The five states with the highest percentage of "A" hospitals this spring are Maine, Hawaii, Oregon, Wisconsin, and Idaho.
The Leapfrog Group released its latest "safety grades" Wednesday for the 2,639 hospitals participating in the group's annual survey. Of that group, 31% (823) earned an "A" and 27% (706) earned a "B," according to the nonprofit, which advocates for quality and safety in healthcare.
The Leapfrog Group began using the letter-grad ranking system in 2012. The grades are based on a numerical score for calculated for each hospital based on a review of 30 patient safety measures.
The organization generates the score using data from the Centers for Medicare & Medicaid Services, data from its own hospital surveys, and data from other sources, including the American Hospital Association's Annual Survey.
The findings are "weighted and then combined to produce a single, consumer-friendly composite score that is published as an A, B, C, D or F letter grade."
Half of the grades are based on process measures, such as hand hygiene and physicians staffing at intensive care units. The other half of the grade is based on outcome measures, including rates of patient falls and infections.
The bulk of the hospitals fall into the A to C range. The 823 that earned the top grade represent about 31% of those in the survey, while the 706 earning a "B" represent 27%. In addition, 933 hospitals received a "C" (35 %), 167 earned a "D" and 10 earned an "F."
Grade
# of Hospitals
% of Total
A
823
31%
B
706
27%
C
944
35%
D
167
6%
F
10
<1%
In New York, 10.1 percent of the hospitals earned As. For nearly half of the states, fewer than 30 percent of hospitals earned As.
Leapfrog notes that the five states with the highest percentage of "A" hospitals this spring are Maine, Hawaii, Oregon, Wisconsin and Idaho. Maine, which is ranked first, is the only state to make it to the top five each year since the safety grade program began in 2012.
The group's grading program is one of three major hospitals review efforts. CMS and U.S. News & World Report also produce reports on hospital on quality.
The American College of Surgeons cites "design limitations" of 21 studies questioning the value of its National Surgical Quality Improvement Program Surgical Risk Calculator.
Researchers from the American College of Surgeons are questioning the validity of more than 20 papers that have found flaws in a tool designed by ACS to measure the risks of surgery.
The tool in question is the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) Surgical Risk Calculator (SRC).
Researchers from the ACS and the surgical departments of the University of California Los Angeles and Washington University, St. Louis, published their findings online at the Journal of the American College of Surgeonswebsite ahead of print publication later this year.
According to the ACS, the tool, which was released in 2013, allows surgeons to enter 23 preoperative patient risk factors and estimate risks for mortality and complications. In a media release the group called it "an accurate, preeminent tool for estimating patients' surgical risk."
ASC researchers have looked at 21 studies challenging the tool's validity and determined that the studies had design limitations. As a result, they "should not disqualify the SRC for its intended goal—to provide a general purpose estimate of complication risk across a wide variety of operations."
Among the findings of studies challenging the tool:
In March, researchers questioned the value of the tool for emergency surgery. "Further studies are needed to validate this risk calculator and to determine its bedside applicability," they wrote.
Another study found the tool is "not a valid tool for the field of plastic surgery without further research to develop accurate risk stratification tools."
In January, a study of colorectal surgery cases found the tool "underestimated the surgical site infection and overall complication rates. "
The ACS researchers cite problems with the studies' sample sizes, case mixes, and "the scope of the data sets." For example, they say most of the studies were based on data from a single institution.
"The calculator provides an estimate for the average NSQIP hospital, but it is unlikely that any of these institutions represents the precisely average hospital…These findings suggest that, as much as possible, external validation studies of SRC prognostic models should be based on large, multi-institution, data sets."
Paperwork, billing, performance measures, regulations, reporting requirements: The American College of Physicians calls these "administrative tasks" a hassle, and calls for a sweeping review.
The American College of Physicians released a position paper Monday calling for the review, revision, and removal of "administrative tasks" they say are cutting into patient care.
Published in the Annals of Internal Medicine, the paper contends that insurance paperwork, government regulations, and performance measures divert physicians' time and focus away from patient care and quality improvement.
It offers recommendation for changes and notes that "an analytic approach to defining and mitigating administrative tasks is critical to addressing them in a more comprehensive, cross-cutting, and holistic manner, rather than fixing one problematic task only to have another arise in its place."
Review
The paper calls for the review of existing regulations and paperwork, the elimination of ineffective requirements, and the justification of new tasks. For example, those who implement administrative tasks should "provide financial, time, and quality of care impact statements for public review and comment."
Tasks that have "a negative effect on quality and patient care, that unnecessarily question the judgment of physicians and other clinicians, and/or that increase costs should be challenged, revised, or removed entirely," it says.
