Hospital Marketing and Honesty

Online Hospital Promos a Marketing Catch-22

Marianne Aiello, for HealthLeaders Media , April 8, 2015

Accurately representing medical procedures online is a conundrum for hospital marketers, who risk scaring off potential patients by posting facts that would be better explained face-to-face by a physician. But there are ways to tackle this challenge.

Even for those of us who should know better, it's nearly impossible not to Google our health ailments. If you think you might have the flu or possibly sprained your ankle, typing symptoms into your phone's web browser is just plain easier than calling your physician's urgent care line.

And even with the knowledge that we're putting our privacy at risk, there's the alluring element of instant gratification, whether it's an alleviation of our fears or the piling on of even more serious concerns.

Informed healthcare consumers and savvy internet users have figured out how to navigate the plethora of results, choosing WebMD over Wikipedia, .org and .edu URLs over .coms. The Mayo Clinic has even gotten into the medical search game by offering up their doctors to fact check Google results for commonly searched conditions.

Hospital and health system websites have traditionally been above scrutiny in terms of providing accurate medical information— they've been safe harbors in a sea of amateurish Yahoo question boards and unwieldy Reddit threads. According to a recent study published in JAMA Internal Medicine, however, information posted on hospital websites is often misleading.

Promotion Presented as Fact 

"Valuable data and tools—including hospital quality ratings, professional treatment guidelines, and patient decision aids—are increasingly available via the Internet and may help patients facing decisions about where to seek care or whether to undergo a medical procedure," states JAMA's study, titled "Risks of Imbalanced Information on US Hospital Websites."

"Clinicians often encourage patients to engage with these types of information as a means of promoting patient involvement in medical decisions and offloading tasks from the too-brief clinical encounter. Unfortunately, valuable online health information may be hard to identify amid a growing number of online advertisements."

For the study, researchers looked at how the 317 US hospitals offering trans-aortic valve replacement (TAVR) are advertising the procedure. They found that while all of the hospitals touted the procedure as minimally invasive, just one-quarter mentioned the risks, and fewer than one in 20 explained those risks numerically.

"Our findings suggest that web-based advertising of TAVR to the public by hospitals may understate the established risks of this procedure and provide little context for the magnitude of those risks to inform patient decision making," the study reads. "Although consumers who are bombarded by television commercials may be aware that they are viewing an advertisement, hospital websites often have the appearance of [being] an education portal."

A Marketing Catch-22 

Accurately representing procedures online is a conundrum for hospital marketers, who are likely wary of scaring off potential patients by posting risks that would be better explained face-to-face by a physician. And, since this facet of hospital marketing isn't currently regulated, most hospitals probably aren't in a rush to slap a big fat warning label on their online procedure information when their competitor down the street isn't going to.

That said, for hospital websites to keep their pristine status in the public eye as providers of comprehensive medical information, marketing leaders need to reexamine how they're presenting their services online.

While it may take some creativity, there are ways to outline risks without sending patients into a panic. It's important to consider that a decent chunk of patients who are looking on your website about having a procedure done at your hospital have already read all about it on WebMD and are intimately familiar with even the most obscure worst-case scenarios. Those patients will be relieved to read your experts' explanation of those risks and the steps your hospital is taking to minimize them.

Embedded physician videos are a smart way to tackle this sort of sensitive subject, and can act as a stand-in for the face-to-face discussion the patient will ultimately have with their doctor. By explaining the risks in simple terms on video, physicians can simultaneously address patient concerns and win their trust.

It may take some getting used to, but transparency and good marketing aren't mutually exclusive. Smart organizations will take this study to heart and realize their website's copy should be held to higher standards than a billboard.

http://healthleadersmedia.com/print/MAR-315091/Online-Hospital-Promos-a-Marketing-Catch22

Joint Replacement Patient Outcomes Registry: Proprietary!

Functional Outcomes Data for Joint Replacement Ups the Quality Ante

Cheryl Clark, for HealthLeaders Media , April 2, 2015  FiDA highlight added

Collected by an evolving roster of state registries, functional outcomes data complements data on readmissions and complications and is of value to surgeons, hospitals, and payers as well as to prospective patients.

