Outspoken Wecht wants readers to understand ‘the multifaceted challenges of the interface of law and medicine’
Pathologists will recognize the name of nationally-acclaimed forensic pathologist Cyril Wecht, MD, JD, who for more than a half-century has been at the center of many of the country’s highest-profile civil and criminal cases. Thus, Dark Daily readers will be intrigued to learn the so-called “godfather of forensic pathology” has published a memoir that takes readers behind the scenes of many of his most controversial forensic pathology cases.
In his recently published memoir (above), forensic pathologist Cyril Wecht, MD, JD, offers readers an inside look at some of his most controversial cases, as well as a defense of his own brushes with the legal system. Anatomic and clinical pathologists may be especially intrigued by Wecht’s description of how “he was acquitted on charges of personally profiting from his office as Allegheny County Coroner” during a federal public corruption charge that was dismissed in 2008, the book’s description states. (Photo copyright: Exposit Books.)
A ‘No-Holds-Barred’ Account
According to TribLIVE, the book—written by Wecht and award-winning writer/filmmaker Jeff Sewald—is a “no-holds-barred account” of Wecht’s personal and professional life. Among the more interesting tidbits are details regarding Wecht’s 1972 discovery that JFK autopsy materials and specimens had gone missing.
“They had been in the government’s possession, so nobody could have touched them, but now the metal container which has held John Kennedy’s brain in formalin was no longer on the list of contents. In addition, various photographs and microscopic tissue slides were also no longer listed. The President’s brain was missing!” wrote Wecht, who argued Lee Harvey Oswald did not act alone in killing JFK and may not have fired the shots that killed him.
In 2006, Wecht faced an 84-count federal public corruption trial, which resulted in him resigning as Alleghany, Pa. medical examiner, the Pittsburgh Post-Gazette reported. In his memoir, Wecht wrote extensively about his public corruption trial. TribLIVE noted Wecht “expresses particular disgust” over the accusation that he supplied Pittsburgh’s Carlow University with cadavers in exchange for use of their laboratory space for his own practice. His trial ended in a hung jury.
“The body-snatching issue was seized upon by the media and was the subject of some of the most horrible cartoons ever,” Wecht wrote. “What made them especially horrible was the fact that I believe anti-Semitism was at their core. They made me look wicked and shadowy, like a ‘Shylock’ who was willing to stoop as low as selling human corpses for a handful of shekels. It was sickening.”
Wecht became known nationally through media appearances and his many decades of work as a medical-legal consultant in civil and criminal cases. At the 2000 Forensic Science and the Law Conference, television host and political commentator Geraldo Rivera, JD, stated, “I’ve known Cyril Wecht for most of my 30-year broadcasting career, and my respect for him has only grown over the decades. His skills as an attorney, as a pathologist, as a medical examiner are legendary.
“Dr. Wecht has guided my audiences through our coverage of crimes ranging from the Kennedy assassination to the O.J. Simpson trial to the JonBenet Ramsey murder mystery,” Rivera added. “And whether or not my audiences knew it, they were getting an education in forensic science—and a lesson in how medical science is applied to this country’s criminal laws.”
An ‘Expert’ and an ‘Irritant’
Though also certified in anatomic pathology and clinical pathology, Wecht has spent his career as a forensic pathologist focused on determining the cause of death. He has performed approximately 17,000 autopsies and has supervised, reviewed, or been consulted on approximately 30,000 additional postmortem examinations, the Cyrilwecht.com website states.
Cyril Wecht, MD, JD (above), told the Pittsburgh Jewish Chronicle that he wrote this memoir so readers could understand the “… complexity and the multifaceted challenges of the interface of law and medicine, specifically in the realm of pathology, and how important it is for justice to be served, with the input from forensic science, and how the system can be subverted, perverted, suppressed, and manipulated.” (Photo copyright: Pittsburg Business Times.)
Pathologists who followed Wecht’s career may know of his reputation “as both an expert and an irritant,” noted the Pittsburg Post-Gazette. For his part, Wecht stated, “If I had been a bit more diplomatic and patient, and a little less antagonistic and controversial, I might have achieved more,” the newspaper reported.
Anyone interested in forensic pathology will likely enjoy reading the behind-the-scenes stories from Wecht’s more than six decades of work. But Wecht’s memoir should be particularly intriguing and informative for clinical and anatomic pathologists, as well as all medical laboratory scientists.
Meaningful use, accountable care organizations, and bundled payment initiatives work best together to reduce readmissions, UM research suggests
Ever since the Centers for Medicare and Medicaid Services (CMS) implemented the Hospital Readmission Reduction Program (HRRP) in 2012, healthcare organizations all over America have sought to prevent unnecessary hospital readmissions within 30 days of discharge. For some clinical laboratories, this meant performing precise microbiology testing to ensure patients are discharged with prescriptions for oral antibiotics in-hand to combat possible infections. Now, a recent study reports that the effort could be paying off, and clinical laboratories played a critical role.
