Using a hospital safety checklist to reduce deadly bloodstream infections can save lives and produces a tenfold return on the cost of the program, a study from Johns Hopkins shows.
The study calculated that the reduction in bloodstream infections at intensive care units in hospitals across Michigan saved an average of $1.1 million a year.
"We already knew that the Michigan project saved lives and reduced infections," Peter J. Pronovost, MD, the lead author of the study and the director of Johns Hopkins' Armstrong Institute for Patient Safety and Quality, said in a media release. "Now we know that by preventing infections, hospitals actually save money too."
The study showed that each central line-associated bloodstream infection in Michigan costs a hospital an average of $36,500 to treat. The patient safety program cost roughly $3,375 per infection averted between 2003 and 2005. The cost of putting the program in place -- mostly in devoted staff time -- was an average of $161,000 per hospital.
"It makes common sense that giving higher quality care would save you money, but before this, there was very little empirical evidence that it did," Pronovost said. "Now we have it."
Pronovost said his study does not show whether other quality improvement initiatives would yield similar financial benefit, but he said that some likely will.
Each year roughly 80,000 patients with central lines develop life-threatening infections. Of those, about 31,000 are estimated to die — nearly as many as die from breast cancer annually.
The collective cost of treating them may be as high as $3 billion nationally, according to the U.S. Centers for Disease Control and Prevention. CDC reported bloodstream infections decreased by 58% between 2001 and 2009.
The Michigan program, developed at Johns Hopkins, includes the "cockpit-style" checklist for doctors and nurses to follow when placing a central-line catheter, and five basic steps from hand washing to avoiding placement in the groin area, where infection rates are higher. The program also promotes a "culture of safety," that includes science of safety education; training in identifying safety problems, implement solutions, and measure improvements; and empowering team members to question each other and stop procedures if safety is compromised.
Pronovost said much of the healthcare savings resulting from the initiative go to insurers — both public and private — who are spared the cost of treating these bloodstream infections and subsequent complications. Because of that, Pronovost said insurers should help hospitals implement and develop infection prevention and other quality improvement programs.
"Strategies to improve quality should be at the forefront of efforts to trim healthcare costs. Reducing preventable harm may be the least controversial way to save money and should definitely get more attention," he said.
The research was funded by Blue Cross and Blue Shield of Michigan, through the Michigan Hospital Association.
St. Joseph's Women's Hospital has opened its $75 million 64-suite neonatal intensive care unit, which houses 15 Level II and 49 Level III beds, the Tampa, FL hospital announced.
The NICU occupies two floors of the five-story addition that also doubles the size of the hospital's breast imaging center.
The Hinks and Elaine Shimberg Breast Center on the ground floor provides diagnostic tools and resources including CT scanner, ultrasound, DEXA scan, digital mammography, MRI, Computer-aided Detection and minimally invasive biopsies. There, patient care is coordinated by an interventional team that includes board-certified radiologists, physician assistants, biopsy technologist, nurse navigator and biopsy scheduler, St. Joseph's said.
The expansion also includes 36 private patient suites for new mothers and a dedicated 16-bed gynecology unit for medical and surgical patients. A staff nurse navigator provides resources for the patients and their families, the hospital said.
The expansion features:
All private NICU suites with an in-room family area
All-digital diagnostic imaging services
All-private suites for Women's Care patients (obstetrics, gynecology, surgical) with full bathroom and in-room family area
Each NICU private room provides a "womb-like setting" to help premature babies develop faster, improve patient safety, and better accommodate families, St. Joseph's said in a media release.
St. Joseph's Women's Hospital is part of 10-hospital, not-for-profit BayCare Health System and is the only hospital in the Tampa Bay area dedicated to women and infants.
While thumbing through the Internet recently I came upon a story from the Indianapolis Star about a new anti-smoking policy at Indiana University Health that extends a smoking ban for hospital employees during their off-campus break times.
The Star article called the ban “one of the most restrictive smoking policies in the nation.”
That is not accurate. Other health systems are far more aggressive. A growing number of providers, for example, have said they will no longer hire smokers, and will screen job applicants for traces of the vile weed. Now that’s restrictive!
Sheriee Ladd, senior vice president for human resources at IU Health, tells HealthLeaders Media that the health system sees its ban as one that can be justified as patient safety issue.
“We have told our employees that as the leading health system in the state, it is incongruent with our brand assurance to our patients and our commitment to wellness for our staff for us to continue to tolerate smoking, because of the irritants that come back into the workplace, not only for the employees but for the patients and their families,” Ladd said.