As Medicare and state agencies increasingly turn their scrutiny to complication and readmission rates for the more than 1 million hip and knee replacement surgeries performed in U.S. hospitals annually, new provider registries are asking patients questions that will determine their HOOS/KOOS.

Come again, you say?

Yes, it's an odd phrase for such a serious subject.

HOOS/KOOS stands for hip disability and osteoarthritis outcome score and knee disability and osteoarthritis outcome score. These are 40- and 42-question surveys that ask about patients' pain levels, symptoms, stiffness, function during sports and recreational activities, and quality of life before and after joint replacement surgeries.

The surveys aim to determine whether a surgery has restored a person's ability to do what she used to do, or what she expected she'd be able to do, and whether it alleviated her suffering.

This is the sort of functional data that has so far been missing from Medicare's Hospital Compare, which recently began disclosing hospital-level rates of 30-day readmissions and serious complications for patients undergoing joint replacement surgery. Readmissions and complications are, of course, extremely significant.

But some might argue that it's also important to know whether patients got the results they anticipated, and whether they perceive that they are worse or better off months later.

Down the line, private payers may tether the price they'll pay for some procedures, at least in part, to how well a surgeon scored on these kinds of surveys. It's another form of value-based contracting.

Registries Abound

Evolving state registries to measure such fine points of patient outcomes include the California Joint Replacement Registry (CJRR), the Virginia Joint Registry, and the Michigan Arthroplasty Registry Collaborative Quality Registry (MARCQI), as well as a national network called the American Joint Replacement Registry (AJRR).

These organizations seek to answer questions about surgeon and hospital proficiency after patients have lived with their new joints for periods of time. Most of the registries use versions of HOOS/KOOS, among other quality and safety indicators.

Now, there's an even larger database on the scene, the Function and Outcomes Research for Comparative Effectiveness in Total Joint Replacement (FORCE TJR). I know, it too has a funny name, like a video game set in outer space.

Co-directed by Patricia Franklin, MD and David Ayers, MD, of the University of Massachusetts, FORCE TJR was funded with a $12 million grant, now expired, from the federal Agency for Healthcare Research and Quality.

To date, Franklin says, FORCE TJR has amassed pain and outcome data for 30,000 surgeries performed by 150 surgeons at 70 hospitals in 24 states. For the bulk of those surgeries, the network has collected more than two years' worth of follow-up data. All patients added to the registry are followed indefinitely.

And while the data is not public, FORCE TJR has used results from 25,000 of those surgeries to create demographically representative benchmarks so various kinds of hospitals and a representative sample of surgeons can compare their risk-adjusted scores.

Now, the network is trying to recruit more doctors to join the registry. It's been "ahead of the others in implementing this and making it mandatory for every patient" so that surgeons and hospitals that participate can't cherry pick the patients who get surveyed, Franklin says.

An important factor in creating and implementing registries is how surgeons learn from information they receive, or from those who get higher scores, especially if it shows wide variation in scores, such as infection rates.

Nationally, she says, the average 90-day all-cause complication rate from hip and knee replacement surgeries is 4.5%, but the variation is nearly four-fold, from 2.2% to 8.9%.

It's Only Good If It's Used to Improve

Reports have suggested that because surgeons are busy and lack support from their hospitals, they may not have an opportunity to learn from better performers or implement practice changes to improve their own results.

After getting less than desirable scores, a surgeon from one orthopedic practice told Franklin that now, there's someone available to answer patients' questions more promptly after they're discharged, and schedules are always rearranged to see patients "the next morning" if there's a concern about redness or swelling or pain near the incision.

Without prompt attention, a patient might go to the emergency department "and see someone who didn't know the patient or know about their surgery."

Another benefit is that results are relayed back to the hospital and surgeon every quarter, unlike data now posted on Hospital Compare, which is usually at least two years old. "Often, this is the first time that the surgeon really [has gotten] this kind of feedback," Franklin says.

In time, she imagines that the Centers for Medicare & Medicaid Services will publish FORCE TJR data, perhaps in aggregate or as a composite, either on Hospital Compare or Physician Compare.

