The drive to create a bipartisan commission to help control the cost of health spending and address mounting deficits picked up momentum as Senate Minority Leader Mitch McConnell and a handful of moderate Democrats and Republicans voiced support for the effort. The commission would draft proposals to control the long-term costs of Medicare, Medicaid, and Social Security, which together account for 40% of all federal spending other than interest on the debt. The recommendations would require a swift vote by a supermajority of members of Congress, to assure bipartisan support for unpopular measures to cut sensitive spending programs or to raise taxes if necessary.
The Illinois Hospital Association's new president is bracing the group's member hospitals for a wave of mandates and regulations brought by federal reform of the healthcare system. Maryjane Wurth, who became president of the 200-member hospital association in October, said that hospitals face many implications regardless of which bill is signed into law by President Barack Obama. As part of Obama's push to improve quality and lower costs, for example, hospitals could see reduced payments from the federal Medicare health program for the elderly if mistakes or poor service were to lead to readmission of patients, Wurth told the Chicago Tribune.
Several hospitals in the Boston area are modifying their visitation rules in response to the spread of H1N1 and seasonal flu in Massachusetts. For example, only people age 18 and older are permitted to visit patients at Winchester Hospital, Lawrence General Hospital, Lawrence Memorial Hospital in Medford, and Melrose-Wakefield Hospital. Anyone visiting an H1N1 patient at Lawrence General Hospital must wear a mask and should not wander around the hospital, said a hospital spokeswoman. Visitors at all the hospitals are asked to wash their hands or use hand sanitizer when entering and leaving a patient's room and cough or sneeze into the bend of their elbow.
As labor leaders fight to sign up 10,000 healthcare workers, a California-based union is charging the Service Employees International Union with changing ballots and threatening to report a worker to immigration officials. The SEIU and the National Union of Healthcare Workers have been fighting for the right to represent 10,000 home healthcare workers in Fresno, CA. An election earlier this year gave the SEIU the victory, but the NUHW is asking that election be invalidated and a new one ordered because of what it says is evidence of intimidation. The NUHW filed charges Nov. 6 with the California Public Employment Relations Board, which oversees the election.
An event where 80 people had their head shaved to raise money to enhance cancer research and treatment at Children's National Medical Center in Washington, DC, raised more than $200,000 for the facility. The goal was to raise enough money to make the hospital a comprehensive cancer center. St. Jude Children's Research Hospital in Memphis is the only pediatric cancer center to be given the designation by the National Cancer Institute.
The nation's 5,010 nonfederal community hospitals saw profits fall to $17 billion in recession-wracked 2008, thanks in large part to investment portfolio losses that accounted for $4.4 billion in red ink, according to the newly released 2010 AHA Hospital Statistics guide.
Hospitals reported total net revenue of $643.6 billion while claiming total expenses of $626.6 billion, for a net gain of about $17 billion in 2008, according to the survey, which was compiled by AHA's Health Forum with data gleaned from all AHA-registered hospitals.
In 2007, bolstered by a record $17 billion in investment income, hospitals reported net revenues of $626.3 billion against total expenses of $583.2 billion for net profits of $43.1 billion, the survey reported.
The survey also reported that hospital admissions grew to 35.8 million in 2008, an increase of more than 400,000 when compared with 2007, while inpatient days hit more than 196 million, an increase of more than 1.5 million when compared with 2007. The average length of stay has remained flat at 5.5 days for at least the last five years. More than 10.1 million inpatient surgeries were reported in 2008, a decrease of 84,474 surgeries when compared with 2007.
The survey also showed that full-time hospital personnel increased by about 80,000 positions, while part-time employees grew by about 20,000 between 2007 and 2008. The Bureau of Labor Statistics recently reported that the hospital sector has reported about 37,000 new payroll additions so far this year with nearly half of those additions coming within the last two months.
The AHA survey reflects data from 2008. Since then, however, there have been encouraging signs that hospitals may be on the rebound. In addition to the recent spate of payroll additions reported by BLS, a new study by Thomson Reuters shows that 80% of the nation's hospitals were back in black in the second quarter of 2009. In the third quarter of 2008, more than half of all hospitals reported that they were losing money.
Kellogg Co. announced will pull immunity claims from its Rice Krispies and Cocoa Krispies cereal boxes amid the public's growing concern about swine flu. Kellogg began adding extra antioxidants to its cereal last year, which it says help support the immune system. The company began advertising the change with large labels on cereal boxes that read in bold letters: "Now helps support your child's immunity." But representatives from the food maker said that given the public attention to swine flu, it has decided to phase out the message from its packages.
