In recent years, more hospitals have hired full-time docs known as hospitalists to provide general care to inpatients. A study was conducted focusing on the treatment of heart attack, pneumonia, and heart failure at 3,619 hospitals, about 40% of which had hospitalists. After adjusting for differences between the groups, researchers found that hospitals with hospitalists adhered more closely to standard quality measures than hospitals without hospitalists.
A recent study shows the number of methicillin resistant Staphylococcus aureus (MRSA) infections found in patients located at 13 New Mexico hospitals and three state clinics was cut almost in half after the facilities agreed to self report cases.
Last year, the facilities reported 44 cases of MRSA, but after agreeing to self report the cases, the MRSA infections dropped to 27 cases. This reduction was a result of simple medical measures, such as handwashing, nasal swab tests, and segregating the infected.
According to Individual.com, mandatory infection reporting has been opposed by New Mexico's medical community, and since 2005, seven bills have been proposed and turned down by the New Mexico legislature.
The study, the New Mexico MRSA Collaborative, was conducted by Susan Kellie, a hospital epidemiologist for the University of New Mexico Hospital and the Raymond G. Murphy VA Medical System. Kellie's study shows that reporting is a key component that guarantees best practices and helps contain or reduce deadly infections.
Kathy Mosley, BSN, CPMSM, CPCS, medical staff PI coordinator at Northern Mjavajo Medical Center in Shiprock, NM, has had discussions with her facilities' own infection preventionist to address varying opinions within her own hospital regarding mandatory infection reporting.
"My own opinion is that data can be reported and collected, but the key [question] is what is being done with the collected data," says Mosley. "The outcome of the information many times is lost or is not received by the users who can make a change or make a difference in care."
Even without mandatory reporting, Mosley has seen positive outcomes from the CMS measures.
"The positive outcome I have witnessed from mandatory reporting, such as the CMS measures, is an increase in awareness and effort amongst the staff when they are included in the sharing of information, and given an opportunity for input," says Mosley. "When they become involved, the collected data becomes meaningful and change occurs."
Until recently, hospitals have had few options for accreditation surveys: The Joint Commission or their respective state boards. Since the Centers for Medicare & Medicaid Services granted deeming status to Det Norske Veritas (DNV Healthcare) in late 2008, folks in the field have been itching to know what makes this accreditor different.
DNV looks for the same things the Joint Commission does—both are tasked by CMS to ensure that hospitals comply with its Conditions of Participation. However, DNV takes an entirely different approach to conducting surveys that DNV-accredited facilities find effective and even friendly. "We might be easier to get along with, but we are not easy," says Patrick Horine, executive vice president of accreditation at DNV Healthcare in Cincinnati.
DNV's accreditation program, called the National Integrated Accreditation for Healthcare Organizations (NIAHOSM), incorporates International Organization of Standardization (referred to as ISO) 9001 quality management standards. ISO 9001 standards require hospitals to document and analyze root causes of poor outcomes, follow through with changes to improve performance and correct inconsistencies, and document preventive and corrective actions—in other words, the focus is on continuous improvement rather than erratic scrambling to "fix" things before an accreditor arrives at the door.
Incorporating ISO quality standards into the survey process calls for yearly surveys, and people don't seem to mind. Judith Purdy, RN, previously the director of quality at Hays (KS) Medical Center who recently retired and will soon work with DNV Healthcare as a surveyor, says the yearly surveys keep medical staffs on track. "Regardless of how good a hospital's intentions are to stay in compliance, people do tend to let things lapse if [they] know [they] aren't being surveyed again for three years."
The whole process of surveying the medical staff services department takes about 90 minutes to two hours, says Horine.
Holland (MI) Hospital was surveyed at the end of April, and Lana Heavilin, RN, medical staff office coordinator, recalls spending about 40 minutes with a physician surveyor reviewing the medical staff bylaws. The reviewer had read the bylaws the day before the medical staff services department was surveyed and came prepared with specific questions. The surveyor also requested the credentials files for an active medical staff member, an AHP, a non-admitting affiliate physician, and a surgeon.
"He gave us positive feedback through the whole thing," says Heavilin.
Heavilin was also surprised that the DNV surveyors invited her and everyone else who participated in the survey to the final survey meeting. "I heard right from the person who surveyed us what he thought we had problems with. I thought it was interesting that they opened up the meeting to everyone, not just administration."
Heavilin found the process to be educational rather than nerve wracking, and Horine attributes that to the fact that DNV surveyors are qualified based on their education, background, and experience, but they are hired for their communication skills.
"The DNV really wants to help hospitals, which I think put the staff at ease," Purdy says of Hays Medical Center's survey in October 2008. "Staff seems more willing to talk about areas where they think some improvements could be made."