"The question is, what data will be useful to the public? That's what Hospital Compare will have to test. I imagine we will get there in time. But it will have to be information that is meaningful to the patient," and information that will show variation as well, Franklin says.

U.S. News & World Report may soon publish names of hospitals and whether they choose to report if their orthopedic surgeons are participating in such a registry, she says. That's at least a start.

Several insurance companies are already using models to collect data like this from surgeons.

With so many aging baby boomers insisting on high levels of physical function into their senior years, hip and knee replacement procedures can only be expected to grow. In 2011, according to the National Center for Health Statistics, there were more than 710,000 knee replacements, and more than 460,000 hip replacement procedures. Their costs were $11.31 billion and $7.96 billion, respectively.

I just hope all of this quality data is available publicly if and when I need to get one.

http://www.healthleadersmedia.com/print/QUA-314942/Functional-Outcomes-Data-for-Joint-Replacement-Ups-the-Quality-Ante

Cheryl Clark is senior quality editor and California correspondent for HealthLeaders Media. She is a member of the Association of Health Care Journalists. 

 

"one of the worst offenders" orthopedic surgery overuse . . .

Orthopedists' Financial Conflicts Can Hurt Patients, Surgeon Says

Cheryl Clark, for HealthLeaders Media , March 17, 2015  FiDA highlight added

It is financially compelling for many doctors to do things that aren't really going to help their patients, says an orthopedist who is leading a campaign against surgical overuse.

Financial conflicts of interest often drive physicians to perform worthless surgeries, but the field of orthopedics "is one of the worst offenders," says an Indiana orthopedist who has launched a "moral persuasion" campaign to persuade his colleagues to stop.

"It's really hard for doctors to acknowledge this and change their ways," says James Rickert, MD, who years ago founded the Society for Patient Centered Orthopedic Surgery to address the problem.

It's especially tough for doctors who own related businesses that depend on surgical volume, which puts even more pressure on them to "be more like businessmen instead of doctors," he says.

A lot of orthopedic surgeons "own part of the distributorships that sell the total hip or knee implants to the hospital, and they'll make a ton of money on that. Or they own the imaging center they send their patients to. They own a piece of the surgical center. They know if they're not doing a lot of surgery, they may lose money on their overhead," Rickert says.

A series of four reports from the Government Accountability Office documents greater numbers of procedures referred by physicians who own providing businesses, compared to referrals from non-owners.

"That makes it really compelling for doctors to do things that aren't really going to help their patients. They become more like salesmen, saying things like, 'Well, it might help.' Or, 'We don't have much to lose, let's try it,' knowing full well the data shows there's very little chance the procedure will help and some evidence the patient could be hurt."

Rickert has long been aware of surgical overuse, including his own. But he didn't work hard to stop it until he himself got sick. He was diagnosed with non-Hodgkin Lymphoma at age 42, underwent chemotherapy, bone marrow, and stem cell transplants, recurrences, and foul-ups in his care. Now 54, he's been cancer free for five years. 

"I was accessing the system every day for months as a very sick person, having a lot of problems. I started to think about patient-centered care expectations and how different that is from reality."

As he got better and returned to his Bloomington practice, he founded the society to appeal to surgeons' consciences. So far, 14 fellow orthopedists have joined his effort.

Performing unnecessary surgeries, he says, "is not [necessarily] below the standard of care. For example, the doctor can usually say, 'Hey, he had a torn medial meniscus and here's an MRI that proves it,' even though it was not the right thing for a severely arthritic patient."

"I certainly have a lot of patients referred to me from nearby. And when I look at the surgery and pathology they had, I just know that there was no way that doctor really thought that was going to help them."

At the Lown Institute conference in San Diego last week Rickert described one of many sad cases. Two decades after performing a successful knee scope on a patient, the now severely arthritic patient returned, seeking another scope. Rickert advised that it would not help and could cause problems.

The patient went to another orthopedist and had the procedure. This surgeon thought the worst that would happen would be the patient wouldn't be any better, but would at least be satisfied that the doctor had tried to help. "Instead, the patient gets a deep vein thrombosis that turns into a pulmonary embolism, and two days later he's dead," Rickert says.   

For doctors, it's like an inside secret, he says. "We know about these risks, but the patients don't."

