Buried among the healthcare reform legislation are dozens of lesser-known provisions—from work breaks for breastfeeding moms to a requirement that chain restaurants disclose how many calories are in the fries, USA Today reports. Many of the ideas have failed to gain traction in the past but supporters hope to better their chances this year by hitching them to health reform. "This is the kitchen sink train leaving the station," Neil Trautwein of the National Retail Federation told USA Today. "Every idea, good, bad or otherwise, that has ever been out there has to find its way in."
Students, state legislators, journalists, and nurse advocates held a press conference at the Connecticut Legislative Office Building to protest the cut of a state-subsidized nurse-training program. Gov. M. Jodi Rell recently decided to suspend the heavily subsidized program to save $1.7 million to help close a $600 million deficit in the state budget. Advocates said suspending the program is short-sighted, not only because a nursing shortage looms in the future, but because jobs are so scarce. The press conference was organized by District 1199, New England Health Care Employees Union.
Martin Memorial Health Systems' proposed 80-bed hospital moved one step closer to reality Dec. 1 when Florida officials granted final approval for the nonprofit to build a hospital in western Port St. Lucie. But Lawnwood Regional Medical Center & Heart Institute and St. Lucie Medical Center, the two HCA Inc.-owned hospitals that have fought against Martin Memorial's efforts to provide medical care in St. Lucie County, still could appeal the decision of the Florida Agency for Health Care Administration. Both hospitals' legal teams are reviewing the order, officials said.
A study published in the Journal of the American Medical Association found that 65% of primary-care docs work in practices that are too small to draw meaningful conclusions about the quality of care they provide. Researchers looked at commonly cited quality measures such as blood-sugar control in diabetics and mammogram screening for women. Their cutoff was the ability to reliably discern when a doctors in a practice varied by 10% from the national average. They found that "only the largest primary care physician practices, which are also the most uncommon, can be expected to have sufficient caseloads to measure significant differences in performance."
Over the next several weeks, members of Congress will be confronted with one scary story after another about what will happen if they try to cut healthcare costs, says David Leonhardt in this article in the New York Times. But it is abundantly clear that our medical system wastes enormous amounts of money on healthcare that does notmake people healthier, Leonhardt says, and healthcare costs must be cut despite the scare stories.
In response to highly publicized mishaps and ongoing concerns that patients are being subjected to excess radiation during CT scans, the FDA this week issued interim recommendations to help prevent additional problems.
"While we do not know yet the full scope of the concern, facilities should take reasonable steps to double-check their approach to CT perfusion studies and take special care with these imaging tests," Jeffrey Shuren, MD, acting director of the FDA's Center for Devices and Radiological Health, said in a media release.
An initial safety notification was issued by the FDA in October after learning of 206 patients who had been exposed to excess radiation at Cedars-Sinai Medical Center in Los Angeles over 18 months. Since then, the FDA has identified at least 50 additional patients who were exposed to excess radiation of up to eight times the expected level during their CT perfusion scans. These cases so far involve more than one manufacturer of CT scanners. The FDA has also received reports of possible excess radiation from other states. Some of these patients reported hair loss or skin redness following their scans.
The settings on Cedars-Sinai's three CT scanners were changed, causing "immediate jeopardy" in a case that the hospital says involved 206 patients who underwent stroke imaging between February 2008 and September 2009, according to a report released in November by California health officials.
The report said that "on or about February 2008, the scanning parameters of three CT Scanners were changed from the manufacturer's recommended output of 80 kv (the amount of voltage delivered) and 200 mA (milliampere, the duration of the exposure) to 120 kv and 'automatic,' meaning the machine determined mA (usually in the 500 mA range)."
As a result of its own investigation, the FDA issued interim recommendations for imaging facilities, radiologists, and radiologic technologists to help prevent additional cases of excess exposure. These recommendations apply to all CT perfusion images, including brain and heart.
The FDA recommends that CT facilities:
Assess whether patients who underwent CT perfusion scans received excess radiation.
Review radiation dosing protocols for all CT perfusion studies to ensure that the correct dosing is planned for each study.
Implement quality controls to ensure that dosing protocols are followed every time and the planned amount of radiation is administered.
Check CT scanner displays to ensure the appropriate radiation level for the patient.
Ensure that if more than one study is performed on a patient in one imaging session, the radiation dose is adjusted to an appropriate level for each study.
The FDA is also working with manufacturers, professional organizations, and state and local public health authorities to investigate the scope of these excess exposures, and is asking manufacturers to review training for users, reassess information provided to healthcare facilities, and put into place new surveillance systems to identify problems quickly.
In a statement this week, Cedars-Sinai said it has already implemented many of the FDA's recommendations following an investigation at the medical center. "The FDA's recommendations are similar to the policy and procedure changes that Cedars-Sinai implemented in September after it identified that brain perfusion CT scans were unexpectedly producing higher than expected levels of X-ray radiation," the medical center said in a media release. "Last month, the California Department of Public Health accepted Cedars-Sinai's policy changes as the medical center's plan of correction in response to the department's investigation of the brain perfusion CT scan equipment issue."
