January 2007

The Institute for Healthcare Improvement (IHI) has announced a national campaign to dramatically reduce incidents of medical harm in U.S. hospitals. The 5 Million Lives Campaign will ask hospitals to improve more rapidly than before the care they provide in order to protect patients from five million incidents of medical harm over a 24-month period, ending December 9, 2008. The Campaign was announced by IHI President and CEO Donald Berwick, MD, MPP, speaking at their 18th National Forum, held in December in Orlando. The new Campaign – which will be sponsored principally by America’s Blue Cross and Blue Shield health plans – builds upon the success of the 100,000 Lives Campaign, in which 3,100 participating hospitals reduced inpatient deaths by an estimated 122,000 in 18 months through overall improvement in care, including improvement associated with six interventions recommended by the initiative.

The 5 Million Lives Campaign will promote the adoption of 12 improvements in care (detailed below) that can save lives and reduce patient injuries, and it aims to enroll even more hospitals than participated in the previous Campaign.

IHI estimates that 15 million incidents of medical harm occur in U.S. hospitals each year. This estimate of overall national harm is based on IHI’s extensive experience in studying injury rates in hospitals, which reveals that between 40 and 50 incidents of harm occur for every 100 hospital admissions. With 37 million admissions in the United States each year, this equates to approximately 15 million harm events annually - or 40,000 incidents of harm in U.S. hospitals every day.

IHI defines "medical harm" as unintended physical injury resulting from or contributed to by medical care (including the absence of indicated medical treatment) that requires additional monitoring, treatment or hospitalization, or results in death. (Please consult www.ihi.org for a detailed definition of medical harm.) The 5 Million Lives Campaign aims to enlist 4,000 hospitals, challenging all to adopt up to 12 of the following interventions – six of which were included in the 100,000 Lives Campaign and six of which are new:

• Prevent Methicillin-Resistant Staphylococcus Aureus (MRSA) infection... by reliably implementing scientifically proven infection control practices throughout the hospital

• Reduce harm from high-alert medications... starting with a focus on anticoagulants, sedatives, narcotics, and insulin

• Reduce surgical complications... by reliably implementing the changes in care recommended by the Surgical Care Improvement Project (SCIP) 

• Prevent pressure ulcers... by reliably
using science-based guidelines for prevention of this serious and common complication

• Deliver reliable, evidence-based care for congestive heart failure… to reduce readmissions

• Get Boards on board… by defining and spreading new and leveraged processes for hospital Boards of Directors, so that they can become far more effective in accelerating the improvement of care

• Deploy Rapid Response Teams… at the first sign of patient decline – and before a catastrophic cardiac or respiratory event.

• Deliver reliable, evidence-based care for acute myocardial infarction… to prevent deaths from heart attack.

• Prevent adverse drug events… by reconciling patient medications at every transition point in care.

• Prevent central line infections… by implementing a series of interdependent, scientifically grounded steps.

• Prevent surgical site infections… by
following a series of steps, including reli-able, timely administration of correct peri-
operative antibiotics.

• Prevent ventilator-associated pneumonia… by implementing a series of interdependent, scientifically grounded steps.

There is no cost for hospitals to join the 5 Million Lives Campaign though there is an obligation to adopt at least one intervention and an expectation of regularly reporting hospital profile and mortality data throughout the Campaign. www.ihi.org

Healthcare workers who employ physical restraints and seclusion when treating patients must undergo new, more rigorous training to assure the appropriateness of the treatment and to protect patient rights, according to a regulation published in the
Federal Register by the Centers for Medicare & Medicaid Services (CMS). The patients’ rights regulations set forth, as a condition of participation (CoP) in the Medicare and Medicaid programs, the expectation that healthcare facilities will protect the rights of patients. These protections are part of Medicare’s revised CoP requirements that hospitals must meet. The requirements apply to all participating hospitals including short-term, psychiatric, rehabilitation, long-term, children’s and alcohol/drug treatment facilities. "Through this regulation, CMS will hold all hospitals accountable for the appropriate use of restraint and seclusion," said Leslie V. Norwalk, acting administrator of CMS.  

To address concerns about the improper use of restraints and seclusion and in response to the 4,000 public comments received on the interim final rule, the final regulation strengthens the staff training standard and specifies components of the training. The rule also expands the category of practitioners who may conduct patient evaluations when a restraint
or seclusion tactic has been implemen-ted. CMS currently requires that a patient be evaluated "face-to-face" within an hour of a patient being restrained or secluded for the management of violent or self-destructive behavior. Prior to this rule, these actions had to be reviewed within that hour by a physician or "other licensed independent practitioner (LIP)." Today’s action expands that list to include a trained registered nurse (RN) or physician assistant (PA). The rule requires, however, that when an RN or PA performs the 1-hour-rule evaluation, the physician or other LIP treating that patient be consulted as soon as possible. The basic rights specified in the regulation include a patient’s right to notification of his or her rights in regard to their care, privacy and safety, confidentiality of their records, and freedom from the inappropriate use of all restraints and seclusion, in all hospital settings.