Rickert and some of his colleagues also criticize the American Academy of Orthopedic Surgeons' Choosing Wisely list of five procedures doctors and patients should avoid. None on the academy's current list is especially common or very important, Rickert says. 

Kevin Bozic, MD, chair of the AAOS Council on Research and Quality, said via email that the Choosing Wisely list was created from systematic reviews of the literature and is limited to available evidence that various treatment options for musculoskeletal conditions are effective, "which we are seeking to improve." AAOS is working to define appropriateness criteria incorporating patient preferences and values into medical decision-making, he said. Since it submitted its list of five practice guidelines in 2012, AAOS has published four more to be reviewed for possible inclusion in a second Choosing Wisely list.

At the conference, Rickert and Rob Rutherford, MD, an orthopedic surgeon from Coeur d'Alene, ID, presented what they say is a more relevant list of procedures that are frequently performed, usually unnecessary, high cost, and sometimes harmful:

1. Vertebroplasty
Cost: $10,000 

The percutaneous injection of cement into a fractured vertebra. The procedure, done in about 100,000 patients a year, is falsely marketed as relieving pain quickly. But in clinical trials, pain relief was similar to that seen in patients who underwent sham surgery. The procedure's risks include compression fractures in adjacent vertebrae, dural tears, infections, cement migration, and nerve pain that requires subsequent surgery.

2. Rotator Cuff Repairs in Elderly Patients

Cost: $15,000

About 600,000 such surgeries are performed in the U.S. each year. The number of surgeries increased by 141% between 1996 and 2006. This surgery is vastly overused on patients who are asymptomatic. Complications include infection, bleeding, re-rupture of the rotator cuff, nerve damage, blood clots, and the need for repeat surgery to correct the first procedure.

3. Clavicle fracture repair or "plating" in adolescents
Cost: $13,000
This procedure is performed in a small percentage of adolescents each year to improve function. "I don't know of any good indication, especially with conservative care being so successful" and rarely does the surgery benefit, Rickert says.  

Regardless of patient age, type of sport, and final clavicle shortening, there's no differences in pain, strength, or range of motion. But there is a risk of deep infections, pneumothorax, and other complications. 

4. Anterior Cruciate Ligament Tear Repair in Low-Risk individuals
Cost: $10,000
ACL surgeries are performed in 100,000 patients a year and carry high risks but demonstrate no difference in rates of return to pivoting-activity sports one year later than conservative rehabilitation and activity modification. Complications include infection, instability, stiffness, pain, patellar fracture and growth plate injury in children.

5. Surgical Removal of Part of a Torn Meniscus 

Cost: $6,000
Annually, this surgery is performed in 700,000 patients with knee arthritis and no mechanical symptoms. But it does not provide significant benefit compared with sham surgery in patients with degenerative meniscal tears. There's equal pain relief and functional status.

Rickert, who is on the faculty of the Indiana University School of Medicine, emphasizes that IU Health has a policy forbidding its doctors from accepting money or gifts from the pharmaceutical or medical device industries.

He says his specific orthopedic group does not own an MRI or an orthopedic surgery center. And he acknowledges that he gets "e-mails and grouchy comments from doctors [at other organizations] who want me to not do this [campaign]."  

"There's still a lot of resistance from entrenched interests. But we have to show doctors the data, studies that show this doesn't work, and then ask, 'why are we still doing this?' We have to confront them with the data."

Cheryl Clark is senior quality editor and California correspondent for HealthLeaders Media. She is a member of the Association of Health Care Journalists. 

http://www.healthleadersmedia.com/print/QUA-314383/Orthopedists-Financial-Conflicts-Can-Hurt-Patients-Surgeon-Says

Let Harmed Patients In: End 'deny-and-defend'!

After a Medical Error,Patients Could Become Hospital Insiders

Cheryl Clark, for HealthLeaders Media , May 22, 2014

Patients who have been harmed by medical errors, and their family members, could be recruited to hospital internal quality review proceedings and their suffering could be used to prevent future mistakes. It's a good, but potentially disastrous idea.

Hospital quality expert R. Adams Dudley, MD, was flapping his official UCSF identification badge that hung from a lanyard around his neck. He told the group at a recent patient safety meeting that when a hospital patient is harmed, "maybe they and their families should be given one of these."

