All Entries in the "State regulations" Category
Transparency… are we there yet?
Apparently not. Public reporting of surgical site infections is required in only eight states. That fact was brought to light by a new Johns Hopkins University report, which calls for more reporting. Lead author of the report, Martin Makary, MD, notes that patients still have little information when choosing hospitals.
Personally, I think the bigger issue is that public reporting gives hospitals, from the top down, a real push to do better. I think Makary does too:
“Nothing motivates hospitals to improve quality and listen to their front line staff like public reporting,” he says. “In order for the consumer to interpret publicly reported SSI rates, it is imperative that the data be collected and reported in a standardized manner,” he and his co-authors wrote.
I would have to agree. Surgical site infections not only result in 8,000 deaths a year in the U.S., they occur in 4% to 25% of patients who undergo major surgical procedures, and their cost to the healthcare system is about $10 billion annually (these stats are mentioned in the report and come from other studies).
Makary calls out state hospital associations for not supporting public reporting. What do you think? Is public reporting the way to change hospital culture?
A win for public reporting?
We all know that CMS is collecting, publicly reporting, and basing reimbursement on quality efforts. We also know that not all hospitals are happy about this. There has been much debate over these quality measures, whether they actually measure quality, the fact that they’re untimely and unfair. But today we have news and some data that might show that at least on a smaller scale, public reporting drives change.
Enter The New Jersey 2011 Hospital Performance Report, the New Jersey Department of Health and Senior Services eighth annual report on the quality of care in New Jersey hospitals. The state’s hospitals outperformed the national average in seven of 10 patient safety metrics, jumping from the bottom 10 to the top 10 nationally for quality over the last 12 years.
Improvements at the state’s hospitals “did not just happen by chance,” said Dr. Peter Gross, former chief medical officer at Hackensack University Medical Center and a co-chair of the state’s quality improvement advisory committee, who participated in the commissioner’s teleconference. “The health department … by setting up this report, encouraged competition among hospitals to get better, and it obviously has worked.”
What do you think? Is this a win for public reporting?
When quality data reaches the public
Most of you who read this blog are likely aware of common adverse events that occur in hospitals, but what about the average Joe? “Never events” and “HACs” are terms the public is becoming more and more aware of. News stories are focusing on such events, mostly due to The Centers for Medicare & Medicaid Services (CMS) March 31, 2011 release of Medicare data on certain measures, such as patient falls and central line infections. Before, only measures concerning heart attack and pneumonia patients were made public.
One thing you learn as a reporter is that all news is local—in other words, what’s happening in your own community usually takes precedent. It’s one thing to have the federal data on Hospital Compare, a site that is a bit cumbersome for average people to explore and find information that is meaningful to them, even if they know of the site in the first place; it’s another to read it in your local newspaper.
For example, if you live in Louiseville, KY, an article in yesterday’s paper explains which “never events” are occurring in your hospitals. The Post Crescent reports that hospitals in Fox Cities, Wisconsin suffer from a higher rate of pressure ulcers. Connecticut residents read last month that collectively, the state’s hospital had a higher level of objects left after surgery than the national average. In April, The Chicago Tribune reported on the newly available data and in Georgia, a state that does not publicly post such data, the Atlantic-Journal Constitution headline announces that Georgia residents have been kept in the dark on hospital infections. A simple Google news search shows many more city newspapers are reporting on the new data.
Of course, this is what transparency is all about. However, not all reports explain that the AHA is against the release of such raw data, and why. (The AHA is concerned the data are too raw and do not account for sickliness of patients. The organization has other concerns, including the fact that the measures have not been reviewed by an organization such as the National Quality Forum.)
What do you think? Is this ultimately good? Will this lead to more quality efforts in healthcare? Will it lead to more funding, more public awareness? Will more news coverage lead consumers to use Hospital Compare more regularly? Have you seen your hospital in the news? Has the media had an effect on your quality efforts?
A new proposed rule would allow more Medicare data to be available, as I posted last week. The new link to the proposed rule can be found here.
New CMS final and proposed rules address HACs, transparency
Last week, The Centers for Medicare & Medicaid Services (CMS) issued the final rule on reducing or prohibiting payments to providers for hospital-acquired conditions (HAC). The new rule will better align Medicare and Medicaid payment policy and give states flexibility to add to the federal list of HACs. This rule specifically prohibits states from making payments to providers under the Medicaid program for HACs, using the current list of HACs under the no-payment Medicare rule already in place.
The final rule is effective July 1, 2011 and gives states the option to implement its effective date July 1, 2012.
View the press release and the list of reduce or no-pay HACs.
In other CMS news, a new proposed rule would allow Medicare and private sector claims data to be used to produce public reports that evaluate the performance of physicians, other healthcare providers, and suppliers. Organizations seeking such Medicare information would have to undergo an application process and be continually monitored by CMS.
To prevent mistakes, the proposed rule requires that any reports generated from the Medicare data be shared confidentially with providers and suppliers before being released to the public. Publicly released reports would contain aggregated information only, meaning that no individual patient/beneficiary data.
“Performance reports that include Medicare data will result in higher quality and more cost effective care,” CMS administrator Donald M. Berwick, MD, said in a statement.
For more analysis, visit HealthLeaders Media.
The proposed rule will be published in the Federal Register on June 8, and the CMS will accept public comments for 60 days. Until June 8 the proposed rule is available here.
Patient Safety Monitor Free Live Demo!
I wanted to let all our readers know that HCPro will be hosting a complimentary live demo of Patient Safety Monitor on April 26! Our blog is just one piece of this online resource—there’s also a library of tools, forms, policies, and checklists, a monthly newsletter providing quality improvement case studies and news from the field, weekly news e-mails, an e-mail listserv to post questions and share tools with your patient safety peers, and most importantly, the Crosswalk, which organizes CMS, Joint Commission, and state patient safety regulations.
