The Minnesota Senate and House approved multi-billion-dollar health and human service bills, as DFLers continued their march toward a showdown with Gov. Tim Pawlenty over a major area of the state budget. The two bills, which have some notable differences, include what DFL leaders said are painful but necessary reductions in light of the state's $4.6 billion budget deficit. But the reductions fall short of what the governor said is necessary to slow down rising costs. The House and Senate DFL majorities both tried to convince Minnesotans that Pawlenty is going too far in pushing people off state-subsidized healthcare and in cutting funds for hospital and nursing home facilities.
This blog posting from the Los Angeles Times outlines Wellpoint's pilot with Serigraph Inc., a specialty graphics company with operations in Wisconsin, Mexico and Asia, that gives U.S. employees the option to travel to India to have surgery on a non-emergency basis. Wellpoint's Paul McBride, vice president of healthcare management and services, spoke on the topic during a panel on healthcare economics at the Milken Institute's Global Conference today in Beverly Hills.
A conservative group will begin a $1 million television advertising campaign warning Congress not to enact a government-run healthcare plan similar to those in other countries. The ads feature British and Canadian doctors saying the healthcare plans in their countries reduce choices and asserting that patients have died while awaiting care.
The ads are funded by Conservatives for Patients' Rights Action Fund.
Nashville-based HCA Inc.'s first-quarter net income surged 92% even as the hospital operator sharply boosted spending on charity care and discounts to the uninsured. The nation's largest owner of acute healthcare facilities said earlier this month that it expected higher revenue amid analyst and investor concern about weakening results.
The number of confirmed cases of a deadly new strain of the flu continued to rise Monday, as the World Health Organization moved one step closer to declaring a pandemic. The United Nations public-health agency raised its global alert to phase 4 from phase 3. The change recognizes that the new A/H1N1 virus spreads from person to person, and signals that governments should prepare for outbreaks. Phase 6 is a pandemic.
At the White House press briefing on the administration's efforts to combat and control a potential swine flu outbreak, press secretary Robert Gibbs was joined by Homeland Security Secretary Janet Napolitano, deputy national security adviser John Brennan, and Centers for Disease Control and Prevention acting director Dr. Richard Besser. But absent on stage was a fully confirmed federal healthcare official: There was no health and human services secretary, notes this blog posting from the Washington Post.
Invented 16 years ago, virtual colonoscopy has become an increasingly popular alternative to standard, or optical, colonoscopy, which is typically performed by a gastroenterologist. Initially regarded as a high-tech novelty, the new procedure has in recent months received key endorsements as a first-line screening test from influential medical groups. But in February, officials at the Centers for Medicare & Medicaid Services announced a preliminary decision not to cover the procedure as a mass screening test for Medicare recipients.
Dublin (OH) Methodist Hospital has not had a hospital-acquired infection since January 8, 2008, when it opened. Chief Nursing Officer Lamont Yoder, RN, attributes the hospital's infection control success not just to its staff members' compliance, but to the physical environment in which they work every day.
"Private rooms are not just for the luxury of having a private room," says Yoder. "They're actually for the [patient's] outcome afterward."
Private rooms are not the only design helping Yoder keep his hospital a safe place to heal. Dublin Methodist was designed with consultation from the Center for Health Design (CHD), a non-profit research, education, and advocacy organization that conducts research to guide hospitals on best design practices for healthcare organizations.
Hundreds of research reports conducted by the center have gathered evidence on the impact of healthcare design on patient care, quality, outcome, and safety.
"The work [the CHD has] done over these last 10 to 20 years have shown quite conclusively that physical environment actually makes a difference to patient safety and quality improvement," says Anjali Joseph, PhD, director of research at CHD. "What we've been suggesting is that physical environment should be a part of the bundle of interventions that are put in place."
Dublin Methodist is contributing to more research as a partner in the Center's Pebble Project, which aims to collect information on newly-designed hospitals to find out what works best. "Patient safety was our top strategy in how we designed the building, from an architectural and work flow standpoint," says Yoder.
In November, 2008, the Joint Commission released its Guiding Principles for the Development of the Hospital of the Future, a report that guides hospitals in meeting the challenges of the future. Hospital design was one of its five core areas of action. In the report, the Joint Commission urges hospitals to offer private rooms, decentralize work stations, and reduce noise through evidence-based design.
