As I was putting together this week’s edition of QualityLeaders, the Centers for Medicare & Medicaid released nine new proposed “never events” that hospitals won’t be reimbursed for if they are acquired while a patient is receiving care at the organization.
These conditions include:
Blood clots in the vascular system
Bloodstream infections
Ventilator-associated pneumonia
Legionnaire’s disease
Delirium
Collapsed lung as a result of medical treatment
The nine new conditions on the “won’t reimburse” list aren’t much of a surprise to anyone. Many of the quality leaders I’ve spoken with in recent weeks seemed to expect that the original eight on CMS’s list would soon have company. Some even went so far as to say that the first eight were the “low-hanging fruit” or the most obvious of the conditions that hospitals must take care of to provide quality and safe care to patients. But what do these new additions tell us about where CMS is headed? Are they reasonable?
James Kennedy, MD, CCS, of FTI Healthcare in Brentwood, TN, told my colleague Lisa Eramo that although the majority of the new conditions listed by CMS are reasonable, there are some that raise eyebrows. For example, patients can acquire Legionnaires’ disease both in and out of the hospital setting, particularly through air conditioning units that contain waterborne pathogens. Certainly, he says, patients have acquired the disease from hospital air conditioning units, but it isn’t clear how hospitals will determine if the condition was present on arrival.
The additions of clostridium difficile colitis and delirium have also been questioned, as these two conditions often occur as a side effect of medication or being in the hospital for expanded periods of time.
Fortunately, CMS gives us until June 13 to comment on these proposed additions before it releases the final rule on or before Aug. 1. Will you be sending your comments? If so, what will you tell them? Do you think your feedback will be addressed in the final rule?
A note to my faithful readers: In last week’s column, I promised to introduce you to more “zero heroes.” I haven’t forgotten about them. Stay tuned.Maureen Larkin is quality editor with HealthLeaders magazine. She can be reached at mlarkin@healthleadersmedia.com.
The director of the Agency for Healthcare Research and Quality says pharmacists have an important role in improving medication safety in emergency departments. Carolyn M. Clancy, MD, emphasizes the growing need to employ pharmacists to reduce the risk of adverse drug events in the EDs. Clancy adds that the "Introducing an Emergency Pharmacist into Your Institution" initiative helps hospitals obtain support for and implement emergency pharmacist programs.
New York State Sen. Kenneth LaValle said he plans to reintroduce legislation by to put "more teeth" into Stony Brook University Medical Center's oversight board. The oversight board was not informed until recently of a case in which diseased organs were transplanted from a 15-year-old Sag Harbor boy. LaValle also wants to introduce a bill to ensure that transplant doctors statewide are following best practices.
The Penn State Milton S. Hershey Medical Center supports telling the public about its infection rates, despite the medical center having Pennsylvania's highest infection rate in a recent report.
The report looks at infections that strike patients after they enter the hospital, and nearly five out of every 100 patients came down with an infection at Hershey. The authors of the report by the Pennsylvania Health Care Cost Containment Council warned people not to use the infection rates to make harsh judgments or compare hospitals, saying the process of reporting infections is complicated and new. Some hospitals might not even be detecting or reporting all of their infections, the council added.
At the Society for Healthcare Epidemiology of America's annual meeting in Orlando, FL, the medical director of Infection Control at North Carolina's Pitt County Memorial Hospital said a program is making significant progress in reducing the number of patients bringing MRSA into the hospital. The hospital made a considerable investment in its "search and destroy" approach to MRSA, totaling $950,000 for new technology, kits and employees, according to the report. PCMH has the ability to run 30 MRSA tests at a time in its detection system for up to 150 tests per day.
Milford (MA) Regional Medical Center has reached out to its non-medical personnel and volunteers to encourage them to wash their hands while moving about the hospital and installed hand sanitizing stations near patients' rooms to encourage visitors to keep their germs away from hospitalized loved ones. The hospital is now trying to take its in-house campaign outside its borders to towns within its service area.