The Miami Herald points out that the news is even more stressful for small employers.

Meanwhile, a growing number of workers at smaller firms are getting less coverage for their money as health plans with high deductibles and fewer benefits become more prevalent.

The portion of workers with single coverage who pay a deductible of at least $1,000 has jumped from 10 percent to 18 percent in the past two years. Among smaller firms with three to 199 employees, the rate has more than doubled from 16 percent to 35 percent.

Anticoagulants have been identified as one of the top five drug types associated with patient safety incidents in the United States, the commission says.

Among the causes for adverse events is incorrect dosages, food and drug interactions, and poor labeling that lends to confusion and error.

Says the commission:

Anticoagulant medication errors are such a serious patient safety issue that The Joint Commission addresses these types of errors in the 2008 National Patient Safety Goals, with full implementation of the requirements expected by January 1, 2009, for hospitals, outpatient clinics, home care and long term care organizations across the United States.

The United States could face a shortage of as many as 4,080 oncologists by 2020, according to a report from the American Society for Clinical Oncology.

Factors contributing to the impending shortfall include the aging of the U.S. population (cancer is more prevalent among older adults), retiring oncologists, and — shockingly — a growing number of female oncologists. Apparently, studies show female cancer doctors see fewer patients than their male counterparts.

They want better hours and recompense for the amount of time and work it requires to treat the large portion of elderly and medically complex patients this specialty sees.

A study to find out students’ impressions and concerns found they were concerned about patient complexity, the practice environment and lifestyle, compared with other specialties, officials said.

“Current students recognize the increasing demands on internists, particularly primary care physicians, to accomplish large numbers of preventive and therapeutic interventions during short visits with chronically ill patients while also managing increasing administrative expectations,” the authors wrote. “Career interest in general (internal medicine) is particularly low, reflecting the challenges in the primary care practice environment…”

The awe-inspiring bonuses and other impressive incentives from the recruitment craze of recent years, spurred by a national nursing shortage, are starting to settle in favor of the quieter, but more favorable conditions that actually keep nurses happy.

The hard truth:

Five years ago, hospitals waged intense bidding wars to fill nursing vacancies, luring nurses with huge signing bonuses and even sport-utility vehicles and vacations to the Bahamas. Those efforts often only served to exacerbate turnover, spurring nurses to remain in jobs just long enough to claim the prizes before moving to other hospitals with better incentives.

As it turns out, many nurses want better working conditions more than they do extra money. Hospitals now are responding by introducing technology to dramatically reduce paperwork, offering more flexible hours, reducing caseloads, paying for advanced training and giving them more authority.

The results will show you 30-day death (mortality) rates for heart attack, heart failure and pneumonia. Yes, the data is risk-adjusted for balance.

Out of seven hospital choices, I chose to compare Galichia Heart Hospital, Via Christi Regional Medical Center and Wesley Medical Center, three acute-care hospitals/systems in Wichita with emergency departments. I am happy to report that all three hospital systems were very close to the national average and considered, statistically, “no different than the national rate.” However, it’s worth noting that both Galichia and Via Christi rates were consistently a few points better than the national average.

This is a 7 percent decline from 1990, when 9 percent of graduating students said they planned to go into primary care.

The study looked at MinuteClinics — associated with CVS drugstores — vs. family doctors and the emergency department for the treatment of common ailments, such as sore throats and ear infections.

Reports the Pioneer Press on the study published in the latest issue of the journal Health Affairs:

The total cost of a patient treated at a MinuteClinic for one of five basic illnesses was $51 cheaper on average than a patient treated at urgent care and $55 cheaper than a patient treated by a primary-care doctor. Pharmacy costs were also slightly lower for the patients using MinuteClinics.

The study authors note that 10 clinical problems such as sinusitis and immunizations make up more than 90 percent of retail clinic visits. These same 10 clinical problems make up 13 percent of adult primary care visits, 30 percent of pediatric primary care visits, and 12 percent of emergency department visits.

But then the authors talk about the main issue that really concerns the medical establishment:

Whether there will be a future shift of care from emergency departments or primary care doctors to retail clinics is unknown.

A new study published in the September Journal of Occupational and Environmental Medicine reports that a program to reduce weight and improve health risk factors in obese employees produced a short-term return on investment of $1.17 per dollar spent.

In this case, a group of 890 overweight and obese employees from various companies were studied as they used a program called Healthyroads, which costs an average of $300 a year per employee. The study found for each dollar spent on the obesity management program, costs decreased by $1.17.

So where was the money saved? Mostly reduced health care spending, but also better productivity:

To assess the financial impact of the program, the researchers used a recently developed ROI model, which estimated the changes in medical costs and worker productivity resulting from reductions in health risks. The results suggested a total projected savings of nearly $312,000. About 60 percent of the savings resulted from reduced health care spending; the remaining 40 percent resulted from improvements in productivity.

If that’s not an argument for the effectiveness of workplace wellness programs, I don’t know what is.

In an informal poll of Chasing Zero Summit attendees, respondents said that of the 11 preventable conditions that will receive lower or no Medicare reimbursements, the top three most difficult conditions to address are HAIs (hospital acquired infections). In addition, 80 percent of poll respondents indicated that increasing hospital staff awareness, education and training related to infection prevention would have the most significant impact on providers’ abilities to reduce HAIs.

The first ever summit on hospital-acquired infections features a number of prominent speakers, including Alan Greenspan, chairman of the Federal Reserve System from 1987 to 2006; Thomas Valuck, Center for Medicare Management medical officer and senior advisor; Mark McClellan, director of the Engelberg Center for Health Care Reform at the Brookings Institution and Uwe Reinhardt, James Madison Professor of Political Economics at Princeton University.

Too bad it took Medicare’s plan to lower or deny claims for certain preventable conditions beginning next month to get these folks to the table, but I’m glad they’re there.