 Under the new regulations, hospitals must provide the patient or family member with a formal notice of their rights at the time of admission. These rights include freedom from restraints and seclusion in any form when used as a means of coercion, discipline, convenience for the staff, or retaliation. Stricter standards for when a healthcare facility must report the death of a patient associated with the use of restraints and seclusion have also been adopted with this rule. The regulation is posted in the Federal Register and will become effective on February 6, 2007.

The Association of periOperative Regis-tered Nurses (AORN), the Association for Professionals in Infection Control and Epidemiology (APIC) and Kimberly-Clark presented the 11th Conference on Infectious Diseases last month at the Kimberly-Clark campus in Roswell, GA. The sold-out conference included a nationally recognized faculty of experts on infectious disease, and patient and workplace safety. Sessions emphasized the need for team efforts and investigative case studies of Healthcare Associated Infections (HAIs) in a healthcare facility. Discussions centered on the need for clear definitions of what constitutes an HAI and where it originated. As the CMS moves toward pay-for-performance, and as patients are often moved to long term care and rehabilitative facilities, how we identify where the infection originated will be an important factor in reimbursements. The advent of mandatory infection reporting will increase the need for healthcare workers to adhere to the steps and practices that have already been identified as being able to drastically lower infection rates where they have been used. We have the ability to identify which patients are most at risk for developing infection such as patients with immune disorders and could set up aggressive anti-infection care for that patient. Potential changes that patients can make prior to surgery such as lowering high blood sugar levels were also covered. The take home message from the conference is that there are successful processes already developed that we can use to lower infection rates.

An estimated 120,000 people develop methicillin-resistant Staphyloccus aureus (MRSA) bacterial infections in the United States each year. Average treatment costs are estimated at $27,000 to $34,000 per case, adding billions of dollars to the national health care budget. VHA Inc., the national health care alliance, has launched a national MRSA initiative to help hospitals rapidly implement methods to detect and treat or prevent MRSA infections and to measure their performance. The program leverages the collective strength of the VHA membership to bring together industry leading subject matter experts, data measurement tools and a broad network of peer organizations to facilitate reduction of MRSA infections. "MRSA is a top priority of VHA hospitals," said Betty Wilson, RN, director of clinical performance at VHA and MRSA initiative leader. "Eighty-nine percent of our member hospitals surveyed said addressing this issue was a top clinical priority and expressed interest in MRSA education."

One of the first initiatives VHA has launched in this arena is an educational collaborative that focuses on detecting, treating and preventing MRSA infections. To date, 125 hospitals, from small and rural areas to large metropolitan tertiary health systems, are participating in the six-month MRSA program. The collaborative allows participants to review the immediate action steps hospitals can take to begin combating MRSA, including active surveillance, barrier protection, hand hygiene and performance measurement. VHA has found that performance measurement is essential to achieving lasting and significant improvement. "Infection control practitioners know what steps need to be taken to combat MRSA, but many hospitals don’t have appropriate measures in place because of lack of resources and staff," said Wilson. "VHA’s initiative will help hospitals expand or streamline current efforts to identify problem areas, and improve prevention." Next summer, VHA will assess success of the initiative and anticipates the launch of a second MRSA collaborative in late 2007. For more information, visit www.vha.com

A tribute to Robert "Bob" Majors
Healthcare Purchasing News salutes an industry leader gone silent

Schaumburg, IL-based healthcare alliance Consorta Inc. no doubt tagged January 2007 as a monumental month in the group purchasing organization’s eight-year history.

One week after unveiling it was becoming an equity shareholder in the nation’s largest GPO representing investor-owned healthcare facilities, HealthTrust Purchasing Group (Nashville, TN) (See related story on p. 14), Consorta inked a separate deal with MedAssets Analytical Systems for supply chain-related strategic information services.

Executives at both Consorta and MedAssets assured Healthcare Purchasing News that the new agreement with Atlanta-based GPO MedAssets Inc.’s information technology unit is separate and unrelated to Consorta’s decision with HPG.

In fact, the decision-making processes occurred concurrently, according to Anna Fox, Consorta’s vice president of contract operations and data management. Consorta began deliberations on what culminated in a three-year contract with a two-year renewal option "at least a year ago," she said. "We looked at a whole host of strategic initiatives that would help us provide our shareholders and prospective shareholders with distinct and specific services that offered real value," she said. "We were very careful and deliberate about our decision – who to choose, how to set it up."