Clinicians and staff spend about three to five hours on billing and insurance administration and up to fifteen hours on quality measurement and reporting, according to a literature review by the authors.
They also cited studies concluding that the cost of dealing with administrative tasks was 12% to 14% of physician revenue, or about $68,000 to $85,000 per physician.
Revise
The paper further calls for regular, transparent revision of any administrative tasks that cannot be eliminated. Specialty societies, clinicians, patients, and HIT vendors should "aim for performance measures that minimize unnecessary clinician burden" and integrate performance measurement into quality improvement programs.
The authors note that their recommendations are important as the healthcare system moves toward value-based payment.
Finally, they call for "meaningful collaboration to improve the development, testing, and implementation of measures and to ensure that health IT is used innovatively to streamline processes and reduce burden."
In the face of unprecedented change in the healthcare industry, Vanderbilt University Medical Center has found ways to better engage patients and meet the high expectations they have developed as consumers.
Hospital marketing strategies have long been accused of lagging behind other industries in a number of categories, from technological integration to customer experience.
Now, consumers are more sophisticated and empowered than ever before, and hospitals are faced with two options—either meet patients' high expectations or surrender to the competition.
Vanderbilt University Medical Center has chosen the former.
Heightened Patient Expectations
"Across the healthcare industry, providers like Vanderbilt University Medical Center are facing unprecedented changes," says Jill Austin, chief marketing officer for the Nashville, TN, medical center. Those changes include:
Uncertainty surrounding the ACA and the move from volume to value
The possible unwinding of the ACA's exchanges
Rapid innovation from new players in the field
The explosion of available digital channels
The move toward consumerism in healthcare, with consumers making decisions based on price, experience, service, and quality
"Marketers across every industry are facing a revolution in how they connect with consumers, and that couldn't be more true than for those in the hospital and health system world, which has struggled to keep up," says Brandon Edwards, chief executive officer of ReviveHealth, VUMC's agency of record.
"No longer are patients content with the out-of-touch hospital experience."
Today's patients expect the same level of interaction with their hospital as they do with top retail stores—the want personalized communications, a clear understanding of purchases, and a streamlined experience.
This new, heightened patient expectation is forcing hospital marketers to break down the walls between marketing communication disciplines.
New Marketing Strategies
VUMC has begun adapting its marketing strategies to better engage patients and meet their high expectations. They are doing this by pursuing and applying three new principles to their branding and go-to-marketing efforts:
Big data
Digital first
Personalized communications
"In the end, we're shifting our brand to become one valued not only for delivering the best healthcare, but as a partner in helping those we serve stay healthy throughout their life," Austin says. "That obviously is about more than advertising or messaging—it's a fundamental shift in how we show up and deliver value in the market."
To achieve that goal, the VUMC brand is becoming increasingly mobile and "always on."
An Integral Internal Shift
An integral component that set VUMC's new strategy in motion was a shift in how it approached marketing internally.
"The marketing vision we created—which really triggered all of this—has become a beacon not just for our marketing team, but throughout the organization in terms of how we hope to provide value to patients and consumers in the coming year," Austin says.
"It's a common platform that we can all orient to, and which has helped us in bringing together essential partners internally, such as Information Systems and Population Health Management, who we'll need to make our vision a reality."
Austin and her team are also using the academic medical center's resources to their advantage.
"We have access to thinking and innovation that others don't necessarily, allowing us to push the boundaries even further," she says. "For example, we've begun exploring neuromarketing—which we have available to us here—to test and improve our marketing approaches." Neuromarketing claims to apply the principles of neuroscience to marketing research.
VUMC's marketing innovation shows that leading health systems are, indeed, catching up to top brands in more marketing-savvy industries.
By dialing back on offline advertising and focusing on marketing automation, paid digital and social advertising, content marketing, and influencer marketing, health systems are poised to meet patients' heightened expectations without them grading on a curve.
"The best hospitals now see themselves as great marketers, not just great healthcare marketers," Edwards says.
The Washington DC-based principal of a national advisory and advocacy firm gives an overview of Donald Trump's plans for healthcare and an outlook on other healthcare policies if the Republican nominee wins the presidency.
The full webcast includes Ilisa Halpern Paul, president of the District Policy Group, which is part of Drinker, Biddle & Reath, who discusses the outlook under a Democratic victory. This transcript has been edited for length and clarity.
Nicholas Manetto: For Republican Donald Trump, primary health policy discussion has been around repealing the Affordable Care Act. That is very much in line with national Republican orthodoxy, and it's been a core point for the last six or so years.
Trump is very different from [Hillary] Clinton. This is not just in their differences on policy issues, but really his lack of focus on healthcare throughout his career. This is, of course, as you know, his first run for elected office, and his business interests have not really focused in the healthcare arena, as compared to Secretary Clinton, who has had a sizable focus on health going back to her early career in Washington.