The Harvard report released this week that showed that half of 722 sampled hospital boards don't see clinical quality as a top priority wasn't much of a surprise.
Nor was it startling that two-thirds of these nonprofit boards had not received formal training in clinical quality. Or that those hospitals whose boards downplayed quality were more likely to perform worse in Hospital Quality Alliance measures than hospitals where quality was a top priority.
I've heard many complaints from physician leaders over the years that data on outcomes and adverse events just weren't on their trustees' radar. Financial performance and philanthropy? Sure. Reputation in the community? Definitely. Building projects? Let's meet with the architect.
But reviewing last month's stats on the number of avoidable falls or the number of medication mistakes? Those details get delegated to management.
"All our board members care about is the artwork and the atrium," I often heard one physician executive grumble.
Parodied another: "The flowers in the lobby are drooping. Isn't it time for lunch?"
But I wonder: With so much emphasis on quality and pay for performance–and with the threat that Medicare now can withhold reimbursement when avoidable mistakes require additional care—shouldn't this board culture be changing?
Yes it should, says James Conway, the Institute for Healthcare Improvement's senior vice president. And the IHI's "Boards On Board" Campaign is trying to do just that.
He ought to know. The IHI is now promoting "Boards on Board," a campaign to get hospital leadership "deeply engaged, starting with the Board of Trustees." He personally visits boards around the country to see how they are addressing quality improvement.
Evidence shows a more engaged board can power the push for programs or controls that prevent adverse events from happening. IHI has run educational programs for thousands of trustees and executive leaders.
"Traditionally, hospital boards and trustees have focused on topics they were most comfortable with, which have been issues of finance or building a marketing strategy," Conway says.
"But this is no dinner party anymore. Sitting on a board is a tremendous responsibility."
Conway sent me the "Boards On Board" 36-page How To Guide, which begins with a list of routine board activities to improve quality and safety within their hospitals. For example, boards should know their mortality and harm rates and set specific goals to reduce them. They should also establish a monitoring system for adverse events.
"At a minimum," the campaign advises, boards should spend "more than 25% of their meeting time on quality and safety issues and by conducting, as a full board, a conversation with at least one patient, or family member of a patient, who sustained serious harm at their institution within the last year."
That will make trustees understand in a powerful and personal way the consequences of avoiding the issue, Conway says. It may seem like a harsh order. But it really works.
"There's nothing we find more powerful than having the board meet with the patient," he says. Some hospitals now regularly show a video of a person with a hospital-acquired infection, or meet with a patient who sustained an avoidable fall, he says. At one hospital in Vermont, the chairman of the board and the CEO interview some of the patients who were hospitalized in the preceding month.
CEOs should personally conduct investigations of events that caused significant patient injury, according to the How To Guide. And then, the CEO "should personally present that case to the board in a session of no less than one hour in length." And if possible, the patient and family should be there to add their account in person.
"The trustees have to become outraged," he says. That doesn't happen "if they don't know that they killed someone, or that five people got serious infections." Those boards also have to make it clear to their CEOs that they expect to be told about such issues. But for some CEOs, "this just isn't the type of information they usually share with the board."
Conway knows what he's talking about. He was COO of Dana Farber Cancer Institute in Boston in the mid-1990s when two chemotherapy overdoses resulted in the death of one woman, a reporter for the Boston Globe, and serious heart injury to another. The events provoked a major introspection of processes and medical error prevention at the institute, and may have laid much of the groundwork for the safety movement today.
Now, regulatory agencies and payers are pushing for boards that have a better appreciation for quality matters, Conway says.
For example, in some states, insurance companies and the Joint Commission are focusing attention on board involvement in hospital quality benchmarks. Blue Cross Blue Shield of Massachusetts will reimburse hospitals more money if the board undergoes quality training, he says.
States like New Jersey have passed laws requiring hospital boards to go through a formal quality curriculum. And, Conway says, quality training for trustees has even provoked some state attorneys general to weigh in on the issue.
"The Inspector General has issued several reports on the topic, and Leapfrog has embraced this as well."
Is it working? I asked Conway.
"Am I meeting more extraordinary boards today? Yes," he says. Today, if the Harvard researchers conducted the same survey, nearly three-fourths would rank clinical quality a major priority, he said, up from 50%.
