An international panel of heart specialists has recommended people with implanted heart devices receive closer follow-up care. The guidelines spell out who should do what to ensure good care, and tackles ethical dilemmas such as when to turn off a device and let a patient die. The guidelines also endorse new wireless technology that lets doctors check devices remotely while a patient is at home.
The quality of care at "safety-net" hospitals that treat poor and underserved patients is lagging well behind hospitals that do not serve these patients, according to a study. The safety net hospitals rely on state and federal funding from Medicaid and other sources, and do not have the money to improve the quality of care at the same rate that better-funded hospitals do. In the study, researchers examined data collected between 2004 and 2006 from 3,665 safety-net and non-safety-net hospitals. They found that hospitals that cater to a low percentage of Medicaid patients had significantly more improvement in quality compared with safety-net hospitals.
The Healthcare Association of New York State has received a $105,000 state grant for a program aimed at reducing hospital-acquired infections. The money will be used for The Healthcare Educational and Research Fund, which provides educational programs and monitors the systematic implementation of evidence-based control measures to reduce ventilator-associated pneumonia infections in critical care patients. HANYS was one of seven organizations to share in more than $1.2 million in funding from the state Health Department.
Recently the Centers for Medicare and Medicaid Services indicated its intention to move forward with measures to support value-based purchasing, a system where Medicare pays hospitals based on the quality of care delivered and patient outcomes. However, CMS failed to state whether the value-based model will transition healthcare to a new model or create the worst case scenario, a hybrid model where performance only partially counts and regulation requirements remain heavy.
In mid-April, Medicare proposed adding nine new conditions, such as bed sores, to a growing list of complications that Medicare won't pay to treat if they were acquired at the hospital. Granted, the government has only proposed these additions, but the message is clear: Medicare doesn't want to cover instances where hospital mistakes or less than optimal care contribute additional cost to the hospital stay.
At first glance, not paying for ineffective care makes sense. However, Medicare offered these changes with no direction as to how they relate to existing measurement standards. In addition, some of the medical complications are very difficult for hospitals to detect or prevent. Further, Medicare also is asking hospitals to begin reporting on 43 new quality measures in order to receive full payment. The prospect remains for the government to add other conditions, too.
The previous push for onsite hospital accreditation, including Joint Commission reporting, could be considered reasonable as hospital quality and safety data were not readily available. With the recent and accelerated push for transparency of performance information, it seems less realistic to continue to ask hospitals to meet accreditation standards that were designed as approximates for quality. In fact, hospitals are currently forced to make the tough decision of how many resources to allocate toward accreditation activities while still meeting the new performance standards.
Imagine that performance only partially counted in golf. We would have tournament officials stating Tiger Woods gets partial credit for his performance but the officials need to investigate whether his swing is consistent with the idealized swing before he could be considered the champion.
Providing quality care for patients is always the ultimate goal. However, there are limited resources available for healthcare, and hospitals can expect to spend hundreds of millions of dollars to meet the new quality measures. The last thing we want is for hospitals to be forced to divert resources and funding from direct patient care.
To be truly efficient, measurement standards need to take into consideration the succession of administrative requirements they trigger in a hospital. Further, as the conditions being reviewed become less precise, the costs of mechanisms needed to ensure reliable coding and comply with mandates, in addition to the cost of enforcement should be determined. While saving money may not be CMS’s sole objective, performing some sort of risk/benefit analysis is certainly warranted.
We also must be aware of the unintended consequences. The first set of conditions for which no payment will be made hasn’t even been implemented yet. Therefore, we don’t have the benefit of understanding the impact of these newest standards. Moreover, it’s worth considering whether CMS is even equipped to manage and process data effectively to ensure accurate payment to hospitals that meet the standards, which is important given that hospitals are already financially fragile. We would gain substantially from a “test run” with the first set of rules before launching into a discussion around nine additional new conditions.
These new guidelines bring focus and attention to hospital performance in an important and worthwhile way. However, simply adding another layer of reporting measures is not going to magically improve hospital performance —particularly if they are already burdened by outdated modes of looking at quality.