It is still not clear who is to blame for the mishap at Cedars-Sinai. Hospital officials previously said they did not want to shift responsibility for the incident to the CT scanner's manufacturer, General Electric. But in its statement last month, Cedars-Sinai officials said the incident "has raised considerable questions about why the manufacturer-set ‘auto' mA setting for the brain perfusion CT scan delivered a higher than expected level of X-ray radiation, since ‘auto' mA settings in CT and other imaging scanners are generally designed to provide the lowest appropriate level of X-ray radiation."
Cedars-Sinai said that nearby Glendale Adventist Medical Center also "reported a similar problem with GE brain perfusion CT scan equipment where patients received higher than expected levels of X-ray radiation."
GE has denied culpability, saying: "Due to pending litigation, we cannot comment on that, but again, there were no malfunctions or defects in any of the GE Healthcare equipment involved in the Cedars incident."
The state's classification of the event as one involving "immediate jeopardy" means that Cedars-Sinai may be subjected to fines of $25,000 to $50,000. Hospital officials have said that about 40% of 206 patients who received doses of radiation either had patches of hair fall out or redness of skin.
Medical center officials also have said that the additional radiation exposure may have made patients more susceptible to cataracts. The hospital has volunteered to pay for any medical expenses caused by conditions related to their overexposures.
While the healthcare industry anxiously waits for the definition of meaningful use—which will be defined by the Centers for Medicare & Medicaid Services in the next few weeks—I wonder whether the grant programs and initiatives that the Office of the National Coordinator for Health Information Technology has developed during these past few months to help support the adoption of electronic health records and the exchange of health information will be successful.
I commend the ONC for moving swiftly on many of these initiatives to get them in place as quickly as possible given the deadlines providers will need to meet to receive stimulus funds or avoid penalties. However, successfully implementing EHRs is a tricky endeavor and each facility has its own unique challenges. So the question I have is whether these programs will be able to meet the needs of such a diverse group of providers.
For instance, this past week the U.S. Department of Health and Human Services announced that it will be providing $235 million through the HITECH Act for the Beacon Community Program, which will offer support to 15 "communities" that are viewed as technology leaders. The idea is to enable these hospital systems, provider groups, and state and local governments to expand and strengthen their health IT systems and be able to share their experience with others in an effort to discern what sorts of health benefits the industry can achieve when it makes concentrated investments in health IT.
The plan is to select communities that represent large and small, urban and rural, prosperous and underserved regions. "But they will have two things in common: they will all be well above-average users of health IT, and they will be fully committed to employing health information exchange within their communities," wrote David Blumenthal, MD, the national coordinator for health information technology on the Health IT Buzz blog. "The core goal of the Beacon Community Program is to advance specific health improvement goals through interoperable health IT and standards-based information exchange within and among providers, hospitals, and populations."
Examples of healthcare organizations that could be viewed as beacons in their use of EHRs are the Veterans Health Administration, Geisinger Health Plan and Clinics, and Kaiser Permanente. These organizations are so unique in alignment and design, however, I question how useful their approach and lessons learned will be for many community hospitals and physicians.
Similarly, HHS announced a couple of weeks ago that it is investing $80 million in ARRA funds for workforce training. The goal of the program is to address the nation's need for highly skilled and trained health IT professionals. Community colleges will get $70 million of the grant money to develop intensive, non-degree training that can be completed in six months or less by people with some background in either healthcare or IT fields. The remaining $10 million will be used to develop educational materials to support those programs. But will these newly trained health IT professionals really have the depth of knowledge to help support the implementation and adoption of EHRs and health information exchanges? How reliant will some providers be on these IT workers? Are we creating a system that will depend on these workers in the long term? That could be a problem considering that many smaller hospitals or individual practitioners don't have the resources to pay for this support in the long run.
I have similar concerns about the health information technology extension program. The program will allocate $598 million for 70 individual regional centers—with the average amount being about $8 million for each center—to offer technical assistance, guidance, and information on best practices to support and accelerate healthcare providers' efforts to become meaningful users of EHRs.
The concerns with this program are whether these are enough centers to adequately help all the providers who need it, whether the funding sufficient, and whether the centers will have the expertise in each of the vendor products to effectively help providers.
I believe the ONC is targeting the right areas, but with such a huge amount of investments I question whether these programs will be effective, somewhat effective, or not effective at all in supporting providers' efforts to not only adopt EHRs but use the technology in a meaningful way.
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Sarasota (FL) Memorial Health Care System officials say an iPhone platform at one hospital has helped give nurses more time with patients, increasing patient and nurse satisfaction. The 806-bed Sarasota Memorial Hospital, Florida's second largest acute care public hospital, began using iPhones this summer. Nurses could send and receive text messages, make voice calls, and receive critical care alarms, providing faster response to patient needs, hospital executives told Healthcare IT News.
