Hospital company HCA Inc. announced it expects first-quarter revenue higher than a year earlier. Analysts and investors had been concerned about weakening results from the company as hospitals have been hurt by the global recession as patients cut back elective surgery and hospital admissions. HCA said it expects revenue of $7.4 billion to $7.45 billion, up from $7.13 billion a year earlier. Same-facility admissions are seen falling 0.9%, with the rate for the uninsured being flat.
As pills and capsules improve life for some cancer patients, they are sapping the finances of many cancer doctors. For drugs they administer in their offices, oncologists can make money: They buy those drugs wholesale and then get reimbursed by patients and insurers when they use the drugs. They also are paid for administering the infusion.
But with oral drugs, the doctors just write a prescription the patient fills through a pharmacy. The doctors make no money from the drug, and they have no infusion to bill for. Some doctors say the pills are actually raising their operating expenses.
Hospitals and healthcare institutions have strong reason to control construction costs. A case in point: The first free-standing hospital project in New York State in more than two decades, according to the state's Department of Health, is being built using an unusual construction method to cut costs by almost a third. To build what is estimated to be a $269 million hospital, Orange Regional Medical Center chose a construction company that uses the design-build method, which differs from traditional construction because the architect and general contractor are from one company.
A hospital can be a frightening place for children, which in turn creates a barrier of distrust nurses must work through in order to provide them with adequate care. However, recently released research suggests nurses can do less scaring and more caring for their facility's pediatric patients by brightening up their wardrobe.
A study published in the April 2009 issue of the Journal of Clinical Nursing examining the effect of multicolored, nonconventional attire on hospitalized children found it improved children's and parents' perceptions of the nurses providing them care. These enhanced perceptions led to increased comfort for the pediatric patients and increased confidence among parents of the nurses' abilities.
"Our goal was to understand the perception of nurses," says Filippo Festini, BA, BSN, RN, lead author of the study and professor of nursing science at the University of Florence in Italy. "The importance of our findings is that the multicolored uniforms improve the relationship between the nurse and the child, and this helps obtain the child's compliance to the treatment and reduce anxiety and fear."
The study was conducted by Festini and his team of University of Florence researchers between July and September 2005 among children at Meyer Children's Hospital in Florence. The researchers surveyed 112 children—ranging from six to 16 years of age—before and after nurses on two pediatric hospital wards swapped their light blue, traditional scrub uniform for nonconventional attire inspired by children's drawings collected throughout the country (you can view a picture of both uniforms here).
In both instances, researchers asked the children to define the nurses using one word, discovering a higher percentage (96%) used positive words such as "pleasant," "friendly," and "helpful" for nurses wearing the new uniforms than when they wore the former (82%).
The study cites "the children also expected the nurses to be 'funny' and 'cheerful,' and to play with them" while wearing the new uniforms. Researchers concluded the children's perceptions regarding the hospital environment, however, did not improve.
While the nursing uniform has dramatically evolved over the past few decades, many nurses still shy away from those splashed with child-friendly prints for fear they detract from their professional image. Shelley Cohen, RN, BS, CEN, president of the Hohenwald, TN-based Health Resources Unlimited, LLC, recently conducted an anonymous, national survey among more than 1,000 nursing professionals to delve into the types of behaviors, attitudes, appearances, and circumstances they felt shaped their image. Respondents were asked to rate several factors based on how much they affected the image of nursing, choosing from "no effect," "little effect," or "great effect." How nurses present themselves to patients and families was reported to have the greatest effect on their image. How nurses' dress was found to have the fifth greatest effect.
Furthermore, respondents suggested individual nurses could shape a more realistic image of nursing by ridding cartoon scrubs from their wardrobe.
Still, peering back into the pediatric study, the multicolored scrubs did not worsen pediatric patients' and parents' perceptions of nurses' professionalism, yet seemed to improve it. For example, researchers asked parents to rate the nurses on a one-to-five scale. Of their findings, parents' perceptions of nurses':
Adequacy in their role increased from 4.0 to 4.7
Ability to be reassuring rose from 4.0 to 4.5
Ability to not frighten their child rose from 4.4 to 4.7
Ability to be fun improved from 2.3 to 4.6
"By wearing creative and child-friendly scrubs, nurses demonstrate respect for the patients they are caring for and send a message that they understand children and their developmental needs," says Jill Duncan, RN, MS, MPH, director of the IHI Open School for Health Professions in Cambridge, MA, who has more than 15 years of pediatric-related experience in a variety of acute care settings.
Duncan says nurses can even use their scrubs as a discussion starter with their young patients by pointing out drawings or characters and asking the child what he or she sees. "This helps engage the child as well as assure the parents that there is a confident and competent nurse caring for their child," she says.
The OIG established new requirements for the Self-Disclosure Protocol in what experts believe is an attempt to clear smaller cases from the OIG's plate. But legal experts say providers might find their own plates are filling up with violations they cannot disclose.
