A new, state-sponsored Web site publishes data on Illinois hospitals and surgery centers that includes information about what these medical providers charge, how many procedures they perform, how often they deliver recommended care, and how consumers rate their care. The publication of Illinois' first Hospital Report Card and Consumer Guide fulfills the promise of legislation passed in 2003. The goal was to help people become better consumers of medical services and hold medical providers accountable for their performance.
For nearly 2 years, SG2 have advanced the concept of disease-centered Sg2 Systems of CARE as the model of the future for healthcare delivery, says Sg2 Vice President Stephen Jenkins. As health systems are increasingly held accountable for what happens across the continuum, Systems of CARE provide the platform to succeed, clinically, and financially, Jenkins says. Here, Jenkins provides some key ideas of how to build these disease-centered Systems of CARE.
Jordan Hospital of Plymouth, a 155-bed community hospital serving a dozen towns in the Massachusetts counties of Plymouth and Barnstable, said it has formed a clinical affiliation with Boston's Tufts Medical Center and its Floating Hospital for Children. The alliance will give Jordan Hospital patients greater access to specialists, technology, and patient education at its Plymouth site, officials said.
Northeast Hospital Corp., parent company of Beverly (MA) Hospital and an outpatient affiliate in neighboring Danvers, MA, announced it has eliminated 22 jobs in an effort to become leaner and more efficient. The job cuts, which include 11 vacant positions and layoffs of 11 employees ranging from managers and assistants to secretaries, will save the healthcare provider about $1.8 million annually in salary and benefits.
Senate Democrats are touting the immediate benefits their health bill would bring to some Americans, although many of the benefits of the bill won't take effect for several years, the Wall Street Journal reports. But Democrats pointed to popular changes for consumers that kick in quickly: They include an immediate ban on insurers imposing lifetime caps on benefits and a ban on terminating coverage because an enrollee falls ill.
The Senate healthcare bill does not include a new surtax on the wealthy that House Democrats' legislation relies on to offset costs of overhauling the system. But Senate Democrats have their own taxes that are stirring controversy and likely to be at the center of debate, the Wall Street Journal reports. Senate Majority Leader Harry Reid made a late change to his bill by adding an extra Medicare payroll tax, which would generate $54 billion over 10 years according to the Congressional Budget Office. Under the plan, wages over $200,000 for single people and $250,000 for married couples would be subject to a 1.95% payroll tax, up from the current 1.45%.
Chances of business supporting the Obama administration's health overhaul are fading fast after Senate Majority Leader Harry Reid's bill took a liberal turn, the Wall Street Journal reports. The Obama administration has courted small businesses from the start, and at times executives have shown favor toward Democratic plans such as the bill passed by the Senate Finance Committee. But now several industry groups are banding together to ask Congress to scrap the current bills and start from scratch on a health overhaul, saying the public plan included in Reid's bill will pay lower rates and shift costs to those with private insurance.
This month marks the 10th anniversary of the publication of the Institute of Medicine's To Err Is Human—a study that put a new focus on how patient safety is addressed in the United States. Though the report served as a clarion call to healthcare organizations to promote safety, many in the healthcare industry would probably agree that more still needs to be done at the local level.
Earlier this week at a forum sponsored by Consumers Union's Safe Patient Project in Washington, DC, Richard Shannon, MD, chair of the department of medicine at the Hospital of the University of Pennsylvania in Philadelphia, provided health leaders with some insights on how to move their organizations forward to becoming high-performing facilities that can effectively address patient safety concerns.
Healthcare in the U.S. today is not "a high-performing organization," Shannon said. But it could be.
Shannon, borrowing pages from colleague Steve Spear's book, Chasing the Rabbit: How Market Leaders Outdistance the Competition and How Great Companies Can Catch Up and Win, suggests it could be different if healthcare organizations recognize—and try to change—a number of traits that hold them back:
Many high-performing organizations "swarm and solve problems to build new knowledge—[where] problems are not things to be avoided," Shannon said. "They're learning opportunities." However, "in healthcare, we are the best work-around experts. We see problems every moment and absolutely do nothing about them . . . the antithesis of the high-performing organization."
High-performing organizations tend to be "level" in structure—where individuals at all levels have a say. Many healthcare organizations, though, tend to be hierarchical—where decisions are made from the top down.
High-performing organizations are constantly expanding the frontier of what they don't know. They must look for new ways and new ideas.
So what does this have to do with patient safety? Well, plenty. Before working at the University of Pennsylvania, Shannon was chief of medicine at Allegheny General Hospital in Pittsburgh, where he was instrumental in initiating a project that lowered central-line associated bloodstream infections and ventilator-associated pneumonia rates in the intensive care unit. He has continued with this work at Penn.