Peer Assistance Services, a Colorado nonprofit organization that provides guidance, support, and rehabilitation services for healthcare professionals, has seen an increase in nursing clients this year—a majority of whom needed help for alcohol and drug abuse.
But, the growing number of nurses seeking treatment for substance abuse doesn't necessarily reflect a growing problem, according to Rebecca Heck, BSN, RN, MPH, program director of the Nursing Peer Health Assistance program at Peer Assistance Services in Denver.
"We are seeing more nurses come forward, but the problem of substance abuse among healthcare professionals mirrors that of the general public," she says. "I don't know if there is an actual increase in the problem or if nurses are becoming more comfortable coming to us for help."
Heck attributes recent media attention surrounding drug thefts by Colorado healthcare professionals as influencing more nurses to seek treatment. The most recent being the case of a former Rose Medical Center surgical technician, Kristen Diane Parker, who admitted to stealing fentanyl-filled syringes and occasionally swapping them with her used syringes filled with saline. The Denver Post reports that 20 patients appear to have contracted hepatitis-C from Parker as a result.
"I think the stigma is still there and is powerful," Heck says. "But this is making the front page and people are getting scared and realizing they need help."
Treatment plans through the Nursing Peer Health Assistance program are individualized depending on nurses' needs and range from one to five years. Rehabilitation requirements can include therapy treatment, psychiatry, pain management, urinary analysis testing for drugs and alcohol, 12-step groups, sponsorship with a 12-step participant, and peer support groups. Any deviation from the rehabilitation may result in a referral to Colorado's Board of Nursing, in which a nurse may deal with consequences, such as a suspended license to practice or a public discipline in the form of stipulation.
"We want to lead nurses to treatment and monitor them to hold them accountable for that treatment," says Heck.
Literature shows that anywhere between 8%-12 % of nurses have substance abuse disorders that affect their ability to practice, says Heck. Studies have found prescription medication use to be higher among nurses than in the general population, while marijuana and cocaine use has been found lower among nurses than in the general population.
Aside from the easy access of prescription drugs on the job, a number of factors make nurses and other healthcare workers at high risk for substance abuse.
"The culture amongst all healthcare professionals is that we know how the drugs work, so therefore we think we can control them," says Heck. "But they control us like they do everyone else."
Nurses' often stress-filled and lengthy work shifts and nature to "take care of others—not ourselves" are other risk factors, says Heck.
Clients receiving Nursing Peer Health Assistance services complete intensive portions of treatment before returning to work. However, some practice while receiving less serious forms of support with approval from Peer Assistance Services, a therapist, a psychiatrist, or other treatment provider.
Nurses' identities are kept confidential, but they are required to disclose of their participation in the program to their nurse managers.
"Our number one goal is public safety," says Heck. "If a nurse relapses, whether through behavioral symptoms or positive drug tests, we remove them from work within 24 hours and we inform the nurse manager. But then we also make sure the nurse gets treatment."
Heck believes increased education about the causes of and prevention of substance abuse in nursing school and in the profession is needed to minimize the problem and push more nurses to get help.
"Nurses, risk management, and nurse educators do all of this work to make hospitals safer for patients, but we are all missing this huge element; to make nurses safer to provide patient care," says Heck.
Francisco Partners, a technology-focused private equity firm, has entered into a definitive merger agreement to purchase QuadraMed Corporation, a provider of healthcare information technologies and services, according to QuadraMed.
Under the agreement, Francisco Partners agreed to acquire all of the outstanding shares of QuadraMed's common stock for $8.50 per share in cash and all of the outstanding shares of QuadraMed's Series A Cumulative Mandatory Convertible Preferred Stock for $13.70 per share in cash. The all-cash transaction is valued at about $126 million, according to QuadraMed.
"After a thorough and careful review of the strategic alternatives available to us, QuadraMed's special committee and Board of Directors have concluded that this transaction represents the best option to maximize value for our shareholders," said James E. Peebles, chairman of QuadraMed's Board of Directors.
"Francisco Partners brings to QuadraMed extensive resources, expertise, and a proven track record of helping healthcare technology companies sharpen their strategy and operational execution. Operating as a private company will also allow us to place more emphasis on generating long-term value for our clients with less distraction on short-term results for the public markets," said Duncan James, QuadraMed's president and chief executive officer.
Francisco Partners has approximately $5 billion of committed capital and offices in San Francisco and London, and is one of the world's largest technology-focused private equity funds. The principals of Francisco Partners have invested in excess of $3 billion of equity capital in more than 50 technology companies, according to QuadraMed's announcement.
"We are excited to become part of QuadraMed's future success with this acquisition," said Ezra Perlman, partner at Francisco Partners. "We understand the critical role technology plays to drive quality care and to make healthcare more efficient. QuadraMed has a quality set of products, an extensive customer base, and a solid market position."
QuadraMed is Francisco Partners' fifth separate investment in the healthcare IT industry, including current portfolio companies API Healthcare, AdvancedMD Software, and Healthland.
