The need for outpatient facilities in particular is expected to increase as the industry adapts to the ongoing health reform and a move toward accountable care organizations. Outpatient facilities generally provide more access at the local level, and at a lower-cost care overall.

Another driver behind that activity is an expected increase in mergers and acquisitions. The company said that the anticipated activity — of both hospital mergers and the acquisition of physician practices — will create real estate dilemmas for the organizations involved.

More young people are entering the profession thanks to a efforts to make nursing a more appealing career option. According to a new study published in Health Affairs, there’s been an 62% increase in the amount of people aged 23-26 who started careers in the field between 2002-2009.

Now, the number of registered nurses is expected to keep pace with population growth through 2030. Previously, the number of nurses was expected to decline over the next 20 years.

The problem isn’t totally resolved though. Several independent reports suggest that key specialties, most notably geriatrics, may not have adequate numbers of well-trained nurses to meet patient needs.

To keep the workforce growing, experts recommended finding ways to make nursing a more mobile career. Right now, more than 52% of nurses work within 40 miles of where they went to high school. In the long-term, that could create regional pockets where there aren’t enough nurses to fill the required positions. To meet long-term needs of those areas, the researchers recommended:

• Expanding the number of educational programs in under-served areas, such as off-campus “registered nurse to bachelor’s degree in nursing” programs or increased use of distance learning
• Targeting educational support such as scholarships and loan forgiveness programs to local students, to encourage them to not only be nurses but also to serve their local area
• Urging state and university leaders to review admission policies for nursing programs and the financial aid they offer, and
• Funding programs and policies such as the National Health Services Corps that offer financial incentives to attract nurses to under-served areas.

Overall, measures of factors, such as wait time and one-on-one time with doctors, show that most patients are satisfied with the care they receive.

A recent study looked at doctor rankings at Dr.Score.com. The data, from nearly 15,000 patients, ranked six years worth of their doctor visits. Doctors were ranked on a 1-10 scale, with 10 being the highest rating.

The verdict: Health care pros are doing a good job of leaving patients satisfied.

The average overall satisfaction rating was an excellent 9.28. About 85% of ratings were a 9 or higher. Less than 2% of ratings were below a 1.

That may seem at odds with common public perception that a doctor’s appointment is little more than a date with frustration. The researchers said that perception is driven mainly by things that are out of doctors’ hands, such as opaque insurance company policies, and bad-news headlines. But most patients realize that their doctors are doing a good job of taking care of them.

The study appeared in Health Outcomes Research and Medicine.

What kind of discipline do doctors face when they commit serious violations of patient safety? In many cases, nothing at all.

That’s what Public Citizen discovered after analyzing records from the National Practitioner Data Bank Public Use File for 1990-2009. The research found that of more than 10,000 physicians in the file who had at least one revocation or restriction of their clinical privileges, 45% also had one or more state licensing actions — which means 55% of the docs didn’t.

In one of the states least likely to take disciplinary action, California, the group found that the state medical board had failed to discipline about half of the doctors who had been disciplined by their own hospitals or health organizations between September 1990 and December 2009. That’s more than 700 doctors — most disturbingly, 102 of those doctors had been deemed by their peers as an “immediate threat” to patient health or safety.

Typical actions that landed physicians in the database were alcohol and substance abuse, providing substandard care, wrong diagnoses and leaving equipment in surgical patients.

Yet the state medical board didn’t act.

Since the initial report this spring, the state medical board hasn’t picked up the pace, and Public Citizen sent a letter to the governor outlining both the slow action against potentially dangerous docs and the state’s alarming recent decline in enforcing medical standards.

While these complaints are specific to California, it’s hardly the only state where malpractice is dealt with something less than haste. The real question is why some states seem to make it a practice to do little more than wink at physicians’ serious missteps.

Do physicians get a free pass when it comes to unprofessional behavior? Or is it merely that the process moves slowly? Share your thoughts in the comments.

So far, more than 30,000 doctors have signed up for the Doximity network since its launch seven months ago — that’s twice the number of physicians on LinkedIn, according to Doximity.

The services is a HIPAA-secure communication platform for doctors that lets them connect and collaborate with their professional peers.
Unlike other popular social media sites, Doximity membership is reserved for medical professionals, such as  physicians, nurse practitioners and physician assistants. Members sign up with their real names and verified credentials. The general public can’t access any information on the site, so health care pros can have true — and private — peer-to-peer communication.

According to the report, hospital outpatient department visits attended only by PAs or APNs increased by 50% between 2000 and 2009. But not all areas are seeing the same level of growth. More urban hospitals are less likely to have PAs and APNs handle patient visits on their own.