More recently, the Institute for Healthcare Improvement published Using Evidence-Based Environmental Design to Enhance Safety and Quality, as part of its Innovation Series 2009. Joseph served as one of the paper's authors. The paper attempts to highlight the connection between world of hospital and patient safety and that of architectural design.
Private rooms, fewer transfers
Apart from patients having their own rooms at Dublin Methodist, they also move around much less, which Yoder says reduces infection rates.
"This is probably one of the most unique aspects in the design," says Yoder, referring to the hospital's acuity adaptable model of care, which allows any patient to stay in the same room until he or she is discharged, "no matter what happens to them in the hospital" according to Yoder.
"We don't have geographically delineated locations for certain types of patients. We don't have a medical floor, then a surgical floor, and then an intensive-care unit (ICU)." Instead, rooms are adaptable and medical equipment and nurses are brought to the patient.
Better light, less noise
Light and noise are both significant areas of interest for the CHD. Natural light in patient rooms can help patients gain better orientation, decreasing confusion in some patients, and is associated with both a shorter length of stay and lower use of pain medications, says Yoder. And though Joseph says there hasn't been much research to determine the environmental effects on medical errors, one CHD study found better lighting in the pharmacy lowers medication dispensing errors.
"We have an extremely, extremely quiet environment," says Yoder, explaining that this improves patient sleep patterns and communication between staff members and physicians, as well as between patients and their caregivers. Yoder says most hospitals are at the decibel level of highway traffic. Although most healthcare workers would probably not be surprised by that estimation, says Yoder, the noise can affect care.
"Those of use who have worked in busy units know that it can become extremely loud during shift change, when you have multiple nurses, caregivers, and physicians in an area where they all gather together. Our ability to lower noise was done by having no centralized location for people to gather," says Yoder.
Dublin Methodist has no centralized nursing stations; instead, it has working areas called perches, which are smaller, sitting or standing height stations closer to patient rooms. From each perch, a nurse can see three to five rooms. The perches also eliminate communication barriers.
Environment of safety in older hospitals
Though Yoder concedes that having breakthrough design and technology helps reduce errors and improve patient safety, he says that without the implementation of a culture of safety—which he adds can be implemented at any hospital—it wouldn't be enough.
"You can have the most beautiful building that is designed with the greatest architectural pieces that add into outcomes, but if you don't have the culture of safety developed, it will not work."
In addition to implementing a culture of safety, Joseph says any hospital should consider small implementations to improve the safety of its environment. She suggests conducting light and noise audits, ensuring there is enough light in critical spaces such as pharmacy, and find the source of loud noises to see whether the source can be removed. Installing sound-absorbing ceiling tiles, if possible, helps reduce noise, while rubber floors reduce noise and soften patient falls. She also suggests adding visual cues to highlight hand washing facilities.
Tami Swartz is an associate editor at HCPro, Inc., where she serves as editor for books, videos, and other resources in the accreditation and quality/patient safety markets. Tami also writes for Briefings on Patient Safety, an HCPro monthly publication. Contact Tami by e-mailingtswartz@hcpro.com
Attendees at the 40th annual membership meeting of the American Hospital Association in Washington were assured Monday that healthcare reform is on track on Capitol Hill. But the message underlying that prediction is somewhat bittersweet: Hospitals are likely facing a future with a new definition of success that entails "doing less but producing greater results for patients," said AHA President and CEO Rich Umbdenstock at the opening session.
"Let's be realistic: A balanced final reform package will be a mixed bag of gain and pain for everyone. We [undoubtedly] will applaud much in it—particularly if it moves us closer to an affordable available coverage for all," Umbdenstock said.
"But without a doubt, some [reforms] will scare the pants off us because [they] will challenge us to carve out new relationships with other providers and reorder the way we use resources," he added. "I suspect everything in it will compel us to speed up the pace of change at a time when economic conditions are already requiring hospitals to change in ways we might rather not."
Nancy-Ann DeParle, director of the White House Office of Health Reform, told AHA attendees that hospitals likely will have differences on some issues, but "I think we can agree that real reform is in everyone's best interest."
She said that during the time leading up to the first 100 days of the Obama administration, the White House has been listening to hospitals—including providing support for Medicaid under the American Recovery and Reinvestment Act, and encouraging the implementation of health information technology in hospitals and physicians’ offices.
