The majority of the nation's hospitals will be smoke-free campuses by the end of 2009, according to a new report from The Joint Commission.
The study—The Adoption of Smoke-Free Hospital Campuses in the United States—is the first to examine the national prevalence of smoke-free hospital campus policies.
The study cited 2008 reports that 45% of hospitals reported having smoke-free campuses, and that another 15% said they would be implementing similar policies in the near future.
"Hence, it is safe to assume on the basis of these results that the majority of US hospitals will have smoke-free campuses by the end of 2009," says Scott C. Williams, director of the Commission's Center for Public Policy and Research.
The 2008 data show that not-for-profit hospitals were more likely to have smoke-free campuses than for-profit hospitals. The 2008 data also show that hospitals in Arkansas, Iowa, Massachusetts, Minnesota, Oklahoma and Wisconsin had among the highest proportion of smoke-free campuses. Hospitals in several tobacco states also had a significant proportion of smoke-free campuses.
In 1992, The Joint Commission implemented a standard which required hospitals to adopt a campus-wide non-smoking policy, limiting smoking to separate, ventilated areas. "At that time, fewer than 3% of hospitals extended this indoor smoking ban to include the entire hospital campus, both indoors and outdoors," Williams says. "Our study shows that around 2004-2005 this began to change dramatically. Now a majority of the nation's hospitals do not allow smoking anywhere on their property."
The study examined the smoking policies of 1,916 Joint Commission-accredited hospitals to determine the prevalence of smoke-free hospital campus policies and whether they impacted smoking cessation counseling offered in those hospitals. Not-for-profit hospitals were slightly more likely to offer smoking cessation counseling than for-profit hospitals, the study found.
Federally owned hospitals were less likely to have smoke-free campuses. This, according to the study, was likely due to the influence of federal legislation requiring all Veterans Administration hospitals to have a suitable and accessible patient indoor smoking area for patients and residents. "Such legislation makes it virtually impossible for VA hospitals to adopt a completely smoke-free campus," Williams says.
The American Hospital Association appointed two new executives to fill positions on the 29-member Joint Commission Board of Commissioners. Their three-year terms begin in January. They are:
Nancy Howell Agee, chief operating officer and executive vice resident for Carilion Clinic in Roanoke. She also is the CEO of Carilion Medical Center, an 825- bed tertiary care teaching hospital and level I trauma center. She also currently chairs the Board of Virginia Hospital and Healthcare Association and the Foundation of Roanoke Valley.
R. Timothy Rice, president and chief executive officer of the Moses Cone Health System in Greensboro, NC. Rice has a bachelor of science degree in pharmacy and is a fellow in the American College of Healthcare Executives. He also is the chair-elect of the board of directors of the North Carolina Hospital Association.
The 29-member board meets four times a year and includes physicians, administrators, nurses, employers, a labor representative, health plan leaders, quality experts, ethicists, a consumer advocate and educators. They are appointed by the AHA, the American Medical Association, the American College of Physicians, the American College of Surgeons and the American Dental Association.
The Joint Commission evaluates and accredits more than 16,000 healthcare organizations in the U.S., including more than 8,000 hospitals and home care groups and more than 6,200 other organizations providing long term care, behavioral health, lab and ambulatory service care.
The National Quality Forum has endorsed 18 measures for managing over-the-counter and prescription medications. The new measures, which are among the first to be endorsed for medication management, assess prescribing and use of appropriate medications and medication adherence, reconciliation, and monitoring for a variety clinical conditions.
Nearly 90% of Medicare beneficiaries currently take prescription medications and almost half use five or more different medications. However, an estimated 40% of those patients are not taking their medications as prescribed by their healthcare providers--causing approximately 1.5 million preventable adverse drug events each year, according to NQF.
These measures are a "starting point to improve quality and lay the groundwork for additional measure development for continued improvement in medication management," according to NQF President and CEO Janet Corrigan.
The measures will add "standardization and clarity to the field of medication management" and provide "better measures for quality improvement in medication management," said Pincus Harold, who co-chaired NQF's steering committee on medication management. He is director of quality and outcomes research at New York Presbyterian Hospital and Health System.
The NQF endorsed measures are focused specifically on measuring and improving adherence and management of medication for a range of conditions where medication non-adherence has been prevalent and subsequent severe adverse outcomes have been linked to that non-adherence. These conditions include diabetes, asthma, coronary artery disease, kidney disease, chronic obstructive pulmonary disease, and schizophrenia.
The endorsed measures for adherence measure for adherence of antipsychotics among patients with schizophrenia, and medication possession for statin therapy for patients with coronary artery disease.
Other measures focus on medication reconciliation and review by measuring the percentage of adults over age 65 who have had a medication review, or the percentage of discharged patients over 65 whose medications have been reconciled.
Individuals may request reconsideration of the recommendations, in whole or in part, by notifying NQF in writing via e mail no later than Sept. 15.