Some specialties rely more on PAs and APNs, as well. More visits with only a PA or APN were made to general medicine (21%) and OB/GYN (19%) practices. The specialties least-likely to rely on PAs and APNs for these visits were pediatrics (8%) and surgical (5%).

The types of visits most likely to be handled solely by a PA or APN were visits where a patient was coming in to discuss a new issue (22%). Other types of patient visits included treatment for a flare-up of a chronic condition (14%), routine treatment of a chronic condition (11%) and pre- or post-op care (6%).

Primarily, systems that protect anonymous reporting and don’t emphasize assigning blame for the error get more reports than more traditional reporting systems. That’s the takeaway from a recent report in the journal Pediatrics.

After instituting a new system at a pediatric clinic in North Carolina, the number of mistakes reported increased from an average of five per year to 86.

Under the clinic’s old system, reports weren’t anonymous and frequently led to punishment of some sort for those involved in the error. With the new system, employees were able to report anonymously, and punishments weren’t attached to the error reports. Employees from all areas of the practice were put on a safety team to review reports once a month and find solutions to the reduce the likelihood of a similar mistake happening again.

The most common mistake by far was incorrect data being entered into a patient record, followed by delayed or forgotten lab work and medication errors. About 75% of the mistake reports were addressed by the team with simple procedural changes and staff training.

The committee was set up to find a compromise on how to cut $1.2 trillion in federal spending over the next decade. Failure to do so — which the committee officially announced on Nov. 21 — means the back up plan of “sequestration” takes effect. That means automatic cuts of that $1.2 trillion is cut from domestic and defense programs starting with 2013 spending.

Most directly affecting the health industry are planned cuts to Medicare — capped at 2%. Understandably, providers are worried about the effect that’ll have on their bottom lines.

The American Medical Association released a statement by President Peter W. Carmel, M.D., noting that cuts triggered by sequestration, along with the planned Jan. 1 physician payment cut of 27%, mean physicians may be forced to limit the number of Medicare patients they serve.

Similarly, the American Hospital Association’s statement warned that the cuts to Medicare will affect not just the elderly and disabled who rely on Medicare but their families who have to pick up the slack, as well as hospitals’ ability to provide essential services. The statement is available here (downloadable PDF).

“Sequestration means that arbitrary reductions in resources for patient care under Medicare will now be set to take effect under the law for the remainder of the decade,” Richard Umbdenstock, president and CEO of the American Hospital Association (PDF), said in a statement. “This will have an impact not just on the elderly and disabled beneficiaries of the program, but on their families,” he continued. “It will also have an impact on the ability of hospitals to provide essential public services to the communities they serve given the impact that Medicare has on the entire healthcare system. It is likely that Congress will reconsider whether this approach should take effect in January 2013 as required under current law.”

Attention all germophobes: Latex gloves may actually worsen the hand hygiene of health care workers who wear them. That’s the finding of a recent study published in the journal Infection Control and Hospital Epidemiology.

The researchers found that health care workers who wear latex gloves are less likely to wash their hands in between patients.

That’s a problem because latex gloves are far from foolproof when it comes to protecting patients and health workers from each others’ germs.

Germs can travel through the latex material, or get sprayed through the air when the gloves are removed. Since gloves are most commonly worn when providers are dealing with the sickest of patients or procedures that are most likely to involve bodily fluids, it means even greater exposure to germs through health care workers’ germ-tainted hands.

For the study, researchers reviewed more than 7,000 contacts between doctors and patients, at 15 different hospitals throughout England. They found that the overall hand-washing rate among physicians was just under 48%. But when doctors wore latex gloves — for about 25% of patient interactions — the hand-washing rate dropped to a dismal 41%.

Essentially, when dealing with the sickest and most infectious patients, doctors are least likely to wash their hands. The researchers suspect doctors and other health care workers are lapsing on hand-washing out of the mistaken belief that latex gloves are impervious to germs and therefore, wearing them leaves their hands clean. In fact, latex gloves lower the risk of germ transmission — they don’t prevent it.

The study looked at patients using the POLST form — for Physician Orders for Life-Sustaining Treatment. The form gives patients an easy way to indicate their wishes about a variety of treatments — such as the use of ventilation or feeding tubes — and it’s signed by both the patient and the doctor.

Patients in the study who used the PLOST form had their wishes regarding resucitation followed 98% of the time. Their preferences regarding limited medical interventions were followed just slighltly more than 91% of the time.

About 24% of the patients refined their orders as the end of their lives approached — most patients opted for more comfort-focused care.

The use of the forms has faced some criticism from activists who think patients should always be given treatment to prolong life at any cost.