DAILY UPDATE

HTSI honored for patient safety work

The Institute for Safe Medication Practices (ISMP), a nonprofit organization that seeks ways to reduce medication errors, has named the AAMI Foundation’s Healthcare Technology Safety Institute (HTSI) as one of its recipients of its annual Cheers Awards. HTSI is being honored for its work to advance infusion system safety.

Each year, the ISMP’s Cheers Awards pay tribute to individuals, organizations, nonprofit associations, companies, and agencies that have set the standard in their efforts to prevent medication errors and other adverse events, according to its website. To be eligible, an organization must have clearly identified a high-risk medication safety initiative and successfully implemented error-reduction strategies based on ISMP's philosophy and recommendations. Organizations also must share what they have learned through presentations, journal articles, or other activities.

Formally established in 2011, HTSI dedicates itself to strengthening the development, management and use of healthcare technology for improved patient outcomes. The focus on infusion systems was the first major initiative for the institute.

Between 2005 and 2009, the U.S. Food and Drug Administration received more than 56,000 reports of adverse events associated with the use of infusion pumps. Those events, according to the FDA, included serious injuries and more than 700 deaths. During the same time period, there were 87 infusion pump recalls. Those sobering statistic prompted the FDA and AAMI to host a ground-breaking summit on infusion systems in October 2010. HTSI was born from that effort, and its initiatives have grown to include clinical alarms, interoperability, and more.

It also has done pioneering work in the area of clinical alarms, including looking for was ways to combat alarm fatigue. HTSI organizes webinars, facilitates discussions between key stakeholders, and supports cutting-edge research to find and promote better ways to design, manage, and safely use healthcare technologies.

The annual awards dinner is scheduled for Dec.10, 2013, at the Cuba Libre restaurant in Orlando, FL. James Conway, an adjunct lecturer at the Harvard School of Public Health and an Institute for Healthcare Improvement senior fellow, will deliver the keynote address. For more information on the awards, visit here.

For more information on HTSI’s work, please go to www.aami.org/htsi/.

Seven healthcare providers join Premier, Inc.'s Bundled Payment Collaborative

Premier, Inc. has added seven new members to its Bundled Payment Collaborative, which now includes 17 healthcare provider systems with more than 45 hospitals across the nation.

With a focus on episode-based care, Premier's Bundled Payment Collaborative was launched in July 2012 to help providers develop, implement and succeed in using bundled payment arrangements in both public and private markets. The following new members will work together and with other members of the collaborative:

·         Adventist Health, Roseville, CA

·         Centra Health Inc., Lynchburg, VA

·         El Camino Hospital, Mountain View, CA

·         Regional Health, Rapid City, SD

·         Regional Medical Center, Orangeburg, SC

·         Rockford Memorial Hospital, Rockford, IL

·         Southwest General Health Center, Middleburg Heights, OH

New care delivery models are starting to have an impact on the healthcare industry. In fact, bundled payment care models are projected to save $2.4 billion nationwide over the next five years.

Bundled payment models allow providers to bid as a team to provide a continuum of services for a predetermined target amount to include physician payment, nursing-home care, surgery and other care, most commonly for treatments such as heart, colon and spinal surgery, as well as hip and knee replacements. Premier's Bundled Payment Collaborative serves as a convener, providing ongoing analysis, assessment, technical assistance, education and knowledge sharing to those interested in designing a bundled payment program.

Members of the collaborative are committed to sharing best practices and data with each other. They focus on improving care and reducing costs across multiple episodes of care, including hip/knee joint replacement, lumbar spine fusion, coronary artery bypass grafts, heart valve replacement, congestive heart failure, percutaneous coronary intervention and colon resection.

The Centers for Medicare & Medicaid Services (CMS) created the Bundled Payments for Care Improvement (BPCI) initiative to link payments for the multiple services beneficiaries receive during an episode of care. Within BPCI's four broadly defined models, Premier is helping to support awardees that are focusing on hospital stay and post-acute care services.