Beyond repealing the ACA, there's not a lot of detail in his agenda. It largely consists of a core set of Republican principals that have been in the arena for some time.
These include points around changing the tax code to incent the use, affordability, and access to Health Savings Accounts, as well as some insurance regulatory reform to broaden the markets for insurance products, and you also see a longstanding staple around turning Medicaid into a Block Grant program to give the states more flexibility in how they design their programs.
There are two areas where you do see some disagreement from the typical Republican agenda. Those come in the area of prescription drugs, where you see Donald Trump being pro-allowing Medicare to negotiate directly for prices of drugs rather than letting the Part D plan work with the pharmacy benefit managers to do that as they have done for decades since the MMA [Managed Medical Assistance] was enacted.
You also see Trump expressing support for drug reimportation. This is a hot topic that we saw in the lead-up to the Medicare prescription drug bill earlier in 2003–2004, when you had a lot of seniors purchasing drugs from pharmacies located outside the border to address cost concerns. Now, you're having Trump say he would support some of those efforts as a way to address the rising costs of prescription drugs.
You see this sort of mesh of longstanding Republican principals for the most part, with a few of these outliers that sort of reflect the Trump populist appeal.
So, the agenda, in summary, is longstanding ACA repeal-and-replace, but not very detailed, with a few of these outliers. Especially when you talk about price sensitivity and transparency, those are going to be sensitive areas, especially in the eyes of the biopharmaceutical stakeholders.
For a long time, the assumption has been that a Trump administration would cede the bulk of their health policy agenda to leaders in the Republican congress; folks like Speaker Paul Ryan, who has developed a very comprehensive health policy agenda under the A Better Way heading.
However, the more recent and continued tensions between Trump and Speaker Ryan will raise questions about what exactly this relationship might look like, if it comes about.
On the insurance side, a Better Way includes a lot of policies like tax incentives to help individuals purchase insurance, trading various interstate compacts and insurance pools like "high risk" pools, and use of association health plans, all to try to drive private sector uptake of insurance and access to insurance.
We'll see a lot of policies focused on HSAs, such as allowing spouses to make more catch-up contributions and expanding access to populations that can use the HSAs, including programs like Tricare, and even in the Indian Health Service.
While repeal of the ACA is fundamental to the Better Way agenda, you do see recognition of some of the more popular reforms, like allowing people to stay on their parents' plan through age 26 and protecting folks with preexisting conditions from being taken off a plan or prevented from purchasing insurance.
You don't see any open debate with anyone saying that these should be undone, but you do see some calls in the Ryan agenda for changing the age rating ratio from 3:1 to 5:1 as a way to address healthcare pricing.
A Washington DC-based consultant gives an overview of what might happen to healthcare if the Democrats win control of Congress, the Senate, or the presidency.
The full webcast includes Nick Manetto, principal at FaegreBD Consulting, who discusses the outlook under a Republican victory. This transcript has been edited for length and clarity.
Ilisa Halpern Paul: Secretary Clinton has 30 years in public service and public policy. So, not surprisingly, she has very long list of things which she counts as her accomplishments, as well as things which she's outlined that she still hopes and plans to do if she's elected president.
Of particular note, I wanted to highlight a few items on this list that have bipartisan support. For example, the Cadillac tax. This is a provision of the Affordable Care Act that many of you may be familiar with, which pertains to the tax associated with higher expense healthcare plans with high premiums.
This is a provision which is universally disliked; Democrats dislike it and Republicans dislike it. It's been delayed once, but it's on track to go into effect in 2020. Both sides of the aisle and both chambers—house and senate—have indicated a desire to either repeal it or further delay it.
So, there are issues on Secretary Clinton's health policy agenda that would generate some bipartisan support. She wants to continue the plan to move forward the shift from fee-for-service to value-based care. That's another area where there is some bipartisan interest.
The discussion around the high cost of drugs certainly has bipartisan interest this year, and will continue to be in the public domain in the year ahead.
I thought we should spend a minute or two focusing specifically on drugs and the cost of drugs because of its national prominence on the policy agenda. Secretary Clinton has outlined a number of policies that she envisions putting in place if she's elected president with respect to the high cost of drugs.
In particular, as she highlighted in a policy paper in the New England Journal of Medicine recently, she wants to institute a monthly cap so that no individual need spend more than $250 a month on their prescription drugs.
She also is interested in negotiating and having the federal government negotiate drug prices for the Medicare program, as well as getting greater rebates from the pharmaceutical companies.
Again, there are some issues here where there's bipartisan agreement, and other issues, such as negotiating drug prices for the Medicare program, which, while it does not have bipartisan support in the congress, interestingly, Donald Trump has indicated his interests potentially in working on that issue.