The point he was trying to make was this:

It's not enough for healthcare providers to merely be honest and apologize when a patient suffers harm, a strategy slowly replacing the standard "deny-and-defend" practice that persists in most hospitals, he says.

And it's not enough to do the thorough root cause analysis, even offering compensation right away, which some organizations are starting to do to avoid litigation and help patients grapple with the tragedy.

They need to do more if they're truly serious about being honest and preventing errors going forward, and this is what Dudley thinks might be the next step to take.

"What if, when someone is harmed in our hospitals, we say not only, 'we're sorry you were harmed', but 'here's a badge. Now you're part of our team. Now, if you choose, you can be a patient advocate, come to our staff meetings, talk about what happened, [and] attend patient safety conferences. We'll e-mail you the meeting schedule.'"

We want you to help tell us how we can prevent this from happening to someone else, he says.

'They Know We Messed Up'


"What better way for us to open ourselves to really, truly be transparent than to say that the people we let watch us should be the ones who know we can mess up, because we messed up with them?"

Dudley's patient badge isn't figurative. It should be a real piece of plastic that lets these patients and their families inside the hospital's inner sanctum, so they may walk the halls with the doctors and nurses. It's important symbolically and psychologically, he acknowledges.

"If we really believe that we [as providers] should be held accountable, why wouldn't we be willing to talk about these issues in front of the people who no doubt feel a strong need to check us out?"

But what if patients and their families see providers arguing with each other about what went wrong, pointing fingers to assign blame? Wouldn't it be a bad idea to allow patients or their families to see that discord?

Not at all, Dudley says.

"If one specialist thinks one thing, and another thinks another, there's no reason to hide that. That's just part of medicine. It happens all the time." It's part of the process of getting to the truth, he says.

Dudley, founder of the California Hospital Assessment and Reporting Task Force (CHART) and many other research initiatives geared to performance improvement, is known for his sometimes unconventional ideas. He acknowledges that many hospital officials will write them off as just more craziness from California's wacky healthcare system, he jokes.

But increasingly, this idea is taking off in a few places, although not quite as intimately as Dudley describes. Patients and their family members are being recruited in very public ways to the patient safety movement —although rarely inside the hospital's often tense and internecine adverse event review committees —to use their experiences to help fix flaws in the system.

Former Patient Outsiders Are Now Insiders


Helen Haskell of Mothers Against Medical Error, whose son died from one, now sits on numerous national safety panels. The parents of Rory Staunton, the 12-year-old who died of sepsis that a New York hospital failed to recognize, began a working relationship with state regulators and the Centers for Disease Control and Prevention to increase sepsis early detection. 

Then there's ePatient Dave, MRSA survivor Jeanine Thomas and dozens of other national examples of outsiders who are now insiders.

Of course, there's a point at which this could be a disaster, accomplishing the opposite of its intent, provoking nonproductive disruption from patients and family members who are still too angry and confused to make cogent contributions. Dudley acknowledges that he hasn't even proposed the idea yet to UCSF, although he might.

Because of that concern, I ran the idea by attorney Richard Boothman, chief risk officer and director for clinical safety at the 925-bed University of Michigan Health System. In 2001, Boothman replaced what he says was the classic "deny-and-defend" model for responding to adverse events with "the Michigan Model," in which patients are told up front what happened, followed by three specific actions:

1.              Compensate patients quickly and fairly when unreasonable medical care caused injury.

2.              If the care was reasonable or did not adversely affect the clinical outcome support caregivers and the organization vigorously. (A child with an ear infection who has a severe reaction to an appropriate antibiotic)

3.              Reduce patient injuries [and therefore claims] by learning through patients' experiences.

The result, published in the Annals of Internal Medicine in August, 2010, was that the average rate of new claims dropped from 7.03 to 4.52 per 100,000 patient encounters and the rate of lawsuits dropped from 2.13 to .75.

Also, median time from claim reporting to resolution dropped from 1.36 years to .95 years. And costs incurred for paying total liability, patient compensation, and non-compensation-related legal costs all declined, from $405,921 per lawsuit before the program was implemented to $228,308 after, a trend that persists.