This is a time when hospitals are finding times are tough: in addition to seeing the financial health of many hospitals sharply decline (as seen in a new AHA survey), many hospitals are shouldering a large proportion of uninsured care. In 2008, more than $35 billion in uncompensated care was provided nationwide,” DeParle said. A system left unchecked will tie up 25% of our economic output by 2025. "It cannot continue."
She outlined "simple practices and principles"—several highlighting hospitals—that she said the Obama administration wanted to see in final healthcare reform legislation. They are:
A reform plan must reduce the long-term growth of healthcare costs for business and government. "Hospitals know better than almost anyone about the skyrocketing healthcare costs," she said. "Reform that does not cut costs is not reform at all."
Individuals can choose their own physicians and health plans. "The Obama administration won't force Americans to change plans, change physicians or alter the care they receive," she said. "Americans satisfied with their care should know one simple thing: if your healthcare ain't broke, we don't intend to fix it."
Families should be protected from bankruptcy or crushing debt because of healthcare prices. Healthcare systems put too many patients on a fast track between a hospital and bankruptcy court. "That's bad for everyone. Preventing this kind of crushing debt must be a cornerstone of reform."
Investments must be made in prevention and wellness. "We need to make healthcare about more than just treating the sick. Instead, our healthcare institutions should focus on keeping Americans healthy—reducing the incidence of painful and potentially deadly chronic diseases," she said.
Any reform measure must take significant steps to improve patient safety and quality of care. Citing deaths related to medical errors and hospital-acquired infections, she said that although hospitals "around the country provide excellent care, the healthcare system can do better."
Efforts should be made to cover or maintain coverage (aside from COBRA) when individuals lose or change jobs. "The employer-based healthcare system has serve billions well, but it's meant that many Americans have lost their healthcare when they receive a pink slip," she said.
Reforms should be put in place to assure quality healthcare coverage to all.
DeParle, who did not take questions from the audience following her presentation, did not specifically address the issue of creating a government-run health insurance plan.
Hospital job growth, until recently one of the few bright spots for a nation deep in recession and high unemployment, has all but flat-lined so far this year, Bureau of Labor Statistics show.
For the first quarter of 2009, preliminary BLS figures show that the hospital sector created slightly less than 6,200 jobs nationwide. In the first three months of 2008, the hospital sector created 32,500 new jobs.
BLS reports that there were more than 4.7 million hospital jobs nationwide through the end of March 2009.
“It’s a response to the fact that volumes are weak and hospitals are adapting their staffing to adjust to that,” says David Bachman, an analyst with Longbow Research in Cleveland. “Employee expense is a huge cost center for hospitals, so the extent that they can manage that appropriately that is one of the few levers they have to try to keep margins from deteriorating too much in this environment.”
If hospital job creation continues at this pace, fewer than 25,000 new jobs will be created in 2009, as compared with 137,100 new hospital jobs in 2008; 105,700 new jobs in 2007; and 81,400 new jobs in 2006, according to BLS data.
“We are going to see subdued job growth throughout the remainder of this year,” Bachman says. “The sentiment among hospital leaders could be we are not going to see a big upswing in patient volumes and margins are so tight, or negative, so they are going to try to continue to do more with less. Essentially, there is no real employment growth in the hospital space over the course of the year, which is very different from what we’ve seen recently.”
The stagnant job growth in the hospital sector comes as the American Hospital Association today released a nationwide survey of more than 1,000 hospitals, nearly half of which report layoffs.
“The fact that hospitals are cutting staff challenges the notion that hospitals are recession-proof,” says AHA President and CEO Rich Umbdenstock.
The job growth is also adversely affected by reduced patient volumes, which are being reported by hospitals across the nation.
It’s not all bad news. The slowdown in job growth and the weak economy have helped hospitals—at least temporarily—quell an acute shortage of nurses and other clinical staff. Hospitals are reporting that turnover has declined, and that many former nurses have returned to the workforce for any number of pocketbook reasons.
Bachman says the recession has created a “bunker mentality” among nurses and other healthcare workers. BLS data show that—like everyone else—nurses and other healthcare workers are digging in, putting their heads down, and staying put until the economy improves.
Historic trends have shown an uptick in hospital hiring in the second quarter of each year, as hospitals get a better idea of their patient volume projections and they look to graduating nurses and other clinicians to fill jobs. “You start to get some pickup again in March, based on what we’ve seen historically,” Bachman says. “Probably if you look out over April, May, and June, those are a good test to see what is going on here.”