Research performed at the University of Michigan (UM) has linked lower readmission rates under the HRRP to voluntary value-based programs. The three value-based programs the UM researchers identified as contributing to the successful lowering of hospital readmission rates are:
The UM researchers published their findings in the Journal of the American Medical Association (JAMA) Internal Medicine. It could be the first study to demonstrate that synergistic value-based reward programs facilitate healthcare improvement and efficiency. As opposed to HRRP financial penalties alone that is, according to a UM news release.
Researchers Had No Expectations of Payment Reform Programs
Researchers at UM found that all three programs operating together in 2015 (the last year included in the longitudinal study) resulted in about 2,400 fewer readmissions and a $32-million savings to Medicare, the UM release noted.
The team analyzed data on patients treated at 2,877 hospitals from 2008 through 2015 for:
“We had no real expectations that hospitals’ participation in voluntary reforms would be associated with additional reductions in readmissions. We thought that it was just as likely that hospital participation in meaningful use, accountable care organization programs, or the Bundled Payment for Care [Improvement] Initiative may be distracting to hospitals, limiting readmissions reduction,” stated Andrew Ryan, PhD, in ACEPNow, a publication of the American College of Emergency Physicians (ACEP) in Irving, Texas. Ryan is an Associate Professor, Health Management and Policy, at UM’s School of Public Health.
More Participation Leads to Greater Reduction in Readmissions
Nevertheless, the UM researchers linked more reductions in readmissions based on common diagnoses to value-based “reward-style” programs than to HRRP financial penalties. And the more value-based programs a provider implemented, the greater reduction in hospital readmission rates, the study found.
Nearly all hospitals studied were participating in at least one of the value-based programs by 2015, as compared to no program participants in 2010, when the Affordable Care Act was signed into law, noted a Healthcare Dive article.
The chart above from the Kaiser Family Foundation (KFF) illustrates the reduction in hospital readmissions starting in 2012, which multiple studies have linked to the CMS Hospital Readmission Reduction Program (HRRP). The rates, according to the KFF, are risk adjusted to account for age and certain medical conditions. (Image copyright: Kaiser Family Foundation.
For 56 providers that were not participating in value-based care programs by 2015, researchers found the following readmission reductions also were associated with HRRP:
3% drop in heart failure readmissions;
76% drop in heart attack readmissions; and
82% decline in pneumonia readmissions.
For the majority of providers, however, escalating value-based care program participation resulted in greater readmission rate reductions, the study noted.
Readmission Reductions for Heart Failure Patients
Noting the influence of value-based programs, HealthcareDIVE and FierceHealthcare reported the following results for the heart-failure patients studied:
ACOs result in 2.1% annual readmission reduction;
MU participation attributed to a 2.3% drop in annual readmission reduction;
Involvement in all three programs (ACOs, MU, and bundled payments) result in the largest annual readmission declines for hospitals of 2.9%.
Readmission Reductions for Heart Attack, Pneumonia Patients
For myocardial infarction patients, the study showed these effects from value-based programs on readmission declines:
7% from ACO launch;
5% associated with MU; and
2% readmission reductions when all programs were in effect.
For pneumonia patients, the research suggested these changes in readmission declines were associated with value-based programs:
4% from ACO launch;
4% due to MU; and
9% when all programs were in effect.
The researchers advise that providers, aiming for quality improvement and cost savings, should leverage as many of these programs as possible.
“There is a reason to believe these [value-based] programs are reinforcing the broader push to value-based care. Our findings show the importance of a multi-pronged Medicare strategy to improve quality and value,” noted Ryan in the UM news release.
Clinical Laboratories Play Key Role in Reducing Readmissions
Accurate medical laboratory testing plays a critical role in the success of these hospital readmission reduction programs. Thus, all pathologists and laboratory personnel should congratulate themselves for a job well done. And commit to continuing their outstanding performance.
Tableau Software, IBM, Apple and others are building a future where analysis of clinical data guides personalized medicine, fuels research, and helps reduce healthcare costs
Use of big data in healthcare is poised to become a big business. That’s because new players in data analytics have begun to help providers and accountable care organizations (ACOs) effectively use data to improve their business operations, personalize care for patients, and/or discover new medical insights.
Computer diagnostics could offer opportunity for pathologists and clinical laboratory managers to add value to clinicians in diagnosing diseases
Efforts are intensifying to develop computer software that successfully emulates the skills of highly proficient diagnosticians. The motivation is increased pressure to reduce medical errors, including misdiagnosis. This is welcome news to many pathologists, who often see physicians ordering the wrong laboratory tests.
