When it comes to kids' access to healthcare in Florida, the state ranks dead last, according to a recent study by the Commonwealth Fund. The 55-page report found that Florida's care for kids also ranked 37th for quality, 34th for costs, 43rd for equity and 38th for "potential to lead healthy lives."
Beginning in October, New York hospitals won't be able to bill Medicaid for "never events" such as mistakes during surgery, medication errors and other deadly complications caused by preventable hospital blunders. The goal is to shift the burden to hospitals, practices and doctors if they make a dangerous mistake, and the state health department expects to save $6 million from the change. New York's Medicaid program is among the most expensive in the nation, costing taxpayers $47 billion annually.
A vacuum-cleaner-like device that sucks blood clots out of the arteries of heart attack victims before angioplasty reduces the death rate in the following year by nearly half, according to researchers. By physically removing clots, the device prevents loose fragments from breaking off, flowing through the bloodstream and blocking other vessels. Cardiovascular surgeons in many large centers are already using the technique to improve outcomes for their patients.
The number of New York City residents 50 and older who have undergone a colonoscopy has risen by about 50 percent in five years, according to a survey conducted by the city from 2003 through 2007. The gains were credited to the work of a group of physicians, insurers, union workers, hospital administrators and city health officials called the New York Citywide Colon Cancer Control Coalition. The coalition emphasizes that a colonoscopy should be performed once every 10 years for anyone 50 or older without a family history or other heightened risk factor for colon cancer, and more often for those who have those risk factors.
Texas-based JPS Health Network got hit with two surprise inspections recently—one by state investigators and one by the Joint Commission. As a result of the Joint Commission inspection, JPS has already been told of a number of deficiencies that must be addressed by certain deadlines, according to interim Chief Executive Robert Earley. Earley added, however, that The Joint Commission inspectors did not indicate that there would be a suspension of accreditation due to the investigation. The state inspection is ongoing, and if it uncovers violations it could also force changes in the way the hospital and its clinics operate, said JPS representatives.
Believe it or not, the first week of June is almost over, and time is running out to give your comments to CMS on its proposed 2009 Inpatient Prospective Payment System rule. The federal agency is accepting comments about its nine new proposed "never events" and 43 new reporting requirements until June 13.
Since the proposed rule was released in April, there has been chatter in the medical community about the possible effects the rule as it is written could have on the industry. Some have questioned how reasonable the new "never events" are, namely delirium and Legionnaire's Disease, says Nancy Foster, vice president for quality at the American Hospital Association. The AHA plans to file a response to CMS before the June 13 deadline based on the feedback it is getting from members and those who work in the field.
"Most of the feedback we are hearing is concern that CMS has stretched beyond the bounds of what we would think would be included in something that is reasonably preventable with known evidence-based practices," Foster says. "Certainly, delirium has raised a number of questions, and Legionnaire's disease—when it appears in any institution—is usually a function of not what clinicians are doing, but the hospital's cleaning and air conditioning systems."
The bottom line, Foster says, is that even when clinicians do everything possible to prevent the infections and conditions on CMS' list, they may still occur. That's why, leading up to the end of the comment period, the AHA has been working with infectious disease experts, surgeons, and intensivists to understand how each of the conditions on the CMS list can be prevented and the circumstances in which a hospital may not be able to prevent a condition from occurring.
The AHA will also express its concern with the section of the rule that would require hospitals to report another 43 quality measures. Foster says for hospitals to not only collect the data, but have staff members learn what it all means, will take time away from patient care.
"We're not sure that's the right way to deliver care to patients in our hospitals," she says.
The American Medical Association says it will also provide comments to CMS before the deadline, and Foster says she's heard that many state hospital associations have drafted opinions, too. Will CMS listen? That's yet to be seen, but Foster says the federal agency has a history of listening to constructive criticism from those in the field.
"CMS will receive a wide variety of comments from those of us in the healthcare provider role as well as other individuals—payers, policy makers, and the like," she says. "How they mash all that together to come up with a final rule is best known inside CMS, but they've shown in the past that they do take into account comments, especially when there is logic and reason."
What worries me most about the 2009 IPPS proposal is that no one yet knows how hospitals will be affected by the 2008 rule. As you recall, CMS won't stop reimbursement for the first eight "never events" until October 1. So it feels like CMS is jumping the gun just a bit. While I applaud its efforts to continue improving the care offered in hospitals, it may be better to delay another list of never events until we can get a handle on the effect of the first round.
Foster agrees.
"I do think it would be more prudent after the first round," she says. "Understanding the intended effects and the unintended consequences is important, as these are a large and very diverse set of additional issues."
Maureen Larkin is quality editor with HealthLeaders magazine. She can be reached at mlarkin@healthleadersmedia.com.
Note: You can sign up to receive HealthLeaders Media QualityLeaders, a free weekly e-newsletter that reports on the top quality issues facing healthcare leaders.