Horine says that although DNV prides itself on its education approach to accreditation surveys, surveyors do not act as consultants by any means. "We can provide best practices, share information learned from other hospitals, and give some general guidance as to how to go about addressing corrective actions, but it is important to relay that we don't consult or certify our own work," he says.
Conservatives in the United Kingdom have promised huge cost savings for the National Health Service by scrapping government plans for a central database of patient records. The new proposal includes plans for electronic medical notes being stored locally by physicians and hospitals, with patients having online access to their medical records. But some said the Conservatives' plans raised concerns about patient confidentiality.
Australian health and tourism experts say the country is losing some of its best doctors and nurses because they are being poached to work in the booming health tourism industry in the Middle East and Asia. The experts said places such as Dubai were building major infrastructure to cater to the growing market and luring Australian health professionals with big salaries. "They're looking for pools of talent that have high levels of training and experts who preferably speak English, so Australia is a prime target," Australian Tourism Export Council managing director Matt Hingerty told the Daily Telegraph.
When I was in the fourth grade, my teacher, Mr. Stone, rewarded spelling bee winners with a banana split. That probably wouldn't happen today, but it was a powerful motivator for me to win. The fact that my parents had banned all refined sugar products a few years earlier sharpened my focus even more. I aced a couple of spelling bees that year. Would I have won without the incentive? Maybe. Maybe not.
Having an incentive to do better works for kids and it works in business because we humans are hardwired, for the most part, to want to do our very best.
In the case of 260 hospitals that are part of CMS and Premier Inc.'s value based purchasing project, having financial and other incentives to improve quality is making a difference in five clinical areas, according to recent analysis of the project. The hospitals are rewarded with cash awards and public acknowledgement on the CMS Website for improved quality. In years 1 to 3, top performers had an opportunity to earn either a 1% or 2% bonus of Medicare DRG payments for a given condition. As well, the top 50% of hospitals in each clinical area received public acknowledgement.
CMS and Premier have been testing value based purchasing initiatives since 2003. Known as the Hospital Quality Incentive Demonstration P4P Project, the program was established to determine if hospitals could improve quality in acute myocardial infarction, congestive heart failure, coronary artery bypass graft, pneumonia, and hip/knee replacement if they were properly incentivized and also recognized on the CMS Web site. The results for the first three years show that the Composite Quality Score improved by an average of 15.8% and more than $24.5 million has been awarded to the top performers.
While all hospitals improved clinical quality while reducing care variation, it took safety net hospitals until year three to perform as well as non-safety net hospitals in the areas of heart attack, heart failure, and hip/knee replacement. For instance, safety net hospitals "received fewer awards and less recognition in the first two years of the project," according to analysis by Premier. But after year three, safety nets began receiving top performance awards. According to Premier's analysis, safety-net hospitals may take longer to adjust to value-based purchasing initiatives because they have "less reliable revenue streams," which make it more difficult to close performance gaps. How do you become a top performer? Hospitals must be in the top 10% and 20% of performance compared to all participants.
While the cash incentives are an important component, the fact that hospitals continue to set and achieve new quality goals throughout the project is very motivating for some of the organizations.
"The program creates a dynamic where the work is never done – quality goals keep getting more aggressive because as a group, HQID hospitals are improving rapidly over time," said Jack Garon, MD, chief medical officer at Sinai Health System of Chicago, in a press release. The program, he says, has incentivized the organization to "chase the top levels of performance."
CMS has extended the program through 2009 to include multiple conditions and test new "incentive models." At year four, for example, the top 20 percent of hospitals in each clinical area will receive an additional payment incentive.
Lesson's to be learned by Washington reformers? Radical payment reform takes years to implement successfully.
Sue McCarthy has been named chief financial officer of Grady Health System. She began her new role with the health system on Aug. 1, replacing Michael Ayres who left to take another position. McCarthy came to Grady in May of this year as senior vice president for revenue cycle and special projects.
A new law passed in the recent Tennessee legislative session should help state officials cast a wider net in going after potential fraud against TennCare, including healthcare providers that charge for services that never took place. Under the law, TennCare would use proceedings before an administrative law judge to pursue cases that involve less than $10,000 of suspected fraud. That would allow the state's attorney general to focus on larger, more serious cases that have to go through the federal court system where the process is more time-consuming.
The Cleveland Clinic and University Hospitals won stable bond outlooks from a credit-rating agency in recent weeks, bucking a national trend in the nonprofit hospital industry. The rating reports provide the most recent indication of the financial strength of the hospitals : Both are reporting increases in operating profit margins for the first six months of the year.
LifePoint Hospitals' earnings fell 5% in the second quarter compared to the same period a year ago, and the stock is trading lower this morning after missing analysts' estimates. The Brentwood, TN-based community hospital owner reported net income of $26.3 million, or 49 cents per diluted share, in the quarter ended June 30, compared to $27.8 million, or 52 cents per diluted share, in the year-ago period.