Of course, there is also an HR component at play. Employee smoking and obesity are among the biggest healthcare cost drivers for employers. If a ban on break-time smoking off-campus also encourages employees to quit smoking, everybody wins.
IU Health has discovered what many of the nation’s hospitals and healthcare providers have come to understand: They must be the tip of the spear in tobacco cessation and other broad public health initiatives.
First, as Ladd points out, it’s a patient safety issue. Second-hand smoke is dangerous. The stinky residue contains carcinogens that can prompt allergic reactions or asthma attacks among patients, their families, and coworkers. A British study last year attributed about 600,000 deaths globally each year to second-hand smoke.
Second, healthcare is a labor-intensive field. More than 14 million Americans are employed in healthcare. IU Health has 24,000 employees statewide. If a large sector of the economy that is dedicated to the well-being of others cannot take the lead controlling a huge societal cost driver for employee healthcare, who will?
Finally, healthcare sets the example for the rest of the nation to follow. It’s hard to lecture patients about the dangers of smoking, when they look out your hospital window and see a half-dozen caregivers in green scrub suits sparking up on the loading bay. Nobody should smoke -- particularly anyone who works in healthcare. They can’t plead ignorance.
All the hospital and health system executive I have spoken with who back aggressive anti-smoking policies for employees also point out that their systems offer smoking cessation classes and other help for employees who want to quit.
Health plans have medical alternatives, such as the patch.
Nicotine is highly addictive, and many smokers are hooked. To take a Zero Tolerance anti-smoking policy and firing violators without offering them the tools to quit would violate the same healing mission that the hospital is trying to protect. Smokers are not bad people. They are addicts.
At IU Health, for example, employees who violate the on-duty smoking ban are first counseled by a supervisor, given a written warning, and given a written invitation to join the hospital’s Quit For Life smoking cessation program. “If there are repeat offenses, they ultimately could be terminated, but that is just like any other policy,” Ladd says. “Our values are not that we are a mean-spirited organization but we are saying to our employees this isn’t helping our patients. It’s not safe. And you can’t do that to our patients.”
In previous columns I have questioned the right of employers to dictate what employees can do on their own time. And – justified as it may be as a matter of health and economics -- I am still very uneasy with the idea of removing smokers as job candidates. Smoking tobacco is legal. And if banning people for using a legal product is done in the name of controlling health insurance costs, then the slippery slope argument begs the question, what’s next? Bans on pizza and beer after work? Will diabetics be the next class of workers to be banned from the workplace? After all, much of Type 2 diabetes is related to diet, which is a lifestyle choice.
The distinction with smoking cessation that should be made for the healthcare sector is the very nature of the healing mission. Healthcare can make the case that employees who smoke directly and negatively impact the people they are hired to serve.
IU Health has it right. Promoting smoking cessation in hospitals and in the provider community is a patient health issue. That by itself is a strong enough justification. The fact that it will also improve employee health, and quality of life, and lower employee healthcare costs is a bonus.
Sanford Health has unveiled its plans for an "X-shaped" $360 million, 371-private room Sanford Fargo Medical Center that the health system is calling the largest project of its kind in North Dakota history.
"Designing a new medical center from the ground up is an extraordinary opportunity to do things right for our patients," Sanford Health President/CEO Kelby Krabbenhoft said in a media release.
Sanford has committed to more than $600 million in construction projects and facilities improvements in northern Minnesota across the Dakotas. On Aug. 17, the health system announced the Edith Sanford Breast Cancer Center named in honor of philanthropist Denny Sanford's mother. It includes a new building in Sioux Falls and an expansion in Fargo.
Earlier in the month it announced the $60 million Sanford Thief River Falls Medical Center and Clinic in Minnesota.
The design of the "X" shaped Fargo hospital is intended to facilitate integration between the hospital and clinics. Room for growth at the current facilities, facility design limitation, and aging buildings were given as the main reasons for the new hospital.
About 58% of Sanford's downtown Fargo campus patients come from outside the area. However, downtown Fargo is difficult to navigate with multiple railroad crossings and congested traffic. The threat of flooding is also a factor – many of the downtown campus buildings are antiquated and the campus is land-locked.
By 2015, it is estimated that 7,178 Sanford employees will be needed to serve 200,000 people in the Fargo-Moorhead metro area. Sanford currently employs more than 5,600, the health system said.
"We believe we are building a healthcare campus of the future and providing new facilities which will support innovations in care and research discoveries close to home for all our communities," Lauris Molbert, Sanford Board of Trustees vice-chair said in a media release. "Through these developments, we are ensuring that our health system meets its goal to improve and expand access to the highest quality care."
