Giving every patient the beyoncé experience

Marianne Aiello, for HealthLeaders Media

The gossip mills have gone into overdrive since celebrity power couple Beyoncé and Jay-Z welcomed their daughter Blue Ivy into the world this month at Lenox Hill Hospital in Manhattan.

Much of the hype is standard fare among celebrity births—discussing the child’s unique name, guessing when photos will be released, and debating which weight-loss company the mother will sign with to lose the extra pregnancy pounds. But in Blue Ivy’s case, the media is also focusing on the allegedly lavish hospital suite in which she was born.

Of course, the media has also been reporting on the tight security measures that may have been enacted in the Lenox Hill maternity ward while Beyoncé was there. There were rumors that other parents weren’t allowed to see their babies and that the musicians’ personal security guards patrolled the halls, but so far New York state health officials have dismissed the two complaints that were filed, according to the Wall Street Journal.

But some of the more sensational reports, and those that are more interesting to the patient experience-focused marketer, are about Beyoncé “penthouse-style” maternity room. According to the sometimes-reputable TMZ, the hospital room featured “4 flat screen TV’s, state of the art electronics, a kitchenette, nice art, mahogany walls,  and plush furnishings.”

Leaked photos of the room show a large, modern-looking space with hardwood flooring, sleek white couches, some artwork, and lots of windows. Nothing about the room stuck me as especially excessive, but it did get me thinking. The public has such low expectations for hospital design and the patient experience that anything above mediocre seems extravagant.

Unfortunately, the patient experience bar has been set low, but this also means there is a prime opportunity for hospital marketers to give every patient the celebrity treatment, even if there isn’t room in the budget for any major redesigns.

To glean some insight, I researched three hospitals that have recently updated their facilities to improve the patient experience and incorporate evidence-based design elements: Fort Belvoir Community Hospital in Virginia, Children’s Hospital Colorado, and Dublin Methodist Hospital in Ohio.

Top 12 healthcare quality concerns in 2012

Cheryl Clark, for HealthLeaders Media

Which quality issues will provoke the most influential changes in healthcare in 2012? Or, which ones will most rapidly accelerate the graying of chief quality officers’ hair? There are so many, it’s hard to pick the most significant.  We interviewed quality experts around the country to glean the most influential and then picked a dozen.

Here’s the list:

1. Patient experience scores hinge on “always” responses

The value-based purchasing sweepstakes have begun, with the first performance period for clinical process of care and HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) questions scheduled to end March 31. Payment adjustments will begin for patients discharged as of Oct. 1, and the winners and losers will then be revealed.

What makes many hospitals and clinical nurse managers most nervous, however, is that the patients responding to these surveys must reply “Always,” in order for the hospital to get credit for high quality patient experiences. Responses “Sometimes,” or “Usually” aren’t going to cut the mustard.

“How often did nurses listen carefully to you?”  “How often did doctors treat you with courtesy and respect?” “How often was your pain well controlled?”

“Always.”

And by the way, Jan. 4, 2012 is the data submission deadline for patients dishcharged in July, August and September, 2011.

2. Physician Compare

As if providers didn’t already have enough to worry about with Medicare, Medicaid and private insurer payment reductions, electronic medical record and meaningful use compliance, disclosing payments from durable equipment and pharmaceutical companies and yes  – remembering to answer their patients’ e-mails. Now they have something else to fret about.

As of this New Year’s Day, according to the Patient Protection and Affordable Care Act, the official reporting period begins for physician performance on quality and patient experience measures for physicians enrolled in Medicare on Physician Compare.

Starting “no later than” next New Year’s Day, 2013, the Health and Human Services Secretary shall “implement a plan” to make publicly available on Physician Compare a huge number of quality scores.

They include measures from the Physician Quality Reporting Initiative, an assessment of each physician’s patients’ health outcomes and their functional status, an assessment of the continuity and coordination and care and care transitions including episodes of care and resource use, efficiency, patient experience and patient, caregiver and family engagement, safety, and effectiveness and timeliness of care.

And if all that weren’t enough, the HHS secretary gets to publish other information on Physician Compare he or she determines appropriate.

Read the rest of the list on HealthLeaders Media.

Sneak Peak: Cook up a solid discharge plan

Planning a patient discharge is a lot like cooking a Thanksgiving dinner, said Karen Zander, RN, MS, CMAC, FAAN, principal and co-owner of The Center for Case Management, Inc., in Wellesley, MA. Everyone coming to the table has his or her own preferences. Ultimately, everyone needs to work together to make sure all the components of the meal come together so everyone is satisfied.

Discharge planning is not a linear process. There are different things happening simultaneously, but like the Thanksgiving dinner, they've all got to come together for a successful outcome. And like a good host, in order for the process to work, case managers have to stay on top of potential problem areas, Zander said.

