News and Views

Becker's Hospital CFO

Haney Mallemat, MD Assistant Professor of Emergency Medicine

Dr. Mallemat discusses the impact and expansion of the CMS Hospital Acquired Conditions payment program in patient care as well as overall Medicare payments to hospitals.  He also explains the role of point-of-care ultrasound at his hospital to assist in lowering complications and costs associated with central lines.

by Nidhi Nikhanj, MD

In this article for ​Health Management Magazine, Dr. Nidhi Nikhanj lays out the path for a system-wide implementation of point-of-care ultrasound to bring quality of care and enhanced patient safety to the bedside. What 6 steps should a large health system use to successfully implement point-of-care ultrasound?

In an article by FUJIFILM SonoSite's own Bill Medford, RDMS, RMSKS, Lead Musculoskeletal Ultrasound Specialist, he explains how as a clinical expert with over 17 years of experience, he sees the advances in ultrasound and in particular the X-Porte's significant contribution to the practice of musculoskeletal (MSK) medicine.

The American Journal of Orthopedics

Alan M. Hirahara, MD, FRCS(C), and Alberto J. Panero, DO

In the first of a three part series for the American Journal of Orthopedics, Drs Alan Hirahara, MD, FRCS(C) and Alberto Panero, DO discuss the advantages of diagnostic and ultrasound guided procedures in the shoulder.

ICU Management

Diku Mandavia, MD, FACEP, FRCPC, Chief Medical Officer at SonoSite, and clinical associate professor of emergency medicine at the University of Southern California

Dr. Mandavia discusses how ultrasound guidance adds value to both patient safety and removing costs from healthcare delivery.

Medical errors continue to be a major problem in the US healthcare system, with hospital acquired infections (HAC) becoming an area of greater focus and where significant financial penalties are being incurred. Medicare has added one especially dangerous--or even potentially fatal--adverse event, iatrogenic pneumothorax during central line placement, to its HAC list. Along with putting patients in peril, the mistake can also increase hospital costs by up to $45,000 per incident, according to a study by the Agency for Healthcare Quality and Research (AHRQ). 

Many excellent studies show that ultrasound guidance can powerfully improve the safety and success of this very common procedure. In fact, in one randomized study of 900 critical care patients, use of ultrasound visualization reduced the rate of collapsed lung during central line placement to zero, compared to 2.4 percent for blind placement. 

Dr. Sierzenski is the Director of Emergency, Trauma and Critical Care Ultrasound for Christiana Care Health System’s Department of Emergency Medicine. He is also the Chair, Government Policy & Public Relations for the American College of Emergency Physicians Ultrasound Section and a Master's Candidate in Health Quality and Safety at the Jefferson School of Population Health.

In his article that advises American Hospital Association member trustees, Rodney Hockman, MD warns that hundreds of hospitals are likely to be penalized by Medicare for patient injuries under the Hospital-Acquired Condition (HAC) Reduction Program starting in October 2014. He points out that each penalized hospital stands to lose nearly $434,000 in Medicare reimbursements on average, with large hospital systems and those with a high volume of Medicare payments potentially facing much greater losses should they provide unsafe care.

Dr. Hochman points to institutions using a bundle of best practices to address this,  including 353-bed White Memorial Hospital, part of the Adventist Health System in Los Angeles, to eliminate two of the serious complications used to determine penalties under Medicare’s HAC Reduction Program: pneumothorax and central line-associated bloodstream infections (CLABSIs).  Both conditions are now included on AHRQ’s list of patient safety indicators. 

In this article for Becker's Orthopedic Review, Dr. Don A. Buford explains both the clinical evidence and benefits for the use of diagnostic ultrasound for shoulder evaluation. In particular, evidence for the use of ultrasound as the first imaging study in cases of suspected rotator cuff tear. Dr. Buford, an orthopedic surgeon, also covers the benefits of ultrasound to patients, his clinical practice and the costs to the healthcare system. As the healthcare system moves toward both Appropriate Use Criteria for imaging and lower costs, this article explains why it is time to implement such practices.

Healthcare Financial Management Association Blog

Paul R. Sierzenski, MD


The emerging healthcare environment requires expanded patient access while minimizing the cost of care. This is of particular importance for accountable care organizations that are assuming significant risk and must develop more innovative ways to deliver care to drive better outcomes and wring out inefficiencies. Our practice has experienced this struggle on a daily basis as patients, who needed a surgical consult, were frustrated with limited access. Our clinical schedule was filled with non-surgical candidates. This created a paradox where the most specialized health system resources (e.g., surgeon and MRI) were being allocated to a continuum of care that did not result in better care or outcomes, while also increasing physician and patient frustration. The long-standing dilemma was that the wrong patient was often in the wrong clinic leading to an inefficient and circuitous path for the delivery of appropriate care. When evaluating our practice it was clear that we could improve our allocation of available resources with the outcome being happy patients and happy physicians within a healthcare system that was delivering high quality, low cost, appropriate care.