California and Los Angeles County inspectors found serious irregularities in the admission and treatment policies of City of Angels Medical Center four years before authorities raided it and charged its chief executive with providing unnecessary medical services to patients recruited on skid row, according to a report. After inspections in early 2004, state health officials ordered the hospital to correct an array of problems, including accepting patients with "questionable medical criteria for admission." But there is no evidence that the state ever followed up to ensure changes were made.
California healthcare regulators have fined four San Diego-area hospitals $25,000 each for preventable mistakes that led to the death of one patient. Five more reports of similar incidents at San Diego-area hospitals are under review and could lead to additional fines, according to a spokesman for the state Department of Public Health. The reports are part of a statewide review of reported incidents. Forty California hospitals have been fined since July 2007.
A man on disability since surgeons may have operated on him with instruments coated in hydraulic fluid will be able to sue Duke University Medical System after a judge ruled that the $14,000 price tag to bring the grievance before a panel of private arbitrators is too costly. The ruling could be repeated in other courtrooms around the state, and it echoes a decision by the North Carolina Supreme Court earlier this year that found mandatory arbitration agreements can make it too pricey for consumers to pursue their disputes. The ruling could also help create a more favorable legal climate for an untold number of the 3,648 patients who may have been operated on in late 2004 with contaminated instruments at two Duke hospitals.
Floridians can now go online to find inspection reports and the results of complaint investigations involving most health facilities in the state. The data previously took a formal public-records request to obtain. The Florida Agency for Health Care Administration began posting the reports online to give consumers another tool for assessing 32,000 hospitals, nursing homes, clinics, surgery centers, dialysis units, and other healthcare facilities. Consumers can look up official state reports written after annual inspections, investigations into complaints, safety inspections, and unannounced visits. Such reports include details of violations such as cleanliness, medical mistakes, and procedural errors.
The University of Kansas Hospital has implemented a mandatory training program—the first of its kind in the nation—to train staff on how to handle delivery emergencies. The exercises are designed to save newborns and their mothers during potentially catastrophic emergencies. About 100 members of the hospital's staff have been going through two days of classroom and hands-on training. They have been learning how to deal as a team with a variety of obstetrical emergencies that are each relatively rare, but account for many of the deaths and serious injuries of childbirth.
Is there a point where CMS' demands will become more important to hospitals than providing actual patient care? I suspect that most CEOs would immediately answer "No!" But as CMS reporting requirements continue to increase, there may come a time when healthcare organizations are forced to choose between collecting data and providing patient care.
The 13 new reporting requirements added by CMS late last month probably won't add too much of an additional reporting burden on most hospitals. Most of the 13 added indicators are already calculated from Medicare billing information. But by adding these 13 requirements, CMS is sending a clear message to hospitals that data reporting is the way of the future, and many in the industry believe these new mandates are the tip of the iceberg. There may come a day when a hospital will have to choose between hiring an additional nurse for the intensive care unit, or an additional staffer to collect and report data.
Which will you choose?
Answering that question will no doubt be difficult. Hospital executives know how important reimbursement from CMS is to the financial health of a hospital, and they must do everything they can to position their organization to receive the appropriate amount. But on the other hand, making someone a data collector rather than a caregiver seems to go against the mission of any hospital. And as patients get more demanding, the care you offer them can also have a financial impact on your organization.
Studies have shown that patients remain unconcerned with data when it comes to healthcare, and they are even less interested when the data is something that they don't understand. Most patients, for example, don't know why the time between when a patient comes out of surgery and when he or she receives a beta blocker is important. What does matters most to patients is that they have a nurse who responds quickly when they hit the call button, gives them medication on schedule, and helps them out of bed to use the restroom. For patients, quality is receiving the care they need when they need it. And if they don't receive the care they want, they're likely to take their business elsewhere, and that of friends and family who hear about their poor hospital experience.
Thankfully, the 13 additional reporting indicators that CMS will require in this year's rule won't be significantly taxing to a hospital's resources. The new requirements are significantly less than the 43 the agency proposed earlier this year. However, I'm not convinced that the 30 requirements that didn't make this year's cut are gone forever. Down the road, CMS will place further reporting mandates on America's hospitals, and at some point, executives might have tough choices between patient care and the organization's financial wellbeing.
Maureen Larkin is quality editor with HealthLeaders magazine. She can be reached at mlarkin@healthleadersmedia.com.
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