Some of those problem areas are:

•Lack of patient understanding. Case managers need to understand the patient's cognitive and literacy levels as well as his or her cultural needs when planning and managing transitions. Making sure the patient understands what will happen after discharge and determining whether he or she has the proper support from family and/or care providers is essential to making sure the patient is not readmitted, said Zander.
•Being assigned to the wrong level of care. Don't assume that discharging the patient to a nursing home means your facility is off the hook when it comes to readmission. Often the hospital blames the nursing home for improper care when the patient is sent back. But in reality, it could be that the patient simply wasn't referred to the proper level of care, or maybe he or she was discharged to the proper level of care, but just too soon, said Zander. The patient may not have been stable enough to transfer, or maybe the chosen facility was not the appropriate choice for the patient.
•Inadequate home care. Often, case managers neglect to ask the right questions and fail to consider all the variables involved in a patient's discharge, said Birmingham. Consider a patient readmitted for dehydration after spending a weekend home. Case managers had asked her if she could eat, but no one had asked her whether she had food available in her home or if she could contact someone to help her if she needed to, said Jackie Birmingham, RN, BSN, MS, CMAC, vice president of clinical leadership, emeritus, at Curaspan Health Group, Inc., in Newton, MA.

This article is adapted from an article in the December Case Management Monthly.

News: Study reports nursing shortage less likely than anticipated

A new study published in the December Health Affairs indicates that the feared nursing shortage may be less likely than originally predicted, the Los Angeles Times recently reported.

Economists studied census data from 2002 to 2009 and found a 62% increase in full-time registered nurses between the ages of 23 and 26. This demonstrates the fastest increase in the nursing profession since the 1970s.

David I. Auerbach of Rand Health, Peter I. Buerhaus of Vanderbilt University, and Douglas O. Staiger of Dartmouth University estimate that if the trend continues individuals born during the 1980s could comprise the largest group of nurses ever. “If the trend continues, it will help to ease some of the concerns about future nursing shortages.” Auerbach told the Los Angeles Times.

Sneak Peak: Case Study: Centralized unit facilitates patient transfers

Patient transfers can be a case management headache, particularly for facilities that are part of a multihospital system.

One Dallas-area hospital system found a way to centralize the patient transfer process, making it easier to move patients within the system while providing valuable information to help increase its volume and tailor the medical service lines it provides to the community.

Previously, when a physician at a neighboring hospital needed to transfer a patient into the Baylor Hospital system for a higher level of care, it was the physician's responsibility to call each of the 15 individual hospitals to determine whether an appropriate bed was available, says Elisa Ayers, LMSW, CCM, director of care coordination support at the Baylor’s Patient Transfer Center and Denial Resource Center. The process could be time-consuming, inefficient, and frustrating.

Today, when a patient needs to transfer to a Baylor hospital, the medical staff at the sending facility simply calls the organization's transfer center, and its staff process the request from beginning to end.

This article is adapted from an article in the December Case Management Monthly.

CMS innovation advisors aim to improve quality of care

Margaret Dick Tocknell, for HealthLeaders Media

The Centers for Medicare & Medicaid Services has tapped 73 healthcare professionals for its innovation advisors program. Funded with $6 million from the healthcare reform act, the program is designed to help drive improvements to patient care and help reduce healthcare costs. A second group of 120 advisors will be selected in June 2012.

The program, which is managed by the CMS Innovation Center, includes six months of orientation as well as in-person national and regional meetings, virtual training sessions, and seminars and presentations by healthcare experts. Each advisor will receive a stipend of about $20,000 to help cover the cost of transportation, lodging, and other expenses.

This first group of advisors includes clinicians, allied health professionals, health administrators, physicians and nurses from 27 states. Each one is required to develop a systems improvement project that will be scalable to other areas.

Julie Lewis, vice president of health policy and government relations for Amedisys, will look at care management for high risk elderly patients. Tina Schwien, quality improvement consultant at Qualis Health in Seattle, is developing a project to engage patients and their families to help reduce hospital acquired infections.

Lewis, who works out of Washington, D.C., says her project is an offshoot of some work she did with Jeffrey Brenner while she was at the Dartmouth Institute for Health Policy and Clinical Practice. Brenner, a New Jersey physician, formed the Camden Coalition of Healthcare Providers to provide care management for vulnerable populations in the city. Lewis plans to take that effort a few steps further to test if care management for high risk populations can be sustained and replicated across a larger population.

The project will be based in Louisiana where Amedisys, a home health and hospice company, is based. Plans call for a hospital-physician partnership that initially will treat 50 to 100 Medicaid, Medicare Advantage and indigent patients.

Read more on HealthLeaders Media.

Patient progress record

Check out this form that helps with a care coordination assessment. It is provided by Karen Zander, UMass Memorial Medical Center.

UMass readmissions

Most providers unprepared for HIPAA audit

Most healthcare organizations charged with HIPAA compliance are not fully prepared for a privacy and security audit by federal regulators, a November survey conducted by HCPro, Inc. reveals.