As Consorta explored its breadth and depth into IT capabilities, it discovered a need that wasn’t being filled. "We found we didn’t have the ability to efficiently normalize and standardize shareholders’ purchasing data," she said. "Many of our customers have disparate systems that don’t talk to one another and work with different descriptions for products. It’s a labor-intensive process to go through all that data and clean it up so that we can do meaningful analysis.

"We’ve tried to do some of that analysis internally but we felt that to get more meaningful and timely results we had to go outside," she continued. "We typically build or develop our own and we’ve done some good work in that area. But the time and financial investment required was so high that we didn’t think we could do it quickly. It would have taken us a couple of years and several million dollars. During our strategic planning one of the first questions we asked was do we build or buy? Would we go in or out?"

Fox couldn’t provide any projected fiscal results because specific outcomes will vary by participating shareholder facilities.

Consorta selected MedAssets Analytical Systems largely for three reasons, Fox noted. First, they market their services to customers that didn’t belong to their parent company’s GPO. Second, they have a long history behind the technology, which emerged from the acquired Health Services Corporation of America (HSCA). Third, they offered noteworthy staffing and human resources support in addition to software applications rather than just providing software and leaving the customer to figure out how to staff up to handle it.

"They seemed to understand all of the components we needed," she added. "They were GPO-neutral, which intrigued us, and it didn’t matter what existing technology you used so long as you used it consistently."

As a result, the MedAssets system will support Consorta’s existing contract management system, electronic catalog, pharmacy bid system and a variety of other IT products that members access.

Rand Ballard, executive vice president of MedAssets Inc. and president of its group purchasing unit MedAssets Supply Chain Services indicated that the technology was a plug-and-play overlay. "End users don’t have to invest in software or switch out systems and replace any existing technology," he said. "It’s done in an [application service provider] environment so there’s no need to change the internal infrastructure."

Consorta represents MedAssets Analytical Systems’ largest customer-to-date, which already includes nearly 4,000 hospitals and three smaller GPOs. The agreement remains independent of and separate from group purchasing services. Ballard declined to identify them because MedAssets provides the services as a "private label turnkey solution" for those groups.

The U.S. Occupational Safety and Health Administration (OSHA) has released new workplace safety and health guidance explaining how employers should protect employees from exposure to influenza virus during a flu pandemic. The guidance covers all U.S. workplaces but places special emphasis on health care and public health, one of 13 infrastructure sectors designated as critical to a strong national defense and thriving economy. OSHA Administrator Edwin G. Foulke Jr. said employers and employees should use the guidance to help identify risk levels and implement appropriate control measures to prevent illness in the workplace. Health care workers should be considered at "very high" or "high" risk of exposure to pandemic influenza, depending on the level of contact with known or suspected pandemic patients, the guidance states. Health care workers in contact with or within six feet of people who are known or suspected to have pandemic influenza should wear an N95 or higher-rated respirator for most situations and a supplied air respirator for procedures likely to generate bioaerosols. While the guidance is advisory in nature, OSHA reminded employers that they can be cited under the Occupational Safety and Health Act’s general duty clause for failure to provide a workplace free from recognized hazard likely to cause death or serious physical harm. To access the full text of the 43-page "Guidance on Preparing Workplaces for an Influenza Pandemic": http://www.osha.gov/

Recently released data indicate that more Americans are cutting their prescription drug costs by switching to generic medications. New data from the Centers for Medicare & Medicaid Services (CMS) find that generic use is especially high among those in the new Medicare drug benefit, with generics accounting for nearly 60 percent (59.6 percent) of the drugs dispensed to people in Medicare Prescription Drug Plans (PDPs) and Medicare Advantage (MA) plans through the third quarter of 2006. Generic medications are as effective as their brand-name counterparts and offer significant savings. According to the National Association of Chain Drug Stores (NACDS), generic dispensing has increased among private third-party payers growing by 9 percent over the past year, from 48.4 percent in 2005 to 52.6 percent in 2006. The most recent CMS data demonstrate that generic use among those enrolled in the Medicare drug benefit is 13 percent higher than the private third-party demonstrating that the Part D program is delivering savings well above the national average to beneficiaries and the government alike. The new Medicare data mark the third consecutive quarter of growth in generic utilization among those in the Medicare prescription drug benefit, indicating that beneficiary choice and broad formularies are yielding even greater savings as the program has progressed. Due to lower-than-expected costs, the Medicare Part D program is already realizing significant savings relative to what the Congressional Budget Office (CBO) predicted when the program started over a year ago.

