Health legislation moving through Congress would force drug makers to disclose how much they spend on continuing medical education classes for doctors has sparked some resistance from the industry, the Wall Street Journal reports. Defenders of industry funding say the money helps pay for high-quality classes that keep doctors up to date on the latest treatments. They say the classes are developed independent of industry influence. The healthcare overhaul bill that passed the full House mandates disclosure of drug and medical-device industry payments to both doctors and third parties, including medical-education companies. Senate versions of the bill don't require the disclosure of third-party payments.
Kaiser Permanente's Oregon-based unit has agreed to pay $1.8 million to settle charges of false billing brought by the federal Medicare program. The U.S. Justice Department said Kaiser's hospice program billed for services without obtaining written certifications of terminal illness required by federal regulations. Kaiser Permanente officials said Kaiser voluntarily disclosed the billing errors to the government in 2005, when the company discovered the errors during an internal review.
About 22 million Americans have become ill with pandemic H1N1 influenza in the past six months and 3,900 have died, according to new estimates by the Centers for Disease Control and Prevention. The number of pediatric deaths—about 540—is four times as high as the number that physicians, hospitals and health departments had reported to the CDC. The new estimates are drawn from detailed surveillance and record-checking in 10 states, and found the total number of people who have been hospitalized is 98,000, with 36,000 of them age 17 and younger. The vast majority of deaths have been in people age 18 to 64.
Sarasota (FL) Memorial Healthcare System plans to bring peace and quiet, along with improved healthcare, to its hospital by supplying Apple's iTouch to all its nurses.
Sarasota Memorial was approached by Voalte to be part of a piloting program. Voalte is a startup developing point-of-care communications company that uses mobile technology, specifically applications from Apple, to send pages and alerts. During the 60-day pilot program that started in June, Sarasota Memorial handed out 25 iPod Touches to nurses on one specific floor with the goal of reducing the amount of noise and inefficiency involved in paging nurses.
At any given time in Sarasota Memorial, one can hear an overhead page every three minutes, and when a patient is in pain and trying to recover, that can be an issue. However, during the pilot program, the one floor that had nurses using the iPod Touches, reduced the number of pages in eight hours from 172 to 38, which pleased patients who appreciated the new quiet. Overall, the iPod Touches were receiving 4,000 messages a day.
With the pilot program a success, senior management at the hospital is looking into distributing 100 additional devices to another nursing floor as well as the critical care environment. Further down the line, the hospital hopes to incorporate anesthesiologists for communication between the 26 emergency rooms located across Sarasota Memorial.
For this next step, the hospital will deal with Apple's iPhone, and not the iTouch, because the iPhone will support Voice over Internet Protocol (VoIP) even though the hospital anticipated the iTouches would be able to handle the application.
The Apple devices permit a greater level of physical security and when the hospital eventually switches to electronic medical records, the iPhone will be compatible with the software. Also, it allows for more than two-way communication, which the pager was limited to, and the ability to set different ring-tones depending on the severity of the message and who sent the message.
In a survey conducted by the IT department, Sarasota nurses were asked to rate their experience before and after the introduction of the iPhones. Prior to the administration of the devices, nurses rated their ability to find peers a 2.2 out of 4, and rated their effectiveness a 2.5 out of a possible 4.
However, after using the iPhones and software, nurses rated their ability to find peers and their effectiveness at a 3.4 out of a possible four.
Sarasota Memorial plans to get the new iPhones in late November, and hopes to deploy them to its nurses by December.
Sarasota Memorial is not the only hospital that is making the switch from overhead pages to iPhones and iTouches.
University of North Carolina Hospitals has switched from pagers to iPhones to help with communication between interpreters at the hospital. Using the iPhones allow interpreters to have access to the Internet, and if a question arises, the entire group can respond via text message, and not be inundated with phone calls.
Massachusetts General Hospital (MGH) is also using iPhones for communication between its staff members and MGH even has its own application called "The Massachusetts General Hospital Handbook of Internal Medicine." This application provides key clinical information about common problems in all areas of internal medicine.
While accountable care organizations (ACOs) officially don't exist, the concept has been attracting attention as a new way to help reform the healthcare delivery system. They could encourage providers to work together to bend the cost curve and improve quality, according to a new analysis.
ACOs will not be "a real game changer in the short run," but are definitely worth "a concerted try—given longstanding problems" with the fee-for-service provider payment and delivery systems that can impede healthcare cost controls, said Robert Berenson, MD, and Kelly Devers, PhD, of the Urban Institute in a policy brief on ACOs prepared for the Robert Wood Johnson Foundation.
"ACOs can help overcome the impasse of where to start first—provider payment or delivery system reform—by coupling and 'co-evolving' them over time," the authors wrote. ACO also could "offer the opportunity to harness the tremendous purchasing power of the traditional Medicare program," they added.
ACOs can be developed in a variety of ways: For instance, existing organizations could either exclusively serve as an ACO in a local geographic area, or be part of an ACO led by another provider organization in the area. The existing provider organizations can include:
Various types of physician groups or physician centered organizations, namely multispecialty group practices and interdependent physician organizations.
Hospital-centered organizations, namely hospital medical staff organizations and physician hospital organizations.
Health plan provider organization or networks, which can already participate in Medicare as Medicare Advantage plans.
In addition, the ACO concept may avoid "a one size-fits all provider payment or delivery system reform approach," which is unlikely to work given the variation in local markets and provider organizations and their capabilities, the researchers said.
In the long run, ACOs could potentially complement other reform initiatives, including the patient-centered medical home, meaningful use of electronic medical records, and comparative effectiveness research.