"But do I also meet with boards whose journey has yet to begin? No question."
Of course, some of hospital boards' failure to grapple with these topics might be blamed on CEOs, who keep their board in the dark. Boards must insist that they expect to be informed.
A formidable obstacle to change remains, one he calls the "arrogance of excellence."
"Good organizations talk about the wonderful things that go on in their hospitals, and bring you to tears about their beautiful stories. But the problem is that those stories are seductive. The arrogance of excellence is that you don't create a space to talk about the harm, the tragedy, and the waste."
Conway says one board meeting he recently attended "was lovely. Everyone was very nice to each other. But there was no discussion of the degree of harm that had gone on. There was a detailed report, and if you were smart enough, you could go find it, but no one pointed it out to the board that it was there."
Images of stethoscopes, smiling nurses, and thoughtful doctors littered the table in one of Monroe (WI) Clinic's conference rooms. The marketing team was unveiling a rebranding campaign to clinic administrators and they brought clippings of their competitors' cliché ads to show how different their new campaign really was in their market.
Monroe decided to create a rebranding campaign when marketers realized its current messaging, which emphasized its innovation, was better suited for one of their competitors.
"It wasn't a position in the market we could really own, so we just needed to embrace what we do well," says Liz Carroll, director of marketing and community relations. "We have a great multi-specialty clinic and hospital system located in a small town of about 10,000 people. Rather than try to convince our community that we were just like those big city doctors, instead we opted to talk about how 'around here' we were just a little bit different."
The campaign launched in May and ads for different service lines will run in a rotation over the next few years. It includes, print, outdoor, radio, and Web elements.
"Our main message for all of the ads is that we know people around here, and practice the kind of healthcare they need just a little bit better because we're their friends and neighbors," Carroll says. "The campaign also features people from the community rather than pictures of our doctors and our technology."
The clinic has already heard a great deal of positive feedback from patients, employees, and community members, Carroll says.
"The ads are so appealing and compelling and made people feel it was a fit for our market," she says. "We heard, 'Finally, they're showing everyday people in their ads.' There's a sense of small town nostalgia."
The U.S. Green Building Council awarded Spectrum Health's Lemmen-Holton Cancer Pavilion LEED gold certification last week, making it the first healthcare facility in Michigan to achieve this status. Lemon-Holton, which opened in June 2008, received the certification because of its energy conservation, lighting, water, and material use.
"We made a decision as an organization that moving forward with all construction we will go for LEED certification," says Carrie Manders, media relations manager for Spectrum Health, an eight-hospital system in Western Michigan. "We thought it was very important to be environmentally responsible, but it's something our patients were looking for as well."
Facility planners designed Lemon-Holton with a green certification in mind. Lemon-Holton reduced the urban heat island effect by using underground parking and reflective and vegetated roof areas, installing low-flow plumbing and rainwater collection, saving energy through heat recovery, HVAC, and lighting controls, using regional and recycled material products, and using materials that minimize emission of indoor air contaminants.
"We recognize the environmental impact that healthcare operations have because healthcare is one of the largest consumers of energy and we're bringing a lot of projects to the organization each day that potentially contain harmful materials," says Josh Miller, sustainability coordinator for Spectrum Health. "It's not only looking at the construction but how we operate the facilities as well."
Finding products, such as furniture, that are local, sustainably made, contain nontoxic materials, and are cost-competitive was one of the most difficult challenges when building the facility, Miller says. But in the long run the extra effort and dollars will have been well spent.
"It just makes financial sense to invest upfront in these energy saving technologies and ways to reduce waste," he says. "If we're bringing in green cleaning chemicals or other chemicals used in labs, then we're not having to dispose of a hazardous material if we have a spill. We're eliminating that by purchasing products that are not hazardous to begin with."
Sustainable furniture wasn't the only thing that dictated Lemon-Holton's design—the organization also took direction from patient and family advisory counsels.
"Each member had a loved one or currently or previously went through cancer treatment so they knew what kind of environment they wanted to be in," says Manders. "They were the experts that wanted to help us design this facility and I think they were really excited that we were going for the LEED Certification as well."
The counsel chose the artwork for the entire pavilion and the themes for the garden on each floor.
"We wanted to create a healthy environment for patents and families, but we wanted to create a healthy facility for the environment as well," Manders says. "Not only did we do everything we need to do to be LEED Certified, but we made it a lush, serene healing environment."