The U.S. Food and Drug Administration (FDA), part of the U.S. Department of Health and Human Services, is requesting nearly $2.1 billion to protect and promote public health as part of the President’s fiscal year (FY) 2008 budget, more than a 5 percent increase over the budget submitted to Congress last year. The FY 2008 request, which covers the period of Oct. 1, 2007 through Sept. 30, 2008, includes $1.64 billion in budget authority and nearly $444 million in industry user fees. The budget proposal includes significant increases to strengthen food safety, modernize drug safety, speed approval of generic drugs, and improve the safety and review of medical devices. The request also includes significant increases to cover higher infrastructure expenses and cost of living adjustments for FDA employees to support the agency’s highly trained and specialized public health workforce. These investments will accelerate the availability of new and innovative medical products and help ensure the safety of the food supply. The following are FDA’s key proposed budget increases: Strengthening food safety ($10.6 million); Modernizing drug safety ($11.2 million); Improving medical device safety and review ($7.2 million); Conducting more—and more timely—generic drug reviews ($5.6 million and $15.7 million in user fees).

The Department of Health and Human Services (HHS) and its Centers for Disease Control and Prevention (CDC), in cooperation with departments and agencies across the Federal Government, announced two new efforts designed to improve state, local and community preparedness for an influenza pandemic. CDC released new guidance on community planning strategies that state and local community decision-makers, as well as individuals, need to consider based on the severity of an influenza pandemic. These strategies are important because the best protection against pandemic influenza, a vaccine, is not likely to be available at the outset of a pandemic. Community strategies that delay or reduce the impact of a pandemic (also called non-pharmaceutical interventions) may help reduce the spread of disease until a vaccine that is well-matched to the virus is available.

In order to help authorities determine the most appropriate actions to take, the guidelines incorporate a new pandemic influenza planning tool for use by states, communities, businesses, schools and others. The tool, a Pandemic Severity Index (PSI), takes into account the fact that the amount of harm caused by pandemics can vary greatly, with that variability having an impact on recommended public health, school and business actions. The PSI, which is modeled after the approach used to characterize hurricanes, has five different categories of pandemics, with a category 1 representing moderate severity and a category 5 representing the most severe. The severity of pandemic is primarily determined by its death rate, or the percentage of infected people who die. A category 1 pandemic is as harmful as a severe seasonal influenza season, while a pandemic with the same intensity of the 1918 flu pandemic, or worse, would be classified as category 5.

Based on the projected severity of the pandemic, government and health officials may recommend different actions communities can take in order to try to limit the spread of disease. These actions, which are designed primarily to reduce contact between people, may include: 1.) Asking ill persons to remain at home or not go to work until they are no longer contagious (seven to 10 days). 2.) Asking household members of ill persons to stay at home for seven days 3.) Dismissing students from schools and closing child care programs for up to three months for the most severe pandemics, and reducing contact among kids and teens in the community 4.) Recommending social distancing of adults in the community and at work, which may include closing large public gatherings, changing workplace environments and shifting work schedules without disrupting essential services. These measures will be most effective if they are implemented early and uniformly across communities, objectives that can only be met through advance planning. The guidance illustrates the interventions that are likely to be recommended at each category of severity. While these actions could significantly reduce the number of persons who become ill during a flu pandemic, they each carry potentially adverse consequences that community planners should address in their planning efforts. www.pandemicflu.gov.

VHA Inc., a national healthcare alliance, has enhanced its Comparative Clinical Measurement tool (CCM), which was introduced four years ago. The tool will give member hospitals additional flexibility in collecting and reporting clinical improvement data, as well as the ability to link this information with other types of data, such as patient safety, patient satisfaction, finance and workforce information. The enhanced CCM tool leverages VHA’s new Performance Measurement information technology Platform (PMP), which it developed to help members improve clinical operations. CCM will allow hospitals to pull information on clinical analytics and conduct more in-depth analysis.

VHA is currently working with the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) to upload JCAHO Core Measures data into CCM. The enhanced tool also has the capability to collect and report data from non-VHA member hospitals so members can compare themselves against VHA and/or non-VHA hospitals. The new tool will be accessible to all VHA members through VHA’s Web site, www.vha.com.

3M Attest Sterile U Network resources summarize key changes in ANSI/AAMI ST79

Hospital RFID market worth $8.8 billion by 2012  

CMS announces measure specifications for Physician Quality Reporting Initiative  

The 22nd Annual Conference and Healthcare Marketplace, Connecting People, Partners, and Possibilities, of the American Society for Healthcare Environmental Services (ASHES) will be held Sept. 30-Oct. 4, 2007 in St. Louis. This year’s annual conference features prominent healthcare leaders and content experts that will stimulate, motivate and excite participants. Chip Madera of Chip Madera Productions is the Opening Keynote Speaker of the conference. His session, "7 Policies That Create WOW!!", was developed to clarify the essential policies that need to be initiated and standardized to create a world-class environment of engagement and success.