Premier's Bundled Payment Collaborative members use Premier's integrated technology and social business platform, PremierConnect. PremierConnect combines all of Premier's data assets -- including data on 1 in 4 U.S. hospital discharges, evidence-based best practices from 2.5 million daily clinical transactions and $40 billion in annual provider purchases -- on a single platform. It also serves as a hub for providers to network across the nation. Visit here for more information.

New U.S. drug security law requires review of track-and-trace strategies

A new U.S. law requires pharmaceuticals to be tracked and secured across the healthcare supply chain. Pharmaceutical supply chain leaders must re-evaluate their current and future track-and-trace strategies now.

On 28 November 2013, U.S. President Barack Obama signed H.R. 3204 — the Drug Quality and Security Act (DQSA) — into law. The law calls for the U.S. Food and Drug Administration (FDA) to set standards for tracking and tracing pharmaceuticals, and phases in requirements for specified trading partners across the U.S. healthcare supply chain. It requires manufacturers of pharmaceuticals sold in the U.S. to:

·         Begin capturing and reporting product transaction histories by 1 January 2015

·         Implement systems to report suspect or illegitimate products by 1 January 2015

·         Serialize individual products by 2017

This law is a positive step for securing the U.S. pharmaceutical supply chain and has encouraging implications for the industry globally. The DQSA removes uncertainty around governance, enabling manufacturers to move forward with investments and serialization deployments with increased confidence.

Pharmaceutical manufacturers can begin to make decisions to ensure traceable electronic records of custody for their manufactured products. This tracking will protect their revenue streams against the risk of counterfeited products.

The law provides the FDA with the authority to oversee all nodes of U.S. pharmaceutical supply chains for the first time. It sets out staggered compliance timelines for manufacturers, repackagers, third-party logistics providers, wholesalers, distributors and pharmacies. The law will offer the potential for a more network-centric approach to track and trace, and more flexibility in compliance.

The law will require the phased implementation of standardized numerical identifiers on a 2D data matrix bar code. This requirement is consistent with identifier trends in Europe, China and many other countries. The law proposes guidance on standards for the interoperable exchange of transactional data as well as governance for potential waivers and enhanced packaging security measures.

The DQSA may also help shape global standards, bringing further direction to a diverse patchwork of national and geographic regulations. In particular, China and Europe have proactively centered deployment models around track and trace, and verification, respectively. Due to the high maturity of deployments in these regions, they are likely to influence emerging global standards and best practice adoption. Visit Gartner for more information.

As hospital prices soar, a single stitch tops $500

In a medical system notorious for opaque finances and inflated bills, nothing is more convoluted than hospital pricing, economists say. Hospital charges represent about a third of the $2.7 trillion annual United States healthcare bill, the biggest single segment, according to government statistics, and are the largest driver of medical inflation, a new study in The Journal of the American Medical Association found.

A day spent as an inpatient at an American hospital costs on average more than $4,000, five times the charge in many other developed countries, according to the International Federation of Health Plans, a global network of health insurance industries. The most expensive hospitals charge more than $12,500 a day. And at many of them, including California Pacific Medical Center, emergency rooms are profit centers. That is why one of the simplest and oldest medical procedures — closing a wound with a needle and thread — typically leads to bills of at least $1,500 and often much more.

The main reason for high hospital costs in the United States, economists say, is fiscal, not medical: Hospitals are the most powerful players in a healthcare system that has little or no price regulation in the private market. Rising costs of drugs, medical equipment and other services, and fees from layers of middlemen, play a significant role in escalating hospital bills, of course. But just as important is that mergers and consolidation have resulted in a couple of hospital chains — like Partners in Boston, or Banner in Phoenix — dominating many parts of the country, allowing them to command high prices from insurers and employers.

Sutter Health, California Pacific Medical Center’s parent company, operates more than two dozen community hospitals in Northern California, almost all in middle-class or high-income neighborhoods. Its clout has helped California Pacific Medical Center, the state’s largest private nonprofit hospital, also earn the highest net income in California. Prices for many of the procedures at the San Francisco hospital are among the top 20 percent in the country, according to a New York Times analysis of data released by the federal government.