Secretary Clinton has also outlined a number of other issues as key areas of policy focus for her if she's elected president. One issue of particular concern to her is affordable access for individuals who are not old enough to get in the Medicare program.
She long has advocated opening up the Medicare program to individuals who are under the age of 65; in particular, allowing individuals age 55 and older to buy into the Medicare program.
She also wants to strengthen the Medicaid program, provide additional flexibility and support to states with respect to Medicaid expansion, and ensure that there continues to be a safety net for individuals through the National Health Service Corps and the Community Health Centers program.
Secretary Clinton's agenda is a very broad and aggressive one. It's important also to spend a few minutes looking more broadly at the Democratic agenda. The Democratic National Committee put out its platform this summer, and it includes a number of issues beyond those that have been outlined and highlighted by Secretary Clinton.
The Democrats continue to call for universal healthcare, and they continue to advocate a public option. That's an incredibly important piece of Secretary Clinton's plan, which is to allow each state to have a public option available through their respective state exchanges. This currently does not have bipartisan support.
NIH funding—increasing funding for research—better treatments, cures, and diagnostics for a range of diseases and conditions—is something where there is bipartisan support.
HealthLeaders Media conducts proprietary analysis and forecasts and publishes monthly reports for senior leaders of healthcare organizations. Here are five recent reports that may be downloaded free.
Discover the top challenges healthcare organizations are facing in the emergency department, where organizations are expecting increases over the next three years, and what care settings have the most potential to improve the industry’s ability to deliver value-based care.
Merger, acquisition, or partnership decisions are being made to increase market share, improve position for population health management, and numerous other contributing factors. In this report, you’ll find the top financial objectives for MAP activity and what type of entity healthcare organizations are most looking to pursue for a MAP.
Most providers are involved in at-risk payment models of one kind or another. Their experience now should help them develop expertise that will be vital when value-based payments are the norm. Among the lessons to learn today is how to benefit from closer working relationships with payers in the future. In this latest report, peer leaders examine ways to benefit from closer working relationships with payers.
The need for analytic tools to make sense of disparate data sources will certainly be expanding in the upcoming years. This report highlights what analytical data healthcare leaders are currently focusing on, as well as the challenges they expect to face when using analytics to support their organizations in the future.
This report outlines the top challenges providers are facing in the transition to value-based care. The results this year reinforce both the magnitude of the task and leaders' reluctance to make a full commitment while details of emerging but still largely unknown payment models are unresolved.
At the first HealthLeaders Media CNO Exchange, healthcare executives focused on solutions and innovations to address changes in the industry and the nursing profession.
This article appears in the January/February 2016 issue of HealthLeaders magazine.
More than two dozen nurse executives from across the country gathered at the Omni Barton Creek Resort in Austin, Texas, last November for the first HealthLeaders Media CNO Exchange. This newest addition to the Exchange series of annual executive events focused on nursing's key role in care redesign, the challenge of recruiting and retaining nurses, and the evolving role of the chief nursing officer.
The leaders at the invitation-only gathering came from a range of organizations, including large health systems such as Baylor Scott & White Health in Dallas; Carolinas HealthCare System in Charlotte, North Carolina; Catholic Health Initiatives in Englewood, Colorado; Ochsner Health System in Jefferson, Louisiana; Scripps Health in San Diego; and UPMC in Pittsburgh, as well as independent hospitals including Community Hospital in Munster, Indiana; Jupiter (Florida) Medical Center; and Louis A. Weiss Memorial Hospital in Chicago; and academic medical centers such as University of Wisconsin Hospital and Clinics in Madison; University Health System in San Antonio, Texas; and Wake Forest Baptist Medical Center in Winston-Salem, North Carolina.
As providers undertake contracts with increasing levels of downside risk, their need for advanced analytics to manage decision making and monitor results will only grow.
The evolution of analytics from mainly functioning as a finance and administration tool to an expanded role that includes integrating financial and clinical data continues to gain momentum. Its use and increasing sophistication, driven by the steady advance of value-based care and the assumption of greater downside risk by providers, are trends that will likely accelerate in the coming years.
As the industry moves from fee-for-service to value-based care, providers will likely find themselves consumed with analyzing payer- and patient-related data from diverse internal and external sources. The need for analytics tools to make sense of the disparate sources for both financial and clinical data will only grow.
And as providers undertake contracts with increasing levels of downside risk, their need for advanced analytics to manage decision making and monitor results will also grow.
The need for analytic tools to make sense of disparate data sources will certainly be expanding in the upcoming years. This report highlights what analytical data healthcare leaders are currently focusing on, as well as the challenges they expect to face when using analytics to support their organizations in the future.