Vince Pelote and Lynne Route, partners, daVinci Consulting, session on, "Environmental Services: Manager vs. Leader – How Do Your Leadership Practices Compare to the Best?" will show how successful managers spend their time to truly motivate their staff to reach top performance and discuss the implications for themselves and their organizations.

Ron J. Levy, regional president and system vice president, SSM Healthcare St. Louis, Kathy Harris, RN, MS, FACHE, regional vice president Clinical Services, Banner Health Western Region, and Bruno Giacomuzzi, vice president Cardiac & Outpatient Services, Resurrection Medical Center will be the panelists in the "ASHES Situation Room". This town hall meeting is designed as an interactive general session to discuss current topics in healthcare that have a direct effect on your department and organization.

Greg Nelson from The Studer Group, ASHES Closing Session Speaker will explain principles and pillars you can implement in your department in his session "Principles, Pillars, and Passion: Service Excellence in Environmental Services." For more information about the ASHES Conference, visit www.ashes.org and click on the 2007 conference logo.

The Green Guide has made a set of technical briefing papers available on its  website (http://www.gghc.org). The Tech Briefs, written by practitioners with diverse expertise, provide in-depth information on going green at your healthcare facility, along with strategies and case studies. To access the Green Guide for Health Care Technical Briefs:

1.Go to http://www.gghc.org. 2. Click on the "Login" link in the black banner at the top of the page. 3.Enter your user name (or create one) and password and click "Login". Click on the  "Downloads" button. 4.Open the "Technical Briefs" folder to access the documents.

Skytron has moved to new world headquarters located at 5085 Corporate Exchange Drive, Grand Rapids, MI 49512. Skytron is a medical equipment supplier for Operating Rooms, Emergency Departments, GI Lab, Cardiac Cath and EP Labs, Central Supply, Labor & Delivery, C-Section Rooms and Intensive Care throughout North America. For more information visit www.skytron.com.

VHA Inc., the national health care alliance, has analyzed capital purchasing patterns for its 1,400 member hospitals and estimates that hospitals across the nation overpay by $3.5 billion to as much as $5 billion annually for capital equipment purchases. "Hospitals suffer from a lack of information, automated tools and staff resources to focus on strategically managing capital spending, which limit their effectiveness when it comes to capital purchase planning," said Nik Fincher, senior director of capital asset services for VHA. Fincher says hospitals can save money on capital spending if they: 1.) Develop a strategic long-term capital plan; 2.) Use automated budgeting tools; 3.) Develop a budget development process; 4.) Access accurate pricing information; 5.) Leverage group purchasing organization (GPO) contracts; 6.) Obtain current supplier information; 7.) Look at purchases as opportunities to aggregate value over time rather than treating purchases as single events; 8.) Develop a standardization plan; 9.) Use a functional negotiation process; 10.) Focus on life cycle costs versus price.  

A recent survey of hospital chief nursing officers (CNO’s) and chief human resource officers showed that one-third of respondents said their hospital could continue operations without external resources for less than one week.

According to the survey, conducted by Novation, a health care contracting services company, more than half of the hospitals surveyed (64 percent) reported that they have devoted resources to developing comprehensive pandemic-specific disaster plans, yet they are still unprepared in the event of a pandemic flu crisis. Twenty-nine percent said they could continue operations for 1-2 weeks, 10 percent say they could continue operations for 3-4 weeks, and 29 percent said they can sustain operation without external resources for more than four weeks.

CNO’s report the following items are included in their hospitals pandemic plan: Identifying key employees (95 percent); Making significant changes to employment practices, such as work rosters and shift patterns (50 percent); Educating employees regarding hand hygiene, respiratory etiquette (95 percent); Communication strategy for employees (89 percent); Identifying employees able to work from home (50 percent) ; Increasing remuneration for employees working additional duties/hours (39 percent) ; Addressing loss of productivity due to having employees out of work to care for children because of school closures (47 percent); Addressing loss of productivity due to employee anxiety/poor morale (37 percent); Ability to support existing business functions with limited staffing (66 percent).

 For the complete study visit http://www.apic.org/Content/Navigation Menu/ResearchFoundation/National MRSAPrevalenceStudy/MRSA_Study_ Results.htm

The Kaiser Family Foundation released a new primer that explains recent trends in healthcare costs in the United States and the factors that contribute to their growth. Prepared by Foundation staff, the primer examines the rapid growth in the nation’s healthcare costs since 1970, when the average growth in health spending exceeded the growth of the economy as a whole by an average of 2.5 percentage points. The share of the economy devoted to healthcare grew from 7.2 percent in 1970 to 16 percent in 2005, and is projected to increase to 19.6 percent by 2016. Between 2000 and 2006, insurance premiums for family coverage rose 87 percent, more than four times the growth in wages. The primer describes the types and sources of healthcare spending, the demographic factors associated with higher or lower levels of spending, and the impact of higher premiums and out-of-pocket costs on families. It also discusses other factors that influence healthcare spending growth, including the use of new medical technology, population changes, and changes in disease prevalence.