Groundbreaking is expected in 2013, with completion in 2016. The 704,000 square foot, 11-story hospital will house Sanford's medical and surgical services, emergency medicine, and Centers of Excellence for heart, children's, women's, orthopedics/sports medicine. Highlights include: 30 operating rooms, 10 heart catheterization/interventional labs, 40 emergency treatment/trauma rooms, 300 clinic exam rooms, and space for 200 physicians and 2,700 employees.
In addition, Sanford plans a $30 million facilities upgrade for the Roger Maris Cancer Center at the downtown campus, which will be home to about 2,000 employees and will occupy about 200,000 square feet with 220 private rooms.
As the projects get underway, the Sanford Health Foundation will launch The Building Tomorrow Today Campaign to raise $50 million in endowment funding for perpetual support for the new facility, its programs and services, Sanford said.
Sanford Health is the largest, rural, not-for-profit health care system in the nation with a presence in 112 communities in seven states. The system includes 34 hospitals, 116 clinic locations and more than 900 physicians in 70 specialty areas of medicine. With more than 20,000 employees, Sanford Health is the largest employer in North and South Dakota.
The costs of Medicaid's brand-name drugs grew at about three times the rate of inflation from 2005-2010, but that increase was offset by rebates to state programs, a federal audit shows.
The report from the Department of Health and Human Services Office of Inspector General found that brand-name drug payments by state Medicaid programs grew between 34% and 40% for the five year period, while overall inflation grew only 13%.
"For the 50 Medicaid brand-name drugs with the highest expenditures, total median increases in prices and payment amounts not only outpaced the inflation rate, but also outpaced total median increases in prices and payment amounts for brand-name drugs as a whole," the audit said.
ACCESS. INSIGHT. ANALYSIS.
Join the HealthLeaders Media Council
Get members-only access to industry-wide intelligence, forecasts, and analysis positions your organization to benchmark against your peers, identify and respond to key trends shaping healthcare, and make sound business decisions. JOIN TODAY
However, the audit also found that when drug manufacturers' rebates to state Medicaid programs were taken into account, "the per-unit net cost to Medicaid increased at a much lower rate than other points of comparison between 2005 and 2009 (rebate data were not available for 2010).
"In fact, Medicaid's rebate-adjusted payment amounts for brand-name drugs actually declined at the median in 3 of 4 years, lagging behind the inflation rate," the audit said.
The OIG study had been requested by U.S. Sen. Bill Nelson (D-FL) after AARP published its own study last summer showing a significant increase in the cost of brand-name prescription drugs since 2002.
The OIG study looked beyond the reported increases in published prices – which do not often represent the actual price that is paid -- and examined changes in transaction-based prices, and the financial effect of price changes on Medicaid.
ACCESS. INSIGHT. ANALYSIS.
Join the HealthLeaders Media Council
Get members-only access to industry-wide intelligence, forecasts, and analysis positions your organization to benchmark against your peers, identify and respond to key trends shaping healthcare, and make sound business decisions. JOIN TODAY
Since 2006, Medicaid payments for prescription drugs have remained relatively steady. In 2009, Medicaid drug expenditures totaled approximately $26 billion (not including rebates). Brand-name drugs generally account for about 80% of the total dollars reimbursed. However, Medicaid recouped approximately one-third of its costs for prescription drugs between 2006 and 2009, an average annual savings of about $8 billion, OIG said.
Drug makers pay higher rebates for brand-name drugs than for generic drugs. From 1996 to 2009, the unit rebate amount (URA) for a generic drug was 11% of the wholesale price and the basic URA for a brand-name drug was the around 15%, OIG said.
The average per capita cost of healthcare services covered by commercial insurance and Medicare grew 5.61% over the 12 months ending in June 2011, representing a second straight month of modest acceleration of cost growth, Standard & Poor's Healthcare Economic Indices show.
The index posted its lowest annual growth rate in its six-year history -- +5.37% in April 2011. Since then, the rate of growth accelerated slightly in May and June. Healthcare costs easily outpaced the 3.6% growth in overall inflation as measured by the Consumer Price Index for the same 12-month period ending in June, Bureau of Labor Statistics data show.
"Although rates have been slightly up in most indices over the past two months, the overall story continues to be moderation in trends over the past 12-15 months," David Blitzer, chairman of the Index Committee at Standard & Poor's, said in the report. "As noted in prior reports, some market participants are reporting relatively low trends in office visits and hospital admissions, as well as steps being taken to address healthcare reform and control costs. If true, these could be contributing to these lower trends."