The OIG released an open letter to providers that put new limitations on the types of violations that could be reported using the Self-Disclosure Protocol. The OIG will no longer accept Stark Law violations that do not implicate the anti-kickback statute, and it also established a minimum settlement amount of $50,000.
"It's shocking" said Robert A. Wade, Esq., partner at Baker & Daniels, LLP, in South Bend, IN.
Wade said the new guidance seems to contradict the message the OIG originally sent when it established the Self-Disclosure Protocol in 2006. The Self-Disclosure Protocol was designed to create a means for providers to voluntarily bring violations to the government's attention without fear of further litigation.
The OIG not only allowed, but used to encourage providers to use the Self-Disclosure Protocol for Stark Law violations, according to Wade, but now the OIG has said it will not accept straight Stark violations.
That means a provider could potentially discover a multi-million dollar Stark violation, but if it doesn't also include "colorable violations of the anti-kickback statute" the provider cannot come clean to the government using the Self-Disclosure Protocol.
These changes have left some providers scratching their heads. Wade said he and a client were preparing to disclose a violation via the Self-Disclosure Protocol, but that violation no longer meets the OIG's new requirements.
However, Wade said providers have two options for violations that do not meet the new self-disclosure requirements—neither of which provide the same closure as the self-disclosure protocol.
The first option is to treat the violations like overpayments, and attempt to return the money through a Medicare carrier/fiscal intermediary.
Wade points out that carriers/fiscal intermediaries are not equipped to perform the duties necessary to ensure that the provider did its due diligences. This includes making sure the audit that discovered the violation was thorough, complete, and within an acceptable time frame. Wade said carriers/fiscal intermediaries must address this issue.
The second option providers have is to disclose the violation to the Department of Justice. This option also does not guarantee no further action, and Wade said this option is "not one you prefer to use."
Until further guidance comes advising providers what to do with theses lesser violations, they will need to either choose between these two options, or choose to do nothing and hope for the best.
Ben Amirault is an Editorial Assistant for the revenue cycle division of HCPro. He manages the Compliance Monitor e-newsletter and has developed a number of online learning modules. He can be reached at bamirault@hcpro.com.
When Rochester (NY) General Health System determined to cut down on Methicillin resistant Staphylococcus aureus (MRSA) in its cardiothoracic unit, the organization didn't just see the number of cases shrink—there has not been a MRSA case in the unit since January of 2008.
"It's all about execution," says Linda Greene, RN, MPS, CIC, director of infection prevention and control for the New York hospital system.
The organization pursued this goal as part of the Association for Professionals in Infection Control and Epidemiology's (APIC) Targeting Zero campaign.
"Since 2006, APIC has been promoting a Targeting Zero philosophy," says Liz Garman, the association's director of communications. "In keeping with APIC's mission and vision for 2012, Targeting Zero is the philosophy that every healthcare institution should be working toward a goal of zero (healthcare-associated infections) HAIs. While not all HAIs are preventable, APIC believes that all organizations should set the inspirational goal of elimination and strive for zero infections."
Why MRSA?
The primary reason behind targeting MRSA for a zero infection rate is and was patient safety. But the secondary factors are hard to ignore: Average length of stay jumps from 7.6 days to 25.6 days for a MRSA patient, and the average case costs $40,000 more to treat than a non-infected patient.
"That's not the driving force for from a quality perspective, but this information is important," says Greene. "When you're doing a risk assessment, you're looking at those things—what is the end result and what are opportunities for improvement."
The question was: Were these infections inevitable, or preventable? A large amount of infections are preventable, says Greene. In fact, targeting MRSA in one unit had an interesting fringe benefit.
"What we did in 2008 drove all our infection rates down," says Greene. Implementing and hardwiring improved practices caused an across-the-board lowering of infection rates in the cardiothoracic unit.
The facility looked at infections from the perspective of the science of epidemiology.
"Infections are preventable. We know they're not all preventable, but how many are? Have we done enough?" says Greene.
Bi-directional change
"One of the reasons we chose this population—which is a high risk population—is that the people working in this area are innovators," says Greene. "At the beginning it is important to engage key people."
Because MRSA is such a high-profile topic, it was also easier to engage and leverage administrative support.
"We needed some early wins," says Greene. "While it's a really high-performing unit anyway, we found that it's all about execution—incorporating changes into the routine standard of care."
This sort of change is bi-directional, Greene says.
"Top down and bottom up—we need the executives on our side but also the stakeholders," she says.
To this end, they made it a point to drive home individual consequences. For example, education was provided to environmental services staff to demonstrate how their actions could eventually have an effect on the patient.
Rochester's MRSA efforts fit in with its overall accreditation activities because Targeting Zero falls in line with the Joint Commission's National Patient Safety Goals and new governmental regulations (e.g., CMS regulations reducing reimbursement if an infection occurs during a hospital stay)
"There are institutions that have managed to greatly reduce and even eliminate certain infections—showing that zero is possible," Garman says. "It's changing a mindset that these are the inevitable consequence of more complicated care to one where these can be avoided in many cases."