Health care Costs: A Primer is available at http://www.kff.org/insurance/7670.cfm

Prominent health organizations asked U.S. Food and Drug Administration to label medical devices containing the toxic chemical di-2-ethylhexyl phthalate (DEHP). The phthalate leaches out of vinyl plastic medical devices into patients, posing risks to developing reproductive systems, including reduced fertility, of boys. The letter accompanied a legal petition to FDA from the non-profit organization Health Care Without Harm (HCWH). Organizations joining HCWH in calling for mandatory labeling of DEHP-containing medical devices include the American Medical Association; American Nurses Association; American Public Health Association; Association of Women’s Health, Obstetric and Neonatal Nurses; Physicians for Social Responsibility and American College of Nurse Midwives. "Despite FDA warnings about the health risks of DEHP-containing medical devices, these products are still being used in many hospitals to treat at-risk patients, even though safer alternatives are available for most," said Ted Schettler, MD, MPH, of the Science and Environmental Health Network. "Labeling of products containing DEHP is crucial to enable healthcare facilities to heed safety directives." In 2002, FDA warned that sick baby boys and other vulnerable patients may be harmed by DEHP exposure from vinyl medical devices. In 2006, the National Toxicology Program reviewed the science and concluded that: "There is serious concern that certain intensive medical treatments of male infants may result in DEHP exposures levels that affect development of the male reproductive tract".

Cost-effective, non-DEHP, non-PVC medical devices are available and being used by some leading hospitals. The petition to FDA contains statements from healthcare institutions that have successfully eliminated DEHP from neonatal intensive care units (NICUs). However, the hospitals note it has not been easy to make the switch, and say it is necessary for FDA to require labeling of vinyl devices so healthcare institutions can make better-informed purchasing decisions in order to reduce DEHP exposure in vulnerable populations.

For more information, see http://www.noharm.org/us/pvcDehp/issue

Many medical facilities are faced with the issue of extended steam sterilization cycles for their surgical instruments (a cycle time longer than the traditional 4 minutes). The Association of periOperative Registered Nurses (AORN) Sterile Processing/Materials Management Specialty Assembly Coordinating Council has released a general statement on extended Cycles:

"Each medical facility needs to make sure that all of their products used for sterilization (peel pouches, wrap, etc.) can withstand theses longer steam sterilization cycles. Each medical facility needs to make sure that the products used in extended cycles are validated for these types of cycles. Many manufactures have tested their products for these longer cycles’ times. The manufacture of the products should supply information to the user for their records."

Amerinet Inc., a national healthcare purchasing organization, announced that it is collaborating with the U.S. Department of Defense (DoD) in a pilot program to test product data synchronization through a potential "product data utility" (PDU) to reduce supply chain costs and increase efficiencies in healthcare.

"By strategically partnering with healthcare leaders, such as Amerinet, we can accelerate efforts to make synchronized data via a single source a reality in the supply chain," said Kathleen Garvin, program manager, for DoD/VA Data Synchronization. "An industry PDU has the potential to bring the same type of efficiencies to the healthcare supply chain that many other multi-billion dollar industries have achieved, including the grocery and retail industries. Data synchronization through a PDU provides consistent product data throughout the supply chain, ensuring all trading partners are sharing the same common and consistent language, which will reduce costs and increase patient safety."

 Amerinet is joining an ongoing DoD pilot testing a potential PDU through the Global Data Synchronization Network (GDSN), as part of its medical/surgical data synchronization program. The GDSN is a non-profit global platform for the secure exchange of product information. DoD began its data synchronization initiative by piloting a "build your own" PDU. Currently, the DoD is advancing the effort by testing the GDSN as a potential PDU for the entire healthcare industry.

Amerinet will contribute to the project by recruiting member participants to take part in the pilot and analyze member data flow, as well as facilitate training. In addition, Amerinet will outline potential data flows and business practices with before and after cost projections and provide improvement process metrics for future collaboration.

The Green Guide for Health Care Pilot Report presents a comprehensive portrait of the healthcare industry’s approach to green building and operations. Pilot projects are analyzed "At a Glance" by building type and construction type, offering a quick, graphic guide to average credit achievement levels. The toolkit is tailored to the healthcare industry, offers a "one stop shop" for implementing healing design features, high performance energy and water strategies, and safer materials in the healthcare setting. To download report, visit http://www.gghc.org/.
 