A further breakdown of the S&P data show that for the year ending June 2011, healthcare costs covered by commercial insurance increased by 7.48%, as measured by the S&P Healthcare Economic Commercial Index. During the same period, Medicare claim costs rose at an annual rate of 2.5%, as measured by the S&P Healthcare Economic Medicare Index. This was the lowest annual growth rate recorded for the Medicare Index in its history, which goes back to January 2005, S&P said.
The Hospital and Professional Services Indices reported increases of 5.16% and 5.89%, respectively, from their June 2010 levels. For the Hospital Index, this rate is slightly higher than the +5.08% posted in May 2011. The Professional Services Index is marginally lower than its +5.91% rate posted in May.
"Based on historic patterns, we also would expect a reduction in healthcare spending on a delayed basis following an economic downturn, due to the considerable lag between investments in healthcare and increased supply," Blitzer said. "So, much of the reduction in trends could be driven by reduced capital spending during the recession. We will need more data to determine whether the slight increase in the past two months is a temporary increase or if it is a sign that trends are beginning to rise."
The S&P Healthcare Economic Indices estimate the per capita change in revenues accrued each month by hospital and professional services facilities for services provided to patients covered under traditional Medicare and commercial health insurance programs. The annual growth rates are determined by calculating a percent change of the 12-month moving averages of the monthly index levels versus the same month of the prior year, S&P said.
The highest annual growth rate for the S&P Composite index in the past six years was during the 12 months ending May 2010, when it posted +8.74%.
It has taken less than nine years for healthcare costs to double for the average family of four covered by a preferred provider organization, the 2011 Milliman Medical Index shows.
St. John's Mercy Hospital has made public its sweeping plans to build a new hospital in Joplin, MO as the centerpiece of a nearly $950 million rebuilding plan for the city's tornado-ravaged healthcare infrastructure.
"We are making this commitment because it's the right thing to do for Joplin," Lynn Britton, president/CEO of Mercy which includes 28 hospitals and more than 200 outpatient facilities in a seven-state area, said in a media release. "The May 22 tornado devastated our community here in Joplin and destroyed our hospital, but we've promised all along we would rebuild. We plan to break ground January 2012 and open the new hospital, as well as a secondary northeast campus, in 2014."
The new 327-bed hospital will be built about three miles from the destroyed St. John's Hospital. The new hospital will include medical, surgical, critical care, women's/children's (labor, delivery, recovery and postpartum rooms), behavioral health and rehab, with planned expansion up to 424 beds as needed.
Within one week of the tornado, which claimed 150 lives, Mercy had made operational a 60-bed MASH-like field hospital. Now the tent hospital is transitioning to a "hard-sided modular facility" and plans are underway to open a component hospital in the spring of 2012 that will allow St. John's Mercy to regain its Level II Trauma Center designation.
The federal government on Wednesday unveiled proposed rules to help consumers better understand their health insurance benefits and costs, and search for the most appropriate coverage.
"We are telling insurance companies that they need to be more transparent about the benefits they offer, what they are spending premium dollars on, and justifications for any proposed rate increases," Centers for Medicare and Medicaid Services Administrator Donald Berwick, MD, said in a Wednesday afternoon media teleconference. "This is all grounded in the idea that the more informed the patient is, the better decisions he or she can make."
Berwick acknowledged that insurance benefits and cost information confuses many consumers. "Many times people will make decisions on coverage and not understand what it means for them until they get sick or until their care is denied or until they face high out-of-pocket costs," he said.
The Summary of Benefits and Coverage proposed rules would give consumers access to two forms to help them evaluate their health insurance choices, including: a summary of benefits and coverage; and a uniform glossary explaining terms such as "deductible" and "co-pay."
If the proposed rules are adopted, health plans would be required to provide the forms to shoppers and enrollees upon request and before coverage is purchased. The forms are scheduled to be available sometime in 2012 for the more than 180 million health insurance consumers with private health insurance coverage.
America's Health Insurance Plans raised concerns that the proposed rule would create an expensive burden that insurers would pass along to their customers. "The benefits of providing a new summary of coverage document must be balanced against the increased administrative burden and higher costs to consumers and employers," AHIP press secretary Robert Zirkelbach said in a media release.
"For example, since most large employers customize the benefit packages they provide to their employees, some health plans could be required to create tens of thousands of different versions of this new document—which would add administrative costs without meaningfully helping employees."
AHIP also wants the federal government to push back the implementation date "to give health plans sufficient time to make the operational and administrative changes needed to create these new documents. We will be submitting detailed comments and look forward to working with regulators to mitigate potential unintended consequences of this new requirement," Zirkelbach said.