For example, if you work in Massachusetts and would like to find all the regulations you need to know about patient identification, we can easily provide that information all in one spot.
I’ll be moderating the FREE live demo. It will be short (about 20 minutes), informational, and fun. If you are already a member of Patient Safety Monitor–if you subscribe to the monthly Patient Safety Monitor Journal, you already are–you can register for the demo by clicking here.
If you are not a member, sign up for the free webcast here and receive a complimentary issue of Patient Safety Monitor Journal.
If you have any questions about Patient Safety Monitor or the live demonstration, feel free to contact me at tswartz@hcpro.com. I really think this is a great resource for any readers of the blog, and hope you’ll join us on April 26.
Radiation continues to harm–this time, the victims are preemies
A recent New York Times article has exposed yet another patient safety incident involving radiation, and this time the mistake was on premature infants at State University of New York Downstate Medical Center in Brooklyn, NY.
The incident, which was discovered in July, 2007, is one of several that has prompted the Times to run its “Radiation Boom” series, which explores the increasing use of medical radiation though new and old technologies, including over radiation of cancer and stroke patients, much of which is caused by misuse of equipment.
Over radiation at Downstate Medical Center occurred from too-frequent full body X-rays of premature babies, CT scanners’ radiation levels being set too high, and poorly positioned babies, making it hard to interpret images.
Radiation regulations are sparse. According to the Times, it’s up to states to decide what, if any, standards radiologists and other similar technicians need to meet. In some states, hair dressers might have tougher standards, and many states do not require continuing education for radiology technicians, though equipment is often updated and becoming increasingly more complex.
Are you confident in your hospitals radiation policies? Is it a concern? Post below.
Johns Hopkins patient safety program gives hope to other hospitals
A study at the 1,000-bed Johns Hopkins Hospital found that even in a big, multifaceted facility, an approved set of patient safety programs can result in an improvement in the “culture of safety.”
“It doesn’t take decades or tons of money to get from a culture that says ‘mistakes are inevitable’ to a belief that harm is entirely preventable,” said Peter Pronovost, a professor of anesthesiology and critical care medicine at the Johns Hopkins University School of Medicine and leader of the study published online Dec. 2 in the journal Quality and Safety in Health Care.
As reported in The Johns Hopkins University Gazette, the study, done from 2006-2008, was based around the implementation of CUSP, a comprehensive unit-based safety program. CUSP was designed to make mistakes more transparent, embraced discussions about improving communication and teamwork, and required buy-in from senior leadership.
Another way Johns Hopkins wanted to improve the culture of safety was by adding an electronic event-reporting system. The patient safety office of the hospital looks at Events that are reported and then gives them to the appropriate team.
Staff members at Johns Hopkins were surveyed annually from 2006 to 2008 to determine whether the program was working. During the first year of the study, 55% of the units accomplished the changes that were given to them in safety. In 2008, 82% accomplished it.
Pronovost said that if a large institution such as Johns Hopkins can achieve such gains in culture, smaller hospitals may be able to achieve even more success.
“If we can do it in our organization, it’s much easier to do in smaller institutions,” he said. “In this case, size is a limitation.”
How have you worked to improve the culture of safety at your organization?
A dozen CA hospitals fined over patient safety issues
The California Department of Public Health (CDPH) has fined 12 hospitals for patient safety-related noncompliance, according to a CDPH release. The fines are for putting patients in “immediate jeopardy” of harm.
Out of 14 fines, eight were for failure to follow proper surgical safety protocol that resulted in objects left inside patients. A portion of the funds received from the fines will go toward improvement projects that focus on preventing this particular type of adverse event.
Hospitals that were cited in 2008 were fined $25,000, but a new law requires hospitals cited in 2009 and beyond to be fined $50,000 for the first citation, $75,000 for the second, and $100,000 for the third.
A detailed run down of each adverse event can be found at HealthLeaders Media. Other events include medication administration errors, medication storage errors, and failure to properly treat pressure ulcers. One patient fell out of bed, causing cardiac monitor to become disconnected. She later died.
New California law prompts healthcare facilities to report radiation overdoses
California hospitals have less than a year to adhere to a new law requiring the state Department of Public Health to be notified any time a patient is given a radiation dose in an imaging scan exceeding 20% of what was intended, reports HealthLeaders Media.
The new bill signed by Arnold Schwarzenegger won’t go into effect until July 1, 2012.
Recent overdoses of radiation in the state have prompted the new bill. Cedars-Sinai Medical Center in Los Angeles admitted to accidently giving 206 stroke victims eight times the dose of a normal radiation procedure, according to an article in The New York Times.
A two-year-old boy in a California hospital was administered an overdose of radiation which allegedly burned parts of his face, according to CW13.
The new law requires hospitals and clinics to record every radiation dose done on CT systems. The recorded doses then must be verified by a medical physicist. Healthcare facilities have five days to inform the Department of Health if anything goes wrong.
Read the rest of this article on California’s new law at HealthLeaders Media.
What do you think of the new law passed by California? Share your comments with us!
AHRQ updates State Snapshots with 2009 information
The Agency for Healthcare Research and Quality has updated its State Snapshots with data from 2009. The State Snapshots break down healthcare quality information by state to help both the public and private sectors understand disparities among states. The latest update includes new data on health insurance.
The data to create the snapshots comes from the 2009 National Healthcare Quality Report. This year states can compare how their care for certain types of insured patients compares with the rest of the nation, or other states. As in previous years, the Snapshots show that all states have a mix of measures on which they perform well and on which they perform poorly.
To find the State Snapshots and check out your own individual state, click here. Readers, have you ever utilized this tool to get a better idea of where your state ranks in terms of quality? How have you used it?
