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JC Physician blog – News for M.D.s from M.D.s at The Joint Commission

Written by and for physicians, the biweekly JC Physician blog discusses health care issues of interest to doctors as well as other topics that may touch on ethics, the environment and current affairs.

NOTE: Physician are encouraged to submit guest blogs for the JC Physician blog. Those interested should contact Social Media Specialist Sean Ostruszka.


Fighting costly and complex … with your help

Aug 20, 2014 | Comments (0) | 542 Views

Daniel J. Castillo, M.D., M.B.A.By Daniel J. Castillo, M.D., M.B.A.
Medical Director
The Joint Commission

You got a taste four months ago. Now, it’s time for the first course.

Back in April, I wrote a blog mentioning an upcoming article I was writing for The Journal of Integrated Healthcare Delivery. I’m happy to say that article, Developing a Strategy for Change, published July 1.

If I caught your attention in the last blog with the $650 billion figure I quoted related to the cost of U.S. health care spending more than other developed countries, you’ll want to read more in the journal article about how emerging integrated systems are working to address waste, cost and quality. Basically, I have visited and spoken to many organizations that are at varying places in their journey towards a truly integrated system. A common theme is that seamless delivery of care and patient-centered clinical integration are difficult because of the rapidly changing landscape, the uncertainty of reimbursements, and the entrenched provider-centered model that flourished for decades. 

What is clear is the need for change. My article starts spelling out this need, but I look to build on this momentum with additional writings on the topic.

Along those lines, it would be great to hear from those going through this journey towards integration, so that I can learn from you, and we can all learn from each other. Whether you’re planning it, going through it, or have gone through the journey, I ask that you to contact me at

The Joint Commission will continue to explore opportunities for the evaluation and inspiration of valuable integration that improves outcomes for patients. I’m hoping we can work together toward this goal.  

Are you a revolutionary?

Aug 06, 2014 | Comments (0) | 925 Views

Erin DuPree, MDBy Erin DuPree, MD, FACOG

Dr. Ernest Amory Codman believed in studying information about a patient, the care he or she received, and the result of that care. That hardly sounds revolutionary nowadays, but considering when Dr. Codman began his “end results system” – the early 1900s – it was not only revolutionary but also outrageous. 

Dr. Codman was considered a rebel by his peers. He was socially ostracized – even by his friends – and he resigned in disgrace as chairman of the local medical society, all because he firmly believed in the end results system.

Luckily, he never wavered in his beliefs, because it was this work that led Dr. Codman to help found the American College of Surgeons and its hospital standardization program, which was the forerunner of The Joint Commission. 
It’s with this in mind that I was honored to attend, on behalf of The Joint Commission, a dedication service for Dr. Codman on July 22, at the Mount Auburn Cemetery in Cambridge, Massachusetts. He had been buried in an unmarked grave all of these years, and the ceremony rectified that, thanks to the efforts led by Dr. Lamar McGinnis.

Dr. Codman was a true revolutionary, not only with his ideas but his actions. He blazed the way for many of us today that are determined to do what is right for the patient. He pushed for the standardization of care processes. He pushed for detailed systems of patient records, including postdischarge follow-up. He pushed for registries to follow patients nationally. He pushed for the public reporting of hospital and physician performance. He pushed for what today is known as outcomes management. He was 100 years ahead of his time.

We all owe a debt of gratitude to Dr. Codman for his passion and commitment to “end results” – his belief that the key to improving quality is through the thoughtful and careful examination of processes followed, treatment provided, and care administered by health care professionals. And, while his efforts were largely dismissed by the medical community at the time, he never wavered, holding firm in his commitment to making health care safe and effective for all.  He is a legend because of that firm commitment. His dream was for patients to have the essential information they need to make informed choices about their treatment and where to go for care.

In every sense of the word, Dr. Codman was a revolutionary.

Dr. Codman’s amazing legacy gave me pause in my busy week as a physician at The Joint Commission and as a patient. I have a dream of safe, reliable, effective, individualized care for all. We have so far to go, as I witnessed during a routine outpatient appointment today. 

Reflecting on Dr. Codman’s career, and reading a recent piece in The New York Times, I was forced to ponder what it means to be a revolutionary.

That prompted me to ask, "What can I do today?" How can I move through all the barriers and inertia? What are the levers and opportunities at my disposal?

I wonder if Dr. Codman asked himself these questions. He certainly had no shortage of barriers. Yet, he persevered. Here’s hoping more of us are inspired enough to follow in his footsteps toward being revolutionaries.

A Sunny Response to the CMO Academy Launch

Jul 16, 2014 | Comments (0) | 1613 Views

Ana Pujols McKee, M.D.By Ana Pujols McKee, M.D.
Executive Vice President and Chief Medical Officer
The Joint Commission

When the people of Seattle get behind something, they really get behind it. Just look at Starbucks, grunge music or how they embrace the rain. The fans of the Seattle Seahawks even once got so loud during a game that the vibrations registered as an earthquake.

This past weekend, we made plenty of waves in our own right.

With The Joint Commission partnering with the American College of Physician Executives (ACPE) to develop a CMO Academy, I was fortunate to attend the ACPE summer institute. This marked the launch of the academy, with the focus being on the needs of chief medical officers less than three years into their leadership roles.

The academy also was an opportunity for physician leaders to learn about the new Joint Commission. Attendees were introduced to our performance improvement expertise, tools and, most importantly, our commitment to support physician leaders as they work to meet or exceed their quality improvement and patient safety goals.

After one of my talks, a CMO approached and exclaimed, “Wow, I didn’t know that The Joint Commission was doing all of this. This is great!” I can’t tell you how many more reactions like this I received, as I simply lost count. I do know that enthusiastic remarks like those make me hopeful that the online CMO Academy – coming in the near future – will be valued and well received.

