Risk Watch e-column
March 2006
An update of risk management news, issues and items of interest
HIPAA’s Common Complaints
The Department of Health and Human Service’s Office of Civil Rights has issued a list of the five most common complaints it has received in relation to the Health Insurance Portability and Accountability Act (HIPAA). They are as follows:
- Impermissible use or disclosure of protected health information (PHI)
- Lack of adequate safeguards to protect PHI
- Refusal or failure to provide access to a copy of the medical records
- Disclosure of more information than is minimally necessary to satisfy a particular request
- Failure to provide the notice of privacy practices.
For more information go to www.hhs.gov/ocr.
(Source: www.hhs.gov)
Men Turning to Cosmetic Surgery in Growing Numbers
While women still make up 87% of all cosmetic surgery patients, 1.2 million procedures were performed on men in 2004, according to the American Society of Plastic Surgeons (ASPS). This represents a 16% increase since 2000.
Based on ASPS statistics, the top five male cosmetic surgeries in 2004 were nose reshaping, hair transplantation, eyelid surgery, liposuction and breast reduction. Another organization that keeps cosmetic surgery statistics, the American Society for Aesthetic Plastic Surgery, has the same five surgeries at the top of its list, albeit in a slightly different order.
According to V. Leroy Young MD, a St. Louis-based plastic and reconstructive surgeon and chairman of the ASPS’ Emerging Trends Task Force, today there is less of a stigma for men to undergo cosmetic procedures. He attributes part of this change to makeover reality television shows, which create awareness of what can be accomplished under the care of a competent surgeon.
(Source: www.plasticsurgery.org)
Collapse of Primary Care?
The American College of Physicians (ACP), the nation’s largest specialty society representing 119,000 internal medicine physicians and medical students, issued a report on January 30 that warns of the potential collapse of the primary care health system in the United States.
The consequences of a collapse will be higher healthcare costs and lower healthcare quality as patients find themselves in a fragmented system in which no one physician accepts responsibility for their care or is accountable for the quality of care provided.
In The Impending Collapse of Primary Care Medicine and Its Implications for the State of the Nation’s Health Care, policymakers are urged to take actions, including reforms to the Medicare fee schedule, and adoption of a new model of care and financing — the advanced medical home. According to the report, very few young physicians are going into primary care and those already in practice are under such stress that they are looking for an exit strategy.
Inadequate Medicare payment policies, coupled with high levels of medical student debt, are key factors behind the impending collapse of primary care, according to the ACP report. The report emphasizes the need to replace existing reimbursement policies with ones designed to encourage and support the importance of the primary care physician. While primary care physicians provide the great majority of evaluation and management services, these clinical services are undervalued by Medicare.
Age is another factor that could contribute to the potential collapse. The AMA, in its 2005 study Physician Characteristics and Distribution in the U.S., reports that 35% of physicians nationwide are over the age of 55; most of those will likely retire within the next five to 10 years.
(Source: www.acponline.org)
Good Medicine Requires Clarity
In practice, the risks and benefits of a treatment can be very different for each patient depending on age, health and other factors. These differences can be spelled out in a conversation, but not in a one-size-fits-all form, according to Clarence H. Braddock III, MD, MPH, an internist and bioethicist at Stanford University.
Every day, patients are faced with undergoing somewhat risky but potentially lifesaving procedures — and doctors must decide how much to tell patients beforehand about the pros, cons and alternatives of the treatments. The disclosure — known legally as informed consent — ideally should start with a candid conversation between doctor and patient that ends in a shared decision. Too often, however, the discussion is replaced with a legal form and a pen.
The reliance on consent forms rather than conversation can be potentially disastrous, considering a National Adult Literacy Survey that found 21% of adults in the United States read at a sixth-grade level or below, and an additional 27% lack the proficiency needed to navigate the healthcare system.
Health literacy specialists are working to remedy this situation by producing a variety of audio or video consent forms to supplement or even replace existing printed forms. Using simpler, friendlier language is just the first step; many of the new forms also utilize larger typeface, shorter paragraphs, illustrations and bulleted points to help clarify the message.
(Source: www.nytimes.com/2006/01/24/health)