In other countries, the price of a day in the hospital often includes many basic services. Not here. The “chargemaster,” the price list created by each hospital, typically has more than ten thousand entries, and almost nothing — even an aspirin, a bag of IV fluid, or a visit from a physical therapist to help a patient get out of bed — is free. Those lists are usually secret, but California requires them to be filed with health regulators and disclosed.

California Pacific Medical Center’s 400-page chargemaster for this year contains some eye-popping figures: from $32,901 for an X-ray study of the heart’s arteries to $25,646.88 for gall bladder removal (doctor’s fees not included) to $5,510 for a simple vaginal delivery (not including $731 for each hour of labor, or $137 for each bag of IV fluid). Even basic supplies or services carry huge markups: $20 for a codeine pill (50 cents at Rite-Aid or Walgreens), $543 for a breast-pump kit ($25 online), $4,495 for a CT scan of the abdomen (about $400 at an outpatient facility nearby). Plenty of other hospitals set similar prices.

Dr. Warren Browner, the chief executive officer of California Pacific Medical Center, said that there were good reasons that hospitals charged what they did: They must have highly trained professionals available 24 hours a day, seven days a week. They must constantly upgrade to the latest equipment and building standards to meet patients’ expectations and state mandates. They charge paying or well-insured patients more to compensate for others they treat at a loss.

“Hospital care is extremely expensive to produce and to have available for everyone in the community,” he said, noting that hospitals needed to have a neurosurgeon on call in case a patient turned up with a blood clot on the brain. “We take every penny of the revenue we earn and use it to build new and better facilities for everyone in the city.”

There is little science to how hospitals determine the prices they print on hospital bills.

“Chargemaster prices are basically arbitrary, not connected to underlying costs or market prices,” said Professor Melnick, the economist. Hospitals “can set them at any level they want. There are no market constraints.”

Prices for any item or service are set by each hospital and move up and down yearly, and show extraordinary variability, health economists say. The codeine that costs $20 and the bag of IV fluid that costs $137 at California Pacific are charged at $1 and $16 at the University of California San Francisco Medical Center, across town. But U.C.S.F. Medical Center charges $1,600 for an amniocentesis, which costs $687 at California Pacific.

After each hospital stay or visit, computer programs and human coders and billers use the chargemaster price list to translate the services rendered into a price. Sutter employs more than 1,300 people at a special center in Roseville, CA, to perform this and other administrative tasks for its hospitals. Emergency room visits typically include separate charges for doctor’s services and for supplies, as well as a “facility fee” — the charge for walking in the door.

Economists note that hospitals can bill for emergency room care with relative impunity, since injured patients generally rush to the nearest treatment facility. Once perennial money pits, emergency rooms have become big moneymakers for most hospitals in the last decade, experts say, as they raised their fees and “managed” their patient mix. California Pacific Medical Center has nearly doubled its emergency room fees since 2005, its chargemaster price lists show.

California Pacific’s emergency room is not a trauma center; poor or uninsured trauma patients who require lengthy inpatient stays can strain a hospital budget. And insurers allow emergency rooms to bill more than urgent-care centers for simple procedures like stitches or X-raying a sprained ankle, making such procedures profitable. Indeed, the financial prospects are so appealing that doctors’ groups in Texas are opening free-standing “emergency rooms” that are not connected to hospitals.

“Hospitals see where they’re making money and try to do more of that,” said Dr. David Gifford, a former health commissioner of Rhode Island, who has studied how labs price their tests. He said that laboratory tests and X-rays are priced high and are profitable, though there is no difference in quality from national commercial labs that charge far less. A blood count and blood electrolyte test — ordered every day for most inpatients and often in the emergency room — are priced at $259.06 and $293.25 on California Pacific Medical Center’s chargemaster price list. Insurers often pay outside labs less than $10 for the services.

But how much actual charity care does a hospital like California Pacific Medical Center perform? And are insurers and patients paying hospitals for better quality? Or also for amenities like valet parking, useless medical gadgetry and inflated salaries?