For hospital leaders, already challenged on the technology front to implement ICD-10, electronic medical records systems, and pursue meaningful use certification, that’s not great news. The government has already begun conducting audits.

Earlier this year, the Office for Civil Rights, the enforcers of HIPAA privacy and security, engaged a contractor to audit covered entities and business associates at random.  The objective is to audit 150 entities by December 31, 2012.

HCPro’s survey results show that only 17% of responding organizations said they are fully prepared for an OCR privacy and security compliance audit.

“It is very hard to get your staff to understand how important this is,” one compliance officer said. “Each breach we have is due to carelessness and not intentional, for example, not checking a patient name when you mail something out.”

Of the more than 400 respondents, which included HIM directors and compliance officers, 281 (or 70%) said they are “somewhat prepared” for a HIPAA compliance audit conducted by the government.

As part the HITECH Act, OCR hired KPMG, LLP, to conduct the audits starting this fall and lasting through December of next year. The audits—targeted for covered entities and business associates—are expected to produce corrective action plans for facilities regarding HIPAA compliance.

“There needs to be an outside agency coming into the hospital and interviewing the employees on a regular basis,” one respondent said in the survey. “Most organizations say they don’t have the time to implement HIPAA regulations on a regular basis.”

At least one survey respondent indicated a lack of commitment from “senior management.” Said another respondent, “The C-suite understands patient care, but doesn’t understand that system security needs more money to enforce HIPAA.”

A full report from this survey will be covered in the January 2012 editions of Medical Records Briefing and Briefings on HIPAA.

HIPAA and HITECH: things you should know

2012 could be a big year for HIPAA. There are still four major rules due out of HITECH that will impact healthcare operations.

Take a look at the following information regarding HIPAA compliance, courtesy of the September 2011 edition of Case Management Monthly, the HCPro, Inc. newsletter.

• Game-changer. On February 17, 2009, President Obama signed into law the $787 billion American Recovery and Reinvestment Act that includes provisions for heightened enforcement of the Health Insurance ­Portability and Accountability Act (HIPAA) and stiffer penalties for privacy and security violations. Those provisions fall under the Health Information Technology for Economic and Clinical Health (­HITECH) Act

• Regulations due. Since HITECH was signed into law, the Office for Civil Rights (OCR) has issued regulations facilities must follow in order to uphold the law. Effective now are an interim final rule regarding breach notification and an ­interim final rule about government enforcement. Regulations pending as of December 30 including:

• Breach notification final rule
• Enforcement final rule
• Modifications to the privacy and security final rule
• Accounting of disclosures final rule (proposed rule published in the May 31 Federal Register)

• Breach exposure. Breaches of unsecured protected health information (PHI) that ­affect 500 or more individuals must be reported to OCR, which posts them on its breach notification website. As of December 30, the list included 380 organizations, led by TRICARE Management Activity (TMA), whose September 13, 2011 breach affected 4.9 million individuals.

• Tougher enforcement. Prior to HITECH, OCR was not known for stiff enforcement. However, since HITECH was signed into law, the OCR has settled and fined organizations for a lack of HIPAA compliance, including:

• CVS Caremark Corp., a $2.25 million settlement for ­potential HIPAA violations affecting millions
• Rite Aid, a $1 million settlement for potential HIPAA ­violations affecting millions
• Cignet Health, a $4.3 million civil money penalty, the first of its kind, when the healthcare company denied ­patients rights to their medical records and failed to ­cooperate accordingly with OCR during an investigation
• Massachusetts General Hospital, a $1 million settlement when an employee lost patient records on a subway

• Case manager’s role. In dealing with patient records ­daily, you must be vigilant to ensure that records ­remain in the proper hands and abide by your organization’s privacy and security procedures. Simple efforts such as always keeping your laptop with you go a long way in preventing breaches of PHI. Consult your team’s privacy, security, or compliance officer immediately regarding potential breaches.

Mentor Moment: Tip: Understanding the Olmstead decision

Determining whether it’s possible to avoid nursing home placement for an elderly patient is important when screening individuals for discharge to post-acute care. Whenever possible, returning a patient to a community, integrative setting, and lease restrictive environment should be the goal. Investigation of these options is required as a result of Olmstead v. L.C., 527 U.S. 581 (1999).

The HHS Office for Civil Rights (OCR) is responsible for investigating complaints alleging a violation of the Americans with Disabilities Act (ADA) ‘integration regulation,’ which requires that individuals with disabilities received public services in the most integrated setting appropriate to their needs. Typically, these ‘most integrated setting’ complaints filed with OCR allege a violation of the ADA rights as set out in the Supreme Court 1999 decision, Olmstead v. L.C., which interpreted the integration regulation.

Each state has an Olmstead plan. Discharge planners should contact their state health departments to obtain this information.

This week’s tip is adapted from Discharge Planning Guide: Tools for Compliance, Third Edition, published by HCPro, Inc. For more information about this book or to order your copy, visit the HCMarketplace.