WHO: International spread of disease threatens public health security

Those on the front line in a disaster, hospitals, medical personnel, public health officials and local emergency workers, will be unprepared to seamlessly handle a surge of patient casualties or to orchestrate a timely, cohesive recovery effort, concluded a report issued by PricewaterhouseCoopers’ Health Research Institute on the state of the nation’s health system preparedness for disaster. Findings include: In at least 11 U.S. cities, including Washington, DC, hospitals lack a sufficient number of beds to handle a surge of patients in a disaster. Only four in 10 health professionals believe that local hospitals are very well prepared to deal with casualties from a disaster, and less than 10 percent believe that primary care physicians and community clinics are very well prepared. More than 40 percent of health professionals lack confidence in their ability to transfer patients to non-healthcare facilities such as a stadium or schools, and 25 percent lack confidence in their ability to transfer patients to other health-related facilities such as skilled nursing facilities, community clinics or regional hospitals. The report, "Closing the Seams: Developing an Integrated Approach to Health System Disaster Preparedness" explores the gaps in preparedness, including a fragmented care system, a lack of planning, breakdowns of command, communications and coordination during disasters, and healthcare workforce shortages that will only be exacerbated in an emergency. The report offers a comprehensive set of recommendations needed to develop an integrated plan that would improve the responsiveness of our healthcare system and save lives in future catastrophes.

To view the report: CLICK HERE.

The Centers for Medicare & Medicaid Services (CMS) issued a final rule with comment period updating the hospital Outpatient Prospective Payment System (OPPS), effective for services furnished during calendar year (CY) 2008, which encourages higher quality and accessible healthcare through new payment policies and the reporting of quality measures. CMS estimates hospitals will receive an overall average increase of 3.8 percent in Medicare payments for outpatient services in CY 2008.

CMS is extending the current packaging approach to include guidance services, image processing services, intraoperative services, imaging supervision and interpretation services, diagnostic radiopharmaceuticals, contrast agents, and observation services. CMS is adopting the use of composite ambulatory payment classification (APC) groups, to encourage efficiencies by providing one bundled payment for several major services. Composite APCs encourage even greater hospital efficiencies than expanding packaging by making a single payment for the totality of hospital outpatient care provided during an encounter. For more visit: THIS LINK.

The Centers for Medicare & Medicaid Services (CMS) issued a final physician payment rule designed to improve accuracy of Medicare payments and give physicians and healthcare professionals additional financial incentives to provide higher quality and value in the delivery of care. Under the new rule, Medicare estimates that it will pay approximately $58.9 billion to about 900,000 physicians and other healthcare professionals. The revised payments, quality incentive rates and related policy changes, which will become effective January 1, 2008, are included in the Medicare Physician Fee Schedule (MPFS) final rule.

The Medicare law includes a statutory formula requiring CMS to implement a negative 10.1 percent update in payment rates for physician-related services. For more see: www.cms.hhs.gov/center/physician.asp

With methicillin-resistant Staphylococcus aureus (MRSA) infections, extensively drug-resistant tuberculosis, and other "bad bugs" routinely making headlines, infectious diseases physicians are applauding Sens. Sherrod Brown (D-OH) and Orrin Hatch (R-UT) for introducing in the Senate the Strategies To Address Antimicrobial Resistance (STAAR) Act. The STAAR Act was introduced in the House of Representatives in September by Reps. Jim Matheson (D-UT) and Rep. Mike Ferguson (R-NJ).

The bill takes a holistic approach to address inappropriate use, a significant problem that diminishes the effectiveness of antibiotics once they are approved. It vastly improves the nation’s capacity to control resistance by establishing a network of experts across the country to conduct regional monitoring of resistant organisms as they occur, a kind of "snapshot" to pick up on problems early. The STAAR Act sets up a network to collaborate with the Centers for Disease Control and Prevention on disease surveillance. Researchers also would work with CDC and the National Institutes of Health to find ways to slow the development of resistance. The Act also creates a board of infectious diseases, public health and veterinary experts to advise the federal government on reducing resistance, and an Office of Antimicrobial Resistance in the Department of Health and Human Services to coordinate, help plan, and guide the government’s response to resistance.