Though hospitals’ nonprofit status allows them to reap tens or hundreds of millions of dollars in tax benefits, California Pacific Medical Center’s main campuses spent 1.27 percent of their more than $1.1 billion in net patient revenues in 2011 on free care for indigent or uninsured patients, lower than the state average of 2.07 percent, according to statistics compiled by the San Francisco Department of Public Health. The far smaller St. Luke’s branch spent 5.32 percent that year.

Consumers may appreciate — or demand — features that contribute to bigger hospital bills. But studies have found no correlation between prices and patient outcomes. A California state rating of hospital services by the California Health Care Foundation gave California Pacific Medical Center average scores in most categories, though its surgical-care measures were rated “superior.”

Its crosstown neighbor, University of California San Francisco, a nationally ranked academic institution, charges far less per day than California Pacific, when the greater severity of illnesses of its patients is factored in, Professor Melnick said. In fact, a recent study in the publication Annals of Surgery, found that hospitals with the highest complication rates tended to have higher prices.

Hospital officials like to say that their list prices do not reflect what most patients actually pay, because private and government insurers negotiate discounts. Simone Singh, a professor of health management and policy at the University of Michigan, estimated that insurers generally paid 40 to 50 percent of charges. But with powerful chains like Sutter, prices are high and the discounts often are not so generous. Patients are left paying more.

In theory, healthcare consolidation can lead to economies of scale, but not if it produces complex supersize systems. Excess administrative costs accounted for about $190 billion of the $2.5 trillion medical bill of the United States in 2009, the Institute of Medicine estimated this year — money that could be used for other purposes. Visit the New York Times for the full article.

Nemours Children’s Hospital puts patients at ease with Rauland, Versus, GetWellNetwork

Nemours Children’s Hospital has brought together a unique combination of nurse call, real-time locating system (RTLS) and patient engagement technology to help put children and their families at ease.

When Nemours, an internationally recognized children’s health system, was planning to open their new, 630,000 square-foot facility in Orlando, FL, they brainstormed ideas for 21st-century care. One of their ideas — what if when a doctor or nurse walked into the patient’s room, their name, title and photo immediately appeared on the room’s television? And further, what if families could view a log of all the caregivers who came into their child’s room during the day?

When the hospital opened in October 2012, this futuristic idea was reality, thanks to collaboration between Nemours and three of its vendors: Rauland-Borg Corporation of Florida (RBF), Versus Technology, Inc. and GetWellNetwork, Inc.

RBF was already installing Versus’ RTLS as part of the Responder 5 Nurse Call System, which intelligently routes patient calls for assistance to the right nurses. When wearing Versus locator badges, nurses no longer need to remember to press a button to cancel those calls. Using a combination of infrared and radio-frequency (RFID) technology, the locating system automatically identifies the nurse’s presence in the patient room so she can immediately tend to the patient’s needs.

Through the patient’s bedside TV, GetWellNetwork was providing their Interactive Patient Care solution to engage patients and families with educational content and information about their hospital stay.

Working closely with Versus, RBF and GetWellNetwork, Nemours integrated all three technologies. “When the employee enters the room, the Versus RTLS sends that information through Rauland Responder to GetWellNetwork,” explains Mark Chamberlain, a Nemours Application Support Analyst who worked on the project. “GetWellNetwork taps into our database, popping up the employee’s credentials and photo on the TV regardless of what else is playing.”

Further, “The RTLS allows us to keep an audit trail in GetWellNetwork,” adds Rodriguez. “The data of who has been in the patient room is available, in case the family would like to see if a doctor has made his rounds while they were out.”

Jackie Gustafson, Director of IT Applications, says leveraging technology in creative ways to support the sharing of information is core to Nemours’ patient- and family-centered care philosophy. “It was truly extraordinary to watch it develop from concept to reality, and our partnership with these three vendors was critical to making it happen.”

“The innovation of this solution has really been a game-changer for us,” explained Jenn Cravens, Healthcare Business Development at Rauland-Borg Corporation of Florida. “Being able to provide patients and their families with this integrated information has transformed the way we approach solutions in the healthcare market.”