While the attendees in Seattle came from all across the country, they certainly caught the Seattle bug, getting fully behind the CMO Academy. Here’s hoping the rest of the health care world does, too. 

Don’t make me wait!

Jul 02, 2014 | Comments (0) | 1878 Views

Ronald Wyatt, Medical Director, The Joint CommissionBy Ronald M. Wyatt, M.D., M.H.A.
Medical Director
The Joint Commission

People hate to wait. They don’t like waiting in line for their coffee. They don’t like waiting to find out the latest gossip. They don’t even like waiting for water to boil.

Coffee, gossip and boiling water – three non-life-threatening things in which the time frame is of little to no consequence, yet we hate waiting for them.

Now imagine how much people hate to wait for something in which the time frame is critical – even potentially life threatening, if delayed.

Unfortunately, it happens in health care far too often.

Sentinel event statistics from The Joint Commission show that one of the top reported events from 2004-2013 is delay in treatment. In 2013, delay in treatment was the third most common reviewable sentinel event.

With increased demands for health care services and clinicians, and a renewed focus on improved health outcomes, there is an urgent need to find ways to prevent these delays.

Whether it be delays in medication, a lab test, physical therapy, or any kind of treatment, these delays don’t just happen, but instead often have proximal contributing factors, such as misdiagnosis, failure to treat, failure to communicate a significant lab result, delay in diagnosis, or misunderstanding of the underlying disease process.

These proximal factors, and the delays they cause, have dangerous outcomes, as an Agency for Healthcare Research and Quality (AHRQ) study found that 28 percent of 583 diagnostic mistakes were life threatening or had resulted in death or permanent disability (Schiff G.D., et al: Diagnostic Error in Medicine: Analysis of 583 Physician-Reported Errors. Arch Intern Med. 2009; 169(20):1881-1887).

Meanwhile, the most common root causes of delays in treatment reported to The Joint Commission include:

  • Communications failures
  • Failed hand offs and care transitions
  • Inadequate staff orientation and training
  • Inadequate staffing levels
  • Clinician availability
  • Failures in the patient-assessment process

So, how to we begin unclogging the timeline and eliminating delays?

One way The Joint Commission is working to help organizations address delays is by increasing patient engagement through its Speak Up program. Started in 2002, the program encourages patients to:

Speak up if they have questions or concerns.
Pay attention to the care they receive.
Educate themselves about their illness or condition.
Ask a trusted family member or friend to be their advocate.
Know the type of medicines they receive.
Use hospitals, clinics and surgery centers that have been carefully assessed by The Joint     Commission.
Participate in all decisions about their care.

If you’re looking to diagnosis areas that might be causing delays in your organization, it would be wise to focus your organizational attention on:

  • Scheduling processes
  • Ordering and reporting test results
  • Improving access to care
  • Implementing a standardized communications method, such as Situation Background Assessment Recommendation (SBAR)
  • Maintaining adequate staffing levels (expect the unexpected)

In 2013, The Joint Commission reviewed 107 sentinel events that were a result of delays in treatment. This means there was either a patient death or permanent loss of function as a result of that delay.

With the combined commitment and efforts of organizational leadership, clinicians and patients, we can reduce that number.

Now is the time to act. Don’t wait.


The Integration of Mental Health and Medical Care – The Future

Jun 18, 2014 | Comments (0) | 1334 Views

Anne_BauerBy Anne C. Bauer, M.D.
Field Director, Accreditation and Certification Operations

Two forces are fueling national changes to the practice of psychiatry – and potentially bringing two health care services together.

Conversation at the annual American Psychiatric Association (APA) conference last month in New York City centered around the Mental Health Parity and Addiction Equity Act, and of course, the Patient Protection and Affordable Care Act of 2010 (commonly called the Affordable Care Act or ACA). Vice President Joe Biden was on hand to talk about the mental health parity law increasing access to mental health care. There are concerns about how this law will be enforced, with current court cases establishing those legal parameters at this time.

The ACA has created several mandates for health care changes, including an increase in care integration. One aspect of that is the integration of psychiatric and mental health care services with medical care.

The incoming president of the APA, Paul Summergrad M.D., emphasized at a recent meeting that the integration of mental health and substance abuse treatment, and general medical care was crucial to achieving the Institute for Healthcare Improvement’s (IHI) Triple Aim: improving patient experience of care, improving the health of populations, and reducing per capita cost of health care.

It has long been believed that the integration of mental health and medical care has the potential to lower health costs overall. Mental health disorders are the strongest predictor of disability. An APA-commissioned actuarial study concluded that general medical costs for treating people with chronic medical problems and mental disorders are two to three times higher than those for treating people with only physical health conditions. 

Presenting at the APA conference, Gary Gottlieb M.D., President and CEO of Partners HealthCare in Boston, Massachusetts, said that a study of Massachusetts General Hospital’s ED showed 50 percent of patients with more than 12 emergency department visits a year had a psychiatric or substance abuse disorder.

What are the best ways to move beyond our siloed health care system?

A continuum for levels of collaborative integration between mental health and medical care has been proposed by the Substance Abuse and Mental Health Services Administration-Health Resources Services Administration (SAMHSA-HRSA) Center for Integrated Health Solutions. These range from basic coordination of care to co-location of care to complete integration of care exemplified by certification programs, such as The Joint Commission’s Behavioral Health Home. This is where primary care and behavioral health care clinicians work as a team with shared information systems and treatment plans.

There are big challenges to implementing these integrated models of care, among them the cultural differences in practice between medical and behavioral health, and coming up with the payment structure to support them. These issues will be explored in future Physician Blogs.


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