Visit www.idsociety.org/STAARAct.htm

HHS Secretary Mike Leavitt announced a five-year demonstration project that will encourage small to medium-sized physician practices to adopt electronic health records (EHRs). Over a five-year period, the program will provide financial incentives to physician groups using certified EHRs to meet certain clinical quality measures. A bonus will be provided each year based on a physician group’s score on a standardized survey that assesses the specific EHR functions a group employs to support the delivery of care. Under the CMS demonstration, all participating practices will be required to use a certified EHR system to perform specific functions that can positively affect patient care processes, such as clinical documentation and ordering prescriptions. The system, which must be in place by the end of the second year, must also be approved by a certification body officially recognized by HHS. The core incentive payment to practices will be based on performance on the quality measures, with an enhanced bonus based on how well integrated the EHR is in helping manage patient care. During the five-year project, it is estimated that 3.6 million consumers will be directly affected as their primary care physicians adopt certified EHRs in their practices. In order to amplify the effect of this demonstration project.

In a major step aimed at making healthcare more affordable while strengthening patient safety and outcomes, the Healthcare Supply Chain Standards Coalition (Standards Coalition) is calling for industry-wide adoption of organizational and product identifiers from GS1, an international organization dedicated to designing and implementing supply chain standards. Specifically, the Standards Coalition, a collaborative of 28 organizations representing the entire healthcare supply chain, is endorsing GS1’s Global Location Number (GLN) for organizational identification and its Global Trade Identification Number (GTIN) for product identification.

To reach its endorsements, the Standards Coalition spent the past year scoping the business problems, collecting industry input about identifiers, and evaluating standards options. It also conducted a survey that found 69 percent were considering adopting an organizational identifier. Almost two-thirds said they were considering adopting GS1’s GLN.

To aggressively move the industry toward adoption, the Standards Coalition is actively working with GS1 to enhance its standards to meet healthcare’s needs. The Standards Coalition is also recommending GS1’s Global Data Synchronization Network (GDSN) serve as the healthcare industry’s system for registering, validating, disseminating, and synchronizing product identification information. Additionally, the Standards Coalition plans to shortly introduce implementation roadmaps for supply chain participants, including providers, manufacturers, distributors, and group purchasing organizations. The Standards Coalition has launched a website, www.hscsc.org, for healthcare organizations to learn more about the standards adoption and implementation.

Members of the Standard’s Coalition Oversight Committee are: Abbott, American Hospital Association, Amerinet, Ascension Health, Association for Healthcare Resource & Materials Management (AHRMM), BD, Cardinal Health, Coalition for Healthcare eStandards (CHeS), Consorta Catholic Resource Partners, U.S. Department of Defense, U.S. Food and Drug Administration (FDA), Geisinger Health System Foundation, GHX, HCA, Inland Northwest Health Services, Intermountain Healthcare, Johnson & Johnson Med. Devices & Diagnostics, Lawson, Mayo Clinic, McKesson Corporation, MedAssets, Mercy Health Systems ROI, Owens & Minor, Novation, Premier Inc., Sentara Healthcare, Strategic Marketplace Initiative (SMI) and University Hospitals. For more: www.gs1.com.

Hospital professionals identified tracking infections across the entire hospital, and the control of resistant organisms, as their top challenges related to managing healthcare-associated infections (HAIs), according to a survey of over 800 hospital clinicians involved in infection prevention. Survey respondents, which include quality, safety, risk management and infection control professionals representing all sizes of hospitals, also identified measuring compliance with hand hygiene and state mandated public reporting as major challenges.

Respondents cited catheter-associated urinary tract infections (49 percent) and pressure ulcers (30 percent) as the most challenging to prevent among infections identified by the Centers for Medicare and Medicaid Services (CMS) for non-payment in 2008. The survey also found inadequate staffing for infection prevention (47 percent) and funding and budget constraints (34 percent) to be the most significant issues their hospitals face in meeting current infection prevention challenges.

Hospitals are clearly turning to technology as a way to manage these demands. More than 22 percent of respondents currently utilize an automated surveillance system, up from 13 percent in February. An additional 47 percent of respondents are actively considering implementing this technology, shown to make surveillance more efficient and to free up time for prevention activities. CLICK HERE FOR MORE INFORMATION.

A new study that estimates nearly 19,000 Americans died in 2005 from a virulent, antibiotic-resistant infection acquired mostly in the hospital underscores the need for Congress to require public reporting of patient infection rates, according to Consumers Union, the nonprofit publisher of Consumer Reports. The study by researchers at the Centers for Disease Control and Prevention (CDC) concluded that almost 95,000 people developed Methicillin-resistant Staphylococcus aureus (MRSA) infections that year, and that 85 percent of the infections were acquired in healthcare settings.

HR 1174, a bipartisan measure sponsored by Rep. Tim Murphy, R-PA, would require the public reporting by hospitals and surgical centers of one or more types of healthcare-acquired infections. Under the bill, the Secretary of Health and Human Services would determine which of the major types of infections would need to be reported. HHS would submit an annual report to Congress on steps being taken to reduce infections, and there would be a pilot program to assist certain hospitals in developing anti-infection programs. Visit: THIS LINK.