If quality patient care is the goal, then performance is what truly matters. Now that we have systems to measure performance in precise areas of patient care, perhaps other performance measurement burdens could be reduced. Otherwise, it calls into question whether performance really matters. If performance truly matters, it seems it can't be for partial credit.
Trent Haywood, MD, is senior vice president and chief medical officer for VHA, Inc., an Irving, TX–based healthcare alliance that provides supply chain management services and networking opportunities for hospitals and healthcare providers. Read our editorial guidelines to find out how you can contribute to HealthLeaders Media.
Clostridium difficile, or C. diff, isn't a new name to those who work in a hospital. But CMS' recent proposal to include the infection on its list of "never events" and figures released recently by the federal government have brought increased media attention to the hospital-acquired infection. And with a new, more drug-resistant strain making its way through our facilities, maybe it's time that we start paying more attention, too.
The last time a patient was discharged from your hospital, you probably made sure that a cleaning crew quickly readied the room for the next patient. They changed the linens, mopped floors, and wiped down counter surfaces. But do you know what kind of cleaning solution they used? Did they thoroughly wipe the phones, the call buttons, the bed rails, and other commonly-touched items?
If you can't confidently say "yes" to all of these questions, it may be time to start paying attention to how well your hospital is cleaned. Two weeks ago, my colleague Gienna Shaw wrote about how important clean facilities are to the image of a hospital, but cleanliness is more than image. With drug-resistant strains of C. diff and MRSA invading our facilities, cleanliness is a matter of life and death. To combat these infections, we have to make sure that our hospitals are not just spotless, but infection-less. Passing the white glove test is no longer an acceptable standard.
Curtis Donskey, MD, director of infection control at the Louis Stokes Veterans Affairs Medical Center in Cleveland, says that this newer, tougher strain of C. diff is why we're seeing so many more cases of the infection—both inside and outside of the hospital. While regular cleaning solutions used to be effective in wiping away C. diff spores, this new strain is tougher to eradicate and is more likely to be transferred from person to person through spores left on surfaces.
"You can go into a room and it looks clean, but it's not until you look closely that you can appreciate the contamination," Donskey says.
That's why at the VA Medical Center, cleaning crews are now using a solution that is 10% bleach to disinfect rooms between patients—but they're not just wiping down the tray tables, call buttons, and doorknobs. They're spraying the solution directly on the surfaces and allowing it to dry there.
"There is evidence that C. difficile is not killed by regular hospital disinfectants that are used to kill other pathogens," he says. A solution with 10% bleach, however, has shown to be effective in killing C. diff spores. "The major issue is not whether it kills, but how well you apply it. Spray it on and let it air dry. It takes contact time to kill the spores."
At Pacific Hospital in Long Beach, CA, controlling infection is a matter of simple hygiene for both the facility and its patients, says Alfonso Torress-Cook, MD, hospital epidemiologist. Over the last eight years, the rehabilitation hospital has completely reevaluated how its hospital rooms are cleaned and instituted a policy that all incoming patients are bathed with a special solution that eliminates C. diff pathogens from skin, he says. The result has been a 90% reduction of C. diff infections at the hospital.
"We made a commitment two years ago to make everything possible for our patients not to develop infections," says Torress-Cook. "We can prevent a lot, and we're trying our best. Am I going to say that I just want to prevent 30% of infections? No. I want to get to zero. Some say I'm crazy, but at least it's a goal and we are seeing results."
"Superbugs" like MRSA and C. diff aren't going away unless we collectively send them packing. Thanks to CMS and the media, there's now increased pressure for hospitals and healthcare organizations to do everything they can to make sure that facilities are not just clean, but super clean. If you haven't paid much attention to the cleaning of your facility lately, it's time to take interest, before the "superbugs" take control.
A Minnesota bill under consideration would define nurse assignment limits as "the maximum number of patients for whom one direct care registered nurse can be responsible during a shift." The number of nurses per unit would be reflective of patient acuity, the severity of patients' illnesses or medical conditions. Carol Diemert, nursing practice specialist with the Minnesota Nurses Association, said if a nurse's patient load is four, adding one patient would increase the risk of death by 7 percent.