Top 10 Quality Issues for 2013
8. Sepsis alerts in the emergency department
Look for CMS to roll out yet another quality checklist for doctors and nurses in the emergency room that will look for symptoms of sepsis, the body's response to infections in the blood that is a frequent cause of preventable hospital death. Symptoms are often overlooked until it's too late.
Premier's Bankowitz says the federal quality initiative is an attempt to get emergency teams to look for evidence of hydration, serum lactate levels, antibiotic administration, and culture sampling so they function more rapidly to prevent progression.
"A lot of the time the diagnosis is missed. Sepsis isn't considered, because the symptoms can be subtle, especially in patients with a fever or mental status changes."
9. Squeezing waste
It's 2014. And let's say you're a poorly performing hospital on every measure now being scored under incentives and penalties written into the Affordable Care Act.
Unacceptable 30-day readmissions, lousy patient experience scores, poor compliance with core measures, high 30-day mortality, and higher numbers of hospital acquired conditions: Your hospital hit the jackpot.
According to a chart presented at a recent Institute for Healthcare Improvement forum, a sample 500-bed hospital that is a poor performer in every respect could see reductions in payments as high as 2.8% starting this year, falling to 9.1% in 2015, 12.2% in 2015, 14.1% in 2016, 15.6% in 2017, 17% in 2018 and 18% in 2019. Repeat for emphasis: 18% by 2019.
That includes market basket, productivity cuts, geographic variation cuts and wage index cuts, as well as disproportionate share reductions for certain hospitals that receive those funds.
No matter how you figure it, there's enormous incentive for hospitals to reduce variation to get costs lower and improve quality to avoid extra charges eroding revenue from each patient DRG.
10. Blood management
Expect there to be more discussion within acute care settings about how blood transfusions in certain patients who are not actively bleeding may not only be unnecessary, but may be resulting in avoidable adverse reactions, longer lengths of stay, and poorer long-term patient outcomes.
Hospital leaders looking to tighten the belt may not have thought about the cost of blood as a significant part of their budget. But now, more are factoring in extended lengths of stay for patients—about 1% of whom may have an adverse reactions to that transfused blood—and hospital lab processing costs that can elevate a red cell unit's price tag from $210 to $1,000.
A several-year program run by Premier for 464 participating hospitals found variation in blood management practices that was astonishingly wide.
If all the hospitals in the group changed transfusion procedures to those adopted by those hospitals that used the least amount of blood, some 802,000 units of blood would not have been used, and these 464 hospitals would have saved $165 million per year.
Top 12 Healthcare Quality Concerns in 2012
Top 10 Healthcare Quality Issues for 2011
Top 10 Issues Facing Healthcare in 2010
Cheryl Clark is senior quality editor and California correspondent for HealthLeaders Media. She is a member of the Association of Health Care Journalists.
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