned when we launched, this blog won’t be your destination for a weekly journal update (there are plenty of sites for that). But I will keep an eye on the literature and let you know when I see something remarkable. And then I’ll try to put Read More... Posted Mon, Nov 12 2007 7:55 AM by Bob Wachter | 1 Comments Filed under: Hospital Care, Transparency and Reporting, Quality Measurement, Ambulatory/Primary Care, Health Policy