Healthcare organizations wishing to learn more about the Versus-GetWellNetwork integration can visit with both companies at the HIMSS14 conference in Orlando, Fla., February 23-27, 2014. For more information about RTLS events at HIMSS, visit www.versustech.com/himss14.

CDC releases new findings and prevention tools to improve food safety in restaurants

Increased awareness and implementation of proper food safety in restaurants and delis may help prevent many of the foodborne illness outbreaks reported each year in the United States, according to data from the Centers for Disease Control and Prevention.  Researchers identified gaps in the education of restaurant workers as well as public health surveillance, two critical tools necessary in preventing a very common and costly public health problem.

The research identifies food preparation and handling practices, worker health policies, and hand-washing practices among the underlying environmental factors that often are not reported during foodborne outbreaks, even though nearly half of all the foodborne outbreaks that are reported each year are associated with restaurants or delis. Forty-eight million people become ill and 3,000 die in the United States.

"Inspectors have not had a formal system to capture and report the underlying factors that likely contribute to foodborne outbreaks or a way to inform prevention strategies and implement routine corrective measures in restaurants, delis and schools to prevent future outbreaks," said Carol Selman, head of CDC's Environmental Health Specialists Network team at the National Center for Environmental Health.

Four articles published today in the Journal of Food Protection focus on actions steps to prevent foodborne illness outbreaks related to ground beef, chicken, and leafy vegetables like lettuce and spinach. The articles also focus on specific food safety practices, such as ill workers not working while they are sick, as a key prevention strategy.

The data surveillance system and e-Learning course will debut in early 2014. With these tools, state, and local public health food safety programs will be able to report data from environmental assessments as a part of outbreak investigations and prevent future foodborne outbreaks in restaurants and other food service establishments.

CDC developed these products in collaboration with the U.S. Food and Drug Administration, U.S. Department of Agriculture, and state and local health departments.

For more information about the National Voluntary Environmental Assessment Information System visit here.

For information about free e-Learning courses in Environmental Assessment of Foodborne Illness Outbreaks visit here.

For more information on the study findings, visit here.

For nurses, hospital jobs harder to come by

Just how many nurses hospitals still need is a big question. In recent months, major hospital chains in Indiana and around the country have reorganized and chopped tens of thousands of jobs, citing declining admissions and lower reimbursements from insurance companies and government programs.

As hospitals shed jobs, openings for nurses and other health professionals are popping up in other settings: outpatient clinics, rehabilitation centers, walk-in clinics and patients’ homes. The jobs pay a little less than the annual median wages of $65,950 for registered nurses in the U.S., but that’s where the growth is, healthcare experts say.

That leaves nurses and students who want to work in hospitals wondering about their future. It wasn’t supposed to be this hard. Nursing long has been a steady, well-paying career, with plenty of openings. Nursing students often got multiple offers before graduating. Hospitals scrambled to fill nursing positions.

For generations, nursing helped families enter or remain in the middle class. The profession provided stimulation, useful skills and community respect. It gave peace of mind during economic downturns that crunched many other occupations.

Now it’s a different picture. Hospitals, facing empty beds and falling revenues, say they have no choice but to consolidate labs, close programs and slash jobs. They say the pace of change is greater than at any time in recent history.

So far this year, the healthcare sector has announced 41,085 layoffs, the third most behind financial and industrial companies, according to outplacement firm Challenger Gray and Christmas.

IU Health, the state’s largest hospital system, cut 900 jobs this fall, or about 2 percent of its workforce. St. Vincent Health cut about 800 people, or about 5 percent. Franciscan Alliance cut 275 jobs, or about 1.4 percent.

Only a fraction of the hospital jobs affected, perhaps 25 percent, involve nurses, said Kim Harper, executive director of the Indiana Center for Nursing. But the contraction has made it tougher for nurses to find hospital jobs and for nursing students to get their first break.

Nursing jobs still abound, just in other settings. It’s part of the great migration of nursing jobs from full-service hospitals to outpatient clinics, patient homes, rehabilitation centers and walk-in clinics.