What he has discovered is that "in the end, the inability to understand in great detail how we do our work is the genesis" of many of the patient safety issues many healthcare organizations now encounter. Many times, the organization will look for the quick fix—hoping the problem goes away. "This characterizes one of the reasons why progress has been so slow," he says.
A new mindset needs to occur about patient safety. First, while it helps that patient safety is viewed as a priority, it is more important that it is seen as a "precondition of work," he says. "The foundation of quality is safety—and safety must be a precondition."
"There are hundreds of priorities that sit on my desk. If safety is one of them, it's in with the hundreds of others. But if it's a precondition, that means I begin work at 6:30 a.m. at the point of care asking 'did anything happen last night that could lead to the risk of someone getting a central line infection?’" he says. "That tells the workers that it's a precondition of coming to work."
Nurses need to be on the frontline with patient safety, he emphasizes. "It's fundamental," he says. "Nurses are the guardians of patient safety. They need to be empowered to do this. It's extraordinary what you can achieve when you partner with nurses."
Shannon recommends moving beyond data collected by the Centers for Disease Control and Prevention. This data generally does not deal with "fixing problems in hospitals." Instead, he suggests becoming a "deep observer of the current condition" within the healthcare organization.
For instance, it is important to know how a central line is "placed, maintained, and manipulated." And then, taking that knowledge and learning and "sharing it with everyone," he says. "As a leader, you must commit to fixing things that are there . . . to make sure [an infection] doesn't happen again."
And while comparative effectiveness has its benefits, it's not feasible when dealing with patient safety issues of waiting around five years or so for answers. "Safety is about making little changes at the point of care and then seeing if they worked," he says. This means listening to ideas of those on the frontline of delivering healthcare.
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A half-million-dollar penalty against a hospital system represents the culmination of what has been a very active year of healthcare scrutiny by the Environmental Protection Agency (EPA).
"I definitely think there is an uptick in activity that will be with us for some time to come," said Charlotte A. Smith, RPh, MS, HEM, director of PharmEcology Services in Wauwatosa, WI, a division of WM Healthcare Solutions, Inc.
The U.S. Department of Veterans Affairs' (VA) Eastern Kansas Health Care System recently settled with the EPA over violations to the Resource Conservation and Recovery Act (RCRA) allegedly found at Dwight D. Eisenhower Veterans Medical Center in Leavenworth, KS, and Colmery O'Neil Veterans Medical Center in Topeka, KS.
RCRA (pronounced RICK-rah) governs hazardous waste management across all industries.
Civil fines against the VA totaled $51,501. On top of that, the VA agreed to invest nearly $482,069 for new systems to better track and manage chemical wastes in the two hospitals. The total penalty was considerable by EPA standards when it comes to hospital enforcement.
Meanwhile, earlier this year, the EPA proposed a rule that would reclassify RCRA-governed hazardous pharmaceutical wastes, in theory ensuring larger quantities of these wastes are collected and disposed of properly (i.e. not flushed down the drain or disposed of in municipal waste streams).
If finalized, the regulation would make it easier for hospitals struggling with following RCRA to the letter, and will force hospitals that are doing little at present to start a disposal program for pharmaceutical waste.
Mainstream press articles about medications discarded in water supplies, increased awareness about drug waste, and the change from the Bush to Obama administration all point to renewed interest by the EPA in hospital affairs, Smith said.
"We continue to hear of EPA audits both for pharm waste and other regulatory issues in healthcare," she added.
More emphasis may come from a new study published earlier this month in the Journal of the American Medical Association, which concluded the healthcare industry accounts for 8% of the U.S. "carbon footprint," a term used to describe the total greenhouse gas emissions attributable to an organization or industry.
"I think there is increasing awareness that hospitals are large contributors to both the economy and then, by association, carbon footprint, so there is a raised awareness surrounding hospitals as they relate to energy use, waste generation, toxicity, and also large amounts of new construction and renovations," said Janet Brown, director of facility engagement for Practice Greenhealth, a national membership organization that promotes environmental improvements in healthcare.
In other healthcare-related actions this year, the EPA:
Mandated that hospitals run full loads in ethylene oxide (EtO) sterilizers and log them, with some exceptions. EtO is a gas used to sterilize heat- and moisture-sensitive medical instruments. The EPA found that, taken together, EtO sterilizers account for a significant source of pollution.
Is increasing oversight of hospital disinfectants after one-third of 325 registered substances failed EPA verification of labeled claims by manufacturers.
Updated rules for hospitals that house medical waste incinerators. There are only 57 active medical incinerators in the entire country.
According to a study conducted by Google, 86% of doctors have gathered health or drug information online, and the Internet is used more than peer review journals, CME courses, or any other source for finding this type of information. Search engines are the most common method for finding health resources, and most doctors click on the top result in the search, the study found.