Lynn Quincy, a senior health policy analyst with the Consumers Union, sat in on the teleconference with Berwick and said the proposed rules would provide consumers with a single, standard method of understanding health plan features, similar to standard disclosures for mortgage terms or credit cards.
Quincy said the nonprofit Consumers Union has heard "hundreds of stories of consumers who purchased a health plan they didn't understand."
"In the most unfortunate cases the consumer suffered a severe illness and was unpleasantly surprised when he or she learned they didn't have the coverage they thought they had purchased," Quincy said.
"Our own studies have revealed that shopping for health insurance is a task that consumers dread. In part, they told us it's because they find current healthcare documents too difficult to understand. There is no doubt that consumers need much better health insurance disclosures."
Physician groups across the country operated at a significant loss in 2010, thanks largely to dwindling Medicare reimbursements. At the same time physician compensation increased by an average of 2.4%, according to the American Medical Group Association's 2011 Medical Group Compensation and Financial Survey.
"The trends are pretty much continuing and have been consistent over the last six years of so. The operating margins are getting smaller and the pay increases are getting smaller as well," Tom Flatt, director of communications and publications at AMGA, told HealthLeaders Media.
The survey of 239 medical groups -- 55% of which had more than 100 physicians -- found that operating margins are getting thinner. In 2010, only physician groups in the Western region of the nation were nearing break-even (-$27 per physician).
All other regions were operating at a loss: the Eastern region averaged a loss of $1,597 per physician; the Southern region averaged a loss of $1,870; and the Northern region continued to experience significant losses (-$10,669 per physician in 2010, compared to -9,943 per physician in 2009).
Flatt says that many of the physician groups were able to offset Medicare reimbursement cuts through ancillary services like pharmacy and imaging. But concerns about cuts to reimbursements remain.
"We are hearing from our own groups who are anticipating significant cuts in Medicare that they are really worried about it. They are operating at such a small margin now that this will have a tremendous impact on access for patients," Flatt says. "They're really feeling like they are on the edge of a cliff and without some sort of revenue, it's really going to impact patient care."
Indeed, a Merritt Hawkins’ survey released in June showed that most job openings for physicians are in hospitals, while demand for private practice physicians is on the wane.
The compensation portion of the survey found that 69% of the specialties experienced increases in compensation in 2010, with the overall average increase around 2.4%. In 2009, 76% experienced an average increase around 3.8%.
The primary care specialties saw about a 2.6% increase in 2010, while other medical specialties averaged an increase of 2.4% and surgical specialties averaged around 3.8%. Primary care and surgical specialties saw about a 3.8% increase in 2009, while other medical specialties saw 2.4%.
The survey results show that during 2010, the specialties experiencing the largest increases in compensation were allergy (6.38%), emergency medicine (6.37%), and hospitalist/internal medicine (6.29%).
Flatt says the compensation packages are being driven "primarily" by supply and demand.
"We've seen this trend in the past decade or so, that certain spikes in the salaries of certain specialties, maybe because the specialty hasn't seen a large pay raise in a long time and demand has suddenly become greater because less people are going into that field, or because of the demand for certain specialties," he says. "Allergies is one of those that we've seen just take off."
Hospitals that invest in pressure-redistribution foam mattresses in the emergency department could save money in the long run by reducing the burden of pressure ulcers among elderly patients, according to a study in Annals of Emergency Medicine.
A claims-based study conducted by Millman, Inc. on behalf of the Society of Actuaries found that in 2008, pressure ulcers cost an estimated $10,288 per error and $3.858 billion total. Pressure ulcers—the most frequent type of expensive error—were most often preventable, the authors wrote.
Ba' Pham of The University of Toronto, the study’s lead author, told HealthLeaders Media that installing pressure-redistribution mattresses won’t solve the bed sore problem, “but it helps.”
“It’s just a fact that people don’t make the link between the risk of a hard surface to bed sores,” he said. “They’re not paying attention to the problems. Obviously changing the mattress is not the full solution, but it is probably contributing to reducing the burden.”
Every year, approximately 6.2 million hospital admissions through EDs involve elderly patients at risk of developing pressure ulcers. Studies have found that approximately 6% of patients admitted through the emergency department acquired pressure ulcers within 48 hours of admission.
CMS will not reimburse hospitals for the cost of treating hospital-acquired pressure ulcers, which it considers a “never event.”
Pham’s research studied the cost-effectiveness of pressure-redistribution foam mattresses on ED stretchers and beds for early prevention of pressure ulcers in elderly admitted emergency department patients. They found that early prevention was 82% likely to be cost-effective.