The new jobs are popping up in unlikely places, said Blayne Miley, director of policy and advocacy at the Indiana State Nursing Association. He said he recently spoke with a new nursing company in New Albany that provides care coordination for patients being discharged from hospitals.

Still, hospitals have typically paid top wages for nurses. As more nurses move out of hospitals and into other settings, the average wage for nurses could drop a bit, Harper said. About 60 percent of the nation’s 2.7 million registered nurses work in hospitals.

At the IU School of Nursing, graduates look for an average of six months to find a job, compared with two or three years ago, when they often had multiple job offers before graduating, said Marion Broome, the school’s dean.

“We have been through this before in the nursing profession,” she said. “Every time there’s a change in the way health care is financed, there’s usually some repositioning of health systems, and a portion of that always affects nurses.”

National experts say nurses can’t assume they will get multiple job offers anymore. Still, nursing advocates say nursing students still have a better chance of landing a job soon after graduating than many other students.

Nursing students with a bachelor’s degree are much more likely to have job offers at the time of graduation (59 percent) than the national average across all professions (29 percent), according to a news release last week from the American Association of Colleges of Nursing.

Still, the long-term outlook is anything but clear. Roughly 40 percent of the nation’s nurses came into the profession in the 1970s and 1980s. Most of those nurses are now in their 50s, nearing retirement. Visit the Indy Star for the article.

Rural hospitals across state face uncertain future

Tennessee's rural hospitals are laying off workers and reducing services as they try to cope with the funding changes brought about by the Affordable Care Act and the political battles that surround expanding TennCare.

The Tennessean reports the federal health law reduces reimbursements to Tennessee hospitals by $5.6 billion over the next 10 years. That money was supposed to be replaced through expanding TennCare, the state Medicaid program.

But Republican leaders in the state legislature oppose expansion, saying they doubt the federal government will stand by its obligation. Gov. Bill Haslam has been trying to design a framework that will satisfy both the Obama administration and fellow Republicans.

The Tennessee Hospital Association lobbied unsuccessfully for expansion last year. Now it is organizing a grassroots campaign to fight for expansion. Randy Davis was promoted to chief executive officer at NorthCrest Medical Center in Springfield on Oct. 1. About two weeks later, he issued a press release when vacation accruals were temporarily suspended.

"I need the realization of this community, and of Middle Tennessee, and the entire state, and of anyone who will listen that this is real," Davis said. "This has real impact. It is serious. Even indecision and passivity are dangerous. It comes at a real cost. That is the human cost."

While layoffs at Vanderbilt University Medical Center and Saint Thomas Health have generated news stories, the smaller but steady trickle of job losses at rural hospitals has gone largely unreported. Capella Healthcare has eliminated positions at its hospitals in McMinnville, Sparta, Woodbury and Smithville.

Davis said NorthCrest has had to let go of several workers. It may also sell off some real estate to beef up cash reserves, but that's only a short-term fix.

Maury Regional Medical Center is losing $10.7 million a year because of the federal health law, the impact of sequestration and other budget cuts. Wayne Medical Center is losing $807,000 a year. Marshall Medical Center is losing $257,000.

Tom Gee, CEO of Henry County Medical Center said the hospital reduced its workforce by 25 positions in October. Gee is contemplating whether to stop offering oncology services and to ask the county to pick up the costs of ambulance services. Gee said financial problems exacerbated by political conflicts over the health law offer the most serious threat to the hospital he has seen in his 23 years at the helm.

"Our future survival is heavily dependent on expansion of Medicaid and signing people up in the health exchange," Gee said. "That's the only place we're going to replace the lost volume and lower reimbursements we're seeing right now."

Craig Becker, president of the Tennessee Hospital Association, said he expects hospitals to cut back on birthing services, oncology programs and specialized trauma services to reduce costs in the short term. Becker said Tennesseans already are paying for Medicaid expansion in the form of new federal taxes tied to the health are law. (Associated Press) Visit the Herald for the story.