If the public plan option is dead—and many members of Congress and virtually every political observer say it is—President Obama may instead press for the creation of local health insurance co-operatives so he can declare victory in the healthcare reform war and go home.
The problem is that a lot of people believe co-ops create as many problems as they hope to solve. For starters, nobody knows if co-ops would work. Or how they'd would work, who'd be covered, how much they'd cost, who'd pay the bills, who'd provide oversight, and how they'd compete—if at all—against entrenched private health insurers that dominate their local markets.
Blogger Bob Laszewski—who calls healthcare co-ops the "single dumbest idea" he has heard in 20 years of health reform debate—notes that even if all those questions are answered, and cooperatives flourish, the end product would at best very much resemble the scores of community-based, not-for-profit health plans—including many Blue Cross Blue Shield plans—that already control more than half of the under-age-65 market in the United States.
Julius Hobson, a senior policy advisory at Bryan Cave LLP consultants, says it's difficult to see how the co-ops, with limited financial resources, few if any members to start with, and therefore no negotiating leverage, can hope to be competitive with large, wealthy health insurance companies that are virtual monopolies in some areas of the country. "If you look at a state like Pennsylvania, Blue Cross Blue Shield controls 90% of the market. There are two Blues in the state and they don't compete with each other. One has the eastern half, one has the western half. Tell me how a co-op is going to compete with them on price? How are they going to crack that market?" he asks.
Consumer Watchdog calls the co-ops "pseudo-reform" that could do far more harm than good if they create loopholes that could gut state consumer protection laws. The consumer advocacy group notes that Sen. Mike Enzi, R-WY, came up with a similar plan in 2006, which would have exempted the co-opts from state consumer protection laws.
Hobson, a former lobbyist with the American Medical Association, says the co-ops could gain favor with shaken Democrats returning from raucous town hall meetings in their districts and facing across-the-board opposition from Republicans. "The Democrats will go to the fallback position of the budget reconciliation process, where they only need 51 votes, and they will pass everything they can under those circumstances. Republicans will scream and yell and say that is a dirty way to do things, but in 2001 they enacted the Bush tax cuts the exact same way," he says.
Co-ops might not do anything more than provide political cover for President Obama and Congressional Democrats, who don't have the 60-vote, filibuster-proof majority needed in the Senate to pass a public plan. But, Hobson says, President Obama and Congressional Democrats have too much invested in health reform to walk away empty handed. "They are going to have to cut back on the size of this bill because they aren't going to get any Republican support and the co-ops could happen as a result of that," Hobson says. "I am absolutely certain they will pass something by the end of the year. The president will sign it and they will declare victory."
Sen. Charles E. Grassley, a key Republican negotiator in bipartisan healthcare reform, said that the outpouring of anger at town hall meetings has fundamentally altered the nature of the debate and convinced him that lawmakers should consider drastically scaling back the scope of the effort. After being besieged by protesters at meetings across his home state of Iowa, Grassley said he has concluded that the public has rejected the far-reaching proposals Democrats have put on the table, viewing them as overly expensive precursors to "a government takeover of healthcare."
The Hospital Corporation of America announced a proposal to build a hospital on Route 50 in Loudoun County, VA, apparently signaling the end of a long struggle with rival Inova Health System over its future in the growing area. StoneSpring Medical Center, which would be Loudoun's second hospital, would have 164 beds, including 124 acute-care beds, cost $195 million and open in December 2015. As recently as last month, HCA officials said they had "no plans" to build a hospital in the area.
As President Obama sought to reframe the healthcare debate as "a core ethical and moral obligation," he implored a coalition of religious leaders to help promote the plan to lower costs and expand insurance coverage for all Americans. "I know there's been a lot of misinformation in this debate, and there are some folks out there who are frankly bearing false witness," Obama told a multidenominational group of pastors, rabbis, and other religious leaders who support his goal to remake the nation's healthcare system.
Two powerful House Democrats have sent a letter to insurance companies asking them to provide detailed information about their conferences and retreats, executive pay, and other business practices. The letter is from Rep. Henry Waxman (D., CA), who is chairman of the House Energy and Commerce Committee, and Rep. Bart Stupak (D., MI), who heads the panel's Subcommittee on Oversight and Investigations. The letter did not refer to the health overhaul debate, saying only that the committee "is examining executive compensation and other business practices in the health insurance industry."
The White House and Senate Democratic leaders, seeing little chance of bipartisan support for their healthcare overhaul, are considering a strategy shift that would break the legislation into two parts and pass the most expensive provisions solely with Democratic votes. The idea is to escape the morass caused by delays in Congress, as well as voter discontent shown in angry town-hall meetings. Polls suggest the overhaul plans are losing public support, giving Republicans less incentive to go along.
While many companies are starting to track social-networking tools like Twitter and Facebook, there has always been challenges in the healthcare business because of privacy concerns. But health insurers are beginning to dip their toes in the water, according to the Wall Street Journal Health Blog.