But Boothman, who attended the same patient safety meeting where Dudley waved his badge, says, "It sounds great until you try it." UMHS did try it a year ago and encountered two insurmountable problems.

First, he says, "there's a practical problem that hit us right in the chops. When something bad happens, the clock starts ticking, and we have an immediate need to do our investigation to understand what happened so no one else gets hurt.

But patients are dealing with new medical needs, or sometimes they [or family members] are grieving. It sometimes takes them six months before they can talk with us, and I can't wait six months. I won't put other patients at risk."

Second, UMHS found "nobody will be honest unless they feel they're in a safe place. You have to create an environment where people can speculate, sometimes offer wild ideas about what happened."

He gives this real UMHS example: "A doctor operated on the wrong spine level, and during the event review everyone involved—doctors, nurses, techs—were in one room going minute by minute to figure out what happened. Afterwards, two nurses called me in tears saying 'You never got the truth.

"That surgeon was working in two different operating rooms at one time, and the residents were in over their heads. The surgeon got disoriented and operated on the wrong level.' "

"Well, why didn't you say anything?" Boothman asked them.

They didn't dare, they replied. "The surgeon was sitting across from us."

That's the problem, Boothman says. "If you put a grieving angry patient in a room like that and expect anyone will speak openly, it will never happen."

I like Dudley's idea because I think patients who believe they've suffered a hospital-caused harm see the system suddenly pivot against them.

Where before they may have felt important and secure, now they see backs turned and calls unanswered. The idea of letting them inside, making them members of this special club so they won't feel abandoned and victimized, and litigious, seems like it couldn't hurt.

But maybe there have to be limits to how far providers actually let them in.

Cheryl Clark is senior quality editor and California correspondent for HealthLeaders Media. She is a member of the Association of Health Care Journalists.

Health Leaders Media encourages patient harm dialogue

New Facebook Page Gathers Stories of Medical Harm

Cheryl Clark, for HealthLeaders Media , May 24, 2012  (FiDA Blog Bold)

As if Facebook didn't grab enough headlines on Wall Street this week, the social media forum is also making healthcare news that should prompt any leader to pay close attention.

ProPublica, the two-time Pulitzer Prize–winning newsroom that collaborates with other media outlets for investigative journalism, a few days ago launched its Facebook "Patient Harm Community."

People can sign up and post a healthcare horror story in graphic detail. Journalists are joining to find patients in their communities who have details to share. There's a special "Files" page entitled "What to do if you've been harmed," which instructs patients on where and how to lodge complaints about doctors, nurses, and hospitals. Even some healthcare providers are weighing in.

ProPublica's Marshall Allen, who uncovered systemic poor quality in Nevada hospitals for a 2010 series in the Las Vegas Sun called Do No Harm, and himself a Pulitzer finalist, explains what prompted the Facebook venture.

For starters, he says, the one million people—a staggering number—who suffer injuries, infections, and errors in healthcare facilities across the country each year had very few places to turn for advice, until now.

"Over the years, I've talked to scores of patients who have been harmed while undergoing medical care, and the one thing that always struck me is the fact they feel so alone," he says.

"When they suffer this type of harm, they complain to doctors and hospital officials and regulators, but they often don't feel that they're being listened to. 

"I wanted to find a way to give these folks an opportunity to talk to one another, offer advice, encouragement, and comfort, and get questions answered. A lot of them are at different stages of the process of working through the things that happened to them."

Healthcare professionals especially should pay attention to what's said on this site, he says, because it might illuminate what a patient with a bad episode of care really goes through. They should join in the conversation.

"I think for hospital leaders this would be a great place for them to put an ear to the ground, to hear what patients are really saying, and factor that in when they make decisions," Allen says. "We created this for doctors, nurses, hospitals, and healthcare officials just as much as it was created for patients."

"Doctors, nurses, and hospital officials also are very interested in reducing the number of patients who suffer infections, injuries, and errors while undergoing medical care," he adds.

Leah Binder, CEO of the Leapfrog Group, which plans to publish patient safety scores for 2,600 hospitals on its website in a few weeks, says ProPublica's patient safety community "is a great idea ... so people who suffer this kind of harm don't think they're the only ones."