Nevertheless, challenging implementation issues do exist that need to be recognized and addressed, they said. In order for ACOs to have an impact, the concept needs to move past the rosy scenario phase that "has become common for energetically endorsed new or reprised concepts."
Instead, lessons from previous experiences and ongoing demonstrations could help identify potential solutions to the complex financial, organizational, legal and regulatory issues, and provide insight into the trade offs between various program proposals and options, they noted.
A Maryland health coalition has launched what has been nicknamed the "secret shopper" hospital project in which teams of unidentified employees will monitor colleagues' hand hygiene each time they exit a patient's room.
Organizers say the Maryland Hospital Hand Hygiene Collaborative is the first in the nation to measure compliance with protocols across a state hospital system using consistent scientific methodology. At least 45 of the 47 general acute care hospitals in the state have agreed to participate.
Starting January 1, the teams will start their secret monitoring. They will observe 30 caregivers exiting patient rooms per hospital unit per month and record what they saw on a small hand-held device or enter it in writing.
The results will be analyzed and reported, perhaps publicly. The idea is that at most hospitals, the observers will be hospital employees who usually work elsewhere in the facility.
"This isn't being designed as a 'gotcha,'" says Nicole Stallings, director of the Maryland Health Quality and Cost Council, one of the organizing agencies. No hospital employee caught forgetting hygiene practice will be penalized, she says.
Rather, "hospitals are really going to benefit because for the first time, everyone will see how they're doing relative to other hospitals in the state." They also will be able to "drill down internally" to see how compliance measures up on each floor and unit, she adds.
"If you ask providers if they wash their hands, 99% of the time they will say 'certainly,'" says Richard "Chip" Davis, vice president for Innovation and Patient Safety at Johns Hopkins Medicine. "But we know that when you observe their behavior, there's a pretty significant difference."
Many of the hospitals already observe versions of the "five points of hand hygiene protocol," which specifies the use of gel or hand-washing before touching a patient or starting a procedure. After a procedure, the protocol suggests the same washing before touching a patient or touching the patient's environment, Stallings says.
But it was decided that all the hospitals could agree to use one of those points—when a caregiver leaves a patient's room—so that the same practice would be compared. Hand hygiene on different levels of care, as well as care on different floors, can also be compared within a hospital.
The project is expected to last for at least one year, and has received $100,000 in federal stimulus funds through the state Department of Health and Mental Hygiene.
Davis says the secret shopper project is modeled after one that has been under way at Johns Hopkins for the last two years.
Carmela Coyle, president of the Maryland Hospital Association, another supporting part of the coalition, says a big part of the project is the education that is going on now, before the observers start chronicling caregivers' behavior. "The education piece of this is dramatic,'' she says.
Davis was asked if there if there is ever staff friction if an observer's identity becomes known by the observed staff. "Sure, people might get upset. But we're not going in the direction of posting names."
"We're not going to be putting a scarlet letter on anyone's chest," says Davis.
Besides, he says, "while the observers may be noticed, on busy active floors they usually blend in."
"This is really all being done from the public health perspective, to reduce what everyone is so well aware of, the health risks from healthcare-associated infections," he adds. "How can we make it safer?"
Transmission of hospital-acquired infections is a major U.S. health problem. According to the Centers for Disease Control and Prevention report, Estimating Health Care-Associated Infections and Deaths in U.S., 1.7 million infections were estimated to have occurred in U.S. hospitals in 2002, with approximately 99,000 deaths.
Another CDC report in March said the overall annual direct medical costs of healthcare-associated infections to U.S. hospitals ranges from $28.4 billion to $33.8 billion (after adjusting to 2007 dollars using the CPI for all urban consumers) this year.
The benefits of prevention can be assumed to range from a low of $5.7 billion, with 20% of infections preventable, to a high of $31.5 billion, if 70% of infections are preventable, the CDC said.
In addition to the above, other agencies involved in the Maryland project include the Maryland Patient Safety Center, the Maryland Health Care Commission, and the Delmarva Foundation for Medical Care.
The nation's children's hospitals are lobbying Congress to change a provision in the pending healthcare legislation that industry leaders say will reduce their federal funding by as much as $876 million. Hospital groups in July agreed to a $155 billion reduction in federal payments over 10 years, part of a broader effort to lower medical costs. But those cuts would have a lopsided effect on children's hospitals, the industry's trade group says, and could cause deep reductions in services.
St. Francis Hospital and Medical Center could open medical offices in a new office tower proposed for downtown Hartford, CT. St. Francis has signed a letter of intent to lease space in the office tower. Lease negotiations are continuing, and it isn't clear what services would be provided by the hospital and during which hours. It is possible the medical offices could dispense immunizations and other services, such as X-rays, oncology support, and gastrointestinal procedures, said St. Francis officials.
Problems following the device failure were among numerous violations cited by Connecticut health officials who placed St. Francis in Hartford on probation for one year. Regulators also cited problems with hospital facilities, inadequate preventive maintenance of medical equipment, and a lack of evidence that staff evaluated the neurological signs of a patient who fell out of bed and sustained a head injury. The patient later died. Under a consent order, the hospital will be required to take corrective action including additional staff training and submitting to a review by an outside consultant.
Both House and Senate healthcare reform proposals are seeking to slash funds to the HMOs that have attracted 283,000 South Florida seniors because of rich benefit packages that can include free dental care and many other perks, the Miami Herald reports. Reformers want to cut healthcare costs to make insurance more affordable for the uninsured, causing many to look at South Florida—where healthcare is far more expensive than other areas, according to this article from the Herald.
