I received a pardon from the cliché police to write this sentence:
What follows represents the columnist's dog days of August. Vacations, heat and drought, Supreme Court decision withdrawal, or election anticipation. Take your pick of excuses.
There wasn't much in the news this week to inspire my usual quality rant, although the New York Times story about federal inquiries into unnecessary cardiac procedures putting patients at risk at Florida HCA hospitals—a deja vu of St. Joseph's Hospital in Towson, MD and Tenet's Redding Medical Center in California—was tempting.
Times like these, the weary writer turns to "the list," in this case, my 10 favorite columns of 2012, so far. From our readership numbers, it looks like they were your favorites too:
1. 10 Things We Don't Know About Looming Readmissions Penalties
This March 29 piece captured the angst and uncertainty about how the Centers for Medicare & Medicaid Services would roll out the final rules for readmissions penalties, how hospitals' risk adjustments would be made, and of course, which hospitals would have to absorb negative payment adjustments of between one cent and $1 for every $100 in base DRG payments starting Oct. 1.
As of last week, the list of all hospitals eligible for readmission penalties is out and published here. Download "FY 2013 IPPS Final Rule: Hospital Readmissions Reduction Program Supplemental Data File."
Of the 3,393 hospitals eligible for the penalty, 2,215 hospitals will receive some payment reduction. But only 278 of those will receive the full 1% according to the final rule, fewer than the 481 slated to receive that penalty in the proposed rule. Of course, next year the price will be steeper, with penalties of up to 2% of a hospital's Medicare base DRG payment.
2. Hospital's Drug Diversion Nightmare Spawns Multiple Infections
This June 28 column detailed the extent of concern for hospitals about the growing practice of drug diversion among their most critical employees. In this small New Hampshire facility, more than 30 patients treated in the cardiac catheterization unit have tested positive for the same strain of hepatitis C as one employee.
A follow-up column Aug. 2 explains how the lack of a federal registry for this level of healthcare provider allowed a worker to potentially infect patients in the 11 other hospitals in eight other states where he worked over the last several years.
The employee, a radiology technician who worked at Exeter for more than a year, now faces federal charges, and the hospital is grappling with multiple investigations by numerous federal and state agencies.
3. Hospitals Give Leapfrog Safety Scores A Failing Grade
When Leapfrog released its first report-card style grade of how likely a patient might endure harm while being treated in several thousands of the nation's hospitals, many hospitals and trade associations were enraged saying that the purchasing collaborative had used a biased algorithm. We interviewed hospital officials for this June 7 column.
4. When A Surgical Site Infection Sends A Friend Through Hell
John Muncie, who now lives in Virginia, was one of my editors in a previous publication. When I heard he suffered a life-threatening infection at a brand new hospital, he was eager to explain what happened for my Feb. 16 column. John has recovered, I'm happy to say, and is so much wiser about how healthcare with the best intentions can go terribly wrong.
5. New Facebook Page Gathers Stories of Medical Harm
The emphasis on healthcare system safety took on a new dimension with the introduction of ProPublica's Patient Harm Community, an interesting experiment on Facebook, which my column detailed on May 24. Patients are encouraged to tell their stories in hope of provoking conversation and system-wide prevention strategies. The Institution for Healthcare Improvement's IHI Patient Activist has launched a similar effort.
6. CMS Reveals Central Line Infection Rates, Finally
This Feb. 9 column applauded the release of hospital intensive care units' rates of central line bloodstream infections on Hospital Compare, a victory for checklist guru Peter Pronovost, MD. The Johns Hopkins intensivist has long argued that hospitals need public comparative data as an incentive for improvement.
I suggested that he should be popping open a bottle of champagne, not knowing his choice of beverage. In fact, when I interviewed him for this piece, he acknowledged pouring himself a glass of wine.
7. ICD-10 Proponents Cry Foul
When federal officials announced they were looking to delay the start date for ICD-10, many quality leaders and coders, as well as hospital officials who had already invested in the update, were pretty upset, as I explained in this March 1 edition. We still don't know when the final decision will come out, but we're expecting it any day.
8. Preventing Hospital Readmissions Takes a Village
Hospitals have long complained that they shouldn't be punished when patients are readmitted for reasons that have nothing to do with the acute care they received or the discharge planning process. Rather, readmissions occur because of demographic, sociological factors in many cases, such as lack of transportation, poor sanitation in the home, lack of funds to pay for prescription drugs.
A new $500 million federal program that would fund community based organizations to tackle these problems was met with lukewarm response from hospital groups. But as I described in this April 12 column, several hospitals were starting to sign up.
9. Eight Reasons Why Ambulatory Care Quality Matters More Than Ever
Federal officials start ramping up the safety and quality markers for ambulatory care services, as I described in this Jan. 19 column. Medical mistakes with potentially life-threatening consequences arguably occur in outpatient settings perhaps even more frequently, although less acutely noticeable, than in inpatient settings.
More complex procedures are performed in clinics and office practices, more drugs given, and more levels of provider are delivering that care.
10. Patients Set to Unleash Feedback on Doctors
Data is now being collected by the federal government to post scorecards for patient experiences they had with physicians on Physician Compare, which is set to go live on Jan. 1. The scorecard is expected to be similar to the HCAHPS survey. Doctors, brace yourselves.