"All too often I will hear from someone, 'I had the most unusual experience; I got an infection in a hospital' or 'someone gave the wrong medication.' But that's not unusual; that's usual," Binder says. "Most people who have been in a hospital have suffered some kind of harm and it's time to put a stop to that. People deserve to know that some hospitals are safer than others."

She notes that the Office of Inspector General at the U.S. Department of Health and Human Services counted up the number of deaths to Medicare beneficiaries caused by medical mistakes for one month. The extrapolated one-year total was 180,000. That makes for a lot of bereaved and frustrated family members.

By my count, membership in the fledgling Patient Harm Community is growing by about 100 a day as word gets out.

In recent days, for example, postings included these issues:

• A nurse in Phoenix claimed she was fired by her hospital, and now faces nursing board charges, for informing a patient about risks of upcoming surgery and the benefits of hospice.
• An infection prevention nurse in California, formerly a hospital inspector with the state Department of Public Health, told of undergoing a spinal disc procedure with a flawed protein material she was never informed about by her surgeon, resulting in multiple subsequent surgeries.
• A warning from an employee at the federal Agency for Healthcare Research and Quality for patients to not take antibiotics and proton pump inhibitors (like Prilosec or Prevacid) at the same time because of links to clostridium difficile infections.

Allen says ProPublica's social media experts looked around the country to find a similar online forum but without success.

This isn't like Yelp or Angie's List, where unhappy patients can anonymously pile on about a rude receptionist. "These are peoples' real identities, as far as we can tell, so if they say something to the group, their name is behind it. There's a little bit more accountability," Allen says.

It occurs to me that hospitals and doctors might be nervous about the page, fearing a free-for-all of complaints from emotional patients and family members who exaggerate claims or confuse the natural course of illness and disease with preventable misdiagnoses, infections, and medication mishaps. I see both sides, and appreciate the very human ways that can happen when people are in distress.

So I asked the American Hospital Association to take a look, noting that ProPublica wants providers to join the conversation.

Nancy Foster, AHA vice president of quality and patient safety, gives a tepid response: 

"When patients have concerns about their care, we encourage them to talk with staff at the hospital. Patients and their family members will find that their care givers are deeply concerned about making care right for them and that care givers also want to improve the care experience for future patients.
"Further, it is often helpful for patients to share their stories in forums like this one. However, as providers, we are both legally and ethically bound to honor our patients' privacy and not discuss their care in open public forums."

The American Medical Association did not respond to a request for comment.

Robert Wachter, MD, a patient safety expert at the University of California in San Francisco and chief of the Division of Hospital Medicine at UCSF Medical Center, thinks the site could be useful for healthcare officials. "One learns about medical mistakes through a variety of lenses, and this is another one," he says. "I suspect there'll be some interesting, useful information, a fair amount of ranting, and lots of people with painful stories they simply want to share with others. It'll be interesting to see how it plays out and whether it gets any traction."

ProPublica's team members monitor discussions and comment, posting relevant news or reference articles. As the site gets going, Allen says, "We want to do keynote question-and-answer sections with healthcare leaders and patient advocates, and whatever the topics are that audiences are most interested in, we'll try to provide useful resources."

I wondered how Allen's team will handle comments specific to named hospital facilities or physicians. "Let's say someone posts 'St. Augustine Hospital in Kansas City, MO killed my father when it gave him an overdose of morphine?'" I asked.

He replies that ProPublica will try to seek comment, "and to the extent we become aware of something we know is not true, we will take it down."

Allen acknowledges that the Facebook effort "is kind of an experiment, to be honest. We don't know how it's going to go or what direction it's going to take. We're trying not to control it too much, but let the members participate and engage one another and direct the direction that things take."

I know people at ProPublica personally, and the excellent reputation it has garnered in the last four years. If anyone can do this in a responsible way, surely this organization can, and highlight at a human level the harm that negligence and nonchalance can cause.

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Cheryl Clark is a senior editor and California correspondent for HealthLeaders Media Online. She can be reached at cclark@healthleadersmedia.com. Follow Cheryl Clark on Twitter.

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